The development of acute kidney injury (AKI) in patients during hospitalization worsens the prognosis. The study aimed to estimate the prognostic value of AKI in patients with ST-segment elevation myocardial infarction (MI) in prospective follow-up study. A prospective follow-up of 12 months included 268 patients with ST-segment elevation MI who underwent percutaneous coronary intervention. The incidence of AKI was assessed and its effect on the outcome of ST-segment elevation MI during the observed period was traced. AKI was diagnosed according to Kidney Disease: Improving Global Outcomes recommendations. AKI was recorded in 20.5%. The incidence of AKI increased with decrease in the level of glomerular filtration rate on admission (P = 0.047) and an increase in the stage of acute heart failure according to Killip on admission (P = 0.006). The development of AKI was associated with an increase in-hospital mortality, increasing with a worsening stage of AKI (P<0.001), the same pattern was characteristic for death from cardiovascular causes during follow-up. AKI increases the risk of death from cardiovascular causes by four times [odds ratio 95% 4.400 (1.928–10.040), P <0.001]. The multivariate analysis revealed risk factors for the development of AKI: age >75 years (P = 0.006), female (P = 0.008), Killip >I (P = 0.045). AKI is common in patients with ST-segment elevation MI and is associated with a poor prognosis. The development of AKI is associated with an increase mortality, increasing with a worsening stage of AKI.

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Since the initial times of renal transplantation in the 1950s, understanding various aspects influencing graft survival and outcome have been progressively improving. However, infections especially urinary tract infections (UTIs), are an important factor leading to an increase in morbidity and graft failure. UTI degrades the health-related quality of life and can potentially impair graft function. UTI occurs in 25% of kidney transplant recipients within one year of transplant and accounts for 45% of infectious complications. Asymptomatic bacteriuria (ASB), uncomplicated UTI, and complicated UTI comprise 44%, 32%, and 24% of cases, respectively. This article reviews important aspects regarding posttransplant UTI, including definition, incidence, predisposing factors, recommendations, ASB, and controversies in management. UTI after renal transplantation is still an under-estimated aspect, despite its degrading effects on allograft and recipient health.

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Chronic kidney disease (CKD) is a serious worldwide health problem with a rising incidence and prevalence. CKD can lead to end-stage renal failure that increases the risk of death and requires dialysis or kidney transplantation. Patients’ adherence, attitude, and knowledge are important to prevent and control CKD. The aim of this study was to investigate the awareness and knowledge about CKD and attitude toward kidney donation among the general population in Saudi Arabia. A cross-sectional study based on a questionnaire survey was conducted in Jeddah, Saudi Arabia. We surveyed the awareness about CKD among adult residents of Jeddah, Saudi Arabia. We used a self-administrated questionnaire that consisted of three sections; socio-demographic information, awareness about CKD, and attitude towards kidney donation. Simple descriptive statistics was employed using IBM SPSS Statistics version 24.0 software. The number of survey respondents was 268. More than half (53.7%) of the included participants knew that the use of non-steroidal anti-inflammatory drugs is a risk factor for CKD, whereas 54% thought that CKD could be diagnosed from a simple urine analysis, and 45% believed that lifestyle modifications can alter the course of the disease. Interestingly, most participants (57.4%) were ready to donate their kidney to a patient with end-stage renal disease, and 68.6% knew that patient can live with one kidney. The present study identifies a low rate of CKD awareness and calls for a need for awareness campaigns and other tools to strengthen knowledge dissemination. Improving public awareness about CKD needs to be addressed to help facilitate disease identification and prevention.

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Acute kidney injury (AKI) is a potentially life-threatening condition. The injury involves the generation of inflammatory mediators which contribute to the recruitment of leukocytes to the site of inflammation. As those inflammatory mediators are secreted directly into the urine, their detection in urine could serve as potential biomarkers for the diagnosis of early kidney injury. This is a prospective cross-sectional descriptive study. Urinary samples were collected from 170 subjects who were admitted to intensive care unit (ICU) at Alkafeel Super Speciality Hospital from September 2017 to June 2018. They were tested for urinary interleukin-18 (IL-18). Among 98 patients, 20 were excluded depending on exclusion criteria. Seventy-two cases in the control group were included. The urine samples were collected at 24, 48, and 72 h after admission to ICU. AKI was diagnosed according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The incidence rate of AKI among 78 patients who were admitted to ICU was 38.46%. Most of the patients with AKI belonged to stage 1 (80%) based on KDIGO guidelines2012. Urinary IL-18 levels were significantly higher (P <0.0001) in the AKI group in comparison with the non-AKI group. The result of receiver operating characteristic analysis showed that the higher area under the curve for urinary IL-18 was 0.946 measured at 24 h before development of AKI (P <0.000), with 87.5% sensitivity and 94.4% specificity. In addition, there was no significant difference of urinary IL-18 levels between the different causes of AKI. The results of the study indicate that urinary IL-18 has an excellent performance in predicting AKI in ICU patients.

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Purple urine bag syndrome is very rare in which urine color changes, and it becomes purple. This occurs when patients with a urinary catheter are bedridden, and suffer from urinary tract infection caused by specific organisms.

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Aspergillus species are ubiquitous, and inhalation of infectious conidia is not so uncommon. With immunosuppression, it can invade adjacent structures and lead to widespread invasive disease. There is no randomized, prospective trial for optimized treatment including the antifungal and surgical approach for aspergilloma. The available literature related to the management of asymptomatic aspergilloma in pre-renal transplant setting is scarce and debatable. Opinion favoring surgery is that it is necessary to eliminate the fungus reservoir before transplantation because of the inadequacy of pharmacological fungus control measures in immunocompromised patients. We present a case of end-stage renal disease that was planned for renal transplantation and during the workup, was detected to have asymptomatic right upper lobe aspergilloma. He underwent surgical resection of the aspergilloma before undergoing successful renal transplantation. In this case report, we will discuss this case and controversies related to its management before undergoing successful renal transplantation.

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Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic renal disease, with a reported prevalence ranging from one in 400 to one in 1000. ADPKD accounts for as high as 10% of end-stage renal disease cases. It is characterized by cystic formation replacing kidney parenchyma leading to renal enlargement and renal functional impairment. Consequently, it is associated with renal and extrarenal complications contributing to high mortality. On the other hand, horseshoe kidney (HSK) is a common congenital renal anomaly, with an incidence ranging between one in 400 and 600. Surprisingly, the coexistence of both distinct common clinical conditions is extremely rare, and it is thought that the incidence of polycystic HSK varies from one in 134,000 to one in 8,000,000 cases. Although the particular genetic association is not established, familial cases raise the question of whether they are related. We report this case to cultivate the current medical literature regarding this rare entity.

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Tubulointerstitial nephritis uveitis syndrome (TINU) is an underdiagnosed entity, defined by association of uveitis and TIN with no evidence of concomitant systemic disease that might present with both ocular and renal manifestations. Although not common, it needs awareness and collaborations of pediatricians and ophthalmologists for prompt diagnosis and treatment. The exact pathogenesis of the disease is poorly understood, and it predominantly affects female adolescents. Since its early description at 1975, many cases have been reported but only a few were familial case reports. Herein, we report TIN in two sisters, first one with uveitis (TINU) and second one, eight years later at the same age without uveitis.

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In Nigeria, there is paucity of data on malnutrition among chronic kidney disease (CKD) patients especially before the initiation of dialysis therapy, necessitating this study. The study subjects consisted of 96 CKD patients recruited from the renal unit of our hospital. Forty age-and sex-matched controls were also studied. Nutritional status was assessed using Subjective Global Assessment (SGA), weight change over six months of follow-up, body mass index, mid-upper arm circumference, triceps skinfold thickness, and serum albumin concentration. A three-day food diary was used to determine the average daily protein intake of the patients. Sixty-six CKD patients completed the study. The age range of CKD patients was 23–65 years with a mean of 47.1 ± 13.2 years while the age range of the controls was 23–65 years with a mean of 44.1 ± 14.3 years. Out of the 66 CKD patients studied, four lost >10% of their body weight. The body mass index (BMI) was low (<20 kg/m²) in eight (12.1%) of CKD patients, while three (7.5%) subjects in the control population had BMI of <20 kg/m². The serum albumin was less than 3 g/dL in seven (10.6%) of the CKD patients, SGA identified malnutrition in 30 (46%) of the CKD patients. The prevalence of malnutrition in predialysis CKD patients was high in this study.

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Contrast medium-induced nephropathy (CIN) is a leading cause of acquired acute kidney injury and has been associated with prolonged hospitalization and adverse clinical outcomes. This study aimed to determine if omega 3 fatty acids reduce the risk of CIN in patients with chronic kidney disease undergoing coronary angiography. A total of 130 consecutive patients undergoing coronary angiography were randomly assigned to one of two groups as follows: 67 patients were assigned to the N-acetylcysteine (NAC; 1200 mg) and 63 patients were assigned to the omega 3 fatty acid (4 g). Both drugs were administered orally twice per day one day before and on the day of contrast administration. Of the 130 patients enrolled in this study, 10 (7.7%) experienced an increase of at least 0.5 mg/dL (44 μmol/L) in serum creatinine levels 48 h after administration of the contrast agent including 5 of the 67 patients in the NAC group (7.5%) and 5 of the 63 patients in the omega 3 fatty acids group (7.9%; P = 0.919). There were no significant differences in the need for renal replacement therapy (3.0% vs. 9.5%, P = 0.121) or in the mortality rate (3.0% vs. 6.3%, P = 0.361) between the two groups. Short-term prophylactic omega 3 fatty acid treatment with hydration does not reduce the risk of CIN in patients with chronic kidney disease undergoing coronary angiography.

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Urolithiasis is a prevalent medical disease affecting the general population. Many epidemiological studies reported an association between a geographic area with a high mean daily temperature and urolithiasis disease. However, it is unclear if the seasonal variation in a high temperature geographical area will affect the acute presentation of renal colic to the emergency department. The aim of this study was to identify the effect of the seasonal variation on the presentation with acute urolithiasis disease. The design was a retrospective chart review, using the database in King Abdulaziz Medical City that was retrieved by the data management office in King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia. The study period was from January 26, 2016, to the end of December 2019. All patients who presented with renal colic, and diagnosed with urolithiasis using a noncontrast-enhanced computed tomography scan, have been included. A total of 1057 patients were included in this study. The majority (71.24%, n = 753) were male, and the mean age was 42.33 ± 16.12 years. The highest proportion presented in summer (31.22%), followed by spring (26.87%), fall (24.12%), and winter (17.79%). The majority of the sample (84.77%) presented with ureteral stones, and 15.23%with kidney stones. Most of the sample (78.33%) had no history of previous stone formation, with 21.67% being current stone former. The acute presentation with urolithiasis is higher during summer, followed by spring, fall, and winter. A public educational program is highly recommended to increase awareness about stone formation and the appropriate avoidance methods. To this end, additional research is required to understand the stone composition and appropriate methods to avoid developing urolithiasis.

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The occurrence of kidney diseases associated with a monoclonal gammopathy in the absence of symptomatic multiple myeloma is increasingly recognized. When the kidney is involved, the monoclonal etiology of these diseases results in clinical and laboratory features distinct from those of other disease, necessitating the nomenclature monoclonal gammopathy of renal significance (MGRS). The detection of these monoclonal diseases involving the kidney is important since they are poorly responsive to conventional immunosuppression and instead require clone-directed therapy. The new International Kidney and Monoclonal research group consensus definition of MGRS includes all proliferative conditions of B cells and/or plasma cells. Renal lesions due to monoclonal immunoglobulins are quite capable of progression with resulting end-stage renal disease development. Hence, these lesions require therapeutic intervention even if they do not satisfy myeloma criteria or the presence of any myeloma defining event. The spectrum of renal lesions that can be observed in a case of MGRS is wide and mirrors the list that may be seen in a case of any plasma cell neoplasm. This includes Ig light chain, heavy chain, and heavy and light chain amyloidosis; immunotactoid glomerulonephritis (GN); monoclonal immunoglobulin deposition disease including light chain, heavy chain, or heavy and light chain disease; light chain proximal tubulopathy; crystal-storing histiocytosis; proliferative GN with monoclonal immunoglobulin deposits; C3 glomerulopathy with monoclonal gammopathy and cast nephropathy. The initial approach after histological assessment is based on presence or absence of monoclonal immunoglobulin deposits. If monoclonality is evident, it is important to distinguish between conditions with deposition of intact immunoglobulin molecule or light chains only. The treatment of MGRS is directed at the underlying neoplastic B-cell or plasma cell clones.

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Carotid-femoral pulse wave velocity (cf-PWV) is the noninvasive gold standard technique for measuring aortic stiffness. Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic renal disease in adults. It is associated with a high risk of cardiovascular complications. We aimed to assess the prevalence of increased arterial stiffness and its predicting factors in a population of ADPKD patients. Sixty-two patients with ADPKD underwent noninvasive measurement of cf-PWV using a COMPLIOR Analyse device. Recruitment period was 17 months and we used the cut-off of 10 m/s to define a high cf-PWV. Mean age was 51 ± 12.7 years. Gender ratio male/female was 0.63. Smoking, hypertension (HTN), and dyslipidemia were reported in 14%, 66%, and 27% of the cases, respectively. Mean glomerular filtration rate (GFR) was 47.7 ± 44 mL/min/1.73 m². Among our patients, 39% had chronic kidney disease stages 1 or 2 and 45% stage 5 (40% stage 5D). Mean cf-PWV was 9 ± 2.4 m/s, and 31% of the patients had a high cf-PWV. In univariate analysis of all our patients, cf- PWV correlated with age (r = 0.565; P <10^-3), GFR (r = -0.268;P = 0.035), C-reactive protein (r = 0.447; P = 0.007), peripheral systolic arterial pressure (r = 0.309; P = 0.015), and peripheral pulse pressure (r = 0.335; P = 0.008). Patients with high cf-PWV were on average nine years older than the others. Patients with HTN were 3.84 times more likely to have high cf-PWV (P = 0.046). cf-PWV did not seem to be lower with any antihypertensive treatment. A level of C-reactive protein higher than 10 mg/L was the only independent predicting factor of a high cf-PWV in multivariate analysis (P = 0.043). Our study confirmed the relationship between cf-PWV and age, renal failure, and HTN in patients with ADPKD. It also emphasized the close relationship between systemic inflammation and arterial stiffness in this nephropathy.

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Nurses are increasingly being regarded as the nucleus of the health care system, as well as serving as an advocate for health-care consumers. Therefore, adequate acute kidney injury (AKI) knowledge of nurses would definitely have a positive impact on an early diagnosis, management, and outcome of AKI. This cross-sectional study was aimed to assess the knowledge of AKI among nurses working at public and private hospitals at Lahore and Sialkot, Pakistan. The study was conducted from October 2017 to March 2018. A convenient sampling method was used and data were gathered using a self-administered questionnaire. The median knowledge score of the study population (n = 200) was 29, with majority (78.5%) having moderate knowledge (score 26–38). Only 2.5% of nurses had good AKI knowledge whereas 19.0% were found to have poor knowledge. Nurses’ age, rank, and their departments had no significant impact on the knowledge scores. Furthermore, there was no significant difference of knowledge among participants who had previously attended any seminar/special training session regarding AKI and those who had not. In conclusion, majority of Pakistani nurses had moderate AKI knowledge. Therefore, in-service training sessions on AKI should be conducted to equip nurses with up-to-date AKI knowledge.

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Kidney transplant recipients appear to be at increased risk for severe coronavirus disease 2019 (COVID-19) illness due to some factors such as comorbidities and chronic immunosuppression. Here, we report four cases of COVID-19 infection in kidney transplant recipients. The one case in this series with the high D-dimer levels and receiving tacrolimus had the worst outcome among reported patients. Other patients had better outcomes that probably due to the effect of immunosuppressive therapy in the prevention of COVID-19-induced cytokine storm. It was suggested that a high D-dimer level occurred in critical patients and likely prognostic and also, the immunosuppressive effect of some treatment regimens.

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West Nile virus (WNV) infections are a mosquito-borne virus of the Flaviviridae family. The clinical feature of the virus varies between individuals from being asymptomatic in most of the cases to severe central nervous system disease manifested as meningitis, encephalitis, and paralysis. Diabetic nephropathy patient with microvascular and macrovascular complications, who received a kidney transplant a year ago on immunosuppressive therapy, presented with a three-day history of upper respiratory tract infection and fever. He lived in an endemic area of brucella infection. He underwent a thorough and full evaluation with various laboratory and radiological evaluations. The patient was started empirically on ceftriaxone and acyclovir for a presumptive diagnosis of herpes encephalitis and covering also Listeria with ampicillin. The patient did not improve with the initial management, so a T2-weighted magnetic resonance imaging of the brain executed that showed nonspecific hyper-intensity in the left frontal area suggestive of microangiopathic changes. WNV-neutralizing antibodies were positive with a high titer >1:640, whereas WNV RNA was not detected in the plasma sample. In the serum sample, WNV IgM and IgG were both positive. WNV IgM antibodies were detected with 6.55 and 5.97 antibody index and were done by a semiquantitative ELISA. Furthermore, WNV-neutralizing antibodies were positive as well as with a titer of 1:80. As there is no specific antiviral treatment available, the patient management was supportive; reduction in immunosuppressive agents and the use of IV IgG. This is the first reported case of one-year post renal transplant who developed WNV encephalitis and neuropathy with significant response to immunoglobulin after 18 days of infections.

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Thrombotic microangiopathy (TMA) includes various diseases with different etiologies which ultimately results in endothelial damage to the small vasculature leading to thrombosis in the micro vessels, this causes mechanical hemolysis, thrombocytopenia due to platelet consumption and ischemic organ damage. Untreated cases carry high mortality, so identifying the cause for TMA assumes importance. We report a 47-year old hypertensive lady presenting with accelerated hypertension (HTN) and TMA picture with rapidly progressive renal failure. She underwent hemodialysis followed by renal biopsy. Biopsy showed patchy cortical necrosis with hypertensive changes. The patient remained dialysis dependent and succumbed to pulmonary edema and alveolar hemorrhage three weeks after initial diagnosis. TMA in this patient could be due to malignant HTN or atypical hemolytic-uremic syndrome, and finding the exact cause is many times difficult. TMA is a medical emergency; a high index of suspicion is needed especially when there is multisystem involvement on background hemolysis and thrombocytopenia. Finding out the cause for TMA is important for prompt initiation of treatment.

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Kaposi’s sarcoma (KS), one of the most typical malignancies after kidney transplantation, is strongly associated with human herpes virus 8 infection. More than 90% of patients had primary skin changes, which make the diagnosis easier and faster. The lack of skin lesions is considered rare, especially in the iatrogenic type of sarcoma, including patients on immunosuppression and may cause a diagnostic challenge due to the variety of organ involvement, imitating other diseases. The aim of this case presentation is to raise attention to the atypical clinical manifestation of this malignancy. Currently, several different therapeutic options are available for patients with KS, including reduction of immunosuppression, conversion of immunosuppression to mTOR inhibitors, or chemotherapy. Here, we present an unusual case of advanced KS human immunodeficiency virus-negative patient after kidney transplantation without primary skin involvement.

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Pregnancy is identified as one of the risk factors for increased severity of illness in severe acute respiratory syndrome novel coronavirus 2019 infection. The severity of illness may range from mild infection to severe multi-organ failure. Acute kidney injury (AKI) may occur in pregnant patients with coronavirus disease (COVID) either due to obstetric cause or due to severe COVID illness. We report six cases of COVID–pregnancy with AKI and their outcomes.

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A 56-year-old male was diagnosed to have carcinoma stomach following evaluation of lack of appetite and weight loss. He underwent neoadjuvant chemotherapy and gastrectomy. Following surgery he developed progressive renal failure. A renal biopsy led to the diagnosis of oxalate nephropathy. Despite treatment his renal functions never recovered. Oxalate nephropathy is an underappreciated cause of renal failure postgastrectomy. It can cause irreversible renal failure unless detected and treated early.

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Living with chronic kidney disease (CKD) is associated with hardships for patients and their care-partners. Empowering patients and their care-partners, including family members or friends involved in their care, may help minimize the burden and consequences of CKD related symptoms to enable life participation. There is a need to broaden the focus on living well with kidney disease and re-engagement in life, including an emphasis on patients being in control. The World Kidney Day (WKD) Joint Steering Committee has declared 2021 the year of “Living Well with Kidney Disease” in an effort to increase education and awareness on the important goal of patient empowerment and life participation. This calls for the development and implementation of validated patient-reported outcome measures to assess and address areas of life participation in routine care. It could be supported by regulatory agencies as a metric for quality care or to support labelling claims for medicines and devices. Funding agencies could establish targeted calls for research that address the priorities of patients. Patients with kidney disease and their care-partners should feel supported to live well through concerted efforts by kidney care communities including during pandemics. In the overall wellness program for kidney disease patients, the need for prevention should be reiterated. Early detection with a prolonged course of wellness despite kidney disease, after effective secondary and tertiary prevention programs, should be promoted. WKD 2021 continues to call for increased awareness of the importance of preventive measures throughout populations, professionals, and policymakers, applicable to both developed and developing countries.

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Our study aimed to assess mandibular osseous changes using radiomorphometric indices by Cone-Beam Computed Tomography (CBCT) in patients with end-stage renal failure (ESRF) to evaluate their jaw bone quality versus a healthy sex- and age-matching population. Twenty-six patients were included in this study. They were divided equally into two groups. The first group (study group) included 13 ESRF patients and the second group (control group) included 13 patients free from any condition that could affect bone metabolism. All of the 26 participants were scanned using CBCT scanner then five indices were obtained from the reformatted panoramic images and the cross-sectional images of each mandible bilaterally mandibular cortical index (MCI), panoramic mandibular index (PMI), mental index (MI), gonial index (GI), and antegonial index (AI). There was no significant difference between MCI, MI, AI, GI and PMI of patients with ESRF and that of the control group. The assessment of intra-observer and inter-observer reliability regarding all measurements (GI, AGI, MI, and PMI) showed very strong agreement except MCI showed substantial agreement. Bone quality assessment of patients, investigated in the current study, with ESRF was not different from those of healthy sex- and age-matching dental patients using radiomorphometric indices. Quantitative radiomorphometric indices (MI, AI, GI, and PMI) are more reliable than qualitative radiomorphometric index (MCI) in the assessment of jawbones.

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According to the elevated infection mortality risks, the incidence of coronavirus disease 2019 (COVID-19) could be raised in rheumatoid arthritis patients with end-stage renal disease (ESRD). Our objectives are to describe the impact of COVID-19 infection on rheumatoid arthritis patients with end-stage renal disease and to identify the risk of in-hospital mortality, comorbid conditions. and the proper way to deal with this category. It was a retrospective analysis of COVID-19 patients in Saudi Arabia from March 1, 2020 to April 27, 2020 and from May 27, 2020 to August 20, 2020. Of 10,482 patients with COVID-19, 419 had ESRD. We assessed main (in-hospital death) outcomes and secondary (mechanical breathing and residence) outcomes. Patients with ESRD were aged and more comorbid disorders. Rheumatoid arthritis patients with ESRD were aged. ESRD rheumatoid arthritis patients have a higher hospital mortality risk relative to rheumatoid arthritis patients not getting complicated with ESRD (31.7% vs. 25.4%, chances 1.38, and 95% trust range 1.12–1.70). After population and comorbid conditions had changed, the rate of rise stayed the same (changed chances: 1.37, 1.09–1.73). In both the crude and modified study (1.62, 1.26–2.07; vs. 1.57, 1.22–2.02), chances for the period of stay of seven or more days have been higher inside a group than in the non-ESRD group. Old age, respiratory support, lymphopenia, and elevated blood urea nitrogen and low serum ferritin were the independent contributing factors for the in-hospital mortality of ESRD rheumatoid arthritis patients infected with severe acute respiratory syndrome coronavirus 2.

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Cardiovascular disease is the leading cause of death of dialyzed patients. Aortic stiffness, evaluated by the carotid-femoral pulse wave velocity (cfPWV), is now considered as a prognostic factor for cardiovascular mortality in patients with chronic kidney diseases. The peritoneal dialysis (PD) patients had significantly stiffer arteries. cfPWV was 9.12 ± 2.7 m/s in PD patients without significant correlation compared to hemodialysis (HD) patients (8.97 ± 2.52 m/s). In the univariate study, we found a statistically significant correlation between PWV and age (P = 0), between the pulse wave velocity and phosphorus (P = 0.46), between the VOP and PTH (P = 0.013) and between PWV and dyslipidemia (P = 0.014). Other variables such as phospho-calcic product, hemoglobin, total cholesterol, and KT/V were not significant. To identify the risk factors independently linked to the event, we conducted a multi-varied analysis. A correlation was found between VOP and dyslipidemia (P = 0.008). The other variables were insignificant.

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Intrapatient variability (IPV) in tacrolimus has been increasingly acknowledged as a risk factor for poor graft survival after kidney transplantation. Although past studies have mainly accounted for IPV in acute or chronic rejection states as due to underimmunosuppression, this is not yet clear. So far, tacrolimus IPV for BK virus-associated nephropathy (BKVN) and chronic calcineurin inhibitor toxicity (CNIT) has not been investigated. Here, we evaluated IPV in tacrolimus for BKVN and chronic CNIT, which are mainly considered as overimmunosuppression states. In this case–control study, kidney allograft biopsies conducted between 1998 and 2018 were included, with patients grouped by biopsy results as BKVN alone group, CNIT alone group, and normal graft function (control group). IPV was estimated as mean absolute deviation. Our study groups included 25 kidney transplant recipients with BKVN alone, 91 patients with CNIT alone, and 60 patients with normal 5-year graft survival (control group). In analyses of IPV in tacrolimus six months before graft biopsy, IPV was highest in the BKVN group (P = 0.001). The BKVN group also had the highest IPV in tacrolimus at 12 months after biopsy (P = 0.001), with all pairwise comparisons statistically different between groups. At 12 months after biopsy, five patients (20%) in the BKVN group and 10 patients (10.9%) in the CNIT group had graft loss. Among other risk factors, BKVN and chronic CNIT are consequences related to high IPV. Quantification of IVP for tacrolimus in clinical practice would help to optimize kidney transplant outcomes.

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Urine neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL- 18) have shown promise for predicting renal graft recovery. However, urinary flow rate variations may cause variable biomarker dilution. Plasma NGAL and IL-18 may form a biomarker panel that may help predict delayed graft function and slow graft function (SGF) in renal transplant recipients within the first two postoperative days earlier than serum creatinine. There are only a few studies in the literature using plasma NGAL for predicting renal graft recovery. Hence, we planned this study. This observational single-center, prospective cohort study was conducted in renal transplant recipients above 18 years of age. In 22 consecutive renal transplant recipients, we collected ethylenediaminetetraacetic acid-plasma samples 1 h before surgery and subsequently at 6 h, 24 h, and 48 h after surgery for NGAL and IL-18 by sandwich enzyme-linked immuno-sorbent assay technique. Serum creatinine was measured as a part of routine transplant protocol. In renal transplant recipients, neither serum levels of NGAL and IL-18 nor their trends could reliably predict SGF. The only significant correlation existed between serum creatinine at day 2 and IL-18 at day 2 with P = 0.023. Serum NGAL did not correlate with serum creatinine in this setting of renal transplantation. Patients with immediate graft function had a greater percentage decrease of creatinine at day 1 and day 2 (P = 0.002 and 0.001) The percentage change in IL-18 at 24 h and 48 h after transplant from baseline could predict the occurrence of early graft loss (EGL) (P = 0.05, 0.04). The cutoffs were -4.12% at day 1 and +3.39% at day 2 with area under receiver operator characteristics of 0.82 and 0.83, respectively. The percentage change in IL-18 may be a useful marker of EGL in renal transplant recipients. Serum NGAL and creatinine were not able to predict EGL.

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This study was conducted to retrospectively investigate the indications for renal biopsy in the native kidneys of children and to analyze the pathological findings in a single tertiary care hospital in North-East India for the past 12 years. All children (≤18 years) who underwent renal biopsy at our hospital from March 2007 to April 2018 were included. Renal tissue specimens were studied under light and immunofluorescence microscopy. The study group included 254 patients (female 57%). The median age was 15 years (range 6–18 years). The most frequent indications for renal biopsy were nephrotic syndrome (NS) (53.9%), urinary abnormality in systemic disease (22.1%), nephritic syndrome (15.4%), asymptomatic hematuria (4.7%), significant proteinuria (3.1%), and unexplained renal failure (0.8%). On histopathological examination, primary glomerular diseases were the most frequent (68.9%) followed by secondary glomerular diseases (30.3%) and tubulointerstitial diseases (0.8%). The most common primary glomerular diseases were minimal change disease (26.8%), focal segmental glomerular sclerosis (12.2%), diffuse proliferative glomerulonephritis (9.1%), membranous nephropathy (8.7%), IgA nephropathy (8.3%), membranoproliferative glomerulonephritis (2%), and mesangioproliferative glomerulonephritis (2%). Lupus nephritis (LN) (29.5%) was the most common secondary glomerular disease. NS was the most common indication of renal biopsy, and LN was the most common histopathological diagnosis in children ≤18 years.

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Coronavirus disease-2019 (COVID-19) is a global pandemic, also affecting Pakistan with its first case reported on February 26, 2020. Since then, it has been declared a pandemic by the World Health Organization. Our study aimed to evaluate the renal derangements associated with COVID-19 infection in our population. A retrospective, observational study was conducted to include all the admitted patients having COVID-19 positive, and evaluated those for derangements of renal function (n = 362). Out of the 362 patients, 229were admitted in the ward, 133 were in intensive care unit (ICU), 258 of them recovered, while 104 deaths reported. At admission, the renal profile was deranged in almost one-half of ICU admissions and mortalities which increased to two-third during the hospital stay, with around 80% of deaths reported with increased urea and creatinine levels. Among the deceased patients, around one-third of the mortalities developed renal profile derangements during the hospital stay although they were admitted with a normal renal profile. An estimated glomerular filtration rate showed a mean increase of 13.37 mL/min/1.73 m² during the hospital stay of surviving patients, while a decline of 19.92 in nonsurviving patients. A hazard ratio of 3.293 (P <0.001) for admitting serum urea and 3.795 (P = 0.009) at discharge and for serum creatinine at 5.392 (P <0.001) on discharge was associated significantly with mortality. Kaplan–Meier plot showed a significant decline in days of survival with deranged urea and creatinine (P <0.001). The deranged renal function in COVID-19 patients is associated with an increased number of ICU admissions as well as mortalities.

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Plasma cell-rich rejection is a rare and poorly defined entity. Its treatment is not clearly defined and has universally poor prognosis. More data should be published from various transplant centers around the world to identify the treatment that has the best outcomes and to formulate treatment guidelines for these cases. It is a retrospective analysis of kidney biopsies form 2008 to 2018. Four hundred biopsied were screened and 55 were found to have features of rejection and among them, 13 had plasma cell-rich rejection. Data of treatment given and the graft survival outcomes in these cases were retrieved by medical records. One patient had complete recovery, three had graft loss and the remaining nine had permanent decline in glomerular filtration rate. Decrease in immunosuppression and presence of infection are risk factors for plasma cell-rich acute rejection (PCAR). It can be acute cell-mediated rejection (ACR)/antibody-mediated rejection (AMR)/ACR+AMR. Resistant rejection, ACR+AMR, C4d positivity, and severe interstitial inflammation are poor prognostic factors. Overzealous decrease in immunosuppression should not be done. Management of immunosuppression during infection is most critical for the development of PCAR. Bortezomib is emerging as a therapeutic modality for the treatment of PCAR.

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A noninvasive and accurate estimate of the glomerular filtration rate (GFR) is an essential prerequisite for medical professionals. In the absence of 24-h urinary creatinine clearance, various predictive equations can be utilized for estimating GFR. A cross-sectional observational study was conducted on healthy adults as well as adult chronic kidney disease (CKD) Indian population. In normal males and females, Modification of Diet in Renal Disease-4 (MDRD-4) and Cockcroft- Gault (CG) were the best equations respectively, which showed the best correlation and best precision in CKD stage 1 males and females, MDRD-4 and MDRD-6 were the best equations respectively In CKD stage 2 males and females, CKD-Epidemiology Collaboration (CKD-EPI) was adjudged the best equation, which showed the best correlation, best precision, and least bias. In CKD stage 3 males and females, CG and CKD-EPI were the best equation respectively, with the best correlation, best precision, least biased, and most accuracy. In CKD stage 4 males and females, MDRD-6 and MDRD-4 showed the best correlation, best precision and most accuracy respectively. In CKD stage 5, CKD-EPI demonstrated the best results in both sexes. We observed that all the predictive equations were good estimates of GFR in one or other stages of CKD, but no single predictive equation showed consistent results when compared among normal subjects and CKD sub-groups.

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There is no consensus regarding timing of peritoneal dialysis (PD) catheter removal following kidney transplant. We hypothesize that early removal of PD catheter reduces the risk of peritonitis. We conducted a prospective closed-loop audit to review existing practice in our department and determine whether a better strategy could be implemented. Simple descriptive and inferential statistics were used to generate results. Categorical data were described using frequency and percentage. Continuous values were reported as mean ± standard deviation. Between November 2016 and April 2017, forty patients had renal transplant with PD in situ. On average time to removal of PD catheter, posttransplant was 84 days. Four patients (10%) developed exit-site infection. Following departmental consultation, practice was changed to remove all PD catheters at the time of transplant. Between May 2017 and January 2018, twenty patients had renal transplant and 19 had PD catheter removed at the time of transplant. Of these, one required re-insertion. In the patient where PD catheter was left in situ, peritonitis was a complication. We continue to recommend PD catheter removal at the time of transplant.

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Posttransplant lymphoproliferative disorders (PTLDs) are potentially fatal complications arising after solid organ or hematopoietic stem cell transplant. The most crucial factor in pathogenesis of PTLDs is either a primary infection with Epstein–Barr virus or reactivation of its latent state due to immune dysregulation. This complex pathobiology leads to a myriad of clinical manifestations due to uncontrolled lymphoproliferation that may be reactive, polymorphous or monomorphous. We report our experience at a tertiary center of six cases detected over a span of six years. All our patients were proven as high grade B-cell lymphoma on histopathology, which remains the gold standard for diagnosis. Two cases were of primary central nervous system lymphoma, two had disseminated disease, fifth showed allograft involvement, and last case presented with gastrointestinal obstruction. All the patients were managed with reduction of immunosuppression, chemotherapeutic agents, and rituximab. Five patients responded well with a follow-up period of 3–28 months since the time of treatment initiation and had preserved renal function with no episodes of disease recurrence or allograft rejection.

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Acute kidney injury (AKI) is an abrupt or rapid decline in renal function as evidenced by a rapid rise in serum creatinine (SCr) or decrease in urine output. AKI occurs in children. The aim of the study is to document the epidemiology of AKI in our setting. This was a prospective cross-sectional observational study of all the admissions at the children emergency room of Federal Medical Center in Asaba, Delta State. A diagnosis of community-acquired AKI was made using the pRIFLE criteria if there was a 25% decrease in estimated creatinine clearance from the premorbid baseline (if known) or assumed baseline of 100 mL/min/1.73 m² and/or urine output <0.5 mL/kg/h for >8 h within the 48 h of admission. There were 404 admissions during the period and those with AKI were 58, giving an incidence rate of 14.4 cases per 100 children aged between >1 month and 16 years. The mean age of the subjects with AKI was 35.7 months. Subjects with AKI stages R (risk), I (injury), and F (failure) were, respectively, 44.8%, 39.7%, and 8.6%. The most common causes were acute gastroenteritis (36.2%), complicated malaria (10.3%), and primary renal disease (10.3%). Age group and sickle cell anemia predicted AKI in these subjects. For the outcome of the AKI, two (3.4%) died, while 55 (96.6%) subjects were discharged alive. The level of SCr within 48 h of admission predicted the outcome of AKI. The prevalence of AKI is high, gastroenteritis being the most common etiology.

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Children with nephrotic syndrome (NS) have a number of potential risk factors for the development of acute kidney injury (AKI) including intravascular volume depletion, infection, exposure to nephrotoxic medication, and renal interstitial edema. This study was aimed to determine the incidence of AKI in children hospitalized with a relapse of NS and its short-term outcome. This prospective observational study was conducted from February 2017 to January 2018 at a tertiary care teaching hospital. A total of 54 children and adolescents (1–18 years) hospitalized with a diagnosis of NS and relapse with/or without other complications were enrolled. Clinical data and examination were recorded. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria and Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (p-RIFLE) classification. Children who developed AKI during the first two weeks of hospitalization were followed up till recovery or six weeks whichever was earlier to determine the outcome and factors predisposing to AKI. The mean age of the study population was 59.5 months and 35 (64.8%) patients were male. Of the 54 patients hospitalized, 42 (77.8%) were admitted with infection-associated relapses while 22.2% of children had relapse alone. Diarrhea and spontaneous bacterial peritonitis were the most common infections (26.1% each) followed by urinary tract infections in 19% and pneumonia in 14.3%. Twenty-three (42.6%) children developed AKI according to the KDIGO definition and 27 (50%) using the pRIFLE classification. Fourteen (60.9%) had stage 2 AKI while 21.7% had stage 3 AKI. Infections [odds ratio (OR) 1.24] and use of angiotensin-converting enzyme inhibitors (ACEI) (OR 2.3) were the most common predisposing factors for AKI. The mean recovery time for AKI was 7.34 days. Development of AKI was associated with prolonged hospital stay (12.57 vs.8.55 days P <0.01) and delayed recovery. At the end of follow-up all children recovered from AKI. The incidence of AKI in children hospitalized with complications of NS is high. While the occurrence of these AKI episodes may appear transient, a recurrence of such episodes may be detrimental to the long-term outcome of children with NS. Infections and the use of ACEI during relapses are risk factor for the occurrence of AKI.

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With the declaration of severe acute respiratory syndrome novel coronavirus-2019 as pandemic by the World Health Organization on March 11, 2020, there has been a steady rise in number of cases. Chronic kidney disease and dialysis population are risk factors for increased severity of illness. Literature about the coronavirus disease 2019 (COVID-19) in dialysis population is scarce. Management of COVID-19 patients in resource poor setting in a developing country does vary compared to developed nations. Nonavailability of the advanced laboratory facility and the newer medicines forces the treating team to manage the patients with available investigations and drugs. We aimed at analysis of clinical characteristics and outcomes of 84 patients on maintenance hemodialysis (HD). Data of all COVID-positive patients on maintenance HD, who were referred to our center were collected. All patients were given HD on NIKISSO machines. Outcomes of all the admitted patients were analyzed. Maintenance HD group formed majority of the kidney referrals (54%). Age group that was commonly affected was >50 years. Factors associated with mortality were age, diabetes, thrombocytopenia, prolonged baseline activated partial thromboplastin time, admission hypoxemia, high qSOFA score. Institutional Ethics Committee approval has been obtained for the study. Methodology of the study was in accordance with the Declaration of Helsinki. Verbal consent was obtained from patients/ attendants. In the ongoing COVID pandemic, in a developing nation where resources are constrained, it is difficult to salvage the critically ill patients. With the drugs available and the changing strategies, treatment was given to all the patients admitted with bedside renal replacement therapies. Our mortality rate was high compared to other studies due to delay in referral, admission hypoxemia, and late initiation of steroids.

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Live-related renal transplantation in India by “caregiver donors” provides huge financial, emotional, and physical support. Their psychological and mental health has not been addressed. We performed a prospective study using the World Health Organization Quality of Life (WHOQoL) BREF Scores and the Hospital Anxiety and Depression Scales preoperatively, at two weeks and three months after transplant. We included 30 pairs; most donors were females (80%, 60% mothers, 28% wives). The mean age of donors was 43.77 ± 10.64 years (34.8 ± 9.01 for recipients). There was improvement in the WHOQoL BREF after two weeks and three months as follows: physical domain (74.30 ± 9.74 vs. 78.30 ± 8.20; P = 0.001), and (74.30 ± 9.74 vs. 86.23 ± 7.25; P <0.001); psychological (74.90 ± 8.44 vs. 82.07 ± 7.19; P <0.001) and (74.90 ± 8.44 vs. 88.07 ± 6.89; P <0.001); environmental (75.33 ± 8.09 vs. 79.57 ± 6.18; P <0.001), and, (75.33 ± 8.09 vs. 86.97 ± 3.8; P <0.001); social-relationships (77.73 ± 8.28 vs. 79.77 ± 7.99; P <0.001), and (77.73 ± 8.28 vs. 84.77 ± 7.45; P <0.001). The recipient scores were similar. Factors with significant Pearson’s or standardized beta co-efficient were donor age <20 years, donor complications, donor anxiety, education (<12^th standard), recipient hospital stay (>3 weeks), and, recipient complications (increased creatinine, hemodialysis, lymphocele, and graft dysfunction). The median anxiety scores of donors increased significantly two weeks after operation but later became normal. Caregiver donors have improved QoL scores, despite kidney donation; a larger study is needed.

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Results from biopsy registries are important to know about the prevalence of renal diseases. In large studies done over several years, significant interobserver variability could have existed. Single-year biopsy registry data are analyzed in this study. The study included 481 renal biopsy specimens including 65 from allografts. Primary glomerulonephritis constituted 37.74% and secondary glomerular diseases constituted 32.21% of native kidney biopsies. Minimal change disease was the most common primary glomerular disease, followed by membranous nephropathy (MN). Lupus nephritis was the most common secondary glomerular disease. This study included specimens from 34 geriatric patients and MN was the most common lesion in that age group. Acute cellular rejection was the most common diagnosis in renal allograft biopsies.

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