Administering intravenous fluids is a common therapy for critically ill patients. Isotonic crystalloid solutions, such as saline or balanced solutions, are frequently used for intravenous fluid therapy. The choice between saline or a balanced crystalloid has been a significant question in critical care medicine. Recent large randomized controlled trials (RCTs) have investigated whether balanced crystalloids yield better outcomes in general or specific critical care populations, and many of them have confirmed this hypothesis. Although the broad eligibility criteria of these RCTs suggest applicability to neurocritical care patients, it is important to discuss whether using balanced crystalloids, as opposed to saline, would benefit patients who primarily have neurological disorders or diseases. This review considers the relevance of this question, weighs the pros and cons of the two fluid types, examines available data, and anticipates results from ongoing RCTs to guide clinicians in selecting the optimal fluid for patients with brain injury.

Radiocontrast media is a major cause of nephrotoxic acute kidney injury(AKI). Contrast-enhanced CT(CE-CT) is commonly performed in emergency departments(ED). Predicting individualized risks of contrast-associated AKI(CA-AKI) in ED patients is challenging due to a narrow time window and rapid patient turnover. We aimed to develop machine-learning(ML) models to predict CA-AKI in ED patients. Adult ED patients who underwent CE-CT between 2016 and 2020 at an academic, tertiary, referral hospital were included. Demographic, clinical, and laboratory data were collected from electronic medical records. Five ML models based on logistic regression; random forest; extreme gradient boosting; light gradient boosting; and multilayer perceptron were developed, using 42 features. Among 22,984 ED patients who underwent CE-CT; 1,862(8.1%) developed CA-AKI. The LGB model performed the best (AUROC = 0.731). Its top 10 features, in order of importance for predicting CA-AKI, were baseline serum creatinine; systolic blood pressure; serum albumin; estimated glomerular filtration rate; blood urea nitrogen; body weight; serum uric acid; hemoglobin; triglyceride; and body temperature. Given the difficulty of predicting risk of CA-AKI in ED, this model can help clinicians with early recognition of AKI and nephroprotective point-of-care interventions.

Contrast-induced acute kidney injury (CI-AKI) is a major concern in clinical practice, particularly among high-risk patients with preexisting renal and cardiovascular conditions. Although periprocedural hydration has long been the primary approach for CI-AKI prevention, recent advancements have led to the development of novel approaches such as RenalGuard and contrast removal systems. This editorial explores these emerging approaches and highlights their potential for enhancing CI-AKI prevention. By incorporating the latest evidence into clinical practice, health-care professionals can more effectively maintain renal function and improve outcomes for patients undergoing contrast-enhanced procedures.

Diabetic kidney disease (DKD) is a major complication of diabetes mellitus (DM), affecting over one-third of type 1 and nearly half of type 2 diabetes patients. As the leading cause of end-stage renal disease (ESRD) globally, DKD develops through a complex interplay of chronic hyperglycemia, oxidative stress, and inflammation. Early detection is crucial, with diagnosis based on persistent albuminuria and reduced estimated glomerular filtration rate (eGFR). Treatment strategies emphasize comprehensive management, including glycemic control, blood pressure regulation, and the use of nephroprotective agents such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), sodium-glucose cotransporter-2 (SGLT2) inhibitors, and glucagon-like peptide-1 (GLP-1) receptor agonists. Ongoing research explores novel therapies targeting molecular pathways and non-coding RNAs. Preventive measures focus on rigorous control of hyperglycemia and hypertension, aiming to mitigate disease progression. Despite therapeutic advances, DKD remains a leading cause of ESRD, highlighting the need for continued research to identify new biomarkers and innovative treatments.

Acute kidney injury (AKI) is not only a worldwide problem with a cruel hospital mortality rate but also an independent risk factor for chronic kidney disease and a promoting factor for its progression. Despite supportive therapeutic measures, there is no effective treatment for AKI. This study employs tetrahedral framework nucleic acid (tFNA) as a vehicle and combines typhaneoside (Typ) to develop the tFNA-Typ complex (TTC) for treating AKI. With the precise targeting ability on mitochondria and renal tubule, increased antiapoptotic and antioxidative effect, and promoted mitochondria and kidney function restoration, the TTC represents a promising nanomedicine for AKI treatment. Overall, this study has developed a dual-targeted nanoparticle with enhanced therapeutic effects on AKI and could have critical clinical applications in the future.