https://www.theskygallerypattaya.com/jcn A Heighpubs Open Access Journal en-us 01/12/2021 https://www.theskygallerypattaya.com/jcn/jcn-aid1065.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Background: Glomerular hyperfiltration (GH) is a common feature of sickle cell nephropathy (SCN) starting at infancy and represents an early marker of incipient glomerular injury and renal dysfunction.&lt;/p&gt; &lt;p&gt;Methods: This study aimed to determine the prevalence and correlates of GH among children (&amp;le; 16 years) with sickle cell disease (SCD) at their steady state, recruited over 6 months at the Pediatric Outpatient Clinic in Al-Sadaqa General Teaching Hospital, Aden, Yemen. Glomerular filtration rate (eGFR) was estimated using the Schwartz formula. Data on clinical history, anthropometry, blood pressure (BP) and laboratory investigations were collected.&lt;/p&gt; &lt;p&gt;Results: Of 101 children (mean age 7.2 &amp;plusmn; 3.9 years), 65 (64.4%) were males. The prevalence of GH was observed in 36 (35.6%) children, who were significantly older (10.7 &amp;plusmn; 3.2 vs. 5.2 &amp;plusmn; 2.7 years, p &amp;lt; 0.001) and had a lower fetal Hb level (5 &amp;plusmn; 3.3 vs. 9 &amp;plusmn; 7.1, p = 0.02). All children were normotensive, but hyperfiltrating children showed significantly higher systolic (97.2 &amp;plusmn; 7.3 vs. 89.7 &amp;plusmn; 5.2 mmHg) and diastolic pressure (55.1 &amp;plusmn; 5.0 vs. 49 &amp;plusmn; 4.3 mmHg) (all p &amp;lt; 0.001). Among evaluated children, 25.7% had hyperfiltration alone, whereas 9.9% had an associated microalbuminuria (MA), and no significant difference in eGFR between those with and without MA (158.4 &amp;plusmn; 33.7 vs. 160.7 &amp;plusmn; 29.8 ml/min/173m2, p = 0.84).&lt;/p&gt; &lt;p&gt;Conclusion: This study demonstrated a relatively high prevalence of GH in Yemeni children with SCD that increased with age. Recognition of hyperfiltration and other early markers of nephropathy in this population could help to develop renal protective strategies to prevent progressive loss of kidney function.&lt;/p&gt; 12/24/2020 https://www.theskygallerypattaya.com/jcn/jcn-aid1064.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;A 66-year-old male with no known past medical history presented with history of two days of throbbing frontal headache associated with nausea, vomiting and left-sided facial droop. The patient also reported dizziness, subjective chills without cough, shortness of breath, or sputum production. Laboratory findings revealed elevated inflammatory markers but normal thyroid, kidney, and liver function tests. Initial sodium level was 126 mEq/L. Urine studies showed elevated urine osmolality of 647 mOsm/Kg and urine sodium level of 175 mEq/L, both suggestive of syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The TSH and ACTH stimulation tests both came back as normal. CT scan of the chest showed no evidence of lung infiltrates. Diffusion weighted MRI of the brain showed no evidence of acute or subacute CVA. SARS-CoV-2 nasal swab test was resulted positive. With these findings we diagnosed our patient with SIADH. Patient was initially started on 3% saline infusion for symptomatic hyponatremia. A fluid restricted diet was enforced. Patient was also started on salt tablets in order to increase solute intake. Sodium slowly corrected throughout the hospitalization. Of note, our patient never became hypoxic, neither did he show evidence of clinical pneumonia. A CT imaging of the chest showed no lung infiltrates, and an MRI of the brain was negative for any acute intracranial abnormalities. This case highlights the role of early recognition of SIADH in the setting of SARS-CoV-2 infection even in the absence of hypoxemia or lung pathology.&lt;/p&gt; 11/04/2020 https://www.theskygallerypattaya.com/jcn/jcn-aid1063.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Oxalate Nephropathy due to Hyperoxaluria and elevated serum oxalate level is a well-known cause for interstitial fibrosis, and ESRD. Conditions associated with high serum Oxalate, should be considered as a possible contributing factor for a patient&amp;rsquo;s tubular injury,&lt;br /&gt; Well known cause for Hyperoxaluria including enteric Hyperoxaluria (due to gastric bypass, chronic pancreatitis, small Bowel resection, or malabsorption, as well as depletion of enteric oxalate-degrading bacteria [e.g., Oxalobacter). Other known causes of oxalate nephropathy include primary Hyperoxaluria, ethylene glycol intoxication, vitamin B6 deficiency, excessive ingestion of vitamin C or dietary substances rich in oxalic acid, aspergillosis, prolonged renal failure and various drugs (e.g., Known medications to cause Oxalate Nephropathy are: Orlistat, Praxilene, COX-2 inhibitors).&lt;br /&gt; Unusual presentation with Acute Kidney Injury with incidental finding of high serum Oxalate in a patient with a known CKD stage III, recently started on Polyethelene Glycol to treat his constipation.&lt;/p&gt; 11/02/2020 https://www.theskygallerypattaya.com/jcn/jcn-aid1062.php &lt;p&gt;Severe Acute Kidney Injury (AKI) is a common, serious problem affecting critically ill children that lacks effective treatment options. Currently, there are no treatment options for AKI other than supportive care. Continuous renal replacement therapy (CRRT) is employed to reduce Fluid Overload (FO) burden and treat metabolic disturbances in AKI. Identifying patients upon admission who may require CRRT has potential clinical care implications. The aim of this study was to determine if the RAI had diagnostic capabilities to identify patients who would require CRRT.&lt;/p&gt; &lt;p&gt;The analytic cohort consisted of patients who required CRRT and illness severity score matched controls who did not require CRRT at a single center. Patients who required CRRT had higher mortality rates, length of stay, and use of ventilatory and inotropic support. Sensitivity, specificity and area under the receiver operating characteristic curve (AUC) assessed and compared the discriminatory accuracy of three scores: 1) the renal angina index (RAI), 2) serum-creatinine (sCr) based AKI on day 0 and 3) modified RAI created with an additional RAI injury tranche that corresponded to severe stage 3 AKI sCr elevation.&lt;/p&gt; &lt;p&gt;Compared to Day0AKI (AUC 0.78, 0.70-0.87; sensitivity 0.63, 0.45-0.79; specificity 0.93, 0.870.97) and RAI (AUC 0.76, 0.69-0.82; sensitivity 0.94, 0.81-0.99; specificity 0.57, 0.47-0.66), the modified RAI had the highest AUC (0.79; 0.72-0.85) with a high sensitivity (0.91; 0.77-0.98) and moderate specificity (0.65; 0.56-0.75) for prediction of CRRT requirements. As a more accurate tool for discriminating patients in need of CRRT, a modified RAI has numerous potential implications. Identifying patients who ultimately require CRRT at an earlier timepoint may influence timing of CRRT initiation in an attempt to avoid further FO, or may influence nephrotoxin administration. The diagnostic capabilities of the modified RAI may be refined by the addition of urinary biomarkers. These findings should be validated in a larger cohort.&lt;/p&gt; 10/20/2020 https://www.theskygallerypattaya.com/jcn/jcn-aid1061.php &lt;p&gt;A novel coronavirus known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) with a high rate of human-to-human transmission has emerged, resulting in a worldwide public health crisis of catastrophic proportions. Common initial symptoms of Coronavirus Disease 2019 (COVID-19) include fever, cough, fatigue, myalgia, and shortness of breath. Complications include acute respiratory distress syndrome (ARDS), acute cardiac injury, acute kidney injury, and secondary infections [1,2]. There have been reports of patients infected with COVID-19 who either presented with muscle pain and rhabdomyolysis or developed muscle damage as a late complication during hospitalization [3-8].&lt;/p&gt; 10/02/2020 https://www.theskygallerypattaya.com/jcn/jcn-aid1060.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Background: Down syndrome (DS) is associated with various congenital diseases and malformations, including those of the kidneys and urinary tract. It has been thought that renal tubular acidosis (RTA) is more frequent in this population. The objective of this study was to assess the frequency of RTA and, secondarily, of other renal and urological disorders in persons with DS.&lt;/p&gt; &lt;p&gt;Method: An observational, ambispective, descriptive and cross-sectional study of patients diagnosed with RTA, or suspected kidney or urological disorders, was carried out from July 2016 to September 2017 at the Down syndrome clinic of the Mexican National Institute of Paediatrics. Urinalysis was performed, along with analyses of venous blood gas, sodium, potassium, chlorine, calcium, phosphorus, albumin and creatinine. Those with any abnormal values were referred to nephrology for diagnostic evaluation.&lt;/p&gt; &lt;p&gt;Results: Of a total of 700 patients seen at the clinic, 47 met the selection criteria. Of these, 32 had no RTA or other renal or urological alterations. The remaining 15 continued to the second phase of the study, where 6 were diagnosed with nephropathy or uropathy (RTA, systemic arterial hypertension, monosymptomatic familial haematuria, mild renal failure secondary to reflux nephropathy, urinary tract infection or right ureteropelvic stenosis). Four had mild metabolic acidosis without meeting the criteria for diagnosis of RTA.&lt;/p&gt; &lt;p&gt;Conclusion: RTA is not more common in children with Down syndrome. Nephropathies and uropathies should be investigated in the evaluation of DS patients.&lt;/p&gt; 09/11/2020 https://www.theskygallerypattaya.com/jcn/jcn-aid1059.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Introduction:&lt;strong&gt; &lt;/strong&gt;Acute kidney injury (AKI) is one of the complications associated with severe COVID-19 infection, and it can present in up to 20% to 40% of the cases; of these, approximately 20% will require renal replacement therapy (RRT).&lt;/p&gt; &lt;p&gt;Objective: To establish clinical and laboratory characteristics in a group of patients from Colombia with COVID-19 infection and AKI that received intermittent and prolonged RRT with the GENIUS&amp;reg; 90 technology in between March and July 2020.&lt;/p&gt; &lt;p&gt;Design: Cross-sectional study.&lt;/p&gt; &lt;p&gt;Results: 78.9% of participants were men and 21.1% were women. The main comorbidities were the following: Hypertension (65.3%), diabetes mellitus (38.9%), obesity (26.3%), cancer (5.3%), Chronic obstructive pulmonary&amp;nbsp;disease (11.6%), cardiovascular disease (23.2%), active smoking (11.6%). 33.7% had chronic kidney disease (CKD) in the average serum creatinine on admission was 4.4 mg/dl.&lt;/p&gt; &lt;p&gt;The following inflammatory markers were elevated: C-reactive protein (CRP), d-dimer and ferritin (20.3 mg/dl, 931mcg/l and 1174 ng/ml, respectively). 63.5% of patients underwent sustained low-efficiency dialysis (SLED) (6 to 12 hours) and the rest of the patients (36.35%) underwent conventional hemodialysis (less than 4 hours). The mortality of the total patient sample was 36.9%, lower in patients with CKD than in patients with no previous renal disease history (18.7% and 40.1%, respectively).&lt;/p&gt; &lt;p&gt;Conclusion: Renal complications are frequent in patients with severe COVID-19. The development of AKI could be an isolated prognostic marker associated with an increase in mortality in patients with COVID-19, and one of the options is intermittent and prolonged RRT with the GENIUS&amp;reg;&amp;nbsp;90 system.&lt;/p&gt; 08/21/2020 https://www.theskygallerypattaya.com/jcn/jcn-aid1058.php &lt;h2&gt;Summary&lt;/h2&gt; &lt;p&gt;Type 2 Diabetes Mellitus constitutes a major problem in public health worldwide. The disease poses a high risk of severe microvascular and macrovascular complications. Diabetic kidney disease is the most common cause of end-stage chronic kidney disease and contributes to the increasing morbidity and mortality associated to diabetes. Sodium-glucose contransporter-2 inhibitors (SGLT2 inhibitors) are the latest oral diabetic medications, which exhibit a great nephroprotective potential, not only by improving glycemic control, but also by glucose-independent mechanisms, such as decreasing blood pressure and other direct renal effects. We conduct a literature review based on the most recent scientific evidence with the goal to elucidate the postulated mechanisms of action of SGLT2 inhibitors in diabetic kidney disease, which are the base of the beneficial clinical effects that are seen in the condition.&lt;/p&gt; 07/28/2020 https://www.theskygallerypattaya.com/jcn/jcn-aid1057.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Patients with end-stage renal disease are suspected to have significant volume shifts and thereby cardiovascular strain as a result to interdialytic weight gain, chronic fluid overload and fluid removal during dialysis. In long-term hemodialysis patients, higher IDWG (interdialytic weight gain) could be associated with poor survival. Patients with the lowest interdialytic weight gain have the greatest survival. Certain laboratory and imaging modalities could help to assess and monitor the appropriate fluid balance for hemodialysis patients.&lt;/p&gt; &lt;p&gt;FGF -23 might be associated with cardiovascular morbidity in ESRD patients.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; To evaluate correlation between hypervolemia and left ventricular hypertrophy and FGF-23 in hemodialysis patients.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Patients and Methods:&lt;/strong&gt; This cross sectional study was conducted on 60 prevalent hemodialysis patients. Patients were divided into two groups according to interdialytic weight gain (IDWG): Group I (low IDWG): Patients with absolute weight gain &amp;lt; 3 kg. Group II (high IDWG): patients with weight gain &amp;ge; 3 kg. FGF 23, routine laboratory tests and echocardiography were done for both groups.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; high IDWG group has higher systolic blood pressure and LVMI than low IDWG group. In all patients group, FGF-23 had a positive correlation with (weight gain, Na, PO4, PTH, systolic, diastolic blood pressure, LV wall septal and posterior wall thickness and left ventricular mass index) and had a negative correlation with Hb level.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; FGF-23 could be a marker of volume overload and LVH in ESRD patients, which affect morbidity and mortality in these patients.&lt;/p&gt; &lt;p&gt;FGF- 23 might be a marker of anemia in ESRD as it has a negative correlation with HB.&lt;/p&gt; 07/20/2020 https://www.theskygallerypattaya.com/jcn/jcn-aid1056.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Acute kidney injury is a common condition associated with high morbidity and short-term mortality. Its pathophysiology varies according to the numerous conditions associated with its genesis. Biomarkers allow detecting changes at the level of kidney function; therefore, they play an important role in the prevention, early diagnosis, therapeutic response and prognosis of acute kidney injury. The search for biomarkers for acute kidney injury began over 15 years ago; initially, only serum creatinine was available for diagnosis. However, throughout history, great advances have been made in research, which have allowed the finding of new biomarkers in order to improve the health and quality of life of patients. A narrative review of the literature is carried out on the basis of available scientific evidence to clarify the role and importance of biomarkers in the context of acute renal injury.&lt;/p&gt; 06/17/2020 https://www.theskygallerypattaya.com/jcn/jcn-aid1055.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;We described a case of specific (tuberculous) encephalitis in a patient after kidney transplantation. Immunosuppressive therapy, continuously required in post-tranplant period, may cause various complications, such as infections. Specific meningoencephalitis is an infection that is rarely diagnosed and more common in immunocompromised patients.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Case report:&lt;/strong&gt; A 30-year-old man had kidney transplantation (kidney donor was his father). He previously was two years on chronic hemodialysis treatment because of end-stagerenal disease based on diabetic nephropathy. He has diabetes type 1. The early post-transplant period duly passed with satisfactory clinical and laboratory parameters of renal function. Two months after transplantation, he presented with febrile condition, signs of septicemia and dehydration with significant neurological deficit and expressed meningeal signs. In cerebrospinal fluid we found lymphocytosis, elevated proteins and positive micobacterium tuberculosis antibodies (Hexagon method) and we suspected to specific etiology of meningitis. Performed computed tomography (CT) scan of the brain with contrast confirmed the expected finding.&lt;/p&gt; &lt;p&gt;Due to the poor prognosis of infections of the central nervous system (CNS) in immunocompromised patients, only prompt diagnosis can improve survival in this group of patients. The therapeutic protocol after kidney transplantation include the prophylactic use of antituberculous drug (Isoniazid 300 mg) during the 9 months.&lt;/p&gt; 06/05/2020 https://www.theskygallerypattaya.com/jcn/jcn-aid1054.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;The basic aim of the present study was to relate tooth decay with the pH of the urine. pH is very important aspect which affects and depends upon the urine specificity .The glomerulus is a necessary part in the structure of kidney .The glomerulus is involved in the filtration of blood ,which is involved in acidification with the help of kidneys. A cavity or hole is formed within the tooth and it can leads towards tooth decay. Cavity in its structure is so small when it is at its starting point but with the passage of time cavity becomes large in between of the teeth and it can be a main reason to the complex diseases. A total of 100 students get participated in this study from Bahauddin Zakariya University Multan, Pakistan. In this subjects went into the lab with their urine samples taking in the urine collection bag. In this a strip is used to find the values pH. Strip is placed in the urine collection bag for a minute. Then we noted the different values of different subjects. We designed a research project based upon the results that depend upon either there was any relation among tooth decay and pH. The aim of the project was either there is any relation among the tooth decay and urine pH. It was concluded that there was no any kind of relation among urine pH and tooth decay.&lt;/p&gt; 04/28/2020 https://www.theskygallerypattaya.com/jcn/jcn-aid1053.php &lt;p&gt;Urinary tract infections are common affection in the general population.&lt;br /&gt; Diagnosis is often easy in the presence of evocative clinical signs.&lt;/p&gt; 04/13/2020 https://www.theskygallerypattaya.com/jcn/jcn-aid1052.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; Anderson-Hynes pyeloplasty remains the gold standard in the treatment of ureteropelvic junction obstruction. The diagnostic criteria for defining the failure of pyeloplasty are not well-defined or even arbitrary. Likewise, the ideal treatment of persistent hydronephrosis after pyeloplasty is not well established. We tested an innovative endourological procedure, which simultaneously allows a diagnostic definition of failure and treatment when necessary.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Materials and methods:&lt;/strong&gt; The endourological procedure was applied prospectively to 13 cases from 2006 to 2015. The mean hydronephrosis was 3 cm and all the patients showed an obstructive pattern at scintigraphie. Of these, only 2 patients had symptoms. The procedure consisted in the endoscopic calibration of the pyeloureteral junction. In case of confirmed persistent stenosis, the procedure continued with the high pressure dilation of the junction. The calibration/dilation procedure was carried out with a balloon catheter, previously used for high pressure dilation in the obstructive megaureter. In all patients, a ureteral stent was positioned for 6 - 8 weeks.&lt;/p&gt; &lt;p&gt;The patients were then followed up using ultrasound and renoscintigraphie.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; According to the endoscopic balloon procedure, anastomosic stenosis was confirmed in 3 cases, treated with high pressure dilation during the same procedure. In 10 cases no stenosis was found and we followed-up these patients with periodic ultrasound and scintigraphie.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; The calibration/dilation of the pyeloureteral junction represents in our opinion a useful diagnostic and therapeutic tool that allows to limit the repetition of open surgery only to symptomatic cases and those non-responders to endoscopic treatment.&lt;/p&gt; 04/13/2020 https://www.theskygallerypattaya.com/jcn/jcn-aid1051.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;We investigated the existence of microalbuminuria in children with corticosteroid-sensitive idiopathic nephrotic syndrome in complete remission. In the study of a series of 18 cases, we noted a clearly different evolution depending on the existence or absence of pathological micro albuminuria.&lt;/p&gt; &lt;p&gt;Microalbuminuria appears to be a prognostic discrimination parameter in idiopathic nephrotic syndrome.&lt;/p&gt; 02/26/2020 https://www.theskygallerypattaya.com/jcn/jcn-aid1050.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Acute renal injury is a rare complication of idiopathic nephrotic syndrome with mesPGN. Here we present a 2-year-old male patient with 4 days history of anuria, generalized edema and hypervolemia. Any evidence other than proteinuria and renal failure could not be identified with laboratory tests and doppler ultrasonography. Anuric presentation was thought to be related with rapidly progressive glomerulonephritis, diffuse mesangial sclerosis or acute tubular necrosis. However, renal biopsy revealed mesangial proliferative glomerulonephritis (mesPGN). Prednisolone 2 mg/kg/day was prescribed. Diuresis was started gradually and on the 10th day of disease, anuria was resolved and acute renal injury recovered without any sequel. This case is presented because of the incompatibility between clinical findings and histopathologic diagnosis. It is concluded that although rare, anuria and acute renal injury could be the presenting symptom of idiopathic nephrotic syndrome in childhood.&lt;/p&gt; 01/20/2020 https://www.theskygallerypattaya.com/jcn/jcn-aid1048.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Granulomatosis with polyangiitis (GPA), a form of ANCA-associated vasculitis (AAV), is a rare disease with an often-occult presentation. It is more common in 4th and 5th decades of life but can be seen in all ages.&lt;/p&gt; &lt;p&gt;This case report details a 76-year-old female presenting with abdominal pain, generalized weakness, and malaise, who was found to have pulmonary nodules on chest imaging. Biopsy of the lung nodule showed organizing pneumonia. Initially, antibiotics were used to treat the patient. However, she developed acute renal failure a few days after presentation and found to have positive serum C-ANCA as well as elevated ANCA-PR3 serologies. A subsequent kidney biopsy demonstrated pauci-immune necrotizing and crescentic glomerulonephritis that was consistent with GPA and the patient was started immediately on combination immunosuppressive therapy, plasmapheresis, and hemodialysis.&lt;/p&gt; &lt;p&gt;GPA&amp;rsquo;s clinical and radiological presentation can mimic other common conditions such as pneumonia, malignancy, bacterial sinusitis, pulmonary tuberculosis, sarcoidosis, and urinary tract infection. Because of this, a high level of suspicion is required for early diagnosis and treatment to alter the high mortality rate in this disease entity. All forms of ANCA-associated vasculitis (AAV) should be in the differential diagnosis for all patients presenting with multiorgan system involvement particularly in individuals with pulmonary and renal manifesations.&lt;/p&gt; 12/17/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1047.php &lt;h2&gt;Text&lt;/h2&gt; &lt;p&gt;A 61-year-old Brazilian black woman consulted with a nephrologist due to proteinuria identified on a routine urine test. She has a personal history of thymoma resection five years ago, followed by multiple episodes of pulmonary infections including mycobacteriosis, recurrent mucocutaneous candidiasis, and paraneoplastic pemphigus. Physical examination showed no edema or hypertension and laboratory tests identified proteinuria of 2.43 g/day without hematuria, serum creatinine of 0.69 mg/dl, urea 34 mg/dl, serum albumin of 2.4 g/dl, hemoglobin 10.9 g/dl, platelets 292,000/mm3, leukocytes 4950/mm3, lymphocytes 594/mm3 and neutrophils 3910/mm3. The hemolysis tests were negative and serum iron was low. Analysis of glicemia and serum lipids levels were normal as well as serum complement and imunoglobulins, except for an IgM level of 283 mg/dl (normal values 40 to 230 mg/dl) and undetectable IgE. Serologies for Syphilis, HIV, hepatitis B, C and antibodies for autoimmune diseases were negative.&lt;/p&gt; 12/09/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1046.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Infantile cystinosis is a lysosomal storage disease leading to end stage kidney disease at early ages. There is no effective treatment and patients require long term dialysis or kidney transplant for survival. We present our experience on three affected children who received HLA matched allogeneic stem cell transplant. The protocol used was novel and designed to promote engraftment. The primary endpoint was safety for treatment related mortality or morbidity; All three children survived without serious adverse effects during extended follow up for over 4 years. Although we could not prove engraftment, all three children met secondary end point of sustained target functions over a 6 month follow-up. Further studies are warranted to further evaluate safety and efficacy of MSC treatment for infantile cystinosis.&lt;/p&gt; 11/27/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1045.php &lt;h2&gt;Summary&lt;/h2&gt; &lt;p&gt;Catheter-associated urinary tract infection (CAUTI) is among the most common nosocomial infections especially in acute care settings. Its economic and unanticipated health implications make it burdensome for the healthcare providers and patients. The paper examined the perceived causes and mode of preventing urinary tract infections in patients with spinal cord injury. Qualitative research approach was utilized; the study site was a Tertiary Hospital in Nigeria. Eight (8) in-depth interviews (IDI) were conducted with healthcare providers managing patients with spinal cord injured in the hospital. The major risk factors causing urinary tract infection identified include financial problems, organization of care, human error, hospital environment and patient-related factors. To prevent urinary tract infections among patients in the hospital, a number of suggestions were made by the participants such as training of caregivers and educating patients and relations. The authors concluded that the incidence of CAUTI could be reduced in the hospital if the opinions of stakeholders are fairly considered.&lt;/p&gt; 11/22/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1044.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Many side effects, in addition to those of the pathology itself, have occurred with hemodialysis treatment but existing literature have shown that physical activity is beneficial to hemodialysis patients. Nevertheless, our parameters have not been studied enough with a resistance training program. In our study we have observed the effect of a 12-week intradialytic resistance training program (T0 vs T12) on the quality of life using the KDQOL-SF questionnaire, blood samples biological parameters and sleep using the Epworth scale and the International restless legs syndrome study group scale. The resistance training program consists of 3 sessions per week and involved lower extremities thanks to elastic band and soft ball. After the training program, the quality of life score trend to the increase at T12 compared to T0. Among the biological parameters, the only trend decrease observed was in the C-reactive protein and a trend increase was observed in urea at T12. Dialysis efficiency presented no changes and no significant results were observed for sleep. Some trends were observed as a result of our program. The type of exercise seems to have different effects on measured parameters. Nevertheless, exercise was beneficial to chronic hemodialysis patients and seemed to improve their health.&lt;/p&gt; 11/20/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1043.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;The authors present the case of a 45-year-old female patient with diabetes and chronic kidney disease (CKD). She had unsatisfactory glycemic control, and showed some intellectual limitations. Her urine exam was unremarkable, and her renal ultrasound revealed single right kidney with aspects suggesting ureteropelvic junction syndrome. Her mother had also suffered from diabetes and CKD G5D presenting in the sixth to seventh decade.&lt;/p&gt; &lt;p&gt;An hereditary cause for CKD was considered, which led the authors to investigate an autosomal dominant cause for CKD with a tubulointerstitial phenotype, taking into account the personal and family history for diabetes and also the renal imaging; a large deletion in the &lt;em&gt;HNF-1&amp;beta;&lt;/em&gt; gene was identified through Multiplex Ligand Probe Assay (MLPA) analysis, explaining the phenotype.&lt;/p&gt; &lt;p&gt;Genetic causes of CKD should be considered in the presence of positive family history for CKD, and the coexistence of diabetes with bland urine sediment should raise the possibility of a syndromic cause of the phenotype, namely involving &lt;em&gt;HNF-1&amp;beta;&lt;/em&gt; gene mutations or deletions.&lt;/p&gt; 09/02/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1042.php &lt;h2&gt;Case Report&lt;/h2&gt; &lt;p&gt;Obesity has become a worldwide Epidemic affecting more than 300 million people. Overweight is defined as BMI (Body Mass Index) of 25-29.9 kg/m2. Obesity is defined as BMI greater than 30 kg/m2, and Morbid Obesity is a BMI of &amp;gt; than 35 kg/m2 [1].&lt;/p&gt; &lt;p&gt;Many Dialysis patients are overweight. Dialysis patients that are labeled morbidly obese based on BMI, may not be able to be listed on the Transplant list. Some Dialysis Clinics require a BMI less than 35 kg/m2 and some require a BMI &amp;lt; than 40 kg/m2. Hence, many obese dialysis patients are asked to lose weight, and we all know that Renal Transplant provides a better quality of life [2].&lt;/p&gt; &lt;p&gt;Because each transplant center may use different criteria for eligibility, patients and members of the dialysis team should be aware of the BMI criteria for the referral transplant center. Patients who are not eligible for the transplant due to obesity should receive counseling emphasizing a healthy lifestyle and weight loss [3].&lt;/p&gt; &lt;p&gt;Successful weight management requires a multidisciplinary approach encompassing health care team members. They consist of the following: Renal Dietitian, Social Workers, Nurse, Exercise Physiologist and a Physician [6].&lt;br /&gt; &amp;nbsp;&lt;/p&gt; 08/26/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1041.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Introduction&lt;/strong&gt;: Pulmonary hypertension (PH) is prevalent in hemodialysis (HD). In the general population, more women than men have PH due to left ventricular (LV) disease with preserved ejection fraction (EF). Little is known about the gender-specific prevalence of PH and associated LV abnormalities in patients with end stage renal disease (ESRD) on HD. Our aim was to evaluate gender differences and LV structural and functional changes in PH among ESRD patients on HD.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: Ninety-four patients (ages 23-77 years) underwent echocardiography after HD. Patients were divided based on estimated pulmonary artery systolic pressure (PASP) (Group A PASP &amp;lt; 40 mm Hg, Group B PASP &amp;ge; 40 mm Hg). LV measurements included LV mass, LV internal dimensions, and LV ejection fraction (EF). LV diastolic function (LVDF) was assessed from mitral inflow deceleration time (DT) and E/A ratio.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: Fifty-five patients (59%) had PH, including 32 of 49 men (65%) and 23 of 45 women (51%). LVEF was lower in Group B (46.4 &amp;plusmn; 17.6 vs. 62.4 &amp;plusmn; 14.4%, p &amp;lt; 0.001). Men with PH had higher LVIDd, cm (5.52 &amp;plusmn; 0.89 vs 4.78 &amp;plusmn; 0.75, p &amp;lt; 0.001), LVIDs, cm (3.75 &amp;plusmn; 0.94 vs 3.14 &amp;plusmn; 0.91, p = 0.03) LV mass, g (236 &amp;plusmn; 74vs 189 &amp;plusmn; 56, p = 0.02) and lower LVEF (40.0 &amp;plusmn; 16.7 vs 52.0 &amp;plusmn; 15.6, p = 0.008) than women.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: Patients on HD have a high prevalence of PH. PH was not associated with clear LV structural changes. There was a depression in LV systolic function without changes in LVDF. PH patients were more often men with hypertrophied LV with depressed LV systolic function.&lt;/p&gt; 08/07/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1040.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Chronic kidney disease (CKD) is a highly prevalent disease, imposing high mortality rates worldwide, and it is closely related to cardiovascular events. Vitamin D deficiency is very prevalent in patients with CKD from the earliest stages of the disease, and it has been associated with higher mortality. In order to assess the prognostic implications of vitamin D deficiency in CKD, we undertook a literature review, searching different databases in October 2018 for publications related to vitamin D in patients with CKD and hypovitaminosis D, and not on dialysis. The main cause of death in these patients is cardiovascular disease. Vitamin D is one of the first parameters that CKD changes and has an important prognostic role in this entity. Deficient levels in blood are associated with increased cardiovascular risk and survival impacts, independently of cardiovascular disease. Treatment with paricalcitol appears to reduce this risk. However, the evidence analyzed is insufficient to establish an association between vitamin D levels and the progression of kidney disease.&lt;/p&gt; 07/31/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1039.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Introduction&lt;/strong&gt;: Obesity may cause progressive chronic kidney disease. Weight loss in the postoperative follow-up of bariatric surgery may improve renal function in these patients. Thus, the purpose of this study was to give insight on the subject using a sensible biomarker.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: This cross sectional study was performed in the Obesity Department from Campina Grande &amp;ndash; Paraiba, Brazil. It was randomly enrolled 23 postoperative patients (7 bypass and 16 sleeve), with at least two years of follow-up, from the outpatient Department and 29 (18 bypass and 11 sleeve) in the preoperative period for bariatric surgery. They were homogeneously from both genders with ages ranging from 25 to 57 years. Serum levels of creatinine and cystatin C were measured, and the glomerular filtration rate (GFR) was estimated using the CKD Epi (chronic kidney disease epidemiology collaboration) cystatin-creatinine equation. The investigation was approved by the Ethics Committee.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: The mean body mass index (BMI) of the preoperative group was significantly greater than the postoperative group (p &amp;le; 0.0001). The mean serum levels of C cystatin was significantly greater in the postoperative group as compared to preoperative (p= 0.0197). However, there was no mean difference between creatinine serum concentrations comparing the two groups (p = 0.3252). The mean glomerular renal function rates of the groups were similar (p = 0.1240).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: There is no definitive evidence for supporting the hypothesis that there is improvement in the kidney renal function after bariatric surgery in obese patients. Prospective cohorts are necessary to enlighten the answer for this important question.&lt;/p&gt; 07/12/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1038.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Hyperuricosuria, persistently low urinary pH, and low urinary volume are the main risk factors of uric acid nephrolithiasis. Epidemiologic studies suggest that high water intake is protective against the occurrence of symptomatic kidney stone events of all types. The objective of this systematic review and meta-analysis were to evaluate the effectiveness of increased water intake to prevent symptomatic uric acid kidney stone events.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: Seventeen studies were identified for the meta-analysis. Analysis of Q and I2% statistics revealed that a high heterogeneity in 16 studies, thus, random effects model was used. Protective associations were identified for high water intake individuals (SMD=0.52 L; 95% CI: 0.19, 0.84; p=0.002); a significantly decreased relative super saturation of uric acid versus controls (SMD=-1.15; 95% CI: -2.00, -0.30; p=0.008). Risk factors including urinary uric acid excretion and pH were not significantly related to high water intake (SMD=7.32mg/d, 95% CI: -52.27, 66.91; p=0.81), (SMD=0.14; 95% CI: -0.02, 0.31; p=0.09), respectively. Further subgroup analyses revealed that urinary uric acid excretion was significantly decreased in healthy individuals (SMD=-36.23 mg/d, 95% CI: -65.14, -7.31; p=0.001) compared to stone formers (SMD=27.41 mg/d, 95% CI: -33.18, 88.01; p=0.38); urinary uric acid excretion was significantly decreased in routine water intake groups (SMD=-61.49 mg/d, 95% CI: -120.74, 12.24; p=0.04) compared to mineral water intake groups (SMD=44.50 mg/d, 95% CI: -18.30, 107.29; p=0.16); urinary pH was significantly higher in mineral water groups (SMD=0.13, 95% CI: 0.01, 0.46; p=0.04) compared to regular water groups (SMD=-0.00, 95% CI: -0.13, 0.13; p=0.98).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: A total of 129 patients had 150 internal jugular catheter insertions. The mean age was 51.4&amp;plusmn;15.2 years with male to female ratio of 1.5:1. All the patients had chronic kidney disease; about 80% had tunneled IJC and 96.9% of the catheters were inserted in the right internal jugular vein. Immediate complications were recorded in 10% and late complications in 34.9% of the procedures. The immediate complications were kinking of guide wire (2%), arterial puncture (1.3%) and difficulty in locating the internal jugular vein (1.3%) or tunneling (1.3%). The late complications were infection (12.8%), poor blood flow (9.2%), bleeding (5.5%) and spontaneous removal of the catheter (5.5%). There was no statistical significant difference in both immediate and late complication with age and sex.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: This meta-analysis identified evidence that urinary uric acid excretion, volume, pH and relative supersaturation of uric acid can be altered with high water intake intervention, reducing the risk of uric acid kidney stones.&lt;/p&gt; 07/11/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1037.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Internal jugular vein catheters (IJC) is recommended as the central venous access of choice in haemodialysis patients. However it is associated with complications of variable severity.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Objectives&lt;/strong&gt;: To study the complications associated with internal jugular vein catheters in haemodialysis patients in southern part of Nigeria.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methodology&lt;/strong&gt;: The clinical details of patients who had IJC insertion at the kidney house, Hilton clinics Port Harcourt from 1st October 2011 to 30th September 2016 were documented. Complications from the IJC developed by the patients during the study period were also documented. The data obtained was analyzed using SPSS version 22. P value less than 0.05 was considered significant.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: A total of 129 patients had 150 internal jugular catheter insertions. The mean age was 51.4&amp;plusmn;15.2 years with male to female ratio of 1.5:1. All the patients had chronic kidney disease; about 80% had tunneled IJC and 96.9% of the catheters were inserted in the right internal jugular vein. Immediate complications were recorded in 10% and late complications in 34.9% of the procedures. The immediate complications were kinking of guide wire (2%), arterial puncture (1.3%) and difficulty in locating the internal jugular vein (1.3%) or tunneling (1.3%). The late complications were infection (12.8%), poor blood flow (9.2%), bleeding (5.5%) and spontaneous removal of the catheter (5.5%). There was no statistical significant difference in both immediate and late complication with age and sex.&lt;/p&gt; &lt;p&gt;The ultrasound examination at discharge had a sensitivity of 31% and specificity of 87% to detect future symptomatic lymphoceles. The positive predictive value was only 10%. The second ultrasound test had the best test variables to detect symptomatic lymphoceles with a sensitivity of 93% and a specificity of 87% and a predictive value of 28%.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: Internal jugular catheter is froth with immediate and late complications in haemodialysis patients.&lt;/p&gt; 07/09/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1036.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Introduction&lt;/strong&gt;: Ultrasound examination is frequently used to evaluate the graft after renal transplantation and to detect possible lymphoceles. The first ultrasound scan in our hospital is normally performed on the day of discharge. We questioned whether perirenal fluid collections detected by ultrasound examination at discharge are predictive for future symptomatic lymphoceles.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: All ultrasound reports of all renal transplant recipients treated in our hospital between January 2010 and December 2017 were collected and screened for abnormalities such as fluid collections. Patients that developed a symptomatic lymphocele were compared with a control group from the same cohort. Sensitivity and specificity of ultrasound examination to detect symptomatic lymphoceles were calculated for the primary and consecutive ultrasounds tests.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: There were no significant differences at baseline characteristics between the Symptomatic lymphocele group and control group, with the exception of mean age at kidney transplantation (47 &amp;plusmn; 17 years in the control group vs. 56 &amp;plusmn; 13 years in the symptomatic lymphocele group, p=0.02).&lt;/p&gt; &lt;p&gt;The ultrasound examination at discharge had a sensitivity of 31% and specificity of 87% to detect future symptomatic lymphoceles. The positive predictive value was only 10%. The second ultrasound test had the best test variables to detect symptomatic lymphoceles with a sensitivity of 93% and a specificity of 87% and a predictive value of 28%.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: Routinely use of ultrasound testing on the day of discharge does detect perirenal fluid collections, but is not predictive for development of symptomatic lymphoceles in the future.&lt;/p&gt; 07/09/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1035.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Introduction&lt;/strong&gt;: The phimosis condition is characterized by the inability to retract the foreskin on the glans, making it impossible to expose them. Surgical treatment, although effective, has been questioned by the risk to which the patient is exposed. Therefore, we have opted for the use of topical corticosteroids to resolve this pathology.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Goals&lt;/strong&gt;: To compare the effectiveness of Dexamethasone and Hyaluronidase + Betamethasone Valerate associated with preputial massage in the treatment of infantile phimosis, the degree of regression of phimosis, the time needed to achieve complete efficacy, possible adverse reactions, long-term outcome and parental adherence to treatment in children attending a specialized service in Blumenau, Santa Catarina.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Materials and methods&lt;/strong&gt;: Controlled clinical trial, quantitative, non-blind, prospective and randomized sample analysis through the analysis of 523 patients.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: After 1 month of treatment, 435 patients presented some degree of regression and 63 children were referred to surgery. The success rate in this period was 45.8% in boys who were taking Hyaluronidase + Betamethasone Valerate and 49.8% in those who used Dexamethasone. In the late evaluation, 398 children reached grade 0, and 213 used Hyaluronidase + Betamethasone Valerate and 185, Dexamethasone; 39 patients were referred to the postectomy. Adherence to treatment was similar in both groups. The average time for degree 0 to be reached similar in both.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: Both topical corticosteroids were effective in the resolution of phimosis. However, in the evaluation after the first month and in the regression, Dexamethasone proved to be more effective. The time to resolution of the condition was similar for both. The surgical procedure was taken when there was no clinical improvement. No adverse effects were reported in both groups.&lt;/p&gt; 06/27/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1034.php &lt;h2&gt;Introduction&lt;/h2&gt; &lt;p&gt;The rise in all-cause and cardiovascular mortality and hospitalization rates among the hemodialysis (HD) patients after the long weekly inter-dialysis interval is very impressive. In fact, there is an additional long-term morbidity risk besides this acute rise in mortality and hospitalizations that can be expected from the weakly exaggerated pre-dialysis peaks of the less risky hemodynamic and biochemical parameters. An approach for eliminating these long weekend inter-dialysis intervals is through the provision of the hemodialysis sessions on every other day (EOD) basis, regardless of the week days. This is likely to be both practical and cost-effective. Such EOD schedule can be introduced easily beside the ongoing thrice weekly HD schedule without disturbance of the HD unit work. The availability of EOD schedule would provide a healthier and cost-effective alternative schedule for those patients who can&amp;rsquo;t tolerate the weekend intervals and for those looking for maintaining their long-term health on the option of hemodialysis. In fact, with available data, medical staff is expected to encourage all patients to shift their HD to the EOD schedule.&lt;/p&gt; 06/21/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1033.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Patients with chronic kidney disease (CKD) are at the risk of increase hospital admission as compared to the general population, due to various reasons. They have increased vulnerability to cardiovascular diseases (CVD) as well as infections, therefore they usually got admit in health care units due to various reasons. The causes of hospitalization in CKD patients in this part of the world are not studied well.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: This cross sectional study was conducted in The Kidney Centre Post Graduate Training Institute (TKC-PGTI) of Karachi. Variables included in the study were age, gender, are of residence, ethnicity, smoking status and level of education. Comorbid conditions like causes of CKD and causes of hospitalization. Data analysis performed by using software IBM SPSS 21.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: Total of 269 patients were enrolled in our study. The male 148(55%), mean age was 55 years. The most common cause of hospitalization in our population was infection148 (55%) and urinary tract infection (UTI) was the most common site of infection 55 (20%) followed by sepsis of unknown origin 29(10.8%). Cardiovascular events like volume overload 32 (11.4%) and acute coronary syndrome 20(7.4%) were the second most important cause of hospitalization.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: Hospitalization of CKD patients is high, and in our population infection is found to be the leading cause of hospital admission. Infection originating from urinary tract is more common in all stages of CKD patients, while blood born infection originating from double lumen (DL) dialysis catheter or arteriovenous fistula (AVF) cannulation is more common in dialysis population. Cardiovascular events, both acute coronary syndrome and pulmonary edema due to volume overload followed the infections.&lt;/p&gt; 05/31/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1032.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background and objectives&lt;/strong&gt;: New AKI biomarkers (on the top of it NGAL biomarker) have demonstrated better performance for prediction of AKI in critically ill patients with heterogeneous illness. Renal angina index was recently reported to enhance prediction of severe AKI at the time of intensive care unit admission. This study tested the hypothesis that incorporation of uNGAL in patients with renal angina improves the prediction of severe AKI.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Design, setting, participants &amp;amp; measurements&lt;/strong&gt;: In our study 53critically ill children admitted to the pediatric intensive care unit in Zagazig university hospital, Measurement of urine neutrophil gelatinase&amp;ndash; associated lipocalin (uNGAL) was determined individually by ELISA kit and in combination with the RAI which is calculated in each critically ill child for severe AKI. Statistical analysis was done for these data.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: Individual uNGAL demonstrated marginal discrimination for severe AKI (area under curve [AUC]: NGAL, 0.877), little higher than prediction by RAI (AUC=0.847). Incorporation of uNGAL significantly added to the renal angina index AKI prediction (AUC=0.847, increased to 0.893).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: This study shows that incorporation of uNGAL into the RAI improves detection ability of severe AKI in critically ill children.&lt;/p&gt; 04/16/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1031.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: In sickle cell anemia (SCA), compromise of the renal vasculature due to sickled red cells has been recognized.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Objectives&lt;/strong&gt;: To assess the renal function and blood pressure pattern in children with sickle cell anaemia (SCA) presenting in a tertiary institution.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Method&lt;/strong&gt;: A cross-sectional study of patients with sickle cell anaemia (SCA) over six months involving the use of questionnaires, general physical examination, blood pressure, investigations for haemoglobin genotype, urinalysis, serum creatinine, screening for hepatitis B and HIV.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: 51 children with SCA were seen. The prevalence of impaired renal function as defined by reduced eGFR &amp;lt;90mL/min/1.73m2 in this study was 27.5%, previous hospital admission and blood transfusion were associated with reduction in eGFR but blood pressure did not have significant correlation with the eGFR. The overall mean age at diagnosis of SCA was 4.09 &amp;plusmn; 3.33 (years).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: Impaired renal function is a major comorbid condition in children with SCA. In countries/locations where there is no newborn screening for sickle cell disease, diagnosis is delayed, thus detecting impaired renal function may be delayed, therefore the need for early detection and management is imperative.&lt;/p&gt; 04/15/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1030.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;The blood and drainage cultures are suggested for early diagnosis of bloodstream infection (BSI), which are time consuming and laborious. Nasal colonization of bacteria is one of the modalities, occasionally can predict BSI. We hypothesized that nasal culture, as an accessible fluid may be helpful to predict future BSI in hemodialysis patients. The present prospective study evaluated 63 patients undergoing maintenance hemodialysis at the Pars hospital dialysis center, Tehran, Iran, from November 2015 until February 2016. Nasal fluid of patients were collected from the 1&amp;ndash;cm internal anterior part of both nostrils of patients by a sterile swab and cultured in Trypticase soy agar. All patients were followed for three months for BSI. The results of first nasal fluid sample revealed that 33.3% in first sampling and 27.0% in sampling had positive nasal fluid culture. The type of bacteria in all positive cases was Staphylococcus aureus. The rate of BSI infection in the patients with positive and negative first nasal fluid culture was 9.5% and 2.4% respectively with no significant difference. We found also no significant association between BSI positivity and nasal culture results so that positive BSI was revealed in 5.9% of patients with positive nasal fluid culture and 4.3% in those with negative nasal fluid culture with no meaningful difference. None of the baseline variables including age and gender, underlying risk factor, access, or duration of dialysis was associated with BSI positivity. In hemodialysis patients, BSI may not be predicted by nasal fluid culture positivity.&lt;/p&gt; 04/03/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1029.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;We report a case involving infection with Strongyloides stercoralis found in the sputum of a 66-year-old male patient who had a medical history of nephrotic syndrome and was treated with methylprednisolone and monthly intravenous cyclophosphamide therapy 3 months previously. This patient presented with stubborn pulmonary symptoms and signs, which was the mechanical destruction caused by larval migration. We found strongyloides in his sputum that provided diagnostic proof.&lt;/p&gt; 04/03/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1028.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Peritonitis is the main complication of peritoneal dialysis caused the withdrawal of treatment like peritoneal dialysis which was used as primary treatment modality few years back in Pakistan. With this motto to know the exact cause of peritonitis this retrospective study was done and 35 out of 42 pervious peritoneal dialysis patients who had peritonitis were analyzed using old data. A total of 57 bags of all these peritonitis patients were analyzed in department of microbiology during the year 2007-2011. Out of these bags positive culture was obtained from 42 bags (74%). Most of patients with positive culture were undergoing acute peritoneal dialysis 66.67% and rest were on chronic ambulatory peritoneal dialysis. Main concern was the yield of organisms causing culture positive peritonitis. It was found that bacterial peritonitis was positive in 80%, fungal peritonitis was 11% and mycobacterium tuberculosis peritonitis was 09%. Various culture techniques along with Gram Stain, Zeihl Nielsen Stain and Auramine stain were used for knowing the yield.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Limitations&lt;/strong&gt;: Old and only small available data of peritonitis patients and stop of further peritoneal dialysis.&lt;/p&gt; 04/03/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1027.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Anti-glomerular basement membrane (anti-GBM) disease is an uncommon autoimmune disease that classically presents as an aggressive necrotizing and crescentic glomerulonephritis (CG), with or without pulmonary hemorrhage, and typically does not relapse. The pathologic hallmark is linear staining of GBM for Immunoglobulin G (IgG) which binds to the alpha-3 chain of type IV collagen. Recent reports have noted the occurrence of anti-GBM disease with atypical clinical presentations. We describe a case of a 22-year-old female presenting an anti-GBM disease with typical histological features with a singular clinical presentation with lower limb edema, elevated serum creatinine and nephrotic range proteinuria. Renal biopsy showed signs of chronicity and direct immunofluorescence microscopy demonstrated diffuse, intense linear positivity for IgG. All serologic tests were negative, including anti-GBM antibodies. Hence, a diagnosis of atypical anti-GBM disease was made. The patient was treated initially with mycophenolate mofetil and corticosteroids. After 3 months she began to aggravate renal function so mycophenolate of mofetil was discontinued and a low dose cyclophosphamide was initiated.&lt;/p&gt; 03/28/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1026.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Haemodialysis is the commonest method of Renal Replacement Therapy in Nigeria. Despite an advancement in the technicality and better understanding of haemodialysis, a number of complications are known to be associated with this procedure.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Objective&lt;/strong&gt;: We aimed to highlight our experiences and share some of the uncommon complications encountered during haemodialysis and present the outcome of our patients.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Subjects and methods&lt;/strong&gt;: A retrospective review of 101 patients during the last two years was done. Data extracted include: sociodemographic characteristic, aetiology of kidney disease, type of vascular access, intradialytic complication and outcome of treatment.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: The total number of dialysis session during the period was 823. Males constituted a higher proportion (64.4%) and were found to be older than female patients 49.8 vs 42.8 years (P=0.001).&lt;/p&gt; &lt;p&gt;Majority (89.1%) had chronic kidney disease while chronic glomerulonephritis was the main cause of CKD as seen in about 45% of the patient.&lt;/p&gt; &lt;p&gt;Due to the cost implication, only 2(1.98%) were able to undergo 3 sessions of dialysis per week for up to 1 month.&lt;/p&gt; &lt;p&gt;Vascular access was femoral (66.3%), internal jugular vein (25.7%), while only 2% used Artero-venous-fistula and one patient had femoral vessel pseudoaneurysm from frequent cannulation.&lt;/p&gt; &lt;p&gt;The commonest complication was hypotension which was present in 15.8%. Twenty-eight deaths were recorded, 44(43%) were either lost to follow up or absconded while 5% were transplanted at a referral centre.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: Challenges of renal replacement therapy is overwhelming in our country due to poor human and financial resources. Early diagnosis and adequate government support are advocated.&lt;/p&gt; 03/12/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1025.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Introduction&lt;/strong&gt;: Chronic kidney disease is a costly and burdensome public health concern. Delayed recognition and treatment of CKD may predispose patients to unfavorable future outcomes and burden the healthcare services. The early detection of disease via screening programs is widely recommended. The present study is a hospital camp-based screening for detecting patients with chronic kidney disease in Varanasi from 2014-18.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: The study subjects constituted 436 apparently healthy adults (age &amp;ge;18 years) of Varanasi. Information on socio-demographic profile, personal characteristics and clinical investigations were recorded. Stepwise binary logistic regression analysis was applied to find the significant predictors of chronic kidney disease.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: Median age of the study subjects was 40.5 years. There were 39.7% males and 60.3% females. Chronic kidney disease was found in 23.9% subjects. Underweight, diabetes mellitus, hypertension, smoking status and higher creatinine levels came out as significant predictors of chronic kidney disease.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: We screened apparently healthy individuals and found very high percentages of chronic kidney disease and its predictors. Henceforth, understanding the preventable and modifiable risk factors of chronic kidney disease becomes a prerequisite to intervene before risk populations reaches to irreversible stages of adverse future outcomes.&lt;/p&gt; 02/22/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1024.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Prednisone-sensitive hypocomplementemia, renal insufficiency, and kidney biopsy demonstrating severe tubulointerstitial nephritis (TIN), storiform fibrosis, and tubulointerstitial immune deposits are typical of IgG4-related tubulointerstitial nephritis and hypocomplementemic interstitial nephritis. A diagnosis of hypocomplementemic interstitial nephritis requires clinical and pathologic exclusion of IgG4-related tubulointerstitial nephritis. We describe a patient with hypocomplementemic interstitial nephritis who did not develop diagnostic features of IgG4 related disease (RD) over 2-year follow-up. We conclude that hypocomplementemic interstitial nephritis could be on a biologic spectrum with IgG4-related disease, but not all cases will develop the abundance of IgG4-positive plasma cells, systemic manifestations, or elevated immunoglobulin levels characteristic of IgG4-RD.&lt;/p&gt; 01/24/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1023.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;We present below a mechanistic molecular approach for development of Anti-Inflammatory biomarkers of Probiotic Bacteria in Fermented Foods. Probiotics are live microorganisms that promote human health by counteracting the noxious toxic gut microflora in human intestine, by modulating of the tight junctions, and by increasing mucin production, enforcing intestinal epithelial cell barrier function, modifying microbial community within the gut intestinal disorders, and improving immune responses associated with chronic inflammation in experimental animal models, collectively enhancing human health. Cytokine secretion by intestinal epithelial cells and macrophages are regulated by probiotics through key signaling pathways such as nuclear factor-&amp;kappa;B and mitogen-activated kinases, resulting in alleviation of several disorders such as allergies, diabetes, obesity, heart diseases and cancer. MicroRNAs are small non-coding RNA molecules involved in transcriptional and post-translational regulation of gene expression by inhibiting gene translation. Using in vitro and in vivo approaches in cell lines and mice models to study effects of probiotic conditional media and heat-killed bacterial strains with anti-inflammatory effect to elucidate the mechanisms by which probiotics affect signaling pathways, and by using global cytokine and microRNA gene expression analyses arrroaches to develop biomarkers for studying different pro- and anti-inflammatory activities, and using statistical approaches to analyse the data, we show that cytokines and miRNAs have an essential role in regulation of cancerous and inflammatory bathways. This mechanistic approach will result in developing specific disease biomarkers for the early diagnosis of certain pathogenic states, as well as evaluating the effect of different dietary componenents on developed biomarkers in health states that will promote and enhance human health. Comparing the concordance of the in vitro to the in vivo research findings will confirm the correspondence of both approaches to each other. Moreover, this study will have a major public health relevance in elucidating the role of miRNAs and their targets in inflammation, paving the way to diagnosing and treating of pathogenic human disease stages.&lt;/p&gt; 01/18/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1022.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Chronic Kidney Disease is no longer considered just a health burden today but a major health priority owing to its high treatment costs and poor outcome. World Kidney Day and International Women&amp;rsquo;s Day in 2018 coincided, thus offering an opportunity to reflect on the importance of women&amp;rsquo;s health, and specifically their kidney health. The current study aims to identify chronic kidney disease in women through a cross sectional screening in hospital based camp in Varanasi on World Kidney Day.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: 138 females attending a health camp were screened for clinical parameters like serum creatinine, random blood sugar, and pregnancy complications. Demographic and anthropometric parameters were noted. Ordinal logistic regression analysis was used to find the predictors of chronic kidney disease stages.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: The median age of the participants was 36 years. The prevalence of chronic kidney disease was 6.4% with 1.4% of Stage 1, 2.1% of Stage 2, 1.4% of Stage 3 and 1.4% of Stage 4. Women with diabetes were nearly 4 times at a greater risk of developing higher stages of chronic kidney disease compared to women without it. With a unit increase in serum creatinine levels, women were nearly 13 times more likely to develop higher stages of chronic kidney disease.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: Serum creatinine levels and diabetes were the significant predictors for the development of higher stages of chronic kidney disease. Early screening for kidney diseases in women could reduce the load of health care delivery system that is involved in renal replacement therapies.&lt;/p&gt; 01/07/2019 https://www.theskygallerypattaya.com/jcn/jcn-aid1021.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Purpose&lt;/strong&gt;: Deficiency of Fetuin A, as a calcification inhibitor, is assumed to be involved in vascular calcification in patients on maintenance hemodialysis (MHD). This study examined the relationship between serum Fetuin-A and vascular and valvular calcification in a cohort of MHD patients.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: The study was conducted on 122 MHD patients. Serum levels of calcium, phosphorus, parathormone, and Fetuin-A were tested. Intima-media thickness (IMT) &amp;ge;0.8 mm and the presence of stenosis&amp;gt;50% or plaques in carotid doppler sonography were considered as vascular calcification. Calcification of cardiac valves or mitral annular calcification in two-dimensional echocardiography, were considered as cardiac valvular calcification. The presence of any or both of the two conditions was defined as cardiovascular calcification (CVC).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: Fetuin-A was lower than normal in 37% of 122. Totally 106 patients (87%) had CVC, who were older (61&amp;plusmn;14 vs. 38&amp;plusmn;14 years, P&amp;lt;0.001), more affected by diabetes (54% vs. 13%, P=0.007), had a longer dialysis vintage (median 5 vs. 2 years, P=0.006), lower levels of creatinine (8.9&amp;plusmn;2.8 vs. 11.9&amp;plusmn;3.1 mg/dL, P&amp;lt;0.001) and higher levels of calcium (8.7&amp;plusmn;0.7 vs. 8.4&amp;plusmn;0.5 mg/dL, P=0.026). There was no significant difference in mean Fetuin-A level between the two groups (P=0.101). In logistic regression increased age (OR=1.1, CI 95%=1.1 - 1.2) and serum calcium (OR=2.8, CI 95%=1.1- 7.6), and diabetes mellitus (OR=7.4, CI 95%=1.1 - 47.4) were risk factors.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: This study showed that 87% of our patients had vascular and/or valvular calcification. Increased age and calcium level and diabetes were the predictors of CVC, whereas Fetuin-A was not.&lt;/p&gt; 12/31/2018 https://www.theskygallerypattaya.com/jcn/jcn-aid1020.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Brucellosis is a zoonotic infection that is endemic in some Mediterranean countries, North Africa and the Middle East. Brucella is a rare cause of peritonitis in Peritoneal Dialysis (PD) population and in non-dialysis patients alike. We report here a challenging case of PD-related Brucella peritonitis in a 45-year-old Saudi male with late peritonitis that delivered some key learning throughout its course from presentation, diagnosis and treatment to catheter salvage attempts so as to circumvent PD failure. We provide an in-depth review of limited published literature on PD-related Brucella peritonitis (seven cases, and present case) and summarized the data on key clinical characteristics, management and PD technique outcome to benefit nephrologists when encountered with this rare presentation.&lt;/p&gt; 12/14/2018 https://www.theskygallerypattaya.com/jcn/jcn-aid1019.php Liver cyst infection in patients with autosomal dominant polycystic kidney disease (ADPKD) is a rare but life-threatening complication. Diagnosis and treatment remain challenging. We report the case of a 64-year-old kidney transplant patient presenting with fever and abdominal pain. The diagnosis of liver cyst infection was made by positron emission tomography scan (PET/CT). Moreover, the course of our patient illustrates the interest of subsequent PET/CT during follow-up as our patient failed on antibiotherapy and required liver cyst drainage. 10/02/2018 https://www.theskygallerypattaya.com/jcn/jcn-aid1018.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Care of kidney transplant recipient remains complex and long-term graft survival is not seen in every transplant recipient. Due to reduced supply and increased demand of human organs, more transplants are carried out using marginal grafts on emergency lists. Transplant recipients have altered physiology due to known end-stage renal disease, recent surgery and the use of potent analgesic and immunosuppressive medications. Amongst the known surgical complications, urine leak remains the most common. It can result from poor graft preparation due to excessive peri ureteric or lower pole dissection or damage to lower polar artery resulting in ischemic necrosis. In addition, poor surgical technique, bladder outflow obstruction, iatrogenic injury to bladder or renal pelvis may contribute to urine leak. Ongoing urine leak may manifest itself as swelling, pain, high drain output, sepsis, ileus and eventual graft loss. Early identification, localisation and quantification of leak remain essential in management of these patients. In addition, sepsis should be identified and treated promptly as these patients are highly susceptible to infections. Early recognition of this complication can significantly reduce hospital stay, improve quality of life and reduce graft loss and mortality. In this article, we aim to develop an evidence-based management approach to a patient with urine leak using a clinical scenario.&lt;/p&gt; 09/12/2018 https://www.theskygallerypattaya.com/jcn/jcn-aid1017.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;We present a case of hypocomplementemic urticarial vasculitic syndrome (HUVS) who developed severe renal failure requiring ICU-level care. Our patient is a 66-year-old man who presented with abdominal pain, rash, confusion, oliguria, and shortness of breath. He was found to be in acute renal failure with leukocytosis and elevated lactate. Work-up for infectious, autoimmune, and hematologic malignant diseases was negative. The presence of chronic urticaria, abdominal pain, hypocomplementemia, and leukocytoclastic vasculitis on skin biopsy confirmed the diagnosis of HUVS. He required hemodialysis for renal failure as well as gastrostomy tube placement for nutritional support secondary to the development of mucosal ulcers, a rare finding in HUVS. He recovered with several months of high-dose steroids and hemodialysis. This case highlights the effectiveness of steroids for initial treatment of HUVS, and the relapsing and remitting nature of the disease. Providers should also be aware of the broad range of presenting symptoms such as mucosal lesions that may require nutritional support. Interestingly, unlike many previously reported cases of HUVS, our patient had not yet developed signs and symptoms of systemic lupus erythematosus, which often overlaps with HUVS.&lt;/p&gt; 08/30/2018 https://www.theskygallerypattaya.com/jcn/jcn-aid1016.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Desensitization allows successful transplantation of patients with a positive crossmatch (PXM) against their live donor. We evaluated outcomes following PXM renal transplant despite failure to convert to negative flow cytometric crossmatch (FCXM) after desensitization. Patients that underwent desensitization before PXM transplant between 1/1/00 and 11/1/11 were identified for analysis. Patients who received a transplant despite failure to convert to negative FCXM were identified as the not converted group. Patients who converted to negative FCXM after desensitization comprised the converted group control arm. 108 patients were desensitized before PXM transplant, (not converted group=42; converted group=66). Mean eGFR was comparable between groups at all time points, and 3-year eGFR was 57.8 mL/min vs. 57.1 mL/min, p=0.91. Patients with eGFR &amp;lt; 30mL/min at 3 years did not differ significantly (28% vs. 14%, p=0.15). Biopsy-proven rejection rates were numerically higher within the not converted group for each type of rejection and time point, but the values did not differ significantly. Opportunistic infections rates were comparable. Patient survival (95% vs. 91%) and death-censored allograft survival (84% vs. 95%, p=0.07) were similar between arms at 3 years post-transplant.&lt;/p&gt; 08/03/2017 https://www.theskygallerypattaya.com/jcn/jcn-aid1015.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: AngioJetTM rheolytic thrombectomy has been used in the treatment of deep vein thrombosis (DVT) to prevent post-thrombotic syndrome. Though not widely appreciated, it has the potential to cause intravascular haemolysis.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Report&lt;/strong&gt;: A 37 year old man with no previous medical history presented to his GP with a three week history of progressive right upper limb swelling. Doppler imaging confirmed right upper limb DVT and CT scan demonstrated thoracic outlet syndrome. The patient underwent AngioJetTM thrombectomy followed by IV heparin infusion. Successful revascularisation of the occluded vein was achieved. Overnight he developed haematuria, which was initially attributed to IV heparin. Urinalysis however revealed no red cells or casts. Apart from an Hb drop from 134 to 117 his blood profile and blood film showed no abnormality. He subsequently developed progressive oliguria with marked oedema and acute kidney injury (AKI). His creatinine peaked at 1070umol/l at 96 hours post procedure and he was started on intermittent dialysis. He remained dialysis dependent for 6 days. Ultrasound imaging excluded urinary obstruction. Autoimmune and vasculitic serology were negative. Intravascular haemolysis and haemoglobinuria was confirmed by raised LDH (1714u/L) and low haptoglobin (&amp;lt;0.1units). Direct Coomb&amp;rsquo;s test, Cold agglutinin test and paroxysmal nocturnal haemoglobinuria screen were negative. The patient&amp;rsquo;s renal function normalised over 3 months.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: The likely cause of this man&amp;rsquo;s AKI is heme pigment nephropathy from intra-vascular haemolysis. Increased awareness of this condition may allow early identification and intervention to reduce the risk of renal injury from AngioJetTM associated haemolysis.&lt;/p&gt; 05/03/2018 https://www.theskygallerypattaya.com/jcn/jcn-aid1014.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;TEmphysematous pyelonephritis (EPN) is a rare but potentially life-threatening necrotizing renal parenchymal infection characterised by the production of intra-parenchymal gas. The approach and the management of emphysematous has changed dramatically over the last two decades with the advent of computed tomography (CT)-based diagnosis and advances in antibiotic therapy as well as multidisciplinary intensive care of sepsis leading to an overall decline in mortality rates to 20-25%. The previously standard treatment for EPN which included nephrectomy of the affected kidney has been replaced by minimally invasive and nephron sparing surgery with better patient outcomes. We present our case series of 12 patients with EPN over a short period of two years treated at our tertiary care centre in South Western India.&lt;/p&gt; 03/23/2018 https://www.theskygallerypattaya.com/jcn/jcn-aid1013.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Thymoglobulin is a rabbit-derived anti-thymocyte antibody directed at T-cells and commonly used for induction immunosuppression therapy in solid organ transplantation, especially in immunologically high risk kidney transplant recipients. Despite its frequent use and efficacy, the heterologous makeup of thymoglobulin can induce the immune system resulting in serum sickness which typically presents with rash, fever, fatigue, and poly-arthralgia in the weeks following drug exposure. ATGAM is another anti-thymocyte antibody, targeting the same epitopes, but differs from thymoglobulin by the animal in which the preparations are generated (equine vs. rabbit). Herein, we present a case of a patient with a known history of thymoglobulin-induced serum sickness, who presented with evidence of acute cellular and vascular rejection at their 12-month post-operative visit. Given their immunologically high risk status, they were successfully treated with ATGAM with improvement in their rejection and kidney function. To the author&amp;rsquo;s knowledge, this is the first case report of successful administration of ATGAM in a patient with a documented history of thymoglobulin induced serum sickness, demonstrating a possible treatment option for acute rejection in patients with reactions to thymoglobulin.&lt;/p&gt; 03/08/2018 https://www.theskygallerypattaya.com/jcn/jcn-aid1011.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;A 50-years old female presented with dysarthria, inability to swallow and quadriparesis for three weeks. She had rapid correction of her serum sodium (Na) from 99meq/l to 138meq/l within 24 hours 1 week prior to development of these symptoms. She was diagnosed as a case of Osmotic demyelination syndrome (ODS) formerly known as central pontine myelinolysis (CPM) which was confirmed by MRI. She underwent Plasma Exchange (PE) on the 20th day since her symptoms started and underwent 7 cycles of PE with complete neurological recovery. Pt was discharged with ability to ambulate independently and complete recovery of speech and swallowing. Hence, we report that PE is beneficial in chronic ODS.&lt;/p&gt; 02/16/2018 https://www.theskygallerypattaya.com/jcn/jcn-aid1010.php &lt;h2&gt;Introduction&lt;/h2&gt; &lt;p&gt;Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome with clinical features of altered sensorium, headaches, visual problems and seizures. It has been associated with uncontrolled hypertension (HTN), thrombotic thrombocytopenic purpura (TTP) and immunosuppressive drugs. Rituximab has also been implicated as a cause of PRES that usually occurs after the first dose. We report a case of PRES that occurred after the second dose of Rituximab. A twenty three years old female known case of resistant TTP treated with multiple courses of steroids and plasmapharesis was admitted with renal failure, severe volume overload ad lower respiratory tract infection. She was treated with hemodialysis, intravenous antibiotics, steroids and plasma exchange (PEX). She did not responded and due to worsening thrombocytopenia and persistent hemolysis was administered Rituximab as an adjunct therapy. She tolerated the first dose well, however 48 hours after the second dose she developed uncontrolled HTN of 190/110 associated with generalized tonic clonic seizures and altered sensorium requiring intubation and mechanical ventilation. MRI findings were suggestive of PRES. Seizures did not get controlled with conventional therapy and patient underwent two consecutive cycles of PEX to remove the drug which resolved the seizures.&lt;/p&gt; &lt;p&gt;However, the patient developed Ventilator associated pneumonia (VAP) and sepsis and expired after family withdrew ventilator support.&lt;/p&gt; 12/29/2017 https://www.theskygallerypattaya.com/jcn/jcn-aid1009.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Endothelial dysfunction and inflammation play a key role in the pathophysiology of diabetic nephropathy; Tetrahydrobiopterin (BH4) is an essential cofactor for nitric oxide synthase, when BH4 is reduced to dihydrobiopterin (BH2), endothelial dysfunction is induced.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Purpose&lt;/strong&gt;: The aim of this study is to evaluate the relationship between the levels of biopterins with albuminuria in type-2 diabetic hypertensive patients.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: We studied 30 hypertensive type-2 diabetic patients in whom biopterins levels were measured by reverse phase high performance liquid chromatography with fluorescence detection. Additionally, 24 h urinary albumin excretion was also measured (nephelometry). The levels of biopterins and albuminuria were correlated with the Pearson correlation coefficient.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: We did not find a significantly correlation between biopterins levels and albuminuria, However, we found a significantly inverse correlation (R= -0.498, p&amp;lt;0.005) between the BH4/BH2 ratio and albuminuria.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: Our results suggest that the BH4/BH2 ratio instead of biopterins levels may be a marker of nephropathy in hypertensive type-2 diabetic patients.&lt;/p&gt; 12/21/2017 https://www.theskygallerypattaya.com/jcn/jcn-aid1008.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Intravenous iron is used in combination with erythropoi esis-stimulating agents to treat the anemia of hemodialysis patients, however, there is variety in the dose and the frequency. So we compare bolus intravenous iron administration protocol vs an intermittent intravenous iron infusion protocol for 3 months in a single blinded design that was conducted on 30 patients randomized into 2 matching groups. Iron parameter, hemoglobin level, and CRP were monitored before and at the end of study. Patients with end stage renal disease on regular hemodialysis with iron deficiency anemia can be treated with intravenous iron administration either by the protocol of divided doses of IV iron through the sessions of hemodialysis or by giving the total dose of iron needed as a single large dose on only one session of hemodialysis, obtaining the same outcome in correction of iron parameters in treatment of iron deficiency anemia.&lt;/p&gt; 11/08/2017 https://www.theskygallerypattaya.com/jcn/jcn-aid1007.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Acute kidney injury (AKI) is a frequent and serious clinical complication in patients with severe malaria. The purpose of this study was to assess the incidence of AKI in a large population of hospitalized patients with a primary admission diagnosis of malaria, and to investigate the robustness of the KDIGO criteria for predicting the need for dialysis, length of hospital stay and hospital mortality.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: We studied 695 consecutive patients admitted with primary diagnoses of malaria, in a 6 months period. AKI occurred in 86 (12.4%) patients (Stage 1 in 30.2%, Stage 2 in 23.3% and Stage 3 in 46.5%), and 19 (22.1%) patients required hemodialysis. No patient in the no-AKI or AKI Stage 1 groups (admission or maximum AKI Stage) required hemodialysis, and the requirement of hemodialysis was higher in patients with AKI Stage 2 (23.1%) and Stage 3 (42.4%). The length of hospital stay was longer (7.3&amp;plusmn;7.4 days vs 5.1&amp;plusmn;3.0 days; t=4.996, p&amp;lt;0.0001), and mortality was higher in patients who developed AKI than in those who did not (22,5% vs 2,5%; &amp;chi;2=79.52; p&amp;lt;0.0001). Patients with AKI Stage 1, 2 and 3 had significantly higher hospital mortality (11%, 23% and 30%, respectively), compared with 2.5% for patients without AKI [odds ratio 5.2 (1.40-19.11, p=0.0331), 13.2 (4.24-41.06, p=0.0002), and 16.9 (7.26-36.65, p&amp;lt;0.0001)], respectively.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: In a relatively large cohort of patients with falciparum malaria infection, the KDIGO criteria identified 12.4% with a diagnosis of AKI. The KDIGO classification was robust in this population for predicting the need for dialysis, length of hospital stay and hospital mortality. The results support the utilization of the KDIGO criteria in diagnosis and to predicting outcomes for patients with malarial AKI.&lt;/p&gt; 09/05/2017 https://www.theskygallerypattaya.com/jcn/jcn-aid1006.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Objective&lt;/strong&gt;: Anemia, a common complication of chronic kidney disease, usually develops because of erythropoietin deficiency. Maintaining target hemoglobin (Hb) with minimal variability is a challenge in hemodialysis (HD) patients. The aim of this study is to compare the long- and short-acting erythropoietin erythropoietin stimulating agents such as Mircera and Eprex in achieving these targets.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: The response rate in the evaluation period was higher in patients treated with methoxypolyethylene glycol-epoetin beta (Mircera) than with epoetin (Eprex) alfa: 36 of 50 (72%) mean Hb concentration (10.51g/dl) versus 29 of 50 (58%) mean Hb concentration (9.81), with statistically significant p-value &amp;lt;0.0001.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: Treatment with (Mircera) administered intravenously once monthly was superior to treatment with (Eprex) administered subcutaneously three times weekly for maintaining haemoglobin concentrations in patients with chronic kidney disease on hemodialysis.&lt;/p&gt; 08/30/2017 https://www.theskygallerypattaya.com/jcn/jcn-aid1005.php <strong>Objective</strong>: In end stage renal disease, the synthesis of vitamin D is disturbed.Hyperparathyroidism is one of the key factors in the pathogenesis of many of the complications of dialysis mainly bone and cardiovascular complications.Aim:This study aimed at assessing vitamin D receptor gene polymorphisms BsmIand FokI in Egyptian patients with end stage renal disease on maintenance haemodialysis and the assosciation of these polymorphisms with cardiovascular complications and hyperparathyroidism among these patients.<br /> <br /> <strong>Methods</strong>: One hundred subjects, recruited from Medical Research Institute, from March to July 2014, divided into two main groups; the control group which included thirty apparently healthy subjects and the patients group which included seventy patients with end stage renal disease on maintenance haemodialysis with median 4 years. To all studied subjects, detailed history was taken, thorough physical examination, carotid intima media thickness, presence of plaques and ECG ischemic changes. Laboratory investigations included serum levels of: glucouse, urea, creatinine, uric acid, albumin, total cholesterol, low and high density lipoproteins, calcium, phosphorus, and CRP as well as plasma PTH level. For molecular studies, the detection of BsmI and FokI polymorphisms using polymerase chain reaction and restriction fragment length polymorphism (PCR / RFLP) technique.<br /> <br /> <strong>Results</strong>: 1.No statistically significant difference could be detected in both BsmI and FokI gene polymorphisms between the hemodialysis patients and the controls, suggesting that the development of ESRD had no relation with either VDR BsmI or FokI gene polymorphisms.2.No statistically significant difference were found in these polymorphisms between the hemodialysis patients with or without cardiovascular complications or between patients with PTH level less or more than 300 pg/ml. These results suggest that the development of cardiovascular complications and secondary hyperparathyroidism among Egyptian patients on maintenance haemodialysis cannot be attributed to these two gene polymorphisms.<br /> <br /> <strong>Conclusion</strong>: No association could be found between the variant alleles of BsmI and FokI gene polymorphisms and the development of ESRD, cardiovascular complications and secondary hyperparathyroidism among the studied samples of Egyptian patients on maintenance haemodialysis. 06/13/2017 https://www.theskygallerypattaya.com/jcn/jcn-aid1004.php &lt;h2&gt;SUMMARY&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Introduction&lt;/strong&gt;: Acute tubulointerstitial nephritis (ATIN) is an acute kidney injury (AKI) resulting from damage to the tubulointerstitial tissue due to infection, trauma, or use of medication. It is clinically non-specific.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Case&lt;/strong&gt;: A teenager with multiple trauma, hospitalised after lowering of level of conscience, and convulsion fits. While in the emergency ward, he received: midazolam, fentanyl and phenytoin. The cranial and abdominal CT scans were normal. He was stable with no signs of shock, trauma or infection; he developed oliguria and serum creatinine (Scr) 1.7mg/dL), 12 hours after the admission. After 36 hours, Scr levels were at 3.4mg/dL and urea at 55mg/dL. He had AKI according to pRIFLE (66.2% reduction in clearance). After other causes of AKI had been ruled out, the possibility of ATIN was raised; the phenytoin was suspended and pulse therapy, with methylprednisolone, was promptly initiated. After the first pulse, there was already a decline in the creatinine and urea readings; 48 hours later: Scr at 2.2mg/dL and urea at 86mg/dL. Thirty days after being discharged from hospital, the patient was in good health and had full restoration of kidney function.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Discussion&lt;/strong&gt;: The singularity of this report relies on the rarity of ATIN secondary to the use of phenytoin and also in the importance of recognizing this aetiology as being one of the origins of AKI.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: Early diagnosis allows the reversal of AKI through suppression of treatment with phenytoin and introduction of corticosteroid therapy, when necessary.&lt;/p&gt; 04/20/2017 https://www.theskygallerypattaya.com/jcn/jcn-aid1003.php &lt;h2&gt;SUMMARY&lt;/h2&gt; &lt;p&gt;Intraperitoneal vancomycin absorption is higher when there is peritoneal inflammation, but the absorption decreases with recovery from peritonitis. Consequently, intraperitoneal maintenance doses are ineffective, reducing the rate of cure.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Aim&lt;/strong&gt;:To evaluate the outcome of Gram-positive peritonitis treated with intraperitoneal and subsequent intravenous vancomycin.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: In April 1996, we initiated a protocol for treating peritonitis caused by Gram-positive organisms using a 2-g intraperitoneal loading dose of vancomycin followed by intravenous vancomycin at 1 g twice in 5 days for coagulase-negative Staphylococcus and at 1 g three times in 5 days for Staphylococcus aureus. We analyzed episodes of Gram-positive peritonitis (coagulase-negative and S. aureus) and the efficiency of the treatment protocol in 113 patients undergoing peritoneal dialysis between 1 April, 1996 and 3 August, 2016. There were 6090 patient-months and the mean treatment lasted 54&amp;plusmn;44 months. The outcomes were evaluated as (1) complete cure, (2) relapsing peritonitis, (3) catheter removal for refractory peritonitis, and (4) death.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: A total of 51 cases of coagulase-negative Staphylococcus peritonitis and 37 of S. aureus were seen in 46 of the 113 patients (40.7%). Of these, coagulase-negative Staphylococcus (92.15%) and 34 S. aureus peritonitis (91.89%) resolved.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;:The response to treatment was very satisfactory.&lt;/p&gt; 03/23/2017 https://www.theskygallerypattaya.com/jcn/jcn-aid1002.php &lt;h2&gt;SHORT COMMUNICATION&lt;/h2&gt; &lt;p&gt;Antiphospholipid syndrome may present in various ways from cutaneous manifestation, obstetric complications, neurological manifestation, and cardiac manifestation to renal involvement. There are many cardiac complication of anti-phospholipid syndrome, among them are valvular dysfunction, pulmonary hypertension, myocardial infarction, intracardiac thrombi, and ventricular dysfunction [1]. The most common cardiac manifestation is valvular abnormalities ranging from 11.6-32% [2-5].&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt; 02/27/2017 https://www.theskygallerypattaya.com/jcn/jcn-aid1001.php &lt;h2&gt;ABSTRACT&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Objectives&lt;/strong&gt;: The role of perioperative hemofiltration (HF) in adult patients with impaired renal function undergoing cardiac surgery is controversial. There are suggestions that it may be beneficial for high risk patients undergoing prolonged cardiopulmonary bypass (CPB) surgery. However, long term outcomes in coronary artery bypass graft (CABG) surgery patients have not been investigated.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: To address this we retrospectively followed 7620 patients who underwent CABG between April 2001 and March 2006. Logistic regression was used to risk adjust in-hospital outcomes. Cox proportional hazards analysis was used to risk adjust Kaplan-Meier freedom from death curves. Outcomes were adjusted for American Heart Association and American College of College of Cardiology recommended variables.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: 113 patients had intraoperative HF, 38 had postoperative HF and control group of 7006 that had no HF. After adjusting for differences in case-mix, patients with preoperative kidney disease who received postoperative HF proportionately had significantly higher rates of hospital deaths as compared with intraoperative HF patients. In addition, 5-year follow-up risk-adjusted freedom from death indicated significant differences between intraoperative HF group and postoperative HF patients.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: These findings support the hypothesis that after adjusting for differences in case mixes, the use of intraoperative hemofiltration may offer superior short term clinical outcomes and longer-term survival benefits for patients with preoperative kidney disease.&lt;/p&gt;