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The thiazide-sensitive sodium-chloride cotransporter (NCC) is exclusively expressed in the apical membrane of the renal distal convoluted tubule (DCT), and it is important for maintaining fluid and salt balance. NCC is responsible for electroneutral NaCl reabsorption, and its activity is determined by phosphorylation, which was reported to be regulated by WNK-stimulated Ste20-type kinases, Ste20-related proline alanine-rich kinase, and oxidative stress response 1 kinase. WNK kinases have chloride-binding sites, and WNK4 has the highest sensitivity to intracellular chloride concentration ([Cl⁻]_i) compared with WNK1 and WNK3. NCC dysfunction often comes together with abnormal urinary potassium excretion, which is not only highlighted by Mendelian disorders such as familial hyperkalemic hypertension (FHHt) and Gitelman syndrome but also presented more frequently by long-term usage of thiazides, specific inhibitors of NCC. Recent studies have shown that extracellular potassium (K⁺) can modulate DCT cell membrane voltage and in turn intracellular Cl⁻, which regulates phosphorylation of WNK kinases. Additional Cl⁻ independent mechanisms were also reported by several groups. This paper is a brief review of the recent discoveries on mechanisms of NCC regulation by extracellular potassium.

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Erectile dysfunction (ED) is the most frequently treated sexual dysfunction in men and affects 70% of men over 70. Recently, numerous studies have focused on the pathogenesis of ED and found many causes and several key molecular changes. However, the understanding of the ED mechanism is still limited. MicroRNAs (miRNAs) are small, noncoding RNA molecules. They regulate many physiological and pathological processes, including ED. In this review, we summarize the expression and regulation mechanisms of miRNAs in ED. In ED rats and patients, many miRNAs were found increased or decreased in corpus cavernosum tissues or blood. MiRNAs can regulate erectile function by regulating many processes related to erection, such as regulating nitric oxide synthase activation, endothelial function, smooth muscle cells, and androgen function. In summary, we found that miRNAs play a critical role in ED development. However, there is inadequate direct evidence to reveal the regulatory mechanism. Further studies are required to meet the scientific needs.

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Objectives: To explore possible link between intradialytic hypotension (IDH) with serum fibroblast growth factor 23 (FGF23) and serum soluble klotho (sKl) in maintenance hemodialysis (MHD) patients in a single dialysis center. Materials and Methods: Cross-sectional data were collected from MHD patients. Intradialytic blood pressure was recorded continuously in a 1-month period. According to the dialysis records, MHD patients were divided into IDH group and non-IDH group. Fast sera of the MHD patients were obtained for FGF23 and sKl assay at the end of IDH record month, and other routing laboratory results were analyzed statistically for comparison between the two groups. Results: A total of eighty MHD patients with complete laboratory data were enrolled into the study. The occurrence rate of IDH was 77.5%. The significant differences in serum ferritin (P = 0.046), serum triglyceride (P = 0.045), parathyroid hormone (P = 0.042), calcium-phosphorus product (P = 0.047), and serum FGF23 (P < 0.001) were found between the two groups, but the difference in sKl between the two groups was marginal (P = 0.747). Furthermore, the serum FGF23 was positively correlated with the occurrence of IDH (r = 0.807, P< 0.001). Conclusions: The present study indicated a positive correlation between serum FGF23 and IDH in MHD patients, which suggested the FGF23 could be a potential biomarker for incidence of IDH in the hemodialysis population.

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Intravesical foreign bodies are rarely encountered in the practice of urology; they are the exception rather than the rule. Radiological imaging plays an important role in the diagnosis and management as it helps to determine the size, shape, number of foreign bodies as well as the possible complications. Treatment should aim to the removal of the foreign bodies and avoid complications whether by endoscopic or open approaches. Here, we present a case of a female child presented with chronic urinary symptoms found to have intravesical foreign with encrustation.

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Multilocular cystic renal neoplasm of low malignant potential, formerly known as multilocular cystic renal cell carcinoma, is a relatively uncommon renal neoplasm. The peculiarity of this neoplasm lies in the absence of expansile solid nodules. We report a case of this uncommon neoplasm with a focal micropapillary pattern, which is a very rare feature. To the best of our knowledge, there are no case reports emphasizing on the micropapillary pattern in case of multilocular cystic renal neoplasm of low malignant potential. We report a case of a 57-year-old female patient who presented with pain abdomen. Ultrasound and computerized tomography of abdomen revealed a multilocular cystic renal mass. The patient underwent right nephrectomy and the specimen was sent for histopathological examination. Grossly, the enlarged lower pole on cutting open showed multiloculated fluid-filled cyst with smooth inner walls. Microscopically, the tumor was composed of cysts lined by cells with clear cytoplasm and of Fuhrman nuclear Grade 1. A rare feature seen was the disposition of tumor cells in micropapillary pattern. The case was reported as multilocular cystic renal neoplasm of low malignant potential. This neoplasm needs special consideration due to its good prognosis and potential amenability to cure by nephron-sparing surgery. Also to be noted is that a multilocular cystic renal neoplasm of low malignant potential can have a micropapillary pattern too.

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Background: In chronic kidney disease, systemic inflammation may contribute to the endothelial dysfunction and accelerated thrombosis. Vascular access thromboembolism is the most common cardiovascular complication of children with end-stage renal disease (ESRD). Recently, a disintegrate-like and metalloproteinase with thrombospondin type 1 repeats 13 (ADAMTS13) is suspected to be involved as a specific von Willebrand factor cleaving protease. Objectives: To evaluate serum ADAMTS13 level in children with ESRD on regular hemodialysis (HD) and its correlation to thrombotic episode in HD patients. Materials and Methods: The present study was carried out on forty children with ESRD on regular HD in Pediatric Department of Tanta and Aswan University hospitals and forty healthy age- and sex-matched children were serving as controls. All patients and controls were subjected to thorough history taking, especially history concerning vascular access thrombosis, clinical examination including anthropometric measurements, and routine laboratory assessment measuring complete blood count (CBC), blood urea, serum creatinine, parathormone, prothrombin time, partial thromboplastin time, bleeding time, clotting time, blood electrolytes, and urine analysis. Laboratory investigations also included serum ADAMTS 13 level in this study. Results: There was a positive history of thrombi formation in patients more than controls, especially in the vascular access, and there was a significant decrease in ADAMTS13 level in patients when compared to controls. Conclusions: Diminished serum ADAMTS13 level is an early biomarker for hypercoagulability and thrombotic tendency. Children with ESRD under regular HD have lower levels of serum ADAMTS 13 than controls which increases the risk for thrombosis.

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