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Saudi Journal of Kidney Diseases and Transplantation
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    Table of Contents - Current issue
Coverpage
January-February 2022
Volume 33 | Issue 1
Page Nos. 0-235

Online since Monday, January 16, 2023

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ANNOUNCEMENT  

Announcement Highly accessed article p. 0

DOI:10.4103/1319-2442.367801  
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ORIGINAL ARTICLES Top

Study of Exogenous Melatonin as a Treatment Modality for Sleep and Psychiatric Disorders in Hemodialysis Patients Highly accessed article p. 1
Elshahat Ali Yousef, Mahmoud Ahmed El Wasify, Aya Atef Baddor, Mohammed Abd-Elkader Sobh
DOI:10.4103/1319-2442.367802  
The pineal hormone melatonin plays a major role in numerous physiological functions such as circadian sleep-wake rhythm, mood, immunity, and reproduction. Patients on hemodialysis (HD) frequently suffer from sleep and psychiatric disturbances. The aim of this study is to assess the effect of exogenous oral melatonin in HD patients regarding sleep disturbances, depression, and anxiety alongside the quality of life (QoL). In this randomized double-blind placebo-controlled study, 60 stable HD patients suffering from sleep disorders [according to Pittsburgh sleep quality index (PSQI) equal or more than 5] were randomized to receive melatonin 3 mg at 10 pm every night or placebo tablets for three months. Routine laboratory investigations were done, moreover, patients were asked to fill the following six questionnaires at the beginning of the study and after three months of treatment; PSQI, Epworth Sleepiness Scale (ESS), and the Insomnia Severity Index (ISI) to assess sleep disorders, assessment of depression by Hamilton Depression Rating Scale (HDRS), assessment of anxiety by Hamilton Anxiety Rating Scale (HARS), and assessment of QoL using Quality of Life Index-dialysis version (QLI). This study showed a significant improvement in serum calcium, low-density lipoprotein level (P ≤0.005), and scores of HDRS, HARS, and total QLI in the melatonintreated group (P ≤0.001, 0.001, and 0.002, respectively). Moreover, there was a highly significant improvement in sleep disorders in melatonin-treated patients regarding total score of PSQI, ISI, subjective sleep quality, and daytime dysfunction (P ≤0.001), also regarding sleep duration, latency, and disturbances (P ≤0.05). However, there was no significant difference in sleep efficiency and ESS scores. Exogenous melatonin treatment was well-tolerated, safe, and efficient in improving sleep disturbances, depression, anxiety, and QoL in HD patients.
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Clinical Characteristics and Outcomes of Coronavirus Disease 2019 Infection of In-center Hemodialysis Patients: An Experience of a Dialysis Center from Pakistan p. 16
Shabana Rahim, Murtaza F Dhrolia, Kiran Nasir, Ruqaya Qureshi, Aasim Ahmed
DOI:10.4103/1319-2442.367808  
Much has now been learned about the coronavirus disease 2019 (COVID-19) in the general population, but data for hemodialysis (HD) patients are limited. This is the first study of COVID-19 disease in patients undergoing maintenance HD in Pakistan. We studied the epidemiological, clinical, laboratory, radiological characteristics, and outcomes of a cohort of HD patients that contracted COVID-19 in our HD center from the first confirmed case on May 12, 2020, until September 9, 2020. Out of the total 423 patients being dialyzed in our center, 87 were suspected and 50 (11.8%) were confirmed for COVID-19. Male:Female ratio was nearly equal. The median age was 59.5 ± 9.99 years. Most patients developed mild disease. The most common symptoms were fever (82%). Ten (20%) had patchy bilateral opacity (ground-glass opacity) on the chest radiograph. Major complications were lymphocytopenia (36%), thrombocytopenia (30%), pneumonia (28%), and septic shock (6%). Eleven (22%) patients were hospitalized. Five required mechanical ventilation. Ten (20%) patients died. The relative risk of death with COVID-19 in HD patient was 1.46 with 95% confidence interval 1.15–1.84, (P = 0.003). The patients aged ≥60 years had 4.3 times more severe disease (P = 0.044) and died 3.3 times (P = 0.164) more than patients aged <60 years. HD patients have a high susceptibility to COVID-19 compared to the general population with an increased mortality rate and prolonged recovery time. Patients with age >60 years, female gender, diabetics, and those presented with more severe symptoms and laboratory parameters, had a higher fatal outcome.
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Does the Prolonged Duration of Continuous Ambulatory Peritoneal Dialysis Affect the Serum Levels of Endothelin-1 and Nitric Oxide? p. 31
Pedja Kovacevic, Sasa Dragic, Tijana Kovacevic, Biljana Zlojutro, Milka Jandric, Danica Momcicevic
DOI:10.4103/1319-2442.367823  
End-stage renal disease and its treatment with continuous ambulatory peritoneal dialysis (CAPD) can affect almost all organs and organ systems including vascular endothelium. Consequently, disturbance in the production of vasoactive substances endothelin-1 (ET-1) and nitric oxide (NO) occurs in these patients. There are only a small number of studies that investigated the impact of long-term CAPD on imbalance in production of vasoactive substances ET-1 and NO among these patients. Therefore, our study aimed to investigate the impact of duration of CAPD on potential overproduction of ET-1 and NO in uremic patients. This study included 23 uremic patients [10 males, mean age: 56.3 (±16.2) years] treated with CAPD. All studied patients were further divided into subgroups, groups A and B. Group A included patients on treatment with CAPD <5 years, and group B included those on treatment longer than five years. Our results showed that serum levels of these vasoactive substances are significantly higher among patients treated with CAPD longer than five years (ET-1: 51.24 ± 32.11 vs. 139.53 ± 42.42; NO: 15.50 ± 2.57 vs. 26.57 ± 5.96, respectively). We concluded that imbalance in production of vasoactive substances is present in long-term CAPD treatment and this imbalance can lead to disturbance in the local blood flow control.
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Idiopathic Nonlupus Full-House Nephropathy: Clinicopathological Presentation and Comparison with Lupus Full-House Nephropathy p. 37
Pranab Mahanta, Shahzad Alam, Manzoor Ahmad Parry, Manjuri Sharma, Prodip Doley, Gayatri Pegu, Mastakim Ahmad Mazumder, Hamad Jeelani, Gayatari Pegu
DOI:10.4103/1319-2442.367824  
Full-house pattern on immunofluorescence (IF) on kidney biopsy in a patient without systemic lupus erythematosus is termed as nonlupus full-house nephropathy (FHN). In this study, we retrospectively compiled patients with nonlupus FHN and compared them with lupus FHN for clinicopathological presentation. We included patients with full-house IF patterns in renal biopsies collected from March 2007 to August 2018, clinical and histopathological data at the time of presentation were studied retrospectively. Treatment received and outcome at the end of follow-up was studied. Patients with nonlupus FHN who did not show any systemic disease (idiopathic group) were compared with a group of lupus nephritis patients. Of 178 patients, 34 had nonlupus FHN with 21 having idiopathic nonlupus FHN and 13 patients having secondary nonlupus FHN (membranous nephropathy, IgA nephropathy, postinfection glomerulonephritis). Males were more often in idiopathic nonlupus FHN patients than lupus FHN patients (P = 0.005). Kidney biopsies more often showed a mesangial (P = 0.0006) and less proliferative pattern of injury (P = 0.0002) and less intense C1q staining (P = 0.0001) in idiopathic nonlupus than lupus FHN. Clinically, idiopathic nonlupus FHN presented with more proteinuria (P = 0.0059) and less complement consumption (P = 0.001) than lupus FHN patients. Compared to lupus FHN, nonlupus has mainly nephrotic syndrome as clinical presentation. There was no difference in the clinical outcome between lupus FHN and idiopathic nonlupus FHN. Nonlupus FHN is not a very common condition and has less female involvement than in lupus FHN. Idiopathic nonlupus FHN has certain histopathological features with less C1q staining by IF, less frequent proliferative lesions and higher mesangial or membranous lesions by light microscopy compared to lupus FHN. Regarding outcomes, there is no significant difference between lupus FHN and idiopathic nonlupus FHN.
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Comparative Analysis of Kidney Transplant Recipients with Severe Acute Respiratory Syndrome Coronavirus 2 Compared with Nonkidney Transplant Recipients: A Largest Single-center Report from the Second Wave of Coronavirus Disease 2019 Pandemic in South East Asia p. 46
Sanshriti Chauhan, Hari Shankar Meshram, Vivek B Kute, Himanshu Patel, Sandeep Deshmukh, Sudeep Desai, Ruchir Dave, Subho Banerjee
DOI:10.4103/1319-2442.367825  
Outcomes of severe acute respiratory syndrome coronavirus 2 in kidney transplant recipients (KTR) compared with matched cohort are certainly lacking for different pandemic waves and geographic regions. In this single-center retrospective study of coronavirus disease-2019 (COVID-19) cases admitted during March 26, 2021 to June 7, 2021, a propensity-matched analysis in a 1:1 ratio was performed to compare the clinical profile and outcomes between KTR and non-KTR. A Cox proportional hazard model from the whole study population to analyze risk factors for severe disease and mortality was calculated. We identified 1052 COVID-19 cases, of which 107 (10.1%) were KTR. In propensity-matched analysis, KTR had higher fever (81.6 % vs. 60%; P = 0.01), lymphopenia (30% vs. 11.7%; P = 0.02), higher neutrophil-to-lymphocyte ratio (43.3% vs. 25%; P = 0.05), and acute kidney injury (66.6% vs. 36.7%; P = 0.001). In Kaplan–Meier survival analysis, there was no difference in mortality or severity of COVID-19. In Cox hazard proportional analysis, the European cooperative oncology group (ECOG) score of 1 to 2 [Hazard ratio (HR) 95% lower confidence interval (CI), upper CI = 4.9 (1.8–13.5); P <0.01], ECOG of >2 [HR = 20 (7.5, 54.7); P <0.01] and waitlisted status [HR = 1.9 (1.1–3.3); P = 0.02] was associated with significant mortality. Kidney transplantation [HR = 0.8 (0.47–1.44); P = 0.5] was not associated with mortality in the analysis. In our report, kidney transplantation status had a different spectrum but was not found to be independently associated with COVID-19 severity or mortality.
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Hepatocyte Growth Factor in Predialysis and Hemodialysis Chronic Kidney Disease Patients p. 58
Sarat Chandra Vulugundam, Vinapamula S Kiranmayi, P.V.L.N Srinivasa Rao, Siva Kumar Vishnubhotla
DOI:10.4103/1319-2442.367826  
Chronic kidney disease (CKD) which is characterized by progressive loss of renal function and renal fibrosis is a worldwide public health problem. Hepatocyte growth factor (HGF) is a polypeptide that exhibits multiple functions including antifibrotic effects on kidneys. The present study was aimed at evaluating HGF levels and studying its association with markers of inflammation and oxidative stress in patients of predialysis and dialysis CKD. A total of 80 subjects including 20 healthy controls, 40 patients of CKD stage 1 to stage 5 (predialysis), and 20 CKD patients with end-stage renal disease on hemodialysis were recruited. HGF, high-sensitivity C-reactive protein (hsCRP), malondialdehyde (MDA), and ferric reducing ability of plasma (FRAP) were measured in all the subjects. HGF levels were significantly higher in all patients with CKD compared to controls. The levels were found to be lower in patients on dialysis than in the predialysis group; however, the difference was not statistically significant. hsCRP, MDA, and FRAP were significantly higher in all patients with CKD than in controls. HGF levels did not show a significant correlation with the markers studied. HGF levels were increased in response to renal injury in CKD patients. The levels were higher in predialysis patients of CKD than in CKD patients on dialysis. HGF levels may be used as an indicator of renal fibrosis in patients with CKD.
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Study of Anti-C1q Antibodies in Egyptian Systemic Lupus Erythematosus Patients p. 66
Reham Emad Eldin, Mohamed A Marie
DOI:10.4103/1319-2442.367827  
Autoantibodies to complement are associated with various diseases. Anti-C1q antibodies are present in all patients with hypocomplementemic urticarial vasculitis, but also with varying prevalence in other conditions. Anti-C1q may interfere with the clearance of apoptotic cells, so influencing induction and expression of autoimmunity. The aim of this work is to study the relation between anti-C1q antibodies and systemic lupus erythematosus (SLE) and its manifestations including renal affection. The presence and levels of anti-C1q antibodies were investigated using enzyme-linked immunosorbent assay technique. The study included 70 Egyptian patients suffering from SLE and 18 healthy controls. They were 65 females and five males. Their age ranged from 12 to 48.5 years with a mean value of 27.4 ± 8.4. Anti-C1q antibodies were statistically significantly elevated in cases compared with controls being positive in 37.2% (mean 18.3 ± 27.1) in patients versus 11.1% (mean value 4.1 ± 3.5) in controls (P = 0. 03). Anti-C1q antibody-positive patients (n = 226) had significantly higher SLE Disease Activity Index (SLEDAI) (16.1 ± 9.9) compared to negative patients (n = 44) (SLEDAI = 8.1 ± 7.7) P = 0.000. Regarding renal affection, the presence of anti-C1q-positive antibodies was associated with proteinuria, P = 0.002. In conclusion, anti-C1q was more common in patients with SLE and disease activity. We confirmed a significant association of anti-C1q with renal involvement, independent of demographics and other serologies.
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Comparative Evaluation of Prevalence, Risk Factors, and Pathologic Features of Kidney Disease in Highly Active Antiretroviral Therapy-Naive and Highly Active Antiretroviral Therapy-Experienced Patients at a Tertiary Health Facility in Maiduguri, Northeastern Nigeria p. 72
Mohammad Maina Sulaiman, Jummai Shettima, Ibrahim Ummate, Fatiu Abiola Arogundade, Haruna Yusuph, Emeka Nwankwo, Abubakr Abefe Sanusi, Adewale Akinsola
DOI:10.4103/1319-2442.367828  
Infection of the kidneys by human immunodeficiency virus (HIV) is known to cause kidney disease. HIV-associated nephropathy occurs with variable prevalence rates in various communities and is found to be higher among sub-Saharan Africans. The disease has not been studied in Northeastern Nigeria. This study was aimed at comparing the prevalence, clinical and histo-pathologic features of kidney disease among highly active antiretroviral therapy (HAART)-experienced and HAART-naive patients in northeastern Nigeria. Four hundred HIV-infected (200 HAART-experienced and 200 HAART-naïve) patients were recruited consecutively from the ART clinic. Their socio-demographic and laboratory data including CD4+ cell counts and viral loads were obtained and documented. Out of the 200 study participants in the HAART-experienced arm, 21 (10.5%) had kidney disease whereas 61 (30.5%) participants in the HAART-naïve group had kidney disease. Their mean ages were 41.43 ± 11.04 years and 37.42 ± 9.96 years in the HAART-experienced and HAART-naïve groups, respectively. The mean serum creatinine (SCr), CD4+ cell counts, and viral load were 185.67 ± 221.80 μmol/L, 493.26 ± 241.97/mm3, and 8,856.79 ± 19,747.11/mL in the HAART-experienced group, respectively. In the HAART-naïve group, the mean SCr, CD4+ cell count, and viral load were 141.88 ± 130.56 μmol/L, 270.00 ± 154.65 cells/mm3, and 139,217.70 ± 12,598.50/mL. Focal segmental glomerulosclerosis (FSGS) was the most common histologic diagnosis in 64.7% of kidney biopsies. Risk factors for chronic kidney disease among the study population included age, low weight and body mass index, high human immunodeficiency virus (HIV)-1 viral load, low CD4+ cell counts, low hemoglobin (Hb), and proteinuria. The prevalence of kidney disease is higher among HAART-naïve HIV-infected patients than in patients who are HAART-experienced patients. Factors associated with development of kidney disease included advanced age, low CD4+ cell counts, high viral load, proteinuria, and HAART-naivety. FSGS is the most common histologic diagnosis in our study population.
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Living Experiences with Maintenance Hemodialysis: A Qualitative Content Analysis p. 80
Hosnieh Miri, Mozhgan Rahnama, Mahin Naderifar
DOI:10.4103/1319-2442.367829  
Assessing and providing interventions to improve the comfort status of the patients’ needs to be a priority of nursing practice and further research. We did this study to explore the living experiences with maintenance HD among these patients. This qualitative study was conducted using a conventional content analysis approach on 12 HD patients from February 10, 2019 to July 30, 2019. The data were collected through in-depth and semi-structured interviews and were analyzed using Grenham and Landman approach. The main theme was “dialysis therapies with dual face." Three main categories were included: “Dual mood by dialysis,”Dual feelings with dialysis, ” and “Relying on the family and health care workers.” The results showed that patients’ dependence on HD was accompanied by both good and bad moods and created dual emotions both positive and negative. Influenced by these feelings, these patients had shown a variety of reactions such as trying to adjust to life on HD, relying on supports and beliefs. In this study, a dual face was seen in HD in the eyes of these patients. Therefore, “dual face HD therapy” was identified as the essence of the experiences of HD patients. Health-care providers should try to eliminate the bad and unpleasant face of HD.
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Assessment of Lupus Nephritis in a Multicenter Retrospective Egyptian Cohort: Initial Characteristics, Influence of Age and Gender, Outcome, and Potential Association with Disease Damage p. 90
Basma M Medhat, Ahmed Elmaghraby, Yomna Farag, Huda Marzouk, Noha Mostafa, Iman Khalifa, AbdelAal Mohammed, Marwa Elkhalifa, Eman Hassan ElSayed Hassan, Waleed A Hassan
DOI:10.4103/1319-2442.367830  
The study aimed to evaluate the association of demographic, clinical, and histopathologic characteristics with renal and disease outcomes. Persistent lack of partial or complete remission despite sequential induction therapy, chronic kidney disease (CKD) or endstage renal disease (ESRD), and/or mortality were determined as poor renal outcomes. Disease damage was investigated through the Systemic Lupus International Collaborating Clinics/ American College of Rheumatology Damage Index (SDI). Of 201 biopsy-proven lupus nephritis patients, a poor outcome was present in 56 (27.9%) patients, with nine (4.5%), 22 (10.9%), and 29 (14.4%) patients demonstrating lack of response, CKD, and ESRD, respectively, and the prevalence of mortality was 5.5% (11/201). The outcome was poor among males [29/201 (14.4%)] [P = 0.008; odds ratio (OR): 2.8; 95% confidence interval (CI): 1.2–6.4], yet comparable between adult- and juvenile-onset patients [80/201 (39.8%) (≤16 years)] (P = 0.6; OR: 0.8; 95% CI: 0.4–1.6). Hypertension (P <0.001; OR: 6.3; 95% CI: 2.6–14.9), elevated creatinine (P <0.001; OR: 5.2; 95% CI: 2.6–10.3), and hematuria (P <0.001; OR: 3.7; 95% CI: 1.9–7.5) at presentation, and fibrinoid necrosis [P <0.001; odds ratio (OR): 4.1; 95% confidence interval (CI): 2.1–8.1], wire loops (P = 0.006; OR: 2.4; 95% CI: 1.2–4.6), crescents (P <0.001; OR: 5.4 95% CI: 2.8–10.5), interstitial fibrosis (P = 0.001; OR: 2.7; 95% CI: 1.4–5.1), and acute vascular lesions (P = 0.004; OR: 3.6; 95% CI: 1.4–9.4) on biopsy were associated with a poor outcome. Chronic glomerular (P = 0.003) and acute vascular lesions (P <0.001), and a higher chronicity index (r = 0.1; P = 0.006) on biopsy, and frequent renal (r = 0.3; P <0.001) and extra-renal flares (r = 0.2; P <0.001) were associated with higher SDI scores. Among the studied renal and extra-renal parameters, independent predictors of higher disease damage solely included frequent renal flares (ᵝ= 1; P <0.001). To conclude, a poor renal outcome (27.9%) was associated with distinct features. Disease damage was associated with frequent renal flares.
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RENAL DATA FROM THE ARAB WORLD Top

Percutaneous Renal Biopsy in Egyptian Children: A Five-year Single-Center Experience p. 106
Ola Abdeltawab Saad, Nahla Mohamed Elkalla, Ferial Moursi
DOI:10.4103/1319-2442.367803  
Ultrasound-guided percutaneous renal biopsy (PRB) stands as an important tool of diagnostic and prognostic value, besides its role in determining the best therapeutic option in some diseases. The advance in medicine over the past years made PRB safer and more feasible. This is an observational retrospective study in a tertiary referral center of pediatric nephrology and was conducted to determine both the indications and the histopathological findings of renal biopsies performed in pediatric patients. The retrospective review of 73 files searching for gender, age, indication for renal biopsy, and histopathological diagnosis of biopsy was done. The statistical analysis was done using Microsoft Excel Worksheet version 2010. The files of 73 cases were reviewed, of which three were excluded due to inadequate sample (success rate of 95.9%). The mean age was 6.9 years (standard deviation ±3.51) with a male-to-female ratio of 1.8:1. The main indication for PRB was nephrotic syndrome (NS) (40%) mainly steroid-resistant NS. Focal segmental glomerulosclerosis was found in most of the cases (46.4%) followed by minimal change disease (32.1%). Among secondary glomerulonephritis, lupus nephritis (LN) was the most common indication (15.7%). Class IV LN came at the top of the list (45.5%). Poststreptococcal GN patients were biopsied when rapidly progressive GN was suspected. Immunoglobulin A nephropathy was found in only 1.4%. Other PRB indications were hematuria (8.6%), unexplained acute (2.9%), or chronic renal failure (4.3%). Renal biopsy remains to be a mainstay diagnostic tool in pediatric nephrology. This study confirms the reliability of PRB as a diagnostic tool which can probably impact the management and hence improve the outcome. The findings in our patients align with findings from other centers and differ in others denoting that disease distribution can vary from one place to another.
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RENAL DATA FROM THE ASIA - AFRICA Top

Outcomes of Different Immunosuppressive Regimen in Adult Biopsy Proven Idiopathic Focal Segmental Glomerulosclerosis: A Retrospective Analysis at a Single Center p. 111
Ruqaya Qureshi, Kiran Nasir, Salman Imtiaz, Murtaza F Dhrolia, Aasim Ahmad, Bina Salman
DOI:10.4103/1319-2442.367804  
Treatment of focal segmental glomerulosclerosis (FSGS) is frustrating, especially for steroid-resistant FSGS. Different immunosuppressive agents have been used with inconsistent outcome. We analyzed the data in our FSGS patients who, in addition to steroid, were treated with cyclosporine (CYA), cyclophosphamide (CYP), and mycophenolate mofetil (MMF) along with the long-term follow-up. This is a retrospective analysis of 113 patients diagnosed to have FSGS with 11 years’ follow-up carried out at The Kidney Center Post Graduate Training institute. Among 113 patients, 51.3% were male with a mean age of 34.4 ± 11.8 standard deviation. Patients who achieved complete remission with steroid alone and steroid with combination of CYA, CYP, and MMF were 38 (26%), 19 (16.8%), and six (5.3%), respectively, similarly those who got partial remission were three (3.6%), five (4.4%), three (2.6%), and eight (7.0%), respectively. The factors which affected the outcome were serum creatinine (SCr), tubulointerstitial fibrosis (TIF), and the treatment. In adjusted analysis, increase in 1 mg of SCr reduces the patient recovery by 56%, while the absence of TIF increases recovery by 80.75%. Taking steroid as reference category, steroid + CYA found 2.03 times more effective as compared with steroid alone. Seven patients developed end-stage renal disease (ESRD) and three died due to disease during the follow-up. CYA comes out as the most effective treatment for steroid-resistant FSGS followed by MMF and CYP. The long-term outcome of all modalities is the same in terms of mortality and developing ESRD. The degree of TIF and renal failure has strong influence on the course of the disease.
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RENAL DATA FROM ASIA-AFRICA Top

Clinicohistological Profile and Outcomes of Rapidly Progressive Glomerulonephritis: A Prospective Study from North India p. 122
Deepak Sharma, Sudhir Mehta, Jasvinder Singh Sandhu, Preet Mohinder Sohal, Vikas Makkar
DOI:10.4103/1319-2442.367805  
The prevalence of this rare and fatal entity varies in different regions and ethnicities. The objective of this study was to determine clinicopathological characteristics and predictors of outcome in rapidly progressive glomerulonephritis (RPGN). We aimed to prospectively study the clinicopathological profile and determine the predictors of renal outcome in patients with RPGN. This study included 40 patients of biopsy-proven RPGN. The diagnosis of RPGN was based on renal histology showing crescents in >50% of glomeruli. All patients were given induction with intravenous (IV) methylprednisolone (0.5 g) for three days followed by maintenance with oral prednisolone (1 mg/kg/day) and six IV pulses of cyclophosphamide (0.5 g) given fortnightly followed by maintenance therapy with azathioprine (2 mg/kg/day). The outcomes were recorded. Three-fourth of the patients (77.4%) required renal replacement therapy (RRT) at diagnosis. More than half of patients (57.5%) were antineutrophil cytoplasmic antibodies mediated. Immune complex and anti-glomerular basement membrane (GBM) disease constituted 25% and 17.5%, respectively. Clinical features, biochemical parameters, histological features, and type of RPGN were analyzed for association with primary outcomes. Entry serum creatinine, entry estimated glomerular filtration rate (eGFR), RRT on admission, interstitial fibrosis, tubular atrophy, and interstitial infiltrates were the parameters which showed association with primary outcomes of the study (P <0.05). In secondary outcomes, infections were the most common (55%), followed by neutropenia (40%). One-fourth of the patients (25%) died during the course of the study. Cause of mortality was infections (50%), cardiovascular system (30%), stroke (10%), and unknown (10%). Our prospective study from north India shows that RPGN is not an uncommon cause of renal failure and there is preponderance in the elderly patients (>60 years). Pauci-immune RPGN is the most common cause of RPGN followed by immune-complex and anti-GBM disease. Entry serum creatinine, eGFR, and RRT on admission predicted the outcome.
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Validation of Two Asian Noninvasive Risk Models for Predicting Prevalent Undiagnosed Chronic Kidney Disease in Diabetic Patients Receiving Care at a Reference Hospital in A Sub-Saharan African Country: A Cross-Sectional Study p. 132
Colette Sih, Simeon-Pierre Choukem, Nina Lubeka, Andre-Pascal Kengne
DOI:10.4103/1319-2442.367806  
Undiagnosed chronic kidney disease (CKD) is common in people with diabetes mellitus. Validated noninvasive risk models are an attractive CKD screening option in diabetic patients to identify patients who are more likely to be diagnosed with CKD via biological tests. The study aimed to validate the Korean and Thai noninvasive CKD risk prediction models in African Type 2 diabetic patients. This was a hospital-based study. The Modification of Diet in Renal Disease (MDRD) and CKD Epidemiology Collaboration (CKD-EPI) equations were used to estimate the glomerular filtration rate (eGFR). CKD was defined as an eGFR <60 mL/min/1.73 m2, and any nephropathy as eGFR <60 mL/min/1.73 m2 and/or proteinuria. Discrimination was assessed and compared using c-statistics and non-parametric methods. Calibration performance was assessed before (original models) and after intercept adjustment. A total of 733 patients (421 men) aged 57.0 years (standard deviation = 10.4) were included. The MDRD equation identified 223 (30.4%) participants as having CKD and 377 (51.4%) participants with any nephropathy. The CKD-EPI equation identified fewer cases of CKD and any nephropathy with 194 (26.5%) and 357 (48.7%) cases, respectively. The original Korean model had the highest C-statistics of 0.696 (95% confidence interval: 0.654–0.739) for the outcome of eGFR <60 mL/min/1.73 m2 (using the CKD-EPI equation). Discrimination was significantly better in men, older and overweight participants. Intercept adjustment markedly improved calibration. Asian models have modest discrimination and good calibration with modest adjustment in predicting undiagnosed CKD in African diabetic patients; limiting their consideration for use in diabetes care in this setting.
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REVIEW ARTICLE Top

Review of Renal Artery Stenosis and Hypertension: Diagnosis, Management, and Recent Randomized Control Trials p. 147
F Sadiq Arab, A Ahmed Alhumaid, Mahmoud Tawfiq Abu Alnasr, A Talal Altuwaijri, Hesham Al-Ghofili, M Mussaad Al-Salman
DOI:10.4103/1319-2442.367807  PMID:36647988

Renal artery stenosis is one of the most common causes of secondary hypertension (HTN). Renal artery stenosis-induced HTN can occur in the presence of unilateral or bilateral narrowing and a solitary kidney with stenotic artery, which may subsequently lead to renal insufficiency (e.g., ischemic kidney disease) or pulmonary edema. Renal artery stenosis can be diagnosed using multiple modalities, including Duplex, computed tomography angiography, magnetic resonance angiography, or selective angiogram. Although atherosclerotic renal artery stenosis management in patients with HTN has been greatly controversial, it is inevitable in the treatment of some selected cases. These cases can be treated by either percutaneous angioplasty (with or without stenting) or less common, open surgical approach revascularization, both of which have excellent primary patency rates. Generally, several trials on renal artery angioplasty or stenting in patients with atherosclerotic disease have shown that the long-term benefits in terms of blood pressure control and renal function over pharmacological management is not substantial. Furthermore, studies could not demonstrate a prolongation of event-free survival after renal vascularization. Moreover, endovascular procedures have substantial risks. Careful patient selection is required when considering revascularization, for including those with refractory HTN or progressive renal failure, to maximize the potential benefits. This paper discusses the epidemiology of atherosclerotic renal artery stenosis and its clinical presentation, diagnosis, treatment, prognosis, and future perspectives.

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REVIEW ARTICLES Top

Outsourcing Dialysis Program: Implementation and Challenges p. 160
Ali Alharbi, Imed Helal, Mohammed Alhomrany, Fayez Alhejaili, Dujanah Mousa
DOI:10.4103/1319-2442.367809  
The demand for dialysis treatment has exceeded supply over the last decade in Saudi Arabia in line with other countries in the region and hence the Ministry of Health (MOH) to outsource dialysis care on a fee-for-service basis. The main objective of this review article is to examine and understand the challenges and strategies devised for the successful implementation, the good operation, and the guaranteed efficiency of outsourcing dialysis program in order to achieve the set clinical performance indicators and quality standards. The outsourcing program has largely helped the MOH in Saudi Arabia to improve the adequacy of dialysis care and the quality of life of dialysis patients and might be cost-effective.
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Is There Gender Discrimination in Living-Donor Kidney Transplantation? p. 168
Ouidad Barmoussa, Yassamine Bentata, Intissar Haddiya
DOI:10.4103/1319-2442.367810  
Kidney transplantation is the ideal treatment for patients with end-stage kidney disease as it provides better survival and quality of life. The best form is living donor kidney transplantation. Numerous studies documented significant gender inequality when it comes to receiving or donating a kidney transplant among women. This article will summarize the present knowledge of gender-related kidney transplantation and discuss the potential causes for the observed disparities and their consequences.
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CASE REPORTS Top

A Berry and Acute Kidney Injury p. 172
B Balaji Kirushnan, R Balasubramaniyam, Raaghav Raj
DOI:10.4103/1319-2442.367811  
Plant toxins have well been implicated in the etiopathogenesis of acute kidney injury (AKI). Certain plant toxins are endemic to a particular country and region. Knowledge of the regional plant toxins will be useful to give travel advisory measures for the public and patients with chronic kidney disease. We report a case of poisoning with tutu berry, endemic to New Zealand causing AKI.
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Immunoglobulin G4-Related Kidney Disease p. 175
Raouya Grati, Yosra Ben Ariba, Jannet Labidi
DOI:10.4103/1319-2442.367812  
Immunoglobulin G4-related disease (IgG4-RD) is an emerging fibro-inflammatory condition known to involve potentially every organ system in the body, especially the kidneys, and is characterized by interstitial nephritis, obstructive nephropathy, and in rare cases, glomerular nephropathy. In this article, we report two cases of IgG4-RD with renal manifestations, hospitalized in the Department of Internal Medicine of the Principal Military Hospital of Instruction of Tunis. In conclusion, the clinical course of IgG4-related kidney disease varies widely and it can sometimes be difficult to diagnosis. A multidisciplinary approach can be useful. Early diagnosis and appropriate therapy are very important.
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Nephrogenic Diabetes Insipidus and Distal Renal Tubular Acidosis in a Patient with Systemic Lupus Erythematosus and Secondary Antiphospholipid Syndrome p. 185
Ricardo Rocha-Rojas, Anayeli Flores-Laguna, Gabriel Solis, Guillermo Flores
DOI:10.4103/1319-2442.367813  
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Severe Rhabdomyolysis Leading to Acute Kidney Injury in a Case of Dengue Fever p. 189
Jigar P Thacker, Somashekhar Nimbalkar, Anal J Chaudhari
DOI:10.4103/1319-2442.367814  
Rhabdomyolysis is not a well-known complication in dengue fever and only a few cases are reported. We report a patient of dengue, with severe body ache and myalgia, passed reddish-brown urine with a very high creatine-phosphokinase level. He also developed oliguria, hypertension, and raised creatinine. This suggests rhabdomyolysis occurred which led to acute kidney injury. This can complicate otherwise stable patients with dengue and affect the outcome. This complication needs to be explored when a similar clinical picture is encountered.
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Bilateral Renal Lymphangiomatosis p. 193
Muhammad Tanzeel Abbasi, Mariam Arif, Muhammad Nauman Hashmi, Rashid Asghar, Khuram Bashir, Wajahat Ali
DOI:10.4103/1319-2442.367815  
Lymphangiomatosis is a rare and benign mesenchymal disorder where there is developmental malformation and dilatation of lymphatic channels. The most common sites for lymphangiomatosis are the cervical neck and axilla, but it can also occur in the mediastinum, retroperitoneum, mesentery, omentum, colon, and pelvis. Renal lymphangiomatosis is an even rarer multicystic disorder which may be hilar, pericalyceal, paracalyceal, peripelvic, or para pelvic. We report a case of 24-year-old female with bilateral perirenal lymphangiomatosis. Her complain was bilateral flank pain and bilateral perinephric fluid collection with multiple sepatations was noted on radiological examination.
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Pauci-immune Lupus Nephritis in Antiphospholipid Disease: A Diagnostic Challenge p. 196
Salwa A Alhemyadi, Abdulaziz A Al-Hamidi, Shuaa Asiri, Ramiz Al-Swailem
DOI:10.4103/1319-2442.367816  
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that leads to immune complex deposition in different organs, especially the kidneys. Pauci-immune lupus nephritis (LN) is a very rare condition. About 40% of SLE cases have a positive antiphospholipid antibody (aPL). So, diagnosing primary antiphospholipid syndrome (APS) in SLE patients is challenging because most symptoms of primary APS can be similar to SLE as described in the American College of Rheumatology/Systemic Lupus Erythematosus International Collaborating Clinics classification criteria for SLE. APS might present as thrombotic microangiopathy (TMA) involving arterioles and glomerular capillaries. We need an adequate renal biopsy to differentiate between lupus and APS nephropathy. A 38-year-old man was diagnosed with biopsy-proven primary APS and LN. Hewas commenced on anticoagulants, pulse steroids, rituximab, and with mycophenolatemofetil as a maintenance therapy in collaboration with the rheumatologist. Here we discuss the occurrence and implications of primary APS and Pauci-immune LN in adults.
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BRIEF COMMUNICATION Top

Prevalence of Chronic Kidney Disease in Nonalcoholic Fatty Liver Disease Patients p. 201
Abdelkader K Elgakhow, Rasha Y Hagag, Ghada A Soliman, Moustafa T Gabr
DOI:10.4103/1319-2442.367817  
Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease worldwide. It is not only associated with liver-related mortality and morbidity but is a multisystem disease that affects multiple extra-hepatic organ systems, such as the kidneys and cardiovascular system. Our study was conducted to evaluate the possible relationship between NAFLD and the risk of chronic kidney disease (CKD) development. This is a comparative cross-sectional study. The study was conducted on 100 patients who were diagnosed with NAFLD by abdominal ultrasound, CKD was diagnosed either by estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m2 or by the presence of albuminuria (albumin creatinine ratio >30 mg/g).These patients were classified into two groups, the CKD group and the non-CKD group, and the two groups were compared according to different parameters. The data were collected, presented, and statistically analyzed with the computer program IBM SPSS Statistics version 23. Among 100 NAFLD patients, there were 19 patients developed CKD diagnosed either by eGFR or by the presence of albuminuria. These CKD patients were older, have abdominal obesity, higher body mass index, higher cholesterol level, higher low-density lipoprotein level, higher triglycerides levels, higher systolic and diastolic blood pressure, and higher fatty liver index and a higher degree of fatty liver by ultrasound. Our current study suggests that NAFLD may be associated with a high risk of CKD.
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Chronic Hepatitis B and Nephrotic Syndrome in Children: Treatment Outcomes p. 210
Shipra Agrwal, Mukta Mantan, Anika Agrawal, Vineeta Vijay Batra
DOI:10.4103/1319-2442.367818  
Hepatitis B-related glomerulonephritis (GN) is an uncommon but important cause of renal morbidity in children. While immunosuppressive therapy has been tried along with antivirals for treatment, some children may undergo spontaneous remission or achieve remission with antivirals alone. We retrospectively studied the outcomes of children with nephrotic syndrome (NS) and chronic hepatitis B infection treated at our nephrology clinic over a five years period; seven children were included of which six (86%) presented with NS and one with nephritic syndrome. Renal biopsy (done in 5 children) showed membranous GN in two (40%), membranoproliferative GN in one (20%), and focal segmental glomerulosclerosis in two (40%). Entecavir therapy was started in 6/7(86%) and four (57%) achieved remission after a median period of 2.7 months and achieved hepatitis B e-antigen seroconversion after mean duration of 1.2 years of treatment with entecavir; the remaining achieved remission with immunosuppression with calcineurin inhibitors.
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LETTER TO THE EDITOR Top

Frontal Lobe Syndrome Following Baclofen Use in a Patient with Chronic Kidney Disease on Hemodialysis p. 216
Abraham Tharakan
DOI:10.4103/1319-2442.367819  
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The Relevance of the Imaging in Autosomal Dominant Polycystic Kidney Disease Management p. 218
Francesca Finazzo, Gioacchino Li Cavoli, Rosalia Mongiovì, Luisa Bono, Angelo Ferrantelli, Angelo Tralongo
DOI:10.4103/1319-2442.367820  
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Anticoagulation-related Nephropathy: An Uncommon Enemy! p. 221
Moumita Sengupta, Keya Basu, Saugat Dasgupta, Arpita Ray Chaudhury
DOI:10.4103/1319-2442.367821  
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SCOT DATA Top

The Critical Pathways of Deceased Organ Donation in Saudi Arabia p. 225
Besher Al Attar
DOI:10.4103/1319-2442.367822  
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