Saudi Journal of Kidney Diseases and Transplantation最新文献

Tubulointerstitial nephritis (TIN) is a frequent cause of acute kidney injury. TIN has a reported incidence ranging from 1% to 10% of all renal biopsies. Among patients with chronic renal failure, the incidence ranges from about 22% to 33.5%. We studied the histological features of renal biopsies with TIN, evaluated its etiology and correlated TIN with clinical features and investigations. Our study extended over a period of seven years, with 50 cases. The slides were stained with hematoxylin and eosin and special stains like periodic acid-Schiff, Jones methenamine silver and Masson's trichrome. All adequate renal biopsies showing features of acute and chronic TIN were included in our study. Renal biopsies showing features of only primary glomerular pathology and inadequate biopsies were excluded from the study. TIN accounted for 14.84% of all the renal biopsies received in our histopathology section within this period, with 74% cases presenting as acute renal failure. The mean age of our study group was 39 years, with the male-female ratio being 1:1.63. Drug-induced TIN accounted for 42% of the cases, making it the most common cause; 48% of the cases of drug-induced TIN were attributed to the use of nonsteroidal anti-inflammatory drugs. The other causes were immunological, infectious, metabolic, vascular, plasma cell dyscrasias, T-cell mediated and idiopathic. TIN is an important cause of acute renal failure, with drug-induced TIN constituting almost half the cases. These cases can be reversed if caught early, making renal biopsy a valuable modality in diagnosing TIN in cases of acute renal failure.

Tuberculosis-associated glomerulonephritis is difficult to diagnose, as it usually presents with hematuria, proteinuria, edema, hypertension or renal insufficiency, which are similar to the symptoms of primary glomerulonephritis. Membranous nephropathy is uncommonly seen in tuberculosis patients. We report a case of a 21-year-old male who presented with adult-onset nephrotic syndrome and was diagnosed by renal biopsy as anti-phospholipase A2 receptor antibody-positive membranous nephropathy. After one year of conservative treatment with ramipril alone without achieving a remission, the patient's condition worsened, presenting with generalized anasarca and left-sided pleural tubercular effusion. Complete remission of nephrotic syndrome was achieved after the completion of 6 months of antitubercular treatment.

Calcific uremic panniculitis is a rare cutaneous calcinosis on the spectrum of calciphylaxis. It mainly affects patients with end-stage renal disease (ESRD). The mortality rate is high, approaching 50% of cases. We report the case of a patient on chronic hemodialysis with secondary hyperparathyroidism who developed calcific panniculitis. The diagnosis was clinical: bluish subcutaneous nodules in the abdomen with rapid extension to the lower limbs and even the back, which quickly became necrotic. X-rays of the abdomen and lower limbs showed rounded calcifications in the fatty tissue. The evolution was rapidly fatal and the patient died of septic shock following superimposed infection of the lesions. Calcific uremic panniculitis is an increasingly rare fatal complication associated with ESRD and secondary hyperparathyroidism. The treatment remains poorly understood and difficult to apply, hence the importance of preventing this complication.

Juvenile idiopathic arthritis is common rheumatic disease in children and adolescents, but renal involvement is uncommon. Renal involvement is mostly in the form of secondary renal amyloidosis presenting as proteinuria. Membranous nephropathy is an uncommon renal manifestation of juvenile idiopathic arthritis. Here, we report a case of HLA-B27-positive oligoarticular juvenile idiopathic arthritis presenting as subnephrotic proteinuria. The patient also had positive anti-phospholipase A2 receptor antibodies in the serum as well as in the glomeruli according to the immunohistochemistry assay. The patient achieved clinical remission with steroids and mycophenolate sodium.

The media has an important and decisive role in creating a culture of organ donation and promoting community health, but there is no effort to identify the elements of the programming framework in this field in the national media of Iran. Given the great importance of this issue, this study examined the development of a framework to promote a culture of organ donation in the production of programs in the national media of Iran. This qualitative study involved a content analysis of six TV programs. The dialog and images related to these programs were extracted on the basis of the semiotic method. The results of this research were classified into two categories of motivational factors (referring to cultural and religious motives, scientific and educational facts, references to gratitude and moral motives, differences in different situations and diseases, attention to legal regulations, encouragement to receive an organ donation card and statistics of transplant status in the country) and barriers (patients' personal barriers, media insufficiencies, cultural barriers, educational and scientific barriers, medical insufficiencies and administrative insufficiencies). The results of this study showed that in order to promote a culture of organ donation in the production of programs in the national media, two categories of motivational factors and barriers should be.

We created a two scoring systems for pediatric dialysis patients to determine the presence of cardiovascular disease (CVD) which are referred to as (CVDS)-1 and CVDS-2. We included 25 patients on hemodialysis (n = 19) and peritoneal dialysis (n = 6). CVDS-1 and CVDS-2 use multiple parameters, to determine the presence of CVD in pediatric dialysis patients. The scoring systems include renal pathology, nutrition, dialysis adequacy, residual urine output, protein catabolism, dialysis modality and some laboratory values. CVD evaluations included the left ventricular mass index, pulse wave velocity and carotid intima-media thickness measurements. The mean age was 11.1 ± 6.51 years, and the male-female ratio was 14:11. Patients on peritoneal dialysis had higher serum levels of calcium × phosphorus product and diastolic blood pressure (P = 0.013 and P = 0.006, respectively). We did not find any significant correlation between peritoneal dialysis and hemodialysis patients in the CVDS-1 and CVDS-2 scores (P >0.005). The CVDS-1 system had a sensitivity of 90% and a specificity 80%. The CVDS-2 system had a sensitivity of 90% and a specificity 66%. Additionally, the area under the receiver operating characteristic curve of CVDS-1 was 0.913 (95% confidence interval (CI) = 0.80-1.00, P <0.001) for a diagnosis of CVD and that of CVDS-2 was 0.86 (95% CI = 0.72-1.00, P <0.001). We believe that CVDS-1 will be more successful in determining the presence of CVD with the biochemical parameters we use in clinical practice on a monthly basis.

Acute kidney injury (AKI) is common in hospitalized patients, and it is associated with higher mortality and morbidity. Drug-induced kidney disease (DIKD) accounts for approximately 8-60% of hospitalized patients and 14-28% in intensive care unit patients. Nephrotoxic agents are one of the possible causes of AKI in acute settings. Most previous studies have identified the relationship between utilizing nephrotoxic medications and the rate of AKI. Limited literature has addressed the relationship between nephrotoxic medications and the need to start renal replacement therapy (RRT). The main aim of this study was to assess the correlation between the use of nephrotoxic medications and the initiation of RRT in acute settings. This retrospective cohort study included adult hospitalized patients older than 18 years at a tertiary academic center who had received one of the following medications for more than 24 hours: angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors (ACEIs), thiazide, amphotericin B, aminoglycoside, vancomycin, piperacillin/tazobactam, colistin, acyclovir, cisplatin, and methotrexate. In total, 86 patients were included in this study; 25 (29%) developed AKI, and only 15 (17.4%) required RRT. Piperacillin/tazobactam (P = 0.01), vancomycin (P = 0.02), and ACEIs (P = 0.02) were the most common nephrotoxic drugs prescribed in patients who required RRT. Hospitalized patients receiving vancomycin, piperacillin/tazobactam, or ACEIs had higher chances of starting RRT. Identifying patients at risk of drug-induced kidney disease is crucial to prevent the need for RRT.

Microalbuminuria, expressed as the urinary albumin-creatinine ratio (UACR), is currently the gold standard for detecting diabetic nephropathy. However, because of its low sensitivity and larger variability, there is a need for novel biomarkers. Although promising, these novel markers require further assessment before achieving clinical utility. The assessment of combined urinary biomarkers is also being explored. Changes in urinary nephrin (uNephrin), urinary podocalyxin (uPCX), urinary N-acetyl-β-glucosaminidase (uNAG) and urinary 8-oxo-7,8-dihydro-2'-deoxyguanosine (u8-oxodG) were estimated in healthy controls and in patients with Type 2 diabetes mellitus (T2DM) with and without microalbuminuria. In total, 30 T2DM patients with normoalbuminuria and 30 with microalbuminuria, alongside 30 healthy individuals, were recruited. Plasma glucose, creatinine, UACR, uNAG uPCX, uNephrin and u8-oxodG were estimated. The urinary markers were corrected for creatinine. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula. All the urinary markers except uPCX showed a statistically significant increase in T2DM patients with normoalbuminuria compared with the controls (P <0.05). UACR was found to have positive correlations with all the urinary markers, whereas eGFR showed a negative correlation. All urinary markers except uPCX showed a statistically significant area under the curve (0.810 for uNephrin; 0.906 for uNAG); 0.828 for u8-oxodG) with good sensitivity and specificity. Combining the markers did not show any additional advantage in their diagnostic performance. Our study shows the importance of including tubular injury markers and their utility in combination with glomerular injury markers for early detection of diabetic renal injury before microalbuminuria sets in.