Routine health data, dating from 1990 to 2015, show a dramatic rise in the incidence of acute kidney injury (AKI) in the general population and an apparent increase in acute dialysis (AKI-D) prompting calls for improvement of care in AKI patients. Recent reports suggest flattening of population-based AKI occurrence rates or declining frequencies of AKI or AKI-D in subgroups of high-risk patients with known onset of AKI. These temporal changes in AKI occurrence relate at least in part to the widespread implementation of AKI prevention care bundles. Nevertheless, AKI frequencies and AKI morbidity and mortality remain high. Incorporation of real-time electronic alerts and the use of novel biomarkers in high-risk patients or patients with known onset of AKI may result in further reductions of AKI incidences by early recognition of AKI and by timely conservative management of AKI. There is an urgent need for further treatment options of established AKI.

This study aims to utilize body composition monitor (BCM) device to achieve euvolemic status in problematic dialysis patients and to evaluate its clinical outcome. One hundred and five hemodialysis (HD) patients were enrolled based on difficulty in achieving dry weight. The reasons for enrollment in the study were (a) recurrent intradialytic hypotension, (b) intradialytic hypertension, (c) intradialytic muscle cramps, or (d) the presence of comorbid conditions that make clinical assessment of dry weight difficult (e.g., cirrhosis of liver, heart failure, severe malnutrition, or morbid obesity). Following initial assessment of hydration status using BCM device, dry weight for each patient was adjusted accordingly (upward, downward, or unchanged). The patients were, thereafter, monitored over a 15-week period for possible resultant change in the clinical and hemodynamic parameters. Forty-two patients were monitored due to hypertension, 18 due to hypotension, 10 due to hypotension and cramps, and 35 due to comorbid conditions that make clinical assessment of dry weight difficult. At the conclusion of study period, there was improvement in the monitored parameters. Hypertension improved in 79% of the patient with hypertension, hypotension in 90%, and hypotension with cramps in 90%. In the comorbid group, BCM monitoring provided better insight to clinical problem management in 80% cases. Overall quality of BCM assessments was 96.1%. In the hypertension group, mean blood pressure decreased by 10.9 mm Hg in the whole group (P = 0.0006), the drop was 3 mm Hg in the patients dialyzing with HD (P = 0.0006) and 8.6 mm Hg in those on hemodiafiltration (HDF) (P = 0.08). In the comorbid conditions group, the mean blood pressure rose by 22.5 mm Hg in the whole group (P 0.00001), 21.5 mm Hg in the patients dialyzing with HD (P = 0.00001) and 21.5 mm Hg in those on HDF (P = 0.0004). BCM monitoring together with clinical assessment is a useful tool which when appropriately applied reduces the incidence of dialysis-related complications.

Distinguishing primary from secondary forms of membranous nephropathy (MN) in paraffin-embedded kidney biopsies is challenging. Previous studies have measured the accuracy, sensitivity, and specificity of phospholipase A2 receptor (PLA2R) on MN. However, due to the absence of a gold standard method for diagnosis, further studies are necessary. Here, we measure the correlation and discrepancy of PLA2R on MN in paraffin-embedded kidney biopsies by correlating PLA2R findings with immunofluorescence (IF), light microscopy (LM), and electron microscopy (EM) results. A total of 116 kidney biopsies were investigated including 87 MN and 29 nonmembranous kidney diseases. PLA2R was examined by indirect IF assay. A total of 79 MN cases were subjected to PLA2R staining and histopathological analyses. The remaining eight cases were excluded due to the lack of the glomeruli in the sections. The correlation and discrepancy between PLA2R and IF findings were seen in 65.45% and 34.55%, respectively. PLA2R and EM findings showed a 65.52% correlation and 34.48% discrepancy. LM features and PLA2R findings showed a correlation of 58.44% and discrepancy of 41.56%. Overall correlation between histopathology and PLA2R was seen in 65.82% and 34.18% showed discordant cases. All 29 non-membranous MN cases were negative for PLA2R. Staining for PLA2R could be a useful adjunctive tool in the stratification of cases of MN. The findings of this study strongly recommend the use of PLA2R IF staining method as a routine test for all MN cases.

Renal ischemia/reperfusion injury is a major cause of acute kidney injury (AKI). The lack of early biomarkers for predicting AKI has hampered our ability to initiate preventive and therapeutic measures in an opportune way. Fibroblast growth factor 23 (FGF-23) is elevated in chronic kidney disease, but data on FGF-23 in humans with AKI are limited. Herein, we tested whether FGF-23 levels rise early in the course of AKI following cardiac surgery. We prospectively evaluated eighty adult patients who underwent cardiac surgery. Patients were divided into two groups (AKI and non-AKI group) on the basis of whether they developed postoperative AKI within 24 h after surgery. Plasma FGF-23 levels were measured before surgery and 24 h after surgery. The primary outcome was AKI diagnosed using the AKI Network criteria. Forty-five patients (56.2.5%) developed AKI after surgery. Plasma FGF-23 increased significantly from a mean of 26.8 ± 2.47 ng/mL at baseline to 341.7 ± 38.1 ng/mL 24 h after cardiopulmonary bypass. Univariate analysis showed a significant correlation between AKI and the following: percent change in plasma FGF-23, postoperative serum level of creatinine, FGF-23, and neutrophil gelatinase-associated lipocalin. Receiver operating characteristic curve analysis revealed that, for percent change in plasma FGF-23 concentrations at 24 h, the area under the curve was 0.9, sensitivity was 100%, and specificity was 97.1%. Plasma FGF-23 percent change is more valid compared with FGF-23 before or after procedure in the prediction of AKI and represents a novel and highly predictive early biomarker for AKI after cardiac surgery.

Children with an overactive bladder generally exhibit frequency, urgency, and urge incontinence. Often, a child will squat to try to prevent urinary incontinence. The bladder in these children is not anatomically and is functionally, smaller than normal and exhibits strong uncontrolled contractions. The aim of this study was to the evaluation of blood pressure (BP) in children with idiopathic overactive bladder syndrome. In this case-control study, we selected 110 children with overactive bladder as cases and 220 children without overactive bladder as controls. Children with overactive bladder and healthy children without overactive bladder were enrolled, and their BP was measured in children. P <0.05 was considered statistically significant in our comparisons. The mean age of the children was 8.8 ± 1.70 and 8.53 ± 2.44 years in overactive bladder and control group, respectively. The mean systolic and diastolic BP were a significant difference between case and control groups (P = 0.001). Systolic and diastolic BP were significantly higher in children with overactive bladder.

This study was performed to investigate the protective effect of combined use of Vitamins E and C on colistin-induced tubular damage in rat. Animals were treated with sterile saline, colistin methanesulfonate (CMS), CMS + Vitamin E + Vitamin C, and Vitamin E + vitamin C, respectively, for seven days. Thereafter, animals were sacrificed and the urine N-acetyl-b-D-glucosaminidase (NAG) and gamma-glutamyl transferase (GGT) levels, plasma level of creatinine (Cr), vitamin E and vitamin C, and renal tissue levels of malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), as well as renal histology were performed. CMS induced acute tubular necrosis, increased the NAG, GGT, and MDA levels, and reduced the Vitamin E, Vitamin C, SOD, CAT, and GPx activities. Co-treatment with vitamins E and C restored all biochemical parameters cited above and improved the histopathological damage. Tubular damage induced by colistin is at least partly due to oxidative stress. Nephroprotective effect of Vitamins E and C is partially mediated through its antioxidant properties, and the higher protection by the combination of these vitamins is related to its synergistic effects.

Liver and renal dysfunction accompanying with the tissues' oxidative damage has been reported to occur during Inflammation. Nigella sativa has been well known for its antioxidant and anti-inflammatory effects. The aim of this study was to investigate preventive effects of N. sativa on liver and renal tissue damage in lipopolysaccharide (LPS) -treated rats. The rats were divided into five groups: (1) control; (2) LPS (1 mg/kg, IP, for 10 days), (3-5) N. sativa hydroethanolic extract (100, 200, or 400 mg/kg) before LPS. Compared to LPS group, treatment by the extract decreased alondialdehyde, nitric oxide (NO) metabolites, and interleukin-6 while increased thiol content and superoxide dismutase and catalase activities in both renal and liver tissues. N. sativa extract also decreased serum aspartate aminotransferase, alanine aminotrans-ferase, and alkaline phosphatase concentration, while it increased serum protein and albumin compared with LPS group. In LPS group, serum blood urea nitrogen and creatinine were higher than control group. The extract reversed the negative effects of LPS. The results demonstrated that the N. sativa prevented liver and renal tissue damage in LPS-treated rats. It is suggested that the effects are due to its antioxidant and anti-inflammatory effects.

Chronic kidney disease (CKD) patients have a high risk for cardiac arrhythmia. This study aimed to investigate the prevalence of cardiac arrhythmia in CKD patients and to evaluate the relationship between arrhythmia and biochemical and echocardiographic parameters. CKD patients between 18 and 80 years of age were enrolled from the nephrology outpatient clinic. Physical examination, complete blood count, urinalysis biochemical analysis, electrocardiogram, echocardiogram, and 24-h Holter electrocardiogram were performed. Patients with and without cardiac arrhythmia were compared regarding their characteristics, laboratory findings, and echocardiographic parameters. Risk factors for cardiac arrhythmia were also evaluated. The carotid intima-media thickness was measured using Doppler ultrasonography. In our study involving 59 patients, 44 (74%) had atrial arrhythmia (AA) and 40 (68%) had ventricular arrhythmia (VA). Atrial and/or VA were diagnosed in 46 patients (78%), of whom six (10.2%) had AA, two (3.4%) had VA and 38 (64.4%) had AA plus VA. Atrial fibrillation (AF) was present in two patients (3.4%) in the form of paroxysmal AF. Risk factors for AA were low calcium level and posterior wall thickness, while factors associated with VA were age, triglyceride level, leukocyte count, and nonusage of angiotensin 2 receptor blockers. Risk factors for AA and/or VA included increased platelet count, age, and leukocyte count. AA and/or VA were found in as high as 78% of CKD patients. Further studies evaluating course of the disease from early stages are needed to identify risk factors.

The relationships between the lungs and the kidneys are clinically important; however, the impact of nitric oxide (NO) on respiratory function in renal patients is less known. The aim of this study is to evaluate pulmonary function tests (PFTs), NO level and their correlation in children on treatment with hemodialysis (HD) for the end-stage renal disease. This study was performed among 20 patients on regular HD and 20 controls. Participants were subjected to clinical examination, and pulmonary function evaluation was performed using spirometry. The following parameters were obtained as follows: forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), Tüffenau index (FEV1/%FVC), (FEF25%-75%), and peak expiratory flow. Spirometry was carried out before and after HD sessions, and at the same time of clinical assessments, blood samples were taken to measure arterial-blood gas (ABG) and NO levels. There was the statistically significant difference between patient and control groups regarding NO and all PFTs except FEV1/FVC. There was no statistically significant correlation between NO and biological parameters in both cases and controls, but there was negative although the statistically not significant correlation between the PFTs, ABG, and duration of dialysis in the case group. There was statistically significant negative correlation between NO and some PFTs in case group; also the effect of dialysis on pulmonary functions tests and NO levels were only on the FVC of patients which significantly improved. Postdialysis blood gases remained normal among children on HD. NO may be involved in the deterioration of pulmonary function, and therefore, we feel that it can be used as a marker of clinical deterioration.

Renal cell carcinoma (RCC) comprises 2%-3% of all visceral and 80%-85% of all adult kidney malignancies. Nephrectomy is the treatment of choice for renal tumors. The accurate pathological evaluation of nonneoplastic renal parenchyma in nephrectomy specimens is important for subsequent management. Eighty-two patients with RCC who underwent surgery at Imam Khomeini Hospital, Urmia, Iran, from April 2006 to February 2015 were studied. Paraffin blocks of the hospital archives were stained by hematoxylin and eosin (H and E) and periodic acid-Schiff staining. Microscopic examination was performed on nontumoral portions that were in the farthest possible distance from the tumor. Out of total 82 cases, 24 (29.3%) had normal renal parenchyma and 58 (70.7%) had pathological changes in renal parenchyma. The most frequent pathological findings were vascular sclerosis with parenchymal scarring and pyelonephritis. Other findings include focal and diffuse mesangial hypercellularity, eight; focal segmental glome-rulonephritis, five; membranoproliferative glomerulonephritis, three; and membranous glome-rulonephritis, two. Parenchymal scarring and vascular change included 36% of clear cell type, 41% of papillary type, and 53.8% of chromophobe type. Although there is not any statistical relation between the gender of patients and pathological findings, there was an obvious correlation between age and pathological findings. Before the age of 55 years, vascular sclerosis with parenchymal scarring and glomerular diseases and then chronic pyelonephritis are more prevalent.Evaluation of pathological changes in nonneo-plastic renal parenchyma is an essential step in recognizing patients at risk of accelerated functional failure of the single remaining kidney, particularly in patients with a background of chronic vascular injury associated with diabetes or hypertension.

Levamisole is often discussed as the first alternative to steroids. It is an antihelminthic drug that has been used for steroid-sensitive nephrotic syndrome (SSNS) for more than 20 years. Interleukin (IL)-18, a member of the IL-1 cytokine superfamily, is recognized as an important regulator of immune responses. The aim of the study was to investigate the IL-18 levels in serum from children with SSNS during relapse and remission after using levamisole or three months in a trial to test the efficacy of its action in reducing frequency of relapses in SSNS. This study was done on 23 children with frequently relapsing SSNS treated with levamisole besides steroids, then followed up three months; 16 males and seven females (mean age: 7.96 years and median 8 years). Clinical and laboratory assessments were done before starting therapy and after three months including cumulative dose of steroids and serum IL-18. We found that IL-18 level showed a significant elevation after three months of levamisole therapy compared to its level before initiation of levamisole therapy, with no relapses in these three months, no reported side effect, and significant reduction of cumulative dose of steroids. Levamisole effectiveness in reduction of relapses of SSNS may be due to resetting of the type 1/type 2 imbalance, proved by induction of IL 18 may be useful in the therapy.

The most important aspect of treating drug-induced acute interstitial nephritis (AIN) is timely discontinuation of the offending drug. Steroids, oral as well as intravenous (IV), are used in the treatment of drug-induced AIN. The present study was undertaken to compare the efficacy of oral prednisolone versus IV suprapharmacological doses of corticosteroids in the treatment of drug-induced AIN. This prospective randomized controlled study included drug-induced AIN diagnosed on histopathology over a period of two years. Patients were randomized to oral prednisolone (Group A) 1 mg/kg for two weeks or pulse methylprednisolone (Group B) 30 mg/kg for three days (maximum 1 g) followed by oral prednisolone 1 mg/kg for two weeks, tapered over two weeks. Response was reported as complete remission (CR) [improvement in estimated glomerular filtration rate (eGFR) to ≥60 mL/min/1.73 m²], partial remission (PR) (improvement but eGFR <60 mL/min/1.73 m²), or nonresponders to steroids (no CR/PR). Steroid therapy was instituted to 31 biopsy-proven AIN cases (Group A - 16 and Group B - 15). Drugs implicated in the causation of AIN included pantoprazole, diclofenac, rifampicin, naproxen, aspirin, imipenem, piroxicam, cefixime, lornoxicam, Chinese herbs, etoricoxib, ciprofloxacin, and phenytoin. There was no difference in the baseline parameters between the two groups. At the end of follow-up, 58.06% achieved CR and 41.93% achieved PR. In Group A, nine (56.2%) achieved CR and seven (43.7%) achieved PR. In Group B, nine (60%) achieved CR and six (40%) achieved PR. There was no significant difference between the two groups. Pulses of high doses of corticosteroids have a significant but transient anti-inflammatory effect. Both oral and IV suprapharmacological doses of corticosteroids are equally effective in the treatment of drug-induced AIN, if used early.

Cardiovascular diseases (CVDs) are leading cause of morbidity and mortality and early identification of risk factors can help reduce mortality from them. The aim of this study was to determine the risk of CVD based on the Framingham Risk Score (FRS) among office workers, Yasuj City, Southwestern Iran. In this descriptive study, 180 workers aged 30-74 years old free of cardiovascular disease were recruited by single-stage stratified cluster sampling from the office of Yasuj City. Analysis showed that 163 workers (90.5%) were at low risk, 12 people (6.6%) at moderate risk, and five people (2.9%) at high 10-year risk of CVD. Mean of FRS and 10-year prediction of CVD risk was significantly higher among male workers than females. Subjects with normal body mass index than overweight and obese people had only significantly lower FRS (P <0.001), but 10-year risk of CVD did not differ among groups. Participants with Master of Science and above educational degree and subjects with normal waist-to-hip ratio had only significantly lower 10-year risk of CVD (P < 0.001). Nonsmokers, whose with systolic blood pressure <140 mm Hg, total cholesterol <240 mg/dL, normal total cholesterol/high-density lipoprotein-cholesterol (HDL-C), and abnormal HDL-C had significantly lower both FRS and 10-year CVD risk (P <0.01). This population-based study will health care policy makers develop targeted strategies to develop individual and community-based health care promotion programs.

The arteriovenous fistula (AVF) is the vascular access of the first choice for hemodialysis (HD). Studies on patency of AVF and its affecting factors reveal a high risk for access failure. The aim of this study was to assess the primary and secondary AVF patency and their determinant factors. It was a retrospective, descriptive study conducted in the HD facility of the Nephrology Department in Rabta University Hospital. We included AVF created before December 2009 in end-stage renal disease (ESRD) patients. The end of the follow-up was fixed in December 2013. We included 126 AVFs created in 111 patients; 22.5% were aged >65 years, 39.6% were diabetic, 68.5% were hypertensive, and 26.1% had peripheral vascular disease. The primary patency rates were 78% at one year and 42% at five years. The secondary patency rates were 80% at one year and 69% at five years. Multivariate analysis revealed that the factors affecting the primary patency of AVF were: the use of jugular catheter for longer than three months (odds ratio (OR):1.91, P = 0.044) and a C-reactive protein >5 mg/L (OR: 1.7, P = 0.049). Aging (>65 years) (OR: 2.46, P = 0.042), referral time to a nephrologist <6 months before onset of ESRD (OR: 2.87, P = 0.015), absence of an antiplatelet therapy (OR: 4.47, P = 0.005), and serum phosphorus <45 mg/L (OR: 2.07, P = 0.045) were the significant impairing risk factors for secondary AVF patency. Our study suggests that early referral and creation of AVF and maturation before ESRD as well as its adequate monitoring are essential for maintaining patency.

The epidemiology of infection-related glomerulonephritis (IRGN) is changing in recent times both in developed and developing nations. Although published studies showed renal outcome in adult IRGN was not as benign as in children, literature regarding clinical profile and outcome of crescentic form of adult IRGN is scarce; hence, we aimed to study the clinical profile of crescentic IRGN. We conducted a retrospective observational study in patients with crescentic IRGN in adults at the Department of Nephrology, Madras medical college, Chennai between 2009 and 2014. A total of 47 patients were included with a mean follow-up of 9.9 ± 4.2 months. The mean age was 42 ± 13.5 years. About 19.1% of patients had diabetes. The skin was the most common site of infection (38.3%) with methicillin-resistant Staphylococcus acareas (MRSA) as the most common organism. Hypocomplementemia was present in 100% in our study. Hemodialysis (HD) was required in 53.2% of patients and oral steroids were given in 78.7%. Complete renal recovery was seen only in 25.5%, progression to chronic kidney disease in 40.4%, seven patients reached end-stage renal disease, and nine patients died during follow-up. On univariate analysis, MRSA infection, the unidentified source of infection, nonisolation of organisms presence of interstitial fibrosis and tubular atrophy in renal biopsy and requirement of HD were found to be significant risk factors for poor renal outcome. In our study, crescentic form of IRGN is associated with poor renal outcome.

Sleep disorder, a common complaint among patients with the end-stage renal disease can affect most aspects of life. Therefore, we aimed to compare sleep quality of patients with peritoneal dialysis (PD) and hemodialysis (HD). This cross-sectional study was conducted on patients on dialysis who were referred to three major centers of Shiraz. The Pittsburgh Sleep Quality Index (PSQI) was used to compare sleep quality between patients on PD and HD. We also assessed some baseline characteristics to find out if they were independent predictors of sleep quality. Spearman correlation coefficients, one and two sample t-test, Chi-square, or Fisher's exact test were used to analyze the data. P <0.05 was considered statistically significant. The Statistical Package for Social Sciences version 18.0 for Windows was used for data analyzing. A total of 144 patients including 63 (43.8%) men and 81 (56.2%) women with the mean age of 54.4 ± 11.8 years completed the questionnaire survey. The total PSQI score showed that 77 (54.6%) of all patients had sleep disturbances without statistical difference between genders (P >0.05). On the other hand, the prevalence of sleep disturbance in HD patients (70.1%) was significantly higher than PD patients (35.9%), (P <0.001). HD patients had a higher rate of poor sleep quality than PD patients. Further studies are necessary to investigate the causes of poor quality of sleep in these patients and also to investigate methods to improve sleep quality in this population.

Angiotensin-converting enzyme inhibitors (ACEi) comprise a drug class, which are potent antihypertensives with renoprotective effects but are grossly underutilized in renal transplant recipients. These drugs have been reported to cause elevated potassium and creatinine levels in some renal transplant patients. There have been no reports of prospective studies on use of ACEi in renal transplant patients in the early post-transplant period. The purpose of this study is to assess the safety of an ACEi, when started in the early post-transplant period. In this prospective observational study, we reviewed 78 kidney transplant recipients during the period of January 2012 to March 2017 at our institution. Sixty-four patients were initiated on ACEi therapy within a month of transplantation, while 14 were initiated after one-month post-transplant; the latter was classified as late initiation group. Patients were enrolled when they met the following criteria: declining serum creatinine, improving urine output, and serum potassium <5.5 mEq/L. Exclusion criteria included anaphylaxis to ACEi, use of ACEi or angiotensin receptor blocker for the treatment of post-transplant erythrocytosis, and serum potassium >5.5 mEq/L. Sixty-four patients were studied, 53 (83%) were male and 11 (17%) were female. Mean age was 32 ± 15 years (12-56). Minimum duration of follow-up was six months. For each patient, hemoglobin, serum creatinine, and potassium levels were tested at the beginning of ACEi and at the end of the first, third, and the sixth month. The average potassium and hemoglobin levels did not differ significantly between the groups and were within the normal clinical ranges. While incidence of graft failure did not differ, death with functioning graft was lower in the ACEi group. ACEi can successfully be used in postrenal transplant with beneficial long-term impact on renal function. However, here is a need for further randomized controlled studies to validate this observation.

The reported causes of nephrotic syndrome (NS) varies between different countries. In this retrospective study, we aimed to evaluate the underlying causes of NS in adult patients who underwent renal biopsy in a region of Morocco and we also determined the distribution of histopathological diagnoses with regard to the age subgroups and genders from January 2007 to December 2016. Patients were divided into four groups according to age at the time of renal biopsy. A total of the 257 patients with NS were included in this study. The mean age of the patients was 40.9 ± 16.7 years; male gender was preponderant (61.9%). One hundred and sixty-six (64.6 %) and 81 (35.4%) patients were diagnosed as primary and secondary glomerulonephritis, respectively. The most common diagnosis in NS was membranous nephropathy (MN) (22.2%), followed by minimal change disease (MCD) (20.6%), and lupus nephritis (LN) (13.6%). Among the patients aged 15–30, 31–45, 46–60, and >61 years, the most common cause of NS was MCD (32.1%), MN (29.6 %), MN (26.1%), and amyloidosis (AM) (28.2%), respectively. The proportion of patients with MCD and LN decreased in parallel with patient age and the proportion of patients with renal AM increased in parallel with patient age. Among the female patients aged 15–30 and 31–45 years, LN was the leading cause of NS (41.5 and 36.7%, respectively). Among the male patients aged 15–30 years, MCD was the leading cause of NS (43.2%). Our study over 10 years represents an important data of regional variations of glomerular diseases presenting with adult-onset NS.

Cardiovascular disease (CVD) risk in type 2 diabetes mellitus (T2DM) increases with the development of albuminuria and is related in part to dyslipidemia. The present analysis assessed lipid profile and patterns of dyslipidemia in T2DM patients according to albuminuria status. This was a post hoc analysis of data from 181 T2DM patients seen at a tertiary health-care hospital and enrolled in a cross-sectional study of albuminuria status. Abnormal albuminuria was defined as microalbuminuria [albumin to creatinine ratio (ACR) 30-299.9 mg/g] or macro-albuminuria (ACR ≥300 mg/g). Atherogenic dyslipidemia was defined as triglycerides (TGs) ≥150 mg/dL and/or high-density lipoprotein-cholesterol (HDL-c) <40 mg/dL in men and <50 mg/dL in women using international consensus criteria. High levels of total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-c), HDL-c, non-HDL-c, TG, and low level of HDL-c were defined according to 2012 American Association of Clinical Endocrinologists' guidelines. Comparisons between T2DM patients with and without abnormal albuminuria were done using Chi-square test, Student's t-test, or two-sample t-test with equal variance and Mann-Whitney test as appropriate. P< 0.05 defined the level of statistical significance. Of the 181 T2DM patients, 93 (51%) had abnormal albuminuria with 32% and 19% having microalbuminuria and macro-albuminuria, respectively. Average TC, HDL-c, HDL-c, non-HDL-c, and TG levels were 171 ± 41, 111 ± 36, 38 ± 16, 133 ± 38, and 98 (45-234) mg/dL, respectively. These values were significantly lower for TC (P = 0.047), LDL-c (P = 0.030), and non-HDL-c (P = 0.05) in comparison with patients with normal albuminuria. Low HDL-c (64.5%) and high TG (9.7%) were, respectively, the most and less frequent patterns of isolated dyslipidemia in patients with abnormal albuminuria. Atherogenic dyslipidemia with mainly low HDL-c levels is common in T2DM patients with abnormal albuminuria and could contribute to CVD and renal disease progression.

Native kidney biopsy reports in previous studies that are mostly originated in Western countries show various results in different parts of the world. In this study, we aimed to determine the prevalence of renal biopsy disorders in Iran and compare it with that of other studies in the world. This cross-sectional study evaluated consecutive native kidney biopsies performed in four centers in Isfahan, Iran, from 2009 to 2014. We also reviewed other relevant studies in Iran and the world. Overall, 1547 renal biopsies were reviewed; 493 cases were excluded (transplant or re-biopsy cases) and 1054 cases (43.3% female) were included in our study with a mean (±standard deviation) age of 33.1 (±18.5) years. The first three most prevalent diagnoses were focal and segmental glomerulosclerosis (FSGS) (24.8%), minimal change disease (MCD) (14.2%), and membranous glomerulonephritis (MGN) (9.6%). IgA nephropathy (IgAN) was more prevalent among men, whereas lupus nephritis had a higher prevalence among women. In three out of six previous studies conducted in Iran, the most prevalent pathological diagnosis was MGN; in two others, MCD predominated; and in the third study, FSGS had the highest prevalence. In Europe and Western Pacific Region, IgAN was by far the most prevalent GN, while studies in other parts of the world show conflicting results. The most prevalent diagnosis in our study was FSGS, which was consistent with previous studies in Iran, which seems to have an increasing prevalence. It is recommended that having a national registry is crucial to determine the current status and for better planning and management of renal disorders.

Organ shortage is the greatest challenge facing the field of organ transplantation today. We aimed to study the attitude and knowledge toward organ donation among health-care professionals (HCPs) in rural India. The study was conducted in a rural town in Konkan region of Maharashtra in India. A questionnaire testing knowledge and attitude about various aspects of organ donation was distributed to HCPs. One hundred percent of the respondents were aware about organ donation. Nearly 40.6% and 21.9% believed that a healthy person and a cardiac dead person can be donors, respectively. Fifty percent believed that a brain dead person can be a donor and 3.1% clearly stated as to be having no idea regarding the health status of a donor. Almost 37.5% were ready to believe a heart beating person declared as “brain dead” as dead. Nearly 15.6% were ready to accept a brain dead person as “legally” dead. Highest awareness was observed regarding eye donation, i.e., 87.5%. High awareness was also observed regarding liver, kidney, heart, skin, and body donations, i.e., 78.1%, 65.6%, 37.5%, 31.3%, and 25.0%, respectively. Awareness regarding organ donation of other tissues and organs was poor. Nearly 46.9% HCPs stated that they felt need for an educational session on organ donation. Awareness regarding concept of organ donation among HCPs in rural India is high. Awareness regarding details of organ donation needs further awareness drives. There is a lack of understanding regarding various aspects of brain death and its importance in organ donation.

IgA nephropathy (IgAN) remains one of the most common glomerular lesions, which has a striking geographic distribution and is the most common form of primary glomerular disease in Asia. However, the exact prevalence or clinicopathological spectrum of IgAN in India is not well documented. This retrospective study analyzed the presentation in 126 patients of primary IgAN out of 298 native kidney biopsies (42.28%) performed over a period of three years (2013–2015). The patients were followed up for three months. This is the second highest prevalence recorded in the world after Japan. Among the clinical features of our cohort, the mean age was 31 years, with a male-to-female ratio of 2:1, with the highest incidence observed in the third decade of life in both sexes. The majority of our patients (47%) presented with renal failure with a mean serum creatinine value of 3.1 mg/dL and with burnt out morphology on histo-pathology; 72.2% of patients were hypertensive at presentation. On histopathology, Haas class V (35.5%) had the highest frequency followed by class IV (25.8%). The Oxford MEST score was not applicable in 36 patients because of advanced sclerosis (>50%). In the remaining ninety patients, majority had tubular atrophy and interstitial fibrosis of varying degrees. At three months of follow-up, the patients who had presented with renal failure (47.6%), settled in chronic kidney disease stage III (25.4%) followed by stage IV (18.6%) and stage V (11.8%). Our study in Kashmir suggests that IgAN is more common in the younger age group, with a significant number of patients presenting with advanced renal failure and, on morphology, showing a burnt out disease, with many developing end-stage renal disease. Studies evaluating the underlying factors can have immense importance in dealing with the disease.

The conducted study aimed to determine the incidence and clinical profile of acute kidney injury (AKI) in hospitalized patients using the AKI Network (AKIN) criteria. This prospective observational study was conducted at the Pediatric ward and pediatric Intensive Care Unit of a tertiary level teaching hospital in North India. The participants were 763 consecutive patients aged three months to 12 years from January 2014 to October 2015 and were assessed for eligibility. Of these, 163 patients were excluded from the study. Main outcome measure was incidence of AKI based on the AKIN criteria. Factors associated with AKI were analyzed. A total of 600 patients (141 critically ill and 459 noncritically ill) were enrolled. The incidence of AKI was 25.2% (n = 151); it was significantly higher among critically ill (53.2%) than non-critically ill patients (16.6%), P <0.001. Most patients with AKI were in Stage 1 (n = 99; 65.6%). Ten patients (6.6%) required dialysis (peritoneal dialysis n = 8; hemodialysis n = 2). Patient with AKI had significantly higher median (interquartile range) PIM-2 score, 22.6 (5–61.7), longer hospital stay (10 vs. 7 days), and mortality rate (28.5% vs. 3.6%); P <0.001. Nephrotoxic drugs [hazard ratio (HR): 5.5, 95% confidence interval (CI): 2.6–11.4; P = 0.001]; hypovolemia (HR: 1.7, 95% CI: 1–2.7; P = 0.035); sepsis (HR 2.3, 95% CI: 1.1–5); and mechanical ventilation (HR: 3.3, 95% CI: 1.6–6.8) were independent predictors for AKI. AKI was an independent risk factor for mortality and risk increased with increasing stage of AKI. Mortality was significantly higher in Stage 3 AKI (n = 14; 60.9%); P <0.001. Independent predictors for mortality in AKI were acidosis (HR: 3.6; 95% CI 1.5–8.6), mechanical ventilation (HR: 34; 95% CI 9.3-123), shock (HR: 19.7; 95% CI 2–194), and sepsis (HR: 3; 95% CI 1-8). The incidence of AKI is high among pediatric patients admitted to this center, including among noncritically ill children. AKI is associated with significantly increased morbidity and mortality.

ABO incompatibility and preformed antibodies against the human leukocyte antigen (HLA) are two impermissible barriers to a successful renal transplantation, especially in highly sensitized patient population. With the availability of effective desensitization regimens, good patient and graft outcomes have been reported. As transfusion medicine specialists we report our experience, where patient presented with dual histocompatibility barriers i.e. ABO incompatibility along with preformed donor-specific antibodies (DSA) and negative complement dependent lymphocytotoxicity (CDC) HLA crossmatch. The desensitization strategy followed for our patient included rituximab (375 mg/m²), bortezomib (1.3 mg/m²) and eleven pre-transplant therapeutic plasma exchange (TPE) followed by intravenous immunoglobulin (100 mg/kg per TPE session). Anti-B titer of 1:1 and negative Luminex crossmatch (LumXm) class II DSA (less than 1000 mean fluorescence intensity; MFI), was achieved prior to renal transplantation. Fifteen months post-transplant, patient is doing well with serum creatinine level of 0.8 mg/dL with repeat LumXm class II DSA negative (891 MFI). The desensitization regimen followed proved to be effective in our case.

Membranous nephropathy (MN) may occur in the transplanted kidney, either as recurrent disease in patients who had MN as the cause of end-stage renal disease (ESRD) in the native kidney or de novo, in patients who had another cause of ESRD initially. The reported incidence of recurrent MN ranges between 10% and 45%. Clinical manifestations of recurrent MN are typically observed 13-15 months after transplantation, although they may be observed much earlier (within weeks). Our patient had a recurrence in three weeks. Recurrent disease can lead to loss of the allograft.

Melioidosis is an emerging infectious disease in many countries including Bangladesh. Genitourinary infection due to Burkholderia pseudomallei is a well-recognized manifestation although less commonly reported in Asia than Australia. Here, we report case history of a 38-year-old Bangladeshi farmer, diagnosed with IgA nephropathy and on oral prednisolone, who presented with features of urinary tract infection. Diagnostic workup confirmed genitourinary infection due to B. pseudomallei and diabetes mellitus. He was treated with ceftazidime followed by the combination of co-trimoxazole and doxycycline. After two-year follow-up, he was free of symptoms with no recurrence of melioidosis. In the context of growing evidence of melioidosis endemicity in Bangladesh, physicians should be aware and include melioidosis as differential in appropriate clinical scenario. Melioidosis may cause urinary tract infections and should be suspected in high-risk groups like farmers and in the presence of risk factors such as diabetes mellitus and other immunosuppressive conditions.

Renal involvement is the most common extrahepatic manifestation of chronic hepatitis B virus (HBV) infection. While membranous nephropathy is the most frequent, the association with focal segmental glomerulosclerosis (FSGS) is not as strong, and only a few cases have been described in the literature. In particular, the tip variant FSGS is extremely rare and to our knowledge has not previously been described in association with chronic HBV infection. The management of such cases can be challenging. Immunosuppression may lead to enhanced viral replication and flare-up of the hepatic disease. Antiviral treatment has been reported to induce remission in hepatitis B-associated glomerulonephritis in a few cases. However, their use is primarily restricted to the treatment of associated liver disease, and the current guidelines do not provide specific recommendations on HBV-mediated kidney disease in the absence of hepatic involvement. We describe a case of nephrotic syndrome due to secondary tip variant FSGS in a patient with chronic HBV infection who went into complete remission with antiviral therapy alone and present an argument for the use of oral antiviral agents as the primary treatment option for FSGS-related nephrotic syndrome in chronic HBV-infected patients without progressive liver disease.

A paradoxical reaction during anti-tuberculosis (anti-TB) therapy is commonly reported in patients with human immunodeficiency virus (HIV). However, a similar reaction to anti-TB therapy can also occur in patients without HIV, especially in patients who have undergone solid organ transplantation. A 65-year-old woman who underwent kidney transplantation six months prior presented to our emergency room with progressive paraparesis. She had been diagnosed with drug-susceptible miliary TB and had undergone two weeks of treatment with anti-TB medication. Magnetic resonance imaging showed a spinal intramedullary mass and multiple intracranial nodules. The etiology of the lesions was confirmed as Mycobacterium tuberculosis. We report a paradoxical reaction of spinal intramedullary and multiple intracranial tuberculomas in a patient with miliary TB who had received appropriate treatment for more than two weeks.

With the development of renal replacement therapy, cardiovascular complications have become the major cause of death in patients with polycystic kidney disease (PKD). Atrial myxoma is a cardiac abnormality that has been rarely reported with PKD. The presence of atrial myxomas is not free of complication as it can cause cardiac outflow obstruction and embolic manifestations ending up in death. Here, we report a case of a 44-year-old female who presented with PKD associated with atrial myxoma. A 44-year-old female presented to the emergency department unconscious with a history of sudden onset of dizziness and palpitation. An urgent electrocardiogram was done and showed supraventricular tachycardia. The patient was sedated and emergency synchronized direct current shock was delivered. She started to regain her conscious and her vital signs started to stabilize. Past medical history revealed our female had left atrial mass discovered 10 months earlier and was surgically excised one month before admission. Histological examination showed this mass was myxoma. Blood investigations at the time of admission showed deranged kidney functions. Urine analysis showed uric acid crystals and microscopic hematuria. Abdominal ultrasound showed bilateral polycystic kidneys, two hepatic right lobe cysts, and bilateral multiple renal stones. Cardiac abnormalities are serious complications that could be associated with PKD and are a major cause of death in this population. Atrial myxomas are a rare association with this condition. Further studies to identify other gene loci in PKD may provide an explanation for the associated cardiac abnormalities.

A 14-year-old female presented with oliguric dialysis requiring kidney injury due to acute poststreptococcal glomerulonephritis (PSGN) with hypertension strongly suggestive of atypical hemolytic uremic syndrome (aHUS) with microangiopathic hemolytic anemia and elevated factor H antibody levels. Renal biopsy revealed crescentic glomerulonephritis with typical subepithelial, intramembranous and mesangial electron-dense deposits (humps) on electron microscopy. She was treated with glucocorticoids following which she recovered, remained dialysis free and her Factor H antibody levels and depressed complement 3 levels normalized. PSGN-associated HUS has rarely been described, with this patient being the 11^th case reported, to the best of our knowledge. This case is unique as we describe the course and management of the first patient with PSGN-associated HUS in the era of eculizumab, without eculizumab, and plasmapheresis. This patient presented with clinical and histological features of PSGN as well as anemia and thrombocytopenia consistent with aHUS. Given that these diseases are both mediated through the alternate complement pathway, it is tempting to speculate that blockade of the terminal complement pathway through the use of eculizumab might improve outcomes. Temporally, the hematological parameters in our patient seemed to improve soon after treatment was initiated; however, none of the prior cases in the literature experienced any long-term hematological issues, suggesting that supportive management can be a reasonable alternative.

Immunosuppression is a well-known risk factor for malignancy. Renal transplant patients are at high risk for cancer in the native kidneys especially in the presence of acquired cystic disease. We report a case highlighting the importance of screening for renal malignancy in renal transplant patients.