Incidence Of Nephropathy Research Articles

A study in prevalence of diabetic nephropathy in recently detected cases of type 2 diabetes mellitus as evidenced by altered creatinine clearance, urinary albumin and serum creatinine, with special emphasis on hypertension, hypercholesterolemia and obesity

Background: Diabetic nephropathy is one of the commonest and most dreaded complications of Diabetes. The Aim was to evaluate the significance of microalbuminuria and creatinine clearance for detecting incipient diabetic nephropathy, and to find out the prevalence of nephropathy among freshly detected Type 2 diabetic patients with vs. those without hypertension, hypercholesterolemia and/or obesity.Methods: In this prospective study, 100 recently diagnosed diabetics were studied. Group A had 50 patients with at least one risk factor are hypertension, hypercholesterolemia and obesity. Group B had 50 patients without any of the aforementioned factors. Patients were investigated for presence of Diabetic nephropathy with abnormal serum Creatinine, creatinine clearance and urinary albumin levels.Results: As many as 43 out of 100 patients were found to have Diabetic nephropathy. The number was significantly higher in group A compared to group B (34/50 vs. 9/50). Incidence of nephropathy was higher with higher number of associated risk factors. Urinary microalbuminuria was the commonest abnormality, Serum creatinine was found in only 30.23% of total positive cases.Conclusions: Incidence of diabetic nephropathy is much larger than imagined in freshly diagnosed/new onset cases of DM type 2. Author also conclude that hypertension, obesity and hypercholesterolemia can contribute to development of nephropathy (68% vs. 18% in those who had the factors vs. those who didn’t). Also, urinary microalbuminuria appears to be much more sensitive than serum creatinine as screening tool.

Contrast-induced nephropathy in patients with diabetes mellitus between iso- and low-osmolar contrast media: A meta-analysis of full-text prospective, randomized controlled trials.

PurposeThis study was conducted to compare iso-osmolar contrast medium, iodixanol, with low-osmolar contrast media (LOCM) for assessing contrast-induced nephropathy (CIN) incidence, exclusively in the diabetic population.MethodA systematic search was conducted for full-text, prospective, randomized controlled trials (RCTs). The primary outcome was incidence of CIN. Medline, Cochrane Central Register of Controlled Trials, and other sources were searched until May 31, 2017.ResultsTwelve RCTs finally met the search criteria. Iodixanol did not significantly reduce the risk of CIN (risk ratio [RR]: 0.72, 95% confidence interval (CI): [0.49, 1.04], p = 0.08). However, there was significantly reduced risk of CIN when iodixanol was compared to a LOCM agent iohexol (RR: 0.32, 95% CI [0.12, 0.89]). There were no differences between iodixanol and the other non-iohexol LOCM (RR: 0.92, 95% CI [0.68, 1.25]).ConclusionIn diabetic populations, iodixanol is not associated with a significant reduction of CIN risk. Iodixanol is associated with a reduced risk of CIN compared with iohexol, whereas no significant difference between iodixanol and other LOCM could be found.

Higher Incidence of Renal Allograft Glomerulonephritis in Living-Related Donor Kidney Transplantation

Glomerulonephritis recurrence has emerged as one of the leading causes of allograft loss. We aimed to investigate the effect of living-related and deceased donation on the incidence of renal allograft glomerulonephritis and its effect on renal allograft survival. MethodsAdult renal allograft recipients with primary glomerulonephritis were enrolled. Transplantation date was from Feb 2004 to Dec 2015. Exclusion criteria included combined organ transplantation, structural abnormality, diabetic nephropathy, hypertension nephropathy, obstructive nephropathy, and primary uric acid nephropathy. The incidence of biopsy-proven allograft glomerulonephritis was compared between the living-related donor group and the deceased donor group. Graft survival was assessed with Kaplan-Meier method, and Cox proportional hazard model was used to evaluate the effect of posttransplant glomerulonephritis on graft outcome. ResultsThere were 525 living-related donor kidney transplant recipients (LRKTx) and 456 deceased donor kidney transplant recipients (DDKTx) enrolled. The incidence of IgA nephropathy was 8.8% in the LRKTx group and 1.3% in the DDKTx group (P < .001); the incidence of focal segmental glomerulosclerosis (FSGS) was 3.8% in the LRKTx group and 1.5% in the DDKTx group (P = .03). FSGS increased the risk of graft failure compared with non-FSGS (hazard ratio [HR], 3.703 [1.459–9.397]; P = .006). IgA nephropathy increased the risk of graft failure by over 5 times 5 years after kidney transplantation compared with non-IgA nephropathy, but it did not affect early allograft survival (HR for ≥5 years, 6.139; 95% CI, 1.766–21.345; P = .004; HR for <5 years, 0.385 [0.053–2.814]; P = .35). ConclusionsHigher incidence of IgA nephropathy and FSGS in renal allograft was observed in living-related donor kidney transplantation compared with deceased donor kidney transplantation. De novo or recurrent IgA nephropathy and FSGS impaired long-term renal allograft survival.

Dramatic Increase of Amoxicillin-Induced Crystal Nephropathy Found in a Cohort Study of French Pharmacovigilance Centers.

An increase in amoxicillin-induced crystal nephropathy (AICN) incidence has been recently suggested. The aims of this study were to investigate the trend of AICN incidence through Paris' regional centers of pharmacovigilance (Paris RCPVs) and better describe this rare adverse drug reaction. Forty-five AICN cases were identified between 1985 and 2016. All cases, except one, were reported since 2010. Amoxicillin (AMX) was administered intravenously (65 [interquartile range {IQR}, 43 to 110] mg/kg of body weight/day) in all patients, either for treating infection (n = 15) or as surgical prophylaxis (n = 30). Delay between AMX administration and AICN onset was 1 (IQR, 1 to 3) day; 30, 4, and 11 patients developed KDIGO stage 1, 2, and 3 acute kidney injury, respectively. Delay between AICN onset and kidney function recovery was 4 (IQR, 2 to 6) days. Precipitating factors were identified in only one-third of cases. Twelve patients required intensive care unit admission, and 8 needed renal replacement therapy. Neither chronic kidney disease nor death was observed. We confirmed the recent and dramatic increase of AICN in the Paris RCPVs since 2010. The absence of precipitating factors in the majority of cases and the onset of AICN in apparent routine indications, such as surgical prophylaxis, are alarming and justify a high vigilance from all AMX prescribers.

Incidence of microvascular complications of type 2 diabetes: A 12 year longitudinal study from Karachi-Pakistan.

Objectives:To estimate the incidence of microvascular complications among subjects with type 2 diabetes at a tertiary care hospital.Methods:This retrospective longitudinal follow-up study assessed the data records of type 2 diabetic subjects who visited the outpatient department of Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, from January 2005 to April 2016. Subjects with gestational diabetes, type 1 diabetes and with history of any microvascular complication were excluded. Medical records were obtained through electronic database (Health Management System). Statistical analyses were conducted using STATA version 14 and SPSS version 20.Results:The incidence of microvascular complications was 92.8, 106.2, and 130.2 per 1000 person per years for retinopathy, neuropathy and nephropathy respectively. Retinopathy, neuropathy and nephropathy were significantly high among diabetic patients with duration of diabetes >10 years followed by 5-10 years. Incidence of retinopathy and nephropathy was significantly higher in patients who had HbA1c>7% than patients with HbA1c≤7% (p-value<0.05). Higher incidence rate of all three microvascular complications were seen in subjects with hypertension than subjects without hypertension.Conclusion:A high incidence of microvascular complications is found in subjects with type 2 diabetes. Poor glycaemic control, longer duration of diabetes and hypertension was found to be associated with the occurrence of these complications.

The demise of contrast nephropathy; can this be true? A contrarian view; a representative case report of contrast nephropathy from Mayo Clinic Health System in Northwestern Wisconsin

In the cognate nephrology literature, a few recent publications from major academic centers in the United States have suggested that the incidence of contrast nephropathy was exaggerated and overstated. These investigators have concluded that intravenous contrast material administration was not associated with an increased risk of acute kidney injury (AKI), emergent dialysis, and short-term mortality in a cohort of patients with diminished renal function. As a contrarian opinion, we first describe a clear cut case of contrast-nephropathy resulting in AKI requiring hemodialysis treatment managed in the Renal Unit of the Mayo Clinic Health System, Northwestern Wisconsin, in the Spring of 2017. We subsequently revisit the overwhelming evidence-base in the English literature that supports the enormous impact of contrast-nephropathy as a clinical syndrome. We finally posit that these recent repudiations of the existence and significance of contrast-nephropathy as a significant clinical entity represent an overreach in statistical expertise. There is no basis for a requiem song over contrast-nephropathy

Relationship between subclinical hypothyroidism and diabetic nephropathy in type 2 diabetic patients

Objective To investigate the relationship between subclinical hypothyroidism and diabetic nephropathy in type 2 diabetic patients (T2DM). Methods We retrospectively analyzed the clinical data of 218 patients with T2DM treated at the Department of Endocrinology, Shanghai Tongren Hospital from January 2015 to December 2016.Based on the level of thyroid stimulating hormone (TSH), patients were divided into a hypothyroidism group (TSH>4.20 mU/L) and a control group (TSH 0.35-4.20 mU/L), and the relationship between subclinical hypothyroidism and diabetic nephropathy was evaluated. Results There were 46 cases in the subclinical hypothyroidism group and 172 cases in the control group.The incidences of diabetic nephropathy were significantly different between the two groups (P<0.05). Furthermore, the incidence of diabetic nephropathy was significantly higher in patients with high levels of TSH (≥10.0 mU/L) than in those with low levels of TSH (<10.0 mU/L) (P<0.05). Conclusions Diabetic patients with subclinical hypothyroidism are prone to diabetic nephropathy, so it is necessary to screen thyroid function. Key words: Diabetes mellitus, type 2; Diabetic nephropathies; Hypothyroidism

The impact of N-acetylcysteine and ascorbic acid in contrast-induced nephropathy in critical care patients: an open-label randomized controlled study

BackgroundThe aim was to investigate whether the use of N-acetylcysteine and ascorbic acid reduce contrast-induced nephropathy incidence in critical care patients.MethodsThis was a one-center, two-arm, prospective, randomized, open-label, controlled trial in the Intensive Care Unit of the University Hospital of Larissa, Greece. Patients with stable renal function, who underwent non urgent contrast-enhanced computed tomography for diagnostic purposes, were included in the study. Patients in the treatment group (NacA, n = 60) received intravenously N-acetylcysteine (1200 mg) and ascorbic acid (2 g) dissolved separately in 100 ml of normal saline 2 hours before, and at 10 hours and 18 hours following the infusion of contrast agent, while control group patients (CG, n = 64) received only normal saline. All patients received additional hydration. Contrast-induced nephropathy was defined as relative increase by 25% of the baseline values of serum creatinine.ResultsContrast-induced nephropathy in NacA and CG were 18.33% and 15.6%, respectively (p = 0.81). The percentage change median (interquartile range (IR)) of serum cystatin-C (mg/L) from baseline in patients who underwent contrast-induced tomography, were 37.23% (28.53) and 93.20% (46.90) in NacA and in CG, respectively (p = 0.03). The 8-isoprostane serum levels in NacA were significantly lower compared to CG at 2 hours (p = 0.012) and 24 hours (p = 0.006) following radiocontrast infusion. Multivariate analysis revealed that contrast-induced nephropathy was independently associated with a higher baseline ratio of serum urea/creatinine (odds ratio, 1.02; 95 CI%, 1.00–1.05) and with the use of nephrotoxic medications (odds ratio, 0.24; 95 CI%, 0.06–0.94).ConclusionIntravenous administration of N-acetylcysteine and ascorbic acid failed to reduce contrast-induced nephropathy in critically ill patients who underwent contrast-enhanced computed tomography, despite a significant reduction of 8-isoprostane levels in treated patients.Trial registrationClinicalTrials.gov, NCT01017796. Registered on 20 November 2009.

Erratum to: Microvascular effects of glucagon-like peptide-1 receptor agonists in type 2 diabetes: a meta-analysis of randomized controlled trials.

In the manuscript, the events of nephropathy and retinopathy recorded for the LEADER trial (Marso et al. 2016) were erroneously imputed; the numbers reported in Table1 for that trial refer to serious adverse events, and not to total events, as stated in Methods. The correct figures are 268 and 416 cases of nephropathy, and 106 and 92 cases of retinopathy in liraglutide and control arms, respectively. As a consequence, the overall risk (MH-OR [95% CI]) of nephropathy and retinopathy with GLP-1RA (vs all comparators) is 0.77 [0.67-0.88], p<0.001, and 0.99 [0.80-1.21], p=0.90, respectively. The analyses reported in Figs.1 and 2 were also corrected and reported below, together with supplementary figures3 and 5. Please note that liraglutide is associated with a significant reduction in the incidence of nephropathy, whereas for retinopathy the difference from placebo is no longer statistically significant.

Type 2 diabetes and cardiovascular prevention: the dogmas disputed.

In randomized controlled trials (RCTs), more intensive glucose control in patients with type 2 diabetes leads to a modest (9%) reduction in major cardiovascular events (MACE), associated with a 20% reduction of kidney events and 13% reduction of eye events. The FDA issued guidance in 2008 led to the conduct of numerous cardiovascular outcomes (CVOT) trials to assess cardiovascular safety of new antihyperglycemic therapies in patients with type 2 diabetes. The results of these trials show that insulin glargine, three different dipeptidyl peptidase-4 (DPP-4) inhibitors (saxagliptin, alogliptin, and sitagliptin) and lixisenatide (a glucagon like peptide-1 receptor agonist) produce no significant difference in CVOT when compared with usual care or placebo. Other trials with newer diabetes drugs, including empagliflozin and canagliflozin (two sodium-glucose co-transporter-2 inhibitors), liraglutide and semaglutide (two GLP-1 receptor agonists) succeeded in demonstrating CV benefit in people with type 2 diabetes. In the last two decades, the equation "diabetes equals myocardial infarction" have contributed to the development of preventive therapy for risk factors in diabetes. In both primary and secondary prevention, the diabetic patients with high rates of statin and aspirin treatment have improved CV outcome, as compared with non-users. The drugs used to reduce glucose levels in patients with type 2 diabetes seem important for the ultimate cardiovascular outcome: the combination of intensive glycemic control, when safely attainable, with newer diabetes drugs (empagliflozin, canagliflozin, liraglutide, and semaglutide) may decrease the incidence of MACE, nephropathy and retinopathy. Moreover, depending on the drug used, CV mortality and heart failure may also be reduced.

Contrast-Induced Nephropathy and Oxygen Pretreatment in Patients With Impaired Renal Function

IntroductionContrast-induced nephropathy is a complication following coronary angiography and percutaneous coronary intervention. Because contrast-induced nephropathy is a predictor of long-term mortality in patients with ischemic heart disease undergoing percutaneous coronary intervention, preventive strategies are required. We assessed the effects of periprocedural oxygenation on contrast-induced nephropathy among patients with pre-existing renal dysfunction.MethodsA total of 200 consecutive patients with impaired renal function (estimated glomerular filtration < 60 ml/min per 1.73 m2) undergoing elective cardiovascular angiography were randomly assigned to an oxygenation treatment (n = 100) or control group (n = 100). In oxygenation treatment, pure oxygen (2 L/min) was administered for 10 minutes before exposure to contrast medium. The primary endpoint was the incidence of contrast-induced nephropathy, defined as a ≥ 25% increase in serum creatinine levels from baseline within 48 hours of exposure.ResultsIn the oxygenation treatment group, partial pressure of arterial oxygen was higher (135 ± 25 mm Hg vs. 84 ± 10 mm Hg, P < 0.001); contrast-induced nephropathy incidence was lower (1% vs. 8%, odds ratio [OR] = 0.12, 95% confidence interval [CI] = 0.01–0.95, P = 0.02); and partial pressure of arterial carbon dioxide and bicarbonate base lactate levels were similar compared with those in the control group. Upon univariate analysis, excess and absence of oxygenation treatment (OR = 9.18, CI = 1.13–74.86, P = 0.03) and anemia (OR = 4.30, CI = 1.04–17.78, P = 0.04) were shown to be associated with contrast-induced nephropathy incidence.ConclusionOxygenation, a simple, nonpharmacological strategy, may be beneficial when using contrast media in patients with impaired renal function from noninvasive angiography to emergency catheterization.

Microvascular effects of glucagon-like peptide-1 receptor agonists in type 2 diabetes: a meta-analysis of randomized controlled trials.

Results with GLP1-receptor agonists (GLP-1RA) on microvascular complications of diabetes are contrasting. In trials designed for cardiovascular outcomes, both liraglutide and semaglutide were associated with a relevant reduction in the incidence and progression of nephropathy. On the other hand, in the same trials, semaglutide was associated with an increased progression of retinopathy, and a similar trend was observed for liraglutide. This meta-analysis is aimed at assessing the effects of GLP-1RA on retinopathy and nephropathy. A Medline search for GLP-1 receptor agonists (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, or semaglutide) was performed, collecting all randomized clinical trials with a duration >11weeks, enrolling patients with type 2 diabetes, and comparing a GLP-1 receptor agonist with placebo or any other non-GLP-1 receptor agonist drug. Of the 113 trials fulfilling the inclusion criteria, 78 and 62 did not report information on retinopathy and nephropathy, respectively. Treatment with GLP1-RA was not associated with a significant increase in the incidence of retinopathy (MH-OR [95% CI] 0.92 [0.74-1.16]. p=0.49). In subgroup analyses, GLP1-RA were associated with a lower risk of retinopathy in comparison with sulfonylureas. Cases of macular edema were reported only in nine trials with no sign of increased risk. GLP1-RA reduced the incidence of nephropathy with respect to comparators (MH-OR [95% CI] 0.74 [0.60-0.92]. p=0.005). This difference was significant versus placebo, but not versus any class of active comparators. GLP1-RA appear to reduce the incidence and/or progression of nephropathy and to have no specific effect on retinopathy-with the notable exception of semaglutide, which could have a negative impact on the retina.

Introduction of the DiaGene study: clinical characteristics, pathophysiology and determinants of vascular complications of type 2 diabetes

BackgroundType 2 diabetes is a major healthcare problem. Glucose-, lipid-, and blood pressure-lowering strategies decrease the risk of micro- and macrovascular complications. However, a substantial residual risk remains. To unravel the etiology of type 2 diabetes and its complications, large-scale, well-phenotyped studies with prospective follow-up are needed. This is the goal of the DiaGene study. In this manuscript, we describe the design and baseline characteristics of the study.MethodsThe DiaGene study is a multi-centre, prospective, extensively phenotyped type 2 diabetes cohort study with concurrent inclusion of diabetes-free individuals at baseline as controls in the city of Eindhoven, The Netherlands. We collected anthropometry, laboratory measurements, DNA material, and detailed information on medication usage, family history, lifestyle and past medical history. Furthermore, we assessed the prevalence and incidence of retinopathy, nephropathy, neuropathy, and diabetic feet in cases. Using logistic regression models, we analyzed the association of 11 well known genetic risk variants with type 2 diabetes in our study.ResultsIn total, 1886 patients with type 2 diabetes and 854 controls were included. Cases had worse anthropometric and metabolic profiles than controls. Patients in outpatient clinics had higher prevalence of macrovascular (41.9% vs. 34.8%; P = 0.002) and microvascular disease (63.8% vs. 20.7%) compared to patients from primary care. With the exception of the genetic variant in KCNJ11, all type 2 diabetes susceptibility variants had higher allele frequencies in subjects with type 2 diabetes than in controls.ConclusionsIn our study population, considerable rates of macrovascular and microvascular complications are present despite treatment. These prevalence rates are comparable to other type 2 diabetes populations. While planning genomics, we describe that 11 well-known type 2 diabetes genetic risk variants (in TCF7L2, PPARG-P12A, KCNJ11, FTO, IGF2BP2, DUSP9, CENTD2, THADA, HHEX, CDKAL1, KCNQ1) showed similar associations compared to literature. This study is well-suited for multiple omics analyses to further elucidate disease pathophysiology. Our overall goal is to increase the understanding of the underlying mechanisms of type 2 diabetes and its complications for developing new prediction, prevention, and treatment strategies.

Reporting renal biopsies from Cyprus: a systematic approach.

Background: The etiology of renal disease varies in different parts of the world. In the Middle East, half of all patients reaching end-stage are categorised as either unknown etiology or hypertension-related nephropathy. Objectives: To report a renal biopsy series, in a reproducible format and manner, so that data can be compared directly among other series. Patients and Methods: Biopsies of native kidneys were performed in a 10-year period, at a tertiary referral hospital that provides the entire nephrology service for north Cyprus. Data are reported from 153 patients older than 17 years, who were either Turkish-Cypriot or from the Turkish mainland. Results: Mean biopsy rate was 48 per million population (pmp) per year. Mean age was 45.7 years (range 18-78). Overall, the sex distribution was similar (male 51%). The most common histopathological categories were primary glomerulonephritis (GN) (56%), secondary GN (27%), and tubulo-interstitial disease (14%). Of those with primary GN, 29% had secondary (2o) focal and segmental glomerulosclerosis (FSGS) (29%), followed by IgA nephropathy (24 %), membranous 18% and a further 11 patients with 1o FSGS (12%). The incidence of IgA nephropathy was 6.3 per pmp/year. When expressed as a percentage of the annual biopsy rate, 14% of all biopsies showed IgA nephropathy. Conclusions: To compare data among centres, they must be expressed in terms of the population (incidence pmp/year) and the biopsy rate. In our population, secondary FSGS is common and uncharacterised and we believe many will be caused by monogenic disease.

A Study of Microalbuminuria (MAU) and Advanced Glycation End Products (AGEs) Levels in Diabetic and Hypertensive Subjects.

The prevalence of non-communicable diseases like diabetes mellitus (DM) and hypertension (HTN) is growing worldwide. Both lead to nephropathy if not controlled effectively. Microalbuminuria (MAU) is recognized as an early predictor for nephropathy. Additionally, the timely detection of advanced glycation end products (AGEs) is also considered to be an important prognostic factor for diabetic nephropathies. Hence, screening for the early detection of MAU and AGEs would be an useful and relatively inexpensive laboratory test for early clinical diagnosis for the incidence of nephropathy in these diseases. This study was conducted in DM, HTN and pregnancy induced hypertensive (PIH) subjects. MAU and Nε-Carboxymethyllysine (CML) levels were estimated by in-house RIA kits in the patient groups and controls, while the total AGEs level in serum was determined by ELISA. The levels of MAU, CML and AGE-BSA were observed to be significantly higher in DM, HTN and PIH subjects compared to controls (p<0.001). Increased serum CML and AGEs levels in DM, HTN and PIH subjects indicated ongoing glycemic damage and their susceptibility to develop renal complications.

The large spectrum of renal disease in diabetic patients.

The prevalence of diabetic nephropathy (DN) among diabetic patients seems to be overestimated. Recent studies with renal biopsies show that the incidence of non-diabetic nephropathy (NDN) among diabetic patients is higher than expected. Renal impairment of diabetic patients is frequently attributed to DN without meeting the KDOQI criteria or performing renal biopsy to exclude NDN. In this editorial, we update the spectrum of renal disease in diabetic patients and the impact on diagnosis, prognosis and therapy.

Parity does not affect diabetes complications in women with type 1 diabetes

The problem concerning the impact of pregnancy on diabetic complications is a matter for discussion as there is some evidence suggesting that pregnancy may trigger development or progression of diabetic chronic complications. However, currently available data concerning this issue is still controversial. The aim of the study was to evaluate the impact of obstetric history on the development of chronic microangiopatic and macroangiopatic complications in type 1 diabetic women. The retrospective study comprised 226 white Caucasian type 1 diabetic women, including 190 parous and 36 nulliparous women. Anthropometric data, information concerning the course of the disease, including metabolic control and chronic complications, together with obstetric history, were registered. Parous women were older (p<0.001), but did not differ significantly regarding metabolic control in the course of the disease (p>0.05) and diabetes duration (p>0.05) from nulliparous subjects. There were no significant differences in the incidence (p>0.05) nor onset (p>0.05) of chronic diabetes complications between the groups. The number of deliveries did not correlate with either the incidence nor the onset of chronic complications. Longer DM duration at the moment of first delivery was related to the higher incidence of retinopathy (p<0.01), nephropathy (p<0.05) and neuropathy (p<0.001). The incidence of chronic diabetic complications does not differ between parous women and the subjects that were never pregnant, and is not related to the number of pregnancies.

Paraneoplastic Glomerulopathy in a Case of Collecting Duct Renal Cell Carcinoma

Paraneoplastic glomerulopathy has been described in established cases of the solid tumors of lung, gastrointestinal system, breast, etc., and rarely in patients with Renal Cell Carcinoma (RCC). Studies on secondary glomerular diseases have described a higher incidence of IgA nephropathy in patients with RCC compared to membranous glomerulopathy, which are commonly reported in malignancies of the lung and gastrointestinal tract. Collecting Duct Carcinoma (CDC), a rare high grade adenocarcinoma accounts for <1% of all renal malignancies. It arises from the cells of the collecting ducts of Bellini. We report a case of an elderly male who was diagnosed to have a disseminated CDC during his evaluation for nephrotic syndrome. Renal biopsy was suggestive of a secondary membranous glomerulonephropathy.

Primary care diabetes prescribing rates: latest analysis shows continued rise in volume and cost

Primary care diabetes prescribing rates: latest analysis shows continued rise in volume and cost

Isolation and Identification of Avian Nephritis Virus from Commercial Broiler Chickens

The present study was undertaken to investigate the incidences of nephropathy encountered in young chicks of certain commercial broiler flocks in the states of Telangana, Andhra Pradesh, Tamil Nadu and Maharashtra. The mortality and growth retardation associated with the condition was a major concern, necessitating a thorough study to establish the etiology. Detailed necropsy of the dead chicks revealed marked inflammation of the kidneys along with gout. Mortality percentage recorded was up to 20%. Samples were collected from the affected flocks for isolation and identification of the causative agent. The presence of ANV RNA was detected using reverse transcriptase-polymerase chain reaction and 42 kidney samples (43.75%) were found to be ANV positive while all were IBV negative. The positive samples were successfully propagated in Specific Pathogen Free chicks and embryonated eggs as was evident from the changes observed and further confirmation using RT PCR. The nucleotide sequence of the representative ANV isolate was determined and showed high identity with ANV sequences in the NCBI database. In the constructed phlyogenetic tree, the ANV isolates were clustered together distinctly separate from the related Chicken Astro virus. This investigation confirms the involvement of ANV in cases of gout, nephritis and related mortality in commercial broiler flocks.