Non-opioid analgesia and local anaesthetic blocks ranked best after kidney stone surgery, in a quiet week for nephrology evidence

The edition in brief

A Bayesian network meta-analysis of 45 randomised trials (2,626 patients) of analgesia after percutaneous nephrolithotomy found that levobupivacaine outperformed bupivacaine and ropivacaine for pain scores when given as an erector spinae plane block or local infiltration, that non-opioid analgesics (NSAIDs and paracetamol) showed superior efficacy, and that opioids worked well early but not later. Intravenous paracetamol plus local levobupivacaine ranked highest in a multicriteria analysis, but safety data were sparse and imprecise and 21 studies had moderate bias. Recommendations from the Brazilian Society of Nephrology, published earlier in the year, aim to help primary care managers build chronic kidney disease into routine work, and note persistent gaps in implementing the care pathway. A single-cell study of eight matched transplant pairs showed distinct donor and recipient immune programmes in delayed graft function; it is descriptive and has no treatment implication yet. A mouse study of human anti-PAPPA antibodies reduced cystic disease in polycystic kidney models, with weaker protection in females; it is preclinical. The pearl covers confirming reduced eGFR and albuminuria over three months.