Urinary Abnormalities Research Articles

Renal Involvement and Outcomes in Patients Hospitalized with COVID-19 Infection in A Tertiary Hospital

Background Kidney involvement is seen frequently in COVID-19 patients and is essential to the prognosis. This study is undertaken to describe the clinical presentation of renal involvement in COVID-19 patients concerning acute kidney injury (AKI), chronic kidney disease (CKD), and urinary abnormalities and to correlate with the severity of COVID-19 illness and its outcome.
 Material and Methods A retrospective cross-sectional study reviewed the medical records of patients admitted with COVID-19 infection who had pre-existing renal conditions or renal manifestations in the form of deranged renal function tests or abnormal urinary findings. All the relevant clinical and laboratory parameters, including the treatment details and outcome, were noted, and statistical analysis was done.
 Results A total of 72 out of 1,544 patients satisfied the inclusion criteria. Hypertension (72%) and Diabetes (62%) were the commonest co-morbidities noted. CKD was seen in 51 (70%) patients, and 21 patients (29%) were on maintenance dialysis. 39 (76%) patients with CKD were diagnosed with severe COVID-19, 25 (49%) of the patients developed acute worsening of CKD, and 45% had mortality. AKI was seen in 19 patients (26%). Urinary abnormality was seen in 34 (47%) patients, out of which 27 (37%) had proteinuria of more than 1+. Haematuria was seen in 27 (37.5%) patients, of which 12(17%) had gross haematuria. Dialysis was required in 24 patients (33%) additionally. Mechanical ventilation was required in 32(44%) patients, and inotropes in 41(56%). 21 (29%) patients developed acute respiratory distress syndrome, 39 (54%) had sepsis, with six patients developing multiorgan dysfunction syndrome. 62.5% of patients had mortality. The presence of other comorbid conditions, thrombocytopenia, coagulopathy, abnormality in arterial blood gases, and usage of inotropes were found to be significantly associated with adverse outcomes.
 Conclusions Most cases had severe renal system involvement, with an AKI prevalence rate of 1.2% and a case-specific mortality rate of 62.5%.

Urinary abnormalities in asymptomatic secondary school children in Calabar, Nigeria

Introduction: Many patients with kidney disease are asymptomatic but may have abnormalities in urine. The aim of this study was to determine the prevalence of urinary abnormalities (UA) in asymptomatic secondary school children in Calabar, Nigeria and its relationship with age, sex, social class, body mass index and blood pressure.
 Methodology: It was a descriptive cross sectional study of 407 apparently healthy secondary school children aged 10-18 years recruited by multistage sampling techniques in June-July, 2022. Semi-structured questionnaires were used to obtain their bio-data and clinical history. Subject’s height and weight were measured using a stadiometer and body mass index (BMI) calculated. Blood pressure of each subject was measured using auscultatory method. Early morning urine was obtained from each subject and urinalysis done using dipstick- combi 10. The result of urinalysis was recorded. Data were analyzed using SPSS version 22.0 and p- value ≤ 0.05 was significant.
 Results: Out of 407 participants, 162 (39.8%) were males and 245 (60.2%) females giving a M:F ratio 1:1.5. The mean age was 13.5 ± 1.9 years. The prevalence of urinary abnormalities was 115 (28.3%) with many having more than one abnormality. Age group 13-15years were more commonly affected. Nitrituria 75(18.4) was the most frequent urinary abnormality followed by proteinuria 38 (9.3%), leucocytes14 (3.4%) andhaematuria 5(1.2%). There was no glucosuria. Nitrituria was statistically significant among females (p=0.040). Blood pressure, overweight and obesity were not statistically significant in relation to urinary abnormalities.
 Conclusion: The prevalence of urinary abnormalities was high among secondary school children but commoner in females and mainly nitrituria, proteinuria, leucocytes and haematuria. We therefore recommend regular screening for urinary abnormalities among secondary school children in our environment for early detection and prevention of renal diseases

A CROSS-SECTIONAL STUDY TO EVALUATE ACUTE KIDNEY INJURY IN SCRUB TYPHUS PATIENTS

Objective: This study was conducted with the objective to estimate the incidence and severity of acute kidney injury (AKI) scrub typhus patients. Methods: This was a cross-sectional study conducted 90 patients diagnosed with scrub typhus in a tertiary care center. Basic demographic and treatment details of the patients were recorded. Routine hematological investigations and biochemical profiles were performed upon admission and follow-up. AKI was defined and classified based on the RIFLE criteria. Results: Mean age of the patients was 49.0±19.5 years and female preponderance was observed. The hemoglobin level was significantly lower in AKI patients as compared to non-AKI patients. Meanwhile, there was a significant increase in mean TLC count, CRP, total bilirubin in AKI patients as compared to non-AKI patients. was significantly higher as compared to those without AKI. Increasing age, ICU admission, shock, urinary abnormalities, and mechanical ventilation were the factors significantly associated with AKI. Conclusion: AKI is a frequently reported complication in scrub typhus patients. In evaluating febrile illness associated with AKI, scrub typhus should be considered.

Rapid identification of chronic kidney disease in electronic health record database using computable phenotype combining a common data model.

Rapid identification of chronic kidney disease in electronic health record database using computable phenotype combining a common data model.

Τhe Impact of Pre-Transplant Kidney Biopsy on the Evaluation of Prospective Living Kidney Donors

Living kidney donation contributes to increasing the donor pool. Since safety and excellent outcomes of living kidney donors (LKD) are essential, renal biopsy must be part of the pre-transplant evaluation in donors with isolated urine abnormalities or other risk factors. We retrospectively collected data on potential living donors evaluated in the pre-transplant outpatient clinic of Laiko General Hospital of Athens between 2007 and 2022, who underwent a pre-transplant biopsy. Biopsy indications included microscopic hematuria, borderline proteinuria and comorbidities suggestive of chronicity. Those with glomerular diseases or chronic lesions were excluded from donation. We identified 59 potential living donors who underwent renal biopsy. Of these, 10 (16.9%) were male. Median age was 58 (IQR 51-63) years, while 23 (39%) were older than 60 years. 49 out of 59 (83%) had glomerular hematuria, 10 (16.7%) had proteinuria (150-300 mg/d). Out of the 59 donors, 21 (35.6%) were hypertensive, three (5.1%) had impaired glucose tolerance and seven (11.9%) had a BMI > 30 kg/m2. A total of 32 (54.2%) potential donors were accepted for donation. Eight (13.6%) had IgA nephropathy, 10 (16.9%) TBMD and nine (15.3%) had increased chronicity including secondary FSGS. When compared with a control group of donors who did not need a pre-transplant biopsy, those 32 who donated were more frequently hypertensive (p = 0.003), but had similar eGFR [61.3 (±10.4) vs. 61.9 (±13.8), p = 0.866] after a follow-up of 79 (36-114) months. Renal biopsy is a useful tool in the evaluation of prospective LKD. Thorough assessment of donors with isolated urine abnormalities and marginal donors is critical to ensure good post-donation outcomes.

MP10-08 PHENOTYPING PATIENTS WITH NEPHROLITHIASIS: CAN WE PREDICT ABNORMAL 24-HOUR URINE PARAMETERS BASED ON INITIAL STONE PRESENTATION?

You have accessJournal of UrologyCME1 Apr 2023MP10-08 PHENOTYPING PATIENTS WITH NEPHROLITHIASIS: CAN WE PREDICT ABNORMAL 24-HOUR URINE PARAMETERS BASED ON INITIAL STONE PRESENTATION? Kevin Chang, Wilson Sui, Heiko Yang, Kevin Shee, Rei Unno, Ukrit Rompsaithong, Marshall Stoller, and Tom Chi Kevin ChangKevin Chang More articles by this author , Wilson SuiWilson Sui More articles by this author , Heiko YangHeiko Yang More articles by this author , Kevin SheeKevin Shee More articles by this author , Rei UnnoRei Unno More articles by this author , Ukrit RompsaithongUkrit Rompsaithong More articles by this author , Marshall StollerMarshall Stoller More articles by this author , and Tom ChiTom Chi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003225.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The American Urologic Association defines high risk stone formers as those with medical conditions predisposing to stone formation, solitary kidneys, repeated stone episodes or those who present with multiple stones initially. How the initial radiographic stone configuration is related to 24-hour urine test outcomes is unknown. We hypothesized that those with small, unilateral stones may have different 24-hour urine parameters than those with bilateral or larger stone burdens. METHODS: The Registry for Stones of the Kidney and Ureter (ReSKU) database was queried for all patients who underwent 24-hour urine testing between 2015 and 2022. In addition to demographic characteristics and medical history, the initial presenting stone characteristics were identified and characterized according to laterality, stone count, overall stone burden and location. These patients were then categorized by presenting phenotype, and their 24-hour urine characteristics were compared using ANOVA for continuous variables and chi-square for categorical variables. RESULTS: 511 patients met our inclusion criteria and were categorized into one of six phenotypes - based on laterality, stone size and number of stones (Figure 1). The mean age for the entire cohort was 55 years, 51% male and for 90% of patients this was their first stone. In comparing the 24-hour urinary analytes as continuous variables across all six phenotypes, there were no differences. Rates of abnormal urinary analytes were tabulated (Figure 1) and no significant differences in rates of hypovolemia (≤2L, p = 0.725), hypercalciuria (>250mmol/day for males, >200mmol/day for females, p = 0.372), hyperoxaluria (>40mg/day, p = 0.746) or hypocitraturia (<450mmol/day for males, <550mmol/day for females, p = 0.422) or hyperuricosuria (>0.8 mmol/day for males, >0.750mmol/day for females, p = 0.659) were noted. CONCLUSIONS: There was no difference when comparing values of 24-hour urine analytes based on initial stone configuration, including stone multiplicity and/or volume, which calls into question the utility of recommending 24-hour testing for high volume stone formers. Further research should focus on novel methods to identify patients at high risk for stone recurrence or metabolic abnormalities. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e117 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Chang More articles by this author Wilson Sui More articles by this author Heiko Yang More articles by this author Kevin Shee More articles by this author Rei Unno More articles by this author Ukrit Rompsaithong More articles by this author Marshall Stoller More articles by this author Tom Chi More articles by this author Expand All Advertisement PDF downloadLoading ...

PD32-01 UNDERSTANDING THE BARRIERS TO PREVENTIVE PHARMACOLOGICAL THERAPY USE

You have accessJournal of UrologyCME1 Apr 2023PD32-01 UNDERSTANDING THE BARRIERS TO PREVENTIVE PHARMACOLOGICAL THERAPY USE Noah Krampe, Mary Oerline, Ryan Hsi, Joseph Crivelli, John Asplin, Vahakn Shahinian, and John Hollingsworth Noah KrampeNoah Krampe More articles by this author , Mary OerlineMary Oerline More articles by this author , Ryan HsiRyan Hsi More articles by this author , Joseph CrivelliJoseph Crivelli More articles by this author , John AsplinJohn Asplin More articles by this author , Vahakn ShahinianVahakn Shahinian More articles by this author , and John HollingsworthJohn Hollingsworth More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003325.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite multiple clinical trials showing thiazide diuretics, alkali citrate therapy, and uric acid reducing agents (collectively referred to as preventive pharmacological therapy [PPT]) can lower the risk of kidney stone recurrence, these medications are infrequently prescribed. To better understand the barriers to PPT use, we analyzed a novel linkage of medical claims and urine chemistry data from a large cohort of patients with kidney stones. METHODS: We identified Medicare beneficiaries with kidney stones with a 24-hour urine collection processed by Litholink from 2011 to 2016. Among the subset with an abnormal urine chemistry (hypercalciuria, hypocitraturia, hyperuricosuria, or low urine pH), we determined whether they had a prescription fill for PPT within six months of their collection. We characterized differences between patients who were prescribed PPT and those who were not. After assigning patients to the providers who ordered their urine collection, we fit multilevel models to determine how much of the variation in PPT prescription was due to patient- versus provider-level factors. RESULTS: A total of 13,368 patients had a 24-hour urine collection with one or more abnormal urine chemistries, and 35.1% were prescribed PPT. Patients who were prescribed PPT tended to be younger, were more likely to be dually eligible for Medicare and Medicaid and had higher levels of comorbid illness (p<0.01). Eighteen percent of the variation in PPT prescription was attributable to the provider whom a patient saw. The Figure 1 shows prescribing rates for 808 providers in the cohort, who saw 5 patients or more, which ranged from 13% to 76%. After accounting for patient characteristics and provider volume, patients had twice the odds of being prescribed PPT if they were cared for by a nephrologist (OR, 2.11; 95% CI, 1.79 to 2.49) or primary care physician (OR, 1.95; 95% CI, 1.38 to 2.75) versus a urologist. CONCLUSIONS: These data highlight that the type of provider patients see for their kidney stones is an important determinant of PPT prescription. As such, efforts to increase PPT uptake might include educational interventions targeting urologists. Source of Funding: Dr. Hollingsworth's research is funded by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases R01DK121709 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e907 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Noah Krampe More articles by this author Mary Oerline More articles by this author Ryan Hsi More articles by this author Joseph Crivelli More articles by this author John Asplin More articles by this author Vahakn Shahinian More articles by this author John Hollingsworth More articles by this author Expand All Advertisement PDF downloadLoading ...

MP10-06 RISK FACTORS FOR NEPHROLITHIASIS IN 24-HOUR URINE STUDIES OF PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE (NAFLD)

You have accessJournal of UrologyCME1 Apr 2023MP10-06 RISK FACTORS FOR NEPHROLITHIASIS IN 24-HOUR URINE STUDIES OF PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) Michelle Chen, Alex Nourian, Johnathan Drevik, Eric Ghiraldi, and Justin Friedlander Michelle ChenMichelle Chen More articles by this author , Alex NourianAlex Nourian More articles by this author , Johnathan DrevikJohnathan Drevik More articles by this author , Eric GhiraldiEric Ghiraldi More articles by this author , and Justin FriedlanderJustin Friedlander More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003225.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) has been suggested to be an independent risk factor for renal stone disease by several studies. We aimed to identify abnormalities on 24-hour urine collection in this patient population. METHODS: 24-hour urine collections from a single tertiary care center were retrospectively reviewed from May 2014 to May 2021. Univariate analysis was performed using Chi-square test and unpaired T-test for categorical and continuous variables, respectively. A multivariable logistic regression was performed controlling for age, body mass index (BMI), diabetes mellitus (DM). RESULTS: 98 (24%) of 406 patients who met inclusion criteria were identified to have radiographic hepatic steatosis. There were no differences in baseline characteristics between groups including age, race, and gender. On univariate analysis, patients with NAFLD had decreased urinary pH (5.88 vs 6.06, p=0.02), elevated urinary oxalate (40 vs 36, p=0.04), calcium (219 vs 186, p=0.02) and sodium (185 vs 163, p=0.02) relative to those who did not have fatty infiltration of the liver on imaging. After controlling for DM and obesity as defined as BMI≥30, no 24-hour urine abnormalities were identified. CONCLUSIONS: After adjusting for confounding factors, patients with hepatic steatosis did not have identifiable abnormalities in their 24-hour urine studies. Increased risk of nephrolithiasis in patients with NAFLD is likely related to contributors of metabolic syndrome such as diabetes and obesity. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e116 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michelle Chen More articles by this author Alex Nourian More articles by this author Johnathan Drevik More articles by this author Eric Ghiraldi More articles by this author Justin Friedlander More articles by this author Expand All Advertisement PDF downloadLoading ...

METABOLIC DISORDERS IN PATIENTS WITH HIGH RISK FOR RECURRENT URINARY TRACT STONES

A cross-sectional study was conducted to assess the frequency of metabolic disorders detected in 24-hour urine collection in patients with increased morbidity for recurrent upper urinary tract stones. This research was conducted Department of Urology Bakhtawer Amin Hospital, Multan. Study was carried out over a period of six months from 01-12-2021 to 01-06-2022. Total 100 cases presented with the recurrent urinary tract stone were enrolled in this study. Patients were asked about their demographics which include name, age, gender and contact details. A 24-hour urine sample from each patient was analyzed for its contents. Metabolic abnormalities were recorded as per operational definition) . Out of 100 patients, 30 %( n=30) were in age Group of 12-30 years whereas 70 %(n=70) were in age Group of 31-60 years, mean age was calculated as 35.85 ± 9.83 years. Mean duration of kidney stone was 1.69 ± 0.46 months. Frequency of metabolic abnormalities were 42%. We concluded that, the most common 24-hour urine abnormalities were hyperuricosuria (32%), hypercalciuria (19%), hypernatriuria (20%).

Metabolic stone workup abnormalities are not as important as stone culture in patients with recurrent stones undergoing percutaneous nephrolithotomy

To investigate the association between metabolic urinary abnormalities and urinary tract infection (UTI) and the stone recurrence status in patients undergoing percutaneous nephrolithotomy (PCNL). A prospective evaluation was performed for patients who underwent PCNL between November 2019 and November 2021 and met the inclusion criteria. Patients with previous stone interventions were classified as recurrent stone formers. Before PCNL, a 24 h metabolic stone workup and midstream urine culture (MSU-C) were done. Renal pelvis (RP-C) and stones (S-C) cultures were collected during the procedure. The association between the metabolic workup and UTI results with stone recurrence was evaluated using univariate and multivariate analyses. The study included 210 patients. UTI factors that showed significant association with stone recurrence included positive S-C [51 (60.7%) vs 23 (18.2%), p < 0.001], positive MSU-C [37 (44.1%) vs 30 (23.8%), p = 0.002], and positive RP-C [17 (20.2%) vs 12 (9.5%), p = 0.03]. Other factors were mean ± SD GFR (ml/min) (65 ± 13.1 vs 59.5 ± 13.1, p = 0.003), calcium-containing stones [47 (55.9%) vs 48 (38.1%), p = 0.01], median (IQR) urinary citrate levels (mg/day) [333 (123–512.5) vs 221.5 (120.3–412), p = 0.04], and mean ± SD urinary pH (6.1 ± 1 vs 5.6 ± 0.7, p < 0.001). On multivariate analysis, only positive S-C was the significant predictor of stone recurrence (odds ratio: 9.9, 95% confidence interval [CI] (3.8–28.6), p < 0.001). Positive S-C, and not metabolic abnormalities, was the only independent factor associated with stone recurrence. A focus on preventing UTI might prevent further stone recurrence.

The Association of Prostate Cancer and Urinary Tract Infections: A New Perspective of Prostate Cancer Pathogenesis.

Background and objectives: Microbiota of the urinary tract may be associated with urinary tract malignancy, including prostate cancer. Materials and Methods: We retrospectively collected patients with newly diagnosed prostate cancer and subjects without prostate cancer from the National Health Insurance Research Database (NHIRD) in Taiwan between 1 January 2000 and 31 December 2016. A total of 5510 subjects were recruited and followed until the diagnosis of a primary outcome (urinary tract infection, pyelonephritis, cystitis, and prostatitis). Results: We found that the patients with prostate cancer had a significantly higher risk of urinary tract infections than those without prostate cancer. The adjusted hazard ratios for pyelonephritis, prostatitis, and cystitis were 2.30 (95% CI = 1.36-3.88), 2.04 (95% CI = 1.03-4.05), and 4.02 (95 % CI = 2.11-7.66), respectively. We clearly identified the sites of infection and associated comorbidities in the prostate cancer patients with urinary tract infections. In addition, we found that the patients receiving radiotherapy and androgen deprivation therapy had a lower risk of urinary tract infections than the patients in corresponding control groups. Conclusions: Our study suggests that an abnormal urine microbiome could potentially contribute to the development of prostate cancer through inflammation and immune dysregulation. Furthermore, an imbalanced microbiome may facilitate bacterial overgrowth in urine, leading to urinary tract infections. These findings have important implications for the diagnosis and treatment of prostate cancer. Further research is needed to better understand the role of the urine microbiome in prostate cancer pathogenesis and to identify potential microbiome-targeted therapies for the prevention and treatment of prostate cancer.

Lens Free Holographic Imaging for Urinary Tract Infection Screening.

The diagnosis of urinary tract infection (UTI) currently requires precise specimen collection, handling infectious human waste, controlled urine storage, and timely transportation to modern laboratory equipment for analysis. Here we investigate holographic lens free imaging (LFI) to show its promise for enabling automatic urine analysis at the patient bedside. We introduce an LFI system capable of resolving important urine clinical biomarkers such as red blood cells, white blood cells, crystals, and casts in 2 mm thick urine phantoms. This approach is sensitive to the particulate concentrations relevant for detecting several clinical urine abnormalities such as hematuria and pyuria, linearly correlating to ground truth hemacytometer measurements with R 2 = 0.9941 and R 2 = 0.9973, respectively. We show that LFI can estimate E. coli concentrations of 10 3 to 10 5 cells/mL by counting individual cells, and is sensitive to concentrations of 10 5 cells/mL to 10 8 cells/mL by analyzing hologram texture. Further, LFI measurements of blood cell concentrations are relatively insensitive to changes in bacteria concentrations of over seven orders of magnitude. Lastly, LFI reveals clear differences between UTI-positive and UTI-negative urine from human patients. LFI is sensitive to clinically-relevant concentrations of bacteria, blood cells, and other sediment in large urine volumes. Together, these results show promise for LFI as a tool for urine screening, potentially offering early, point-of-care detection of UTI and other pathological processes.

Urine Residual Volume in Normal Dogs Determined by Direct Measurement and Comparison to Two-Dimensional Ultrasonographic Measurement.

Normal urine residual volume (URV) in dogs has not previously been established by direct measurement. Twenty-two client-owned normal healthy dogs (8 female spayed, 12 male castrated, 2 male intact) without history of urinary abnormalities were included. Dogs were walked outside for 5 min to allow for natural voiding, immediately followed by urinary bladder ultrasound and urinary catheterization. The URV was recorded, and the ultrasound images were used to estimate URV for each dog. There was no significant difference between male and female URV; therefore, all data were pooled. With a 90% confidence interval, URV was 0-0.47 mL/kg with a mean URV of 0.21 mL/kg and a median value of 0.175 mL/kg. There was no significant difference between the measured URV and the ultrasound-determined URV. This case series supports previously established normal URV in the dog; however, a reference interval based on a larger population of dogs with further evaluation of body size/weight, sex, and neuter status is recommended to be established for use in clinical setting to differentiate normal urination from urinary retention in patients.

The need for kidney biopsy in the management of side effects of target and immunotherapy.

The introduction of innovative therapies, resulting from revisiting cancer as a disease of the immune system, has changed the scenario of complications. These new classes of drugs, such as targeted therapies and immune checkpoint inhibitors, assure substantial advantages in cancer therapy, despite some side effects affecting various organs, including the kidney. Histological evaluations of kidney disorders induced by targeted/immunotherapy are limited. In this study we examined the histological features of patients treated with new cancer agents who underwent a kidney biopsy for new onset kidney failure and/or urinary abnormalities. The cohort included 30 adult patients. The most frequently administered therapies were immunotherapy (30%), targeted therapy (26.7%), immunotherapy plus targeted therapy (13.3%), immunotherapy plus chemotherapy (13.3%), targeted therapy plus chemotherapy (16.7%). The most common histological finding was tubular interstitial nephritis (30%) that was associated with acute tubular necrosis in 4 cases, and thrombotic microangiopathy (23.3%). After kidney biopsy, 16 of the 30 patients were treated according to the histological diagnosis. Fourteen patients were treated with steroids. One patient with membranous nephropathy was treated with a single dose of rituximab. A patient with severe thrombotic microangiopathy requiring dialysis received a treatment with eculizumab for 3 months. Overall some renal response was obtained in all patients treated with glucocorticoids, while complete kidney response was achieved in the patient treated with rituximab. Cancer treatment was resumed without change in 21 out of 30 patients. Kidney biopsy is critical for the management of kidney toxicities and should be strongly encouraged for patients showing adverse kidney effects of novel cancer agents.

Heterogeneity in Kidney Histology and Its Clinical Indicators in Type 2 Diabetes Mellitus: A Retrospective Study

We analyzed the clinical profile and kidney biopsy of a total of 66 type 2 diabetes patients. Based on kidney histology, they were divided into-Class I (Diabetic Nephropathy), Class II (Non-diabetic kidney disease), and Class III (Mixed lesion). Demographic data, clinical presentation, and laboratory values were collected and analyzed. This study tried to examine the heterogeneity in kidney disease, its clinical indicator, and the role of kidney biopsy in the diagnosis of kidney disease in diabetes. Class I consisted of 36(54.5%), class II 17(25.8%), and class III 13(19.7%) patients. The commonest clinical presentation was nephrotic syndrome 33(50%) followed by chronic kidney disease 16(24.4%) and asymptomatic urinary abnormality 8(12.1%). Diabetic retinopathy (DR) was present in 27(41%) cases. DR was significantly higher in the class I patients (p < 0.05). Specificity and positive predictive values of DR for DN were 0.83 and 0.81, respectively (sensitivity 0.61; negative predictive values 0.64). The Association of the duration of diabetes and the level of proteinuria with DN was statistically not significant (p > 0.05). Idiopathic MN (6) and Amyloidosis (2) were the most common isolated NDKD; whereas diffuse proliferative glomerulonephritis (DPGN) (7) was the commonest NDKD in mixed disease. Another common form of NDKD in mixed disease was Thrombotic Microangiopathy (2) and IgA nephropathy (2). NDKD was observed in 5(18.5%) cases in presence of DR. We noted biopsy-proven DN even in 14(35.9%) cases without DR, in 4(50%) cases with microalbuminuria and 14(38.9%) cases with a short duration of diabetes. Almost half (45%) of cases with atypical presentation have non-diabetic kidney disease (NDKD), though even among these cases with atypical presentation diabetic nephropathy (either alone or in mixed form) is commonly seen in 74.2% of cases. DN has been seen in a subset of cases without DR, with microalbuminuria, and with a short duration of diabetes. Clinical indicators were insensitive in distinguishing DN Vs NDKD. Hence, a kidney biopsy may be a potential tool for the accurate diagnosis of kidney disease.

Identification of Calcium Oxalate in Urine Sediment for Consuming Caffeinated Drinks at Pauwo Village in 2021

This study aimed to determine urinary calcium oxalate sediment in men and women who consume caffeinated drinks in the Pauwo Village, Bone Bolango district in 2021. The method in this study used a qualitative approach with the type of research used was descriptive univariate. The type of data used was primary data and secondary data sourced from questionnaires. The sampling technique in this study used a purposive sampling technique using a sample of 30 people consisting of men and women who consumed caffeinated drinks.&#x0D; The results showed that of the 30 samples of men and women who consumed caffeinated drinks in the Pauwo Village of Bone Bolango district found abnormal urine sediment as many as 21 people from 30 samples and normal urine sediment as many as 9 people from 30 samples which contained calcium oxalate urine sediment in it. The factors that influence the presence of calcium oxalate in men and women include age, gender, and duration of consuming caffeinated drinks.

Acute Kidney Injury and Urinary Sediment Abnormalities in Hospitalized Patients with Coronavirus Disease 2019 (COVID-19) in Morocco

Background: The novel coronavirus disease COVID-19 targets mainly the respiratory system, but may in severe cases affect other organs, causing, multiorgan damage, including cardiac injury and acute kidney injury (AKI). The aim of study was to determine the prevalence of AKI and urinary sediment abnormalities in patients with COVID-19 and evaluate the associated factors and outcomes in hospitalized patients. Material and Methods: All laboratory-confirmed COVID-19 admitted to the hospital during this period were involved in the study from 1st of July to the 1st of August 2020. Patients were subjected to Kidney function tests (KFT) and complete urine analysis. Results: Eighty-six COVID-19 patients were included in the present study. The median age of the patients was 43,29 years, and 53,5 % were males. AKI developed in 17 patients (19,8%). Of these, 23,5% required renal replacement therapy (RRT), and 13,9 % patients died. 45 (51.7%) patients displayed abnormality in urinalysis, such as proteinuria, hematuria, leukocyturia and or urinary urothelial cell. Elderly patients, patients with associated comorbidities are more commonly affected. Stepwise multivariate logistic regression analyses showed that age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.006[0.95-1.06], p=0.8], diabetes mellitus (HR [95%CI]: 10,68 [1,78-64], p=0,009) and hyperleucocytosis (HR [95%CI]: 4,63 [1,01-21,1], p=0,04) were independent predictors of AKI. Conclusion: Kidney dysfunction is common among patients with COVID-19. Patients who develop AKI have bad outcomes this brings us to give more interest in urinalysis and kidney impairment in COVID-19 patients, which should be monitored regularly.

The Renal Manifestations of SARS-CoV-2: A Guide for Family Physicians

COVID-19 is a devastating systemic disease characterized by multisystem involvement driven by exuberant hyperinflammatory and dysregulations in coagulation. In COVID-19 patients, renal failure contributes to morbidity and mortality, and its early detection and timely management are critical to minimize such untoward and irreversible complications. In the healthcare system, family physicians constitute the first node in the management of patients, yet there is a dearth of reports and guidelines focusing on them for specific organ affection. This review provides an overview of recent studies examining the renal manifestations following SARS-CoV-2 infection. We focus on the tell-tale signs and laboratory findings of renal affection in the pediatric and adult populations with COVID-19, specifically for family practitioners to assist in their appropriate triage. Among different manifestations, urinary abnormalities and a modest increase in creatinine are the early indicators of renal affection in COVID-19 patients. Although renal transplant patients are conventionally managed by specialized teams, they may present to family physicians during a pandemic. This review provides a framework for family physicians to promptly detect early indicators of renal involvement in patients infected with SARS-CoV-2, including providing triage guidance for kidney transplant recipients.

Analytical Study of Aaharaja Nidana of Madhumeha in Current Era

Madhumeha is a metabolic disorder in which a person passes honey-like (sweet) urine and is associated with the characteristic of urinary abnormality. The clinical conditions described in Madhumeha have much in common with diabetes mellitus which is recognized by hyperglycemia due to improper insulin secretion, insulin resistance, or both. Diabetes mellitus lowers the quality of life, greatly increases medical expenses and increases the disease-related death rate. Excess indulgence in curd, the meat of domestic animals, aquatic animals, fish, dairy products, newly harvested grains, and jaggery products in recent lifestyle are leading causes of Madhumeha. Therefore, it has become necessary that in the present era, we should have proper information regarding wholesome diet along with its nutritional value so that we could avoid impending disease and manage it accordingly. Source: Various classical texts like Charaka Samhita, Astanga Hridaya, Shushrata Samhita, Madhava nidana, and modern medical textbooks and online databases. Conclusion- Diet having Madhur, Guru, Snigdha, Picchil, and Abhisyandi properties produces Kapha which vitiates the Tri-doshas &amp; Kleda dusti that causes the disease. Aim: To study and analyze the Aharaja Nidana of Madhumeha in the present era and manage it accordingly by adopting a diet which is suitable for the Madhumeha Rogi, Objective: To study the Glycemic index, carbohydrate and other nutritional value of the food articles that are usually taken on daily basis. Material And Methods: The Bruhattrayi &amp; Laghuttrayi, modern medical textbooks, journals and online database. Results &amp; Conclusion: Ayurveda not only cures the disease but can also prevent it through the knowledge of Aharaj and Viharaja nidana. Nidana parivarajana helps to manage the disease.

Evaluation of Glomerular Filtration Rate and Urinary Abnormalities in Children with Cancer before Chemotherapy

Evaluation of Glomerular Filtration Rate and Urinary Abnormalities in Children with Cancer before Chemotherapy