Nephrology Unit Research Articles

Clinical Audit of Assisting Renal Biopsy Procedure Performed in Nephrology Unit of a Tertiary Care Hospital with a View to Develop Standard Nursing Procedure Protocol.

Renal biopsy is one of the most commonly performed diagnostic procedures in the nephrology unit. Nurses play a very important role in pre-biopsy preparation, assisting during procedure and post-biopsy care. Nursing care provided during or after renal biopsy is of utmost importance in reducing complications. The study aims to perform a clinical audit of nursing practices to find the gaps in existing practices for the procedure of assisting renal biopsy and to develop standard protocol. This descriptive observational study was conducted on 19 nurses who were working in the nephrology unit of the tertiary care center. They were enrolled through total enumerative sampling. Sociodemographic profile and clinical profile were collected. The observation checklist was formed based on standard nursing practices, which included three dimensions for the procedure of assisting renal biopsy. Based on the gaps identified, a standard protocol was developed. Nurses were observed during two shifts and each nurse was observed once. Scoring of items was done in each dimension and for acceptable practices, nurses have to score ≥80% in each dimension. Data were analyzed using descriptive statistics. The majority of nurses (73.7%) have not undergone any special training in nephrology. None (100%) showed an acceptable level of nursing practices for all the dimensions of assisting renal biopsy procedure. Standard protocol was developed by the researcher following a rigorous process. The clinical audit found that there were gaps in the existing nursing practices for the procedure of assisting renal biopsy and these gaps have been addressed by the development of a standard protocol.

Przypadek nieszczelności zespolenia wywołanej zakażeniem <i>Candida albicans</i> u 64-letniej pacjentki po przeszczepieniu nerki, leczonej w trybie nagłym poprzez wszczepienie pomostu biodrowo-udowego z dostępu nadłonowego

IntroductionVascular complications are a rare but important risk factor for failure and loss of kidney graft, increasing the mortality of renal graft recipients.Case reportWe present the case of massive haemorrhage due to the rupture of the arterial anastomosis caused by <i>Candida albicans</i> infection in a 64-year old female kidney graft recipient managed with suprapubic iliofemoral bypass during emergency life-saving graft nephrectomy performed in our unit. The postoperative period was complicated by femoral vein thrombosis and intraabdominal fluid collection. After 33 days, with a well-functioning iliofemoral bypass, the patient was discharged to the nephrology unit. At the 12-month follow-up, the patient is functioning well, receiving nephrological care and haemodialysis treatment.ConclusionsRoutine fungal cultures of graft preservation fluid and radiological follow-up in high-risk patients after transplantation may be helpful in the prevention of fatal complications in the high-risk patient group – especially if digestive tract injury occurred during organ harvesting. Nevertheless, histological examination remains the gold standard for the detection of fungal arteritis. Negative culture samples from the preservation fluid, blood and urine before the transplantation do not exclude the risk of fungal infection. Urgent allograft nephrectomy with resection and reconstruction of changed vessels seems to be the safest approach in ruptured anastomotic pseudoaneurysm, as shown in our case.

(133) ERECTILE DYSFUNCTION IN MEN UNDERGOING HEMODIALYSIS FOR CHRONIC KIDNEY DISEASE IN A CITY IN THE BRAZILIAN AMAZON

Abstract Introduction Erectile dysfunction (ED) is a prevalent sexual issue that affects men with chronic kidney disease (CKD). The degree of sexual dysfunction generally worsens with the progression of CKD. Objective we assessed the erectile function and sexual quality of life of adult male CKD patients who undergo hemodialysis (HD) in a hospital situated in the Brazilian Amazon. Methods A cross-sectional quantitative study was conducted in the HD Sector of the Nephrology Unit. The study included men with CKD who were 18 years of age or older and had been sexually active for at least six months. These men underwent three weekly HD sessions for three months. To measure sexual satisfaction, we used the Male Sexual Quotient (MSQ). We also used the International Index of Erectile Function (IIEF5) to assess erectile function. We performed statistical analysis with SPSS 21.0, utilizing appropriate tests such as Mann–Whitney and Kruskal-Wallis (P > 0.05). Results Ninety-eight patients with an average age of 51.68 ± 15.28 years were evaluated. Most were married or in a relationship (60.20%), had been receiving HD treatment for 1 to 5 years (55.10%), and had an average KTV of 1.17. The prevalence of ED was found to be 66.30%. It was observed that ED was more common in older patients (p = 0.01), those with lower family income (p = 0.02), diabetes (p = 0.01), lower mean corpuscular hemoglobin (p = 0.04), higher total calcium (p = 0.04), and lower albumin (p = 0.03). Around 75% of patients rated their sexual life as regular to excellent. Conclusions Despite a high prevalence of ED, men with CKD undergoing HD reported regular to excellent sexual function. The study emphasizes the importance of screening and routine evaluations for sexual issues in these patients. Disclosure No.

Management of chronic kidney disease for Māori in Aotearoa New Zealand: a summary of clinical practice guidelines.

The kaupapa of the Caring for Australians and New Zealanders with Kidney Impairment (CARI) Clinical practice guidelines for management of chronic kidney disease for Māori in Aotearoa New Zealand is to provide whānau-centred and evidence-based recommendations to healthcare systems, healthcare providers and healthcare workers. The guidelines include screening, identification, management and system-level responses to chronic kidney disease (CKD) to deliver best practice care to Māori affected by CKD across community, primary and secondary services. The guidelines are funded by the Ministry of Health - Manatū Hauora and are written by a panel of Māori and non-Māori clinicians and literacy experts across Aotearoa New Zealand from Kaupapa Māori organisations, general practice and nephrology units using standardised methods. The guidelines methodology included consultation with whānau Māori with lived experience of CKD and primary and secondary care practitioners. Additional guideline development would be required to inform management of CKD for non-Māori in Aotearoa New Zealand. The guidelines provide recommendations about equity, governance and accountability, cultural safety, case management, information systems, social determinants of equity and wellbeing and screening. Recommendations to health services for Māori with CKD are based on giving effect to Te Tiriti o Waitangi and best practice care to prevent CKD, delaying its progression, treating kidney failure through timely transplantation, delivering in community and providing high-quality symptom management.

Antibody Response after 3-Dose Booster against SARS-CoV-2 mRNA Vaccine in Kidney Transplant Recipients.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with a high rate of mortality in kidney transplant recipients (KTRs). Current vaccine strategies for KTRs seem to be unable to provide effective protection against coronavirus disease 2019 (COVID-19), and the occurrence of severe disease in some vaccinated KTRs suggested a lack of immunity. We initially analyzed the antibody response in a group of 32 kidney transplant recipients (KTRs) followed at the nephrology and dialysis unit of the Hospital Pio XI of Desio, ASST-Brianza, Italy. Thus, we studied the differences in antibody levels between subjects who contracted SARS-CoV-2 after the booster (8 individuals) and those who did not contract it (24 individuals). Furthermore, we verified if the antibody response was in any way associated with creatinine and eGFR levels. We observed a significant increase in the antibody response pre-booster compared to post-booster using both a Roche assay and DIAPRO assay. In the latter, through immunotyping, we highlight that the major contribution to this increase is specifically due to IgG S1 IgM S2. We observed a significant increase in IgA S1 and IgA NCP (p = 0.045, 0.02) in the subjects who contracted SARS-CoV-2. We did not find significant associations for the p-value corrected for false discovery rate (FDR) between the antibody response to all assays and creatinine levels. This observation allows us to confirm that patients require additional vaccine boosters due to their immunocompromised status and therapy in order to protect them from infections related to viral variants. This is in line with the data reported in the literature, and it could be worthwhile to deeply explore these phenomena to better understand the role of IgA S1 and IgA NCP antibodies in SARS-CoV-2 infection.

Epidemiology of tobacco use in dialysis patients in France and survey of nephrologists' involvement in counseling ontobacco discontinuation.

Tobacco smoking is an independent risk factor for chronic kidney disease (CKD) and increases morbidity and mortality in CKD patients. The primary objective of the study was to investigate the epidemiology of smoking in patients undergoing maintenance dialysis in France. A second objective was to assess the involvement of nephrologists in supportingpatients forsmoking cessation. Data on the smoking history of prevalent patients on maintenance dialysis in France between 2010 and 2020 were obtained from the REIN database (Renal Epidemiology and Information Network),updated by all French nephrology and dialysiscenters. As for the support to smoking discontinuation, a questionnaire on smoking cessation assistance was sent to all members of the French Society of Nephrology, Dialysis and Transplantation (SFNDT). The proportion of current smokers among patients on maintenance dialysis was 10.4% in 2010, 11.2% in 2015 and 11.6% in 2020. A total of 228 nephrologists among the 790 members of the SFNDT participated in the survey (28.9%). Most respondents were women (57.3%), worked at a public hospital (61.1%), were under 40years of age (51.3%) and had no history of smoking (60.8%). The majority reported asking patients about their smoking status and offering brief advice. Among respondents, 72.8% offered help with smoking cessation, 46.3% referred their smoking patients to a tobacco specialist, 51.8% reported prescribing drugs to quit tobacco, and 81.6% requested further training in howtosupport patients forsmoking cessation. Smoking cessation training for nephrologists and dedicated programs for patients in nephrology units could improve our practices and decrease the high prevalence of smoking in patients with ESKD.

Vascular access challenges in hemodialysis children.

Hemodialysis (HD) success is dependent mainly on vascular access (VA). The aim of this study is to share the experience of Pediatric Nephrology Unit (PNU), Cairo University Children's Hospital (CUCH), with VA-related obstacles in end stage kidney disease (ESKD) HD children. This is a retrospective analysis of VA related data of 187 ESKD children received regular HD over 3year duration (2019-2021). Kaplan-Meier curves were used to present arteriovenous fistula (AVF) and cuffed catheters survivals. Uncuffed central venous catheter (CVC) was the primary VA for HD in up to 97.3% with 2.7% of patients had AVF performed and attained maturation before initiation of regular HD. Fifty-six (29.9%) patients have inserted 120 tunneled CVCs. AVFs & AV grafts (AVF) were performed in 79 (42.2%) and 6 (3.2%) patients respectively. There were 112 uncuffed CVCs implanted beneath the screen in Rt internal jugular vein (IJV) (44%) Lt IJV (17%), right internal mammary vein (2.7%) while Trans hepatic (TH) technique was used to place 39 uncuffed CVCs (34%) in the inferior vena cava (IVC). Catheter-related bacteremia (CRB) was the most frequent complication in uncuffed and cuffed CVCs (2.58 / 100 catheters day and 10.1 /1000 catheter days respectively). AVFs achieved a high success rate (83%) after 757.71 ± 512.3 functioning days. Native AVF is the preferred VA for pediatric HD but its creation is limited by the small sized vessels where non-cuffed CVC could be a reasonable relatively long-term alternative. Challenging situations (occluded central veins) could benefit from TH technique of CVC insertion in IVC.

Adherence and perception of hemodialysis treatment

The adherence of individuals with chronic kidney disease (CKD) is essential, in the moment of diagnosis, to the management of treatment in the more advanced stages. This study aimed to evaluate the adherence and perception of individuals with CKD undergoing hemodialysis in a nephrology unit of a public hospital in the Federal District. A cross-sectional, descriptive, with a quantitative approach study, the variables evaluated: age, gender, religion, family income, education, marital status, presence of diabetes and hypertension. The Modified Morisky Scale (MMS) used to evaluate the adherence and a previously developed instrument was used to evaluate the perception of participants. The sample consisted of 38 participants, predominantly elderly (n=20; 52.6%) and male (n=23; 60.5%). According to the MMS, 26 (68.4%) participants had good adherence and 34 (89.5%) good self-perception. The practice of some religion and the presence of diabetes improved adherence. The multidisciplinary team is fundamental to develop strategies that provide significant therapeutic results and more adherent behaviors.

Poor Nutritional Status Is Associated with Death in a Population of Dialyzed Older Persons.

Older patients in hemodialysis have high prevalence of malnutrition that is often associated with rapid weight loss till cachexia. We aimed to investigate whether in older patients undergoing hemodialysis the association between poor nutritional status and mortality may be independent of comorbidities and other risk factors. Retrospective longitudinal study. Unit of Nephrology, Dialysis and Kidney Transplantation of the Policlinic Hospital of Milan, Milan, Italy. A total of 107 prevalent patients undergoing hemodialysis for at least three months. Sociodemographic, clinical, and biological data were recorded. Unintentional weight loss (UWL) was defined as loss of body weight > 5% in 3 months or > 10% in 6 months. We computed a 21-item Frailty Index that included clinical conditions associated with malnutrition and mortality in this population. Unadjusted and adjusted Cox proportional hazard models were performed to test the association of UWL, albumin and transferrin levels with death. Survival analyses based on Kaplan-Meier estimates were performed. Patients' age was 79 (±7.7) years; 38 (35%) were women. Thirty-one patients (29%) died during follow-up. Eighteen (16.8%) patients experienced UWL during the follow-up period. UWL was positively associated with death in the unadjusted model and even after the progressive inclusion of potential confounders. Low albumin levels were positively associated with death only in the unadjusted and partially adjusted models while low transferrin levels were not associated with death in none of the models. Mortality was significantly higher in those patients experiencing both UWL and albumin levels below 3.5 mg/dL. In older patients undergoing chronic hemodialysis UWL is associated with mortality independently of comorbidities and other risk factors. Patients presenting both UWL and low albumin levels were those experiencing the worst outcomes in terms of mortality.

Assessment of clinical pharmacist interventions using a web-based application in a Saudi Arabian Tertiary Hospital.

Medication-related problems are a top concern of clinical pharmacists. Medication-related problems can cause patient harm and increase the number of visits, hospital admissions, and length of hospital stay. The objective was to assess clinical pharmacy medication-related problem-related interventions in a tertiary care setting. A retrospective cohort study was conducted at King Fahad Armed Forces Hospital in Jeddah (Saudi Arabia) between June 2021 and June 2022. The data were extracted monthly from a new web-based Microsoft Excel application documenting medication-related problems during any stage of the medication use process. A total of 5310 medication-related problem-related interventions in 1494 patients were performed. The departments associated with the highest frequency of medication-related problem-related interventions were the critical care unit (26.9%), intensive care unit (23.8%), anticoagulation clinic (17.1%), medical ward (11.3%), and nephrology unit (6.8%). The most common type of medication-related problem-related interventions included inappropriate dosage regimens (25.6%), monitoring drug effect or therapeutic drug monitoring (24.4%), requirement of additional drug therapy (21.9%), and inappropriate drug selection (14.1%). The proposed interventions were accepted by physicians in 97% of the incidents. The most frequent medication classes associated with medication-related problem-related interventions were cardiovascular agents (47.6%), antimicrobial agents (27.2%), and nutrition and blood substitute agents (11.4%). The most frequent medication groups associated with medication-related problem-related interventions were anticoagulants (25.6%) and antibiotics (25.2%). The current findings characterize the medication-related problem-related interventions addressed in clinical pharmacy at a tertiary care setting. The high rate of physician acceptance emphasizes the integral patient safety role of clinical pharmacy services.

Urinary tissue factor (uTF), tissue factor pathway inhibitor (TFPI) and plasmin as novel biomarkers in early diagnosis of lupus nephritis

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease, with multi systematic affection. Lupus nephritis (LN) is the most frequent cause of renal damage in SLE patients with variable presentations that may progress to end stage renal failure. Coagulation disorders are frequently reported in SLE and LN with higher mortality rates. Renal biopsy is an invasive process, and the existing indicators for LN diagnosis and activity are unreliable. New urinary biomarkers with significant validity, safety, and accuracy are the current focus of most studies. Our study sought to assess the value of urinary tissue factor (uTF), tissue factor pathway inhibitor (TFPI), and plasmin as biomarkers for the early identification and detection of LN and its activity. This was a cross-sectional study, included 100 subjects (80 SLE patients, and 20 healthy controls), they were recruited from the Internal Medicine department, Rheumatology and Nephrology units and outpatient’s clinics at Assiut University hospital between the period of 2020 and 2022. All patients underwent full history taking, clinical evaluation, and activity scoring calculation and laboratory investigations. The results showed that the best diagnostic accuracy of LN was observed with TFPI (90% accuracy, sensitivity 80% and specificity 95% with p<0.001 at cutoff point of >193.2 ng/ml), followed by uTF (75.4% overall accuracy at cut off point of >12.6 ng/ml, sensitivity 90% and specificity 68% with p< 0.001) and plasmin (70.3% accuracy at cut off point of >30.5 ng/ml, sensitivity 55% and specificity 78% with p< 0.001). Urinary TFPI was the best predictor of LN occurrence with odd ratio of 4.34, (p< 0.001). In conclusion urinary TFPI could be used as a diagnostic marker for LN with high accuracy and an early predictor of LN.

Erectile dysfunction among men with chronic kidney disease undergoing hemodialysis in a Brazilian Amazon urban setting: an epidemiological study.

Erectile dysfunction (ED) is a common sexual problem among men with chronic kidney disease (CKD). The severity of sexual dysfunction tends to worsen with kidney damage. This study aims to evaluate the erectile function and sexual quality of life of adult male CKD patients undergoing hemodialysis (HD) in a hospital located in the Brazilian Amazon. A cross-sectional quantitative study was performed within the HD Sector of the Nephrology Unit including men with CKD aged ≥ 18 years, undergoing ≥ 3 weekly HD sessions for ≥ 3 months who had been sexually active for ≥ 6 months. We used the Male Sexual Quotient (MSQ) to measure sexual satisfaction and the International Index of Erectile Function (IIEF5) to establish erectile function. Statistical analysis was performed with SPSS 21.0 using appropriate tests, such as Mann-Whitney and Kruskal-Wallis (P < 0.05). Ninety-eight patients (51.68 ± 15.28 years) were evaluated. They were primarily married/or living with a partner (60.20%), with HD time between 1 to 5 years (55.10%), and an average KTV of 1.17. ED prevalence was 66.30%, and it was associated with a higher age group (p = 0.01), lower family income (p = 0.02), diabetes (p = 0.01), lower mean corpuscular hemoglobin (p = 0.04), higher total calcium (p = 0.04), and lower albumin (p = 0.03). Around 75% classified their sex life as regular to excellent. Despite the high ED prevalence, most men with CKD in HD reported experiencing regular to excellent sex life. The study underscores the importance of establishing effective screening and conducting routine evaluations regarding sexual issues in these men.

Interventions to reduce falls among dialysis patients: a systematic review

IntroductionDespite all available evidence regarding increased morbidity and mortality among dialysis patients due to falls and their complications, and an increase in risk factors for falls, relatively little attention has been focused on evidence-based interventions that can reduce falls. We evaluated the effectiveness of fall prevention interventions among dialysis patients.MethodsWe searched Ovid-Medline, Ovid-Embase, PubMed, Cumulated Index to Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials (Central) from inception to 19 July 2023 for studies that evaluated the effectiveness of fall prevention interventions among dialysis patients. The search, screening and extraction of data followed standardised processes and the methodological quality of studies was independently assessed by two reviewers. Data was analysed using a narrative synthesis approach.ResultsOf the 18 studies that had full text review, five were eligible. Three studies were performed in the USA and one each in UK and Japan. Four studies were conducted in outpatient hemodialysis centres and one in a hospital-based nephrology unit. Reported sample sizes ranged from 51 to 96 participants per study with a follow-up period of 3 to 35 months. There was moderate-quality evidence that exercises reduce the rate of falls compared to usual care and low to moderate quality of evidence that multifactorial falls prevention interventions reduce the rate of falls. However, treatment effects could not be quantitatively estimated for all interventions due to substantial heterogeneity of included studies.ConclusionsThis systematic review reflects that there is insufficient evidence regarding falls prevention strategies specific to dialysis patients. Available data based on low to moderate quality studies, suggest that among dialysis patients, exercises may reduce falls and the effectiveness of multifactorial interventions such as staff and patient education still need to be explored using high-quality prospective studies.

EBV Reactivation in Transplant Recipients following SARS-CoV-2 Infection: A Retrospective Study.

Reactivation and primary infection with a high Epstein Barr Virus (EBV) DNA level in kidney transplant patients could cause severe complications, including the development of Post-Transplantation Lymphoproliferative Disease (PTLD). While in the general population the reactivation of EBV after SARS-CoV-2 infection has been reported, very few data are available in transplant recipients. Our retrospective study aimed to evaluate a possible EBV reactivation in kidney transplant patients following SARS-CoV-2 infection and a possible impairment of the immune system. In addition, the effects of changes in immunosuppressive therapy on EBV DNA reactivation and vaccination were also evaluated. A total of 166 kidney transplant patients followed at the Kidney-Pancreas Transplant Ambulatory Nephrology Unit at Padova University Hospital were retrospectively considered for an observation period of 6 months from January 2020 to April 2023. EBV DNA level was measured by Rt-PCR and evaluated 6 months before and after SARS-CoV-2 infection. Patients' serological states were established via quantification of anti-VCA and anti-EBNA (chemiluminescence). Patients' immune systems were characterized by CD4+/CD8+ lymphocyte ratio (flow cytometry). EBV DNA was reactivated in 50% of the 166 patients with COVID-19 who completed the study. Older patients with more severe forms of COVID-19 had higher EBV reactivation (p < 0.05). EBV reactivation significantly increased in patients with severe SARS-CoV-2 infection requiring hospitalization compared to patients managed at home (p < 0.001). CD4+/CD8+ lymphocyte ratio was reduced in patients with a younger age of transplant (p < 0.01) and on a higher dose of steroids (p < 0.01). The results of our study confirm the role of immunodepression, especially in recent transplant patients and those on high steroids, in EBV reactivation. These results combined with the few available in the literature might contribute to providing an optimal management of immunosuppressive treatment for these patients in order to obtain an immune state unfavorable to the activation of latent viruses, including EBV.

The Relationship Between The Satisfaction Of Patient For Hemodialysis Services In The Nephrology Unit Of Hngv, Dili, Timor-Leste

In today's era of globalization there are always changes in the needs of patients who always ask to get quality health services according to their wishes. According to the Global Burden of Disease in 2013, showed that the global prevalence of chronic kidney disease caused the death of 965.000 people worldwide. According to (ESRD, 2014), in Europe, it was stated that the number of hemodialysis patient was 79 patients, and according to research results obtained from respondent showed that, there where 45 (57,0%) of patients who were satisfied and 34 (43,0%) of patients who were dissatisfied with hemodialysis services. To know how the relationship between the satisfaction of patient for hemodialysis services in the nephrology unit of HNGV, Dili, Timor-Leste. This study used a quantitative correlation method with a cross sectional approach using non probability sampling techniques and total sampling techniques with a total of 98 respondents. According to the survey results obtained by 98 respondents who were satisfied with the services provided by nurses, the majority with satisfied category of 48 (49%) and minority with dissatisfied category of 10 (10%). Related to the services provided by nurses, the majority with good category of 45 (46%) and the minority with category less than 17 (17%). Based on the Spearman Rank statistic test showed that the result of p value 0.000 &lt; 0.05, with a coefficient r= 0.647 means that there is a relationship between independent and dependent variable that category as a strong relationship. The result of this research demonstrates that there is a strong relationship between independent and dependent variable.

Primary membranous nephropathy in the Italian region of Emilia Romagna: results of a multicenter study with extended follow-up.

Since primary membranous nephropathy is a heterogeneous disease with variable outcomes and multiple possible therapeutic approaches, all 13 Nephrology Units of the Italian region Emilia Romagna decided to analyze their experience in the management of this challenging glomerular disease. We retrospectively studied 205 consecutive adult patients affected by biopsy-proven primary membranous nephropathy, recruited from January 2010 through December 2017. The primary outcome was patient and renal survival. The secondary outcome was the rate of complete remission and partial remission of proteinuria. Relapse incidence, treatment patterns and adverse events were also assessed. Median (IQR) follow-up was 36 (24-60) months. Overall patient and renal survival were 87.4% after 5 years. At the end of follow-up, 83 patients (40%) had complete remission and 72 patients (35%) had partial remission. Among responders, less than a quarter (23%) relapsed. Most patients (83%) underwent immunosuppressive therapy within 6 months of biopsy. A cyclic regimen of corticosteroid and cytotoxic agents was the most commonly used treatment schedule (63%), followed by rituximab (28%). Multivariable analysis showed that the cyclic regimen significantly correlates with complete remission (odds ratio 0.26; 95% CI 0.08-0.79) when compared to rituximab (p < 0.05). In our large study, both short- and long-term outcomes were positive and consistent with those published in the literature. Our data suggest that the use of immunosuppressive therapy within the first 6 months after biopsy appears to be a winning strategy, and that the cyclic regimen also warrants a prominent role in primary membranous nephropathy treatment, since definitive proof of rituximab superiority is lacking.

Prevalence, clinical profile, and risk factors of peripheral artery disease in an Iraqi cohort of chronic kidney disease.

Peripheral artery disease (PAD) is prevalent in patients with chronic kidney disease (CKD) and is associated with substantial morbidity, mortality, and a lower quality of life. This study aimed to determine the prevalence of PAD, clinical profile, and related risk factors among patients with CKD in Iraq (a low-to middle-income country). A cross sectional study comprised 175 CKD patients, of them 60% were male, their mean age was 56 ± 12.5 years, attending Nephrology unit, Hawler Teaching Hospital, Erbil, Iraq between march 2022 and November 2022. Data on demographic and baseline characteristics were collected. Laboratory tests were performed. All participants underwent a detailed history and clinical examination. Vascular lesions in the lower limbs were assessed using the ankle-brachial index. PAD was diagnosed based on an ankle-brachial index value ˂ 0.9, relevant symptoms, and clinical findings. Forty-nine patients (28%) had PAD, and only 17 (34.7%) were symptomatic. PAD was significantly associated with older age (P = .008), male sex (P = .039), diabetes (P = .012), and hypertension (P = .023). In addition, PAD prevalence was significantly higher in patients with prior coronary artery disease (P < .001), advanced CKD stages (P .032), low estimated glomerular filtration rate (P .03), albuminuria (P .002), elevated glycated hemoglobin (P .04), and high sensitive C-reactive protein (P < .001). No significant association was detected between PAD and body mass index, smoking, CKD duration, cerebrovascular disease, dyslipidemia, albumin, creatinine, hemoglobin, total PTH, and phosphate. Peripheral artery disease was prevalent in patients with CKD in Iraq, and the most affected patients were asymptomatic. Older age, male sex, hypertension, diabetes, prior coronary artery disease, advanced CKD stages, albuminuria, higher glycated hemoglobin level, and increased high-sensitivity C-reactive protein level were identified as risk factors. Early detection of occult PAD might enhance efforts toward proper prevention and treatment.

Causes and outcome of pregnancy related acute kidney injury.

To determine frequencies of causes and renal outcomes of pregnancy related acute kidney injury. This descriptive case series study was conducted in Nephrology unit of a tertiary care hospital of Peshawar, from 1st August 2021 to 31st July 2022.A total of 100 patients with acute kidney injury secondary to obstetric conditions were enrolled via non-probability consecutive sampling technique. While patients with pre-existing renal disease, those with renal stones, or having bilateral small kidneys on ultrasound were excluded from the study. Patients were followed till 12 weeks postpartum period. Underlying obstetrical causes and outcome at 12 weeks postnatal period were determined. The mean age of sample of 100 cases was 29.29 ± 6.45. Mean serum creatinine at presentation was 6.5± 3.13. Majority of patient, 89% were multigravidas. Seventy eight percent patients required hemodialysis. Primary postpartum hemorrhage remained the commonest underlying cause of pregnancy related acute kidney injury in this study. The frequency of persistent renal failure in Pr-AKI (pregnancy related acute kidney injury) in this study was 14%. In about 66% of cases complete recovery occurred. All the underlying obstetrical causes, when adjusted for age, gravidity, place and mode of delivery, had no association with persistent renal failure. Primary postpartum hemorrhage is the predominant cause of pregnancy related acute kidney injury. By the end of 12 weeks postpartum, two third patients recover completely from pregnancy related acute renal injury.

Effect of music therapy intervention on anxiety and pain during percutaneous renal biopsy: a randomized controlled trial.

Percutaneous renal biopsy (PRB) may subject patients to emotional distress and pain before and during the biopsy. The aim of this study was to evaluate the effects of complementary/non-pharmacological interventions such as music therapy (MT) on anxiety, pain and satisfaction in renal patients undergoing PRB. A prospective, single-centre, single-blind, randomized controlled two-arm trial was conducted. Patients ≥18years of age, hospitalized at the Nephrology, Dialysis and Transplantation Unit (Bari, Italy) and scheduled for PRB were screened. Participants were assigned to standard treatment (CG) or to the music therapy (MT) intervention group. Participants in the MT group received standard care and an MT intervention by a certified music therapist qualified in guided imagery and music. The CG patients received the standard of care. MT and CG patients were subjected to identical measurements (pre/post) of the parameters in the State Trait Anxiety Inventory Y1 (STAI-Y1), visual analogue scale for pain (VAS-P) and satisfaction (VAS-S) and heart rate variability. A statistically significant difference in the anxiety scores after PRB between MT and CG patients (STAI-Y1 35.4±6.2 versus 42.9±9.0) was observed. MT also had strong and significant effects on VAS-P compared with CG (5.0±1.4 versus 6.3±1.3, respectively; P<.001) and VAS-S (7.8±1.0 versus 6.0±0.9, respectively; P<.001). Decreased activity of the sympathetic nervous system and increased activity of the parasympathetic nervous system was observed after PRB in the MT group. Our study supports the use of MT to mitigate the psychological anxiety, pain and sympathetic activation associated with PRB.

Ofatumumab in Rituximab-Resistant and Rituximab-Intolerant Patients With Primary Membranous Nephropathy: A Case Series

Rituximab is the first-choice therapy for patients with primary membranous nephropathy (MN) and nephrotic syndrome. However, approximately 30% of patients are treatment-resistant or become treatment-intolerant with hypersensitivity reactions upon repeated drug exposures. We aimed to assess whether ofatumumab, a fully human second-generation anti-CD20 antibody, could be a valuable alternative to rituximab in this population. Case series. 7 rituximab-intolerant and 10 rituximab-resistant patients with MN who consented to receive ofatumumab (50-300mg, single intravenous infusion) and were followed at the nephrology unit of Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII (Bergamo, Italy) between September 2015 and January2019. Over a median (IQR) follow-up of 5.0 (3.0-9.8) months, all 7 rituximab-intolerant and 3 of the 10 rituximab-resistant patients exhibited complete (proteinuria<0.3g/d) or partial (proteinuria<3.5g/d with≥50% reduction vs baseline) remission of nephrotic syndrome. Circulating B cells were similarly depleted in all patients by 1 week, and serum anti-phospholipase A2 receptor antibody concentrations decreased to<2.7 relative units/mL in 3 of 4 rituximab-intolerant and 4 of 8 rituximab-resistant patients with phospholipase A2 receptor-related disease. Ofatumumab significantly reduced 24-hour urinary protein and immunoglobulin G excretion and increased serum albumin and immunoglobulin G levels. These effects were greater in rituximab-intolerant than in rituximab-resistant patients. Measured glomerular filtration rate significantly increased by an average of 13.4% at 24 months compared with baseline (P=0.036) among all patients in the series. There were 14 nonserious infusion-related adverse events in 9 patients that recovered with temporary infusion interruption. Retrospective design, limited number of patients. Ofatumumab may represent an effective and safe treatment for rituximab-intolerant cases of MN. Larger prospective studies will be needed to validate these preliminary findings and explore the effectiveness of other second-generation anti-CD20 antibodies in this clinical setting. Primary membranous nephropathy (MN) is one of the most frequent causes of nephrotic syndrome (NS) in adults. In this case series, we explored the efficacy of ofatumumab, a fully human second-generation anti-CD20 antibody, in 17 patients with MN and NS who were intolerant or unresponsive to rituximab. All 7 rituximab-intolerant patients exhibited complete or partial clinical remission, compared with only 3 of the 10 rituximab-resistant patients. Autoantibody levels decreased in all patients with phospholipase A2 receptor-related disease. Ofatumumab achieved a significant reduction in urinary protein and immunoglobulin G excretion while increasing serum albumin and immunoglobulin G levels. Ofatumumab may be a promising option for patients with MN who are rituximab-intolerant. Further investigations are warranted to validate these preliminary findings.