There has been a rapid increase in the incidence of chronic kidney disease and those requiring renal replacement therapy. Managing these patients requires a multidisciplinary team approach. Clinical nurse specialists (CNS's) play a vital role in ensuring the highest quality care is delivered in a cost-effective manner. There is an acute shortage of CNS' in the Middle East and other developing countries. Development of the CNS's role necessitates comprehensive training programs in conjunction with multi-stakeholder acceptance. This article hereby addresses the various steps in developing such a role as facilitating nurses to work to their full professional and academic potential ensures best practice.

The number of patients with chronic kidney disease (CKD) is increasing worldwide. Different studies have shown that patients with CKD have poorer oral health status and they require a high amount of dental treatments than the general population. Therefore, it is crucial for dental care providers to have basic knowledge about kidney function and its implications for oral health and dental treatments. It is also essential to stress to nephrologists the importance of referring patients who are at a late stage of CKD to a specialty center for dental assessment before starting renal replacement therapy (i.e., renal dialysis or kidney transplant). The integrated care pathway of nephrology and dental teams is highly recommended. Patients on renal dialysis or after renal transplant always require a holistic approach. They have a high risk of oral bleeding, dental infection, and possible drug interaction. For safe dental treatment, dental care providers should determine the level of dentistry required and always liaise with the patients' nephrologist prior dental treatments. The aim of this review paper is to help the dental and nephrology teams to have some knowledge of renal patients' needs for dental treatment.

Chronic kidney disease (CKD) in children contributes to the global health burden. The focus on using novel biomarkers to predict the onset and progression of the disease has increased tremendously over the past decade. Discovery of these biomarkers offers prospects for the early anticipation of the late stages of CKD, slowing down disease progression, and achieving better disease outcomes. The aim of this article is to classify and highlight the utility of these novel biomarkers in predicting disease-onset and progression. Biomarkers of CKD are broadly classified into biomarkers of kidney function and biomarkers of kidney damage. Glomerular filtration rate (GFR) remains the most important marker of kidney function, but it cannot be easily measured in most clinical and research settings. Its estimating equations, therefore, depend on filtration biomarkers such as serum creatinine and serum cystatin C. For instance, the CKD-epidemiology collaboration equation has been suggested as the preferred prediction equation for the staging and classification of estimated GFR (eGFR) in CKD. Although albuminuria is the traditional biomarker of kidney damage, it precedes any decline in eGFR and may be absent in tubulointerstitial disease. Thus, more sensitive and specific novel biomarkers of kidney damage are emerging which hold prospects for earlier prediction of CKD in children. They have been classified as tubular and miscellaneous biomarkers. Tubular biomarkers are represented by markers such as kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, N-acetyl-ß-D glucosaminidase, liver-type fatty-acid binding protein, cystatin C and a-1-microglobulin. Miscellaneous biomarkers include monocyte chemoattractant protein-1, interleukin-18, and retinol binding protein 4. Despite their advantages over albuminuria, they still require validation before they can be applied in clinical practice.

Endothelial progenitor cells (EPCs) CD34 are bone marrow-derived cells that decrease in chronic kidney disease (CKD) patients especially when they reach end-stage renal disease and may be a risk marker of cardiovascular (CV) diseases. The aim of our study is to investigate the endothelial progenitor cell CD 34 numbers in children with CKD on regular hemodialysis (HD) and detect their association with vascular stiffness. We recruited 25 children on regular HD, who were selected from the HD unit of Al-Zahraa Hospital, Al-Azhar University. Another group of 25 age and sex matched healthy children served as as controls. We investigated the number of EPC number (CD34) using flow cytometry, intima-media thickness (IMT), and the peak systolic velocity (PSV) of the main arteries including the (aorta, carotid, and femoral) arteries using Doppler ultrasound, this is in the same line with the routine and traditional investigations of the CV risk in the study groups. Children on regular HD have significantly lower EPC numbers (CD34 numbers) compared to their controls, the median and the inter equatorial range of CD34 was 57 (17–122) and five (3–6), respectively (P 0.001). Significant positive correlations were found between CD 34 and triglycerides serum level (r = 0.817, P = 0.001), also between CD34 with IMT and PSV of the aorta (r = 0.685, P = 0.000: r = 0.457, P = 0.022), respectively. CD34 is 88% sensitive and specific for the detection of CV risk in children on regular HD. EPC CD34 exhibited a higher predictive value for CV risk in children on regular HD. Reduced EPC numbers contribute to accelerated atherosclerosis.

Two variants for APOL1; the gastrointestinal (G1) variant (S342G and 1384M substitutions) and the G2 variant (N388 and Y389 deletions) have been previously described to be associated with renal disease. The prevalence of APOL1 variants in Saudi Arabia is unknown. We aimed to determine the prevalence of APOL1 variants in a cohort of patients with renal disease in Saudi Arabia. Patients with renal disease followed up at King Abdulaziz University Hospital were approached consecutively at the out patient clinic, and unaffected controls were approached at the blood donation area. Clinical and laboratory data were collected from electronic medical records. Laboratory variables in controls were obtained on enrollment. This is a cross-sectional, cohort study. One hundred and one patients with a mean age of 54.5 (±19) years, and 119 unaffected controls with a mean age of 31.9 (±7.89) years, were enrolled. Seventy-four patients (68.5%) had hypertension and 62 (57.4%) had diabetes. The mean estimated glomerular filtration rate was 22.47 (± 27.6) mL/min. Two patients were heterozygous for G1 allele. Among the control group, two were heterozygous for G1 allele, and three were heterozygous for G2. All five controls had no evidence of renal disease and no family history of renal disease. The prevalence of APOL1 genetic risk variants in the study cohort was very low. Larger studies are needed to determine the prevalence among renal disease patients in Saudi Arabia.

The aim of this study is to assess the impact of pharmaceutical care on medication adherence, hemoglobin (Hb) levels, blood pressure (BP), and interdialytic weight gain (IDW) among hemodialysis (HD) patients. An open-label randomized controlled study has been conducted at three different hospitals of HD centers. The patients have been randomized into two groups [usual care group (UCG) and pharmaceutical care group (PCG)] by block design. The assessment has been carried out at baseline, 6^th, and 12^th months. At the end of the study, a total number of 153 patients have been followed. Out of 153 patients, 83 (UCG: n = 41; PCG: n = 42), 18 (UCG: n = 09; PCG: n = 09), and 52 (UCG: n = 25; PCG: n = 27) patients have been followed from academic, government, and corporate hospitals, respectively. The PCG had significantly reduced its IDW and BP levels in comparison to UCG at different time intervals with a statistical significance of P <0.05. The Hb levels and medication adherence rate scores of HD patients had significantly increased in PCG compared to UCG at different time intervals. The “World Health Organization-International Pharmaceutical Federation pharmaceutical care” plan model delivered by the registered pharmacist regarding the knowledge about the disease, medications, life style changes, nutritional information, personal interview, and medication review had a positive impact on the on medication adherence, Hb levels, BP, and IDW.

The loss of muscle mass and cachexia is commonly seen in hemodialysis (HD) patients and contribute to morbidity and mortality. The exact mechanism of this fact is multifactorial and still unclear. Myostatin, a transforming growth factor-ß family ligand, is released from the skeletal and heart muscle and may be responsible for muscle degradation and atrophy. The aim of this study is evaluation of the relationship between muscle mass and serum myostatin level in chronic HD patients. One hundred and forty HD patients (79 males, 28 diabetic, mean age; 53.96 ± 13.6) were included in this cross-sectional study. Muscle mass measurement was made with dual energy-X ray absorptiometry. Appendicular skeletal muscle index (ASMI) was used as a muscle mass indicator. The anthropometric and biochemistry data were obtained. Serum myostatin levels were determined by an ELISA kit. Serum myostatin levels were elevated when compared to controls (P <0.001), but no significant correlation with ASMI was observed (P = 0.624). ASMI significantly correlated with serum creatinine (P <0.001), creatine phosphokinase (P <0.001), prealbumin (P <0.012), albumin (P <0.039), transferrin (P <0.001), phosphorus (P <0.001), Ca×P (P <0.012), inversely with Kt/V (P <0.001); not with BUN (P = 0.739), parathyroid hormone (P = 0.698), 25-hydroxyvitamin D (P = 0.603), bicarbonate (P = 0.062); such that these parameters also have influence on muscle mass regulation. Our study indicated that myostatin levels were high in HD patients but had no relation with ASMI. Myostatin is a well-known regulator of muscle mass so further studies are needed to demonstrate possible relationship.

Our objective is to study the demographical data, clinical course and outcome of children with primary focal segmental glomerulosclerosis (FSGS) in Jordan. A retrospective chart review of patients with a diagnosis of FSGS at a tertiary care hospital from the period July 2010 to July 2016 was conducted. A total of 99 patients were analyzed. The mean age of presentation was 3.71 ± 2.59 years, 66% were male. At presentation, 66.6% of patients were steroid-resistant, 10% had a steroid dependant course and 20.2% had familial FSGS. Cyclosporine was used in 66.6% of children with a response rate of 46.9%. Long-term follow-up showed complete remission in 29.3%, partial remission in 31.3%, end-stage renal disease in 22.2%, and death in 11.1%. There is a high prevalence of familial FSGS in our Jordanian cohort with a high rate of progression to end-stage kidney disease.

Several biomolecules potentially serve as promoters or inhibitors of calcification in dialysis patients which include fetuin A, matrix gla protein, osteopontin, osteoprotegerin, etc. The primary aim was to compare the biomarkers of coronary artery calcification (CAC) and to study its role as predictors of CAC in hemodialysis (HD) patients. Of 126 patients undergoing chronic HD, 100 patients completed the study. Blood samples were drawn for serum creatinine, electrolytes, calcium, phosphorus, Vitamin D3, parathyroid hormone (PTH), lipid profile, high sensitivity C-reactive protein, ferritin, fetuin A, and fibroblast growth factor-23 (FGF-23). Non-contrast Computed Tomography scan of the coronary arteries was conducted on all participants. Participants who were positive for CAC (P group) were compared with those negative for CAC (N group) using two sample t-test. Multiple logistic regression analysis was conducted to determine the predictors of CAC. The prevalence of vascular calcification (VC) was 60% with higher prevalence seen in males (71%), older age group, patients with dialysis vintage >5 years (27%), and diabetic population (62%). Mean serum phosphorus was significantly higher (P <0.001) and fetuin A (P <0.001) was significantly lower in the P group. Age (OR: 1.2, P = 0.004), serum phosphorus (OR: 1.8, P = 0.024), and fetuin A (OR: 0.0006, P = 0.001) were found as predictors of CAC. CAC was more prevalent in males, patients with higher age group and in those with longer dialysis vintage and diabetic population. Participants with CAC exhibited significantly high phosphorus and low fetuin A levels. Age, phosphorus level, and fetuin A were found to be predictors of CAC in dialysis patients. FGF-23 could not predict CAC.

Studies among hemodialysis (HD) patients have looked into relationships between illness perception (IP), depression, and adherence yet rarely looked further into medication factors. Those studies were also conducted at urban HD centers leaving out those from a smaller town. Our objective is to determine phosphate binders (PBs) influences on IP and depression among HD population in smaller town. One hundred and thirteen patients from three Central Pahang Cluster Hospitals, Malaysia on HD were interviewed using Malay version of the Brief IP Questionnaire and Beck Depression Inventory II (BDI-II). This study found a significant positive correlation between PBs daily dose frequency with consequence, timeline, and illness concern. Type of PBs used influenced personal control significantly. History of PBs side effects resulted in significantly lower treatment control and lower emotional representation. There was a significant negative relationship between dialysis vintage with both identity and IP score. Depressed patients had significantly higher emotional representation compared to healthy controls. Meanwhile, there was a positive correlation between BDI-II score with coherence, consequence, and emotional representation. Around 23.9% of the patients reported symptoms of depression. Depressed patients had significantly shorter dialysis vintage compared to healthy controls. They tended to report a significant history of hospital admission in the past six months that peaked among those on HD between four to six years. The current study showed the effect of PBs therapy on IP while depression was associated with HD duration and hospital admission. This information can be used to formulate a better treatment approach by health-care practitioners toward better patients treatment hence outcomes.

Postpartum acute kidney injury (AKI) is one of the serious complications of pregnancy and is associated with high mortality and morbidity. We conducted this study to determine the characteristics and outcome of the most severe form of postpartum AKI requiring dialysis. This prospective, observational study was conducted in Sawai Man Singh Medical College, Jaipur. All postpartum female suffering from AKI requiring dialysis between July 2014 and December 2016 were included in the study. Demographic, clinical and laboratory data of the patients were recorded. Outcome variables included survival at hospital discharge and estimated glomerular filtration rate (eGFR) at three months of follow-up. Sixty (88.2%) out of 68 women admitted with postpartum AKI required dialysis. The mean age was 26.5 ± 4.3 years and the majority (80%) had institutional delivery. The mean sequential organ failure assessment (SOFA) score was 8.0 ± 2.9. Puerperal sepsis (n = 37, 61.6%), preeclampsia (n = 21, 35%), and antepartum hemorrhage (n = 14, 23.3%) were the most common obstetric complication associated with postpartum AKI. Maternal mortality was 28.3%. Higher SOFA score (P = 0.015, odds ratio [OR]: 1.99, confidence interval [CI]: 1.14–3.45) and diagnosis of sepsis (P = 0.048, OR: 26.3, CI: 1.03–678.3) were the independent predictors of mortality. Out of 37 patients who were followed up at three months, 51.3% had eGFR <60 mL/min/1.73 m². Duration of anuria (in days) was the only independent predictor of (eGFR <60 mL/min/1.73 m² at three months of follow-up (P = 0.029, OR: 1.2, CI: 1.02–1.46). Postpartum AKI requiring dialysis was associated with high mortality. More than half of the survivors had eGFR <60 mL/min/1.73 m² on follow-up highlighting the need of appropriate follow-up.

The prevalence of subclinical hypothyroidism (SHT) has been reported to be much higher in patients with chronic kidney disease (CKD) than in the general population. SHT has been identified as a strong predictor of mortality and a risk factor for cardiovascular disease in CKD. The study aimed to provide local data on the prevalence of SHT in CKD patients on maintenance hemodialysis (MHD). A total of 72 patients with CKD on MHD were enrolled. Nonprobability consecutive sampling was performed on patients of either gender aged 14-50 years who met the inclusion and exclusion criteria. Thyroid-stimulating hormone and free thyroxine four levels were obtained and interpreted for the presence of SHT. SHT was present in 22 patients (30.6%). When stratified according to age, 22.7% of patients were younger than 30 years, 20.8% between 30 and 40 years and 46.2% were above 40 years. The percentage of patients above 40 years with SHT was much higher, but not statistically significant (P = 0.096). When stratified according to gender, 21.6% were male, and 46.2% were female (P = 0.03). When stratified according to duration on hemodialysis (HD), 4.5% of patients on HD for two years or less had SHT; 25.9% on HD for three to five years and, 60.9% on HD for more than five years had SHT (P <0.01). The study shows a considerably high prevalence of SHT in CKD patients on HD. Routine screening of thyroid functions in these patients, especially in females and those on HD for >5 years, may help in reducing the morbidity and mortality associated with SHT through early detection and timely intervention.

Acute kidney injury (AKI) is an independent predictor of morbidity and mortality for critically ill children at pediatric Intensive Care Units (PICU). It is proposed that heat shock protein 60 (HSP60) may be either a biomarker or a co-factor of survival in PICU. The aim of this work is to assess plasma levels of HSP60 in critically ill pediatric patients with AKI secondary to septic shock within the first 24 h of admission. This study was carried out on 120 pediatric patients admitted to PICUs of four university hospitals. They were divided into Group 1 included 60 patients meeting the criteria of AKI Network and septic shock, the second group included 60 critically ill patients without AKI or septic shock and the third group was 60 healthy children as controls. HSP60 levels were measured in the plasma using a commercially available ELISA and difference between groups were analyzed with a Kruskal–Wallis one-way ANOVA. P <0.05 was considered significant. There was highly significant increase in plasma levels of HSP60 in Group 1 (median 25.85 ng/mL) compared to both Group 2 (median 6.15 ng/mL) and healthy controls (median 4.35 ng/mL) (P <0.001). At a cut-off value ≥10 ng/mL, HSP60 sensitivity for prediction of cases with AKI secondary to septic shock was 96.67% with specificity 86.67%, positive predictive value 87.9%, negative predictive value 96.3%, AUC 0.993. HSP60 levels are significantly elevated in pediatric patients in Group 1 when compared to Groups 2 and 3. Hence, HSP60 may play a role in the pathogenesis of sepsis in pediatric patients.

New-onset diabetes after transplant (NODAT) has been reported to occur in 4%-25% of renal transplant recipients. Its development has also been shown to be associated with an adverse impact on patient survival and an increased risk of graft rejection and graft loss, as well as an increased incidence of infectious complications. The study aims to describe the incidence of NODAT and its important risk factors in a single center. We conducted a retrospective analysis of data from all kidney transplant recipients in our center, transplanted between September 2008 and May 2013. Out of 311 patients, 77 had diabetes mellitus (DM) before transplantation and were excluded, leaving 234 patients as the study population. NODAT was diagnosed based on the WHO definition for DM: any two readings of fasting blood sugar >7 mmol/L or random blood sugar >11 or the use of hypoglycemic medications after 1^st posttransplant month. The mean age of the study patients was 36 years ± 14 years; 55.5% were male, 69% had living-related transplant, 31% had deceased donor transplant, 98% were on tacrolimus-based immunosuppression regimen, 2% on cyclosporine and all patients were on the steroid-based regimen. The 1 and 5-year cumulative incidence of NODAT was 14.1% and 27.5%, respectively. The median duration to onset of NODAT was 2.5 months. The body mass index of >30 kg/m² and age >60 years at the time of transplant were significantly associated with the occurrence of NODAT. Our finding of incidence was not different from what has been reported in the literature. Larger prospective and multicenter studies are needed.

The inadequacy of dialysis and hyperphosphatemia are both associated with morbidity and mortality in chronic hemodialysis (HD) patients. Blood flow rate (BFR) during HD is one of the important determinants of increasing dialysis dose. The aim of this study was to determine the effect of increasing BFR on dialysis dose and phosphate removal. Forty-four patients were included in a cross-sectional study. Each patient received six consecutive dialysis sessions as follows: three consecutive sessions with a BFR of 250 mL/min, followed by three others with BFR of 350 mL/min without changing the other dialysis parameters. Patients' body weight was recorded, and blood samples (serum urea and phosphate) were collected before and after each dialysis session. For assessing the efficacy of dialysis, urea reduction ratio (URR), Kt/VDiascan (Kt by Diascan and V by Watson), Kt/V Daugirdas (Daugirdas 2^nd generation), equilibrated Kt/V, and phosphate reduction rate (PRR) were used. The increase of BFR by 100 mL/min resulted in a significant increase of URR, Kt/V _Diascan, Kt/V_Daugirdas, equilibrated Kt/V, and PRR: URR; 75.41 ± 5.60; 83.51 ± 6.12; P <0.001), (Kt/V_Diascan; 1.28 ± 0.25; 1.55 ± 0.15; P <0.001), (Kt/V_Daugirdas; 1.55 ± 0.26; 2.10 ± 0.61; P = 0.001), equilibrated Kt/V; 1.40 ± 0.19; 1.91 ± 0.52; P = 0.001), and (PRR; 50.32 ± 12.22; 63.66 ± 13.10; P = 0.010). Adequate dialysis, defined by single-pool Kt/V ≥1.4, was achieved using two different BFRs: 250 and 350 mL/min, respectively, in 73% and 100% of the cases. Increasing the BFR by 40% is effective in increasing dialysis dose and phosphate reduction rate during high-flux HD. The future prospective studies are needed to evaluate the impact of increasing BFR on phosphate removal using the total amount of phosphate removed, and also evaluate the cardiovascular outcome of phosphate reduction and dialysis improvement.

Oxygen is very important to the existence of life. Oxygen deficiency, defined as hypoxia, elicits adaptive responses in cells and tissues. Lower oxygen concentration can cause the alteration of renal function, affects the maintenance of a balance of the body fluids, electrolytes, pH, and blood pressure homeostasis. Impaired fluid regulation could, in addition, contribute to the precipitation of pulmonary edema and exacerbate hypoxemia which may accelerate the progression of chronic kidney disease. In this context, the present study attempted to evaluate the association of renal injury and oxidative stress at different atmospheric pressures (1829, 3657, and 5486 m). Limited fecal analysis of experimental animals was also done to evaluate the impact of hypobaric hypoxia on the composition of dominant gastrointestinal microbiota. The study was performed on 24 male Wister strain rats and divided into four groups (C, HA-I, HA-II, and HA-III), and exposure was carried out for seven days period. In hypoxic exposure rats, plasma urea, creatinine, electrolytes and malonaldehyde level elevated and catalase and superoxide dismutase level diminished significantly compared to the controls. Increase in blood uremia profile, toxicity markers, and lipid peroxidation marker enzymes indicated that hypoxia causes renal failure. Histological structures of the kidney of group HA-II and HA-III animals showed severe disorganization of glomerulus and dilation of renal tubules. These results indicate nephrotoxicity or acute renal failure can occur at hypobaric hypoxia and it also affected the gut microbial population. This alteration was observed significantly above 3000 m.

Renal transplantation is the treatment of choice for the end-stage renal disease. Hypervolemia and inflammation are commonly overlooked. We investigated whether hyper-volemia develops in kidney transplant recipients with estimated glomerular filtration rate (eGFR) >70 mL/min and if there is there any correlation between inflammatory cytokines and hypervolemia in the 1^st month and at six months after transplantation. We measured serum tumor necrosis factor-α (TNF-α), interleukin (IL)-1, IL-6, and body composition indices in 11 healthy volunteers and 19 kidney transplant recipients (KTRs) with eGFR >70 mL/min at one month and six months posttransplant. At baseline, body mass index (BMI) and fat tissue index (FTI) were significantly higher and overhydration improved (P = 0.006) at 6^th month in KTRs. There was no difference in BMI, FTI, lean tissue index (LTI), and serum levels of IL-1 and IL-6 in controls and KTRs at six months posttransplant. Volume overload and serum TNF-α levels were significantly lower in controls than KTRs. There was positive correlation between volume overload and serum TNF-α levels in KTRs. Compared to baseline, parameters including volume overload, BMI, and FTI were found to be improved at six months' posttransplant in KTRs. Interestingly, volume overload and high levels of serum TNF-α continued at least six months after transplantation.

Little was known about the relationships between the T lymphocytes (CD3+), expression of glucocorticoid receptors (GCR) and the response to GC treatment in children with the idiopathic nephrotic syndrome (INS). Our objective was to determine the relation between steroid responsiveness and GCR expression in T lymphocytes. The present study was carried out on 80 children with new-onset INS admitted in Pediatric Nephrology Units of Zagazig and Tanta University Hospitals and on 40 healthy children of the same age and sex who served as control group. The Subjects were subdivided into three groups as follows: Group 1 with 40 healthy children of comparable age and sex served as control group; Group 2 consisted of 60 patients diagnosed with INS with early response to steroid therapy [early responder (ER)] and Group 3 with 20 patients diagnosed with INS with late response to steroid therapy [late responder (LR)]. They were subjected to history taking, focusing on the pattern of response to steroids (ERs), clinical examination, routine laboratory investigations and the GCR/CD3% relationship. 75% of newly diagnosed INS cases were ER whereas 25% were LR. GCR/CD3% was significantly lower in LR group in comparison with ER and control groups, with a significant negative correlation between time of steroid responsiveness and GCR/CD3%. LR group showed lower GCR expression in T lymphocytes before starting therapy which may mean that GCR expression could be part of a pathophysiological mechanism of steroid responsiveness in these children and can be used as a useful diagnostic marker to predict steroid responsiveness in patients with INS.

End-stage renal disease is emerging as a major public health problem in the developing countries. It must be treated with renal replacement therapy and hemodialysis (HD) is the most widely used therapy and the only maintenance treatment if kidney transplant is not feasible. This study aimed to determine the effectiveness of intradialytic exercise on dialysis efficacy, physiological parameters, biochemical markers, and quality of life among patients on HD. Experimental research design was adopted to conduct the study with 20 patients in our HD unit who met the inclusion criteria and patients were randomly allocated into experimental group and control group. The experimental group received intradialytic exercise during the first 2 h of HD besides receiving routine care compared to the control group. Data were tabulated and analyzed using the SPSS package. The finding of the present pilot study reveals that the prescribed intradialytic exercise intervention resulted in significant improvement in Kt/V, serum creatinine, blood urea, serum potassium, phosphorous, and quality of life. Based on the findings of the present study, it can be concluded that intradialytic exercise program is a safe complementary intervention and does not need an extra time of the patient and showed improvement in patients' outcome.

Both chronic kidney disease (CKD) and hypothyroidism are associated with decreased serum irisin level. The presence of hypothyroidism may influence serum irisin level in CKD patients. The objective of this study was to evaluate the effect of hypothyroidism on serum irisin level in patients with nondiabetic CKD. Two hundred nondiabetic CKD patients aged between 18 and 65 years with glomerular filtration rate <60 mL/min/1.73 m² were included in this study. Forty-three (21.5%) patients had hypothyroidism (overt and subclinical both). Forty hypothyroid and forty euthyroid CKD patients matched for age and Body Mass Index underwent body composition, biochemical [fasting plasma glucose (FPG) and C-reactive protein], and hormonal (fasting irisin and insulin) evaluation. Body composition analysis including visceral adipose tissue was done by dual-energy X-ray absorptiometry. Homeostatic model assessment 2 insulin resistance was calculated from FPG and insulin levels. The median serum irisin levels were not significantly different between hypothyroid and euthyroid CKD patients [95 (47.74–261.52) vs. 66 (28.25–224.50) ng/mL, P = 0.30]. There was also no difference in renal function, body composition and other metabolic parameters between the two groups. To conclude, the presence of hypothyroidism does not alter serum irisin level in patients with nondiabetic CKD.

Prevalence of chronic kidney disease (CKD) in Nigeria is on the increase and it is associated with increasing caregiving burden for both the professionals and informal caregivers. This study evaluated the burden experienced by nurses caring for CKD patients, identified the procedures causing the caregiving burden and factors associated with burden in two hospitals in Ondo State, Nigeria. Two hundred and forty nurses caring for renal patients were selected from two health institutions in Ondo State. Information on sociodemographic data was obtained using a self-administered questionnaire. The burden of care was evaluated using the Zarith Burden of Life Instrument (ZBI), with aggregate score ranged from 0–88. A score of 21–40 indicates mild-to-moderate burden while a score >40 indicates high burden. The mean age of the respondents was 33.7 ± 7.5 years (age range: 20–67 years). Forty percent experienced no burden, 48.3% experienced mild-to-moderate burden, 10.4% experienced severe burden while only 1.3% experienced very severe burden. Dialysis procedure (65.5%) was identified as posing the greatest caregiving burden. Factors identified as responsible for caregiving burden were shortage of staff (68%), followed by lack of funds on the part of the patients (67.1%). Caregiving burden was not associated with age, gender, or years of experience. Prevalence of caregiving burden was very high among the respondents and dialysis was identified as causing greatest burden. Government should fund and improve staffing of dialysis units to reduce caregiving burden.

End-stage renal disease (ESRD) is prevalent in our region. A major mode of treatment is by maintenance hemodialysis, and reliable vascular access is paramount for this to be successful. Arteriovenous fistula (AVF) creation offers permanent vascular access in patients with ESRD. We present our experience on AVF creation over a 10-year period. Our objective was to retrospectively review the outcome of all cases of AVF that have been created for ESRD patients at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife Nigeria between January 2006 and December 2015. The demographic characteristics, indications, clinical and intraoperative findings, operative complications and outcomes were filled into a pre-designed proforma. A total of 80 cases were reviewed. The age range was 17-80 years, with a mean of 49.03 ± 16.34 years. Males (85%) were more common than females (15%). Chronic glomerulonephritis and hypertension accounted for about 77.5% of etiology of ESRD in these patients. The left (non-dominant) upper limb was used in 88.1% of cases whereas 11.9% were created on the right upper limb. The distal radio-cephalic AVF (76.3%) was most commonly performed; with either the end (vein) to side (artery) (68.8%) or side-to-side (31.2%) anastomotic techniques employed. There was a primary failure in six patients (7.5%). Primary failure was more common in diabetics and thrombosis (7.5%) was the most common cause for primary failure. AVF creation has very good outcome in well-selected patients.

Renal allograft dysfunction (RAD) can have myriad causes and presentations. Allograft biopsy remains the gold standard for optimum management. This is a retrospective study carried out at a tertiary care institute from August 2011 to March 2016. Details of the renal allograft biopsy requisitions were recorded and analyzed. Two hundred and two patients had undergone kidney transplantation (KT) during the study period. One hundred and twenty-six had undergone renal biopsy for RAD. The acute asymptomatic rise of serum creatinine was the most common clinical presentation (47.61%) followed by chronic RAD (CRAD) (19.84%), proteinuria (15.87%), immediate graft dysfunction (10.31%), and persistent active urinary sediments (6.34%) in that order. The incidence of delayed graft function was 1.98%. The overall incidence of biopsy-proven rejection was 8.41% within oneyear and 8.91% beyond oneyear of transplant. Acute cellular rejection (ACR) [with or without antibody-mediated rejection (AMR)] was found in 65%; AMR was found in 40% and 15% had both ACR and AMR. Borderline acute cell-mediated rejection was found in 22.5% of biopsies. CRAD was due to chronic rejection and chronic calcineurin inhibitor toxicity in only about one-fourth of the cases. Incidence of glomerulo-nephritis was 10.89% and most of these occurred two years after KT. Renal allograft biopsy was associated with minor complications in 3.17% of cases. Clinical presentations do not reliably distinguish the various causes of RAD. Allograft biopsy is a mainstay in the diagnosis of RAD and is safe. Results of live donor first transplantation using complement-dependent cytotoxi-city crossmatch are comparable to those programs using newer methods like solid-phase assays. However, the direct comparison of these results with other studies may not be completely applicable.

Hepatitis C virus (HCV) infection one of the most common blood-borne infections is endemic in Cameroon and a serious problem in hemodialysis (HD). We aimed to determine the annual incidence and factors associated with seroconversion to hepatitis C positivity amongst patients on maintenance HD after an exposition of two years in a center with a high prevalence of hepatitis C (20.6%) and where no isolation policy is practiced. This was a retrospective cohort study carried out in January 2015 in the HD unit of Douala General Hospital in Cameroon including 71 patients on maintenance HD who tested negative for HCV in January 2013. Socio-demographic characteristics and clinical data were recorded, while for each patient 10 mL of blood was collected and patients retested for HCV using a fourth-generation ELISA test (BIOREX^R BXEO781A). Fisher's exact test was used for dichotomous variables and using Mann Whitney's test for quantitative variables. Statistical significance was set at P <0.05. Mean age was 47 ± 13 years with 60.6% male. Blood transfusion was the main means for anemia management (85.9%) with a median number of blood units received of 5 (1–44). Facility HCV prevalence was 19.3% in January 2015. Five out of the 71 patients developed anti-HCV antibodies giving us a seroconversion rate of 7.1% and an incidence of 3.6/100 patient years. There was no significant association between age (P = 0.4), number of blood units received (P = 0.8) origin of blood units (P = 0.8), scarifications (P = 0.09) and seroconversion. After two years of exposure seroconversion to HCV positivity was 7.1% in our center with no associated factors. In a setting with high prevalence of HCV, isolation of positive patient may help to reduce the rate of transmission.

Acute kidney injury (AKI) is a common disorder worldwide that is associated with severe morbidity, mortality and cost. If managed adequately and in a timely manner, the majority of these cases are preventable, treatable and often reversible with simple measures. We conducted a two years prospective study of patients admitted to medical and surgical units of a tertiary care center in Central India to identify the causes of Hospital Acquired AKI (HAAKI) and its impact on patient outcomes. HAAKI occurred in 215 of 9,800 patients (2.1%). Sepsis (75; 34.88%), volume depletion and hypo perfusion (62; 28.83%), drugs (50; 23.25%), multifactorial (18; 8.37%) and radiocontrast agents (9; 4.2%) were the causes of HAAKI. Thirty-nine percent of patients had complete recovery and 9.3% had partial recovery of renal function. The overall inhospital mortality due to HAAKI was 41.86%. On multivariate analysis, oliguria, multi-organ failure, metabolic acidosis, anemia, and sepsis showed significant association with in-hospital mortality. The mortality and morbidity associated with HAAKI mandates the need for active measures to decrease its incidence. Knowledge of incidence and risk factors is crucial because it drives local and international efforts on detection and treatment. To the best of our knowledge, no epidemiological study has been conducted or published on HAAKI from the Central India.

We aimed to study the epidemiology and outcome of acute kidney injury (AKI). This is a prospective study of adults aged 18 years or above diagnosed with AKI over a period of 16 months at a tertiary care hospital. Three hundred and nine patients had AKI. The observed incidence of AKI was eight per 1000 admissions. About 92.2% had community-acquired AKI (CA-AKI), and in 7.8% it was hospital-acquired AKI (HA-AKI). Etiological factors for AKI were medical in 87.4% of the cases, surgical in 9.4%, and obstetric 3.2%. Sepsis was the most common (53.1%) etiology of AKI among the medical cases. Among sepsis, scrub typhus, urosepsis, and pneumonia were the most common causes of AKI. Hypovolemia (9.4%), biological toxins (8.4%), nephrotoxic drugs and chemicals (7.4%), cardiac causes (7.4%), and acute glomerulonephritis (1.9%) were other medical causes of AKI. Nearly 38.2% had multiorgan failure, 20.1% required vasopressors, 6.1 % required Intensive Care Unit support, and 23.3% required dialysis. Mortality was 8.7%. Anemia, use of vasopressor drugs, and need for intensive care support were independent predictive factors for mortality. AKI is common in hospitalized adults in India and leads to significant in-hospital mortality. AKI is largely a CA-AKI and the lesser percentage is due to HA-AKI. Many causes are potentially preventable. Early fluid resuscitation, effective anti-infective treatment, appropriate antidotes, and timely referral of established AKI patients to centers with dialysis facilities can improve AKI outcomes.

Atypical hemolytic-uremic syndrome (aHUS) can pose a diagnostic challenge due to the multisystem involvement and varied manifestations. Early diagnosis and initiation of Eculizumab have been reported to have favorable renal outcomes. We report a case of 11-month-old male infant who presented at the age of two months with anemia, acute kidney injury, hypertension, and nephromegaly. Renal biopsy confirmed the diagnosis of aHUS and Eculizumab was started. Thrombotic microangiopathy markers showed the resolution. Kidney sizes improved after nine months of Eculizumab therapy. The successful resolution of nephromegaly in an infant with aHUS has not been reported so far in literature. Renal sizes should be monitored in all children with aHUS.

Acute renal infarction usually occurs in patients with severe atherosclerosis or valvular heart disease. We here report a 42-year Saudi male who presented with severe abdominal pain nausea and vomiting associated with hematuria, after heavy smoking of marijuana. Computed tomography abdomen revealed bilateral renal infarction. Serum anti phospholipids antibody and anti-cardio lipid antibody were positive. To the best of our knowledge, the association between marijuana and secondary lupus anticoagulant-induced renal infarction has not been reported previously.

Urinary tract infection is the most common bacterial infection occurring in renal transplant recipients and is associated with significant morbidity. The etiology and site of origin of hematuria in the transplant recipient is similar to that of the general population. Aeromonas species have been found to cause infection in immunocompromised hosts including patients of chronic kidney disease. To the best of our knowledge, there has not been any case report regarding the infection of Aeromonas in kidney transplant recipients.

We report a case of a young Saudi male who presented with generalized body weakness and easy fatigability associated with fever, night sweating, loss of weight and appetite, and renal impairment. He was diagnosed as a case of sarcoidosis, and renal biopsy report was consistent with necrotizing crescentic glomerulonephritis (GN). Immunosuppressive medication was started to help halting the progression to renal failure and stabilize renal function. To the best of our knowledge, the association between sarcoidosis and crescentic GN has been reported in only few cases in literature.

Encapsulating peritoneal sclerosis (EPS) is the most serious complication of long-term peritoneal dialysis (PD). EPS is diagnosed by clinical symptoms (abdominal pain, nausea, vomiting, diarrhea, and anorexia.) and image study (intestinal expansion, peritoneal thickening and calcification, and ascites.). Steroid therapy and surgery are recommended as the treatment of EPS. Here, we report a case of EPS with steroid-resistant massive ascites successfully treated with peritoneal lavage. A 59-year-old female with end-stage kidney disease secondary to hypertension was started on PD in 2003. Due to recurrent exit-site infection and two episodes of peritonitis, she was transferred to hemodialysis (HD), and her PD catheter was removed in 2011. In February 2012, six months after discontinuation of PD, she was found to have massive ascites on abdominal computerized tomography (CT). The patient was diagnosed to have EPS and was started on prednisolone. Despite eight months of prednisolone therapy, the ascites did not decrease. Therefore, the PD catheter was inserted again, and she was started on daily peritoneal lavage from September 2012. After four months of daily peritoneal lavage, her ascites disappeared in January 2013. The PD catheter was removed in July 2013. Steroid treatment was completed in May 2014, and there has been no recurrence of ascites since then. The evaluation of ascites by abdominal CT is important in a patient on long-term PD. Since EPS may appear any time after the discontinuation of PD, it is important to start screening abdominal CT shortly after the discontinuation of PD. Steroid-resistant massive ascites can be successfully treated with peritoneal lavage.

We report a case of systemic lupus erythematosus (SLE) who presented with rapidly progressive renal failure (RPRF) with positive antinuclear antibody (ANA) and anti-double-stranded DNA (dsDNA) antibody and active urinary sediment in the form of microscopic hematuria and proteinuria. Provisional clinical diagnosis of lupus nephritis was made. Renal biopsy showed pauci-immune crescentic glomerulonephritis, the diagnosis of which was supported by positive serum anti-MPO antibody. Renal biopsy in SLE patients can sometimes reveal varied pathological entities such as antinuclear cytoplasmic antibodies (ANCAs) positive vasculitis, as in our case, which modified our treatment protocol. Thus, in a patient with SLE presenting with RPRF with active urinary sediments, ANCA serology, and renal biopsy with immunofluorescence examination should be performed always.

We describe a patient who had developed hypercalcemic crisis, with altered mental status and renal failure, one year following aggressive corticosteroid-therapy for lupus nephritis. Her disease relapsed after successful live-related kidney transplantation 11 years ago. She had normal parathyroid hormone and 25-hydroxyvitamin D yet high 1,25 dihydroxyvitamin D. Four weeks later, she developed severe dyspnea and hypoxia with a reticulonodular pattern on chest computed tomography. Bacteriological and serological tests were negative for pathogens. However, bronchoalveolar lavage established the diagnosis of Pneumocystis jiroviceii pneumonia (PJP). Her pneumonia and hypercalcemia improved with Co-trimoxazole. The case indicates that severe hypercalcemia can herald PJP.

Alkaptonuria (ALK) is a rare genetic disorder, characterized by binding of ochronotic pigment to the connective tissues in different tissues. This is the first report of a child presented with primary distal renal tubular acidosis associated with ALK. Both disorders were managed by their specific medical treatments, with no further complication.

We report a rare case of two young male siblings with sickle cell anemia who presented with bilateral lower limb deformities, failure to thrive, polyuria, and polydipsia. On investigations, they were found to have normal anion gap metabolic acidosis, hypokalemia, and nephrocalcinosis were seen on ultrasonography of the kidneys. These reports were suggestive of distal renal tubular acidosis (dRTA). They were started on oral alkali replacement and potassium therapy with which clinical improvement was seen. Conventionally, renal tubular dysfunction is thought to occur infrequently in patients with sickle cell anemia. Hence, we report this rare association between sickle cell anemia and dRTA.