R. Ranade, Atul Desai, Mahabaleshwar H Mayya, S. Patil, H. Rani, M. Revanasiddappa
Introduction: Rhabdomyolysis and haemolysis cause pigment nephropathy that progresses to Chronic kidney disease requiring haemodialysis in some patients. As this is a significant financial burden, an understanding of the aetiologies and renal biopsy findings aids in timely diagnosis and optimising the outcomes. Objectives: We analysed the aetiology, clinicopathological features and renal outcome of seventeen patients with pigment nephropathy. Methodology: This Retrospective study was conducted from 2018-2021. Data on detailed clinical history, lab parameters, renal biopsy records, and renal outcome was collected. Results: Among seventeen pateints with Pigment Nephropathy the etiology was rhabdomyolysis in fifteen patients and hemolysis in two patients. Oliguria was the most common clinical presentation and all patients presented as acute kidney injury (AKI). Renal biopsy revealed reddish beaded granule and vermiform like casts in 10, brownish casts with intratubular hemosiderin in 3, granular and calcific casts in 2 patients each. While fourteen patients recovered to normal renal function within 3 months, one progressed to Chronic Kidney Disease stage 5D(CKD), one had CKD stage 2 and one died. Conclusion: In a majority of patients, clinical history did not reveal a direct diagnosis of rhabdomyolysis, and hence one must remain vigilant even in the absence of the classical triad of symptoms.
{"title":"Clinicopathological study of Pigment Induced Nephropathy: A retrospective study","authors":"R. Ranade, Atul Desai, Mahabaleshwar H Mayya, S. Patil, H. Rani, M. Revanasiddappa","doi":"10.34172/jnp.2022.17362","DOIUrl":"https://doi.org/10.34172/jnp.2022.17362","url":null,"abstract":"Introduction: Rhabdomyolysis and haemolysis cause pigment nephropathy that progresses to Chronic kidney disease requiring haemodialysis in some patients. As this is a significant financial burden, an understanding of the aetiologies and renal biopsy findings aids in timely diagnosis and optimising the outcomes. Objectives: We analysed the aetiology, clinicopathological features and renal outcome of seventeen patients with pigment nephropathy. Methodology: This Retrospective study was conducted from 2018-2021. Data on detailed clinical history, lab parameters, renal biopsy records, and renal outcome was collected. Results: Among seventeen pateints with Pigment Nephropathy the etiology was rhabdomyolysis in fifteen patients and hemolysis in two patients. Oliguria was the most common clinical presentation and all patients presented as acute kidney injury (AKI). Renal biopsy revealed reddish beaded granule and vermiform like casts in 10, brownish casts with intratubular hemosiderin in 3, granular and calcific casts in 2 patients each. While fourteen patients recovered to normal renal function within 3 months, one progressed to Chronic Kidney Disease stage 5D(CKD), one had CKD stage 2 and one died. Conclusion: In a majority of patients, clinical history did not reveal a direct diagnosis of rhabdomyolysis, and hence one must remain vigilant even in the absence of the classical triad of symptoms.","PeriodicalId":16515,"journal":{"name":"Journal of Nephropathology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45758829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aimee Hechanova, Pouria Mostafizi, K. Rad, R. Tolouian
{"title":"The ferric conundrum: which intravenous iron preparations are preferred for chronic kidney disease patients?","authors":"Aimee Hechanova, Pouria Mostafizi, K. Rad, R. Tolouian","doi":"10.34172/jnp.2022.17372","DOIUrl":"https://doi.org/10.34172/jnp.2022.17372","url":null,"abstract":"<jats:p>\u0000 </jats:p>","PeriodicalId":16515,"journal":{"name":"Journal of Nephropathology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45327855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Long COVID-19 laboratory findings in hemodialysis patients: Should they be considered post-COVID syndrome?","authors":"N. Stepanova, A. Rysyev","doi":"10.34172/jnp.2022.17346","DOIUrl":"https://doi.org/10.34172/jnp.2022.17346","url":null,"abstract":"<jats:p>\u0000 </jats:p>","PeriodicalId":16515,"journal":{"name":"Journal of Nephropathology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46722574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Sarhan, A. Tawfik, T. E. El Said, Mahmoud Nady Abd El Aziz Abd El Azim, H. Hussein
Introduction: Uremic pruritus is a common discomfort in end-stage renal disease patients on long-term hemodialysis. It negatively affects patients’ quality of life and is associated with increased mortality. The pathogenesis of uremic pruritus is complex. Aluminum is a toxic metal and common human allergen that causes an immune reaction in patients on hemodialysis. Aluminum is hypothesized to play a vital role in the pathogenesis of uremic pruritus. Controlling serum aluminum levels is still critical for patients on long-term hemodialysis. Objectives: To determine the prevalence of hyperaluminemia and assess its correlation with uremic pruritus in patients on long-term hemodialysis. Patients and Methods: We conducted a case-control study on 90 patients on long-term hemodialysis at the dialysis units of Ain Shams university hospitals. We used the 5-D itch scale numerical rating system to determine the presence and severity of pruritus in our study participants. We collected blood samples to estimate blood urea nitrogen levels pre- and post-dialysis, as well as the measured urea reduction ratio, serum creatinine, hemoglobin level, intact parathyroid hormone, ionized calcium, serum phosphate levels, iron study and serum aluminum levels. Results: Our study showed no statistically significant differences between the pruritic and nonpruritic study groups (median values 9.78 [6.48–11.72] and 9.13 [6.3–10.4] for the pruritic and non-pruritic groups, respectively; P = 0.32). Conclusion: The serum aluminum levels of our study participants were higher than the normal levels in humans. Patients in the pruritic group had higher levels than those in the non-pruritic group. However, aluminum levels were not significantly associated with either the presence or severity of pruritus in patients on long-term hemodialysis.
{"title":"Relation of serum aluminum level to uremic pruritus in end-stage renal disease patients on maintenance hemodialysis","authors":"I. Sarhan, A. Tawfik, T. E. El Said, Mahmoud Nady Abd El Aziz Abd El Azim, H. Hussein","doi":"10.34172/jnp.2022.17350","DOIUrl":"https://doi.org/10.34172/jnp.2022.17350","url":null,"abstract":"Introduction: Uremic pruritus is a common discomfort in end-stage renal disease patients on long-term hemodialysis. It negatively affects patients’ quality of life and is associated with increased mortality. The pathogenesis of uremic pruritus is complex. Aluminum is a toxic metal and common human allergen that causes an immune reaction in patients on hemodialysis. Aluminum is hypothesized to play a vital role in the pathogenesis of uremic pruritus. Controlling serum aluminum levels is still critical for patients on long-term hemodialysis. Objectives: To determine the prevalence of hyperaluminemia and assess its correlation with uremic pruritus in patients on long-term hemodialysis. Patients and Methods: We conducted a case-control study on 90 patients on long-term hemodialysis at the dialysis units of Ain Shams university hospitals. We used the 5-D itch scale numerical rating system to determine the presence and severity of pruritus in our study participants. We collected blood samples to estimate blood urea nitrogen levels pre- and post-dialysis, as well as the measured urea reduction ratio, serum creatinine, hemoglobin level, intact parathyroid hormone, ionized calcium, serum phosphate levels, iron study and serum aluminum levels. Results: Our study showed no statistically significant differences between the pruritic and nonpruritic study groups (median values 9.78 [6.48–11.72] and 9.13 [6.3–10.4] for the pruritic and non-pruritic groups, respectively; P = 0.32). Conclusion: The serum aluminum levels of our study participants were higher than the normal levels in humans. Patients in the pruritic group had higher levels than those in the non-pruritic group. However, aluminum levels were not significantly associated with either the presence or severity of pruritus in patients on long-term hemodialysis.","PeriodicalId":16515,"journal":{"name":"Journal of Nephropathology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69815753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Gutierrez, M. Fortunato, C. Vigliano, M. F. Toniolo, Álvaro Espinoza, P. Raffaele
Gitelman syndrome is an autosomal recessive hereditary tubulopathy whose main alteration is at the sodium-chloride symporter in the distal convoluted tubule, characterized by metabolic alkalosis, normotension, hypokalemia, hypomagnesemia and hypocalciuria. Proteinuria and glomerular hyperfiltration (especially at the beginning of clinical course) are not characteristic manifestations of this disease. We present the case of a 25-year-old female with recent diagnosis of Gitelman syndrome who presented with hyperfiltration and glomerular proteinuria, leading to a renal biopsy, which showed hypertrophy of juxtaglomerular apparatus and mesangial proliferation. In electron microscopy focal podocyte detachment was evidenced, which was compatible with secondary focal segmental glomerulosclerosis (FSGS). This case of association of tubulopathy with secondary glomerulopathy of early presentation, shows the final pathway in this disease, when generating sustained renal ischemia due to the increased activity of renin-angiotensin-aldosterone system (RAAS). Renal biopsy and electron microscopy proved to be useful to define prognosis, early recognition of progression and adjust treatment in this patient.
{"title":"Unusual association of Gitelman syndrome with early diagnosis and glomerular proteinuria; a case report","authors":"R. Gutierrez, M. Fortunato, C. Vigliano, M. F. Toniolo, Álvaro Espinoza, P. Raffaele","doi":"10.34172/jnp.2022.17142","DOIUrl":"https://doi.org/10.34172/jnp.2022.17142","url":null,"abstract":"Gitelman syndrome is an autosomal recessive hereditary tubulopathy whose main alteration is at the sodium-chloride symporter in the distal convoluted tubule, characterized by metabolic alkalosis, normotension, hypokalemia, hypomagnesemia and hypocalciuria. Proteinuria and glomerular hyperfiltration (especially at the beginning of clinical course) are not characteristic manifestations of this disease. We present the case of a 25-year-old female with recent diagnosis of Gitelman syndrome who presented with hyperfiltration and glomerular proteinuria, leading to a renal biopsy, which showed hypertrophy of juxtaglomerular apparatus and mesangial proliferation. In electron microscopy focal podocyte detachment was evidenced, which was compatible with secondary focal segmental glomerulosclerosis (FSGS). This case of association of tubulopathy with secondary glomerulopathy of early presentation, shows the final pathway in this disease, when generating sustained renal ischemia due to the increased activity of renin-angiotensin-aldosterone system (RAAS). Renal biopsy and electron microscopy proved to be useful to define prognosis, early recognition of progression and adjust treatment in this patient.","PeriodicalId":16515,"journal":{"name":"Journal of Nephropathology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45731774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seyyedeh Sahereh Mortazavi Khatibani, M. Yaseri, H. S. Fayazi, E. Ramzanzadeh, Azin Hajipoor
Introduction: Adequate and effective dialysis can improve patients’ quality of life and reduce kidney failure complications and mortality in end-stage renal disease on hemodialysis. Objectives: This study aimed to evaluate dialysis adequacy based on Kt/V and its related factors among patients undergoing hemodialysis. Patients and Methods: This cross-sectional, multi-center study was conducted during six months on hemodialysis patients referred to dialysis centers of the Guilan province in the north of Iran. Dialysis adequacy was evaluated using Kt/V (>1.2) criteria. Results: The mean Kt/V was 1.24±0.36 with a median of 1.2. Adequacy of dialysis was desirable in 51.2% of the patients. There was a significant and inverse relationship between body mass index (BMI) and Kt/V (r=-0.139, P=0.013). The relationship between Kt/V criterion and pre-dialysis weight (r=-0.310, P=0.00) and post-dialysis weight (r=-0.314, P=0.00) were inverse. The Kt/V criterion was significantly associated with calcium (Ca) level and the patients with normal Ca level had a higher adequacy than those in the other levels of Ca [normal versus low level, mean difference (MD]: 0.19±0.06; normal versus high level, MD: 0.07±0.04, P<0.001). The Kt/V criterion was inversely related to blood pressure and temperature before and after dialysis (P<0.05). Conclusion: The present study showed a close correlation between blood pressure, Ca level and BMI with dialysis adequacy based on Kt/V criteria. The findings obtained here suggested treatment strategies based on correction of Ca levels, BMI and blood pressure prior to dialysis to increase the adequacy of dialysis.
{"title":"Evaluation of dialysis adequacy based on Kt/V and its related factors among patients undergoing hemodialysis in Guilan dialysis centers","authors":"Seyyedeh Sahereh Mortazavi Khatibani, M. Yaseri, H. S. Fayazi, E. Ramzanzadeh, Azin Hajipoor","doi":"10.34172/jnp.2022.17322","DOIUrl":"https://doi.org/10.34172/jnp.2022.17322","url":null,"abstract":"Introduction: Adequate and effective dialysis can improve patients’ quality of life and reduce kidney failure complications and mortality in end-stage renal disease on hemodialysis. Objectives: This study aimed to evaluate dialysis adequacy based on Kt/V and its related factors among patients undergoing hemodialysis. Patients and Methods: This cross-sectional, multi-center study was conducted during six months on hemodialysis patients referred to dialysis centers of the Guilan province in the north of Iran. Dialysis adequacy was evaluated using Kt/V (>1.2) criteria. Results: The mean Kt/V was 1.24±0.36 with a median of 1.2. Adequacy of dialysis was desirable in 51.2% of the patients. There was a significant and inverse relationship between body mass index (BMI) and Kt/V (r=-0.139, P=0.013). The relationship between Kt/V criterion and pre-dialysis weight (r=-0.310, P=0.00) and post-dialysis weight (r=-0.314, P=0.00) were inverse. The Kt/V criterion was significantly associated with calcium (Ca) level and the patients with normal Ca level had a higher adequacy than those in the other levels of Ca [normal versus low level, mean difference (MD]: 0.19±0.06; normal versus high level, MD: 0.07±0.04, P<0.001). The Kt/V criterion was inversely related to blood pressure and temperature before and after dialysis (P<0.05). Conclusion: The present study showed a close correlation between blood pressure, Ca level and BMI with dialysis adequacy based on Kt/V criteria. The findings obtained here suggested treatment strategies based on correction of Ca levels, BMI and blood pressure prior to dialysis to increase the adequacy of dialysis.","PeriodicalId":16515,"journal":{"name":"Journal of Nephropathology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43713161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: No single nutrition parameter can accurately assess nutritional status, to predict outcomes and to drive the priorities for nutrition care in patients undergoing hemodialysis (HD). Objectives: The aim of this study was to assess the nutritional status of HD patients using two validated assessment tools; the "7-point subjective global assessment" (SGA) and "malnutrition inflammation score" (MIS); to determine participants’ daily energy intakes (DEI) and daily protein intakes (DPI); and also to examine the relationship of these parameters with hospitalization and mortality. Patients and Methods: This is a 12-month prospective, single HD-center study that recruited 77 HD participants from an outpatient center in South Florida. For the purpose of this analysis, participants with SGA ≤ 5 and MIS > 7 and were considered to have an inadequate nutritional status represented by SGA-I and MIS-I, respectively. Inadequate energy (DEI-I) and inadequate protein (DPI-I) intake were defined using cutoff values. The outcomes and endpoints of this study were hospitalizations and mortality, registered over 12 months. Results: Fifty-five male and 22 female patients from a single HD center participated in the study. During the 12-month study, 63.6% of participants were hospitalized, 7% transplanted and 13% died. The group of participants with an inadequate nutritional status (defined as SGA-I and MIS-I) and inadequate energy intake (defined as DEI-I) had an increased hazard ratio for mortality [SGA-I and DEI-I [HR: 7.18 (95% CI: 1.18-43.43; P= 0.032] and [MIS-I and DEI-I [HR: 13.23, 95% CI: 2.1-83.2; P=0.006] and the likelihood of hospitalization increased almost 3-fold [HR: 2.73, 95% CI: 1.09-6.842; P=0.031], in the case of MIS-I. Conclusion: These results indicated that energy intake lower than 25 kcal/kg/day increases the risks of hospitalization and mortality for those HD patients with an impaired nutritional status.
{"title":"The relationship of nutrition status and dietary intake with hospitalization and mortality in hemodialysis patients; a single-center observational cohort study","authors":"Janet Diaz-Martinez, C. Bejar, I. Delgado-Enciso","doi":"10.34172/jnp.2022.17301","DOIUrl":"https://doi.org/10.34172/jnp.2022.17301","url":null,"abstract":"Introduction: No single nutrition parameter can accurately assess nutritional status, to predict outcomes and to drive the priorities for nutrition care in patients undergoing hemodialysis (HD). Objectives: The aim of this study was to assess the nutritional status of HD patients using two validated assessment tools; the \"7-point subjective global assessment\" (SGA) and \"malnutrition inflammation score\" (MIS); to determine participants’ daily energy intakes (DEI) and daily protein intakes (DPI); and also to examine the relationship of these parameters with hospitalization and mortality. Patients and Methods: This is a 12-month prospective, single HD-center study that recruited 77 HD participants from an outpatient center in South Florida. For the purpose of this analysis, participants with SGA ≤ 5 and MIS > 7 and were considered to have an inadequate nutritional status represented by SGA-I and MIS-I, respectively. Inadequate energy (DEI-I) and inadequate protein (DPI-I) intake were defined using cutoff values. The outcomes and endpoints of this study were hospitalizations and mortality, registered over 12 months. Results: Fifty-five male and 22 female patients from a single HD center participated in the study. During the 12-month study, 63.6% of participants were hospitalized, 7% transplanted and 13% died. The group of participants with an inadequate nutritional status (defined as SGA-I and MIS-I) and inadequate energy intake (defined as DEI-I) had an increased hazard ratio for mortality [SGA-I and DEI-I [HR: 7.18 (95% CI: 1.18-43.43; P= 0.032] and [MIS-I and DEI-I [HR: 13.23, 95% CI: 2.1-83.2; P=0.006] and the likelihood of hospitalization increased almost 3-fold [HR: 2.73, 95% CI: 1.09-6.842; P=0.031], in the case of MIS-I. Conclusion: These results indicated that energy intake lower than 25 kcal/kg/day increases the risks of hospitalization and mortality for those HD patients with an impaired nutritional status.","PeriodicalId":16515,"journal":{"name":"Journal of Nephropathology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44040865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Transplantation is the sole viable option for the long-term survival of patients with end-stage renal disease (ESRD) in low-resourced countries. Objectives: To report the histopathological characteristics of kidney graft dysfunction in a large transplant program of a developing country. Patients and Methods: Renal transplant biopsies were analyzed by the Banff 2017 classification and subdivided into early (≤1 year) or late (>1 year) post-engraftment periods during the 12 months of 2019. Results: Here, 290 satisfactory graft biopsies were obtained on 290 patients for graft failure and/ or proteinuria. The median age of the recipient was 39 years (interquartile range 28-47), where 77% were male and 5.5% had been previously transplanted and 84% of donors were unrelated. Histological diagnosis was as follow; acute T-cell mediated rejection (A-TCMR; 23.1%), acute tubular necrosis (ATN; 14.8%), interstitial fibrosis and tubular atrophy (IFTA; 11.4%), recurrent or de novo kidney disease (R/DKD; 8.6%), transplant glomerulopathy (TG; 7.6%), calcineurin inhibitor toxicity (CNI; 6.9%), and active antibody-mediated rejection (A-AMR; 8.6%). Early graft dysfunctions were A-TCMR (29%) and ATN (22.4%). Late graft dysfunction included IF/TA, (20.2%), TG (20.2%), R/DRD (17%), and A-TCMR (9.5%). C4d+AMR was equally represented in early (5.6%) and late (6.3%) biopsies. Conclusion: A-TCMR was the most common cause of early graft dysfunction and was replaced by chronic conditions as the cause of 57.8% of late graft biopsies. The causes of graft dysfunction are not remarkably different from the west and TG will be a major cause of late graft failure in Iraq.
{"title":"Histological changes associated with early and late renal allograft dysfunction in a large three-center transplant program in Iraq","authors":"A. Ali, D. Sharif, S. Almukhtar","doi":"10.34172/jnp.2022.17241","DOIUrl":"https://doi.org/10.34172/jnp.2022.17241","url":null,"abstract":"Introduction: Transplantation is the sole viable option for the long-term survival of patients with end-stage renal disease (ESRD) in low-resourced countries. Objectives: To report the histopathological characteristics of kidney graft dysfunction in a large transplant program of a developing country. Patients and Methods: Renal transplant biopsies were analyzed by the Banff 2017 classification and subdivided into early (≤1 year) or late (>1 year) post-engraftment periods during the 12 months of 2019. Results: Here, 290 satisfactory graft biopsies were obtained on 290 patients for graft failure and/ or proteinuria. The median age of the recipient was 39 years (interquartile range 28-47), where 77% were male and 5.5% had been previously transplanted and 84% of donors were unrelated. Histological diagnosis was as follow; acute T-cell mediated rejection (A-TCMR; 23.1%), acute tubular necrosis (ATN; 14.8%), interstitial fibrosis and tubular atrophy (IFTA; 11.4%), recurrent or de novo kidney disease (R/DKD; 8.6%), transplant glomerulopathy (TG; 7.6%), calcineurin inhibitor toxicity (CNI; 6.9%), and active antibody-mediated rejection (A-AMR; 8.6%). Early graft dysfunctions were A-TCMR (29%) and ATN (22.4%). Late graft dysfunction included IF/TA, (20.2%), TG (20.2%), R/DRD (17%), and A-TCMR (9.5%). C4d+AMR was equally represented in early (5.6%) and late (6.3%) biopsies. Conclusion: A-TCMR was the most common cause of early graft dysfunction and was replaced by chronic conditions as the cause of 57.8% of late graft biopsies. The causes of graft dysfunction are not remarkably different from the west and TG will be a major cause of late graft failure in Iraq.","PeriodicalId":16515,"journal":{"name":"Journal of Nephropathology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41697465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Akhavan Sepahi, Elham Emami, Akshaya Joseph, S. Hassanzadeh, M. Razavi
Spironolactone is a first-generation and non-selective mineralocorticoid receptor antagonist (MRA). It is extensively well-studied and recommended due to increased accessibility for patients. Unfortunately, it is often discontinued in several cases due to its association with hyperkalemia. The apparent benefit of eplerenone over spironolactone is its mineralocorticoid receptor (MR) selectivity. However, it is also characterized by low-potency and higher cost compared to spironolactone. The high adverse-effect profile of spironolactone and eplerenone has led to the innovation of novel medications such as non-steroidal MRAs. Among these medications, finerenone is the most advanced agent. Finerenone is associated with decreased proteinuria, reduced risk of hyperkalemia and increased preservation of renal function with comparable benefit in heart failure compared to selective and nonselective MRAs. The nonsteroidal structure of finerenone affects mineralocorticoid receptor binding, lipophilicity and polarity which have potent effects on distribution, the degree of attachment to blood proteins, transportation, and tissue diffusion.
{"title":"Administration of finerenone in chronic kidney disease","authors":"M. Akhavan Sepahi, Elham Emami, Akshaya Joseph, S. Hassanzadeh, M. Razavi","doi":"10.34172/jnp.2022.17355","DOIUrl":"https://doi.org/10.34172/jnp.2022.17355","url":null,"abstract":"Spironolactone is a first-generation and non-selective mineralocorticoid receptor antagonist (MRA). It is extensively well-studied and recommended due to increased accessibility for patients. Unfortunately, it is often discontinued in several cases due to its association with hyperkalemia. The apparent benefit of eplerenone over spironolactone is its mineralocorticoid receptor (MR) selectivity. However, it is also characterized by low-potency and higher cost compared to spironolactone. The high adverse-effect profile of spironolactone and eplerenone has led to the innovation of novel medications such as non-steroidal MRAs. Among these medications, finerenone is the most advanced agent. Finerenone is associated with decreased proteinuria, reduced risk of hyperkalemia and increased preservation of renal function with comparable benefit in heart failure compared to selective and nonselective MRAs. The nonsteroidal structure of finerenone affects mineralocorticoid receptor binding, lipophilicity and polarity which have potent effects on distribution, the degree of attachment to blood proteins, transportation, and tissue diffusion.","PeriodicalId":16515,"journal":{"name":"Journal of Nephropathology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46020479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Luísa Lemos Costa, Anabela S Rodrigues, R. Pinto, C. Lima, T. Sousa, Helena, Viana, M. Góis, S. Lemos, Andreia Silva
The characteristics of direct oral anticoagulants (DOACs) make them more appealing for prevention of thromboembolic events than vitamin K antagonists (VKA). Despite that, both classes have been a recognized as a cause of anticoagulant related nephropathy (ARN). Herein we describe a case of a 72-year-old man, with chronic kidney disease (CKD), medicated with rivaroxaban, who presented with acute kidney injury (AKI) and microscopic hematuria. The kidney biopsy revealed anticoagulant related-nephropathy. Rivaroxaban was suspended, the patient showed improvement of renal function and apixaban was prescribed. This case emphasizes the need for careful monitoring of serum creatinine when these drugs are prescribed, especially in high risk groups.
{"title":"Case report: rivaroxaban related nephropathy","authors":"Luísa Lemos Costa, Anabela S Rodrigues, R. Pinto, C. Lima, T. Sousa, Helena, Viana, M. Góis, S. Lemos, Andreia Silva","doi":"10.34172/jnp.2022.17343","DOIUrl":"https://doi.org/10.34172/jnp.2022.17343","url":null,"abstract":"The characteristics of direct oral anticoagulants (DOACs) make them more appealing for prevention of thromboembolic events than vitamin K antagonists (VKA). Despite that, both classes have been a recognized as a cause of anticoagulant related nephropathy (ARN). Herein we describe a case of a 72-year-old man, with chronic kidney disease (CKD), medicated with rivaroxaban, who presented with acute kidney injury (AKI) and microscopic hematuria. The kidney biopsy revealed anticoagulant related-nephropathy. Rivaroxaban was suspended, the patient showed improvement of renal function and apixaban was prescribed. This case emphasizes the need for careful monitoring of serum creatinine when these drugs are prescribed, especially in high risk groups.","PeriodicalId":16515,"journal":{"name":"Journal of Nephropathology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46462177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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