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Infection-related glomerulonephritis (IRGN) results from an immune-mediated process in the occurrence of non-renal infection. Despite increased incidence of infections post-transplant, which is attributed to the immunosuppression, IRGN serves to be a rare cause of de novo GN. Here, we present a 43-year old male, a deceased donor renal transplant recipient, who presented with acute decline in allograft function that developed in association with IRGN five years after transplant. He continued to have renal allograft dysfunction despite treatment with antibiotics. We infer that IRGN must be thought of as a possible entity, although rare, in the diagnosis of de novo GN post-transplant. Furthermore, the absence of definitive treatment protocol makes this emerging cause of renal allograft dysfunction be associated with the poor prognosis.Oliguria in the early postoperative phase after renal transplantation has many causes with overlapping presentations. Page kidney refers to external compression of the kidney by a hematoma, urinoma or tumor, leading to parenchymal hypoperfusion, unexplained hypertension (HTN), or frank acute renal failure. About 100 cases of Page kidney are reported; mostly after kidney biopsy. After the analysis of records, we identified four cases of acute Page kidney posttransplant, akin to a compartment syndrome. All biochemical, laboratory, and clinical parameters were recorded. Cases occurred within two to three weeks of transplant, with different causes. Clinical presentation was sudden, with HTN, raised serum creatinine and perigraft swelling in all. Rejection co-existed Page kidney in two cases, while tacrolimus had to be potentiated with diltiazem in one case. Serial parameters such as increased resistive index (>0.7), perigraft collection, and absent diastolic flow with normal peak systolic velocity were consistent with diagnosis. Two were caused by lymphoceles, more than 3 L. Both were managed by laparoscopic fenestration surgery; probably the first such instance for Page kidney. Two patients had postoperative hematoma; in one case, it followed early percutaneous angiographic stenting and "leakage" from the transplant artery, only the second such report. A high index of suspicion required for diagnosis; after excluding rejection and pre/postrenal causes, aggressive early management is the key for graft salvage.C3 glomerulopathy (C3G) is a rare entity that is defined by glomerular pathology characterized by predominant deposition of C3 in the glomeruli, with absent or scant immunoglobulin deposition. The aim of this study was to diagnose this rare entity, using clinical features, light microscopy (LM) and direct immunofluorescence (DIF) findings. A retrospective study was done from January 2016 to December 2018. Out of 207 kidney biopsies, eight cases of C3G were included in the study. Clinical, laboratory, and demographic data of all patients were obtained. LM and DIF findings were further evaluated. Nephrotic syndrome was the predominant clinical presentation in this study. All eight cases showed a membranoproliferative pattern on LM. DIF showed predominant mesangiocapillary staining with C3 in all eight cases. DIF plays an important role in making the correct diagnosis, which is necessary to further perform appropriate complement investigations, as these patients respond well to complement inhibitor therapy.Acute kidney injury (AKI) is a medical complication that can arise from various causes. This study aimed to determine the incidence of AKI and the predictors for the development of AKI in the medical wards of a tertiary hospital. A prospective cohort study was conducted on patients admitted to the medical wards from November 1 to December 31, 2017. Relevant data were obtained from the electronic hospital information system and medication charts. AKI was defined as an increase in serum creatinine (SCr) by ≥0.3 mg/dL (≥26.5 μmol/L) within 48 h, or increase in SCr to ≥1.5 times baseline, within the last seven days. Fisher's exact test or Pearson's Chi-square test was used to determine the association between characteristics of the patients and AKI. Logistic regression was used to determine possible predictors of AKI. A total of 260 patients [mean age 54.7 (19.0) years, 50.8% male] were included. Of these, 23% (n = 60) developed AKI. About 81% (n = 210) of the patients were exposed to nephrotoxic medications. Predictors of AKI were number of comorbidities [adjusted odds ratio (aOR) 4.3; 95% confidence interval (CI) 1.8-10.3; P = 0.001], diuretics (aOR 2.8; 95% CI 1.2-6.3; P = 0.015), proton pump inhibitors (aOR 2.9; 95% CI 1.4-5.8; P = 0.004), and cephalosporin (aOR 4.5; 95% CI 2.2-9.1; P less then 0.001). Mortality rate during hospitalization was similar between AKI and non-AKI patients (12% vs. 3.5%; aOR 1.9; 95% CI 0.5-6.7; P = 0.324). The risk of AKI is high in patients with multiple comorbidities and exposure to nephrotoxic medications. Further studies are needed to establish the role of nephrotoxic medications in causing AKI and its clinical implications.Acute kidney injury (AKI) in postpartum is a rare, but deadly complication of pregnancy. It has great impact on maternal and fetal outcomes. The study aimed to study the incidence and etiological profile with outcomes of postpartum AKI patients and to see whether need for hemodialysis (HD) alters the outcome. This is a retrospective observation study done in a tertiary care center at the Department of Nephrology, Ramkrishnan Care Hospital, Raipur, Chhattisgarh, India. All postpartum women suffering from AKI between May 2011 and May 2017 were included in this study. Demographic, clinical, and laboratory data of the patients were included. Outcome variables including maternal and fetal mortality with renal outcome during discharge and follow-up for three months were noted. Patients were divided into two groups Group 1 underwent HD and Group 2 was managed conservatively. Statistical analysis was done on the Statistical Package for the Social Sciences software version 17.0. selleck chemicals Categorical data were expressed as rati in our patients. Proper antenatal care and peripartum monitoring with practicing aseptic precaution will definitely help in reduction of postpartum AKI and maternal mortality in our state.The primary objective is to find out the epidemiology, characteristics, preparedness, and survival of elderly patients initiated on dialysis from a tertiary center in Sabah. All newly confirmed patients aged 65 and above who were initiated on renal replacement therapy (RRT) from January 1, 2014, to December 31, 2017, were included. There were two groups of patients Group 1 - optimally prepared for RRT; Group 2 - suboptimally prepared for RRT. Survival outcome was recorded at the 3rd-, 6th-, and 12th-month interval. Diabetes mellitus accounted for majority of the primary cause of end-stage renal disease, 67.3%. The median duration of follow-up was 550 days (interquartile range = 787). There were 81 patients (30.5%) in Group 1. 182 patients (69.2%) in Group 2 were considered as suboptimally prepared for RRT. The survival of this elderly group was 85.6% at 3 months, 74.5% at six months, and 65% at 1 year. Group 2 patients had much poorer survival outcome compared to Group 1 (56% vs. 85.2% at one year, P less then 0.001). Age and RRT preparation appeared to be associated with the survival outcome. Decision in initiating dialysis in this group of patients is not as straightforward as in the younger age groups. A more realistic view on the actual survival, as well as consideration regarding the quality of life after the initiation of dialysis, needs to be taken into account. If dialysis therapy is decided, early preparation is important.Glomerulonephritis (GN) is rare kidney disease that often requires treatment with immunosuppressive drugs. The choice of therapy usually relies on international guidelines. There are no data so far regarding the treatment of glomerular diseases in the eastern Mediterranean region. This study aimed to describe the most frequently treated glomerular diseases among the Lebanese population. This is a retrospective study that reviewed all patients' medication coverage claims, presented at the Lebanese Ministry of Public Health between 2014 and 2015. All patients that had kidney biopsies in their charts were included. A total of 144 patients were included 35 children and 109 adults. Half of the children had minimal change disease treated with mycophenolate mofetil (MMF). In adults, 33% had lupus nephritis (LN) with a male to female ratio 12/24, 28.4% focal segmental glomerulosclerosis (FSGS), 14.6% membranous nephropathy (MN), and 24% other types. There was a significant difference in age among different GN (P = 0.01). MMF was the most commonly used drug in adults 88.8% of LN cases, 51.6% in FSGS, 18.7% in MN, and 100% in immunoglobulin A nephropathy. This study showed that LN is the most frequently treated GN in Lebanon and was managed according to guidelines. MMF use was prevailing even in cases not suggested by the Kidney Disease Improving Global Outcomes. Further studies are needed to see whether these results apply to other countries.There is a paucity of data on epidemiology along with an incomplete registry of end-stage kidney disease (ESKD), nephrologist workforce, and variability among the countries of Gulf Cooperation Council (GCC). The study is an observation, descriptive study which aimed to describe current ESKD burden, nephrologist density, and kidney care infrastructure in GCC. Responses to a questionnaire-based survey obtained from representatives of the Nephrology Societies of GCC countries were analyzed. The categorical variables were compared using Chi-square test. A P = 5% was considered as significant. The mean prevalence of ESKD per million populations (pmp) was 551, highest in Oman (1000/pmp), least in Qatar (347/pmp). Predominant etiology in GCC was diabetes mellitus (DM) and hypertension (HTN) (100%, each), followed by chronic glomerulonephritis (66.7%). A transplant registry was maintained by all GCC countries. Hemodialysis (HD) (67.2%) was the most opted modality of kidney replacement therapy (KRT), followed by kidney transplantation (22%) and peritoneal dialysis (9.6%); 1.0% of patients opted for conservative management. Unplanned initiation of HD was three times more common. The access distribution among incident and prevalent HD patients respectively was (i) nontunneled central catheter (nTCC) (58.7 ± 36.6 vs. 1.5 ± 1.5), (ii) tunneled central catheter (23.5 ± 29.9 vs. 33.6 ± 10.0), and (iii) arteriovenous fistula (17.3± 14.4 vs. 57.8 ± 11.86). Death and transplantation were the reasons for dropout from HD. GCC has adequate kidney care infrastructure. There are 1686 nephrologists [range Bahrain 9, Kingdom of Saudi Arabia (KSA) 1279]. Qatar, KSA, and Kuwait provide training in kidney biopsy; all countries except Bahrain have formal training programs for nTCC placement. ESKD prevalence is high, DM, HTN; glome-rulonephritis (GN) is the most common causes. The need for KRT is expected to rise in GCC. HD is the predominant KRT modality with a high prevalence of dialysis catheters as vascular access.Kidney transplant remains the definitive treatment for patients with end-stage renal disease. A retrospective cohort was conducted in Dr. Selma Center for Kidney Diseases (DSCKD) to determine the pattern of follow-up and outcomes of adult kidney transplant recipients (KTRs) on long-term follow-up. Patients presented for follow-up during the period from January to June 2018 were studied regarding their demographic features, kidney transplant surgery, immunosuppressive therapy, graft function, and post-transplant complications. Data analysis was done using the Statistical Package for the Social Sciences version 16.0. During the study period, a total of 941 adult and pediatric KTR presented to DSCKD for follow-up. Only 792 KTRs were included in the study; those were adults, with their first kidney transplant, completed one year post-transplant, and agreed for enrollment. The mean age of the studied population was 47 ± 4.3 years. The majority were males, 74.2%. The median duration of follow-up was 7.4 years (interquartile range 3-11).
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