Chronic kidney disease (CKD) is a condition in which kidneys are damaged and can not function well, so this leads to the aggregation of excessive fluid and waste products in the blood. The acidity and alkalinity of urine are affected by our daily diet. Dietary proteins, especially amino acids containing sulfur (e.g., methionine and cysteine), are the major determinants of the dietary acid load because they can produce sulfate due to oxidation. Diet can affect the excreted acidity through the kidneys to maintain the acid-base balance. Diets with animal protein content contain more precursor acids than basic precursors compared to fruits and vegetables that produce more acid in the body than animal proteins and dramatically affect CKD and its progression. Acid-producing diets can cause high blood pressure through the kidneys, causing the production of the hormones angiotensin II, endothelin-1, and aldosterone. Metabolic acidosis can cause CKD and reduced bone tissue.

The major targets of coronavirus disease 2019 (COVID-19) are the respiratory and immune systems. However, a significant proportion of hospitalized patients had kidney dysfunction. The histopathological surveys have principally focused on respiratory, hematopoietic, and immune systems, whereas histopathologic data of kidney injury are lacking. Our study aimed to summarize the renal histopathological findings in COVID-19 from the published case report and case series. We conducted a systematic searching of databases such as MEDLINE, EMBASE, and Cochrane Library for published reports of COVID-19 patients with renal histopathological changes from autopsy studies and from “for cause” indication biopsies. Included in our study are case reports and case series with extractable quantitative data on patient demographics such as age, sex, ethnicity, as well as data on renal function tests, their comorbidities, and biopsy to study the histopathological changes. Data were analyzed with Microsoft Excel. To evaluate the methodological quality, we chose the framework for appraisal, synthesis, and application of evidence suggested by Murad et al. Systematic searches of literature found 31 studies that fulfilled the eligibility criteria. These studies included a total of 139 cases, where individual case details including clinical and histopathological findings were available. The median age of the cases was 62 years with a male:female ratio of 2.5:1. Associated comorbidities were noted in 78.4% of cases. The majority of the cases had renal dysfunction with proteinuria which was documented in more than two-thirds of the cases. The histopathological findings observed the frequent tubular involvement manifested by acute tubular injury. Regarding glomerular pathology, collapsing glomerulopathy emerged as a distinct lesion in these patients and was noted among 46.8% of cases with glomerular lesions. A small subset of cases (4.3%) had thrombotic microangiopathy. Collapsing glomerulopathy emerged as a hallmark of glomerular changes among COVID-19 patients. Tubular damage is common and is linked to multiple factors including ischemia, sepsis among others. In the form of thrombotic microangiopathy seen in a subset of patients, vascular damage hints toward the hyper-coagulable state associated with the infection. The demonstration of viral particles in renal tissue remains debatable and requires further study.

Initial reports early on in the pandemic in 2020 indicate a high incidence of acute kidney injury (AKI) in coronavirus disease 2019 (COVID-19). There is a need to better understand risk factors for AKI in patients with COVID-19. It is also unclear if AKI in patients with COVID-19 differs from AKI due to other causes. More data are required to clarify if COVID-19 is an independent risk factor for AKI and how COVID-19-associated AKI may differ from AKI due to other causes. We, therefore, sought to review the published evidence about the reported relationship between COVID-19, AKI, and outcomes. We performed a systematic search via PubMed and EMBASE using key words “COVID-19” and “AKI” to identify relevant observational studies, case series, and cohort studies published between March 2020 and April 2021. We also manually examined the reference lists of included studies and reviewed the AKI reports published in general medicine journals such as BMJ, Lancet, NEJM, and JAMA. The prevalence of AKI in hospitalized patients with COVID-19 differed across various regions of the world. Initial reports from China where cases of COVID-19 began initially have shown a much lower prevalence compared to those from Europe and North America, especially in critically ill patients in the intensive care unit with acute respiratory distress syndrome. The various components of severe acute respiratory syndrome-associated AKI appear in large parts to be similar to sepsis-induced AKI. However, affinity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) specifically to the angiotensin-converting enzyme 2 receptors located on podocytes and endothelial cells of the kidney also points toward the direct cytotoxic effects of the virus on the kidney. Numerous mechanisms likely occur simultaneously and hence more treatment approaches need to be streamlined based on pathophysiology. Although data from published literature regarding previous SARS coronaviruses can give some useful insights, we will know more going forward about the nature of kidney injury associated with COVID-19 virus as well as optimum-specific therapeutic management.

Organ transplantation is a common procedure in many countries, but it can still be hampered by a lack of donors. Many reasons exist for people’s hesitation to sign the donor card and this study explores the factors affecting posthumous organ donations motivation. The objectives of the study were to examine the role of knowledge, empathy, and attitude toward willingness to donate in posthumous organ donation decisions. We also examined whether education moderated the relationship between knowledge and attitude to donate. For this purpose, a survey was conducted among university students in public and private universities from Lahore, Pakistan. Structural Equation Modelling using the SmartPLS (3.0) was used to test the hypotheses proposed for this study. Empathy toward posthumous organ donation and the knowledge were positively related to the respondent’s attitude and attitude was positively related to willingness to donate organs posthumously. The results showed that education level did not moderate the relationship between attitude and knowledge. Future research may incorporate other factors such as religious affairs and cultural values for developing a socially appropriate model.

Itching along with other problems can be one of the factors exacerbating the sufferings and disturbing the comfort of patients with chronic renal failure. The present research aimed to study the effects of omega-3 on the treatment of uremic pruritus in hemodialysis (HD) patients. In this crossover randomized clinical trial study, 52 HD patients with pruritus were evaluated. After the random assignment of the participants to Group 1 (treatment mode A) (omega-3 plus cetirizine) and Group 2 (treatment mode B) (cetirizine), they received the treatments for six weeks and then after one week washout period, treatments were changed between the two groups. The pruritus severity was measured using the Yosipovitch pruritus questionnaire before the intervention and at the end of each treatment period. The obtained data were analyzed using descriptive statistics, analysis of variance with repeated measures, and Pearson correlation coefficient. The results of this study showed that pruritus severity reduced in both groups, but it was more significant in Group 1 (omega-3 plus cetirizine). The study findings indicated that omega-3 is effective in the reduction of uremic pruritus. Therefore, this supplement can be used as a convenient method for reducing pruritus in HD patients.

End-stage renal disease (ESRD) introduces physical, psychological, social, emotional, and spiritual challenges into patients’ lives. Spirituality has been found to contribute to improved health outcomes, mainly in the areas of quality of life (QoL) and well-being in especially in terminal, life-threatening, and chronic diseases. The current study was planned to assess the effect of Spiritual therapy in patient undergoing hemodialysis (HD). Post approval from Ethics Committee, the study was commenced at Dialysis Center, Bhaktivedanta Hospital and Research Institute and conducted for 12 weeks. Participants were divided into two groups (one with spiritual intervention and other being control). Spiritual chanting and listening to it was the intervention. The outcome was assessed by kidney diseases QoL (KDQoL), spiritual well-being [Functional assessment of chronic illness therapy (FACIT) Sp 12] score, certain components of ESRD targeted area, 36 item health survey, and laboratory and nutritional parameters. Statistical analysis was done using IBM SPSS Statistics version 20.0 at 5% significance. A total of 100 participants were included in study; males were outnumbered. KDQoL, ESRD targeted areas, components of 36-item health survey, and FACIT Sp 12 scores were significantly different on better side in interventional group at six weeks and 12 weeks. There was no significant difference in laboratory and nutritional parameters. The findings from this study contribute knowledge to increase our understanding of the influence of spirituality on the health outcomes and general well-being of patients with ESRD currently receiving HD treatment. The current study adds to the evidence in support of the use of spiritual therapy in chronic kidney disease patients on HD.

Higher body mass index (BMI) is associated with various comorbidities. In hemodialysis (HD) patients, BMI affects dialysis adequacy and blood pressure (BP) control and is associated with serious comorbidities. This is a cross-sectional observational study that took place at King Abdulaziz Medical City, Riyadh, Saudi Arabia. A total of 262 adult patients on HD for at least six months were recruited to this study. Chart review was used to retrospectively collect patients’ data. Categorical variables were compared using Chi-square test of proportions, whereas analysis of variance was used between categorical and continuous variables. P <0.05 was considered statistically significant. Only 17 (6.5%) patients were underweight, 90 (34.4%) had normal weight, 65 (24.8%) were overweight, and 90 (34.4%) were obese. Diabetes mellitus was the most common cause of chronic kidney disease. A significant relationship was found between BMI and dialysis adequacy (P = 0.004) with 54 (60%) obese patients having inadequate dialysis. The mean postdialysis systolic BP was the lowest in the obese BMI category (129.71 ± 18.38 mmHg, P = 0.037). The obese category scored least on the Charlson Comorbidity Index (CCI) reflecting lower risk of mortality than the other three BMI categories. Despite having the lowest overall rate of hospitalization in the previous 12 months, obese patients had higher rates of hospitalization from sepsis compared to the other three groups (P = 0.048). Despite having reduced dialysis adequacy, obese HD patients scored less on CCI, had better postdialysis BP, and had fewer hospital admissions in the previous 12 months compared to the other BMI groups. These findings distinctly contrast with what is seen among obese persons in the general population.

Peritoneal dialysis (PD) is used in children with end-stage renal disease (ESRD) for renal replacement therapy. However, it can be associated with the risk of post-surgical complications. The objectives of this study were to report our experience with the placement of PD catheters for 14 years and to assess the incidence of PD malfunction and other PD-related complications, including the effect of adopting minimally invasive techniques for catheter placement. The objectives of this study were to report our experience with placement of PD catheters for 14-year period and to assess the incidence of PD-related complications and the effect of adopting minimally invasive techniques for catheter placement. It is a retrospective cohort study at the department of pediatric surgery and pediatric nephrology, dialysis, and transplant in Jeddah, Saudi Arabia. We reviewed the records of all children who had PD catheter placements between 2005 and 2019. The data included demographics, the surgical technique, the performance of omentectomy, duration of PD catheter, and complication rates. Sixty-five patients had PD catheter insertion during the study period; 16 (24.6%) of them were placed in other institutions then referred to us. Thirty-five patients had no complications. Omentectomy during the first procedure was performed in 53 patients (81.54%). Early dialysate leaking occurred in six patients (9.3%); none were treated with surgical revisions. Four leaks resolved spontaneously, and hemodialysis (HD) was needed in two patients. The median PD catheter duration was 29 months (25^th–75^th percentiles: 21–41). Sixteen patients required revision (24.62%), and mortality occurred in five patients (7.69%). PD is a safe option in children with ESRD. Open placement with omentectomy in a specialized center could reduce leakage,help to start dialysis early, and decrease the conversion to HD.

Resistant Gram-negative bacteria (GNB) constitute a severe threat to public health by becoming increasingly prevalent worldwide; they are challenging to treat and highly adaptive pathogens that develop resistance to antibiotics through several mechanisms with high morbidity and mortality rates. This study aimed to determine the incidence and outcome of children with GNB infections at a tertiary hospital in Jeddah, Saudi Arabia. A retrospective cohort study was done in 2019 on a total of 278 patients aged from one month to 16 years. Data were collected from patient medical records by using a data collection sheet without exclusion criteria. Among patients with GNB, more than half were males with 57.9% (161), while 42.1% (117) were females. However, the most GNB isolated were Staphylococcus in 31.7% (88) of the patient then Klebsiella in 18% (50). Organisms isolated from urine were 46.1% (117), which was the primary site of isolation, where blood was 26.6% (74). About 20.1% (56) were primarily diagnosed with sepsis. The length of stay was around one month or less, with more than half of patients 56.5% (157). The mortality rate was 9.4% (26/278). A patient between one and 5 years of age was the most age affected by multidrug-resistant (MDR) (11/16). No statistically significant differences were observed between the MDR and non-MDR patients with GNB infections concerning age, length of stay, and mortality rate. Conversely, there were statistically significant differences in primary diagnosis, isolated organisms, and site of isolation with MDR and non-MDR. Staphylococcus and Klebsiella were the most abundant GNB, and the mortality rate was 9.4%. However, additional studies in other settings with a larger sample size are needed to compare between different healthcare facilities.

Childhood nephrotic syndrome (NS) management is greatly variable among pediatric nephrologists worldwide. We aimed to evaluate if this variability exists among pediatric nephrologists in the gulf countries and whether certain training programs influence this variability. A web-based multiple-choice survey of 35 NS management questions distributed to certified pediatric nephrologists working in the Gulf countries. Amongst 92 invitees, the response rate was 67%. The majority (73%) were older than 50 years and male (58%). Sixty percent trained in North America and 41% had >10 years of experience. Sixty-three percent use a 12- week corticosteroids regimen for the initial treatment of childhood NS and only 10% never consider long-term small alternate dose corticosteroids therapy to sustain remission before commencing a corticosteroids-sparing agent for frequently relapsing or corticosteroids-dependent NS. Mycophenolate mofetil was the drug of choice for frequently relapsing and corticosteroids dependent NS in 51% and 58% of the participants, respectively, whereas calcineurin inhibitors were preferred by the vast majority (95%) of the participants for corticosteroids-resistant childhood NS. Regarding rituximab treatment, almost half of the participants (48%) give two doses of rituximab one to two weeks apart and 61% do not give another course of rituximab until the child relapse. Fellowship training site and the duration of the clinical experience did not seem to influence certain management of childhood NS. As shown in North American studies, great variability in the management of childhood NS does exist in the Gulf countries. The country of fellowship training and the experience did not seem to contribute to this variability.

Idiopathic nephrotic syndrome (NS) is one of the most common primary glomerular diseases in children. In this study, we investigate the association of single-nucleotide polymorphisms of nephrin gene and glucocorticoid receptor gene (NR3C1) and susceptibility to develop NS and the response to steroid therapy in 100 Egyptian children with NS using polymerase chain reaction-restriction fragment length polymorphism. We also analyzed the correlation between the genotypes and clinicopathologic features of the patients. Thirty-four patients (34%) were initial steroid nonresponders, renal biopsy findings of those patients were available, of which 22 (64.7%) showed minimal change NS and 12 (35.3%) had focal segmental glomerulosclerosis. The distribution of the genotypes was comparable between the patient and control groups, allele frequencies showed no significant difference between the patient’s group and the control group. The genotypes showed no correlation with the age of onset of NS, initial steroid responsiveness, renal pathologic findings, estimated glomerular filtration rate (eGFR), and serum albumin. However, 24-h protein in urine showed a significant association with the NR3C1 gene. These data suggested that the nephrin gene and NR3C1 gene SNPs do not affect the development of NS, initial steroid responsiveness, renal pathological lesion, eGFR, and serum albumin. However, 24-h protein in urine showed a significant association with the NR3C1 gene in Egyptian children with NS.

Advanced chronic kidney disease with mineral and bone disorder have a significant obstacles to control serum bone profile [serum intact parathyroid hormone (iPTH), calcium and phosphorus] which subsequently have major effect on optimal bone strength, final adult height, and cardiovascular health. A retrospective, observational study, including a total of 36 children with end-stage kidney disease (ESKD). Fourteen children who were prescribed cinacalcet had been compared with the remaining 22 children who were managed with standard care. We report the efficacy and safety of cinacalcet for treatment of refractory secondary hyperparathyroidism (SHPT) in children with ESKD. After 6 months of cinacalcet treatment, the mean level of iPTH serum level decreased by 56% from 202 pmol/L [95% confidence interval (CI): 150-253] to 88 pmol/L (95% CI: 41-136), compared to the change observed in the control group (P <0.001). None of our patients reported serious adverse effects or developed hypocalcemia. Cinacalcet could be an effective and safe alternative to treat severe SHPT in children with ESKD. Further long-term and large-scale studies are necessary to confirm its safety and efficacy.

Obesity is accompanied by several disorders. This study investigated the role of chronic renal disease on the linking obesity/hypertension (HTN). It also considered the importance of visceral obesity on renal disease with or without HTN. One hundred and forty seven subjects on mean age 68.9 ± 14.2 years old with visceral obesity were enclosed and they matched for the age, gender, estimated glomerular filtration rate (eGFR), diabetes mellitus, and hypertriglyceridemia to 52 people without visceral obesity as a control group. Visceral obesity was defined by the measurement of waist circumference. Our participants were classified in both eGFR and albuminuria categories according to the Kidney Disease Improving Global Outcomes 2012 criteria. The HTN ratio was equal to 89.1% in the patients’ group. Ratios of 72.1% and 70.1% of our patients and 67.3% and 23.1% of our control group had a low eGFR and albuminuria respectively. The relationship between central obesity and HTN was found to be nonsignificant, but in our subjects without an advanced renal disease (eGFR >60 mL/min/1.73 m², n= 58) it was found to be significant (χ² = 5.4, P = 0.02, likelihood ratio = 5.1). Albuminuria was significantly associated with both visceral obesity and visceral obesity with HTN (χ² =34.7, P =, respectively) and it was supported by a built adjusted model. Chronic renal disease may influence the linki001 and χ² = 37.7, P = 0.001ng obesity/HTN in elderly participants with obesity in contrast to the general population with obesity but without renal disease. Visceral obesity was significantly associated with albuminuria independently on HTN.

Emphysematous pyelonephritis (EPN) is a rare but life-threatening acute suppurative infection of the kidney among diabetics. There is no current consensus on the management of EPN. A prospective observational study was conducted at the Department of General Surgery, RML Institute of Medical Sciences, Lucknow, as well as at Eras Lucknow Medical College, Lucknow, from 2015 to 2018 to look for clinical, microbial profile and treatment outcome of diabetic patients with EPN. A total of 76 diabetic patients diagnosed with pyelonephritis were identified, of which 15 patients were diagnosed with EPN (26.3%). The mean age of the patients was 58.4 ± 6.5 years. The mean duration of diabetes was 5.3 ± 3.3 years. 12 (82%) of the 15 patients with diabetes mellitus had a glycosylated hemoglobin level higher than 7.5. Renal dysfunction at presentation was seen in 11 (73.3%) patients. Among the unilateral involvement, the left kidney was more affected. Escherichia coli in 11 (73.3%), Klebsiella sp. in one (6.6%), Pseudomonas in one (6.6%), and one each with polymicrobial and fungal urinary tract infection, respectively. Of 15 EPN patients, 13 (86.6 %) survived, and one (6.6 %) expired. Two of them underwent nephrectomy both survived. All patients with Stage I, II, and IIIa EPN (n = 12) were managed with antibiotics with or without percutaneous catheter drainage (PCD). In EPN Stage IIIb/IV (n = 3), all the three (20%) patients were managed with antibiotics and PCD, and later two (13.3%) needed nephrectomy. Only time to diagnosis, altered sensorium, shock at presentation, and thrombocytopenia were associated with poor outcome in EPN patients (P <0.05) Multiple logistic regression tests showed shock (P = 0.04) and disturbance of consciousness (P = 0.05) on (hospital admission as being the independent factors for poor outcome. EPN in diabetics needs a high index of suspicion, timely diagnosis, and good multidisciplinary approach with adequate antibiotics and surgical management for better patient outcomes.

The Kidney Disease: Improving Global Outcomes (KDIGO) advocates the use of dipstick proteinuria as a primary screening tool. However, the performance of dipstick urinary for proteinuria has been adjudged to be weak, unreliable with poor predictive value. This study aimed to determine and compare significant proteinuria (SP) using spot urinary protein-to-creatinine ratio (UPr/UCr) as a primary screening tools with dipstick proteinuria among the high-risk African children. This study was a cross-sectional study, involving 33 schools in Ogbomoso land, Southwestern Nigeria. A total of 1316 apparently healthy children were recruited through a multistage sampling technique from both rural and urban communities using a semi-structured questionnaire. Dipstick urinalysis was performed on early morning urine samples. Urinary protein was determined using a turbidimetric method, while Jaffe’s reaction was used to measure urinary creatinine concentration. Statistical analysis was performed using IBM SPSS Statistics version 23.0 for Windows. The prevalence of SP using spot UPr/UCr (≥0.2) and dipstick proteinuria (≥1+) was 18.0% and 0.8%, respectively (P <0.001). Of the 224 subjects with SP using UPr/UCr, the females (140; 20.1%) had higher proportion of SP compared to males (84; 15.4% - P = 0.032). Nephrotic range proteinuria was detected in 9/10 (90%) using UPr/UCr, while urinary dipstick method identified only 3/10 (30%). A biserial correlation coefficient (r = 0.092; P =0.001) and inter-rater agreement (Cohen’s Kappa = 0.01) were poor and McNemar’s test was P<0.0001. In the community, UPr/UCr ratio appeared to perform better than dipstick as a primary screening tool for renal disease and may be adopted in the early detection of SP as a marker of kidney disease against the current KDIGO guideline of dipstick proteinuria.

The aim of this study is to investigate the perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) levels in patients with different stages of chronic kidney disease (CKD). Sixty-one CKD stage 1–4 patients who applied to the nephrology outpatient clinic were recruited. A control group consisting of 26 age- and sex-matched healthy controls were also included in the study. Concentrations of PFOA and PFOS were determined by comparing their peak areas with their standard curves. All samples were analyzed three times. The average values of blank samples were subtracted from the detected PFOA and PFOS values. PFOA and PFOS levels were significantly higher in CKD group than the controls (11.4 ± 7.47, 0.45 ± 0.55; 0.13 ± 0. 17, 0.19 ± 0.4 ng/mL, respectively) (P = 0.001). Hemoglobin, serum albumin, and estimated glomerular filtration rate (eGFR) levels were significantly lower and potassium and uric acid levels were higher in the CKD group than the controls. PFOA and PFOS levels were significantly higher in all stages of CKD patients than healthy controls. However, there was no correlation between eGFR, and PFOS and PFOA. We have demonstrated significantly increased PFOA and PFOS concentrations in different stages of CKD patients. We could not find an association between eGFR, age, and serum PFOS and PFOA concentrations.

Metabolic syndrome (MS) is caused by environmental factors as well as genetic. Human studies of efficacy of chromium for glucose and lipid metabolism and insulin function is not still definitive. Furthermore, the effect of chromium supplementation on the expression of inflammatory genes in patients with MS has not been studied. We will assess effects of chromium picolinate supplementation on gene expression of tumor necrosis factor-α (TNF-α) and DNA damage in MS patients. In this triple-blind randomized placebo-controlled clinical trial, 48 MS patients will be randomly assigned into two groups to receive daily 400 μg chromium picolinate supplement or placebo for 12 weeks. The outcome measures include of change in fasting blood sugar, glycosylated hemoglobin A₁C, inflammatory biomarkers, lipid profile, blood pressure, gene expression of TNF-α, and 8-hydroxy-deoxyguanosine concentration as DNA damage biomarker, will be quantified at baseline and end of intervention. This protocol was approved by Institutional Research Ethics Committee School of Public Health Shahid Sadoughi University of Medical Sciences (Approval ID: IR.SSU.SPH.REC.1399.141).

Coronavirus disease-2019 (COVID-19) has become a public health concern and global threat with high morbidity and mortality among kidney transplant recipients. However, risk factors and manifestations in this group of patients remain poorly understood. We aimed to study the clinical characteristics, laboratory parameters, and disease course of kidney transplant recipients with COVID-19 pneumonia. We enrolled 35 kidney transplant patients with COVID-19 pneumonia from March 2020 to November 2020 and studied their clinical records, laboratory results, radiological characteristics, and outcome. Their mean age was 44.82 ± 11.69 years (range: 17-65). The most common symptom was fever (94.28%) followed by cough (54.28%), fatigue (48.57%), shortness of breath (34.28%), and diarrhea/nausea/vomiting (22.85%). Leukopenia was seen in two patients (20.8%), and three patients had leukocytosis, while 75% of the patients had a white cell count in the normal range. Lymphopenia (<1100 per mm³) was seen in 23 patients (79%). All patients had elevated levels of C-reactive protein (CRP) with a range of 6-239.9 mg/L. An increase in serum creatinine from the baseline was seen in 25 patients (71.42%) with a mean of 2.62 mg/dL. Computerized tomography scan of the chest of 30 patients (85.71%) showed typical findings of multifocal ground glass shadows in both lung fields. Injection remdesivir was given in 28 patients (80%), and tocilizumab was given to three patients. Mortality was seen in six patients (17.14%), higher in those with O₂ saturation <95% on admission (odds ratio: 6.29). Patients with kidney transplants display a high risk of mortality. The presence of multiple coexisting comorbidities, hypoxia at the time of admission, and high level of inflammatory markers (lactate dehydrogenase, CRP, D-dimer, and ferritin) is predictive of poorer outcomes.

The transplant recipient stays in an immunocompromised state for a definite period of time to reduce the risk of rejection and hence has more susceptibility to acquiring infections given the current coronavirus disease 2019 (COVID-19) pandemic. This study is aimed to document the clinical features of COVID-19 and biochemical markers in postrenal transplant population. This study was conducted at the renal transplant department of Dow University Hospital, Karachi, for a duration of one month and was designed as a retrospective observational study. It included all postrenal transplant patients who were assessed for COVID-19 through either nasopharyngeal or oropharyngeal swab for polymerase chain reaction. A total of 159 individuals were assessed and 28.30% were found COVID-19 positive. The mortality rate was 8.88% out of the 45 infected patients. The mean age of COVID-19-infected patients was 34.75 ± 11.50 years with 60% of males and 40% of females. The most frequent comorbidities were hypertension and diabetes mellitus. The current use of immunosuppressants either tacrolimus or cyclosporine was independently associated with acquiring COVID-19 (P <0.001) with an adjusted odds ratio [aOR] [95% confidence interval (CI)] of 1.703 (0.842-2.683) while diabetes was not associated with acquiring COVID-19 (P = 0.001) with an aOR (95% CI) of 0.513 (0.240-1.095). The frequent symptoms were fever, dry cough, sore throat, dyspnea, and arthralgia/myalgia. Diabetes mellitus was associated with early onset (P = 0.031), while the use of mycophenolate mofetil (P = 0.008) and corticosteroids (P = 0.002) was associated with delayed onset of bilateral pulmonary infiltrates. Our study brings the most recent data on postrenal transplant COVID-19 infection.

Complications of chronic kidney disease (CKD) can range from localized to systemic manifestations that can worsen patients’ outcomes. CKD results in irreversible deterioration in renal function, which ultimately progresses to end-stage renal failure and necessitates the need for renal transplantation. Our study aimed to identify patients’ complications postrenal transplant during hospitalization and assess the main factors affecting these patients’ outcomes and survival rates. This study is a single-centered, retrospective cohort chart review conducted from January 2016 to March 2019. The collected data parameters included patients’ characteristics (e.g., gender, age, body mass index), as well as surgical-related details and postoperative complications. Microsoft Excel and IBM SPSS Statistics version 22.0 were used for data entry and analysis. The descriptive statistics were presented as frequency and percentage for the categorical variables (e.g., gender and smoking status), while the mean ± standard deviation was used for numerical variables. A total of 80 posttransplant patients who fulfilled the inclusion criteria were recruited. Urogenital complications were the most commonly seen during the postoperative period, especially developing urinary tract infections by 16%. During our study, the rate of complications was considered minimal and not significant in assessing posttransplant patients.

Acute kidney injury (AKI) is very common in intensive care units (ICUs). Its complications are often fatal, life-threatening, and may lead to kidney impairment. This is a multicentric, prospective, and descriptive study, spread over a period of six months, from January 1, 2017 to June 30, 2017, including incident cases of AKI defined according to the AKI Network criteria seen in the ICUs of Ibn Rochd University Hospital of Casablanca. Their evolution was studied during the hospital stay at three, six, 12, and 24 months. A total of 102 patients were included, 52% of whom were female. The median age was 45.2 ±0 22.93 years (10 days-87 years). Clinically, 28.4% were oligo-anuric and 54.8% had a multivisceral failure, mainly neurological and respiratory. The median creatinine level was 37.6 mg/L ± 19.82 (8-230). AKI was mainly organic and functional in 43.1% and 40.2% of cases, respectively, and the main etiologies were dehydration, sepsis, and tumor obstruction. Dialysis was required in 25.5% of cases. When discharged from the hospital, mortality occurs in 35% of cases, total recovery of renal function was observed in 22%, progression to chronicity in 38%, and end-stage renal disease (ESRD) in 5% of cases. The progression to chronicity and ESRD increased in the 1^st and 2^nd year of followup after the first episode of AKI. The risk factors for progression to chronicity were as follows: age, hypertension, the presence of comorbidities, the presence of multivisceral failure and the severity of AKI. AKI is now considered a risk factor for chronic kidney disease and longterm mortality, hence the interest and importance of nephrological monitoring.

The World Health Organization estimates that 3% of the general population is infected with this virus. Hepatitis C remains the main viral infection in dialysis patients, and the severity of this infection is the risk of developing cirrhosis or hepatocarcinoma. We aim to determine the prevalence of hepatitis C in dialysis patients, to calculate the rate of hepatitis C virus (HCV) seroconversion, and to identify the risk factors for seroconversion. This is a nationwide multicenter observational study including all dialysis patients regardless of age and gender. Those with acute renal failure and vacationers were excluded from the study. We included 185 centers including 176 hemodialysis (HD) centers and nine peritoneal dialysis (PD) centers with a total number of patients at 11,238, a number of HCV-positive patients at 402, and a number of functional machines at 3139. The mean age of a patient was 55.6 years (range: 18-65), and sex ratio was 0.9. The prevalence of HCV-positive patients is 3.6%; it is higher in private centers with an average of 2.7 compared to 1.18 in public centers with a significant difference (P = 0.009). The prevalence of HCV-positive patients was significantly higher in HD centers compared to PD centers, in centers where the number of generators was >15 and when the number of patients per center is >70. One hundred and fifty-six patients seroconverted after dialysis, i.e., a prevalence of seroconversion at 1.3% with a mean delay of 6.052 ± 5.3 years. Our study shows a lower prevalence of HCV seroconversion than that reported in the literature; this requires a national survey to be carried out by homogenizing virological diagnostic kits and treating infected patients to eradicate this infection in dialysis patients.

Primary hypothyroidism is observed in adult patients with chronic kidney disease (CKD) though described scantily in the pediatric population. The primary objective of this study was to detect the prevalence of hypothyroidism in children (1-18 years) with CKD as assessed by thyroid profile. This cross-sectional study was conducted in the department of pediatrics of a tertiary care teaching hospital between January 2016 and January 2017. Clinical examination and biochemical investigations were performed for children with CKD aged 1 -18 years. Sixty-five children (51 boys, 43 CKD Stages 1-3) with a mean [standard deviation (SD)] age of 7.9 (3.2) years were enrolled. Overall, 17 (26.2%) had thyroid dysfunction; nine (13.8%) had subclinical hypothyroidism, three (4.6%) overt hypothyroidism, and five (7.7%) had isolated low T3 levels. The prevalence of hypothyroidism increased from 20.9% in CKD Stages 1-3 to 40.9% in Stages 4-5 of CKD; P = 0.09. The mean (SD) height SD scores were lower in those with hypothyroidism than with normal thyroid function [−1.02 (1.69) and −1.89 (1.12), P = 0.003, respectively], lowest at -2.79 (0.65) in overt hypothyroidism. A significant proportion of children with CKD manifest with hypothyroidism who have more profound growth failure. It may be prudent to screen CKD patients for thyroid dysfunction.

Clinical presentation, kidney biopsy findings, and clinical outcomes of immunoglobulin A nephropathy (IgAN) are highly variable. The objective of this study is to study the clinical presentation, histologic patterns, and outcomes of IgAN in the Pakistani population, as no significant data are available in international literature from this part of the world. A retrospective chart review was conducted of all patients with biopsy-proven IgAN between January 2007 and December 2017. Of a total of 977 renal biopsies, 50 patients had biopsy-proven IgAN (5.1%). The median age at the time of biopsy was 34 years (27-42); 92% of patients were between 18 and 40 years. Thirty-eight (76%) were male. Ninety-two percent of patients had significant proteinuria of >1 g/day, with 32% having nephrotic range proteinuria. The mean estimated glomerular filtration rate (eGFR) at presentation was 46.58 mL/min/1.73 m². Seventy-eight percent of patients were hypertensive at the time of presentation and most of them had uncontrolled hypertension (HTN). The most common lesion on light microscopy was focal necrotizing glomerulonephritis (26%), followed by mesangial expansion with segmental/global glomerulosclerosis (22%). Crescents were seen in 38% of cases. Of 50 patients, a follow-up of at least six months was available for 32 patients. Most of the patients who had an eGFR of <30 mL/min at presentation progressed to kidney failure at six-month follow-up period. IgAN usually presents in young male adults in the age range of 18-40 years, with most patients having severe clinical presentation characterized by nephrotic-range proteinuria, HTN, renal insufficiency, and severe histological stages.

Acute kidney injury (AKI) is associated with high mortality and morbidity risk. Factors predictive of mortality can guide in early identification of high-risk patients and escalation of therapy to improve outcomes. There is a paucity of data on AKI in Pakistan, and this study was done to determine in-hospital AKI mortality and the associated predictors of mortality. This was a prospective observational study conducted in the Acute Medical Unit and High Dependency Unit of Pak Emirates Military Hospital, Rawalpindi, from June to December 2018. Based on the Kidney Disease Improving Global Outcomes (KDIGO) AKI definition, 130 critically ill patients were included, while patients with chronic kidney disease were excluded. Data were collected on demographic profile-morbid conditions, etiology, laboratory values, and outcomes. The overall mortality was 45.4% (59/130) and varied with the stage of AKI, as it was 21.6%, 36.0%, and 61.8% in KDIGO stages 1, 2, and 3, respectively (P <0.05). There was a significant association (P <0.001) between sepsis, age >65 years, and mortality. Patients with inhospital mortality had higher median serum creatinine and mean potassium levels (P <0.01), with lower mean sodium levels and bicarbonate levels <10 mmol/L. However, on multivariate analysis using variables age >65 years, AKI stage 3, oliguria, bicarbonate <10 mmol/L, and sodium levels <130 mmol/L, only age [odds ratio (OR): 3.16, confidence interval (CI) 95%: 1.40−7.15), AKI stage 3 (OR: 3.12, CI 95%: 1.32−7.38], and low sodium levels <130 mmol/L (OR: 4.52, CI 95%: 1.40−14.61) were found to be independent predictors of mortality. Diabetes mellitus need for vasopressors, oliguria, hemodialysis requirement, and mean leukocyte counts had no significant association with mortality. AKI was associated with high in-hospital mortality in critically ill patients. Sepsis, hypertension, older age, Stage 3 AKI, higher mean creatinine, and potassium were predictive of increased mortality risk.

Pediatric renal biopsy is an uncommon event, and the spectrum of the disease is evaluated and managed mostly on the clinical grounds. Compared to adults, the indications for renal biopsy in pediatric population are very few. We reviewed the pediatric renal biopsies received at our tertiary center in Mumbai, India, over a period of six years to study the incidence of various medical renal diseases, their spectrum on histology and its correlation with electron microscopy (EM). A total of 65 pediatric renal biopsies in the age group of 0−12 years were evaluated over a period of six years. The mean age of our patients was 7.9 years, with a median of 8.8 years with a male-to-female ratio of 1.3:1. The overall most common indication for biopsy was nephrotic syndrome (NS) including steroid-resistant NS, followed by proteinuria and nephritic syndrome. Majority of the lesions included in the study were primary glomerular disease (71%) while secondary glomerular disease amounted to 18%. The spectrum of disease includes minimal-change disease (MCD) (27.7%), followed by membranoproliferative glomerulonephritis (MPGN) (15.38%), focal segmental glomerulosclerosis (FSGS) (9.23%), lupus nephritis (7.7%), hemolytic uremic syndrome (7.7%), MPGN (6.15%), advanced renal disease (6.15%), membranous glomerulonephritis (3.07%), and crescentic glomerulonephritis (3.07%). This study is an important contribution to the epidemiology of pediatric renal disease spectrum in the Indian population. We conclude that MCD is the most common pathology seen in pediatric age group, with NS as the most common indication for biopsy. There is a steady increase in the incidence of FSGS in the pediatric population with frequent relapses and an increase in the incidence of steroid resistance. However, with the use of immunofluorescence and EM, an accurate diagnosis is possible, so an early renal biopsy should be planned in nonresponding cases and at times even before starting the treatment for appropriate treatment.

Lupus nephritis (LN) is one of the most serious systemic lupus erythematosus complications since it is the major predictor of poor prognosis. We present the clinico-histomorphologic characteristics of LN at a center in Dhaka. The study group comprised diagnosed cases of LN on core-needle renal biopsy specimens received in the Department of Histopathology, Armed Forces Institute of Pathology, Dhaka, from January 2018 to June 2019. Histological evaluation and direct immunofluorescence (DIF) study was carried out on each specimen. Each case was classified according to the International Society for Nephrology/Renal Pathology Society (ISN/RPS) Classification 2003 of LN. A total of 104 (9.20%) LN cases were included of total 1130 nonneoplastic renal biopsy specimens. The mean age was 28.29 ± 12.24 years, with a male:female ratio of 1:4.47. According to the ISN/RPS 2003 classification, most of the LN belong to class IV (42, 40.38%), followed by class III (27, 25.96%), class II (22, 21.15%), and so on. The mean age of class IV LN was 25.95 ± 10.15 years, with M:F = 1:4.25. The mean urinary total protein (UTP) was 4.62 ± 4.47 g/24 h and the mean serum creatinine was 1.87 ± 1.12 mg/dL. On histopathology, 22 (52.38%) had crescent formation, 27 (64.28%) had wire loop formation with subendothelial thrombi, and 30 (71.42%) had necrotizing lesion. Interstitial fibrosis and tubular atrophy (IFTA) was ≥25% in eight (19.04%) class IV LN. Among the subclasses, most common was IV-G (A/C) − 16 (38.09%), followed by IV-S (A/C) − nine (21.42%) and IV-S (A) and IV-G (A) each eight (19.04%). In four (9.52%) cases, class IV + V lesion was found. The mean age of class III LN was 26 ± 11.02 years, with a male:female of 1:26. The mean UTP was 3.45 ± 2.4 and serum creatinine was 1.71 ± 1.51. Among these, crescent was found in eight (29.63%) cases, wire loop and subendothelial thrombi in 11 (37.04%) cases, and necrotizing lesions in eight (29.63%) cases. IFTA was >25% in 14.81% of cases of class III LN. Among 27 class III LN, 17 (62.96%) were classified as III (A) and 10 (37.04%) as III (A/C). Two class III LN had an association with class V and two have presented with TMA. The mean age of class II LN was 29.95+ 12.26 years, with M:F = 1:2.66. UTP was 3.53 ± 2.43 g/24 h and serum creatinine was 1.52 ± 1.5 mg/dL for class II LN. Histologically, these cases had focal/diffuse mesangial proliferation with 25% IFTA in 9.09% of cases. One of the class II LN had associated amyloidosis. Among class V LN, the mean age was 45.12 + 13.64 years, with M:F = 1:3. The mean UTP was 4.06 ± 1.71 g/24 h and serum creatinine was 1.64 ± 0.94 mg/dL. Histologically, 37.5% had >25% IFTA. The mean age of class I lesion was 27.25 ± 17.42 years with equal number of males and females. The mean serum creatinine level was 0.65 ± 0.18 mg/dL and UTP was 2.71 ± 2.3 g/24 h for class I lesion. Only one class VI LN case was found which had IFTA 40% and presented with generalized edema. On DIF, among 100 cases, 86 were found with full-house immune deposits of different intensity; IgM was lacking in 10 cases and IgA was lacking in seven cases, while three cases lacked C3 deposits. The mean activity index was 7.10 and the mean chronicity index was 3.23 among 69 cases of proliferative LN. Among different histological classes of LN, the prevalence of class IV was more in this study which had the most severe form of clinical presentation, biochemical parameters (raised serum creatinine level), and histological findings (crescent formation and IFTA).

The kidney is the most vulnerable organ in coronavirus disease-2019 (COVID-19) patients besides the lungs, with evidence of acute kidney injury (AKI). We aimed to find the prevalence of AKI among COVID-19 patients and further evaluate the association of between COVID-19 and AKI along with an understanding of mortality. A prospective observational study was conducted among COVID-19 patients admitted to a tertiary care hospital, Hayatabad Medical Complex, between March 2020 and June 2020. Chi-square test was applied for comparative analysis, whereas for predictors of mortality, odds ratios (OR) were calculated using logistic regression. A total of 606 patients with COVID-19 were admitted to the dedicated ward, of which 250 (41.3%) had AKI and 190 (31.4%) died, whereas, patients having AKI presented 62.1% of mortality. Our study revealed a statistically significant association between AKI and mortality (OR = 3.5; P <0.0001). Moreover, we observed a greater risk of deaths among patients with AKI stage I-III i.e., AKI stage I (OR = 2.4; P <0.0001), stage II (OR = 5.5; P = 0.0001), and stage III (OR = 6.6; P<0.0001). Our study reported AKI and associated mortality in a considerable number of patients with COVID-19. AKI patients have significantly higher chances of death versus non-AKI patients. Further, the risk of mortality increases with further deterioration in kidney function, i.e., patients with AKI stage III showed a higher mortality rate compared with stage II and stage I.

Platelet dysfunction is common in individuals with advanced chronic kidney disease, and hemodialysis (HD) may cause further activation of platelets, increasing the risk of bleeding and thrombosis. Thrombocytopenia is a potential complication of HD therapy that offen is multifactorial. Both underlying patient-related or specific HD factors may be responsible. We present a case where the patient developed new-onset thrombocytopenia while undergoing training for home HD using NxStage System One. We present a systematic approach in the evaluation and management of this patient that led us to continue with the completion of home HD training and later discharging him on home therapy.

C3 glomerulonephritis (C3GN) is a recently described form of GN that mainly occurs in children and young adults. It results from dysregulation of the alternative complement pathway. Studies have shown that dense deposit disease has a high recurrence rate; however, since C3GN is a recently described disorder, its recurrence rate is still variable. A 28-year-old male with end-stage renal disease caused by C3GN underwent renal transplantation. After 19 months, the patient experienced recurrent C3GN (rC3GN) that involved a variant of unknown significance in the ADAMTS13 gene. Over a short span of time, the patient suffered from rapid deterioration of the graft function that required renal replacement therapy. This is the first case of rC3GN that possibly involved genetic alteration, a variant within the ADAMTS 13 gene.

Immunoglobulin A (IgA) nephropathy is usually restricted to the kidneys in most cases, but associations with other immune and inflammatory diseases exist. Scleritis, however, is an unusual association. We present an observational case series of two patients who initially presented with recurrent episodes of scleritis. A thorough evaluation for recurrent scleritis did not reveal any secondary cause per se. They were further evaluated extensively for incidental proteinuria and microscopic hematuria. Renal function was normal. Renal biopsy was performed which revealed IgA nephropathy in both the patients. They were given oral prednisolone and telmisartan for six months and followed for nine and six months, respectively, after steroids were discontinued. Proteinuria remitted, renal function remained normal, and there were no further episodes of scleritis in these patients.

The outcomes of renal transplantation have improved significantly with the use of calcineurin inhibitors (CNI). However, this improvement comes at the price of side effects. CNI-induced pain syndrome (CIPS) is a benign but disabling painful syndrome. It particularly affects the lower limbs. We present the case of a young male renal transplant recipient. He presented with worsening bilateral lower limb pain four months after transplantation. Induction therapy was basiliximab. Tacrolimus, steroids, and mycophenolate mofetil constituted maintenance immunosuppressive therapy. Pain affected the ankles and toes bilaterally. It started gradually but progressed over four weeks. The relentless pain affected his mobility to an extent that he became wheel chair dependent. Pain was unresponsive to paracetamol and codeine. No formal psychiatry assessment was done but patient-reported depression symptoms related to his reduced mobility. On examination, he had bony tenderness over the affected areas with the good range of passive movements. Neurological and vascular examinations of lower limbs were unremarkable. Inflammatory and infective causes of joint pain were excluded. Magnetic resonance imaging (MRI) feet showed the features of bone marrow edema. He was diagnosed with CIPS. Immunosuppression was changed from tacrolimus to cyclosporine. Pregabalin was also introduced after the diagnosis. Symptoms improved gradually over a month. He started to walk with a stick initially and then without any aid. Renal transplant function remained stable throughout this period. MRI feet scan, five months after the symptoms showed resolution of the bone marrow edema. CIPS is an uncommon, benign but disabling complication of CNI. Recognizing it early could limit the burden of symptoms (both physical and psychological) and loss of productivity. The management of CIPS is not evidence based and further research is required in this therapeutic area.

Tuberculosis (TB)-associated glomerulonephritis is difficult to diagnose that usually presents with hematuria, proteinuria, edema, hypertension, or renal insufficiency, which is similar to symptoms of primary glomerulonephritis. Membranous nephropathy (MN) is uncommonly seen in TB patients. We report a case of a 30-year-old female with Koch’s chest who developed anti-phospholipase A2 receptor antibody-positive MN after initiation of anti-Koch’s therapy and resolved after completion of anti-Koch’s therapy.

Guillain-Barre syndrome (GBS) is an acute polyradiculoneuropathy, caused by dysregulated immune response following an infectious or noninfectious event. Although cardiovascular, respiratory, and gastrointestinal systems are commonly involved secondary to neuromuscular paralysis, renal manifestations are rare. Acute kidney injury (AKI) can develop in GBS due to acute tubular necrosis secondary to dysautonomia. Minimal change nephrotic syndrome in GBS may be due to T-cell dysregulation and cytokine release attributed to molecular mimicry. Here, we report the case of GBS with simultaneously developed AKI and nephrotic syndrome during the course of disease, which recovered completely in parallel with neurological improvement without any immunosuppressive medications.

A 23-year-old girl with morbid obesity, diabetes mellitus, hypertension, obstructive sleep apnea, and immunoglobulin A nephropathy (IgAN) attended a bariatric clinic after multiple failed attempts at weight loss. In the past, she was diagnosed with IgAN with nephrotic syndrome and raised blood pressure at the age of 11 years. Apart from optimization of blood pressure with angiotensin receptor blocker, she required steroid to maintain her remission in initial four years which was later switched to mycophenolate mofetil (MMF). She was diagnosed with diabetes at the age of 13 years; her blood sugars remained poorly controlled despite therapy with oral hypoglycemic agents and insulin. She underwent sleeve gastrectomy with no post-operative complications. During the follow-up, she showed a steady reduction in her weight, along with maintaining normal blood sugars and pressure without medications. At 18 months of follow-up, IgAN remained in remission after stopping MMF at four months after the surgery. Obesity is considered an important cofactor in the progression of IgAN. This case highlights the importance of weight reduction to halt the progression of the disease.

Fibrillary glomerulonephritis (FGN) is a rare form of glomerulonephritis, and the incidence in native renal biopsies is less than 1%. The diagnosis of FGN is defined by the ultrastructural finding of organized, randomly oriented, nonbranching fibrils with a diameter of 10-30 nm. FGN is immune-mediated glomerulonephritis with predominant immunoglobulin (Ig) G deposits. Hypocomplementemia is very rare. We report the case of a 68-year-old Caucasian man with renal impairment, hematuria, subnephrotic proteinuria, hypocomplementemia (low C4, normal C3), and hypergammaglobulinemia. The kidney biopsy revealed a mesangial proliferative pattern with IgM deposits, and the electron microscopy demonstrated FGN. Upon further investigation, secondary causes, such as malignancy, monoclonal gammopathy, or autoimmune disease were excluded, and human immunodeficiency virus (HIV) infection was revealed. Only three cases with FGN associated with HIV infection without concurrent hepatitis C virus have been reported and all of them in already known medical records. Our patient received treatment with corticosteroids and highly active antiretroviral therapy, and the renal function improved.

Anaphylaxis is an acute, severe, and potentially lethal form of an allergic reaction. It can lead to a sepsis-like syndrome and multisystem involvement with complications. It can cause distributive shock with preferential blood supply to vital organs, at the expense of blood supply to skeletal muscle. Skeletal muscle ischemia leads to the fast depletion of myocyte energy source and a cascade of inflammatory reactions leading to myocyte injury and death. Myocyte lysis or rhabdomyolysis releases the cellular contents into circulation. Rhabdomyolysis is not an oft-discussed complication of anaphylaxis. We describe a 21-year-old male with no known comorbidity who presented with anaphylactic shock after consuming one tablet paracetamol + ibuprofen and was found to have rhabdomyolysis-related acute kidney injury.