Contrast-induced acute kidney injury is a common iatrogenic complication associated with increased health resource utilization and adverse outcomes, including short- and long-term mortality and accelerated progression of preexisting renal insufficiency. The incidence of contrast-induced nephropathy (CIN) has been reported to range from 0% to 24%. This wide range reported by the studies is due to differences in definition, background risk factors, type and dose of contrast medium used, and the frequency of other coexisting potential causes of acute renal failure. CIN is usually transient, with serum creatinine levels peaking at 2–3 days after administration of contrast medium and returning to baseline within 7–10 days after administration. Multiple studies have been conducted using variety of therapeutic interventions in an attempt to prevent CIN. Of these, careful selection of patients, using newer radiocontrast agents, maintenance of hydration status, and avoiding nephrotoxic agents pre- and post-procedure are the most effective interventions to protect against CIN. This review focuses on the basic concepts of CIN and summarizes our recent understanding of its pathophysiology. In addition, this article provides practical recommendations with respect to CIN prevention and management.

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Tranexamic acid (TXA) is an antifibrinolytic agent commonly used to achieve hemostasis. However, there have been a few case reports suggesting that high-dose intravenous TXA has epileptogenic property. In patients with renal impairment, even administering the usual recommended dose of TXA can induce seizure episodes. We present here a patient on hemodialysis who developed seizures after receiving two doses of TXA over 5 h period.

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The Page kidney is a rare phenomenon. External renal parenchymal compression is the culprit. We report two cases of young males with flank pain, renal mass, and hypertension with history of blunt abdominal trauma. Initially, hypertension was controlled by angiotensin-converting enzyme (ACE) inhibitors but gradually became refractory to medical treatment. Laparoscopic nephrectomy was performed in both patients. We emphasize the Page kidney as a cause of hypertension in young patients, presenting with flank pain and renal mass with or without complications of hypertension. Management is aimed to control blood pressure by ACE inhibitors, aspiration of the hematoma, open hematoma evacuation, or nephrectomy.

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Banff'13 update included C4d-antibody-mediated rejection (ABMR) as a separate entity responsible for graft dysfunction with limited clinical/prognostic implications. We present a retrospective study to determine the incidence and outcome of C4d-negative ABMR. A total of 987 renal allograft (RA) biopsies obtained from 987 RA recipients were studied from January 2013 to January 2016. All samples were subjected to light microscopy using standard stains and C4d immunohistochemistry on paraffin sections and reported according to modified Banff’s criteria. Adequate biopsies with immunological injuries were categorized as Group 1: pure ABMR, Group 2: combined ABMR with concurrent T-cell-mediated rejection (TCR), and Group 3: pure TCR. Groups 1 and 2 were further subgrouped as C4d positive (Group 1a and 2a) or C4d negative (Group 1b and 2b). Graft function was measured by serum creatinine (SCr) level (mg/dL). Of the 987 biopsies, 43.3% (404) biopsies revealed immunological injury. Of these, 27.7% of the biopsies revealed pure ABMR (Group 1), 60.6% revealed combined ABMR with TCR (Group 2), and 11.3% revealed pure TCR (Group 3). The overall incidence of ABMR (pure ABMR + ABMR with TCR) was 36.27%, of which C4d-negative rejections were 18.48% and 18.7% in Group 1 and Group 2, respectively. The mean SCr at the end of three years follow-up in patients with C4d-negative rejections was comparatively higher. C4d-negative ABMR, recently included in Banff’13, has a low incidence, usually presents early after transplantation but carries better outcome than C4d-positive ABMR. However, further long-term studies are still required for knowing the clinical course over years.

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Organ shortage is the greatest challenge facing the field of organ transplantation today. We aimed to study the attitude and knowledge toward body and organ donation among people in rural India. The present study was conducted in a rural town called Lanja, in the Konkan region of Maharashtra in India. A questionnaire covering demographic data, knowledge, and attitude of the participants was distributed to 400 students, middle-aged and senior citizens; 91.5% of the respondents were aware about organ donation. Television (55.2%) and newspaper (45.8%) were the most popular sources of information. About 56.2% and 32.8% believed that a healthy person and a cardiac dead person can be donors, respectively. Nearly 29.4% believed that a brain-dead person can be a donor and 22.4% clearly stated as to be having no idea regarding the health status of a donor. Highest awareness was observed regarding eye donation (92%). High awareness was also observed regarding heart, kidney, and liver donations, that is, 71.1%, 61.2%, and 54.2%, respectively. Awareness regarding donation of other tissues and organs was poor. Only 46.8% believed that the family of the deceased person can give consent for organ donation if the donor had not signed the donor card. Awareness regarding both body and organ donation in rural India is high. However, there is lack of understanding regarding the concept of brain-death. Awareness regarding body and other organ and tissue donations besides eye, kidney, etc., needs further awareness drives.

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The relationship between frailty and chronic kidney disease in elderly population has been recognized; however, studies concentrating on frailty in predialysis patients are limited. For nephrologists, the recognition of frailty is important as it has impact on decisions on the choice of dialysis modality and sometimes on whether dialysis is indeed in the patients’ best interests. Many of the tools for routine assessment of frailty are not easily applicable to those clinicians not practicing elderly care medicine. A tool needs to be simple and applicable for daily routine practice. The aim of this study was to assess the prevalence and clinical outcome of frailty in an elderly predialysis population using simple tools. A nonrandomized prospective study was conducted in which, 104 patients aged 65 years or above with an estimated glomerular filtration rate of 25 mL or less were included. Data including age, sex, renal function, calcium, albumin, parathormone, and comorbidities were collected at baseline and at three months interval for one year. Functional performance was assessed using Karnofsky scale. The Charlson comorbidity index was used to assess comorbid status of each patient. Frailty was assessed using a combination of PRISMA questionnaire and Timed up and Go test. End points were death or start of dialysis at 20-month follow-up. A frail group (n = 58; males = 32, females = 26) and a nonfrail group (n = 46; males = 21, females = 25) were identified. Frailty was prevalent in 53.8% of the selected population. There was no significant difference between both groups in terms of age, gender, comorbidities, hemoglobin, inflammatory markers, or calcium hemostasis. Nine patients chose conservative management in the frail group and six in nonfrail group. Rate of death was significantly higher in the frail group (death = 14) compared to nonfrail group (death = 3; P = 0.01). There was no significant difference between both groups in terms of initiation of dialysis (P = 0.1). Frailty and Charlson comorbidity index were significantly associated with mortality (P = 0.023 and 0.032, respectively). Survival in frail patients who started peritoneal dialysis (PD) was slightly better than those started on hemodialysis (HD) with hazard ratio = 3.23 (P = 0.23). Our study shows that the prevalence of frailty and mortality rate is high among elderly predialysis patients. Frailty and Charlson comorbidity index are independent predictors of outcome in this population. PD might be a better option of dialysis modality compared to HD in the frail population.

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Our objective is to study the outcomes and complications of peritoneal dialysis (PD) including comparison of self-care PD with home-care assisted PD during a five-year period. A retrospective study of PD data at King Saud University-affiliated hospital in Riyadh from January 1, 2009, to December 31, 2013. One hundred and eleven patients were included (female 55%). The average age was 47.4 (1–83) years. Twenty-one (18.91%) patients were on continuous ambulatory PD and 90 (81.08%) on automated PD. The mean time on PD was 23.5 (3–60) months. At the end of five years, 47 (42.34%) patients were continuing on PD, 12 (10.81%) had renal transplant, 33 (29.73%) patients were transferred to hemodialysis, and two (1.8%) patients were transferred to other centers. Seventeen patients died during this period giving a mortality rate of 7.13 deaths/100 patient-year during the five-year period. Six patients died due to cardiovascular causes, while five had sepsis. There was one death each due to prostate cancer, hyperoxaluria, and toxic epidermal necrolysis. Three patients died suddenly at home. Peritonitis rate was one episode/35.28 patient/month or one episode/2.94 patient/year. We compared the results for patients doing the dialysis themselves [56 (50.45%)] “self-care PD” to 55 (49.5%) patients assisted by a family member or other caregivers “assisted PD.” We found no significant difference in the incidence of complications, technical outcome, mortality, and peritonitis episodes. However, we found a high prevalence of diabetes mellitus and significant increase in exit site infection in assisted PD. Our study suggests that PD patients in Saudi Arabia have a good overall outcome. Furthermore, assisted PD showed good patient and technique outcome.

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Acute kidney injury (AKI) in the newborn is a common problem in the neonatal intensive care unit with many underlying factors such as asphyxia, respiratory distress syndrome (RDS), and urogenital anomalies. The aim of this study is to highlight possible risk factors and profile of neonates developing AKI in the Neonatal Intensive Care Unit (NICU) of Cairo University Pediatric Hospital. The study was carried out on 90 neonates (30 patients and 60 controls), among neonates admitted to NICU. The study was done over two months, from January 2015 to March 2015. Our study showed that sepsis was detected in 53.3%, prematurity in 46.67%, RDS in 43.3%, congenital heart disease in 20%, and hypoxic-ischemic encephalopathy in 6.67% of patients. Maternal illness and low body temperature were both significant risk factors of AKI in neonates. History of maternal illness, low body temperature, sepsis, prematurity, and respiratory distress can contribute to the development of AKI in neonates.

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Cisplatin is one of the important antineoplastic drugs. Its clinical use has been restricted due to severe kidney toxicity. Nigella sativa (N. sativa) is an herbaceous plant with many pharmacologic effects. In the present study, we evaluated the protective effects of aqueous-ethanolic extract of N. sativa and Vitamin E on cisplatin-induced nephrotoxicity in rats. Eighty male rats were divided into eight groups: control, cisplatin (6 mg/kg; ip), preventive Vitamin E (100 mg/kg), preventive N. sativa (100,200 mg/kg), preventive + treatment Vitamin E, and preventive + treatment N. sativa (100, 200 mg/kg). Duration of this study was 11 days and cisplatin was injected on the 6^th day of the experiment. Tissue damage in all groups that received N. sativa extract and Vitamin E showed a significant improvement compared with the cisplatin group. In addition, serum and tissue total thiol content in preventive and preventive + treatment N. sativa groups showed significant increase compared with cisplatin group. There was no significant difference in serum malondialdehyde concentration of the control rats compared with the preventive and preventive + treatment N. sativa groups. N. sativa extract and viamin E improved the pathology and oxidative stress in the rat kidney. However, more studies are needed to determine the mechanism of action of N. sativa on cisplatin-induced kidney toxicity.

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Dietary assessment is absolutely necessary to meet the dietary requirements of hemodialysis (HD) patients. A food record is the most commonly used method; however, it is not routinely performed. The weakness of this method is that it is burdensome for some respondents and requires more time to complete data entry. Meanwhile, the brief food frequency questionnaire (BFFQ) is a quicker and simpler method to assess individual dietary intake. We aimed to compare the BFFQ and food records as assessment methods of energy and protein intake for HD patient in Dr. Sardjito Hospital in Indonesia. This study was conducted on March to April 2015 in HD Unit of Dr. Sardjito Hospital, Indonesia, as an observational study. This was a cross-sectional study. Data were collected from 103 patients, who were selected using a purposive sampling method. All participants’ dietary intakes were assessed using a food record and the BFFQ to obtain total protein and energy intakes. Wilcoxon test was used for the statistical analysis. There was a significant difference (P <0.0001) between the methods used to assess energy intake in HD patients at Dr. Sardjito Hospital. However, there was no significant difference (P = 0.732) between the two methods used to assess protein intake among patients. This difference was caused by a missing list in the BFFQ about snacks that were usually consumed by patients as energy sources. The BFFQ can be used as a protein intake assessment tool in HD patients. However, the BFFQ is not suitable to assess energy intake in patients.

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The association between Alport’s syndrome (AS) and focal segmental glomerulosclerosis (FSGS) in the same patient is complex and rarely reported. We report a case of a 42-year-old male presenting with proteinuria, microscopic hematuria, elevated serum creatinine and hypertension with unremarkable physical examination apart from obesity. The renal biopsy showed well-established FSGS pattern of injury with mild interstitial fibrosis and tubular atrophy, while the electron microscopic examination demonstrated glomerular basement membranes (GBM) changes compatible with AS. AS can be complicated by segmental glomerular scarring, which can mimic primary FSGS, while familial FSGS can result from mutations in collagen IV network of the GBM. This overlap can complicate histopathological interpretation of renal biopsy, which should be accompanied by mutational analysis for accurate diagnosis and proper therapeutic intervention.

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Acute peritonitis (AP) is a common and devastating complication in end-stage renal disease patients on peritoneal dialysis (PD). We are reporting an epidemiologic study of AP in Qatar over 8-year follow-up. We retrospectively reviewed medical records of all PD patients in Qatar from 2007 to 2014. The analysis was conducted to report epidemiology, outcome, and associated risk factors of AP. We had 318 AP episodes in 180 patients between 2007 and 2014. Six (3.3%) patients died as a result AP. Six cases of fungal peritonitis were reported. AP rate has decreased from 1 episode/29.7 PD-months in 2007 to 1/43.7 PD-months in 2014. Ninety-nine (55%) patients had single AP while 81 (45%) patients had 2 episodes or more (multiple AP). Patients on automated PD carried a higher risk of developing multiple AP [odds ratio (OR) = 1.46, 95% confidence interval (CI): 1.01–1.71]. The first episode of AP caused by Gram-positive cocci carried a significant risk of multiple AP (OR = 4.3, 95 % CI: 2.2–8.2). Negative-culture AP carried a significant protective role from multiple AP (OR = 0.35, 95% CI: 0.19–0.66). Most deaths occurred with the first episode of AP (4 out of 6). In this 8-year follow-up, epidemiologic study from Qatar, fungal peritonitis and mortality rate were very low, AP rate improved overall, multiple AP was prevalent (45%), and its risk increases with Gram-positive cocci infections. Our results signify the importance of implementing more efficient care bundles to prevent multiple AP.

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This study was carried out to evaluate spontaneous renal regeneration after stopping colistin methanesulfonate (CMS), which induces tubular damage, and the curative effect of Vitamin E (vit E) in rats. Animals were given the following: sterile saline (n = 6), 300,000 IU/kg/ day of CMS (n = 24), or 450,000 IU/kg/day of CMS (n = 24) for seven days. Each CMS group was subdivided into four subgroups (n = 6) and sacrificed as follows: (i) 12 h after stopping CMS, (ii) two weeks after stopping CMS, (iii) two weeks after stopping treatment with vit E, and (iv) two weeks after stopping treatment with olive oil. Subsequently, plasma creatinine (pCr), urine N-acetyl-b-D-glucosaminidase (NAG), renal tissue level of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione reductase (GSH), and renal histology were tested. CMS-induced tubular damage increased the NAG and MDA levels and decreased the SOD and GSH activities. After two weeks of stopping CMS, there was no significant renal recovery. However, treatment with vit E improved tubular regeneration and reduced the biochemical impairments. Two weeks might not be long enough for significant spontaneous renal regeneration. Improvement of renal parameters by vit E could be explained by the reduction of oxidative stress damage.

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Anemia is common in patients on hemodialysis (HD). Adequate iron stores are essential for achieving the best hemoglobin level through maximum benefit from erythropoiesis-stimulating agents (ESA). Decreased iron stores or decreased availability of iron are the most common reasons for resistance to the effect of these agents. Our objective was to categorize a group of Iraqi HD patients according to absolute or functional iron deficiency anemia (IDA); this study was conducted in the HD unit of the Baghdad Teaching Hospital from October 2012 to January 2013. Seventy prevalent adult HD Iraqi patients were enrolled. All patients were tested for full blood counts and iron parameters. They were categorized as nonanemic and those with absolute or functional iron deficiency. The patients were also tested for serum albumin, C-reactive protein (CRP), parathyroid hormone, and serum hepcidin levels. Data were expressed as mean ± standard deviation, and frequencies (number) and proportions (%). The mean age of the study group was 49.8 ± 12.3 years. Diabetes was the primary cause of end-stage renal disease, seen in 30 patients (42.8%). Majority of the HD patients were anemic, [51 (82.9%)] and among them, 39 (76.4%), had functional IDA. The mean serum iron, serum ferritin, and transferrin saturation were significantly higher in patients with functional IDA than those with absolute IDA (P <0.05). The mean highly sensitive CRP, parathormone and hepcidin values were also significantly higher in functional IDA patients than in those with absolute IDA and the nonanemic group (P <0.05). More than half of the study patients had functional IDA, and this can explain ESA hyporesponsiveness. This is besides the interplay of other factors including inflammation, inadequate dialysis, and secondary hyperparathyroidism. It is essential to diagnose functional IDA early, before the initiation of unnecessary iron therapy.

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Conventional hemodialysis (HD) is the most common treatment modality used for renal replacement therapy. The concept of HD is based on the diffusion of solutes across a semipermeable membrane. Hemofiltration (HF) is based on convective transport of solutes; hemodiafiltration (HDF) is based on combined convective and diffusive therapies. Data about survival benefit of on-line HDF (OL-HDF) over high-flux HD (HF-HD) is conflicting. We conducted this study to investigate if there is a survival difference between the two treatment modalities. This study is a retrospective, single-center study in which 78 patients were screened; 18 were excluded and 60 patients were analyzed. The study patients were aged 47.5 ± 20.7 years, 33 patients (55%) were on HF-HD, and 27 patients (45%) were on OL-HDF. A total of 24 patients (40%) of both groups were diabetic and, the mean duration on dialysis was 43.5 ±21.3 months in the HF-HD group and 41.2 ± 22.0 months in the OL-HDF group. The mean substitution volume for OL-HDF was 22.3 ± 2.5 L. Survival was 73% [95%, confidence interval (CI) 60–84] in the HF-HD group and 65% (95%, CI 54–75) in the OL-HDF group by the end of the study period. The unadjusted hazard ratio (HR) with 95% CI comparing HF-HD to high-volume postdilution OL-HDF was 0.78 (0.10–5.6; P = 0.810). Kaplan–Meier analysis for patient survival over five years showed no significant difference between the two modalities. Prospective controlled trials with a larger number of patients will be needed to assess the long-term clinical outcome of postdilution OL-HDF over HF-HD.

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Vascular access complications are common in patients with end-stage kidney disease who are receiving maintenance hemodialysis (HD) and are responsible for an enormous burden of morbidity and mortality among these patients. Differences in the all-cause mortality rate and hospitalization between dialysis catheter use and arteriovenous (AV) vascular access use have not been documented in our HD population. We performed a 12-month prospective analysis of our HD patients from four dialysis centers. We examined all-cause mortality and hospitalization in patients being dialyzed through HD catheters as compared to patients with AV access. A total of 382 patients were included in the study. Of these, 88 had catheters and 294 had AV accesses. Seventy-eight percent of all catheters were temporary nontunneled dialysis catheters. The overall gross mortality rate for all patients was 14.7%. Gross mortality was significantly lower among AV access group compared to the catheter group (12.2% vs. 22.7%; P = 0.015). Catheter use was associated with a relative hazard ratio (HR) of 1.85 [95% confidence interval (CI), 1.13–3.03] compared with use of an AV access. Hospitalization rate was also significantly lower among patients with AV access versus patients who used catheters (27.6% vs. 46.6%; P = 0.006). The risk of hospitalization was also higher in catheter users with a relative HR of 1.69 (95% CI, 1.26–2.26) compared with use of AV access. In our HD population where the majority of catheters were temporary nontunneled catheters, dialysis catheter use was associated with higher mortality and increased hospitalization rates compared with AV access. These results emphasize the urgent need to minimize the use of dialysis catheters, in order to reduce mortality and hospitalization rates among HD patients.

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As the life expectancy is increasing, there is a rise in elderly population and consequent increase in the patients with renal disease. There is an inconsistency between clinical and histopathological diagnosis in elderly, and so renal biopsy is important in these patients to decide appropriate clinical management and prognosis. This study outlines the importance of renal biopsy in elderly and describes the clinical and pathologic spectrum of renal diseases in patient ≥60 years. All patients (age ≥60 years) undergoing renal biopsies from January 2011 to December 2014 were included in this retrospective study. The clinical presentation and biochemical findings were recorded, and the patients were grouped based on their clinical presentation. Renal biopsies were also evaluated. The mean age of patients was 67.7 ± 6.4 years with a male:female ratio of 3:1. The most common clinical manifestation was nephrotic syndrome (37.4%) followed by rapidly progressive renal failure (RPRF) (20.6%). Amyloidosis and membranous nephropathy were two most common diagnoses in patients with nephrotic presentation whereas pauci-immune crescentic glomerulonephritis and cast nephropathy were common in patients presenting with RPRF. Clinical diagnosis differed from the histopathological diagnosis in 32% cases of nephrotic syndrome. There was good agreement between clinical diagnosis and histology in cases with RPRF. In 73% cases of elderly with (Type II) diabetes suspected of having nondiabetic renal disease clinically, renal biopsy showed evidence of diabetic nephropathy. Renal biopsy is essential in the diagnosis of renal diseases even in elderly. Amyloidosis and membranous nephropathy are common causes of nephrotic syndrome in elderly. Renal biopsy is very useful in diagnosing cast nephropathy and amyloidosis as they are not suspected clinically. It is also helpful in elderly diabetics without retinopathy to differentiate between diabetic and nondiabetic kidney diseases.

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Chronic kidney disease (CKD) has become a public health problem because of its increasing prevalence. The objective of this study was to describe the current profile of CKD in our working conditions. This is a descriptive retrospective study of patients admitted for CKD during the period from January 2010 to December 2014 in the Internal Medicine Department of the university hospital of Treichville in Abidjan. CKD was defined by a glomerular filtration rate below 60 mL/min lasting for at least three months. We collected 252 cases of CKD out of 3573 patients recorded during the study period, yielding a prevalence of 7%. The mean age was 39.6 ± 14 years (15–83 years). We observed a male predominance (sex ratio 1.2:1). Of the CKD patients studied, 67.1% were hypertensive, 7.9% were diabetic, and 8.7% were positive for human immunodeficiency (HIV) virus. The CKD was Stage 3 in 2.4%, Stage 4 in 3.2%, and Stage 5 in 94.4% of the patients. The etiology of CKD was hypertension in 59.9% of cases, followed by chronic glomerulonephritis (25%), HIV infection (9.1%), and diabetes (4.8%). On bivariate analysis, hypertension was the cause of CKD in 48.8% of patients under 35 years, 66.4% in patients between 35 and 64 years, and 85.4% in patients ≥65 years (P = 0.001). Chronic glomerulonephritis was the cause of CKD in 40.2% of patients under 35 years, in 14.3% between 35 and 64 years, and in 4.8% of patients ≥65 years (P = 0.0001). CKD is a common cause of hospitalization in our department. Patients generally consulted at the late stage of the disease. Risk factors are mainly hypertension, HIV infection, and diabetes.

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Primary hyperoxaluria type 1 (PH1) is an inborn error of glyoxylate metabolism. It results from genetic mutation of the AGXT gene. The study objective was to verify the clinical and epidemiological patterns of PH1 in Libyan children at Tripoli Children Hospital confirmed by AGXT gene mutation. A descriptive case series study of 53 children with PH1 diagnosed between 1994 and 2015 was carried out in the Nephrology Unit at Tripoli Children Hospital. Diagnosis of PH1 was based on the clinical presentation (renal stones or nephrocalcinosis), positive family history of PH1, and high 24 h urinary oxalate. Sampling for AGXT gene mutation was collected from April 2012 to December. 2015. Among the 53 children included, males composed of 62.3% of patients. Their age at presentation ranged between two months and 20 years with a mean age of 55.4 ± 48 months. The parents of 81.1% of these patients had positive consanguinity. Forty (75.5%) patients were from South West (mountain area), and 16 (40%) of them were from Yefrin. The most common mutation found in this study was c.731T>C (p.lle244thr) seen in 32 (71%) of children, and interestingly, among these patients, 87.1% were homozygous in gene typing, 86.2% had positive history of consanguinity, 71.4% were from South West (mountain area), 96.6% had family history of PH1, and 20% presented with impaired renal function. The patients with this mutation were younger at presentation than that with other genes, and it was more prevalent among boys (61.3%). Thus, the most common gene mutation found in Libyan children with PH1 was c.731T>C (p.lle244thr) and this is more likely due to the strong genetic pooling caused by the high consanguinity rate which requires an extensive genetic counseling.

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Prune belly syndrome (PBS) is a rare congenital disorder affecting 2.5 to 3.8/100,000 live births worldwide. Our objective of this report is to describe clinical manifestation, laboratory, and radiological characteristics of PBS in our patients, to highlight the limitations to offering appropriate patient care due to parents demanding discharge against medical advice and the need to increase the awareness regarding this rare disease. We report three cases; all referred after birth with lax abdominal wall, congenital anomalies of kidney, and urinary tract. One of the patients had an absent right foot. They all had cryptorchidism, and in one, there was deranged renal function. The reported cases had both medical and radiological interventions to varying degrees. They all had an abdominal ultrasound which revealed varying degrees of hydronephrosis, hydroureters, and bladder changes. Voiding cystourethrogram showed vesicoureteric reflux in one of the reported cases. Urinary tract infections were appropriately treated with antibiotics based on sensitivity. PBS management in our setting remains a challenge because of strong cultural beliefs, and high rate of discharge against medical advice. Focus should be on parent education, early diagnosis, and multidisciplinary management approach.

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Reactivation of cytomegalovirus (CMV) and BK polyomavirus (BKV) can result in virus-associated tubulointerstitial nephritis in renal allografts. All those renal biopsies reported as viral cytopathic were isolated and examined by two independent renal histopathologists from our institute and classified as CMV, BKV, and CMV-BKV coinfection-associated viral cytopathic changes with confirmation through polymerase chain reaction technology in either serum or urine or both. All twenty patients were categorized as 10 in CMV, four in BKV, and six were in CMV-BKV coinfection. One patient each had received antithymocyte globulin and basiliximab as induction all patients received triple-drug immunosuppression. The mean graft survival was 69, 61, and 59 months in CMV, BKV, and CMV-BKV coinfection group, respectively. At the end of the study period, 10 (50%) patients died. 1-, 3-and 5-year patient survival was 94%, 88% and 76% among CMV group, 75%, 75% and 50% in BKV group, and 96%, 83% and 62%, in CMV-BKV coinfection group (P = 0.157). CMV and BK virus are not so common infections in postrenal transplant patients yet an important cause of graft dysfunction. Coinfection did not pose an increased risk for acute rejection or patients and death-censored and uncensored graft survival among compared groups

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Cardiovascular (CV) event is the most common cause of death in dialysis patients. Both traditional and nontraditional CV risk factors related to malnutrition, inflammation, and anemia are commonly found in this population. This study was conducted to evaluate the burden factors of CV risk factors and its management in our regularly dialyzed patients. It was a single-center, cross-sectional analysis of prevalent intermittent hemodialysis (IHD) and continuous ambulatory peritoneal dialysis (CAPD) patients followed up in our hospital. Both the traditional and non-traditional CV risk factors were recorded and compared between the two groups. Eighty-eight patients were recruited. Forty-five were treated with CAPD and 43 patients were treated with IHD. The mean age was 49.5 ± 15.17 years old and 54.5% were females. Eighty percent were Malay followed by Chinese (14.7%) and Indian (5.7%). Thirty-eight percent were hypertensive and 17% were diabetic. The mean age of CAPD patients was 48.9 ± 16.9 compared to 50 ± 13.5 years old for IHD patients (P > 0.05). The body mass index (BMI) of CAPD patients was 23.9 kg/m² versus 21.7 kg/m² of the IHD (P = 0.04). The systolic and diastolic blood pressure of CAPD patients were 158 and 89 mm Hg in comparison to 141 and 72 mm Hg in IHD patients (P <0.001) and their total and low-density lipoprotein cholesterol level were 5.93 mmol/L and 3.84 mmol/L versus 4.79 mmol/L and 2.52 mmol/L, respectively (P≤0.001). The CAPD patients were hyperglycemic more than IHD patients, although it was not statistically significant. All the nontraditional CV risk factors except serum albumin were comparable between the two groups. Serum albumin in CAPD patients was 35.5 g/L compared to 40.8 g/L in the IHD patients (P <0.001). In our prevalent dialysis-dependent patients, both traditional and non-traditional CV risk factors are common. Due to the prolonged and continuous glucose exposure from the peritoneal dialysis fluid, the CAPD patients had highly atherogenic serum, higher BMI, and intensified inflammation which pre-disposed them to higher CV events.

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Cytomegalovirus (CMV) is the most common cause of congenital infections in humans occurring in 1% of all liveborns. Symptomatic congenital CMV infection involves multiple systems and causes significant morbidity and mortality in newborns. Isolated CMV infection of the kidneys in a living infant has not been reported in literature. Here, we report an infant who presented only with renomegaly and renal biopsy showed extensive CMV inclusions. Serum and urine polymerase chain reaction for CMV were positive, and CMV involvement of other organs was ruled out. The child for treated with intravenous ganciclovir and is currently on follow-up. Cytomegalic inclusion disease involving only kidneys without other systems involvement can occur. The treatment protocol is unclear and long-term follow-up is needed.

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Choreoathetotic syndrome is a rare complication of open cardiac surgery that is seen usually in children after surgery for congenital cardiac anomalies. Here, we report two cases of adult patients with end-stage renal disease (ESRD) on regular hemodialysis who developed acute choreoathetotic syndrome few days after cardiac surgeries under cardiopulmonary bypass (CPB). Improvement was seen after an interval with complete resolution in one case. Investigations of the cause have been noncontributory. Long CPB time seems to be the main identified risk factor in these cases. One of the unusual features of our adult cases was the existence of ESRD. To the best of our knowledge, this is the first time this complication is described in association with ESRD although the role of this comorbidity in these cases is uncertain.

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Abnormal bone architecture contributes to high incidence of hip fractures in chronichemodialysis (HD) patients. Their clinical epidemiology is incompletely described. We conducted a retrospective cohort study to assess the implications ofhospitalization with hip fracture in HD patients compared to the nonchronic kidney disease population. Thirty-three chronic HD patients admitted with hip fracture overfiveyears were age- and sex-matched on a 1:1 ratio with controls that had hip fracture and normal renal function. Demographic characteristics, deaths, and readmissions atsixmonths,hospitalization length, time to operation, and laboratory resultswere recorded from electronic health files. Datawere compared betweenthe two groups usingpairedt-test for continuous variables and McNemar's test for categoricalvariables. The compositeendpoint of deathand/or readmission at6 months was higher in HD patients (12.1% vs. 6.2%, P<0.001). Furthermore, mean time tooperationwas more delayed due to comorbidities (4.7 vs. 2.9 days, p = 0.04). HD patients had anemia more frequently at presentation (hemoglobin below 10 mg/dL, 32.1% vs. 12.5%, P = 0.003). Finally, they were more likely to be considered toofrail for surgery and not be operated (21.2% vs. 6.2%, P<0.001). Hip fractures are associated with increased morbidity and mortality and represent an important health-care burden for chronic HD patients. Future research is needed to identify definite predictors of adverse outcomes and to implement prevention strategies.

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Suttonella indologenes is a Gram-negative, aerobic coccobacillus of Cardiobacteriaceae family and its natural habitat is the mucous membranes of the upper respiratory system. The literature includes limited number of case reports concerning fatal endocarditis due to infection in the prosthetic heart valves caused by the aforementioned microorganism. However, there is no information on extracardiac involvement due to this microorganism. Here, we present a peritonitis case caused by Suttonella indologenes in a patient receiving continuous ambulatory peritoneal dialysis.

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In tumor nephrectomy specimens, the evaluation of the normal renal parenchyma is often overlooked. A patient with both end-stage renal diseases (ESRDs) with a renal cell carcinoma is more likely to die of the ESRD rather than cancer. At the time of nephrectomy, a pathologist has a large amount of tissue available to him to comment upon the presence of disease in the nonneoplastic kidney. Hence, this study was undertaken with the idea of characterizing disease in the nonneoplastic kidney at the time of tumor nephrectomy. A two-year retrospective study was carried out on all tumor nephrectomies and partial nephrectomies. Glomerular, tubulointerstitial, and vascular compartments were evaluated for abnormalities. Twenty-four cases were included in the study. A total of 17 cases showed abnormalities in the nonneoplastic renal parenchyma. In the glomeruli, two cases showed IgA nephropathy, one case showed segmental sclerosis, and one case showed the presence of cellular crescents. A single case showed diabetic glomerulosclerosis. Interstitial fibrosis and tubular atrophy were noted in seven cases. Fifteen cases showed intimal sclerosis and medial hypertrophy and six cases showed nodular hyalinosis. Tumor nephrectomy specimens may very often show the presence of various nonneoplastic diseases. Hypertensive and diabetic renal disease are the major contributors, although primary glomerular diseases may also be present. At the time of the evaluation of a renal tumor on nephrectomy specimen, the status of the nonneoplastic kidney may become as an important predictor of clinical outcome as the tumor itself.

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Various adverse reactions may occur after intravesical bacillus Calmette-Guérin (BCG) therapy. Although the virulence of attenuated BCG is low, serious complications such as bacterial cystitis, bladder contractures, granulomatous prostatitis, epididymitis, orchitis, and systemic reactions such as fever and malaise have been described. Disseminated granulomatosis such as hepatitis and pneumonitis have also been described, but are rare. We report here the case of a 67-year-old patient who presented with renal granulomatosis with polyangiitis following intravesical BCG therapy for superficial bladder tumor. The biological evaluation revealed the presence of perinuclear anti-neutrophil cytoplasmic antibodies with specificity for antimyeloperoxidase. Renal biopsy specimen revealed pauci-immune crescentic glomerulonephritis with segmental glomerular necrosis, presence of granulomas and no evidence of any caseating necrosis. He received antituberculosis drugs in addition to corticosteroids and cyclophosphamide without any improvement of the renal function.

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Polymyositis (PM) is a rare heterogeneous group of disorders with frequent multisystem involvement including uncommon renal manifestations. Acute kidney injury (AKI) as the primary manifestation of PM is extremely rare. Herein, we report a case of recurrent episodic AKI in an adult female who was subsequently diagnosed to have PM.

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Prevalence of different glomerulonephritides and their clinical course vary geographically. Our objectives are to assess the prevalence of different histological types of glomerulonephritis (GN) based on the light microscopic histology and to assess their progression according to histological type. A retrospective cross-sectional study was carried out among adult patients (>18 years) with a histological diagnosis of GN at the University Professorial Unit over a period of six months. Information including demographic data, renal biopsy findings, and progression of the disease through serum creatinine (SCr) level were collected through existing clinic records of consenting patients. Data were analyzed by Statistical Package for the Social Sciences. There were 109 patients (females = 90) with a mean age of 40.32 ± 15.24 years. The most common histological type was focal segmental glomerulosclerosis (FSGS) in 27 (24.8%) followed by minimal change disease in 25 (22.9%), mesangioproliferative glomerulonephritis (MesPGN) in 18 (16.5%), membranoproliferative glomerulonephritis in six (5.5%), membranous glomerulonephritis in three patients (2.8%), and crescentic GN in one patient (0.9%). There was a statistically significant rise in SCr level at seven years from the initial presentation in the histological types; FSGS [P = 0.04; 95% confidence interval (CI) = 0.06–1.0] and MesPGN (P = 0.03; 95% CI = 0.3–0.9). Focal segmental glomerulosclerosis was the most common histology type in the population studied. There was a statistically significant progression of FSGS and MesPGN.

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We aimed to study the association of fibroblast growth factor-23 (FGF-23) as a novel cardiovascular risk factor with Doppler pulse wave velocity (PWV) as an arterial stiffness measuring tool in hemodialysis (HD) patients. We conducted a cross-sectional study in which blood samples from 86 HD patients were obtained to estimate FGF 23 and other parameters. Flow waveforms were obtained at two locations within right common carotid artery, and right femoral artery by Doppler ultrasound with ECG recorded in addition. The time differences between the R wave of the ECG signal and the onset of the flow waveforms at the two sites yield ΔT. Distances between sampling sites were measured using a tape measure. PWV was defined as (m/s) = D (m)/ ΔT (s). In the current study, we found significant positive correlations between Doppler PWV and both age (r = 0.401, P = 0.039) and systolic blood pressure (r = 0.602, P = 0.034), while no significant association between Doppler PWV and FGF-23 (r = 0.123, P = 0.259) could be detected. Serum FGF-23 levels are not significantly associated with Doppler PWV in HD patients.

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We report a case of very early postoperative iatrogenic dissection of common iliac artery (CIA), external iliac artery (EIA) causing acute ischemia of the right lower limb, and impairing the perfusion of a renal allograft. This was managed successfully by graft nephrectomy and interposition polytetrafluoroethylene grafting of the CIA and EIA with re-implantation of the kidney allograft and restoration of its perfusion and function, together with restoration of the lower limb circulation.

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