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Yang Li,1 Xue Yan,2 Zhen Luo,1 Xianxian Fu,1 Zhongju Li,1 Qiuzhu Xu,3 Juanjuan Chen,1 Jingmin Yang,2,4,5 Daru Lu4,5 1Department of Nephropathy, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Hainan, People’s Republic of China; 2Department of Medicine, Shanghai WeHealth Biomedical Technology Co., Ltd., Shanghai, People’s Republic of China; 3Department of Central Supply Service Department, Haikou Orthopedic and Diabetes Hospital, Hainan, People’s Republic of China; 4NHC Key Laboratory of Birth Defects and Reproductive Health (Chongqing Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning, Science and Technology Research Institute), Chongqing, People’s Republic of China; 5State Key Laboratory of Genetic Engineering and MOE Engineering Research Center of Gene Technology, School of Life Sciences, Fudan University, Shanghai, People’s Republic of ChinaCorrespondence: Jingmin Yang; Daru Lu, Email jingmin.yang@we-health.vip; Email drlu@fudan.edu.cnIntroduction: X-linked Alport syndrome (XLAS) is caused by pathogenic variants in COL4A5 which lead to abnormalities of the glomerular basement membrane (GBM) structural and is characterized by progressive kidney disease, hearing loss, and ocular abnormalities. The aim of this study was to identify gene mutations in a Chinese family with XLAS by whole-exome sequencing (WES) and verified the pathogenicity of the mutation in vitro experiments.Case Presentation: A five-generation pedigree with a total of 49 family members originating from Hainan province of China was investigated in this study. The proband was a 23-year-old male who developed microscopic hematuria, proteinuria and end-stage kidney disease (ESKD) at age 17. WES identified a novel splicing mutation c.321+5G>A of COL4A5, which cause exon skip. Further co-segregation analysis confirmed that this mutation exists in relatives who had renal abnormalities using Sanger sequencing. Accor

Nahom Dessalegn Mekonnen,1 Tigist Workneh Leulseged,1,2 Buure Ayderuss Hassen,3 Kidus Haile Yemaneberhan,4 Helen Surafeal Berhe,5 Nebiat Adane Mera,6 Anteneh Abera Beyene,4 Lidiya Zenebe Getachew,7 Birukti Gebreyohannes Habtezgi,3 Feven Negasi Abriha8 1Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 2Clinical Research Capacity Building Unit, Medical Research Lounge (MRL), Addis Ababa, Ethiopia; 3Department of Internal Medicine, Hayat Medical College, Addis Ababa, Ethiopia; 4Department of Internal Medicine, Myungsung Medical College Comprehensive Specialized Hospital, Addis Ababa, Ethiopia; 5Department of Internal Medicine, Afya Clinic, Kansas City, Missouri, USA; 6Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; 7Department of Internal Medicine, Eka Kotebe General Hospital, Addis Ababa, Ethiopia; 8Department of Internal Medicine, Jimma University School of Medicine, Jimma, EthiopiaCorrespondence: Tigist Workneh Leulseged, Email tigdolly@gmail.comBackground: Acute kidney injury (AKI) is a frequent complication in critical patients, leading to a worse prognosis. Although its consequences are worse among critical patients, AKI is also associated with less favorable outcomes in non-critical patients. Therefore, understanding the magnitude of the problem in these patients is crucial, yet there is a scarcity of evidence in non-critical settings, especially in resource limited countries. Hence, the study aimed at determining the incidence and predictors of hospital acquired acute kidney injury (HAAKI) in non-critical medical patients who were admitted at a large tertiary hospital in Ethiopia.Methods: A retrospective chart review study was conducted from September 25, 2022 to January 20, 2023 among 232 hospitalized non-critical medical patients admitted to St. Paul’s Hospital Millennium Medical College between January 2020 and January 2022. The incidence of HAAKI was esti

Sriya Kosaraju,1 Rong M Zhang2 1Department of Biomedical Sciences, University of Missouri-Kansas City, Kansas City, MO, USA; 2Department of Medicine-Division of Endocrinology, Washington University, St Louis, MO, USACorrespondence: Rong M Zhang, Email rongmeizhang@wustl.edu

Keiji Hirai,1 Masako Shimotashiro,2 Toshiaki Okumura,2 Susumu Ookawara,1 Yoshiyuki Morishita1 1Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan; 2Mizue Yuai Clinic, Tokyo, JapanCorrespondence: Keiji Hirai, Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan, Tel +81-48-647-2111, Fax +81-48-647-6831, Email keijihirai@kfy.biglobe.ne.jpBackground: We assessed the anti-SARS-CoV-2 spike antibody response to four doses of BNT162b2 mRNA COVID-19 vaccine in Japanese hemodialysis patients and determined factors associated with the anti-SARS-CoV-2 spike antibody titer after the fourth dose.Methods: Fifty-one patients were enrolled in this single-center, prospective, longitudinal study. Change in anti-SARS-CoV-2 spike antibody titers between after the second and fourth doses were evaluated. Multiple linear regression analysis was used to identify factors associated with the anti-SARS-CoV-2 spike antibody titer after the fourth dose.Results: The anti-SARS-CoV-2 spike antibody titer was higher 4 weeks after the fourth dose compared with 4 weeks after the third dose (30,000 [interquartile range (IQR), 14,000– 56,000] vs 18,000 [IQR, 11,000– 32,500] AU/mL, p< 0.001) and 4 weeks after the second dose (vs 2896 [IQR, 1110– 4358] AU/mL, p< 0.001). Hypoxia-inducible factor prolyl hydroxylase inhibitor use (standard coefficient [β]=0.217, p=0.011), and the log-anti-SARS-CoV-2 spike antibody titer 1 week before the fourth dose (β=0.810, p< 0.001) were correlated with the log-anti-SARS-CoV-2 spike antibody titer 4 weeks after the fourth dose, whereas only the log-anti-SARS-CoV-2 spike antibody titer 1 week before the fourth dose (β=0.677, p< 0.001) was correlated with the log-anti-SARS-CoV-2 spike antibody titer 12 weeks after the fourth dose.Conclusion: Hypoxia-inducible f

Valeria Cernaro, Elisa Longhitano, Chiara Casuscelli, Luigi Peritore, Domenico Santoro Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Messina, ItalyCorrespondence: Domenico Santoro, Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria n. 1, Messina, 98124, Italy, Email domenico.santoro@unime.itAbstract: Hyperphosphataemia represents a significant challenge in the management of chronic kidney disease, exerting a pronounced influence on the pathogenesis of cardiovascular complications and mineral bone disorders. Traditional approaches to address hyperphosphataemia involve implementing dietary phosphate restrictions, administering phosphate binders, and, in cases of end-stage renal disease, resorting to dialysis. Unfortunately, these interventions frequently prove inadequate in maintaining phosphate levels within recommended ranges. Additionally, commonly employed pharmacological agents are not immune to eliciting adverse events, thereby limiting their prescription and therapeutic adherence. There is a growing focus on exploring novel therapeutic strategies in this context. The current discussion centres on tenapanor, a pharmacological agent predominantly acting as a selective inhibitor of sodium/hydrogen exchanger isoform 3 (NHE3). Its mechanism of action involves modulating tight junctions, resulting in reduced sodium absorption and intestinal paracellular permeability to phosphate. Furthermore, tenapanor downregulates sodium-dependent phosphate 2b transport protein (NaPi2b) expression, thereby impeding active transcellular phosphate transport. Clinical trials have elucidated the efficacy and safety profile of tenapanor. This evidence hints at a potential paradigm shift in the management of hyperphosphataemia. However, the burgeoning optimism surrounding tenapanor warrants tempered enthusiasm, as further research remains indispensable.

Nkosingiphile Matthew Sandile Twala,1,&ast; Grace Tade,2,&ast; Patrick Hector Dessein,2,3 Gloria Teckie1,4 1Department of Medicine, Chris Hani Baragwanath Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; 2Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; 3Internal Medicine Department, Rheumatology division, University of Witwatersrand, Johannesburg, South Africa; 4Division of Nephrology, Department of Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa&ast;These authors contributed equally to this workCorrespondence: Patrick Hector Dessein, Email patrick.dessein22@gmail.comIntroduction: The causes of chronic kidney disease (CKD) in people living in Sub-Saharan Africa await identification. Also, whether cardiovascular risk and disease extent differ among patients with different CKD etiologies is uncertain.Methods: In this prospective cross-sectional study, we examined the presumed causes of chronic kidney disease (CKD) and their relationships with cardiovascular risk and disease in 743 consecutive patients from a sub-Saharan low-income population.Results: Hypertensive nephropathy (HNP) (60.2%), diabetic nephropathy (DNP) (24.4%), HIV associated CKD (20.0%) and glomerular disease (13.6%) comprised the major CKD etiologies upon enrolment at the hospital nephrology clinic. Pulse pressure was larger in patients with concurrent HNP and DNP than in those with HNP only (p< 0.001). Pulse pressure and systolic blood pressure were larger in HNP or/and DNP patients than those with HIV associated CKD and glomerular disease (p=0.04 to < 0.001). Cardiovascular disease was more prevalent in patients with HNP and concurrent HNP and DNP than those from other etiologic categories (p< 0.05). HNP and DNP were associate

Elrika Anastasia Wijaya, Purboyo Solek, Dedi Rachmadi, Sri Endah Rahayuningsih, Rodman Tarigan, Dany Hilmanto Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, West Java, IndonesiaCorrespondence: Dany Hilmanto, Tel +628122266879, Email danyhilmanto@yahoo.comIntroduction: As the highest function in the brain that regulates our daily activity, executive dysfunction might affect someone’s health-related quality of life (HRQoL), especially in those with chronic diseases, including chronic kidney disease (CKD). Neurocognitive functions, including intelligence quotient (IQ) and executive function can be affected through various mechanisms in CKD. However, there was still no specific study regarding how IQ and executive function might affect HRQoL in children with CKD.Purpose: To assess Executive Function’s impact on HRQoL and to find association between treatment modalities and CKD stages with HRQoL in children with CKD.Methods: A cross sectional study was conducted at Pediatric Nephrology Clinic at Hasan Sadikin General Hospital, Bandung, Indonesia from September 2022 to April 2023. We included 38 children whose age range were 6– 16 years 11 months old with CKD stage III – V. Assessment tools used were: BRIEF questionnaire for executive function; WISC III tool for IQ; PedsQLTM questionnaire generic module for HRQoL. Data was analyzed using SPSS ver. 26.0.Results: Total number of samples was 38. Complete examinations were done on 30 patients. Eight other patients did not undergo the IQ test. There was a negative correlation between executive function components scores (GEC, BRI, MI) with HRQoL scores on parents’ proxy in all domains. We found no correlation between HRQoL and IQ scores, but we found a correlation between IQ and CKD stage. There was a significant difference in HRQoL from the children’s perspective among the three modalities; children who underwent conservative treatment were having

Ahmed Fathi Elkeraie,1 Saeed Al-Ghamdi,2 Ali K Abu-Alfa,3 Torki Alotaibi,4 Ali Jasim AlSaedi,5 Abdulkareem AlSuwaida,6 Mustafa Arici,7 Tevfik Ecder,8 Mohammad Ghnaimat,9 Mohamed Hany Hafez,10 Mohamed H Hassan,11 Tarik Sqalli12 1Department of Internal Medicine and Nephrology, Alexandria University, Alexandria, Egypt; 2Department of Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut, Beirut, Lebanon; 4Transplant Nephrology, Hamed Al-Essa Organ Transplant Center, Sabah Health Region, Kuwait City, Kuwait; 5Department of Nephrology, College of Medicine, University of Baghdad, Nephrology and Transplantation Center, Medical City Complex, Baghdad, Iraq; 6Department of Medicine, King Saud University, Riyadh, Saudi Arabia; 7Department of Nephrology, Faculty of Medicine, Hacettepe University, Alt&inodot;nda&gbreve;, Ankara, Turkey; 8Department of Medicine, Istinye University; Division of Nephrology, Topkap&inodot;, Istanbul, Turkey; 9Department of Nephrology, Specialty Hospital, Jaber Ibn Hayyan St. Shmeisani, Amman, Jordan; 10Department of Nephrology and Medicine, Cairo University, Cairo, Egypt; 11Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; 12Department of Nephrology, Moroccan Society of Nephrology, Casablanca, MoroccoCorrespondence: Ahmed Fathi Elkeraie, Department of Internal Medicine and Nephrology Alexandria University, Alexandria, Egypt, Email drahmed@hotmail.comAbstract: Chronic kidney disease (CKD) is a major public health concern in the Middle East and Africa (MEA) region and a leading cause of death in patients with type 2 diabetes mellitus (T2DM) and hypertension. Early initiation of sodium-glucose cotransporter - 2 inhibitors (SGLT-2i) and proper sequencing with renin-angiotensin-aldosterone system inhibitors (RAASi) in these patients may result in better clinical outcomes due to

Teguh Marfen Djajakusumah, Putie Hapsari, Prapanca Nugraha, Arrayyan Muhammad, Kiki Lukman Department of Surgery, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Kiki Lukman; Teguh Marfen Djajakusumah, Email kiki.lukman@unpad.ac.id; marfen.djajakusumah@unpad.ac.idBackground: End-stage kidney disease (ESKD) is associated with a tremendous financial burden. Data in Indonesia shows an increasing number of patients with ESKD taking hemodialysis as a routine procedure every year. Establishment and maintenance of vascular access are important in the management of ESKD. Vascular complications that often arise due to hemodialysis are common and one of the main reasons for hospitalization. Cannulation complications ranged from minor hematomas to acute bleeding from pseudoaneurysms that required emergency surgical procedures. This study aims to assess the different clinicopathological characteristics of ESKD patients with vascular access cannulation complications and the surgical management related to the complications.Materials and Methods: This research is a retrospective observational study. The research subjects in this study were ESKD patients in the vascular and endovascular surgery division of the tertiary hospital in West Java, Indonesia. There were 121 study subjects. Clinicopathological characteristics of vascular cannulation complications and surgical management are extracted from the medical record.Results: Three major vascular complications were ruptured pseudoaneurysms 64/121 (52.9%), impending rupture pseudoaneurysms 28/121 (23.1%), and pseudoaneurysms 21/121 (17.4%). Common surgical procedures were ligation of the draining vein 47/121 (38.8%), arterial primary repair 28/121 (23.1%), and arterial patch repair 18/121 (14.9%). There was a significant relationship between symptoms of bleeding in ruptured pseudoaneurysms and bulging masses in pseudoaneurysms (p = 0.001). There was a significant rela

Eyob Beyene,1 Zekewos Demissie,2 Wubshet Tolossa Jote,3 Seyfemichael Getachew,3 Addisu Melkie Ejigu,4 Wondwossen Amogne Degu1 1Department of Internal Medicine, Division of Infectious Disease, Addis Ababa University, Addis Ababa, Ethiopia; 2Department of Internal Medicine, Lancet General Hospital, Addis Ababa, Ethiopia; 3Department of Internal Medicine, Division of Nephrology, St. Paul Millennium Medical College, Addis Ababa, Ethiopia; 4Department of Internal Medicine, Division of Nephrology, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Eyob Beyene, Email eyobebu@gmail.comBackground: Patients with end stage renal disease (ESRD) are at a higher risk of developing tuberculosis (TB) due to the immunosuppressed state along with concomitant comorbidities and socioeconomic and demographic factors. Data on the prevalence of tuberculosis in ESRD are scarce despite the high burden of the disease in developing nations.Methods: A multicenter, cross-sectional study was conducted at eight dialysis centers in Addis Ababa on the prevalence of TB among CKD patients on maintenance hemodialysis from August 2022 to October 2022 G.C. The study enrolled 263 participants selected by systematic random sampling. Data were collected by reviewing the patient’s electronic medical records. The Collected data were analyzed using SPSS version 26.0.Results: Our study found a 27% prevalence of TB in patients with ESRD receiving maintenance hemodialysis (MHD). Pulmonary tuberculosis was the most prevalent form, and lymphadenitis was the most common extra-pulmonary tuberculosis (EPTB). Only 5.6% of the study participants had microbiologic evidence of TB. Chemistry and cytological studies from pleural fluid and imaging evidences were commonly used diagnostic modalities. The presence of HIV infection, longer duration of dialysis (> 1 year), and contact history with a known TB patient were all significantly associated with higher prevalence of TB among the study participants.Conclus

Samuel Mbadu Lelo,1,2 François-Pantaléon Musungayi Kajingulu,1,3,4 Jean-Robert Makulo,1,2 Yannick Mayamba Nlandu,1,5 Justine Busanga Bukabau,1,5 Pierre Koso Mbulupasu,1,6 Augustin Luzayadio Longo,1 Jeanine Nina Losa Luse,7 Vieux Momeme Mokoli,1,2 Ernest Kiswaya Sumaili,1 Nazaire Mangani Nseka1 1Hemodialysis Center, Division of Nephrology, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo; 2Hemodialysis Center, Ngaliema Medical Center, Kinshasa, Democratic Republic of the Congo; 3Dialysis Center, HJ Hospital, Kinshasa, Democratic Republic of the Congo; 4Department of Internal Medicine, Saint-Joseph Hospital, Kinshasa, Democratic Republic of the Congo; 5Hemodialysis Center, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of the Congo; 6Department of Internal Medicine, Clinique Ngaliema, Kinshasa, Democratic Republic of the Congo; 7Hemodialysis Center, Hôpital Général de Référence de Kinshasa, Kinshasa, Democratic Republic of the CongoCorrespondence: Jean-Robert Makulo, Email jrmakulo2016@gmail.comBackground: Data on 25 [OH] vitamin D and intact parathyroid hormone [iPTH] in hemodialysis patients are very limited in sub-Saharan African countries. The present study aimed to assess the magnitude of hypovitaminosis D, and to evaluate the achievement of iPTH KDIGO 2017 targets among chronic hemodialysis patients followed in Kinshasa.Methods: We conducted a multicenter cross-sectional study in 6 hospitals in Kinshasa. All patients followed on hemodialysis for more than 3 months were included. Hypovitaminosis D was defined as < 30 ng/mL (insufficiency = 20– 29 ng/mL; deficiency if < 20 ng/mL) and the targets for iPTH values were based on the 2017 KDIGO guidelines. The determinants for hypovitaminosis D were evaluated by logistic regression.Results: 251 patients [mean age 56 ± 14 years, 72.5% men, 63% hypertensive, 31% diabetic, 100% supplemented with native 25 [OH] vitamin D + CaCO3 were included. Hypovitaminosis D was found

Marcos Vinicius de Sousa University of Campinas, School of Medical Sciences, Department of Internal Medicine, Division of Nephrology, Renal Transplant Unit, Transplant Research Laboratory, Campinas, SP, BrazilCorrespondence: Marcos Vinicius de Sousa, Renal Transplant Unit, Division of Nephrology, School of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, 13083-970, Brazil, Email marcosnefro@gmail.comAbstract: Glomeruli can be damaged in several conditions after kidney transplantation, with a potential impact on the graft function and survival. Primary glomerulonephritis, a group of glomerular immunological damage that results in variable histological patterns and clinical phenotypes, can occur in kidney transplant recipients as a recurrent or de novo condition. Specific immunologic conditions associated with kidney transplantation, such as acute rejection episodes, can act as an additional trigger after transplantation, impacting the incidence of these glomerulopathies. The post-transplant GN recurrence ranges from 3% to 15%, varying according to the GN subtype and post-transplant time, mainly occurring after 3– 5 years of kidney transplantation. Advances in the knowledge of glomerulonephritis pathophysiology have provided new approaches to pre-transplant risk evaluation and post-transplant monitoring. Glomeruli can be affected by several systemic viral infections, such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV), severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), cytomegalovirus (CMV), and BK virus. The diagnosis of these infections, as well as the identification of possible complications associated with them, are important to minimize the negative impacts of these conditions on kidney transplant recipients’ outcomes.Keywords: glomerulonephritis, viral infection, kidney trans

Sumedh Jayanti,1,2 Gopala K Rangan1,2 1Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia; 2Michael Stern Laboratory for Polycystic Kidney Disease, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, AustraliaCorrespondence: Gopala K Rangan, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, 176 Hawkesbury Road, Westmead, Sydney, NSW, 2145, Australia, Email g.rangan@sydney.edu.auAbstract: Advances in the treatment of kidney failure with chronic dialysis have stagnated over the past three decades, with over 50% of patients still managed by conventional in-hospital haemodialysis. In parallel, the demands of chronic dialysis medical care have changed and evolved due to a growing population that has higher frailty and multimorbidity. Thus, the gap between the needs of kidney failure patients and the healthcare capability to provide effective overall management has widened. To address this problem, healthcare policy has increasingly aligned towards a human-centred approach. The paradigm shift of human-centred approach places patients at the forefront of decision-making processes, ensuring that specific needs are understood and prioritised. Integration of human-centred approaches with patient care has been shown to improve satisfaction and quality of life. The aim of this narrative is to evaluate the current clinical challenges for managing kidney failure for dialysis providers; summarise current experiences and unmet needs of chronic dialysis patients; and finally emphasise how human-centred care has advanced chronic dialysis care. Specific incremental advances include implementation of renal supportive care; home-assisted dialysis; hybrid dialysis; refinements to dialysis methods; whereas emerging advances include portable and wearable dialysis devices and the potential for the integration of artificial intelligence in clinical practice.Keywords: pa

Peng-Tzu Liu,1– 4 Jong-Dar Chen1,4 1Department of Family Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan; 2Graduate Institute of Chemistry, Fu Jen Catholic University, New Taipei City, Taiwan; 3Graduate Institute of Biomedical and Pharmaceutical Science, Fu Jen Catholic University, New Taipei City, Taiwan; 4School of Medicine, Fu Jen Catholic University, New Taipei City, TaiwanCorrespondence: Jong-Dar Chen, Center for Occupational and Environmental Medicine, Department of Family Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Shih Lin, Taipei City, 110, Taiwan, Tel +886-2-28332211, ext. 2626, Fax +886-2-28389468, Email m006671@ms.skh.org.twBackground: Cardiovascular disease (CVD) is the primary cause of mortality in chronic kidney disease (CKD) patients, with metabolic disorders exacerbating this risk. Compared with body mass index, waist circumference (WC) has been proposed as a more effective indicator of abnormal visceral fat. However, the associations among CKD, abnormal WC, and CVD remain understudied.Material and Methods: A cross-sectional study in Taiwan (July 2006 to May 2016) involved 10,342 participants undergoing self-paid health checkups at a single medical center. Physical examinations and blood samples were taken to assess metabolic parameters, and renal function was evaluated using the Chronic Kidney Disease Epidemiology Collaboration formula. Coronary artery calcification (CAC) scores were determined through coronary 256-slice multidetector computed tomography angiography, with a CAC score of > 0 Agatston unit (AU) and ≥ 400 AU denoting positive CAC and severe CAC, respectively.Results: Sex-based comparisons were conducted between individuals with CKD and those without CKD. In the CKD group, both sexes exhibited significantly elevated levels for systolic blood pressure, serum fasting blood glucose (FBG), and hemoglobin A1c (HbA1c) as well as reduced serum high-density lipoprotein cholesterol. Examination

Huanhuan Zhu, Chen Chen, Luhan Geng, Qing Li, Chengning Zhang, Lin Wu, Bo Zhang, Suyan Duan,&ast; Changying Xing,&ast; Yanggang Yuan&ast; Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yanggang Yuan, Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, 210029, People’s Republic of China, Tel/Fax +86-25-6813-6462, Email ygyuan@njmu.edu.cnBackground: Mounting evidence suggests that mitochondrial dysfunction contributes to lupus nephritis (LN) pathogenesis. Mitochondrial pyruvate carrier 1 (MPC1) and mitochondrial pyruvate carrier 2 (MPC2) mediating pyruvate transport from the cytoplasm to the mitochondrial matrix, determines the cell survival and cellular energy supply. Here, we aimed to investigate the association of mitochondrial pyruvate carrier expression with the clinical and histological features in LN.Methods: Patients with biopsy-proven proliferative LN (class III and class IV, n=18) and membranous LN (class V, n=18) were included. Expression of MPC1 and MPC2 were examined by immunohistochemistry. MPC protein levels in the two groups were evaluated by the Student’s t-test. Correlation analysis between MPC levels and clinicopathological features was performed by Spearman’s rank correlation.Results: Both MPC1 and MPC2 were exclusively expressed in renal tubules of enrolled LN. Significantly lower MPC1 and MPC2 were observed in patients with proliferative LN compared to membranous LN. In addition, the MPC1 and MPC2 were negatively correlated with SLEDAI-2K score, renal function, and renal pathology activity index.Conclusion: Both MPC1 and MPC2 were localized in renal tubules, and decreased MPC content was more pronounced in proliferative LN than membranous LN. MPC l

Hani Susianti,1 Aswoco Andyk Asmoro,2 Sujarwoto,3 Wiwi Jaya,2 Heri Sutanto,4 Amanda Yuanita Kusdijanto,1 Kevin Putro Kuwoyo,1 Kristian Hananto,5 Matthew Brian Khrisna1 1Clinical Pathology Department, Faculty of Medicine Brawijaya University/Saiful Anwar General Hospital, Malang, Indonesia; 2Anesthesiology and Intensive Therapy Department, Faculty of Medicine Brawijaya University/Saiful Anwar General Hospital, Malang, Indonesia; 3Faculty of Public Administration, Brawijaya University, Malang, Indonesia; 4Internal Medicine Department, Faculty of Medicine Brawijaya University/Saiful Anwar General Hospital, Malang, Indonesia; 5Faculty of Medicine, Brawijaya University, Malang, IndonesiaCorrespondence: Hani Susianti, Clinical Pathology Department, Medicine Faculty of Universitas Brawijaya/Dr. Saiful Anwar General Hospital, Malang, Indonesia, Email hanisusianti.fk@ub.ac.idIntroduction: AKI is a frequent complication in sepsis patients and is estimated to occur in almost half of patients with severe sepsis. However, there is currently no effective therapy for AKI in sepsis. Therefore, the therapeutic approach is focused on prevention. Based on this, there is an opportunity to examine a panel of biomarker models for predicting AKI.Material and Methods: This prospective cohort study analysed the differences in Cystatin C, Beta-2 Microglobulin, and NGAL levels in sepsis patients with AKI and sepsis patients without AKI. The biomarker modelling of AKI prediction was done using machine learning, namely Orange Data Mining. In this study, 130 samples were analysed by machine learning. The parameters used to obtain the biomarker panel were 23 laboratory examination parameters.Results: This study used SVM and the Naïve Bayes model of machine learning. The SVM model’s sensitivity, specificity, NPV, and PPV were 50%, 94.4%, 71.4%, and 87.5%, respectively. For the Naïve Bayes model, the sensitivity, specificity, NPV, and PPV were 83.3%, 77.8%, 87.5%, and 71.4%, respectively.Discus

Evelyn Del Socorro Goicochea-Rios, Ana María Chian-García, Irma Luz Yupari-Azabache, Néstor Iván Gómez Goicochea School of Medicine, Universidad César Vallejo, Trujillo, PeruCorrespondence: Irma Luz Yupari-Azabache, Email IYUPARI@ucv.edu.peIntroduction: Chronic kidney disease affects a large part of the population with hypertension, diabetes mellitus as well as those over 50 years of age. Research reported that male sex and other comorbidities such as obesity and anemia are more frequent in Chronic kidney disease, as well as uncontrolled diabetes mellitus or hypertension.Objective: To determine the risk factors associated with the development of chronic kidney disease in adults with arterial hypertension.Material and Methods: Retrospective cohort study of 455 patients with hypertension treated in a primary health care hospital. Medical records and laboratory information were reviewed for the diagnosis of chronic kidney disease and its staging. Patients aged 40 years and older, of both sexes and evaluated between the years 2015 − 2017 were included. Logistic regression analysis allowed the identification of risk factors associated with the development of chronic kidney disease.Results: 63.7% were female and 36.3% male. The average age for 2015 was 69.79 ± 9.03, more than half of participants had diabetes mellitus and controlled hypertension and the predominant nephroprotection was with Losartan (53%) that year. Male sex (OR 1.68, CI 1.03– 2,76), age: 60 years or older (OR 6.38, CI 2.65– 15,37) and anemia (OR 1.71, CI 1.03– 2,85), were risk factors for the development of chronic kidney disease (p < 0.05), whereas nephroprotection (OR 0.39, CI 0.18– 0,88) and controlled diabetes mellitus (OR: 0.18, CI 0.07– 0,47) were shown to be protective factors (p < 0.05). The prevalence of chronic kidney disease between 2015 and 2017 was 19% and 45%, respectively, with predominance of category G2. The comparison group is the same cohort analyzed in each ye

Tiwabwork Tekalign,1 Mistire Teshome Guta,2 Nefsu Awoke,2 Tesfaye Yitna Chichiabellu,2 Mengistu Meskele,3 Gubay Anteneh,4 Tilahun Saol Tura,2 Shimelash Bitew Workie3 1School of Nursing, College of Medicine and Health Science, ArbaMinch University, ArbaMinch, Ethiopia; 2School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 3School of Public health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 4School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, EthiopiaCorrespondence: Tiwabwork Tekalign, Email tiwabworkt@gmail.comBackground: Diabetic kidney disease (DKD) develops in nearly half of patients with type 2 diabetes mellitus (DM) and one-third of those with type 1 DM during their lifetime. The incidence of DKD as a cause of end stage renal disease is increasing each year. So this study aimed to assess the time to develop diabetic nephropathy and predictors among diabetic patients treated in Wolaita zone hospitals.Methodology: A ten-year retrospective cohort study had conducted among 614 diabetic patients using systematic random sampling in Wolaita and Dawuro zone hospitals. Bivariable and multivariable Cox proportional hazards regression had used to identify the possible associations between variables. Those variables with a p-value of less than 0.25 in bivariable analysis exported to multivariable Cox regression analysis. Finally, variables with p-value less than 0.05 at multivariable Cox regression were considered significantly significant. The Cox-proportional hazard model assumption had checked using the Schoenfeld residual test.Results: Of the total participants, 93 (15.3%; 95% CI = 12.45– 18.14) patients had developed nephropathy in 820,048 people year observation. A mean time to diabetic nephropathy in this study was 189.63 (95% CI, 185.01, 194.25) months. Being illiterate (AHR: 2.21, 95% CI: 1.34– 3.66), being hyperten

Intissar Haddiya,1,2 Siria Valoti3 1Department of Nephrology, Faculty of Medicine and Pharmacy, University Mohamed Premier, Oujda, Morocco; 2Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, University Mohamed Premier, Oujda, Morocco; 3Department of Medicine, Faculty of Medicine, Università degli Studi di Milano Statale, Milano, ItaliaCorrespondence: Intissar Haddiya, Department of Nephrology, Faculty of Medicine and Pharmacy, University Mohamed Premier, BP 724 Hay Al Quods, Oujda, 60000, Morocco, Tel +212 661 28 14 00, Email intissarhaddiya@yahoo.frAbstract: Beta-blockers include a large spectrum of drugs with various specific characteristics, and a well-known cardioprotective efficacy. They are recommended in heart failure, hypertension and arrhythmia. Their use in chronic hemodialysis patients is still controversial, mainly because of the lack of specific randomized clinical trials. Large observational studies and two important clinical trials have reported almost unanimously their efficacy in chronic hemodialysis patients, which seems to be related to their levels of dialyzability and cardioselectivity. A recent meta-analysis suggested that high dialyzable beta-blockers are correlated to a reduced risk of all-cause mortality and cardiovascular complications compared with low dialyzable beta-blockers. Despite their benefits, beta-blockers may have adverse effects, such as intradialytic hypotension with low dialyzability beta-blockers or the risk of sub-therapeutic plasma concentration of high dialyzable ones during dialysis sessions. Both cases are linked to adverse cardiovascular events. A solution for both high and low dialyzable drugs could be their administration after dialysis sessions. Futhermore, the bulk of existing literature seems to favor cardioselective beta-blockers with moderate-to-high dialyzability as the ideal agents in dialysis patients, but further, larger studies are needed. This review aims to

Rui Xue,1,&ast; Haiting Xiao,2,&ast; Vinod Kumar,3 Xiqian Lan,2 Ashwani Malhotra,4 Pravin C Singhal,4 Jianning Chen1 1Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, People’s Republic of China; 2Key Laboratory of Luzhou City for Aging Medicine, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China; 3Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India; 4Feinstein Institute for Medical Research and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, 11030, USA&ast;These authors contributed equally to this workCorrespondence: Jianning Chen; Pravin C Singhal, Email chenjn1987@zju.edu.cn; psinghal@northwell.eduAbstract: Diabetic nephropathy (DN) is a common complication affecting many diabetic patients, leading to end-stage renal disease. However, its pathogenesis still needs to be fully understood to enhance the effectiveness of treatment methods. Traditional theories are predominantly centered on glomerular injuries and need more explicit explanations of recent clinical observations suggesting that renal tubules equally contribute to renal function and that tubular lesions are early features of DN, even occurring before glomerular lesions. Although the conventional view is that DN is not an inflammatory disease, recent studies indicate that systemic and local inflammation, including tubulointerstitial inflammation, contributes to the development of DN. In patients with DN, intrinsic tubulointerstitial cells produce many proinflammatory factors, leading to medullary inflammatory cell infiltration and activation of inflammatory cells in the interstitial region. Therefore, understanding the molecular mechanism of renal tubulointerstitial inflammation contributing to DN injury is of great significance

Kirk N Campbell,1 Siân Griffin,2 Howard Trachtman,3 Rob Geletka,4 Muh Geot Wong5,6 1Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 2Department of Nephrology, University Hospital of Wales, Cardiff, UK; 3Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA; 4Travere Therapeutics, Inc., San Diego, CA, USA; 5Department of Renal Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia; 6Concord Clinical School, University of Sydney, Concord, NSW, AustraliaCorrespondence: Kirk N Campbell, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1243, New York, NY, 10029, USA, Tel +1 212-241-6271, Fax +1 212-987-0389, Email kirk.campbell@mssm.eduAbstract: Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. It is characterized by the mesangial deposition of IgA-containing immune complexes, triggering damage to the glomerular filtration barrier that is amplified by the tandem action of endothelin-1 and angiotensin II at their receptors. Proteinuria and progressive glomerular damage cause loss of kidney function in up to 50% of patients within 10– 20 years. The risk of progression is strongly associated with persistent proteinuria (> 0.75– 1 g/day). Current standard of care involves interventions to decrease proteinuria and control blood pressure. Immunosuppressive agents, used in selected patients at high risk for progression, can be associated with significant side effects. Sparsentan, a novel non-immunosuppressive single-molecule Dual Endothelin Angiotensin Receptor Antagonist (DEARA), received FDA accelerated approval based on interim results from the PROTECT trial, which demonstrated that sparsentan-treated patients achieved a significantly greater reduction in proteinuria from baseline versus the active control irbesartan and that sparsentan was generally safe and well tolerated. Sparsentan is the first non-immunosuppressive treatment to b

Miko&lstrok;aj Dopiera&lstrok;a, Krzysztof Schwermer, Krzysztof Hoppe, Ma&lstrok;gorzata Kupczyk, Krzysztof Pawlaczyk Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, PolandCorrespondence: Krzysztof Pawlaczyk, Email kpawlac@ump.edu.plIntroduction: Chronic kidney disease is a widespread medical problem that leads to higher morbidity, mortality, and a decrease in the overall well-being of the general population. This is especially expressed in patients with end-stage renal disease (ESRD) undergoing maintenance haemodialysis. Several variables could be used to evaluate those patients’ well-being and mortality risk. One of them is the presence of residual urine output.Materials and Methods: The study was conducted on 485 patients treated with maintenance haemodialysis. After enrollment in the study, which consisted of medical history, physical examination, hydration assessment, and blood sampling, each patient was followed up for 24 months. We used residual urine output (RUO) as a measure of residual renal function (RRF). The entire cohort was divided into 4 subgroups based on the daily urinary output ( 100mL to 500mL to 1000mL).Results: The data show that the mortality rate was significantly higher in groups with lower RUO, which was caused mainly by cardiovascular events. Also, patients with higher RUO achieved better sodium, potassium, calcium, and phosphate balance. They were also less prone to overhydration and had a better nutritional status. Preserved RRF also had a positive impact on markers of cardiovascular damage, such as NT-proBNP as well as TnT.Conclusion: In conclusion, preserving residual urine output in ESRD patients undergoing maintenance haemodialysis is invaluable in reducing their morbidity and mortality rates and enhancing other favourable parameters of those patients.Keywords: end stage renal disease, haemodialysis, residual urine output, cardiovascular risk, mortality

Danuta Kielar,1 Andrew M Jones,2 Xia Wang,3 Heide Stirnadel-Farrant,1 Rohit K Katial,4 Abhinav Bansal,5 Manu Garg,5 Chandrakant Sharma,5 Shubhankar Thakar,5 Qin Ye5 1BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK; 2Late-Stage Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; 3Data Science & AI, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; 4BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA; 5ZS, Philadelphia, PA, USACorrespondence: Danuta Kielar, AstraZeneca, Academy House, 136 Hills Road, Cambridge, CB2 8PA, UK, Tel +44 7384905053, Email danuta.kielar@astrazeneca.comBackground: Blood eosinophils can increase in response to infection, inflammation, and hypersensitivity reactions, yet their involvement in the progression of chronic kidney disease (CKD) is poorly understood. This study explores the relationship between blood eosinophils and CKD progression among patients in a real-world setting.Methods: This retrospective study analyzed data obtained from the Optum® de-identified electronic health records dataset in the United States. Patients diagnosed with CKD stage 3 or 4 (International Classification of Diseases diagnosis code or estimated glomerular filtration rate [eGFR] < 60 mL/min) between January 2011 and March 2018 were included and followed until progression to the next CKD stage, death, or dropout. The primary objective of this study was to assess the relationship between blood eosinophil counts (bEOS) and CKD progression, adjusting for clinical and demographic features as well as known risk factors for CKD stages 3– 4. The primary outcomes were CKD progression and all-cause mortality.Results: We found that high eosinophilic levels (bEOS ≥ 300 cells/μL) were associated with CKD progression from stage 3 to stages 4 or 5 (hazard ratio [HR] ranging from 1.30 to 1.50) and from stages 4 to 5 (HR ranging from 1.28 to 1.50). Among patients with CKD progres

Hussam Al Nusair,1 Wael Hamdan,1 Joy Garma,1 Ahmed Eid,1 Rafi Alnjadat,2 Nezam Al-Nsair,3 Mariezl Fonbuena,1 Christin Davao1 1Dialysis Department, Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates; 2Applied Health Sciences, Al-Balqa Applied University, Irbid, Jordan; 3College of Nursing, Xavier University, Cincinnati, OH, USACorrespondence: Rafi Alnjadat, Applied Health Sciences, Al-Balqa Applied University, Irbid, Jordan, Tel +962772496680, Email rafi.alnjadat@bau.edu.joBackground: Fluid overload is a common complication of the care of End-stage Renal Disease patients that may lead to prolonged hospitalization and mortality. This warrants an effective and systemic approach to early recognition and management to improve patient outcomes.Aim: This study aims to evaluate the effect of a modified fluid assessment tool to improve accurate clinical assessments, detection, and management of blood pressure control and fluid alteration among hemodialysis patients.Methods: In this retrospective study, data were collected from forty-three dialysis patients who were seen and followed up from a dialysis unit of an acute care hospital during 8 weeks of standard care. A modified assessment tool was used to systematically highlight the appropriateness of the patient set dry weight using intradialytic weight gain (IWDG) and patient blood pressure. Paired sample t-test and repeated measure ANOVA within-group analysis were applied to compare the mean difference score for IDWG and the mean arterial pressure within the study group, respectively.Result: A total of 43 patients were enrolled (mean age, 59.07) (ranges 27– 88 years) (SD – 14.30); 51.16% female; 79% Emirati Nationals, with Chronic Kidney Disease. A repeated measure ANOVA analysis showed a significant difference in the mean arterial pressure within the study group based on time, over six measurements (p = 0.001). However, the difference between the pre- and post-intra-dialytic weight gain mean scores yi

Qiping Liu,1,&ast; Huiling Gong,1,&ast; Qiqi Chen,1 Chunyan Yuan,2 Bin Hu1 1Department of Ultrasound, Minhang Hospital, Fudan University, Shanghai, 201199, People’s Republic of China; 2Department of Pathology, Minhang Hospital, Fudan University, Shanghai, 201199, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Bin Hu; Chunyan Yuan, Email Niuniuhu1213@qq.com; masterychy@126.comObjective: To study the clinical application value of contrast-enhanced ultrasound (CEUS) in diagnosing renal space-occupying lesions.Methods: Sixty-seven patients with renal space-occupying lesions detected by routine ultrasound examination received the contrast-enhanced ultrasound examination. When observing the perfusion mode of the mass, we analyzed the perfusion characteristics of contrast-enhanced ultrasound and compared them with the surgical pathological results.Results: Sixty-seven lesions, which were identified in 67 patients with renal space-occupying lesions, included 55 renal malignant tumors and 12 benign ones. The sensitivity of qualitative diagnosis by CEUS imaging was 96.4%, the specificity was 66.7%, and the accuracy was 91.0%.Conclusion: The real-time blood supply of renal space-occupying lesions helps judge their nature according to the enhancement mode. It has high clinical application value in diagnosing benign and malignant lesions.Keywords: ultrasound examination, renal lesions, contrast-enhanced ultrasound

Danilo Fliser,1 Maria Mata Lorenzo,2 Katherine Houghton,3 Claire Ainsworth,3 Martin Blogg,2 Elena González de Antona Sánchez,4 Jose Portoles5 1Saarland University Medical Center, Homburg, Germany; 2Astellas Pharma Europe Ltd., Addlestone, UK; 3RTI Health Solutions, Manchester, UK; 4Astellas Pharma España S.A., Madrid, Spain; 5Hospital Universitario Puerta de Hierro, Madrid, SpainCorrespondence: Danilo Fliser, Saarland University Medical Center, Homburg, Germany, Tel +49 – 6841 – 16 15040, Fax +49 – 6841 – 16 15454, Email danilo.fliser@uks.euBackground: Anemia is prevalent among patients with chronic kidney disease (CKD), yet current evidence indicates that treatment may not adhere to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. We aimed to document the management of patients with non-dialysis-dependent (NDD)-CKD receiving erythropoiesis-stimulating agent (ESA) therapy in Europe.Methods: This retrospective, observational study extracted information from medical records in Germany, Spain, and the UK. Eligible patients were adults with NDD-CKD stages 3b– 5 who initiated ESA therapy for anemia between January and December 2015. Anemia was defined as hemoglobin (Hb) < 13.0 g/dL (males) or < 12.0 g/dL (females). Data regarding ESA treatment, treatment response, concomitant iron therapy and blood transfusions were extracted up to 24 months post-ESA initiation, and data on CKD progression until abstraction date.Results: Eight hundred and forty-eight medical records were abstracted. Approximately 40% received no iron therapy prior to ESA initiation. At ESA initiation, mean ± standard deviation Hb level was 9.8 ± 1.0 g/dL. Most patients received darbepoetin alfa, and switching between ESAs was rare (8.5% of patients). Concomitant intravenous and oral iron therapy was prescribed for 36% and 42% of patients, respectively, during initial ESA therapy. Mean Hb levels reached the target level (10– 12 g/dL) within 3– 6 months of ESA initiat

Saeed Al-Ghamdi,1 Ali Abu-Alfa,2 Turki Alotaibi,3 Ali AlSaaidi,4 Abdulkareem AlSuwaida,5 Mustafa Arici,6 Tevfik Ecder,7 Ahmed F El Koraie,8 Mohamed Ghnaimat,9 Mohamed H Hafez,10 Mohamed Hassan,11 Tarik Sqalli12 1Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom Saudi of Arabia; 2Department of Nephrology and Hypertension, American University of Beirut, Beirut, Lebanon; 3Department of Transplant Nephrology, Hamed Al-Essa Organ Transplant Center, Kuwait City, Kuwait; 4Department of Nephrology, College of Medicine, University of Baghdad, Nephrology and Transplantation Center, Medical City Complex, Baghdad, Iraq; 5Department of Medicine, King Saud University, Riyadh, Saudi Arabia; 6Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey; 7Department of Nephrology, Demiroglu Bilim University Faculty of Medicine, Istanbul, Turkey; 8Department of Internal Medicine and Nephrology, Alexandria Faculty of Medicine, Alexandria, Egypt; 9Department of Nephrology Specialty Hospital, Amman, Jordan; 10Department of Nephrology and Medicine, Cairo University, Cairo, Egypt; 11Department of Medical Affairs, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; 12Department of Nephrology, Moroccan Society of Nephrology, Casablanca, MoroccoCorrespondence: Mohamed Hassan, Department of Medical Affairs, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, Tel +971 508187944, Email mohamedhas@msn.comAbstract: The burden of chronic kidney disease (CKD) and other comorbidities, such as hypertension and diabetes, which increase the risk of developing CKD, is on the rise in the Middle East and Africa. The Middle East and Africa CKD (MEA-CKD) steering committee, comprising eminent healthcare specialists from the Middle East and Africa, was formed to identify and propose steps to address the gaps in the management of CKD in these regions. The current article lists the MEA-CKD steering committee meeting outcomes and ev

Tigist Kefyalew Goffe,1,&ast; Zewdie Aderaw Alemu,1,&ast; Tadios Niguss Derese,2,&ast; Yohannes Bayou Tilahun,3 Robel Bayou Tilahun4 1Department of Public Health, Gamby Medical and Business College, Addis Ababa, Ethiopia; 2Department of Research and Training, Eka Kotebe General Hospital, Addis Ababa, Ethiopia; 3General Practitioner at Health Hub Specialty Clinics by Al-Futtaim, Dubai, United Arab Emirates; 4General Practitioner, Uniteam Medical Assistant, Abu Dhabi, United Arab Emirates&ast;These authors contributed equally to this workCorrespondence: Tigist Kefyalew Goffe, Tel +251960291564, Email tgkefyalew59@gmail.comBackground: Although diffuse alveolar damage and respiratory failure are the most common symptoms of coronavirus disease 2019, other organ involvement, such as the kidney, has been reported. The incidence of acute kidney injury in COVID-19 patients has been reported to vary greatly. In this study, we look at the magnitude and risk factors for acute kidney injury in COVID-19 patients in Ethiopia, a developing country.Methods: A hospital-based retrospective cross-sectional study design was conducted among admitted COVID-19 patients at Eka Kotebe general hospital and Saint Peter COVID-19 treatment center by reviewing data from September 2020 to September 2021. A random sampling technique with proportional size allocation was used to select a total sample of 402 patients (225 from Eka Kotebe and 177 from St. Peter). Secondary data was collected from patient medical records using a standard, pre-tested data collection checklist using the Kobo toolbox, which was then exported to SPSS version 25.0 for analysis. The association between dependent and independent variables was analyzed using binary logistic regression. A statistical significance test was declared at a p value ofÂ

Thea Bjune,1,&ast; Thea Bjerkestrand Bøe,2,&ast; Stig Arne Kjellevold,3,&ast; Kristian Heldal,4,&ast; Sadollah Abedini3,&ast; 1Vear General Practitioner Group, Vear, Vestfold, Norway; 2Vestfold Hospital Trust, Medical Clinic, Toensberg, Vestfold, Norway; 3Vestfold Hospital Trust, Medical Clinic, Section for Kidney Disease, Toensberg, Vestfold, Norway; 4Department of Transplantation Medicine, Oslo University Hospital and Institute of Health and Society, University of Oslo, Oslo, Norway&ast;These authors contributed equally to this workCorrespondence: Thea Bjune, Vear General Practitioner group, Steinbruddveien 8, Vear, 3173, Norway, Tel +47 33362700, Email theabg@me.comPurpose: Hyperkalemia is a common metabolic complication of chronic kidney disease (CKD) and is associated with several serious adverse events. We aimed to treat/prevent hyperkalemia using the new of potassium-binders, allowing maintained renin-angiotensin-aldosterone system inhibitors (RAASi) treatment in proteinuric CKD and/or congestive heart failure (CHF) patients.Patients and Methods: We conducted a retrospective cohort study in long-term users of potassium binders for chronic hyperkalemia. Patients aged 18 years and older, treated with potassium-binders and who met the reimbursement criteria and indication for RAASi treatment were included.Results: Fifty-seven percent of the patients were males and mean age was 65 years. During the study period, no patients were admitted to hospital due to hyperkalemia after initiation of potassium binders. Potassium maximum values were significantly lower after treatment. Few patients reported major side effects, and discontinuation was mostly due to normokalemia. We found no significant changes in bicarbonate, serum creatinine or GFR stage after starting potassium binder treatment. All patients on RAASi treatment before initiating potassium-binders were retained on RAASi treatment.Conclusion: New potassium binders in clinical practice a

Bjune T, Bøe TB, Kjellevold SA, Heldal K, Abedini S. Int J Nephrol Renovasc Dis. 2023;16:73–82 The authors have advised that there is an error that runs through the entire paper. Calcium zirconium cyclosilicate is written incorrectly, where it should have been written sodium zirconium cyclosilicate. The authors apologize for this error.

Sune Moeller Skov-Jeppesen,1,2 Nicky Anúel Petersen,1 Knud Bonnet Yderstraede,2,3 Boye L Jensen,4 Claus Bistrup,2,5 Lars Lund1,2 1Department of Urology, Odense University Hospital, Odense, Denmark; 2Clinical Institute, University of Southern Denmark, Odense, Denmark; 3Department of Endocrinology, Odense University Hospital, Odense, Denmark; 4Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark; 5Department of Nephrology, Odense University Hospital, Odense, DenmarkCorrespondence: Sune Moeller Skov-Jeppesen, Department of Urology, Odense University Hospital, Sdr. Boulevard 29, Odense, 5000, Denmark, Tel +45 51210911, Fax +45 65411726, Email sun_mjep@hotmail.comBackground: Low-intensity extracorporeal shockwave therapy (LI-ESWT) has been suggested as a treatment for vascular diseases such as ischemic heart disease, diabetic foot ulcers, and erectile dysfunction. Primarily, LI-ESWT is known for its ability to stimulate angiogenesis and activation of stem cells in target tissues. Application of LI-ESWT in chronic progressive renal diseases is a novel area. The aim of the present review was to summarize available data on the effects of LI-ESWT used in the setting of renal diseases.Methods: We systematically searched PubMed, Medline, and Embase databases for relevant studies. Our review included the results from preclinical animal experiments and clinical research.Results: Eleven animal studies and one clinical study were included in the review. In the animal studies, LI-ESWT was used for the treatment of hypertensive nephropathy (n=1), diabetic nephropathy (n=1), or various types of ischemic renal injury (ie, artery occlusion, reperfusion injury) (n=9). The clinical study was conducted in a single-arm cohort as a Phase 1 study with patients having diabetic nephropathy. In animal studies, the application of LI-ESWT was associated with several effects: LI-ESWT led to increased VEGF and endothelial

Rey Isidto,1 Romina Danguilan,2 Oscar Naidas,3 Russell Vilanueva,2 Mel-Hatra Arakama,2 Layla Marie Paraiso2 1HealthLink Medical, Surgical, Dental Clinics and Diagnostic Center, Iloilo City, Iloilo, Philippines; 2Department of Adult Nephrology, National Kidney and Transplant Institute, Quezon City, Manila, Philippines; 3Department of Adult Nephrology, St. Luke’s Medical Center, Quezon City, Manila, PhilippinesCorrespondence: Rey Isidto, HealthLink Medical, Surgical, Dental Clinics and Diagnostic Center, Iloilo City, Iloilo, Philippines, Tel +63 9178406232, Fax +63 33 3303863, Email rsid2@yahoo.comAbstract: Chronic kidney disease is one of the leading causes of morbidity and mortality in the Philippines. It is associated with a growing health burden as many patients progress to end-stage renal disease. Until recently, therapeutic options for the management of chronic kidney disease were limited. Sodium–glucose co-transporter 2 inhibitors offer an alternative therapeutic approach for patients with chronic kidney disease. Several trials have shown renal benefits with sodium–glucose co-transporter 2 inhibitors in patients with cardiovascular disease with and without type 2 diabetes and across a range of estimated glomerular filtration rate levels. In the Philippines, the sodium–glucose co-transporter 2 inhibitors dapagliflozin and canagliflozin are approved for the prevention of new and worsening nephropathy in type 2 diabetes. With emerging treatment options, an urgent need exists for guidance on the management of chronic kidney disease within the Philippines. In this review, we focus on the putative renal-protective mechanisms of sodium–glucose co-transporter 2 inhibitors, including effects on tubuloglomerular feedback, albuminuria, endothelial function, erythropoiesis, uric acid levels, renal oxygen demand, and hypoxia. Furthermore, we discuss the findings of recent large clinical trials using sodium–glucose co-transporter 2 inhibitors in patients with chr

Eyob Assefa Betiru,1 Ephrem Mamo,2 Dube Jara Boneya,3 Abebawork Adem,4 Dessie Abebaw5 1General Public Health Department, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; 2Public Health Departments, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; 3Departments of Public Health College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia; 4Departments of Public Health College of Health Sciences, Gambi Medical College, Addis Ababa, Ethiopia; 5Public Health Department of Reproductive Health’s, Yekatit 12 Hospital Medical College, Addis Ababa, EthiopiaCorrespondence: Eyob Assefa Betiru, Email eyoba116@gmail.comBackground: Diabetes mellitus and hypertension are the most prominent conditions causing chronic kidney disease and eventually end-stage renal disease. Renal replacement therapy, particularly hemodialysis (HD), is the mainstay of treatment. The aim of this study is to assess the overall survival status of HD patients and potential survival predictors at Saint Paul hospital millennium medical college (SPHMMC) and Myungsung Christian Medical Center (MCM) in Addis Ababa, Ethiopia.Methods: A retrospective cohort study was conducted on HD patients at SPHMMC and MCM general hospital from January 1, 2013 to December 30, 2020. Kaplan Meier, Log-rank, and Cox proportional regression models were used for the analysis. Estimated risks were reported as hazard ratios with 95% confidence intervals and P< 0.05 was considered as having a significant association.Results: A total of 128 patients were included in the study. Median survival time was 65 months. The predominant co-morbid condition was found to be diabetes mellitus with hypertension (42%). The total risk time for these patients was 143,617 person years. The overall incidence rate of death was 2.9 per 10,000 person years (95% CI=2.2– 4). Patients who developed blood stream infection were 2.98-times more likely to die than those without infection. Those using an arteriovenous fis

Ngozi R Mbanefo,1 Samuel N Uwaezuoke,1 Chizoma I Eneh,2 Chioma L Odimegwu,1 Ugo N Chikani,1 Uzoamaka V Muoneke,1 Charles E Nwolisa,3 Kenneth E Odo,1 Francis N Ogbuka,2 Anthony T Akwue4 1Department of Pediatrics, the University of Nigeria Teaching Hospital Ituku-Ozalla Enugu, Enugu, Nigeria; 2Department of Pediatrics, Enugu State University Teaching Hospital Enugu, Enugu, Nigeria; 3Department of Pediatrics, Federal Medical Centre, Owerri, Imo State, Nigeria; 4Emergency Department, ASEER Field Hospital, Al Rabwah, Kingdom of Saudi ArabiaCorrespondence: Samuel N Uwaezuoke, Tel +2348033248108, Email snuwaezuoke@yahoo.comIntroduction: Frequent relapses and steroid dependence are common treatment challenges of steroid-sensitive nephrotic syndrome (SSNS) in children. Acute respiratory infection (ARI) is the most frequently reported trigger of relapse. Given the role of zinc supplementation in preventing ARI, some studies show that this targeted intervention may reduce relapses in childhood SSNS.Aim: This systematic review aimed to determine if oral zinc supplementation can significantly reduce relapses in this disease.Methods: We searched the PubMed and Google Scholar electronic databases for interventional and observational analytical studies without limiting their year or language of publication. We selected studies with primary data that met our inclusion criteria, screened their titles and abstracts, and removed duplicates. We used a preconceived structured form to extract data items from selected studies and conducted a quality assessment of randomized controlled trials (RCTs) and non-randomized studies with the Cochrane collaboration tool and the Newcastle Ottawa Scale, respectively. We qualitatively synthesized the extracted data to validate the review’s objective.Results: Eight full-text articles were selected, comprising four RCTs and four observational analytical studies. Two of the RCTs had a high risk of bias in three parameters of the Cochrane collaboration

Solos Jaturapisanukul,1,2 Chutima Chavanisakun,3 Nontawat Benjakul,3 Tanun Ngamvichchukorn,1 Punnawit Laungchuaychok,1 Sathit Kurathong,1,2 Wanjak Pongsittisak1,2 1Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand; 2Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand; 3Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, ThailandCorrespondence: Wanjak Pongsittisak, Tel +66818345228, Email wanjak@nmu.ac.thBackground: Percutaneous kidney biopsy (PKB) is the gold standard for diagnosing various kidney diseases, but it can result in potential complications. This study aimed to compare kidney tissue adequacy and safety between the two biopsy techniques, including cranial direction (CN) and caudal direction (CD), of needle biopsy under real-time ultrasonogram guidance.Methods: This single-center, prospective, single-blinded, randomized trial included patients undergoing native PKB from July 5, 2017, to June 30, 2019. Patients were randomized to the CN and CD groups. Adequacy and complications between the two groups were analyzed. All PKBs were performed under real-time ultrasonogram guidance with a 16-gauge kidney biopsy needle.Results: A total of 107 participants were enrolled (53 in the CD group and 54 in the CN group). The CD group has more glomeruli than the CN group but with no statistical significance (16 versus 11, p = 0.0865). The CD group obtained more adequate kidney tissue samples than the CN group (69.8% versus 59.3%, p = 0.348). The number of inadequate glomeruli tissue sampling is similar in both groups (14 versus 15, respectively). Furthermore, the CN group had more adverse events, including Hb decline ≥ 10% after kidney biopsy, perinephric hematoma size ≥ 1 cm, hematuria, and the need for blood transfusion, than the CD group.Conclusion: The CD techni

Bach Nguyen,1 Quynh Thi Huong Bui,2,3 Phuong Que Tran2 1Department of Nephrology, Thong Nhat Hospital, Ho Chi Minh City, Vietnam; 2Department of Clinical Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; 3Department of Pharmacy, Thong Nhat Hospital, Ho Chi Minh City, VietnamCorrespondence: Bach Nguyen, Department of Nephrology, Thong Nhat Hospital, 1 Ly Thuong Kiet Street, Tan Binh District, Ho Chi Minh City, 700000, Vietnam, Tel +84 28 918209808, Fax +84 28 3865 6715, Email nguyenbach69@gmail.comPurpose: The present study aimed at evaluating the survival rate, its associated factors, and the causes of death in elderly patients undergoing continuous ambulatory peritoneal dialysis (CAPD) in Vietnam.Patients and Methods: This is a retrospective, observational study conducted among patients aged ≥ 65 years who underwent CAPD at Thong Nhat Hospital, Ho Chi Minh City, Vietnam, from April 2012 to December 2020. The Kaplan–Meier method was used to calculate the cumulative survival rate, and the Log rank test was used to analyze the factors associated with the survival rate of patients.Results: This study enrolled a total of 68 patients with a mean age of 71.93 ± 7.44 years at the initiation of CAPD. The most common complication among kidney failure patients was diabetic nephropathy (39.71%). The rate of concomitant cardiovascular diseases was 58.82%. The average survival rate was 45.59 ± 4.01 months. Peritonitis was the most common factor causing death (31.25%), followed by cardiovascular diseases (28.12%) and malnutrition (25%). The factors that impacted the survival rate included concomitant cardiovascular diseases, low serum albumin (< 35 g/dL), and an indication of CAPD due to exhausted vascular access for hemodialysis at baseline. The main factor associated with a shorter survival time was concomitant cardiovascular diseases.Conclusion: It is necessary to improve the survival time beyond 5 years for elderly patients

Syah Mirsya Warli,1,2 Mohammad Taufiq Alamsyah,3 Alwi Thamrin Nasution,4 Dhirajaya Dharma Kadar,1 Ginanda Putra Siregar,1 Fauriski Febrian Prapiska1 1Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia; 2Department of Urology, Universitas Sumatera Utara Hospital, Universitas Sumatera Utara, Medan, Indonesia; 3Department of Urology, Faculty of Medicine, Universitas Indonesia - Haji Adam Malik General Hospital, Medan, Indonesia; 4Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, IndonesiaCorrespondence: Syah Mirsya Warli, Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia, Tel +6261-8218928, Email warli@usu.ac.idPurpose: To determine the differences in mean scores of erectile dysfunctions (EDs) assessed by the International Index of Erectile Function (IIEF-5) questionnaire between patients with chronic kidney disease (CKD) undergoing hemodialysis and patients undergoing continuous ambulatory peritoneal dialysis (CAPD).Patients and Methods: This is an analytic observational study with a cross-sectional design that was conducted from June to December 2022 at the Urology Center of Haji Adam Malik General Hospital and Rasyida Kidney Specialized Hospital. The sample of this study were male CKD-patients who underwent regular hemodialysis (HD) and who underwent CAPD, and met the inclusion and exclusion criteria. Psychological disorders experienced during therapy session are considered as risk factors and assessed via the Hospital Anxiety and Depression Scale (HADS). These disorders assessment was used to evaluate the severity of the patients’ anxiety and depressive symptoms. Statistical data analysis was carried out.Results: Both groups had HADS-A and HADS-D scores with an average < 7

Seyed Mehrdad Hamrahian,1 Salem Vilayet,2 Johann Herberth,2,3 Tibor Fülöp2,3 1Department of Medicine - Nephrology, Thomas Jefferson University, Philadelphia, PA, USA; 2Department of Medicine - Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA; 3Medicine Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USACorrespondence: Tibor Fülöp, Department of Medicine - Division of Nephrology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC, 29525, USA, Tel +1 843 792-4123, Fax +1 843 792-2995, Email tiborfulop.nephro@gmail.com; fulopt@musc.eduAbstract: Intradialytic hypotension, defined as rapid decrease in systolic blood pressure of greater than or equal to 20 mmHg or in mean arterial pressure of greater than or equal to 10 mmHg that results in end-organ ischemia and requires countermeasures such as ultrafiltration reduction or saline infusion to increase blood pressure to improve patient’s symptoms, is a known complication of hemodialysis and is associated with several potential adverse outcomes. Its pathogenesis is complex and involves both patient-related factors such as age and comorbidities, as well as factors related to the dialysis prescription itself. Key factors include the need for volume removal during hemodialysis and a suboptimal vascular response which compromises the ability to compensate for acute intravascular volume loss. Inadequate vascular refill, incorrect assessment or unaccounted changes of target weight, acute illnesses and medication interference are further potential contributors. Intradialytic hypotension can lead to compromised tissue perfusion and end-organ damage, both acutely and over time, resulting in repetitive injuries. To address these problems, a careful assessment of subjective symptoms, minimizing interdialytic weight gains, individualizing dialysis prescription and adjusting the dialysis procedure based on patients’ risk factors can mitigate negative outc

Toni Rahmat Jaelani,1 Kusman Ibrahim,1 Jonny Jonny,2 Sri Hartati Pratiwi,1 Hartiah Haroen,1 Nursiswati Nursiswati,1 Bunga Pinandhita Ramadhani2 1Faculty of Nursing, Padjadjaran University, Bandung, West Java, Indonesia; 2Nephrology Division, Department of Internal Medicine, Gatot Soebroto Indonesia Army Central Hospital, Jakarta, IndonesiaCorrespondence: Toni Rahmat Jaelani, Faculty of Nursing, Padjadjaran University, Jalan Ir. Soekarno Km. 21 Jatinangor, Sumedang, West Java, 45363, Indonesia, Tel +62-813-2211-0115, Fax +62-022-7795596, Email toni15003@mail.unpad.ac.idBackground: Peritoneal dialysis (PD) training is essential to ensure patient independence and prevent life-threatening complications, such as peritonitis. The International Society for Peritoneal Dialysis (ISPD) recommends that every PD unit worldwide implement local PD training programs with the goal of improving self-care capabilities. This scoping review aims to give an overview of recent literature and recommendations on PD training programs aiming to improve the quality of care and outcomes for PD patients.Methods: The literature search was conducted using the PC (Population, Concept) approach. The population of interest in this study is PD patients, and the study concept is the PD training program. Several databases were used to conduct the literature search, including PubMed, Science Direct, and CINAHL. The search process began from July 2022 until January 2023. The inclusion criteria for the search included research articles and recommendations.Results: The search yielded 22 articles recommending training programs lasting from 5– 8 days, with 1– 3-hour sessions and a nurse-to-patient ratio of 1:1. A cumulative training time of 15 hours or more is recommended to enhance patient independence and reduce peritonitis rates. Home-based or in-unit PD training, conducted by experienced nurses using adult learning strategies, has shown significant value in improving self-care and preventing peritoni

Rami AlAzab,1 Owais Ghammaz,2 Nabil Ardah,2 Ayah Al-Bzour,2 Layan Zeidat,2 Zahraa Mawali,2 Yaman B Ahmed,2 Tha’er Abdulkareem Alguzo,1 Azhar Mohanad Al-Alwani,1 Mahmoud Samara1 1Department of General Surgery and Urology, King Abdullah University Hospital, Irbid, Jordan; 2Faculty of Medicine, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Owais Ghammaz, Faculty of Medicine, Jordan University of Science and Technology, P.O Box 3030, Irbid, 22110, Jordan, Tel +962775741299, Email oaghammaz189@med.just.edu.joPurpose: The study aimed to create a machine learning model (MLM) to predict the stone-free status (SFS) of patients undergoing percutaneous nephrolithotomy (PCNL) and compare its performance to the S.T.O.N.E. and Guy’s stone scores.Patients and Methods: This is a retrospective study that included 320 PCNL patients. Pre-operative and post-operative variables were extracted and entered into three MLMs: RFC, SVM, and XGBoost. The methods used to assess the performance of each were mean bootstrap estimate, 10-fold cross-validation, classification report, and AUC. Each model was externally validated and evaluated by mean bootstrap estimate with CI, classification report, and AUC.Results: Out of the 320 patients who underwent PCNL, the SFS was found to be 69.4%. The RFC mean bootstrap estimate was 0.75 and 95% CI: [0.65– 0.85], 10-fold cross-validation of 0.744, an accuracy of 0.74, and AUC of 0.761. The XGBoost results were 0.74 [0.63– 0.85], 0.759, 0.72, and 0.769, respectively. The SVM results were 0.70 [0.60– 0.79], 0.725, 0.74, and 0.751, respectively. The AUC of Guy’s stone score and the S.T.O.N.E. score were 0.666 and 0.71, respectively. The RFC external validation set had a mean bootstrap estimate of 0.87 and 95% CI: [0.81– 0.92], an accuracy of 0.70, and an AUC of 0.795, While the XGBoost results were 0.84 [0.78– 0.91], 0.74, and 0.84, respectively. The SVM results were 0.86 [0.80– 0.91], 0.79, and 0.858, respectively

Ioannis Koulouridis, Efstathios Koulouridis Private Nephrology Office, Corfu, GreeceCorrespondence: Ioannis Koulouridis, Spirou Rath 41, Corfu, 49100, Greece, Tel +30 6944276642 ; +30 2661022660, Email yannis_koulouridis@yahoo.com; koulef@otenet.grAbstract: Chloride anions are the most abundant in humans. For many years, it has been believed that chloride is simply a counterion of all other cations, ensuring the electroneutrality of the extracellular space. Recent data suggests that chloride anions possess a broad spectrum of important activities that regulate vital cellular functions. It is now evident that, apart from its contribution to the electroneutrality of the extracellular space, it acts as an osmole and contributes to extracellular and intracellular volume regulation. Its anionic charge also contributes to the generation of cell membrane potential. The most interesting action of chloride anions is their ability to regulate the activity of with-no-lysine kinases, which in turn regulate the activity of sodium chloride and potassium chloride cotransporters and govern the reabsorption of salt and excretion of potassium by nephron epithelia. Chloride anions seem to play a crucial role in cell functions, such as cell volume regulation, sodium reabsorption in the distal nephron, potassium balance, and sodium sensitivity, which lead to hypertension. All of these functions are accomplished on a molecular level via complicated metabolic pathways, many of which remain poorly defined. We attempted to elucidate some of these pathways in light of recent advances in our knowledge, obtained mainly from experimental studies.Keywords: intracellular chloride, cell volume regulation, WNK kinases, extracellular potassium, salt sensitive hypertension

Hanny Sawaf,1 Tariku T Gudura,1 Sylvester Dorobisz,1 Dianne Sandy,2 Xiangling Wang,1 Shane A Bobart2 1Department of Kidney Medicine, Cleveland Clinic, Cleveland, OH, USA; 2Department of Kidney Medicine, Cleveland Clinic Florida, Weston, FL, USACorrespondence: Shane A Bobart, Department of Kidney Medicine, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA, Email bobarts@ccf.orgAbstract: Chronic kidney disease (CKD) is associated with significant morbidity and mortality worldwide. In recent years, our understanding of genetic causes of CKD has expanded significantly with several renal conditions having been identified. This review discusses the current landscape of genetic kidney disease and their potential treatment options. This review will focus on cystic kidney disease, glomerular disease with genetic associations, congenital anomalies of kidneys and urinary tract (CAKUT), autosomal dominant-tubulointerstitial kidney disease (ADTKD), inherited nephrolithiasis and nephrocalcinosis.Keywords: genetics, chronic kidney disease, end stage kidney disease, cystic kidney disease

Shaheer Farooqi,1 Afshan Mumtaz,2 Aabiya Arif,1 Mehwish Butt,3 Una Kanor,4 Samuel Memoh,5 Mohammad Aadil Qamar,1 Abubakr Yosufi6 1Department of Medicine, Ziauddin University, Karachi, Pakistan; 2Department of Medicine and Allied, Karachi Medical and Dental College, Karachi, Pakistan; 3Department of Medicine and Allied, Jinnah Medical and Dental college, Karachi, Pakistan; 4Department of Medicine, Bogomolets National Medical University, Kyiv, Ukraine; 5Department of Medicine, Windsor University School of Medicine, Cayon, Saint Kitts and Nevis; 6Medical School, Kabul University of Medical Sciences, Kabul, AfghanistanCorrespondence: Abubakr Yosufi, Kabul University of Medical Sciences, Kabul, Afghanistan, Tel +93 747236767, Email abubakr.educational@gmail.comAim: Nephrogenic systemic fibrosis (NSF) is a rare disorder that occurs in association majorly with chronic kidney disease (CKD). The lack of collective quantitative data on its clinical manifestations and the different treatment options’ efficacy, call the need for our investigation.Methods: A systematic review was conducted covering a timeline from inception up to July 2022 without any restrictions. Article screening and data extraction were performed independently on PubMed, Google Scholar, ScienceDirect, and Cochrane Library. The keywords that we used were CKD, NSF, Gadolinium enduced fibrosis, etc; shortlisted articles were assessed for risk of bias. Data were presented as frequencies and percentages, with a confidence interval of 95%. A chi-square test was also done to find significant relationships, with a p-value < 0.05 considered significant.Results: We had 83 patients in this review consisting of 44 (55.7%) females with a mean age of 51.4± 14.6 years. Sixty-nine (83.1%) patients had chronic kidney disease predisposition to NSF. Previous exposure to gadolinium-based contrast dyes was seen in 66 (79.5%) patients). The most common symptom in patients was cutaneous lesions in 69 (83.1%) patients. The mo