Papers by Nephrology – Open Journal
Openventio Publishers, 2023
Background
Donor nephrectomy for living donor kidney transplantation using minimally invasive te... more Background
Donor nephrectomy for living donor kidney transplantation using minimally invasive techniques is a safe procedure that has been used for more than 20 years with excellent results. The total minimally invasive approach offers decreased postoperative pain, better cosmesis, a lower chance of incisional hernia, and a faster recovery time.
Methods
We present the results of a series of 120 laparoscopic donor nephrectomies performed at our center. The procedures were performed with transperitoneal access using the standard five ports. The main renal artery and vein were ligated using a hemo-o-lock clip. The specimen was extracted through the additional inguinal incision.
Results
All procedures were performed laparoscopically without conversion to open surgery. The average warm ischemia time was 4.0 min. In all recipients, immediate kidney allograft function was seen.
Conclusion
Total laparoscopic living donor nephrectomy is a safe procedure that gives the highest benefit to the donor. It was performed successfully in all cases, with a short operative time and no morbidity or mortality.
Openventio Publishers, 2023
Vascular complications following renal transplant surgery are extremely uncommon, and pseudoaneur... more Vascular complications following renal transplant surgery are extremely uncommon, and pseudoaneurysm is even rarer, with an incidence of 0.3%. The presentation can vary from acute blood loss to chronic dull aching pain, anorexia, etc. Majority of pseudoaneurysms are associated with allograft loss. We present a case of an anastomotic pseudoaneurysm successfully managed with an endovascular approach. A 54-year-old female, post cadaveric renal transplant (end-to-end anastomosis between the renal artery and right internal iliac artery) presented on post-operative day 159 with complaint of fever with chills. On treating conservatively with antibiotics, the fever subsided, only to recur after 5-days. On further investigation, c-reactive protein (CRP) was found to be persistently elevated. Patient’s fever of unknown origin was further investigated with repeat blood culture and fluoro-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT). Blood culture was positive for Klebsiella pneumoniae sensitive to colistin and tigecycline and FDG-PET showed a 5 cm aneurysm of the juxta anastomotic segment of the right internal iliac vessels, a possible pseudoaneurysm. After a multidisciplinary discussion, the patient underwent renal angiography, an aneurysm was delineated, and a covered stent was placed which partially excluded the aneurysm. The patient responded well to the intervention. Pseudoaneurysm formation is a rare and potentially life-threatening complication and can present even in the late post-operative period. Endovascular management can be a safe approach in carefully selected cases with allograft preservation being of paramount importance.
Openventio Publishers, 2023
Here we report on a patient that consumed recreational drugs, successfully passing a urine drug s... more Here we report on a patient that consumed recreational drugs, successfully passing a urine drug screen (UDS) by consuming a marketed detoxification product. After some exploration of the product consumed, there proved to be a viable mechanism by which the UDS outcome can be manipulated. The UDS relies on urine meeting specific concentration criteria to validate the sample. Dilute samples may mask the tested drugs as they fall below a concentration threshold for detection. Common UDS require a specific gravity with a reference range of 1.003-1.035 and a urine creatinine concentration above 20 mg/dL. Participants are told not to drink fluid for 4-5-hours pre-test to allow urine to concentrate above these thresholds. The 21-year-old female we describe along with each UDS had lab drawings on two separate occasions in which both measurements revealed elevated serum creatinines of 1.8 mg/dL. She had ingested QCarbo Maximum Strength Same-Day Cleansing Formula™, a marketed detoxification product, the day prior to the lab draws. The product recommended that the consumer ingest a large volume of water to “flush” the drugs from the body. This resulted in dilution of her urine to cause the drug levels to fall below the detectable range, while still exceeding the urine creatinine concentration to provide a valid test. Although she was unaware that this product increased both serum and urine creatinine, this proved successful. She passed the test and was awarded the position.
Openventio Publishers, 2021
Living with chronic kidney disease (CKD) is associated with hardships for patients and their care... more 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.
Openventio Publishers, 2021
Introduction
Acute antibody-mediated rejection (aAMR) can negatively impact renal allografts outc... more Introduction
Acute antibody-mediated rejection (aAMR) can negatively impact renal allografts outcomes. To date, there has not been a consistent therapeutic approach to manage aAMR. The aim of the study is to evaluate the tolerance and efficacy of an institutional
protocol of methylprednisolone, intravenous gamma globulin (IVIG), rituximab, and bortezomib used to treat aAMR in pediatric
renal transplant recipients (pRTRs).
Methods
A retrospective chart review was performed on 10 pediatric renal transplant recipients (pRTRs) who were diagnosed with aAMR
on a renal biopsy performed between January 2014 and November 2015.
Results
Over the study period, 9.5% of pRTRs had aAMR. Sixty percent of whom had concurrent acute cellular rejection (ACR). Renal
allografts survival was 100% during the the first post-aAMR. At the time of diagnosis of aAMR, estimated glomerular filtration
rate (eGFR) had decreased by 42% (mean at baseline eGFR=67.2±19.5 mL/min/1.73 m2 vs mean at aAMR eGFR=38.9±14.2
mL/min/1.73 m2
; p=0.002). At 1-year post rejection, eGFR had increased by 26% as compared eGFR at the time of rejection
(mean eGFR=49.0±13.2 mL/min/1.73 m2
; p=0.006). Immuno-dominant donor-specific anti-HLA antibody titers (iDSAs) class
I and class II decreased by 69% and 15% at 6-month follow-up visit. No serious opportunistic infections nor malignancy were
reported in our subjects.
Conclusion
Our study suggests that our protocol improved kidney function with 100% graft survival at 1-year post aAMR episode. The percentage decline in iDSAs class I titers was more significant than class II. Furthermore, our treatment protocol was well-tolerated
with no life threatening complications.
Openventio Publishers, 2020
Aim
Fluid overload is a major contributor to mortality in critically ill patients but is difficul... more Aim
Fluid overload is a major contributor to mortality in critically ill patients but is difficult to estimate clinically. Bioimpedance has
been used to estimate fluid volumes with three different methods of analysis:1. single-frequency; 2. multi-frequency; 3. bioimpedance spectroscopy. The aim of this study is to assess the accuracy of different types of bioimpedance analysis in detecting changes
in fluid volumes.
Methods
Prospective observational study, in end-stage renal disease patients requiring dialysis, in a tertiary care center. During hemodialysis, we assessed the correlation between change in estimated total body water volumes, as measured by all three methods of
bioimpedance, and fluid volumes removed, as measured by changes in body weight.
Results
Twenty-four pediatric and adult patients were included in the study (median age 42.4 years) with a total of 30 study assessments
performed. There was a weak correlation between change in body weight and change in estimated total body water volumes
(R=0.15, 0.41, and 0.38, respectively). In the Bland-Altman analysis, the mean biases along with their associated 95% confidence
limits of agreement were -0.23 L (-4.1 to 3.5 L) for single-frequency; -1.1 L (-4.1 to 1.9 L) for multi-frequency; and -0.6 L (-6.1 to
4.8 L) for bioimpedance spectroscopy.
Conclusion
In this study of end-stage renal disease patients requiring dialysis, the accuracy of bioimpedance measurement to evaluate fluid
changes was poor, regardless of bioimpedance modality.
Openventio Publishers, 2019
Transcriptomics has allowed for a better understanding of disease, and the sequencing of individu... more Transcriptomics has allowed for a better understanding of disease, and the sequencing of individual genes is becoming a leading
approach to discovering novel germ lines. A newly defined cell type, described as transitional cells, was characterized based on
their expression of key marker genes that define principle cells (PC) and intercalated cells (IC). Gene expression patterns suggested that a Notch signaling pathway was activated during the transition from IC to PC. An experimental model studying the
transition in an inducible transgenic mouse demonstrated that Notch signaling and receptor expression is sufficient to drive cell
transition in differentiated adult kidney collecting tubule. The identification of novel cell lines allows for a more accurate diagnosis
of kidney disease and precise staging of disease. Molecular profiling and precision therapy will continue to revolutionize the field
of medicine and warrants further exploration.
Openventio Publishers, 2019
Introduction
There is a global increase in occupational exposure to solvents, some of which are s... more Introduction
There is a global increase in occupational exposure to solvents, some of which are suspected to cause acute or chronic toxic
nephropathies in humans. However, limited studies have been done to evaluate the systemic effects of exposure to some of the
commonly used solvents such as paints.
Aim
The aim of the present study was to assess the effect of chronic exposure to paint fumes on renal and hepatic functions of industrial spray painters.
Methodology
In this cross-sectional study, 49 occupationally exposed male industrial spray painters who had served for greater than 5 years
were evaluated for changes in renal, hepatic and hematological indices using standard instruments and results were compared with
levels in the unexposed (sex and age-matched) participants.
Results
Significant changes in markers of renal, hepatic and hematological functions were observed in the exposed compared with unexposed participants including significant decrease in estimated glomerular filtration rate (eGFR) and serum levels of potassium
(K+) and chloride (Cl-
), and significant increases in serum levels of creatinine (Cr), sodium (Na+), urea (Ur) and uric acid (UA) in
the exposed compared to levels in the unexposed group. Abnormal serum levels of hepatic enzymes (AST, ALT and ALP) and
hematological indices (PCV, total-RBC, nuetrophils, basophils, monocytes and lymphocytes) were also observed in the exposed
compared to levels in the unexposed participants.
Conclusion
Prolonged exposure to paint fumes may be associated with a significant risk for hepato-renal dysfunction and hematotoxicity.
Preventive measures should include limiting exposure and using antioxidant medications.
Openventio Publishers, 2017
Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disease that causes significant... more Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disease that causes significant morbidity and mortality. The main manifestation of the disease is cyst formation in the nephron and liver, the pathogenesis of which involves the primary cilia. Recently, the mecha-nosensory ability of primary cilia which leads to calcium signaling has come into question. It is hypothesized that failed control of a physiologic process called cyst-dependent cyst activation (CDCA) contributes to cyst formation in ADPKD. Studies into the dysregulation of CDCA may reveal the exact mechanism for cystogenesis in ADPKD. Autosomal dominant polycystic kidney disease (ADPKD) caused by mutations in either of two genes, PKD1 or PKD2, is the 4 th leading cause of end-stage renal disease (ESRD) in adults, affecting approximately 12.5 million people worldwide. 1 ADPKD is characterized by the development of epithelial-lined cysts in the kidney, liver, and pancreas and the presence of connective tissue abnormalities. At the cellular level, changes in cell polarity and structural variation to the extracellular matrix are also seen. 2 The protein products of PKD1 and PKD2 are transmembrane proteins called polycystin 1 (PC1) and polycystin 2 (PC2), respectively. 3 PC1 is a glycoprotein and is found in the luminal membrane of renal tubular cells, at apical junctions and in the primary cilium. PC1 has a large extracytoplasmic domain and a short cytoplasmic tail. The N-terminal region is located at the extracytoplasmic domain and the C-terminal region is at the cytoplasmic tail. When proteins bind to PC1, it is usually at the cytoplasmic tail. PC1 interacts with PC2 through the C-terminal region. This interaction forms a Ca 2+-permeable mechanosensitive ion channel. PC1 has been hypothesized to have receptor type function on primary cilia. For a long time, PC1 has also been thought to have a sensory function; however, recent studies contradict that notion. 4 PC1 was found to play a role in Ca 2+ signaling when it was shown that cells lacking PC1 had little or no Ca 2+ influx to their cytoplasm after the application of shear stress to the cells' cilia. However, the mechanism of Ca 2+ influx and the function of PC1 has come into question in recent studies. 4,5 A full understanding of the function of polycystins, how they are controlled, and the roles of PC1 and PC2 has yet to be reached. 6 The exact cause of cyst formation in ADPKD is also not yet known. Primary cilia play an important role in the pathogenesis of ADPKD; however, not in the way originally thought. 4 Further, investigations of the various signaling pathways associated with primary cilia will most likely uncover the
Openventio Publishers, 2019
Kidney disease is a global public health problem, affecting over 750 million persons worldwide. I... more Kidney disease is a global public health problem, affecting over 750 million persons worldwide. In many settings, rates of kidney
disease and the provision of its care are defined by socio-economic, cultural, and political factors leading to significant disparities.
World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and
current state of global capacity for prevention and management.
Openventio Publishers, 2017
In India around 20,000 people are dependent upon hemodialysis. The greatest burden of morbidity
a... more In India around 20,000 people are dependent upon hemodialysis. The greatest burden of morbidity
and mortality for hemodialysis patients are cardiovascular diseases (CVDs) including
fluctuations in blood pressure, as CVDs account for approximately 50% of all deaths. Intradialytic
hypertension (IDH) is one such complication responsible for increased morbidity and
mortality in chronic kidney disease (CKD) patients undergoing hemodialysis. In India, there
is limited data available in the literature for the incidence of IDH in CKD patients on hemodialysis.
In this observational study, we evaluated the incidence of IDH in Indian CKD patients
undergoing hemodialysis. We found a higher incidence of IDH (34.51%) in our cohort than in
Western studies. These patients were further evaluated for the association of IDH with contributory
factors and patient outcomes after one year of follow-up. This analysis yielded a
novel finding of a higher incidence of IDH in patients with lower creatinine, which needs to be
confirmed with multicenter trials.
Openventio Publishers, 2017
Carcinoid tumors are low grade malignant neoplasms which classically occur in the
gastrointestina... more Carcinoid tumors are low grade malignant neoplasms which classically occur in the
gastrointestinal tract and in the lungs. This is explained by the presence of neuroendocrine
cells in these organs. The kidney is an extremely rare localization for this tumor as there are
no neuroendocrine cells in normal renal parenchyma. Thus, a very few reported cases of this
disease can be found in the literature. We report another case of primary carcinoid tumor of the
kidney in a 60 year old Moroccan woman who complained of an intermittent left flank pain.
Abdominal computed tomography (CT) scan objectified a renal mass, highly suspicious of
malignancy. Histological examination of the specimen after nephrectomy confirmed a renal
carcinoid tumor. This case presentation seeks to add another report with the view of enriching
the existing literature. Through this case report we will present our clinical workup and surgical
intervention of this rare urological neoplasm.
Openventio Publishers, 2015
A New Hypothesis: The Immunomodulatory
Effects of Mesenchymal Stromal Cell
Derived Extracellular ... more A New Hypothesis: The Immunomodulatory
Effects of Mesenchymal Stromal Cell
Derived Extracellular Vesicles in Ischemic
Kidney Injury Partly through Spleen
Openventio Publishers, 2015
Introduction: A wrong estimate of the dry weight in hemodialysis patients increases their morbidi... more Introduction: A wrong estimate of the dry weight in hemodialysis patients increases their morbidity
and mortality. The aim of our study was to compare the results of the estimated dry
weight using the clinical examination with the results of the lung ultrasound, impedance measurement,
ultrasound of the inferior vena cava and B-type Natriuretic Peptide (BNP) assay.
Methods: A cross-sectional study was conducted in an hemodialysis center at Fez. The estimated
dry weight of the patients was evaluated before and 30-60 minutes after the hemodialysis
session using the four above-mentioned methods.
Results: The values, measured by the different techniques used, drop significantly after hemodialysis
(p<0.001). The measurement studied before and after the hemodialysis, had shown a
significant correlation between the results of the impedance measurement, lung ultrasound, the
maximum and minimum of the Venous Collapsibility Index (VCI) index diameter as well as
its collapsibility. However, no correlation was found between BNP levels and other methods.
A significant difference between the results provided by the techniques studied and the results
of the clinical evaluation was found in 84.4% of patients. In univariate analysis, only age was
significantly shown as an associated factor with error estimation (p<0.04).
Conclusion: This study is one of the few studies using lung ultrasound to assess the hydration
status of hemodialysis patients. It also showed a good correlation with other methods. The existence
of a gap between the subjective and objective target weight suggests the usefulness of a
systematic periodic use of bioimpedance and ultrasound techniques even if clinical symptoms
are absent.
Openventio Publishers, 2015
Diabetic nephropathy is a leading cause of end-stage renal failure. Approximately
20-40% patients... more Diabetic nephropathy is a leading cause of end-stage renal failure. Approximately
20-40% patients with diabetes mellitus will develop nephropathy with a significant proportion
requiring regular dialysis or kidney transplantation. The International Diabetes Federation
estimates that 366 million people had diabetes worldwide in 2011 and 552 million people will
have this disease by 2030.1 The increasing incidence of diabetes elevates diabetic nephropathy
to one of the most important current public health issues, representing a significant burden on
the health system.2 Despite current interventional strategies being intensively implemented,
the number of patients with diabetes requiring renal replacement therapy for end-stage renal
disease is growing.3 Current treatments of diabetic nephropathy slow its progression,3 so the
optimal therapeutic strategy to arrest or reverse the nephropathy is needed urgently. As multiple
risk factors and their interactions promote the development of diabetic nephropathy, targeting
a single factor may be ineffective in the treatment of this disease; thus, optimal treatments by
targeting multiple factors need to be developed to arrest or reverse the diabetic nephropathy.
Openventio Publishers, 2015
Introduction: Little is known about patients sustaining Acute Kidney Injury (AKI) in the Communit... more Introduction: Little is known about patients sustaining Acute Kidney Injury (AKI) in the Community
Acquired Acute Kidney Injury (CA-AKI) and how this differs from AKI in Hospital Acquired
Acute Kidney Injury (HA-AKI). The objective of this study is to compare epidemiology,
clinical characteristics, etiologies, severity and outcomes of patients of these two categories.
Methods: A prospective study was conducted during seven months from September 2012 to
March 2013 in Hassan II University Hospital including all patients admitted to different departments
of the hospital and having AKI. AKI was verified by applying the Acute Kidney Injury
Network (AKIN) criteria, and patients were categorized as CA-AKI if AKIN criteria were met
at admission. While HA-AKI was defined as if AKIN criteria were met twenty-four hours or
longer after hospitalization.
Results: Among the 210 patients with AKI, 157 were classified as CA-AKI (74.8%). There
was no significant difference in age average and comorbidities between CA-AKI and HA-AKI.
Dehydration and volume depletion were significantly more prevalent in patients with CA-AKI
(47.7% vs. 34% for HA-AKI p<0.04). While HA-AKI was associated with a significantly higher
prevalence of acute tubular necrosis than CA-AKI (50% vs. 3,8% in CA-AKI p<0.0001).
Having the same severity of AKI, the two groups had sustained a high rate of residual renal failure.
Also there were no significant differences between the numbers of patients requiring renal
replacement therapy, and the length of hospital stay in both groups. The mortality in hospital
was significantly higher in the HA-AKI group compared to AC-AKI group (39.6% AH-AKI
versus 25.4% AC-AKI p<0.03).
Conclusion: This study highlights that risk factors for CA-AKI and HA-AKI are similar, with
CA-AKI also being similar in patients with preexisting CKD, diabetes, heart disease, hypertension,
and cancer. This highlights the clinical characteristics of people in the community
who may benefit from more frequent blood tests in the event of an acute illness or medication
change.
Openventio Publishers, 2015
Kidney cancer is one of the top ten most common cancers in men and women. There
are four types of... more Kidney cancer is one of the top ten most common cancers in men and women. There
are four types of kidney cancer, including Renal Cell Carcinoma (RCC), Transitional cell
carcinoma, renal sarcoma, and Wilm’s tumor. The most common type of kidney cancers is
renal cell carcinoma (RCC), with around nine out of ten kidney cancers being RCC (American
Cancer Associate). Epidemiology studies have identified several risk factors associated with
kidney cancer.1 Among them, male gender is associated with twice incidence rate of RCC
as female.2 Androgen and Androgen Receptor (AR) are major factors contributing to malegender-
associated-diseases, such as prostate cancer,3 suggesting that androgen and AR might
be involved in RCC development and progression.
Openventio Publishers, 2016
During the past decade a lot of work has been done to better understand the roles
of fibroblast g... more During the past decade a lot of work has been done to better understand the roles
of fibroblast growth factor-23 (FGF-23); a relatively newly discovered endocrine hormone,
in multiple organ systems in the body. This review focuses on expressions of FGF-23, coexpressions
of α-Klotho and FGF receptors, and FGF-23 mediated end-organ effects in the
physiological and pathological conditions. We also discuss the controversial reports regarding
α-Klotho-dependent and α-Klotho-independent functions of FGF-23.
Openventio Publishers, 2015
Objective: To document general baseline data on the patterns of childhood genitourinary tumors.
D... more Objective: To document general baseline data on the patterns of childhood genitourinary tumors.
Design, Setting and Participants: This is a retrospective analysis of 28 cases of pediatric genitourinary
tumors (Age group 0-12 years) in surgical pathology in a tertiary care hospital encountered
over a period of 5 years.
Results: In the genitourinary system tumors of the kidney, bladder, prostate, testis, and adrenal
were included. A total of 3149 pediatric surgical specimen presented over a five years. Of this,
28 were diagnosed with genitourinary tumors. In the renal tumors only Wilm’s tumors (WTs) (9
cases) was seen, with classical triphasic tumors were more common. The mean age of presentation
is 3 year with commonest age group of presentation (8 cases out of 9) in the age group 1-5
years. Three of them had showed unfavorable histology. Among the gonadal germ cell tumors,
there were noted four mature teratoma, one immature teratoma, two yolk sac tumors of ovary
& one yolk sac tumour in testis was seen. In the adrenal gland, adrenal medullary tumors were
more common than adrenal cortex with neuroblastoma (4 of 10 cases) as common individual
tumor.
Conclusion: Different types of genitourinary tumors seen in the childhood. A high index of
suspicion should be maintained with an aim of surgical treatment to avoid the poor management.
Histological type is important for understanding etiology and progression of disease. The
likelihood of a given type of tumor being present in a particular age or sex group or particular
site may heighten the index of suspicion and ultimately influences etiology, biology, and natural
history, relative incidence and distribution frequency, clinical presentation and manifestations,
and response to therapy and outcome.”
Openventio Publishers, 2016
If history can serve as a guide quite some time can lapse between the inception of a
concept and ... more If history can serve as a guide quite some time can lapse between the inception of a
concept and its proof. For instance, Einstein had described the special theory of relativity in
1905, but he published the general theory of relativity only after thinking about the problems
for 10 years. On March 29, 1919, the opportunity to get proof came. British Astronomer Sir
Arthur Eddington had traveled to Príncipe Island off the western coast of Africa. His team
photographed star fields during the eclipse and compared the photos with those of the same star
field taken when the sun was not present. Eddington found the apparent location of the stars had
shifted, just as was predicted by Einstein’s theory. That 15-year delay between conception and
proof did not cause suffering or deaths as was the case with the germ theory of Semmelweis,
who did not live to see his momentous insight being accepted. He was declined reappointment
and admitted to an asylum where he died after only two weeks with the following on his mind
“When I look back upon the past, I can only dispel the sadness which falls upon me by gazing
into that happy future when the infection will be banished . . . The conviction that such a time
must inevitably sooner or later arrive will cheer my dying hour”.1
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Papers by Nephrology – Open Journal
Donor nephrectomy for living donor kidney transplantation using minimally invasive techniques is a safe procedure that has been used for more than 20 years with excellent results. The total minimally invasive approach offers decreased postoperative pain, better cosmesis, a lower chance of incisional hernia, and a faster recovery time.
Methods
We present the results of a series of 120 laparoscopic donor nephrectomies performed at our center. The procedures were performed with transperitoneal access using the standard five ports. The main renal artery and vein were ligated using a hemo-o-lock clip. The specimen was extracted through the additional inguinal incision.
Results
All procedures were performed laparoscopically without conversion to open surgery. The average warm ischemia time was 4.0 min. In all recipients, immediate kidney allograft function was seen.
Conclusion
Total laparoscopic living donor nephrectomy is a safe procedure that gives the highest benefit to the donor. It was performed successfully in all cases, with a short operative time and no morbidity or mortality.
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.
Acute antibody-mediated rejection (aAMR) can negatively impact renal allografts outcomes. To date, there has not been a consistent therapeutic approach to manage aAMR. The aim of the study is to evaluate the tolerance and efficacy of an institutional
protocol of methylprednisolone, intravenous gamma globulin (IVIG), rituximab, and bortezomib used to treat aAMR in pediatric
renal transplant recipients (pRTRs).
Methods
A retrospective chart review was performed on 10 pediatric renal transplant recipients (pRTRs) who were diagnosed with aAMR
on a renal biopsy performed between January 2014 and November 2015.
Results
Over the study period, 9.5% of pRTRs had aAMR. Sixty percent of whom had concurrent acute cellular rejection (ACR). Renal
allografts survival was 100% during the the first post-aAMR. At the time of diagnosis of aAMR, estimated glomerular filtration
rate (eGFR) had decreased by 42% (mean at baseline eGFR=67.2±19.5 mL/min/1.73 m2 vs mean at aAMR eGFR=38.9±14.2
mL/min/1.73 m2
; p=0.002). At 1-year post rejection, eGFR had increased by 26% as compared eGFR at the time of rejection
(mean eGFR=49.0±13.2 mL/min/1.73 m2
; p=0.006). Immuno-dominant donor-specific anti-HLA antibody titers (iDSAs) class
I and class II decreased by 69% and 15% at 6-month follow-up visit. No serious opportunistic infections nor malignancy were
reported in our subjects.
Conclusion
Our study suggests that our protocol improved kidney function with 100% graft survival at 1-year post aAMR episode. The percentage decline in iDSAs class I titers was more significant than class II. Furthermore, our treatment protocol was well-tolerated
with no life threatening complications.
Fluid overload is a major contributor to mortality in critically ill patients but is difficult to estimate clinically. Bioimpedance has
been used to estimate fluid volumes with three different methods of analysis:1. single-frequency; 2. multi-frequency; 3. bioimpedance spectroscopy. The aim of this study is to assess the accuracy of different types of bioimpedance analysis in detecting changes
in fluid volumes.
Methods
Prospective observational study, in end-stage renal disease patients requiring dialysis, in a tertiary care center. During hemodialysis, we assessed the correlation between change in estimated total body water volumes, as measured by all three methods of
bioimpedance, and fluid volumes removed, as measured by changes in body weight.
Results
Twenty-four pediatric and adult patients were included in the study (median age 42.4 years) with a total of 30 study assessments
performed. There was a weak correlation between change in body weight and change in estimated total body water volumes
(R=0.15, 0.41, and 0.38, respectively). In the Bland-Altman analysis, the mean biases along with their associated 95% confidence
limits of agreement were -0.23 L (-4.1 to 3.5 L) for single-frequency; -1.1 L (-4.1 to 1.9 L) for multi-frequency; and -0.6 L (-6.1 to
4.8 L) for bioimpedance spectroscopy.
Conclusion
In this study of end-stage renal disease patients requiring dialysis, the accuracy of bioimpedance measurement to evaluate fluid
changes was poor, regardless of bioimpedance modality.
approach to discovering novel germ lines. A newly defined cell type, described as transitional cells, was characterized based on
their expression of key marker genes that define principle cells (PC) and intercalated cells (IC). Gene expression patterns suggested that a Notch signaling pathway was activated during the transition from IC to PC. An experimental model studying the
transition in an inducible transgenic mouse demonstrated that Notch signaling and receptor expression is sufficient to drive cell
transition in differentiated adult kidney collecting tubule. The identification of novel cell lines allows for a more accurate diagnosis
of kidney disease and precise staging of disease. Molecular profiling and precision therapy will continue to revolutionize the field
of medicine and warrants further exploration.
There is a global increase in occupational exposure to solvents, some of which are suspected to cause acute or chronic toxic
nephropathies in humans. However, limited studies have been done to evaluate the systemic effects of exposure to some of the
commonly used solvents such as paints.
Aim
The aim of the present study was to assess the effect of chronic exposure to paint fumes on renal and hepatic functions of industrial spray painters.
Methodology
In this cross-sectional study, 49 occupationally exposed male industrial spray painters who had served for greater than 5 years
were evaluated for changes in renal, hepatic and hematological indices using standard instruments and results were compared with
levels in the unexposed (sex and age-matched) participants.
Results
Significant changes in markers of renal, hepatic and hematological functions were observed in the exposed compared with unexposed participants including significant decrease in estimated glomerular filtration rate (eGFR) and serum levels of potassium
(K+) and chloride (Cl-
), and significant increases in serum levels of creatinine (Cr), sodium (Na+), urea (Ur) and uric acid (UA) in
the exposed compared to levels in the unexposed group. Abnormal serum levels of hepatic enzymes (AST, ALT and ALP) and
hematological indices (PCV, total-RBC, nuetrophils, basophils, monocytes and lymphocytes) were also observed in the exposed
compared to levels in the unexposed participants.
Conclusion
Prolonged exposure to paint fumes may be associated with a significant risk for hepato-renal dysfunction and hematotoxicity.
Preventive measures should include limiting exposure and using antioxidant medications.
disease and the provision of its care are defined by socio-economic, cultural, and political factors leading to significant disparities.
World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and
current state of global capacity for prevention and management.
and mortality for hemodialysis patients are cardiovascular diseases (CVDs) including
fluctuations in blood pressure, as CVDs account for approximately 50% of all deaths. Intradialytic
hypertension (IDH) is one such complication responsible for increased morbidity and
mortality in chronic kidney disease (CKD) patients undergoing hemodialysis. In India, there
is limited data available in the literature for the incidence of IDH in CKD patients on hemodialysis.
In this observational study, we evaluated the incidence of IDH in Indian CKD patients
undergoing hemodialysis. We found a higher incidence of IDH (34.51%) in our cohort than in
Western studies. These patients were further evaluated for the association of IDH with contributory
factors and patient outcomes after one year of follow-up. This analysis yielded a
novel finding of a higher incidence of IDH in patients with lower creatinine, which needs to be
confirmed with multicenter trials.
gastrointestinal tract and in the lungs. This is explained by the presence of neuroendocrine
cells in these organs. The kidney is an extremely rare localization for this tumor as there are
no neuroendocrine cells in normal renal parenchyma. Thus, a very few reported cases of this
disease can be found in the literature. We report another case of primary carcinoid tumor of the
kidney in a 60 year old Moroccan woman who complained of an intermittent left flank pain.
Abdominal computed tomography (CT) scan objectified a renal mass, highly suspicious of
malignancy. Histological examination of the specimen after nephrectomy confirmed a renal
carcinoid tumor. This case presentation seeks to add another report with the view of enriching
the existing literature. Through this case report we will present our clinical workup and surgical
intervention of this rare urological neoplasm.
Effects of Mesenchymal Stromal Cell
Derived Extracellular Vesicles in Ischemic
Kidney Injury Partly through Spleen
and mortality. The aim of our study was to compare the results of the estimated dry
weight using the clinical examination with the results of the lung ultrasound, impedance measurement,
ultrasound of the inferior vena cava and B-type Natriuretic Peptide (BNP) assay.
Methods: A cross-sectional study was conducted in an hemodialysis center at Fez. The estimated
dry weight of the patients was evaluated before and 30-60 minutes after the hemodialysis
session using the four above-mentioned methods.
Results: The values, measured by the different techniques used, drop significantly after hemodialysis
(p<0.001). The measurement studied before and after the hemodialysis, had shown a
significant correlation between the results of the impedance measurement, lung ultrasound, the
maximum and minimum of the Venous Collapsibility Index (VCI) index diameter as well as
its collapsibility. However, no correlation was found between BNP levels and other methods.
A significant difference between the results provided by the techniques studied and the results
of the clinical evaluation was found in 84.4% of patients. In univariate analysis, only age was
significantly shown as an associated factor with error estimation (p<0.04).
Conclusion: This study is one of the few studies using lung ultrasound to assess the hydration
status of hemodialysis patients. It also showed a good correlation with other methods. The existence
of a gap between the subjective and objective target weight suggests the usefulness of a
systematic periodic use of bioimpedance and ultrasound techniques even if clinical symptoms
are absent.
20-40% patients with diabetes mellitus will develop nephropathy with a significant proportion
requiring regular dialysis or kidney transplantation. The International Diabetes Federation
estimates that 366 million people had diabetes worldwide in 2011 and 552 million people will
have this disease by 2030.1 The increasing incidence of diabetes elevates diabetic nephropathy
to one of the most important current public health issues, representing a significant burden on
the health system.2 Despite current interventional strategies being intensively implemented,
the number of patients with diabetes requiring renal replacement therapy for end-stage renal
disease is growing.3 Current treatments of diabetic nephropathy slow its progression,3 so the
optimal therapeutic strategy to arrest or reverse the nephropathy is needed urgently. As multiple
risk factors and their interactions promote the development of diabetic nephropathy, targeting
a single factor may be ineffective in the treatment of this disease; thus, optimal treatments by
targeting multiple factors need to be developed to arrest or reverse the diabetic nephropathy.
Acquired Acute Kidney Injury (CA-AKI) and how this differs from AKI in Hospital Acquired
Acute Kidney Injury (HA-AKI). The objective of this study is to compare epidemiology,
clinical characteristics, etiologies, severity and outcomes of patients of these two categories.
Methods: A prospective study was conducted during seven months from September 2012 to
March 2013 in Hassan II University Hospital including all patients admitted to different departments
of the hospital and having AKI. AKI was verified by applying the Acute Kidney Injury
Network (AKIN) criteria, and patients were categorized as CA-AKI if AKIN criteria were met
at admission. While HA-AKI was defined as if AKIN criteria were met twenty-four hours or
longer after hospitalization.
Results: Among the 210 patients with AKI, 157 were classified as CA-AKI (74.8%). There
was no significant difference in age average and comorbidities between CA-AKI and HA-AKI.
Dehydration and volume depletion were significantly more prevalent in patients with CA-AKI
(47.7% vs. 34% for HA-AKI p<0.04). While HA-AKI was associated with a significantly higher
prevalence of acute tubular necrosis than CA-AKI (50% vs. 3,8% in CA-AKI p<0.0001).
Having the same severity of AKI, the two groups had sustained a high rate of residual renal failure.
Also there were no significant differences between the numbers of patients requiring renal
replacement therapy, and the length of hospital stay in both groups. The mortality in hospital
was significantly higher in the HA-AKI group compared to AC-AKI group (39.6% AH-AKI
versus 25.4% AC-AKI p<0.03).
Conclusion: This study highlights that risk factors for CA-AKI and HA-AKI are similar, with
CA-AKI also being similar in patients with preexisting CKD, diabetes, heart disease, hypertension,
and cancer. This highlights the clinical characteristics of people in the community
who may benefit from more frequent blood tests in the event of an acute illness or medication
change.
are four types of kidney cancer, including Renal Cell Carcinoma (RCC), Transitional cell
carcinoma, renal sarcoma, and Wilm’s tumor. The most common type of kidney cancers is
renal cell carcinoma (RCC), with around nine out of ten kidney cancers being RCC (American
Cancer Associate). Epidemiology studies have identified several risk factors associated with
kidney cancer.1 Among them, male gender is associated with twice incidence rate of RCC
as female.2 Androgen and Androgen Receptor (AR) are major factors contributing to malegender-
associated-diseases, such as prostate cancer,3 suggesting that androgen and AR might
be involved in RCC development and progression.
of fibroblast growth factor-23 (FGF-23); a relatively newly discovered endocrine hormone,
in multiple organ systems in the body. This review focuses on expressions of FGF-23, coexpressions
of α-Klotho and FGF receptors, and FGF-23 mediated end-organ effects in the
physiological and pathological conditions. We also discuss the controversial reports regarding
α-Klotho-dependent and α-Klotho-independent functions of FGF-23.
Design, Setting and Participants: This is a retrospective analysis of 28 cases of pediatric genitourinary
tumors (Age group 0-12 years) in surgical pathology in a tertiary care hospital encountered
over a period of 5 years.
Results: In the genitourinary system tumors of the kidney, bladder, prostate, testis, and adrenal
were included. A total of 3149 pediatric surgical specimen presented over a five years. Of this,
28 were diagnosed with genitourinary tumors. In the renal tumors only Wilm’s tumors (WTs) (9
cases) was seen, with classical triphasic tumors were more common. The mean age of presentation
is 3 year with commonest age group of presentation (8 cases out of 9) in the age group 1-5
years. Three of them had showed unfavorable histology. Among the gonadal germ cell tumors,
there were noted four mature teratoma, one immature teratoma, two yolk sac tumors of ovary
& one yolk sac tumour in testis was seen. In the adrenal gland, adrenal medullary tumors were
more common than adrenal cortex with neuroblastoma (4 of 10 cases) as common individual
tumor.
Conclusion: Different types of genitourinary tumors seen in the childhood. A high index of
suspicion should be maintained with an aim of surgical treatment to avoid the poor management.
Histological type is important for understanding etiology and progression of disease. The
likelihood of a given type of tumor being present in a particular age or sex group or particular
site may heighten the index of suspicion and ultimately influences etiology, biology, and natural
history, relative incidence and distribution frequency, clinical presentation and manifestations,
and response to therapy and outcome.”
concept and its proof. For instance, Einstein had described the special theory of relativity in
1905, but he published the general theory of relativity only after thinking about the problems
for 10 years. On March 29, 1919, the opportunity to get proof came. British Astronomer Sir
Arthur Eddington had traveled to Príncipe Island off the western coast of Africa. His team
photographed star fields during the eclipse and compared the photos with those of the same star
field taken when the sun was not present. Eddington found the apparent location of the stars had
shifted, just as was predicted by Einstein’s theory. That 15-year delay between conception and
proof did not cause suffering or deaths as was the case with the germ theory of Semmelweis,
who did not live to see his momentous insight being accepted. He was declined reappointment
and admitted to an asylum where he died after only two weeks with the following on his mind
“When I look back upon the past, I can only dispel the sadness which falls upon me by gazing
into that happy future when the infection will be banished . . . The conviction that such a time
must inevitably sooner or later arrive will cheer my dying hour”.1
Donor nephrectomy for living donor kidney transplantation using minimally invasive techniques is a safe procedure that has been used for more than 20 years with excellent results. The total minimally invasive approach offers decreased postoperative pain, better cosmesis, a lower chance of incisional hernia, and a faster recovery time.
Methods
We present the results of a series of 120 laparoscopic donor nephrectomies performed at our center. The procedures were performed with transperitoneal access using the standard five ports. The main renal artery and vein were ligated using a hemo-o-lock clip. The specimen was extracted through the additional inguinal incision.
Results
All procedures were performed laparoscopically without conversion to open surgery. The average warm ischemia time was 4.0 min. In all recipients, immediate kidney allograft function was seen.
Conclusion
Total laparoscopic living donor nephrectomy is a safe procedure that gives the highest benefit to the donor. It was performed successfully in all cases, with a short operative time and no morbidity or mortality.
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.
Acute antibody-mediated rejection (aAMR) can negatively impact renal allografts outcomes. To date, there has not been a consistent therapeutic approach to manage aAMR. The aim of the study is to evaluate the tolerance and efficacy of an institutional
protocol of methylprednisolone, intravenous gamma globulin (IVIG), rituximab, and bortezomib used to treat aAMR in pediatric
renal transplant recipients (pRTRs).
Methods
A retrospective chart review was performed on 10 pediatric renal transplant recipients (pRTRs) who were diagnosed with aAMR
on a renal biopsy performed between January 2014 and November 2015.
Results
Over the study period, 9.5% of pRTRs had aAMR. Sixty percent of whom had concurrent acute cellular rejection (ACR). Renal
allografts survival was 100% during the the first post-aAMR. At the time of diagnosis of aAMR, estimated glomerular filtration
rate (eGFR) had decreased by 42% (mean at baseline eGFR=67.2±19.5 mL/min/1.73 m2 vs mean at aAMR eGFR=38.9±14.2
mL/min/1.73 m2
; p=0.002). At 1-year post rejection, eGFR had increased by 26% as compared eGFR at the time of rejection
(mean eGFR=49.0±13.2 mL/min/1.73 m2
; p=0.006). Immuno-dominant donor-specific anti-HLA antibody titers (iDSAs) class
I and class II decreased by 69% and 15% at 6-month follow-up visit. No serious opportunistic infections nor malignancy were
reported in our subjects.
Conclusion
Our study suggests that our protocol improved kidney function with 100% graft survival at 1-year post aAMR episode. The percentage decline in iDSAs class I titers was more significant than class II. Furthermore, our treatment protocol was well-tolerated
with no life threatening complications.
Fluid overload is a major contributor to mortality in critically ill patients but is difficult to estimate clinically. Bioimpedance has
been used to estimate fluid volumes with three different methods of analysis:1. single-frequency; 2. multi-frequency; 3. bioimpedance spectroscopy. The aim of this study is to assess the accuracy of different types of bioimpedance analysis in detecting changes
in fluid volumes.
Methods
Prospective observational study, in end-stage renal disease patients requiring dialysis, in a tertiary care center. During hemodialysis, we assessed the correlation between change in estimated total body water volumes, as measured by all three methods of
bioimpedance, and fluid volumes removed, as measured by changes in body weight.
Results
Twenty-four pediatric and adult patients were included in the study (median age 42.4 years) with a total of 30 study assessments
performed. There was a weak correlation between change in body weight and change in estimated total body water volumes
(R=0.15, 0.41, and 0.38, respectively). In the Bland-Altman analysis, the mean biases along with their associated 95% confidence
limits of agreement were -0.23 L (-4.1 to 3.5 L) for single-frequency; -1.1 L (-4.1 to 1.9 L) for multi-frequency; and -0.6 L (-6.1 to
4.8 L) for bioimpedance spectroscopy.
Conclusion
In this study of end-stage renal disease patients requiring dialysis, the accuracy of bioimpedance measurement to evaluate fluid
changes was poor, regardless of bioimpedance modality.
approach to discovering novel germ lines. A newly defined cell type, described as transitional cells, was characterized based on
their expression of key marker genes that define principle cells (PC) and intercalated cells (IC). Gene expression patterns suggested that a Notch signaling pathway was activated during the transition from IC to PC. An experimental model studying the
transition in an inducible transgenic mouse demonstrated that Notch signaling and receptor expression is sufficient to drive cell
transition in differentiated adult kidney collecting tubule. The identification of novel cell lines allows for a more accurate diagnosis
of kidney disease and precise staging of disease. Molecular profiling and precision therapy will continue to revolutionize the field
of medicine and warrants further exploration.
There is a global increase in occupational exposure to solvents, some of which are suspected to cause acute or chronic toxic
nephropathies in humans. However, limited studies have been done to evaluate the systemic effects of exposure to some of the
commonly used solvents such as paints.
Aim
The aim of the present study was to assess the effect of chronic exposure to paint fumes on renal and hepatic functions of industrial spray painters.
Methodology
In this cross-sectional study, 49 occupationally exposed male industrial spray painters who had served for greater than 5 years
were evaluated for changes in renal, hepatic and hematological indices using standard instruments and results were compared with
levels in the unexposed (sex and age-matched) participants.
Results
Significant changes in markers of renal, hepatic and hematological functions were observed in the exposed compared with unexposed participants including significant decrease in estimated glomerular filtration rate (eGFR) and serum levels of potassium
(K+) and chloride (Cl-
), and significant increases in serum levels of creatinine (Cr), sodium (Na+), urea (Ur) and uric acid (UA) in
the exposed compared to levels in the unexposed group. Abnormal serum levels of hepatic enzymes (AST, ALT and ALP) and
hematological indices (PCV, total-RBC, nuetrophils, basophils, monocytes and lymphocytes) were also observed in the exposed
compared to levels in the unexposed participants.
Conclusion
Prolonged exposure to paint fumes may be associated with a significant risk for hepato-renal dysfunction and hematotoxicity.
Preventive measures should include limiting exposure and using antioxidant medications.
disease and the provision of its care are defined by socio-economic, cultural, and political factors leading to significant disparities.
World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and
current state of global capacity for prevention and management.
and mortality for hemodialysis patients are cardiovascular diseases (CVDs) including
fluctuations in blood pressure, as CVDs account for approximately 50% of all deaths. Intradialytic
hypertension (IDH) is one such complication responsible for increased morbidity and
mortality in chronic kidney disease (CKD) patients undergoing hemodialysis. In India, there
is limited data available in the literature for the incidence of IDH in CKD patients on hemodialysis.
In this observational study, we evaluated the incidence of IDH in Indian CKD patients
undergoing hemodialysis. We found a higher incidence of IDH (34.51%) in our cohort than in
Western studies. These patients were further evaluated for the association of IDH with contributory
factors and patient outcomes after one year of follow-up. This analysis yielded a
novel finding of a higher incidence of IDH in patients with lower creatinine, which needs to be
confirmed with multicenter trials.
gastrointestinal tract and in the lungs. This is explained by the presence of neuroendocrine
cells in these organs. The kidney is an extremely rare localization for this tumor as there are
no neuroendocrine cells in normal renal parenchyma. Thus, a very few reported cases of this
disease can be found in the literature. We report another case of primary carcinoid tumor of the
kidney in a 60 year old Moroccan woman who complained of an intermittent left flank pain.
Abdominal computed tomography (CT) scan objectified a renal mass, highly suspicious of
malignancy. Histological examination of the specimen after nephrectomy confirmed a renal
carcinoid tumor. This case presentation seeks to add another report with the view of enriching
the existing literature. Through this case report we will present our clinical workup and surgical
intervention of this rare urological neoplasm.
Effects of Mesenchymal Stromal Cell
Derived Extracellular Vesicles in Ischemic
Kidney Injury Partly through Spleen
and mortality. The aim of our study was to compare the results of the estimated dry
weight using the clinical examination with the results of the lung ultrasound, impedance measurement,
ultrasound of the inferior vena cava and B-type Natriuretic Peptide (BNP) assay.
Methods: A cross-sectional study was conducted in an hemodialysis center at Fez. The estimated
dry weight of the patients was evaluated before and 30-60 minutes after the hemodialysis
session using the four above-mentioned methods.
Results: The values, measured by the different techniques used, drop significantly after hemodialysis
(p<0.001). The measurement studied before and after the hemodialysis, had shown a
significant correlation between the results of the impedance measurement, lung ultrasound, the
maximum and minimum of the Venous Collapsibility Index (VCI) index diameter as well as
its collapsibility. However, no correlation was found between BNP levels and other methods.
A significant difference between the results provided by the techniques studied and the results
of the clinical evaluation was found in 84.4% of patients. In univariate analysis, only age was
significantly shown as an associated factor with error estimation (p<0.04).
Conclusion: This study is one of the few studies using lung ultrasound to assess the hydration
status of hemodialysis patients. It also showed a good correlation with other methods. The existence
of a gap between the subjective and objective target weight suggests the usefulness of a
systematic periodic use of bioimpedance and ultrasound techniques even if clinical symptoms
are absent.
20-40% patients with diabetes mellitus will develop nephropathy with a significant proportion
requiring regular dialysis or kidney transplantation. The International Diabetes Federation
estimates that 366 million people had diabetes worldwide in 2011 and 552 million people will
have this disease by 2030.1 The increasing incidence of diabetes elevates diabetic nephropathy
to one of the most important current public health issues, representing a significant burden on
the health system.2 Despite current interventional strategies being intensively implemented,
the number of patients with diabetes requiring renal replacement therapy for end-stage renal
disease is growing.3 Current treatments of diabetic nephropathy slow its progression,3 so the
optimal therapeutic strategy to arrest or reverse the nephropathy is needed urgently. As multiple
risk factors and their interactions promote the development of diabetic nephropathy, targeting
a single factor may be ineffective in the treatment of this disease; thus, optimal treatments by
targeting multiple factors need to be developed to arrest or reverse the diabetic nephropathy.
Acquired Acute Kidney Injury (CA-AKI) and how this differs from AKI in Hospital Acquired
Acute Kidney Injury (HA-AKI). The objective of this study is to compare epidemiology,
clinical characteristics, etiologies, severity and outcomes of patients of these two categories.
Methods: A prospective study was conducted during seven months from September 2012 to
March 2013 in Hassan II University Hospital including all patients admitted to different departments
of the hospital and having AKI. AKI was verified by applying the Acute Kidney Injury
Network (AKIN) criteria, and patients were categorized as CA-AKI if AKIN criteria were met
at admission. While HA-AKI was defined as if AKIN criteria were met twenty-four hours or
longer after hospitalization.
Results: Among the 210 patients with AKI, 157 were classified as CA-AKI (74.8%). There
was no significant difference in age average and comorbidities between CA-AKI and HA-AKI.
Dehydration and volume depletion were significantly more prevalent in patients with CA-AKI
(47.7% vs. 34% for HA-AKI p<0.04). While HA-AKI was associated with a significantly higher
prevalence of acute tubular necrosis than CA-AKI (50% vs. 3,8% in CA-AKI p<0.0001).
Having the same severity of AKI, the two groups had sustained a high rate of residual renal failure.
Also there were no significant differences between the numbers of patients requiring renal
replacement therapy, and the length of hospital stay in both groups. The mortality in hospital
was significantly higher in the HA-AKI group compared to AC-AKI group (39.6% AH-AKI
versus 25.4% AC-AKI p<0.03).
Conclusion: This study highlights that risk factors for CA-AKI and HA-AKI are similar, with
CA-AKI also being similar in patients with preexisting CKD, diabetes, heart disease, hypertension,
and cancer. This highlights the clinical characteristics of people in the community
who may benefit from more frequent blood tests in the event of an acute illness or medication
change.
are four types of kidney cancer, including Renal Cell Carcinoma (RCC), Transitional cell
carcinoma, renal sarcoma, and Wilm’s tumor. The most common type of kidney cancers is
renal cell carcinoma (RCC), with around nine out of ten kidney cancers being RCC (American
Cancer Associate). Epidemiology studies have identified several risk factors associated with
kidney cancer.1 Among them, male gender is associated with twice incidence rate of RCC
as female.2 Androgen and Androgen Receptor (AR) are major factors contributing to malegender-
associated-diseases, such as prostate cancer,3 suggesting that androgen and AR might
be involved in RCC development and progression.
of fibroblast growth factor-23 (FGF-23); a relatively newly discovered endocrine hormone,
in multiple organ systems in the body. This review focuses on expressions of FGF-23, coexpressions
of α-Klotho and FGF receptors, and FGF-23 mediated end-organ effects in the
physiological and pathological conditions. We also discuss the controversial reports regarding
α-Klotho-dependent and α-Klotho-independent functions of FGF-23.
Design, Setting and Participants: This is a retrospective analysis of 28 cases of pediatric genitourinary
tumors (Age group 0-12 years) in surgical pathology in a tertiary care hospital encountered
over a period of 5 years.
Results: In the genitourinary system tumors of the kidney, bladder, prostate, testis, and adrenal
were included. A total of 3149 pediatric surgical specimen presented over a five years. Of this,
28 were diagnosed with genitourinary tumors. In the renal tumors only Wilm’s tumors (WTs) (9
cases) was seen, with classical triphasic tumors were more common. The mean age of presentation
is 3 year with commonest age group of presentation (8 cases out of 9) in the age group 1-5
years. Three of them had showed unfavorable histology. Among the gonadal germ cell tumors,
there were noted four mature teratoma, one immature teratoma, two yolk sac tumors of ovary
& one yolk sac tumour in testis was seen. In the adrenal gland, adrenal medullary tumors were
more common than adrenal cortex with neuroblastoma (4 of 10 cases) as common individual
tumor.
Conclusion: Different types of genitourinary tumors seen in the childhood. A high index of
suspicion should be maintained with an aim of surgical treatment to avoid the poor management.
Histological type is important for understanding etiology and progression of disease. The
likelihood of a given type of tumor being present in a particular age or sex group or particular
site may heighten the index of suspicion and ultimately influences etiology, biology, and natural
history, relative incidence and distribution frequency, clinical presentation and manifestations,
and response to therapy and outcome.”
concept and its proof. For instance, Einstein had described the special theory of relativity in
1905, but he published the general theory of relativity only after thinking about the problems
for 10 years. On March 29, 1919, the opportunity to get proof came. British Astronomer Sir
Arthur Eddington had traveled to Príncipe Island off the western coast of Africa. His team
photographed star fields during the eclipse and compared the photos with those of the same star
field taken when the sun was not present. Eddington found the apparent location of the stars had
shifted, just as was predicted by Einstein’s theory. That 15-year delay between conception and
proof did not cause suffering or deaths as was the case with the germ theory of Semmelweis,
who did not live to see his momentous insight being accepted. He was declined reappointment
and admitted to an asylum where he died after only two weeks with the following on his mind
“When I look back upon the past, I can only dispel the sadness which falls upon me by gazing
into that happy future when the infection will be banished . . . The conviction that such a time
must inevitably sooner or later arrive will cheer my dying hour”.1