Urinanalysis, considered the “liquid biopsy” of the kidney, is rapidly becoming a lost art among nephrologists. A well-performed urinanalysis provides information on the presence of kidney disease, identifies the affected compartment, and helps monitor disease activity. The three main components of urine analysis are gross examination, dipstick tests, and urine sediment examination under microscopy. The urine sediments should be analyzed under a bright-field, dark-field, phase-contrast, and polarization microscope for better visualization and categorization of cells, casts, and crystals. The Sternheimer-Malbin (SM) stain can enhance urine sediments under a microscope. The urine sediment, like in a kidney biopsy, should be systematically analyzed for evidence of glomerular (dysmorphic RBCs, acanthocytes, RBC casts, lipid casts) and tubulointerstitial (RTE cell casts, Granular casts, Leucocyte casts, broad waxy casts) injury. For crystal identification in sediments, knowledge of urinary pH, morphology, and birefringence features under polarized light is essential.

Joubert syndrome (JS) is a rare, autosomal recessive ciliopathy characterized by neurological abnormalities and, less commonly, renal, retinal, and hepatic involvement. We report a 13-year-old male with developmental delay and abdominal pain. He was diagnosed with bilateral medullary nephrocalcinosis. Detailed examination revealed truncal ataxia and bilateral retinitis pigmentosa. MRI of the brain showed the characteristic molar tooth sign, and genetic testing identified a novel homozygous c.1304G>A (p.Arg435Gln) variant in exon 6 of the INPP5E gene. This report expands the known phenotypic spectrum of INPP5E -related JS and emphasizes the importance of recognizing syndromic associations in patients with unusual renal findings.

Erythropoietin (EPO) supplementation for anemia due to CKD rarely causes pure red cell aplasia (PRCA) initiated by anti-EPO antibodies. Treatment involves discontinuation of erythropoiesis-stimulating agents (ESAs) and administration of immunosuppressive agents like cyclosporine or corticosteroids. The latter increases risk for infection. Desidustat is a hypoxia inducible factor-prolyl hydroxylase (HIF-PH) inhibitor. Its advantage in EPO-induced PRCA in patients with CKD remains unclear. We report a case series on desidustat administration for treating 14 CKD patients with EPO-induced PRCA. Most patients (64%) responded to Desidustat therapy, with a median hemoglobin of 12.5 g/d (range: 8.5-13.6 g/d) at last follow-up. Desidustat can be potentially repurposed in this context with better tolerability. Further randomized controlled trials are warranted.

Background Continuous ambulatory peritoneal dialysis (CAPD) is widely used for ESKD, but catheter migration remains a major cause of malfunction. The Santosh-PGI Hanging Loop Technique, introduced in 2015, minimized the need for intracorporeal suturing and reduced migration. However, this technique was marred by difficult clip placement on the anterior abdominal wall and consequent catheter migration. We describe a novel modification to further enhance catheter stability. Materials and Methods Under general anesthesia, pneumoperitoneum was created via the Veress technique. A 5 mm camera and two 12 mm ports were employed, with the catheter placement port tunnelled obliquely for added anchorage. Initially, a modified epidural needle with a polypropylene loop was used; subsequently, the Carter-Thomason® Port Site needle facilitated easier passage of 2-0 polypropylene sutures around the catheter. Two snug subcutaneous loops were created to secure the catheter to the anterior abdominal wall while ensuring cuff positioning and catheter patency. Results Eight patients underwent the procedure with an average operative time of 37.5 minutes and negligible blood loss. All catheters remained functional without migration, malfunction, or omental entrapment during follow-up. Two catheters were removed for peritonitis at 8 and 18 months, unrelated to migration. The Carter-Thomason needle simplified fixation and reduced operative time compared to the epidural needle technique. Conclusion The Sharma-Devana PGI modification of the Hanging Loop Technique provides a reliable, minimally invasive solution to prevent CAPD catheter migration. It is reproducible, adaptable with locally available instruments, and may reduce the need for reoperations in patients with multiple comorbidities.