Nephrology Clinic Research Articles

Baseline Characteristics of the First Geriatric Nephrology Clinic in Mexico City

Baseline Characteristics of the First Geriatric Nephrology Clinic in Mexico City

Mental health and social-emotional functioning in children and adolescents with chronic kidney disease.

For children and young adults, living with chronic kidney disease (CKD) poses physical, mental, and social challenges. The mental health functioning of children and adolescents with CKD plays an important role in the medical, educational, vocational, and quality of life outcomes, yet receives little systematic attention in the busy pediatric nephrology clinic. This article will provide an overview of the prevalence of mental illness and symptoms in children and young adults with CKD, strategies to assess for dysfunction, and the long-term outcomes associated with impaired functioning.While there is a relative dearth of literature regarding evidence-based interventions in this population to improve mental health functioning, we provide "best practice" strategies based on the available literature to address emotional and/or behavioral challenges once they are identified.More research is needed to define appropriate interventions to alleviate mental health issues and social-emotional distress, and this review of the literature will serve to provide directions for future research.

Neurological and Dermatological Manifestations of Tuberous Sclerosis Complex: Report from a Romanian Tertiary Hospital Cohort.

Tuberous sclerosis complex is a rare multisystem genetic disorder characterized by multiorgan involvement, frequently associated with intellectual impairment and epilepsy. The aim of our study was to describe the neurological and dermatological manifestations of TSC in 32 adult patients (of whom 19 were females) who attended the Neurology and Nephrology Clinics of Fundeni Clinical Institute in Romania from 2015 to 2020. Seventeen patients were diagnosed with epilepsy, nine patients had intellectual impairment, and complete neuroimaging was available for twenty-two patients. As expected, the most frequent dermatological lesions were cutaneous angiofibromas in 20 patients, but with a lower frequency than described in the current literature. Statistical analysis was performed considering the small number of patients. Cortical tubers in neuroimaging seemed to be associated with the diagnosis of epilepsy, while subependymal nodules represented a risk factor for intellectual impairment. Males showed a larger number of dermatological types of lesions, especially café -au-lait patches. Interestingly, we found a statistically significant positive association between epilepsy and the presence of cutaneous angiofibromas, as well as total dermatological involvement. Females had significantly higher Charlson comorbidity index scores, indicating a higher burden of disease. Everolimus seemed to be a well-tolerated treatment and showed promising results in controlling epileptic seizures alone in two patients. More studies, with the inclusion of a larger number of patients, are needed to confirm these results.

The Impact of Infections on the Progression of Chronic Kidney Disease.

Background and Objective: Infectious diseases continue to be a global burden and their impact is even worse if the patients already have other comorbidities. Because chronic kidney disease is very frequent, affecting 10% of the population, our study aims to explore the impact that infectious events have on its progression. Material and Methods: This is a retrospective, observational study based on a cohort of 238 dialyzed patients from the Nephrology Clinic of "Dr. Carol Davila" Clinical Hospital of Nephrology, Bucharest, who were followed from their first visit for five years, between 1 January 2007 and 1 January 2022. For each of them, the presence of an infectious event and the moment of the initiation of dialysis were recorded. Results: Statistical analysis showed that the patients who had at least one infectious episode were older (p = 0.004), their hemoglobin and lymphocytes were significantly lower (p = 0.03 and p = 0.02, respectively) and the time until the initiation of dialysis was lower (p = 0.007). Also, the preservation of kidney function was influenced by the number and the severity of infectious episodes. In the univariate Cox model, the following variables were associated with increased risk of dialysis: advanced age (p: 0.009; HR: 1.021; CI: 1.005 to 1.036), low hemoglobin (p: 0.001; HR: 0.861; CI: 0.786 to 0.943), previous diagnosis of chronic obstructive pulmonary disease (p: 0.002; HR: 2.467; CI: 1.376 to 4.424), presence of hematuria (p: 0.03; HR: 1.604; CI: 1.047 to 2.457) and increased values of proteinuria (p: 0.01; HR: 1.122; CI: 1.028 to 1.224) and of serum creatinine measured both at the time of the first visit and at the time of each infectious event (p: <0.001; HR: 1.262; CI: 1.141 to 1.396). Also, the presence of an infectious episode was associated with a 1.7-fold increase in the risk of dialysis initiation. The independent predictors of survival identified by the multivariate Cox model were age (p: 0.004; HR: 1.034; CI: 1.010-1.058), serum creatinine (p: <0.001; HR: 1.421; CI: 1.203 to 1.658) and proteinuria (p: <0.001; HR: 1.241; CI: 1.126 to 1.369) at the time of enrollment, but also the presence of an infectious episode during the patient's evolution (p: 0.04; HR: 1.705; CI: 1.013 to 2.868). Conclusions: In the evolution of patients with chronic kidney disease, an active search for individual factors favoring the occurrence of infectious episodes should be taken into consideration to prevent a faster progression toward end-stage kidney disease.

Status of Dhātu sāratā (the Level of Tissue Excellence) and its Association with Deha prakṛti (Body Constitution) in Patients with Chronic Kidney Disease

At present, Chronic kidney disease (CKD) has emerged as a significant global health concern even in Sri Lanka. The statistical data regarding the increased incidence and prevalence rate of CKD have already proven that there is still no identification of a permanent cure or solution instead of renal replacement therapy for disease management. This remains a tremendous challenge for Western and Āyurveda medical systems. Although the Āyurveda medical system is well nourished by its own concepts such as Dhātu sāratā (tissue excellence), Deha prakṛti (body constitution), which can potentially contribute to the prevention and management of CKD, their clinical applicability appears to be limited. Therefore, this study was planned to assess the status of Dhātu sāratā (the level of tissue excellence) and its association with Deha prakṛti (body constitution) in patients with CKD – Western Province, Sri Lanka. This is a prospective observational case – control study. University Nephrology Clinic at the National Hospital, Sri Lanka and the Renal Clinic at Bandaranaike Memorial Āyurveda Research Institute, Nawinna, Sri Lanka. 113 patients with a diagnosis of CKD and 122 healthy volunteers residing in the Western Province were enrolled in the study. Dhātu sāratā status of Rasa to Sattva was assessed using a standardized and validated questionnaire and ĀyuSoft software was used to assess the type of Deha prakṛti of the research participants. Data analysis was done by using Microsoft Excel 2007 version and appropriate statistical software. The study results revealed that a majority between 43 – 50 % of CKD patients exhibited a predominance of Madhyama sāra status (moderate level of tissue excellence) for Rasa, Rakta and Māṃsa dhātu. A considerable percentage (over 60%) of patients displayed Avara sāra status (inferior or lower level of tissue excellence) in their subsequent dhātu (including Sattva), commencing from Asthi. Compared to the CKD patients, the number of healthy individuals/ controls with Pravara sāra status (superior level of tissue excellence) of each dhātu and Sattva is substantially high. None of the healthy individuals had Avara sāra status of Dhātu nor Sattva. Furthermore, it was observed that the mean percentage scores of all dhātu (commencing from Rasa to Śukra dhātu) and Sattva sāratā significantly differed according to CKD stages under a 5% level of significance. It was also observed that the status of Dhātu commencing from Rasa to Śukra dhātu and Sattva sāratā was significantly associated with the Deha prakṛti types i.e., Vāta, Pitta and Kapha pradhāna prakṛti in CKD patients – Western Province, Sri Lanka, under a 5 % level of significance.It can be concluded that Dhātu sāratā status including Sattva depends on the type of Deha prakṛti in CKD patients and Sāra status of each Dhātu including Sattva declines from Pravara sāra to Avara sāra as the disease progresses. In addition, the CKD patients with Kapha pradhāna prakṛti type can be considered to have the maximum Deha bala whereas those with Pitta and Vāta pradhāna prakṛti types exhibit average and lowest levels of Deha bala respectively.

Cribado de infecciones tropicales e importadas en candidatos a trasplante renal migrantes desde la consulta de acceso al trasplante renal

Background and objectiveKidney transplantation (KT) should be postponed in those people with active bacterial, fungal, viral and parasitic processes, since these must be treated and resolved previously. The objective of this study is to present the screening circuit implemented by the Nephrology clinic and describe the prevalence of tropical and imported infections in KT candidates born or coming from endemic areas. Materials and methodsDescriptive cross-sectional study, carried out in 2021. Sociodemographic and clinical variables, serological data of general infections and specific tests of tropical infectious diseases were collected. A descriptive analysis of the data was carried out. ResultsSixty seven TR candidates from Latin America (32.8%), North Africa (22.4%), Sub-Saharan Africa (14.9%) and Asia (29.9%) were included. 68.7% were men and the mean age was 48.9±13.5 years. After the general and specific studies, 42 (62.7%) patients were referred to the Infectious Diseases Service to complete this study or indicate treatment. 35.8% of the patients had eosinophilia, and in one case parasites were detected in feces at the time of the study. Serology for strongyloidiasis was positive in 18 (26.9%) cases, while positive serology for other tropical infections was hardly detected. 34.3% of patients had latent tuberculosis infection. ConclusionsThe prevalence of tropical and imported infections in migrant candidates for RT was low, except for strongyloidiasis and latent tuberculosis infection. Its detection and treatment are essential to avoid serious complications in post-TR. To this end, the implementation of an interdisciplinary screening program from the KT access consultation is feasible, necessary and useful.

Incidence of cataract and glaucoma in children with nephrotic syndrome undergoing steroid treatment

Background Nephrotic syndrome (NS) is by far, the most common glomerular disease in childhood period and is considered as one of the main aetiologies of child exposure to systemic steroids. High-dose corticosteroids for NS, are usually prescribed by pediatrians for a long period. Posterior subcapsular cataract (PSC) and increased intraocular pressure (IOP) are the two most common ocular complications associated with steroid treatment. The exact incidence, prevalence, severity, and time of cataract and glaucoma onset in those childrens have not yet been thoroughly investigated. Aim Evaluating the incidence of cataract and glaucoma in children with NS receiving steroid treatment during and after treatment cessation. Patients and methods This cohort prospective study was done at the Pediatric Nephrology Clinic at Zagazig University Children’s Hospital in co-operation with the Department of Ophthalmology, Zagazig University, for detailed eye examination. Totally 48 children with primary NS who received corticosteroids either as a single treatment or with other treatment modalities for more than 3 months were included in our study. Clinical features plus laboratory tests confirmed by renal biopsy were the main parameters used in the diagnosis of NS. Results Posterior subcapsular cataracts (PSC) were observed in 14 patients (29.2%). All studied patients had normal intraocular pressure ranging between 10 and 20 mmHg in both eyes during the follow-up period with no glaucomatous optic disc changes observed. Conclusion A significant number of children with NS treated with steroids are liable to develop cataracts and glaucoma that may progress and need surgery to preserve vision, so they have to be well diagnosed and followed-up.

Sofosbuvir and Velpatasvir Regimen Outcome for Chronic Hepatitis C Patients With End-Stage Renal Disease Undergoing Hemodialysis.

Background Patients on hemodialysis (HD) are most likely to contract hepatitis C (HCV) infection, which is associated with significant morbidity and disease progression. Direct-acting antivirals (DAAs) are safe and tolerable in chronic kidney disease (CKD) with a 90-100% cure rate, and limited data exist regarding their efficacy in end-stage renal disease (ESRD), particularly for HDpatients in South Asia. The study aimed to assess the outcome of a 12-week sofosbuvir (SOF) and velpatasvir (VEL) treatment regimen on ESRD patients with chronic HCV infection undergoing HDin the Pakistani Asian population. Methodology This prospective cohort study was conducted between January 2022 and January2023 at the outpatient nephrology and gastroenterology clinic of Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, Pakistan. This study included a total of 220 ESRD patients fulfilling the inclusion criteria, aged 20-55 years, who had been undergoing weekly HD sessions for at least two years, with acquired HCV infection. Data on demographic and clinical characteristics were collected through patient interviews. Laboratory and dialysis profiling was executed to assess ESRD and discover the underlying cause by ultrasound abdomen, blood pressure measurement by sphygmomanometer, random blood sugarfor diabetes, and taking note of the duration and frequency of dialysis. HCV RNA PCR was done at selected intervals to evaluate the virological response to treatment. Sustained virological response (SVR), liver cirrhosis status, and number of weekly HD sessions were compared at one year of SOF/VEL regimen. Results The mean age of patients with ESRD was 41.8 with a standard deviation (SD) of 9.3 years, and HCV diagnosis was 1.3 years with SD of 0.4 years; 52.7% (n=116) were males, 47.3% (n=104) were females, 75% (n=165) were urban dwellers, and 93.6% (n=206) were married.CKD that requires dialysis was caused mainly by hypertension (78, 35%), diabetes mellitus type 2 (52, 24%), bilateral small kidney disease (40, 18%), and others (34, 16%). One hundred and six (48.2%) received dialysis thrice weekly, 83 (37.7%) twice, and 31 (14.1%) once weekly. The study monitored the rapid virological response (RVR) at four weeks of SOF/VEL regimen in 89.5% of ESRD patients, observed end-of-treatment response (ETR) at 12 weeks in 93.2%, and noted 91.4% SVR response at one year. Only four (1.8%) relapses were observed in the study, which was statistically insignificant. The status of liver cirrhosis showed a 50% improvement, decreasing from 40% to 20%. The frequency of weekly HD sessions decreased from thrice to twice-thrice a week. Conclusion The prevalence of contracting HCV is high among CKD and dialysis ESRD patients. All-oral DAA therapy has revolutionized HCV treatment with co-morbidities. Renal functions improved after the SOF/VEL regimen for chronic HCV infection in ESRD patients undergoing HD, with the number of weekly dialysis sessions reduced and SVR reaching 91.4%. Thus, a single-tablet, pan-genotypic DAA regimen of SOF/VEL for 12 weeks is safe, effective, and tolerable regardless of the underlying etiology of ESRD, complications of cirrhosis, HCV genotype, or previous treatment exposure. The successful treatment of HCV and achieving SVR lowers the risk of ESRD complications, improves extra-hepatic manifestations, and greatly enhances survival. Further studies are warranted after the availability of other DAAs to confirm findings with no limitations.

Conservative Kidney Management Practice Patterns and Resources in the United States: A Cross-Sectional Analysis of CKDopps (Chronic Kidney Disease Outcomes and Practice Patterns Study) Data

Conservative kidney management (CKM) is a viable treatment option for many patients with chronic kidney disease. However, CKM practices and resources in the United States are not well described. We undertook this study to gain a better understanding of factors influencing uptake of CKM by describing: (1) characteristics of patients who choose CKM, (2) provider practice patterns relevant to CKM, and (3) CKM resources available to providers. Cross-sectional study. This study is a cross-sectional analysis of data from US nephrology clinics enrolled in the chronic kidney disease Outcomes and Practice Patterns Study (CKDopps) collected between 2014 and 2020. Data for this study includes chart-abstracted characteristics of patients with an estimated glomerular filtration rate≤30mL/min/1.73m2 (n=1018) and available information on whether a decision had been made to pursue CKM at the time of kidney failure, patient(n=407) reports of discussions about forgoing dialysis, and provider (n=26) responses about CKM delivery and available resources in their health systems. Descriptive statistics were used to report patient demographics, clinical information, provider demographics, and clinic characteristics. Among data from 1018 patients, 68 (7%) were recorded as planning for CKM. These patients were older, had more comorbidities, and were more likely to require assistance with transfers. Of the 407 patient surveys, 18% reported a conversation about forgoing dialysis with their nephrologist. A majority of providers felt comfortable discussing CKM; however, no clinics had a dedicated clinic or protocol for CKM. Inconsistent survey terminology and unlinked patient and provider responses. Few patients reported discussion of forgoing dialysis with their providers and even fewer anticipated a choice of CKM on reaching kidney failure. Most providers were comfortable discussing CKM, but practiced in clinics that lacked dedicated resources. Further research is needed to improve the implementation of a CKM pathway. For older comorbid adults with kidney failure, conservative kidney management (CKM) can be an appropriate treatment choice. CKM is a holistic approach with treatment goals of maximizing quality of life and preventing progression of chronic kidney disease (CKD) without initiation of dialysis. We investigated US CKM practices and found that among 1018 people with CKD, only 7% were planning for CKM. Of 407 surveyed patients, 18% reported a conversation with their provider about forgoing dialysis. In contrast, most providers felt comfortable discussing CKM; however, none reported working in an environment with a dedicated CKM clinic or protocol. Our data show the need for further CKM education in the United States as well as dedicated resources for its delivery.

Identifying barriers and utility of obtaining ambulatory blood pressure monitoring in a pediatric chronic kidney disease population

BackgroundHypertension is a prevalent complication of Chronic Kidney Disease (CKD) and Ambulatory Blood Pressure Monitoring (ABPM) is the gold standard for diagnosis. The aim of our study was to assess the usefulness of obtaining ABPM and to identify barriers to ABPM in this pediatric patient population.MethodIn this retrospective analysis of patients with CKD stage 3–5 who were seen in one academic medical center’s outpatient Pediatric Nephrology clinics between 2018 and 2021, we performed logistic regression to evaluate for associations between demographic factors and odds of having an ABPM.ResultAmong 96 patients included in the study, 48 patients carried a diagnosis of hypertension. 31 patients had ABPM performed with usable data. In those who had ABPM done, 21 had normotension and 10 had undertreated hypertension. Our study also showed 1 had masked hypertension and 5 had white coat hypertension or effect. We did not find a statistically significant difference in those who did or did not undergo ABPM evaluation based on gender, previous diagnosis of hypertension, distance from clinic, language preference, or racial or ethnic identity.ConclusionABPM is a useful tool in our CKD population for the diagnosis and management of hypertension. We did not identify specific barriers to ABPM in our CKD population, and there were no differences in patients who obtained ABPM when looking at specific demographic and disease characteristics. Given these findings, we recommend focusing on areas of future improvement in spheres of patient and provider education as well as better quantification using surveys to further illuminate barriers.

Investigating household catastrophic health expenditure and coping mechanisms in patients with Chronic Kidney Disease in Enugu, Nigeria: a single center experience

The methods of financing healthcare expenditure for any country are vital in determining the health status of the country. To meet the rising costs of seeking health care, many poor households in managing chronic disease conditions like Chronic Kidney Disease (CKD) often resort to coping strategies that are further detrimental to their well-being. CKD is the 12th highest cause of death and 17th highest cause of disability worldwide. This study assessed the incidence of household catastrophic health expenditure and payment coping mechanism of patients with CKD. It was a descriptive cross-sectional study involving 100 patients with various stages of CKD attending the Nephrology clinics of University of Nigeria Teaching Hospital Enugu, South eastern Nigeria. They were recruited using a systematic sampling technique. A questionnaire was used to collect data. Data were collected using pre-tested semi-structured questionnaires and analyzed using descriptive statistics of frequencies, percentages, mean, standard deviation and interquartile range. Chi-square was used to test for association between payment coping mechanisms used by patients across socioeconomic groups. The study demonstrated uniformly high incidence of catastrophic expenditure for all the respondents both at 10% and 40% threshold (100% and 97%) respectively, with cost of treatment uniformly distributed among the various socioeconomic classes. Most of the patients assessed their treatment by paying out of pocket without reimbursement (88%), with money from personal bank savings being the commonest coping mechanism especially among the poorest Socioeconomic Status (SES) class, and borrowing among the least poor SES class. The study concluded that the prevalence of catastrophic expenditure was very high across all the socioeconomic status. It is recommended that the Nigerian Health Insurance program should be expanded to cover at least dialysis treatment of CKD, if not all aspects of CKD management in order to protect these patients and their household from ill-health mediated catastrophic expenditure.

Implementation of the Kidney Failure Risk Equation in a United States Nephrology Clinic

The kidney failure risk equation (KFRE) estimates a person's risk of kidney failure and has great potential utility in clinical care. We used mixed methods to explore implementation of the KFRE in nephrology clinics. KFRE scores were integrated into the electronic health record at Johns Hopkins Medicine and were displayed to nephrology providers. Documentation of KFRE scores increased over time, reaching 25% of eligible outpatient nephrology clinic notes at month 11. Three providers documented KFRE scores in >75% of notes, whereas 25 documented scores in<10% of notes. Surveys and focus groups of nephrology providers were conducted to probe provider views on the KFRE. Survey respondents (n= 25) reported variability in use of KFRE for decisions such as maintaining nephrology care, referring for transplant evaluation, or providing dialysis modality education. Provider perspectives on the use of KFRE, assessed in 2 focus groups of 4 providers each, included 3 common themes as follows: (i) KFRE scores may be most impactful in the care of specific subsets of people with chronic kidney disease (CKD); (ii) there is uncertainty about KFRE risk-based thresholds to guide clinical care; and (iii) education of patients, nephrology providers, and non-nephrology providers on appropriate interpretations of KFRE scores may help maximize their utility. Implementation of the KFRE was limited by non-uniform provider adoption of its use, and limited knowledge about utilization of the KFRE in clinical decisions.

Posterior urethral valve in thai boys

BackgroundPosterior urethral valve (PUV) is the most common congenital bladder outlet obstruction in boys, causing renal damage beginning in utero. There are scarce data from Thailand regarding the long-term outcomes of PUV in boys, thus the aim of this study was to examine the presentation, clinical course, complications, outcomes and renal survival in PUV boys.MethodsWe reviewed the medical records of PUV boys treated at the Pediatric Nephrology Clinic, Prince of Songkla University, Thailand, over a 30-year-period.ResultsSeventy-seven PUV boys were identified, with a median age at diagnosis of 4.8 months. The most common presentations were urinary tract infection (UTI), poor urine stream and urinary dribbling in 26 (33.8%), 19 (24.7%) and 11 (14.3%) boys, respectively. Renal ultrasound results in 70 boys showed 8 (11.4%) unilateral and 56 (80%) bilateral hydronephroses. Of 72 voiding cystourethrograms, 18 (25.0%) showed unilateral and 22 (30.6%) bilateral vesicoureteral refluxes. 99mTc dimercaptosuccinic acid renal scans in 30 boys showed 12 (40%) unilateral and 8 (26.7%) bilateral renal damage. Fifty-nine (76.6%) boys had 149 UTIs; 42 (54.4%) had recurrent UTI. Forty-eight boys had valve ablation at the median age of 30.3 months. 22 boys (28.6%) developed chronic kidney disease (CKD) at a median age of 15.0 years.ConclusionOf 77 PUV Thai boys, UTI was the most common presentation. Recurrence of UTI and CKD was the most common consequence. Lifelong follow-up for renal and bladder functions is essential for all PUV patients.

The relationship between quality of life and dietary fluid restriction non-adherence in hemodialysis patient

Hemodialysis is now the preferred method in the treatment of kidney failure. Patients who do not adhere to the diet during hemodialysis may experience negative changes in fluid-electrolyte balance. This study aimed to investigate the relationship between restricted fluid intake and the quality of life of hemodialysis patients in our country. The study was conducted with 186 hemodialysis patients, treated as outpatients in the hemodialysis unit of a university hospital in Samsun and as inpatients in the nephrology clinic. Data were collected using a questionnaire that included 23 questions on patients' sociodemographic and clinical characteristics, the SF-36 Short Quality of Life Scale, and the Dialysis Diet and Fluid Restriction Nonadherence Questionnaire. Kruskal-Wallis and Mann-Whitney U tests were used for analysis of quantitative data while Spearman correlation coefficient was used for correlation analysis. In line with the evidence obtained, it was established that there was a negative correlation between the status of non-compliance to dialysis diet and fluid restriction and the quality of life of individuals on hemodialysis treatment.&#x0D; Keywords: Diet; hemodialysis; fluid restriction; quality of life.

The relationship between asymptomatic atherosclerosis and hepcidin-25 in chronic kidney disease patients.

The most common and lethal consequence of chronic kidney disease (CKD) is atherosclerotic cardiovascular disease. The persistent inflammation present in CKD increases hepcidin levels. Iron accumulates in the arterial wall in atherosclerosis. Hepcidin-25 was thought to accelerate the development of atherosclerotic plaques by blocking iron release from macrophages. Therefore, we sought to determine the relationship between hepcidin-25 and asymptomatic atherosclerosis in non-dialysis CKD patients. Investigate the relationship between hepcidin-25 and subclinical atherosclerosis in non-dialysis CKD patients. Cross-sectional SETTINGS: Outpatient clinic for urology and nephrology at a university hospital SUBJECTS AND METHODS: Participants above the age of 18 years included a group of healthy controls and a group of CKD patients who were not routinely maintained on hemodialysis. The latter group was further divided according to eGFR into CKD-3, CKD-4 and CKD-5 subgroups. We excluded patients with comorbidities, patients with chronic liver disease, and other conditions or habits. CBC, kidney function tests, and serum levels of hepcidin-25 (SH-25), TNF-α, IL-6, high-sensitivity C-reactive protein (hs-CRP), TC, TG, LDL-C and HDL-C were assessed. To measure carotid intima media thickness (CIMT) and determine presence of plaques, carotid ultrasonography was performed. The near or far walls of common carotid artery, bulb, and internal carotid artery were used to measure CIMT. SH-25 association and indicators of subclinical atherosclerosis. 128 participants, the control group (n=25) and the non-hemodialysis CKD patients (n=103) RESULTS: The CKD patients had significantly higher serum levels of markers of inflammation including IL-6, TNF-α, and hs-CRP (P<.001 for each) compared to the controls. There was a significantly higher level of TC, TG and LDL-C (P<.001 for each) and a lower level of HDL-C (P<.001) in the CDK patients compared to controls. SH-25 was considerably higher in all CKD subgroups, especially with progression of CKD. CIMT was increased in CKD patients especially CKD-4 and CKD-5 subgroups when compared to healthy participants (P<.001 for each). In the patient group, CIMT showed a positive correlation with SH-25, (r=.65 and P<.001), IL-6 (r=.65, P<.001), TNF-α (r=.71, P<.001), and hs-CRP (r=.52, P<.001). The ROC curve study showed that SH-25 (AUC=.86, P<.001), IL-6 (AUC=.83, P<.001), hs-CRP (AUC=.72, P<.001), TNF-α (AUC=.82, P<.001) were strong predictors of subclinical atherosclerosis in the CKD patients. SH-25 and CIMT had a positive relationship in CKD patients. The ROC curve showed that SH-25 is a reliable predictor of carotid atherosclerosis. Therefore, we suggest that SH-25 is a vital biomarker of asymptomatic atherosclerosis. Single-center.

The Role of Genetic Testing in Pediatric Renal Diseases: Diagnostic, Prognostic, and Social Implications.

Pediatric renal diseases vary widely and are linked to high morbidity and mortality; hence, early diagnosis is vital. Presently, genetic testing is being incorporated into the standard of care for children and their families with kidney disease, primarily as a diagnostic tool. In the present review, we aim to collect all potential evidence from relevant studies that reported the role of genetic testing in pediatric renal disease diagnostic, prognostic, and social implications. We have conducted both electronic and manual searches within PubMed, the Cochrane Library, Web of Science, and Scopus to find relevant studies. Studies from the years 2013-2023 were included. Case reports with limited sample sizes and no descriptive statistics, along with review papers and meta-analyses, were excluded from this review. Quality assessment for all included studies was performed. The pooled diagnostic yields were calculated using the common effect and random effect models utilizing the R program (R Foundation for Statistical Computing, Vienna, Austria). The pooled result for the diagnostic yield as per the common effect model is a pooled proportion of 0.42 (42%) 95% confidence interval (CI): [0.39,0.44], while with the random effects model the pooled proportion is 0.43 (43%) 95% CI: [0.31,0.57]. The diagnostic yield for the included studies ranged from 78.10% to 16.8%. The spectrum of kidney diseases included nephrolithiasis/nephrocalcinosis, glomerular diseases, cystic kidney disease, ciliopathies, tubulopathies, chronic kidney disease, and congenital anomalies of the kidneys and urinary tracts (CAKUT), while hematuria and proteinuria were reported by two studies and autosomal recessive and autosomal dominant idiopathic kidney disease was reported by only one study. Genetic testing validates clinical diagnosis and aids in tailoring management strategies; hence, a more precise treatment plan is developed and unnecessary investigations are avoided, which is crucial in the case of children during routine nephrology clinic visits. Genetic counselling is of the utmost importance, so all ethical and social concerns related to genetic testing are addressed in addition to patient satisfaction.

Platelet to Lymphocyte Ratio and Neutrophils to Lymphocyte Ratio as Potential Markers for Lupus Nephritis Flares

Abstract Background Systemic lupus erythematosus is chronic autoimmune disorder with variable clinical presentations and multi-organ involvement. The disease has female predominance and unpredictable course. The aim of this study was to measure platelet to lymphocyte, neutrophil to lymphocyte ratios in patients with lupus nephritis. Subjects and Methods This study was conducted on patients of lupus nephritis either in Nephrology clinic&amp; Dialysis unit or admitted as inpatient in Ain Shams university Hospitals. For 60 Patients as two groups; the first group includes 30 SLE patients with ESRD. The second group includes of 30 lupus, and 3rd group 30 control healthy group. Results A highly significant difference was observed between lupus nephritis patients and healthy controls regarding neutrophil to lymphocyte ratio (p &amp;lt; 0.001) Conclusion In conclusion, NLR appear to be potentially useful biomarkers in lupus nephritis patients for disease activity and damage-compared with the other inflammatory cytokines as IL-6. Being easily obtained and cheap, they can be applied as predictors of not only disease activity and damage but also relapse and remission in lupus nephritis patients before applying other expensive and invasive measures. Dangerous disease activity and flares in SLE are unpredictable and represent a challenge in clinical practice.

Aortic stiffness in patients with childhood essential hypertension: Is obesity a risk factor or not?

BackgroundHypertension (HTN) is a global health problem with a rising prevalence that affects both children and adults. ObjectivesWe aim to assess aortic stiffness in children with essential HTN using echocardiography and evaluate the parameters that influence the development of aortic stiffness. MethodsIncluded in the prospective study were patients who were newly diagnosed with essential HTN and who were admitted to the Pediatric Nephrology and Pediatric Cardiology outpatient clinics of Adiyaman University between June 1 and December 31, 2022. All patient groups underwent 24-hour ambulatory blood pressure monitoring (ABPM) for a definitive diagnosis of essential HTN. The echocardiographic examinations of all participants were carried out by the same pediatric cardiologist. Aortic stiffness parameters and Epicardial Adipose Tissue (EAT) thickness were measured by routine echocardiography. Patients under the age of 18 years were included in the study. Demographic data, serum biochemical parameters, echocardiography findings, and 24-hour ABPM data were noted. ResultsA total of 76 children were enrolled in the study, including 31 patients (9 female; 22 male) and 45 controls (14 female; 31 male). The control and patient groups had similar overall sex and age distributions. Systolic and diastolic blood pressure and pulse pressure were higher in the hypertensive group than in the control group (p < 0.01). Considering the effects of obesity and HTN, three groups were formed. A significant reduction in aortic distensibility was noted in the non-obese hypertensive group when compared to the control group (p = 0.047). ConclusionNon-obese hypertensive children showed significantly reduced aortic distensibility than the control group, suggesting that the etiology of HTN in the non-obese hypertensive group may involve mechanisms beyond obesity-related factors. Seeking preventative care is more common in obese patients than non-obese patients.

Assessment of the Needs of Nephrology Divisions to Implement Return of Clinically Significant Research Genetic Results: A Survey of Nephrotic Syndrome Study Network (NEPTUNE) Investigators

Introduction: There is an increasing need to return genetic testing results to patients with kidney disease who were first genotyped on a research basis. Operationalizing this process in nephrology clinics is challenged by a limited number of genetic providers with whom to partner and a general lack of support services for all clinicians. Methods: We administered a survey in March 2022 to assess the current ability and ongoing needs of nephrology divisions to return clinically significant research genetic results to patients and to implement clinical genetic testing. This survey was distributed to institutions within the Nephrotic Syndrome Study Network (NEPTUNE) as part of the planning process for return of research genetic results to participants with pathogenic variants in Mendelian nephrotic syndrome genes. Results: Twenty-seven of 28 sites (96%) completed the survey. 59% (n = 16) of sites said they could handle return of research genetic results independently, with the rest expressing hesitation about the volume and complexity of patients and the limited resources and access to genetics services. 81% (n = 22) of these institutions did have a genetics clinic and 26% (n = 7) have a nephrology genetics clinic. However, 70% (n = 10) of these clinics have a waiting time over 1 month. 89% of divisions (n = 24) were conducting genetic testing and 96% of those (n = 23) used a kidney multi-gene panel. In 46% of divisions (n = 11), nephrologists were handling logistics of obtaining genetic testing samples themselves. Conclusion: We identified specific areas of support needed for return of clinically significant genetic results from research studies. While the surveyed nephrologists were conducting genetic testing, there were limitations in the support services available. This survey will help guide other research studies that wish to return genetic results to participants and also highlight the need for increasing support to effectively operationalize genetic testing in nephrology clinics.

Prognoses of Multicystic Dysplastic Kidney Patients: A Single Center Experience

Introduction: In this study, was aimed to evaluate the demographic characteristics and follow-up results of patients with multicystic dysplastic kidney (MCDK) in our pediatric nephrology clinic, in the light of the literature.&#x0D; Material and Methods: The files of the patients who applied to the Pediatric Nephrology Clinic of Selçuk University Faculty of Medicine between January 2011 and January 2022 were analyzed retrospectively. Data of 22 patients with MCDK were recorded.&#x0D; Results: Twelve (55%) of the patients were left-sided and 10 (45%) were right-sided MCDK. Urinary system infection (UTI) was seen in three patients. Right-sided MCDK was accompanied by right ureterocele in one patient and hydronephrosis in the contralateral kidney in 5 patients. No urinary anomaly was observed in other patients. Proteinuria and hypertension were not detected in the patients. Vesicoureteral reflux (VUR) was not detected in 5 patients who underwent voiding cystourography. In the follow-up of the patients, MCDK was involved in a mean of 16.2±29.3 (1-107) months.&#x0D; Conclusion: Multicystic dysplastic kidney in children has a good prognosis with conservative management. Periodic follow-up is important to prevent the potential development of hypertension or hyperfiltration injury.