Journal of Renal and Hepatic Disorders
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<p><img style="padding-right: 15px; padding-bottom: 15px; float: left;" src="https://jrenhep.com/public/site/images/jdisord/Jrenhep_logo_png_1001.png" />Journal of Renal and Hepatic Disorders (eISSN: 2207-3744) is a peer-reviewed, online-only, open-access journal that publishes basic science and clinical research articles on disorders of the kidneys and the liver. In addition to considering disorders of each organ separately, the journal aims to be a scholarly forum for discussing how disorders of one organ influence the other. Chronic liver disease is associated with primary and secondary kidney diseases. Similarly, renal disorders are associated with hepatic disorders. Original articles, reviews, and case reports on any aspects of nephrology and hepatology are suitable for submission.</p> <p> </p> <p> </p>Codon PublicationsenJournal of Renal and Hepatic Disorders2207-3744<p>Authors who publish with this journal agree to the following terms:</p><ul><li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a title="License" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li><li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li></ul>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a href="http://opcit.eprints.org/oacitation-biblio.html" target="_new">The Effect of Open Access</a>Mitochondrial Impairment and Oxidative Stress Are Essential Mechanisms Involved in the Pathogenesis of Acute Kidney Injury
https://mail.jrenhep.com/index.php/jrenhep/article/view/94
<p>Acute kidney injury (AKI) is an emergency condition that requires restrictive and appropriate clinical interventions. Identifying mechanisms of organ injury is a critical step in developing clinical interventions. Unilateral ureter obstruction (UUO) is widely used as an animal model for investigating AKI. The current study was designed to evaluate the role of mitochondrial impairment and oxidative stress in the pathogenesis of renal injury in UUO model. Mice underwent UUO surgery. Then, kidney tissue histopathological changes, plasma biomarkers of renal injury, oxidative stress, and different renal mitochondrial indices were evaluated at scheduled time intervals (3, 7, 14, and 21 days after UUO surgical procedure). Significant increase in plasma creatinine and blood urea nitrogen levels was evident in UUO mice. The UUO surgery induced severe kidney tissue histopathological alterations, including necrosis, severe tubular atrophy, and interstitial inflammation. Moreover, kidney biomarkers of oxidative stress included reactive oxygen species formation, lipid peroxidation, protein carbonylation, decreased glutathione reservoirs (GSH), and increased oxidized glutathione (GSSG) observed in UUO mice. On the other hand, significant mitochondrial depolarization, decreased mitochondrial dehydrogenases activity, mitochondrial permeabilization, and decreased adenosine triphosphate and GSH/GSSG levels were discovered in mitochondria isolated from the kidneys of UUO mice. The data obtained from the current study demonstrated a pivotal and interconnected role for oxidative stress and mitochondrial dysfunction in the pathogenesis of renal injury in UUO model. Therefore, these directions could serve as therapeutic targets in animal models or patients of acute renal failure.</p>
Original Articles Nephrologyantioxidantsbioenergeticsmitochondrianephrotoxicityrenal failureHeresh RezaeiZahra HonarpishefardFatemeh GhaderiAyeh RouhaniAkram JamshidzadehSeyyed Mohammad Amin KashaniNarges AbdoliForouzan KhodaeiOmid FarshadAbdollah ArjmandIssa SadeghianNegar AzarpiraMohammad Mehdi OmmatiReza Heidari
Copyright (c) 2023 Heresh Rezaei, Zahra Honarpishefard , Fatemeh Ghaderi, Ayeh Rouhani, Akram Jamshidzadeh, Seyyed Mohammad Amin Kashani, Narges Abdoli , Forouzan Khodaei , Omid Farshad , Abdollah Arjmand, Issa Sadeghian , Negar Azarpira , Mohammad Mehdi Ommati, Reza Heidari
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2023-12-262023-12-26304510.15586/jrenhep.v7i2.94Acute Hepatitis by Bartonella henselae Infection in an Adult Patient with Decompensated Liver Cirrhosis
https://mail.jrenhep.com/index.php/jrenhep/article/view/172
<p>Hepatitis caused by Bartonella henselae in adults is a condition that is seldom reported in the literature, as well as its current incidence and prevalence. While there is a broad spectrum of well-defined and established clinical entities, hepatic involvement represents the third most frequent clinical manifestation of infection by this genus of bacteria. It may or may not be characterized by the presence of hepatosplenic granulomas. Diagnosis requires a high level of clinical suspicion, exclusion of additional etiologies, and a causal relationship with risk factors. Polymerase chain reaction is the diagnostic test with the highest diagnostic yield, and treatment varies depending on the clinical expression. We describe the case of an adult patient with hepatitis secondary to Bartonella henselae infection.</p>
Case Reports HepatologyadultBartonellagastroenterologyhepatitishepatologyJorge Alonso Garay-OrtegaLouis Fernando Robles FernandesVianey Guadalupe Téllez BolañosKarla Paulina Sandoval MosquedaKarla Daniela Salgado Guizar
Copyright (c) 2023 Jorge Alonso Garay Ortega, Louis Fernando Robles Fernandes, Vianey Guadalupe Tellez Bolaños, Karla Paulina Sandoval Mosqueda, Karla Daniela Salgado Guizar
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2023-08-302023-08-30151710.15586/jrenhep.v7i2.172Incidence, Histopathological Pattern, and Predictors of Non-Diabetic Renal Disease in Type 2 Diabetes Mellitus: A Single-Center Prospective Observational Study
https://mail.jrenhep.com/index.php/jrenhep/article/view/167
<p>Patients with type 2 diabetes mellitus (T2DM) may have renal involvement because of isolated diabetic nephropathy (DN), isolated non-diabetic renal disease (NDRD), or mixed lesions (DN combined with NDRD). This study was conducted to find out incidence, histopathological pattern, and clinical predictors of NDRD in the Kashmiri population. This is a single-center prospective observational study conducted from August 2015 to July 2017. Patients with T2DM presenting with atypical clinical features of renal involvement underwent kidney biopsy. A total of 33 patients were included. Isolated NDRD was found in 16/33 (48.5%) patients, isolated DN was discovered in 10/33 (30.3%), and mixed lesions in 7/33 (21.2%) patients. NDRD with or without DN was present in 23/33 (69.7%) patients. Overall, the most common renal histopathological lesion in NDRD was immunoglobulin A (IgA) nephropathy present in 7/23 (30.4%) patients. In mixed lesions, FSGS and TMA were the most common renal lesions present in 2/7 (28.57%) patients. The mean duration of diabetes in NDRD and isolated DN groups was 4.4±3.6 and 7.0±2.9 years, respectively (P = 0.04). NDRD was present in 21/23 (91.3%) patients without diabetic retinopathy (P = 0.016). Our data demonstrated that more than half of the patients with T2DM with atypical features had NDRD upon renal biopsy. The absence of diabetic retinopathy and a shorter duration of diabetes were indicators of NDRD. IgA nephropathy was the most prevalent renal pathology. Clinicians must consider kidney biopsy liberally, especially in patients with unclear etiology of a kidney disease. Patients with type 2 diabetes mellitus (T2DM) may have renal involvement because of isolated diabetic nephropathy (DN), isolated non-diabetic renal disease (NDRD), or mixed lesions (DN combined with NDRD). This study was conducted to find out incidence, histopathological pattern, and clinical predictors of NDRD in the Kashmiri population. This is a single-center prospective observational study conducted from August 2015 to July 2017. Patients with T2DM presenting with atypical clinical features of renal involvement underwent kidney biopsy. A total of 33 patients were included. Isolated NDRD was found in 16/33 (48.5%) patients, isolated DN was discovered in 10/33 (30.3%), and mixed lesions in 7/33 (21.2%) patients. NDRD with or without DN was present in 23/33 (69.7%) patients. Overall, the most common renal histopathological lesion in NDRD was immunoglobulin A (IgA) nephropathy present in 7/23 (30.4%) patients. In mixed lesions, FSGS and TMA were the most common renal lesions present in 2/7 (28.57%) patients. The mean duration of diabetes in NDRD and isolated DN groups was 4.4±3.6 and 7.0±2.9 years, respectively (P = 0.04). NDRD was present in 21/23 (91.3%) patients without diabetic retinopathy (P = 0.016). Our data demonstrated that more than half of the patients with T2DM with atypical features had NDRD upon renal biopsy. The absence of diabetic retinopathy and a shorter duration of diabetes were indicators of NDRD. IgA nephropathy was the most prevalent renal pathology. Clinicians must consider kidney biopsy liberally, especially in patients with unclear etiology of a kidney disease.</p>
Original Articles Nephrologydiabetic nephropathydiabetic retinopathyfocal segmental glomerulosclersosisIgA nephropathynon-diabetic renal diseaseAabid HussainRayees Yousuf SheikhMurtaza Rashid PalaManzoor Ahmad Parry
Copyright (c) 2023 Aabid Hussain, Rayees Sheikh, Murtaza Pala, Manzoor Parry
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2023-09-062023-09-06242910.15586/jrenhep.v7i2.167Pulmonary Hypertension in Patients of Chronic Kidney Disease on Maintenance Hemodialysis: Study from a Tertiary Care Center in Central India
https://mail.jrenhep.com/index.php/jrenhep/article/view/168
<p>To study the incidence of pulmonary hypertension (PH) in chronic kidney disease (CKD) stage V patients on maintenance hemodialysis (HD) at our center. To compare clinical and metabolic variables among CKD patients with and without PH to search for possible etiologic factors. Comparison of PH in CKD patients at baseline and after 3 months of sildenafil therapy. The study was conducted in the Department of Nephrology, Sri Aurob-indo Institute of Medical Sciences, Indore, for a period of 1 year from December 2021 to November 2022. All CKD patients on maintenance HD at our center were included in the study. A pre-structured proforma was used to record patient data. Detailed clinical examination, 2DECHO, and Biochemical tests were done. All patients with mean pulmonary artery pressure (mPAP) > 25 mmHg on 2D echocardiography were considered to have PH and were started on sildenafil therapy 20 mg three times a day for 3 months. PH was classified as mild PH (mPAP > 25 up to 40 mmHg), moderate PH (mPAP > 40 mmHg to 60 mmHg), and severe PH (mPAP > 60 mmHg). Patients were then followed for 3 months to look for episodes of dyspnea and emergency admissions and reassessed after 3 months by repeat 2D echocardiography to find improvement in PH. A total of 102 patients were analyzed during the study period; among them, 40 patients (39.2%) had PH. Out of them, 18 patients (45%) had mild PH, 14 patients (35%) had moderate PH, and 8 patients (20%) patients had severe PH. Average age of our patients was 48.8 ± 9.4 years, the majority being men. On comparing the clinical features between patients with and without PH, none of the clinical parameters had any statistically significant impact on PH. Also, none of the laboratory parameters had statistical significance among PH and non-PH groups. Among the patients with PH, 25 patients (62.5%) had Arteriovenous (AV) fistula, 10 patients (25%) had temporary dialysis catheters. Eight patients (20%) had jugular catheters, two patients (5%) had femoral catheters, and 5 (12.5%) patients had tunneled jugular catheters. Initially, 102 patients were enrolled in the study. Of these, 40 (39.2%) had PH and 62 (60.7%) did not. Patients who had PH started sildenafil 20 mg three times a day. Of these 40 patients, at 3 months, eight patients were lost to follow-up, and 32 patients with PH remained in the study. Emergency admissions in each group of PH declined after 3 months, and the result was statistically significant. Echocardiographic findings were compared in patients with PH and without PH, but the difference in patients on HD with PH and without PH was not statistically significant. PH is a significant problem in CKD patients on HD. This issue needs to be evaluated in a timely manner to avoid the risk of morbidity and mortality. It is vital to treat them at the earliest to prevent life-threatening complications.</p>
Original Articles Nephrologychronic kidney diseasehemodialysismean pulmonary artery pressurepulmonary hypertensiontwo-dimensional echocardiographyTrishala ChhabraNaresh PahwaShraddha GoswamiRiyaz AsadMohit MahajanSharada Chandrashekhar Aher
Copyright (c) 2023 Trishala Chhabra, Naresh Pahwa, Shraddha Goswami, Riyaz Asad, Mohit Mahajan, Sharada Chandrashekhar Aher
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2023-08-312023-08-31182310.15586/jrenhep.v7i2.168IgA Nephropathy Associated with IgA Vasculitis Coexisting with Focal Segmental Glomerulosclerosis Tip Variant: A Case Report
https://mail.jrenhep.com/index.php/jrenhep/article/view/166
<p>IgA vasculitis (IgAV), previously known as Henoch–Schönlein purpura, is a form of small vessel vasculitis that affects the skin, joints, intestines, and kidneys. The clinical presentation in adults is usually infrequent, more severe, with a worse prognosis and a higher recurrence rate. Due to limited scientific evidence, IgAV is viewed similarly to IgA nephropathy (IgAN), and the renal histopathological lesions are indistinguishable between the two. IgAN is the most prevalent glomerular diseases worldwide. The diagnosis of IgAN is confirmed through a renal biopsy. The most frequently found histopathological lesions are mesangial proliferation and concurrent IgA deposition confirmed by direct immunofluorescence. Focal segmental glomerulosclerosis (FSGS) appears as a glomerular pattern of injury in up to 40% of renal biopsies with IgAN, although there are few reported cases in the international literature where both diseases coexist as primary etiologies. We report a case of a female patient presenting with vasculitic lesions, abdominal pain, and nephrotic syndrome, whose cause is confirmed by a renal biopsy with a diagnosis of IgAN secondary to IgAV and coexistence of FSGS, an unusual presentation with few case reports.</p>
Case Reports NephrologyglomerulosclerosisIgA nephropathyIgA vasculitisnephrotic syndromeZitlali Guadalupe Paulín ZepedaKarla Daniela Salgado GuizarVianey Guadalupe Téllez BolañosLouis Fernando Robles FernandesMaría Inés Gil Arredondo
Copyright (c) 2023 Zitlali Guadalupe Paulín Zepeda, Karla Daniela Salgado Guizar, Vianey Guadalupe Tellez Bolaños, Louis Fernando Robles Fernandes, María Inés Gil Arredondo
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2023-07-142023-07-14101410.15586/jrenhep.v7i2.166Clinicopathologic Spectrum of Nephrotic Syndrome in the Elderly
https://mail.jrenhep.com/index.php/jrenhep/article/view/162
<p>The elderly population is affected by a wide range of kidney diseases like young adult patients. However, their clinical course and morphological manifestations are affected by aging. Recognition, diagnosis, and management of glomerular disease in elderly persons have several unique challenges. We aimed to study the clinicopathologic spectrum of elderly patients with nephrotic syndrome (NS). In this retrospective study, we looked at 234 patients of adult NS who were biopsied during the last 5 years. Among them, 31 patients were above the age of 60 years (Elderly). Mean age in elderly patients was 67.48 ± 6.11 years, with age range from 60 to 86 years. Elderly NS patients constituted 13.2% of total adult NS patients. Nineteen patients (61.2%) were males and 12 (38.7%) were females. Hematuria was observed in 19% and hypertension in 48% patients. Mean serum albumin was 2.79 ± 0.39 g/dl and mean 24 h urinary protein was 3.77 ± 0.8 grams. Membranous nephropathy (MN) followed by minimal change disease (MCD) was the most common diagnosis. No major complication with biopsy was reported in our study as has been the case with most studies.</p>
Original Articles Nephrologyelderlynephrotic syndromekidney biopsyMembranous nephropathyMCDFSGSSheikh ZubairJunaid AhmedSyed Mubashir NissarMuzamil Rashid PalaAabid HussainMurtaza Rashid PalaMuzamil Latief
Copyright (c) 2023 Sheikh Zubair, Junaid Ahmed, Syed Mubashir Nissar, Muzamil Rashid Pala, Aabid Hussain , Murtaza Rashid Pala, Muzamil Latief
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2023-04-242023-04-24343710.15586/jrenhep.v7i1.162A Prospective Non-Randomised Interventional Study of Goal-Directed Ultrafiltration Compared With Clinical Dry-Weight Assessment in Achieving Euvolemic Status of Patients on Maintenance Hemodialysis
https://mail.jrenhep.com/index.php/jrenhep/article/view/148
<p>An accurate assessment of intravascular volume status in hemodialysis (HD) patients presents a significant challenge. Current clinical practices to determine dry weight is flawed due to interobserver variability and nonreproducibility. This miscalculation results in either chronic hypervolemia or hypovolemia with intra or interdialytic hypotension. The quest for noninvasive volume assessment tools to aid in the estimation of dry weight still continues. This study aims at goal-directed ultrafiltration removal compared with clinical dry-weight assessment in achieving euvolemic status of patients on chronic HD. It is a prospective, single-centered, nonrandomized, noninvasive interventional study on HD patients, for 12 months. Fifty two patients participated out of which 46 completed the study. Ultrasound-guided inferior vena cava collapsing index (IVCCI) and B lines were measured at intervals along with cardiac parameters. Dry weight was first estimated clinically by trial and error method. New dry weight target was set when B-lines were less than four in the eight site lung ultrasound and IVCCI between 50 and 75%, after 30 min post dialysis. Approximately 23.9% of the patients did not require dry-weight modification throughout the study. About 19% patients did not achieve dry weight in spite of all interventions. Overall, 56.5% of the patients achieved dry weight during the study period. A total of 46.3% of patients with NYHA Grade 3 dyspnoea observed at the start of study was reduced to 2.2%, showing statistical significance. Clinical assessment when bundled with noninvasive technology of assessment of dry weight showed encouraging results. B-lines and IVCCI estimation could be additional tools to achieve target weight goals, reducing complications and increasing compliance.</p>
Original Articles NephrologyB-linesdry weight assessmenthemodialysisinferior vena cava collapsing index (IVCCI)left ventricular hypertrophyPankaj GanvirC.H. Sudhiranjan DashAmjad Khan PathanRushi DeshpandeAshay ShingareMadan Mohan BahadurAshwin Patil
Copyright (c) 2023 Dr Pankaj Ganvir, Dr Sudhiranjan Dash, Dr Amjad Khan Pathan, Dr Rushi Deshpande, Dr Ashay Shingare, Dr M M Bahadur, Dr Ashwin Patil
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2023-07-032023-07-031910.15586/jrenhep.v7i2.148A Comprehensive Overview of In-patients Treated for Hepatocellular Carcinoma at a Tertiary Care Facility in Tanzania
https://mail.jrenhep.com/index.php/jrenhep/article/view/153
<p>Hepatocellular carcinoma (HCC) is one of the commonest causes of cancer-related morbidity and mortality worldwide. However, only a limited number of studies on HCC have been conducted in Tanzania. We therefore conducted a cross-sectional study among in-patients treated for HCC in a tertiary referral hospital located in Dar es Salaam, Tanzania, in order to provide a concise description of the clinical characteristics and treatment options offered in the study setting. We identified 36 in-patients treated for HCC over a 6-month data collection period. Seventy-seven percent (n = 28) of the participants were males and about two-thirds (61.2%) were aged between 40 and 60 years. Majority (44.4% [n = 16]) of the patients had Child-Pugh class B and an Eastern Cooperative Oncology Group (ECOG) performance status of 2 (33.3% [n = 12]). Patients with tumors >6.5 cm and multinodular tumors (>3 nodules) accounted for 69.4% (n = 25) and 55.6% (n = 20), respectively. Portal vascular invasion and extrahepatic metastasis were respectively present in 27.8% (n = 10) and 25% (n = 9) of the patients. Of the study participants, only two had early-stage disease as per the Barcelona Clinic Liver Cancer (BCLC) staging system, corresponding to the observed tumor resection rate of 5.6%. The most frequently reported inoperable factor among the study participants was an ECOG performance status > 0 (n = 30 [83.3%]). Findings thus reveal a high proportion of late-stage diseases among participants that could have resulted in the observed low tumor resection rate. Initiatives to facilitate identification of the disease at an early stage are therefore paramount in optimizing care.</p>
Original Articles Hepatologyepidemiologyhepatocellular carcinomaliver cancerliver resectionliver transplantationTanzaniaAlly H. MwangaJames D. MwakipesileDaniel W. KituaYona E. Ringo
Copyright (c) 2023 Ally H. Mwanga, James D. Mwakipesile, Daniel W. Kitua, Yona E. Ringo
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2023-03-112023-03-11222710.15586/jrenhep.v7i1.153L-Ornithine-L-Aspartate and Intermittent Renal Replacement Therapy in Fulminant Hepatitis A: A Case Report
https://mail.jrenhep.com/index.php/jrenhep/article/view/154
<p>Hepatitis A is a common viral infection worldwide that is transmitted via the fecal-oral route. Since the introduction of an efficient vaccine, the incidence of infection has decreased but the number of cases has risen due to widespread community outbreaks among unimmunized individuals. Classic symptoms include fever, malaise, dark urine, and jaundice, and are more common in older children and adults. People are often most infectious 14 days prior to and 7 days following the onset of jaundice. We will discuss the case of a young male patient, diagnosed with acute hepatitis A, leading to fulminant hepatitis refractory to conventional therapy and the development of subsequent kidney injury. The medical treatment through the course of hospitalization was challenging and included the use of L-ornithine-L-aspartate and prolonged intermittent hemodialysis, leading to a remarkable outcome. Hepatitis A is usually self-limited and vaccine-preventable; supportive care is often sufficient for treatment, and chronic infection or chronic liver disease rarely develops. However, fulminant hepatitis, although rare, can be very challenging to manage as in the case of our patient.</p>
Case Reports Hepatologyfulminant hepatitishepatitis AL-ornithine-L-aspartateintermittent renal replacement therapycontinuous renal replacement therapya case reportNourhane J. ObeidKhaled H. SoukariehJessy G. FadelRayyan M. Wazzi-MkahalMarianne A. AlwanJessica J. FakhirPaul W. RassamNajat I. JoubranMona H. Hallak
Copyright (c) 2023 Nourhane Obeid, Khaled H. Soukarieh, Jessy G. Fadel, Rayyan M. Wazzi-Mkahal, Marianne A. Alwan, Jessica J. Fakhir, Paul W. Rassam, Najat I. Joubran, Mona H. Hallak
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2023-03-242023-03-24283310.15586/jrenhep.v7i1.154Impact of Induction Therapy on Clinical Outcomes of Kidney Transplant Recipients: A Single-Centre Cohort Study
https://mail.jrenhep.com/index.php/jrenhep/article/view/150
<p>The purpose of this study was to evaluate long-term efficacy of immunosuppressive drugs based on the type of induction therapy given to kidney transplant recipients, and determine the occurrence of graft dysfunctions or rejections. We compared the safety and efficacy of anti-thymocyte globulin (ATG) and basiliximab (BAS) in high-risk patients and analyzed the cumulative incidence of immediate, slow, and delayed graft function in kidney transplant recipients to determine their initial short-term graft function. Evaluation of the long-term efficacy after 3 years post-transplantation by assessment of patients and graft survival, incidence of infections, and risks of rejection were the primary endpoints. Patients with stable graft survival were observed more with ATG (85%) than BAS (70%); in contrast, graft dysfunctions, graft nephrectomy, rejection episodes, and patient deaths were more prevalent with BAS than ATG, with statistically significant differences in long-term graft functioning. Patient survival at 3 years in ATG group was 90.4%, compared to 88% in BAS group, and graft survival was 90.4% in the ATG group and 81.3% in the BAS group (P < 0.001). The use of both induction therapies resulted in good patient and graft survival outcomes than placebo, and the results showed that there was a significant difference in both patient and graft survival after 3 years between induction of ATG and BAS, suggesting that ATG can be safer, effective, and preferable drug over BAS for high-risk recipients.</p>
Original Articles Nephrologyimmunosuppressive therapyinduction therapyinitial graft functionlong-term graft functiontransplantationVijaya Madhuri DevrajGangadhar TaduriSwarnalatha GuditiUttara DasMP ShamsudheenMegha SaigalRaja Kartik Kalidindi
Copyright (c) 2023 Vijaya Madhuri Devraj, Gangadhar Taduri, Swarnalatha Guditi, Uttara Das, MP Shamsudheen, Megha Saigal, Karthik Kalidindi
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2023-01-242023-01-2411010.15586/jrenhep.v7i1.150Indications for Percutaneous Ultrasound-Guided Renal Biopsy and Complications Associated with it: An Observational Study
https://mail.jrenhep.com/index.php/jrenhep/article/view/149
<p>Renal biopsy is performed for various reasons depending on the clinical manifestations presented. Although percutaneous kidney biopsy is a safe procedure, major or minor complications could occur. Our study aimed to assess the indications for percutaneous renal biopsy and complications associated with the procedure. This was a prospective observational study conducted in the Department of Nephrology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India. Patients who underwent percutaneous ultrasound-guided renal biopsy at the institute between October 2017 and June 2019 were enrolled in the study. Data regarding indications for performing a percutaneous renal biopsy and incidence of minor and major post-biopsy complications were collected. A total of 229 patients who underwent ultrasound-guided percutaneous renal biopsy were enrolled in the study. The most common indications for ultrasound-guided percutaneous renal biopsy were nephrotic syndrome (33.3%), subnephrotic proteinuria with azotemia (14%), and unexplained azotemia with proteinuria and hematuria (13.5%). Post-biopsy complications were observed in 89 (37.55%) patients. Minor complications developed in 83 (36.22%) patients and major complications in six (2.62%) patients. Among patients with major complications, two (0.87%) patients underwent invasive procedures (embolization and cystoscopic removal of bladder clot) and four patients developed hemodynamic instability. No procedure-related mortality was reported in the study. The most common indications for renal biopsy were nephrotic syndrome, subnephrotic proteinuria with azotemia, unexplained azotemia with proteinuria, and hematuria. The incidence of major complications was low.</p>
Original Articles Nephrologyazotemiacomplicationsnephrotic syndromepercutaneous ultrasound-guided renal biopsyrenal biopsyMohammad Ashraf BhatShahid SulaymanManzoor Ahmad ParryMuzaffar Maqsood WaniImtiyaz Ahmad Wani
Copyright (c) 2022 Mohammad Ashraf Bhat, Shahid Sulayman, Manzoor Parry, Muzaffar Wani, Imtiyaz Wani
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2022-12-312022-12-3181310.15586/jrenhep.v6i2.149Quality of Life of Patients on Peritoneal Dialysis and Contributing Factors: A Cross-Sectional Study
https://mail.jrenhep.com/index.php/jrenhep/article/view/151
<p>In recent years, interest in Health-Related Quality of Life (HRQoL) as a major indicator of clinical efficacy and treatment outcome in patients of End-Stage Renal Disease (ESRD) has grown significantly. This study aimed to determine the contributing factors affecting the quality of life (QoL) of ESRD patients undergoing peritoneal dialysis (PD). A cross-sectional study was conducted on PD patients presented at PD centres of Al-Zahra and Noor hospitals in Isfahan, Iran, from May to August 2019. A total of 173 patients having peritoneal dialysis for more than 3 months filled the validated 36-item short-form health survey questionnaire (SF-36). Baseline demographic details and dialysis-related factors were collected from patients’ medical records. The overall QoL score of patients was 50.28 ± 20.87. Male patients had a higher QoL score than female patients (58.18 in males, compared to 48.18 in females; P = 0.04). A significant association between frequency of dialysis and quality of life was observed, where three sessions of dialysis per day yielded the highest quality of life (QoL score = 59.62; P = 0.047). A significant positive correlation was discovered between QoL score and residual renal function (P = 0.013). In addition, a higher QoL score was observed in self-employed patients (60.95), compared to housewives (46.49) (P = 0.001). QoL assessment should be included as an integral part of patient follow-up to evaluate treatment outcomes and implement possible interventions to improve patient’s quality of life.</p>
Original Articles Nephrologychronic kidney diseaseend-stage renal diseaseperitoneal dialysisquality of lifeSF-36 questionnaireNiloofar NiliShiva SeirafianSayed Mohsen HosseiniAbdolamir AtapourMaryam Kazemi NaeiniMojgan Mortazavi
Copyright (c) 2023 Niloofar Nili, Shiva Seirafian, Sayed Mohsen Hosseini, Abdolamir Atapour, Maryam Kazemi Naeini, Mojgan Mortazavi
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2023-03-012023-03-01112110.15586/jrenhep.v7i1.151Paraquat-associated Severe Acute Kidney Injury—Study from India
https://mail.jrenhep.com/index.php/jrenhep/article/view/140
<p>To analyze the outcomes of severe acute kidney injury in patients with paraquat ingestion. This retrospective analysis of case records was done in our institute, a tertiary care government teaching hospital, over a period of 4 years. Of the total 1310 acute paraquat poisonings during this period, severe acute kidney injury (AKI), referred for nephrology management was observed in 60 patients. Common symptoms at presentation include vomiting, oral ulcers, and abdominal pain. Oliguric AKI was present in 26%. Need for renal replacement therapy was observed in 95% of the cases. Mortality was observed in 38 of the 60 patients (68%). Factors associated with mortality on Cox regression analysis include amount of consumption. Estimated duration of survival on analysis curves was 8 days in 50% after admission and 15 days after consumption in 50%. Paraquat poisoning is associated with grave outcomes of morbidity and mortality. Severity of AKI is significant in this poisoning. Amount of consumption, latency of referral play a major role in outcomes.</p>
Original Articles Nephrologysevere acute kidney injuryparaquat ingestionpoisoningrenal replacement therapyManjusha YadlaK. ManuK.V. AnupamaB. Rajasekhar
Copyright (c) 2022 Manjusha Yadla, Manu K, KV Anupama, B Rajasekhar
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2022-12-132022-12-13142310.15586/jrenhep.v6i2.140Fibrolamellar Carcinoma with DNAJB1-PRKACA Fusion in a 16-Year-Old: Case Report and Review of Literature
https://mail.jrenhep.com/index.php/jrenhep/article/view/147
<p>Fibrolamellar hepatocellular carcinoma (FLC) is a unique primary liver malignancy arising in noncirrhotic livers of young adults with an incidence of 0.02 per 100,000 in the USA (<a href="https://jrenhep.com/index.php/jrenhep/article/download/147/296/1896#ref1">1</a>). In the 5th edition of the WHO classification of the digestive system tumors published in 2019, fibrolamellar carcinoma is categorized as a subset of hepatocellular carcinoma (HCC). In 2014, the unique DNAJB1-PRKACA chimeric fusion protein was identified. Later studies proved this chimeric fusion protein as the main pathological driver in the disease manifestation of fibrolamellar carcinoma. Despite the invention of specific molecular genetic alteration in FLC, its oncogenic role and implication in FLC treatment remain an enigma. Surgical resection remains the primary therapeutic option, and the recurrence rate is extremely high (<a href="https://jrenhep.com/index.php/jrenhep/article/download/147/296/1896#ref1">1</a>). We present a case of fibrolamellar carcinoma in a pediatric patient with the PRKACA rearrangement resulting in DNAJB1-PRKACA fusion.</p>
Case Reports HepatologyDNAJB1-PRKACA fusionfibrolamellar carcinomahepatocellular carcinomamixed fibrolamellar hepatocellular carcinomaPRKACA rearrangementVarsha PrakashNeha Varshney
Copyright (c) 2022 Varsha Prakash, Neha Varshney
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2022-07-192022-07-191710.15586/jrenhep.v6i2.147Differences in Urinary Calculi Characteristics among the Three Main Racial Groups in KwaZulu-Natal, South Africa
https://mail.jrenhep.com/index.php/jrenhep/article/view/142
<p>Racial differences in the characteristics of urinary calculi are poorly described in the South African context, limiting our local understanding of urolithiasis pathology and thwarting our efforts in designing appropriate preventative interventions. We sought to investigate differences in urinary calculi characteristics among the main racial groups in KwaZulu-Natal, South Africa. We conducted a retrospective chart review of patients with urinary calculi at a quaternary hospital in KwaZulu-Natal, South Africa, during 2018–2019. We collected data on the patient’s age, sex, race (Caucasian, Asian, Black African), residence, and pre-stenting. Five study outcomes were investigated across racial groups: number of calculi, location of the calculi, size of the calculi, density of the calculi (Hounsfield Unit measurement >600), and the number of operative interventions performed. Data were analyzed with descriptive statistics, the chi-squared test, and unadjusted/adjusted logistic regression. Our study sample consisted of 147 patients (10.9% Caucasian, 55.8% Asian, and 33.3% Black African). Most patients (86.4%) were from urban areas. A higher proportion of Black Africans had urinary calculi with Hounsfield Unit measurements >600 (P = 0.002). In the logistic regression models, Black Africans had a higher probability of having urinary calculi with Hounsfield Unit measurements >600 (Unadjusted Odds Ratio: 7.17, 95% Confidence Interval: 2.00–27.80; Adjusted Odds Ratio: 18.75, 95% Confidence Interval: 3.37–157.57). Our analysis suggests that Black Africans are at higher risk of having harder urinary calculi than other race groups. This has implications for urolithiasis management and highlights the importance of primary prevention in this group. We recommend additional research to confirm our findings.</p>
Original Articles Nephrologycharacteristicsracial disparitySouth AfricaUrinary calculiUrolithiasisDhesigan NaidooVishan Ramloutan
Copyright (c) 2023 Dhesigan Naidoo, Vishan Ramloutan
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2023-05-042023-05-04384310.15586/jrenhep.v7i1.142Time-Dependent Alterations in Liver Oxidative Stress due to Ethanol and Acetaldehyde
https://mail.jrenhep.com/index.php/jrenhep/article/view/143
<p>Binge drinking is a major public health issue and ethanol-related liver insult may play a major role in the pathology of alcoholic liver disease. However, the degree of oxidative stress, cell death and contribution of acetaldehyde to liver damage over a 24-h period has yet to be determined. Herein, we aimed to investigate the effect of acute alcohol and elevated acetaldehyde levels on hepatic oxidative damage, apoptosis, and antioxidant enzyme activity over a 24-h period. Male Wistar rats were divided into four groups and animals were pre-injected (intraperitonially [i.p.]) with either saline (0.15 mol/L) or cyanamide (5-mmol/kg body weight), followed by either saline (0.15 mol/L) or ethanol (75-mmol/kg bodyweight). After 2.5, 6 and 24 h, hepatic cytosolic and mitochondrial fractions were analysed for indices of oxidative stress. At 2.5 h, cytosolic glutathione and malondialdehyde levels were significantly reduced and increased, respectively, with alcohol treatment. Caspase-3 activity and cytochrome c levels were increased with alcohol treatment at 24 h. The combination of cyanamide and alcohol treatment at 24 h led to a significant increase in serum alanine aminotransferase levels, and reduced albumin and total protein levels. Furthermore, glutathione peroxidase activity and glutathione reductase activity were significantly decreased and increased, respectively. Finally, superoxide dismutase activity was decreased in cytosol and increased in the mitochondria after cyanamide and ethanol treatment, respectively. This study indicates a complex differential effect of alcohol and acetaldehyde, whereby alcohol toxicity in the mitochondria takes place throughout the 24-h period, but raised acetaldehyde has a further detrimental effect on liver function.</p>
Original Articles Hepatologyacetaldehydealcoholantioxidantapoptosismitochondriaoxidative stressLucy PetagineHannah EverittRoy SherwoodDaniel GyamfiVinood B. Patel
Copyright (c) 2022 Lucy Petagine, Hannah Everitt, Roy Sherwood, Daniel Gyamfi, Vinood Patel
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2022-05-112022-05-11566610.15586/jrenhep.v6i1.143Histopathological Spectrum of Nephrectomies; a Single Centre Experience of over 14 Years
https://mail.jrenhep.com/index.php/jrenhep/article/view/138
<p>Nephrectomy is conducted either as an open or a laparoscopic procedure for a variety of clinical indications. These include both neoplastic and non-neoplastic conditions, such as the non-functioning kidney. In many patients the final diagnosis is established on the histopathology of the retrieved kidney. In this study, retrospective analysis of data of last 14 years was studied pertaining to the number and indications of nephrectomy at the present study centre. Demographic and clinical details were assessed. Gross and microscopic histopathological details were recorded. Diagnosis was established on the basis of clinical features and histopathology. A total of 638 total nephrectomy specimens were received. Of these, 280 cases were of neoplastic and 358 of non-neoplastic lesions, with a male-to-female ratio of 1.21:1. The age range varied widely according to clinical manifestations. The age range in the present study was 5–84 years. Patients operated for non-neoplastic disorders were younger (mean age: 38.1 years) than those operated for neoplastic disorders (mean age: 54.4 years). Clear <em>renal cell carcinoma</em> (RCC) was the commonest RCC type (150 patients) followed by papillary RCC (51 cases). Nephrectomy is done due to both benign and malignant clinical indications as observed in this study. The most common indication was chronic pyelonephritis with the non-functioning kidney.</p>
Original Articles NephrologyNephrectomyPyelonephritisRCCFarhat AbbasGul AalmeenMuzamil LatiefShahid WaniMohsin WaniSummyia Farooq
Copyright (c) 2022 Farhat Abbas, Muzamil Latief, Shahid Wani, Gul Aalmeen, Mohsin Wani, Summyia Farooq
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2022-04-132022-04-13364010.15586/jrenhep.v6i1.138Epidemiological, Clinical, and Diagnostic Aspects of Urinary Tract Infection in Newborns at the Departmental Teaching Hospital of Borgou-Alibori (DTH-B/A) in Benin
https://mail.jrenhep.com/index.php/jrenhep/article/view/127
<p>To study epidemiological and diagnostic aspects of urinary tract infection (UTI) in newborns at the Departmental Teaching Hospital of Borgou-Alibori (DTH-B/A). This was a cross-sectional study conducted from April 1, 2019 to September 30, 2019 and concerned all newborns admitted to the neonatal unit of DTH-B/A. According to the National Agency for Health Accreditation and Evaluation (NAHAE)recommendations of 2002, all symptomatic newborns who did not have a visible malformation outside the genitourinary system and whose parents gave their consent were included in the study. The census was exhaustive despite the calculated minimum size of 109 newborns. Urine sedimentation and cytobacteriological examination of urine samples, taken in adhesive bags after local disinfection, demonstrated presence of pathogenic microbes. Sensitivity of detected microbes was studied to different antibiotics. Interpretive reading of antibiograms was established according to the Standards of the French Society of Microbiology (FEMS), edition 2012. If UTI was confirmed, an abdominopelvic ultrasound was performed in search for a malformative uropathy as a contributing factor in newborns. A standardized survey was developed for data collection. The data entered were analyzed using the Epi info software, version 3.5.4. In all, 124 newborns were included in the study. UTI accounted for 8.06% of all neonatal infections and 2.15% of admissions. The average age of onset was 7.8 days, with a gender ratio of 1:1. The main clinical manifestations were jaundice and respiratory distress. Microbes involved were <em>Staphylococcus aureus</em> (6/10), <em>Escherichia coli</em> (2/10), and <em>Klebsiella oxytoca</em> (2/10). The resistance of microbes to antibiotics was generally high. No abnormalities were revealed in the ultrasound. Although neonatal UTI is not a rare infection, bacterial resistance is of concern.</p>
Original Articles NephrologyBeninnewbornurinary tract infectionSéraphin AhouiGerard KpanidjaAlphonse NoudamadjoFalilatou AgbeilleHermione Nelly DjimaAhmed AdegbolaAristide DahJulien Didier AdedemyJoseph Agossou
Copyright (c) 2022 Seraphin Ahoui , Gerard Kpanidja, Alphonse Noudamadjo, , Hermione Nelly Djima, Ahmed Adegbola, Aristide Dah , Julien Didier Addemy, Joseph Agossou
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2022-04-262022-04-26414710.15586/jrenhep.v6i1.127Epidemiological, Clinical, Therapeutic, and Evolutionary Aspects of Acute Kidney Damage during Severe Malaria in Children at the Borgou Departmental Teaching Hospital (Benin)
https://mail.jrenhep.com/index.php/jrenhep/article/view/137
<p>Malaria is an endemic pathology with several complications, including kidney damage. The objective of this work was to study kidney damage during severe malaria in children at the pediatrics department of the Borgou Departmental Teaching Hospital (Borgou DTH), Benin in 2021. This was a longitudinal study carried out over 4 months from June 1, 2021 to September 30, 2021 (with 1 month of recruitment from June 1 to July 1, 2021) at the pediatric department of the Borgou DTH. The study included children aged 1 month–15 years, hospitalized for <em>Plasmodium falciparum</em> malaria with at least one clinical manifestation of malaria severity established by the World Health Organization in 2000 and whose parents had given their informed consent. The damage was established by urinary sedimentation using urine dipstick and urinary cap and serum creatinine. Acute kidney injury (AKI) was intended and classified according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The dependent variable was the presence of at least one clinical, biological, and functional impairment. Follow-up was regular for up to 3 months. Lost to follow-up were excluded. Predictors of occurrence were identified. Statistical difference was considered significant at P < 0.05. Of the 164 children hospitalized for severe malaria during the study period, 72 had at least one renal impairment, with a frequency of 43.90%. The average age of the children was 44.93 months. On urine dipstick, 76.39% of the patients had hemoglobinuria and 55.56% had albuminuria. Urinary cap revealed 44% granular cylindruria and 32% crystalluria. AKI was detected in 4.54% patients. Recovery was complete in all follow-up cases. The predictors of kidney damage were coma ( P = 0.017), jaundice ( P = 0.007), thrombocytopenia ( P = 0.021), and long hospital stay ( P = 0.008). Kidney damage in severe malaria is frequent. Early diagnosis and prompt treatment are fundamentals of rapid and complete recovery of kidney functions.</p>
Original Articles Nephrologychildrenkidney diseasemalariapredictorsParakouSéraphin AhouiAlphonse NoudamadjoGerard KpanidjaEvariste EtekaK.O. Auguste AkotoFalilatou AgbeilleMuriel ToutcheAristide DahJulien Didier AdedemyJoseph Agossou
Copyright (c) 2022 Seraphin Ahoui , Alphonse Noudamadjo, Gerard Kpanidja, Evariste Eteka, K. O. Auguste Akoto, Falilatou Agbeille, Muriel Toutche, Mr, Julien Didier Adedemy, Joseph Agossou
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2022-04-262022-04-26485510.15586/jrenhep.v6i1.137Outcome of Hospitalized Pneumonia Patients with and without COVID-19: A Retrospective Cohort Study
https://mail.jrenhep.com/index.php/jrenhep/article/view/132
<p>COVID-19 pneumonia and community-acquired pneumonia (CAP) have been associated with morbidity and mortality. The aim of this study was to evaluate the outcome of hospitalized patients with COVID-19 pneumonia versus CAP in terms of mortality. This was a retrospective cohort study conducted between pre-COVID-19 era (May 2019–November 2019) and COVID-19 era (May 2020–November 2020). The study included all adult patients with COVID-19 pneumonia (Group 1) and adult patients with CAP but are COVID-19 negative (Group 2). A total of 106 patients were included in the study, of which 56 were in the COVID-19 pneumonia group and 50 in the CAP group. Patients who developed acute kidney injury (AKI) were 60.7% (n = 34) in Group 1 and 48% (n = 24) in Group 2. Mortality occurred in 37.5% (n = 21) patients in Group 1 and 12.0% (n = 6) in Group 2 (P = 0.003). A total of 52 patients required admission to intensive care unit (ICU), of which 44.6% (n = 25) were in Group 1 and 54.0% (n = 27) in Group 2. Of the 58 patients who developed AKI, 3 (8.8%) patients in Group 1 passed away compared to none in Group 2. Moreover, 58.8% patients (n = 20) in Group 1 and 70.8% patients (n = 17) in Group 2 required ICU admission. Mortality rate in the ICU was 80.0% (n = 16) and 35.3% (n = 6) in Groups 1 and 2, respectively (P = 0.006). The overall mortality rate was higher in case of COVID-19 patients than those with CAP. In case of patients with AKI, mortality rate in the ICU was significantly higher in COVID-19 pneumonia patients compared to CAP patients.</p>
Original Articles Nephrologyacute kidney injuryCOVID-19mortalitypneumoniaRabab KhalilLoubna SinnoHousam Rabah
Copyright (c) 2022 Rabab Khalil, Loubna Sinno, Housam Rabah
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2022-01-072022-01-07172310.15586/jrenhep.v6i1.132Clinicopathologic Spectrum of Xanthogranulomatous Pyelonephritis: A Single Center Experience over 8 Years
https://mail.jrenhep.com/index.php/jrenhep/article/view/135
<p>Xanthogranulomatous pyelonephritis (XGP) is a chronic pyelonephritis subtype in which destruction of the renal parenchymal occurs, resulting in progressive loss of kidney functions. Although middle age is the predominant age group affected, but it can be spotted at any age. There is accumulation of macrophages (lipid-laden), leading to renal parenchymal destruction and fibrosis. In this study, we present our data of 15 patients who had undergone nephrectomy and had biopsy-proven XGP. XGP constituted 4.53% of the 331 nephrectomies performed for infective causes over a period of 8 years. All our patients had undergone unilateral total nephrectomy. Demographic and clinical data were analyzed after taking consent from all the patients. The age range of patients in our study was 18–65 years with a mean age of 43.93 ± 13.86 years. Ten (66.6%) of our patients were females. Diabetes was present in 40% of the patients. Three patients had imaging, suggestive of pyonephrosis, 3 had perinephric collection and 9 patients (60%) had concomitant nephrolithiasis. All the kidneys were grossly enlarged and were nonfunctional on renal scintigraphy. XGP is a form of chronic pyelonephritis, which, although less common, is devastating because of destruction of the renal parenchyma and associated morbidity. Clinicoradiologic correlation cannot be overemphasized. Definitive diagnosis is established through histopathologic examination.</p>
Original Articles NephrologypyelonephritispyonephrosisXGPFarhat AbbasSummyia FarooqGul AalmeenMuzamil LatiefMohsin Wani
Copyright (c) 2022 Farhat Abbas, Summyia Farooq, Gul Aalmeen, Muzamil Latief, Mohsin Wani
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2022-04-072022-04-07323510.15586/jrenhep.v6i1.135Clinical Profile and Outcomes of COVID-19 in Renal Transplant Recipients
https://mail.jrenhep.com/index.php/jrenhep/article/view/133
<p>There is minimal information on coronavirus disease 2019 (COVID-19) in developing countries regarding renal transplant recipients (RTRs). This paper aimed to study the clinical profile, immunosuppressive regimen, treatment, and outcomes in an RTR with COVID-19. This retrospective study was conducted in the nephrology department of Sri Aurobindo Medical College & Postgraduate Institute, Indore (MP), India, from April 1, 2020 to December 15, 2020. We studied 15 patients, of which 13 were treated at our hospital and two were treated in OPD. The median age of transplant recipients was 45 (Interquartile range [IQR]: 26–62) years, the majority being males, and recipients presented at a median of 4 (IQR: 0.3–11) years after transplant. The most common comorbidities included hypertension in 14 (94%) and diabetes 3 (20%) patients. The presenting symptoms at presentation were cough (80%), headache (52%), fever (46%), and breathlessness (26%). Clinical severity as per computerized tomography (CT) severity score ranged from mild (20%), moderate (53%), and severe (27%). Strategies to modify immunosuppressants included discontinuation of antimetabolites without changes in calcineurin inhibitors and steroids (100%). Antiviral therapy (Favipiravir and Remdesivir) was associated with better outcomes and reduced hospital stay. Risk factors for mortality included ABO-incompatibility, severity of disease, high Coronavirus Disease 2019 (COVID-19) Reporting and Data System (CO-RADS) score, allograft dysfunction before COVID-19 infection, acute kidney injury, elevated inflammatory markers, and intensive care unit/ventilator requirement. Overall patient mortality was 13.2%. Risk factor for mortality in COVID-19 positive with RTR appears to be ABO-incompatible transplant, having a previous history of rejection, and patient requiring ventilatory support.</p>
Original Articles Nephrologyacute kidney injurycorona virus diseaseintensive care unitrenal transplant recipientsmycophenolate mofetilMohit MahajanNaresh PahwaShraddha GoswamiVijay MalviyaVishnu ShuklaTrishala Chhabra
Copyright (c) 2021 Mohit Mahajan, Naresh Pahwa, Shraddha Goswami, Vijay Malviya , Vishnu Shankar Shukla , Trishala Chhabra
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2021-12-232021-12-23101610.15586/jrenhep.v6i1.133Clinicopathological Features of Lupus Nephritis Patients in North-East India; A Single Center Retrospective Observational Study
https://mail.jrenhep.com/index.php/jrenhep/article/view/130
<p>Clinicopathological presentation of lupus nephritis (LN) patients varies with different race and ethinicity of the population. Only few studies describe clinicopathological spectrum of LN patients in the Indian population. The aim of this study was to determine the clinicopathological spectrum of LN in the North-East Indian population. This was a retrospective observational study that included patients with LN at a tertiary care center in North-East India from March 2007 to August 2018. Clinical and histopathological data at the time of presentation were collected from hospital records. Renal biopsies were examined by light microscopy and direct immunofluorescence techniques. A total of 340 patients of LN were included in this study. The mean age of presentation was 22.42 ± 4.3 years. The minimum age at presentation was 8 years and 18.8% belonged to the <18 year age group. The present study showed a male:female ratio of 1:8. The majority of patients were of class IV (71.9%). Arthralgia (47.1%) and anemia (60.3%) were the most common presenting symptom and sign, respectively. Immunoglobulin (Ig) G was the most abundant immunoglobulin (positive in 98.47%) and the least positive was IgA (positive in 41.18%). Complement (C) 3 and C1q were positive in all. Full house deposition was found in 59.3% of the biopsies. The rates of hypertension, microscopic hematuria, renal dysfunction, and nephrotic syndrome were 43.5, 59.12, 45.9, and 35.3%, respectively. Patients of LN in the North-East Indian population present at an earlier age with a more severe form of the disease (class IV) at the time of presentation.</p>
Original Articles Nephrologyclinicopathological presentationhistopathologylupus nephritissystemic lupus erythematosusShahzad AlamManzoor ParryManjuri SharmaHamad JeelaniMastakim Mazumder
Copyright (c) 2022 Shahzad Alam, Manzoor Parry, Manjuri Sharma, Hamad Jeelani, Mastakim Mazumder
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2021-12-102021-12-101610.15586/jrenhep.v6i1.130Clinicopathological Spectrum and Outcome of Crescentic Glomerulonephritis: A Retrospective Study from North-East India
https://mail.jrenhep.com/index.php/jrenhep/article/view/125
<p>Crescentic glomerulonephritis (CrGN) is characterized by the presence of crescents in more than 50% of glomeruli. This study aims to identify the etiology and clinicopathological features and outcomes of CrGN. In this observational study, 80 biopsy-proven CrGN were included. Patients’ demographic profile, clinical parameters, treatments, and outcomes were collected and analyzed. The mean age in our study population was 40.86 ± 16.5 years. Type II CrGN was the most common type of CrGN. Female predominance was observed in type I and type II CrGN. The highest percentage of glomeruli with crescents was seen in type I (87 ± 15.2%, P = 0.04), followed by type III and type II. At the last follow-up, mean estimated glomerular filtration rate was 25.8 ± 11.41 mL/min/1.73 m<sup>2</sup> and was significantly lower in type I CrGN (11.6 ± 4.8 mL/min/1.73 m<sup>2</sup> P = 0.001). The overall 5-year renal survival rate was 55% and was highest in type II (69.4%), followed by type III and type I (27.3%) CrGN (P = 0.0299). In our study, oliguria at the time of presentation, percentage of crescents, glomerular sclerosis, and moderate/severe IFTA were associated with poor renal outcomes. In conclusion, CrGN was seen in 5.7% of kidney biopsies in our study. Type II CrGN was the most common type of CrGN followed by type III CrGN. Renal survival was poor in type I CrGN patients compared to type II and type III CrGN. Also, oliguria, crescents, glomerular sclerosis, and moderate/severe IFTA were associated with poor renal outcomes.</p>
Original Articles Nephrologycrescentic glomerulonephritispauci-immune glomerulonephritisantineutrophil cytoplasmic antibodies–associated vasculitislupus nephritisIg A nephropathyManzoor Ahmad ParryMastakim Ahmad MazumderManjuri SharmaHamad JeelaniShahzad Alam
Copyright (c) 2022 Manzoor Parry, Mastakim Mazumder, Manjuri Sharma, Hamad Jeelani, Shahzad Alam
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2022-01-252022-01-25243110.15586/jrenhep.v6i1.125A Neglected Case of Wilson’s Disease Presenting as Symptomatic Urolithiasis and Proteinuria: A Case Report and Review of the Literature
https://mail.jrenhep.com/index.php/jrenhep/article/view/123
<p>We report a short-statured, 39-year-old male presenting with recurrent kidney stones, history of refractory rickets, and bone deformity. He had been consuming multiple doses of calcium supplements and multiple courses of vitamin D over past 30 years before prior to reporting in our clinic without any significant laboratory or clinical improvement. The patient was diagnosed as having Fanconi’s syndrome attributable to Wilson’s disease. This patient highlighted that in case of resistant rickets, a high index of uncertainty must be invoked for Wilson’s disease. Appropriate timely recognition of this entity results in prompt ministrations and prevention of disability. We also presented and discussed reviews on Wilson’s disease from literature.</p>
Case Reports Nephrologybone diseaserenal tubular acidosisWilson’s diseaseElham ZareZahra MahbubiMaryam Panahi
Copyright (c) 2021 Elham Zare, Zahra Mahbubi, Maryam Panahi
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2021-10-072021-10-07394410.15586/jrenhep.v5i2.123Comparison of Standard Percutaneous Nephrolithotomy with Mini-Percutaneous Nephrolithotomy for Removal of Renal Stones in Adults
https://mail.jrenhep.com/index.php/jrenhep/article/view/118
<p>Renal stones are the third most common problem affecting about 10% of global population. The management of nephrolithiasis has undergone a complete transformation since the 1980s. Percutaneous nephrolithotomy (PCNL) has established itself an effective and safe technique that delivers high stone-free rate as well as overall shorter treatment time. We aim to compare the outcome of mini-PCNL with standard-PCNL in patients presenting with renal stones. In all, 90 patients fulfilled the selection criteria and randomized into two groups. Group A underwent mini-PCNL whereas Group B underwent standard-PCNL. Pre-operative hemoglobin level was recorded. Duration of procedure as well as drop in hemoglobin level was also recorded. A kidney, ureter, and bladder (KUB) X-ray was performed to confirm the presence of stone and stone-free status. The mean age of patients in mini-PCNL group was 43.11 years and in standard-PCNL group, it was 36.91 years. The mean stone size in patients of mini-PCNL group was 29.53 mm and 31.58 mm in standard-PCNL group. The mean duration of renal stone in mini-PCNL group was 1.91 years and that in standard-PCNL group 1.80 years. The mean operative time in mini-PCNL group was 59.56 min and 61.22 min in standard-PCNL group. The mean fall in hemoglobin in mini-PCNL group was 0.38 g/dL and that in standard-PCNL group 0.51 g/dL. In mini-PCNL group, stone clearance was observed in 42 (93.3%) patients, while in standard-PCNL group, it was observed in 45 (100%) patients. This difference was insignificant (P > 0.05). Mini-PCNL and standard-PCNL have no significant differences in terms of outcome, operative time, and stone clearance, although fall in hemoglobin level was less in mini-PCNL group, which showed less blood loss in this group, thereby making it a more appropriate method for renal stone removal.</p>
Original Articles Nephrologyhemoglobinmini-percutaneous nephrolithotomyoperative timerenal stonestandard procedurestone removalAsif Alam KhanInam MalkaniJunaid Jameel KhattakHassan MumtazMubashir MazharFalak NazArsalan Riaz
Copyright (c) 2021 Asif Alam Khan, Inam Malkani, Junaid jameel khattak, Hassan Mumtaz, Mubashir Mazhar, Falak Naz, Arsalan Riaz
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2021-09-082021-09-08202510.15586/jrenhep.v5i2.118Orthotopic Liver Transplantation in a Case of Novel YAP1-TFE3 Hepatic Epithelioid Hemangioendothelioma [HEHE]; Case Report and Review of Literature
https://mail.jrenhep.com/index.php/jrenhep/article/view/122
<p>Epithelioid hemangioendothelioma is an extremely rare vascular neoplasm arising in soft-tissues and different visceral organs, with liver being the most commonly involved viscera. Hepatic epithelioid hemangioendothelioma (HEHE) is a malignant tumour with an indolent behaviour and unpredictable clinical course. It has a better prognosis among the malignant tumours of the liver, in spite of being a diffuse multifocal liver disease or metastatic at the time of presentation. HEHE is usually found to be noted in the fifth decade with slight female preponderance. No single treatment strategy has yet been established owing to its variable clinical course, ranging from an indolent tumour with prolonged survival to an aggressive, metastatic disease with a fatal outcome. Here, we present a case of a novel HEHE in a 25-year-old female who was treated successfully with orthotopic living donor liver transplantation and discuss the presentation, histopathology and management of this rare, fatal yet treatable malignant tumour.</p>
Case Reports Hepatologyhepatic epitheloid hemangioendotheliomavascular tumourSugi SRVElankumaran KrishnanKulaseharan Venugopal HaribabuHari BalakrishnanShantha Ravisankar
Copyright (c) 2021 Sugi SRV, Elankumaran Krishnan, Kulaseharan Venugopal Haribabu, Hari Balakrishnan, Shantha Ravishankar
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2021-10-142021-10-14454910.15586/jrenhep.v5i2.122Kidney Injury in Children Infected with HIV, Followed at the Teaching Hospital of Borgou (Benin): Epidemiological and Clinical Aspects
https://mail.jrenhep.com/index.php/jrenhep/article/view/120
<p>The history of kidney disease associated with HIV infection dates back to the years of HIV breakthrough. The objective was to study kidney damage in children infected with HIV at the Teaching Hospital of Borgou (Benin) in 2019. This was a cross-sectional, descriptive, analytical, matching-type study carried out from June 1, 2019 to September 30, 2019 at the pediatrics department of Teaching Hospital of Borgou (Benin). The study included HIV-positive children, followed in consultations, and whose parents gave their consent. The biological markers were demonstrated with urine dipstick. Glomerular filtration rate was calculated using the Schwartz test and classified according to stages. The dependent variable was the presence of at least one impairment (biological or functional). Sample size was determined by Schwartz’s method on the basis of one case for two controls. Sociodemographic, clinical, biological, and therapeutic data were collected. Comparisons were made using the Chi- square test or Fisher’s exact test. The identification of associated factors was possible using a multiple logistic regression model at 5% threshold. In total, we included 117 children, including 39 HIV-positive children. The average age was 8 ± 4.81 years and the gender ratio was 1:17. The frequency of kidney damage was 76.5%. Permanent proteinuria and at least two crosses on urine dipstick were present in 20.5%, leukocyturia in 2.6%, and proximal tubular dysfunction in 5.1%. Glomerular hyperfiltration was found in 38.5%, acute kidney injury in 38.5%, and chronic kidney injury in 5.1%. Associated factors were age (P = 0.004), presence of opportunistic infections (P = 0.00), and treatment adherence (P = 0.004). Kidney damage is common in HIV-positive children. Careful follow-up is necessary to avoid complications.</p>
Original Articles NephrologyBeninHIV-positivekidney diseasepediatricsSéraphin AhouiFalilatou AgbeilleGerard KpanidjaAlphonse NoudamadjoMuriel Fridzie ToutcheBruno Leopold AgbotonEvariste EtekaJacques ViganAdedemy Julien DidierJoseph Agossou
Copyright (c) 2021 Séraphin Ahoui, Falilatou Agbeille, Gerard Kpanidja, Alphonse Noudamadjo, Toutche Bruno Leopold Agboton, Evariste Eteka, Jacques Vigan, Julien Didier Adedemy, Joseph Agossou
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2021-10-262021-10-26505610.15586/jrenhep.v5i2.120Sewing Needle as Foreign Body in Urethra of an Adolescent Boy: Case Report
https://mail.jrenhep.com/index.php/jrenhep/article/view/119
<p>Self-insertion of a foreign body in the urethra is an uncommon presentation clinically. The cases usually arise due to fulfillment of sexual desire, for recreation, play, or exploration, or the foreign body insertion may take place accidentally. We present a case of an adolescent boy with a foreign body urethra presenting to the emergency room with urinary retention, pain, and dysuria. Attending urologist suspected urethral stricture and ordered ultrasonography to investigate which turned out to be a sewing needle in his urethra. The patient was then enquired about the foreign body. He tried to self-dilate his urethra as he was experiencing lower urinary tract symptoms. The sewing needle was removed by endoscopy and he was administered with antibiotics and painkillers. The urethral foreign bodies may present with pain, dysuria, or urinary incontinence and these foreign bodies are mostly seen in the male population in the adolescent age group.</p>
Case Reports Nephrologyendoscopyforeign bodyremoval urethraKashif BangashMuhammad NaeemHassan MumtazAaliah Akhtar HayatMubashar MazharShahzaib Ahmad
Copyright (c) 2021 Kashif Bangash, Muhammad Naeem, Hassan Mumtaz, Aaliah Akhtar Hayat, Mubashar Mazhar, Shahzaib Ahmad
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2021-09-082021-09-08171910.15586/jrenhep.v5i2.119Gabapentin Toxicity and Role of Dialysis; Case Series and Literature Review
https://mail.jrenhep.com/index.php/jrenhep/article/view/104
<p>Gabapentin is frequently used as an analgesic in patients with chronic kidney disease (CKD). It is excreted exclusively through kidney, and therefore impairment in kidney function could lead to gabapentin accumulation and hence toxicity. We present our experience of 3 cases with Gabapentin toxicity who were managed according to the severity of symptoms. Case 1: A 32-year-old male was found lying unconscious after consuming around 12,000 mg of gabapentin and had respiratory depression, rhabdomyolysis, and acute kidney injury (AKI). Patient was managed with supportive care and hemodialysis (HD). Case 2: A 64-year-old male CKD Stage 5 (5D) patient with diabetic neuropathy was started on gabapentin 300 mg daily by his primary care physician 1 week back. Patient started to feel sleepy and developed altered sensorium and myoclonus. Discontinuation of gabapentin and a session of HD led to dramatic improvement in patient’s status. Case 3: A 70-year-old female diabetic patient with CKD Stage 3 and had diabetic neuropathy. Her neuropathic symptoms had improved with gabapentin 300 mg twice daily, but lately patient was feeling sleepy during the day and was confused. Discontinuation of the drug led to improvement in symptoms. Gabapentin is a relatively safe medication, but in certain clinical scenarios, particularly in impaired renal functions, can lead to severe complications. Moreover, it per se can rarely lead to rhabdomyolysis and AKI. Clinical suspicion and timely decontamination are needed, and sometimes dialytic therapy may be needed.</p>
Case Reports HepatologydialysisgabapentinmyoclonusMuzamil LatiefMohd Iqbal BhatMohd Latief WaniObeid ShafiL. Naresh GoudFarhat AbbasMohsin Wani
Copyright (c) 2021 Muzamil Latief, Mohd Iqbal Bhat, Mohd Latief Wani, Obeid Shafi, L Naresh Goud, Farhat Abbas, Mohsin Wani
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2021-12-142021-12-147910.15586/jrenhep.v6i1.104