Kidney Swelling Research Articles

A case of renal sarcoidosis complicated by parotid gland and uterine lesions

BackgroundSarcoidosis is a systemic disease that can affect multiple organs. While pulmonary sarcoidosis is most commonly observed, renal sarcoidosis occurs less frequently. We herein report a case of sarcoidosis with an exceptionally rare distribution including renal lesions.Case presentationA 51-year-old Japanese female was referred because of bilateral parotid swelling and renal dysfunction. Computed tomography scan showed the swelling of bilateral kidneys, parotid glands, and uterus. Ga scintigraphy also showed remarkable accumulation in these organs. Renal biopsy and cytological evaluations of parotid gland and uterus were performed and she was diagnosed as sarcoidosis of these organs. Treatment was initiated with prednisolone 40 mg/day and then renal dysfunction subsequently improved. In addition, the swelling of parotid glands and uterus improved and Ga accumulation in each organ had disappeared.ConclusionThis is a first case of renal sarcoidosis complicated by parotid glands and uterus lesions. Pathological findings and the reactivity observed in Ga scintigraphy indicated the presence of lesions in these organs.

Ultrasound accuracy in evaluating renal calculi in Maysan province.

Renal calculi are a common clinical presentation. While ultrasound (US) is a widely used imaging modality for kidney stone diagnosis due to its accessibility and lower cost, its accuracy compared to computerized tomography (CT), the gold standard, remains understudied. This cross-sectional study evaluated the diagnostic accuracy of ultrasound for detecting and characterizing kidney stones compared to computed tomography (CT). Fifty-six patients with suspected kidney stones based on flank pain underwent abdominal ultrasound to assess stone presence, size, location, and the severity of any hydronephrosis (kidney swelling). These findings were then confirmed with a subsequent non-contrast CT scan. There was a fair agreement between US and CT (Kappa = 0.368) for detecting the stone location. The US could not detect 7 (12.5%) stones, being less sensitive in the middle and upper calyx compared to CT. There was a fair agreement between the US and CT (Kappa = 0.394) for detecting the severity of hydronephrosis. The US was less sensitive to moderate and severe hydronephrosis compared to CT. The abdominal ultrasound demonstrated excellent reliability for stone size measurement (intraclass correlation = 0.924), with CT measurements only slightly larger on average (mean difference 0.9 mm). Although abdominal ultrasound provides reliable stone size assessment, its capacity to accurately localize stones and assess hydronephrosis severity is limited.

Isolation and molecular characterization of fowl adenovirus from inclusion body hepatitis cases in Western India during 2019-2021.

Inclusion body hepatitis (IBH) resulted in a substantial economic loss in Western India during 2019 to 2021. The study aimed to characterize fowl adenovirus (FAdV) from field outbreaks. The study was conducted on 290 liver samples from 66 poultry flocks. The samples were subjected to histopathology and molecular detection, followed by phylogenetic typing of the partial hexon gene of the virus. Spiking mortality (14%) was recorded from day 21 to day 35 with peak mortality at the 28th day of age. The necropsy showed a pale and enlarged liver with hemorrhagic and yellowish necrotic foci, accumulation of straw-colored transudate in the pericardial sac which resulted in a flabby appearance of the heart, heart enlargement, and hemorrhages on the spleen, enlarged and congested kidneys. The virus inoculation resulted in stunting and poor feathering with hepatomegaly, hemorrhages and yellowish necrotic foci on the liver as well as greenish discoloration, and kidney swelling in SPF embryonated chicken eggs. Out of 29, 16 liver samples yielded 1219 bp amplicons specific to hexon gene fragments. The sequence and phylogenetic analysis identified 14 isolates as FAdV species E serotype 11 and two as species D serotype 8b. Conclusion: The results indicated that FAdV-8b and FAdV-11 strains are involved in disease outbreaks in western India.

Papillary Renal Cell Carcinoma Type 1 Accompanied by Hemorrhagic Anemia: A Case Report

Background: Kidney cancer or renal cell carcinoma (RCC) accounts for 5% and 3% of all adult malignancies in men and women, respectively, thus representing the 7th most common cancer in men, and the 10th most common cancer in women. The incidence of kidney cancer in the last two decades has shown an increase, but in recent years the death rate due to kidney cancer has decreased because it is increasing.
 Case Presentation: A 27 year old male patient came with complaints of bloody urination. Patients also complain of body weakness. Every time they are active, the weakness decreases if the patient rests. The patient was stated to be suffering from anemia and a left kidney tumor. There was bilateral antebrachial pitting edema. There was bilateral pretibial edema. Cytological examination revealed papillary renal cell carcinoma type 1.
 Conclusion: Papillary cell carcinoma type 1 is a kidney tumor that has a good prognosis, especially if found at an early stage. The classic symptoms of type 1 pRCC are anemia, hematuria and kidney swelling.

Dynamics of co-infection in fish: A review of pathogen-host interaction and clinical outcome

Co-infections can affect the transmission of a pathogen within a population and the pathogen's virulence, ultimately affecting the disease's dynamics. In addition, co-infections can potentially affect the host's immunological responses, clinical outcomes, survival, and disease control efficacy. Co-infections significantly impact fish production and can change several fish diseases’ progression and severity. However, the effect of co-infection has only recently garnered limited attention in aquatic animals such as fish, and there is currently a dearth of studies on this topic. This study, therefore, presents an in-depth summary of the dynamics of co-infection in fish. This study reviewed the co-infection of fish pathogens, the interaction of pathogens and fish, clinical outcomes and impacts on fish immune responses, and fish survival. Most studies described the prevalence of co-infections in fish, with various parameters influencing their outcomes. Bacterial co-infection increased fish mortality, ulcerative dermatitis, and intestinal haemorrhage. Viral co-infection resulted in osmoregulatory effects, increased mortality and cytopathic effect (CPE). More severe histological alterations and clinical symptoms were related to the co-infection of fish than in single-infected fish. In parasitic co-infection, there was increased mortality, high kidney swelling index, and severe necrotic alterations in the kidney, liver, and spleen. In other cases, there were more severe kidney lesions, cartilage destruction and displacement. There was a dearth of information on mitigating co-infections in fish. Therefore, further studies on the mitigation strategies of co-infections in fish will provide valuable insights into this research area. Also, more research on the immunology of co-infection specific to each fish pathogen class (bacteria, viruses, fungi, and parasites) is imperative. The findings from such studies would provide valuable information on the relationship between fish immune systems and targeted responses.

Left Renal Vein Division during Open Surgical Repair for Abdominal Aortic Aneurysm May Cause Long-Term Kidney Remodeling

Left renal vein division (LRVD) is a maneuver performed during open surgical repair for abdominal aortic aneurysms. Even so, the long-term effects of LRVD on renal remodeling are unknown. Therefore, we hypothesized that interrupting the venous return of the left renal vein might cause renal congestion and fibrotic remodeling of the left kidney. We used a murine left renal vein ligation model with 8-week-old to 12-week-old wild-type male mice. Bilateral kidneys and blood samples were harvested postoperatively on days 1, 3, 7, and 14. We assessed the renal function and the pathohistological changes in the left kidneys. In addition, we retrospectively analyzed 174 patients with open surgical repairs between 2006 and 2015 to assess the influence of LRVD on clinical data. Temporary renal decline with left kidney swelling occurred in a murine left renal vein ligation model. In the pathohistological assessment of the left kidney, macrophage accumulation, necrotic atrophy, and renal fibrosis were observed. In addition, Myofibroblast-like macrophage, which is involved in renal fibrosis, was observed in the left kidney. We also noted that LRVD was associated with temporary renal decline and left kidney swelling. LRVD did not, however, impair renal function in long-term observation. Additionally, the relative cortical thickness of the left kidney in the LRVD group was significantly lower than that of the right kidney. These findings indicated that LRVD was associated with left kidney remodeling. Venous return interruption of the left renal vein is associated with left kidney remodeling. Furthermore, interruption in the venous return of the left renal vein does not correlate with chronic renal failure. Therefore, we suggest careful follow-up of renal function after LRVD.

Isolation and molecular characterization of infectious bursal disease virus circulating in western and central India.

Infectious bursal disease (IBD) caused substantial economic loss in central and western India during 2020 and 2021. The study was conducted to characterize IBD virus (IBDV) from field outbreaks. The study was conducted on 360 samples from 42 poultry flocks. The samples were subjected to histopathology and molecular detection, followed by phylogenetic typing of the partial VP2 gene. The mortality ranged from 15.25 to 60.18%. The necropsy showed hemorrhages on thigh muscles, mottled spleen, swelling of kidneys and bursae with hemorrhages, and cheesy exudate. Histopathology revealed extensive necrosis and depletion of follicular lymphoid cells within the cortex and medulla, along with widespread hemorrhages, edema, and cystic cavities in the bursa. The field isolates showed cytopathic effects in the seventh passage. The cytopathic effects included swelling, rounding, granulation of cytoplasm around the nucleus, fragmentation of the infected cells, and detachment. The reverse transcription-polymerase chain reaction amplified 664 bp partial VP2 gene. The phylogenetic analysis identified 19 field isolates as very virulent IBDVs (vvIBDVs) and three as classical strains. The results indicated that different vvIBDV strains are involved in disease outbreaks in central and western India.

Aggravated renal fibrosis is positively associated with the activation of HMGB1-TLR2/4 signaling in STZ-induced diabetic mice.

Diabetic kidney dysfunction is closely associated with renal fibrosis. Although the suppression of fibrosis is crucial to attenuate kidney damage, the underlying mechanisms remain poorly understood. In this study, renal injury in diabetic mice was induced by the intraperitoneal injection of streptozotocin (100 or 150 mg/kg) for 2 consecutive days. In the model mice, remarkable renal injury was observed, manifested by albuminuria, swelling of kidneys, and histopathological characteristics. The renal fibrosis was obviously displayed with high-intensity staining of fibrin, type IV collagen (Col IV), and fibronectin. The levels of Col IV and transforming growth factor-β1 were significantly increased in diabetic mice kidneys. The aggravated fibrotic process was associated with the overexpression of HMGB1, TLR2/4, and p-NF-κB. Furthermore, a high expression of F4/80 and CD14 indicated that macrophage infiltration was involved in perpetuating inflammation and subsequent fibrosis in the kidneys of diabetic mice. The results demonstrate that the severity of renal fibrosis is positively associated with the activation of HMGB1/TLR2/4 signaling in diabetes.

Isolation, identification, and pathogenicity of a goose astrovirus causing fatal gout in goslings

Since November 2016, severe infectious diseases characterized by gout and kidney swelling and caused by goose astrovirus (GoAstV) have affected goslings in major goose-producing areas in China. In 2021, a similar serious infectious disease broke out in commercial goose farms in Heilongjiang Province, China. In this study, strain HLJ2021 was successfully isolated from goose embryos. Electron microscopy showed that the viral particles are spherical, with a diameter of about 28 nm. The complete genomic length of strain HLJ2021 is 7210 nt, and it encodes three viral proteins. A phylogenetic analysis showed that strain HLJ2021 belongs to GoAstV-2 (G2). Compared with the two original GoAstV strains, amino acid site 540Q of the strain HLJ2021 spike domain has a mutation that affects the protein structure. One potential recombination event occurred between strains HLJ2021 and AstV/HB01/Goose/0123/19, which led to the generation of recombinant strain AstV/HN03/Goose/0402/19. Strain HLJ2021 also showed strong pathogenicity in goslings. Goslings infected with GoAstV began to die at 48 h post-infection (hpi), with a mortality rate of 83.3% at 240 hpi. At autopsy, visceral urate deposits, severe renal hemorrhage and swelling, and urate in the ureter were observed in the dead goslings. These findings extend our understanding of the evolution of GoAstV, which causes gout. The isolated GoAstV strain HLJ2021 provides a potential resource for the development of biological products for the prevention of goose gout.

Bromoacetic acid causes oxidative stress and uric acid metabolism dysfunction via disturbing mitochondrial function and Nrf2 pathway in chicken kidney.

Since the outbreak of COVID-19, widespread utilization of disinfectants has led to a tremendous increase in the generation of disinfection byproducts worldwide. Bromoacetic acid (BAA), one of the common disinfection byproducts in the environment, has triggered public concern because of its adverse effects on urinary system in mammals. Nevertheless, the BAA-induced nephrotoxicity and potential mechanism in birds still remains obscure. According to the detected content in the Taihu Lake Basin, the model of BAA exposure in chicken was established at doses of 0, 3, 300, 3000 μg/L for 4 weeks. Our results indicated that BAA exposure caused kidney swelling and structural disarrangement. BAA led to disorder in renal function (CRE, BUN, UA) and increased apoptosis (Bax, Bcl-2, caspase3). BAA suppressed the expression of mitochondrial biogenesis genes (PGC-1α, Nrf1, TFAM) and OXPHOS complex I genes (ND1, ND2, ND3, ND4, ND4L, ND5, ND6). Subsequently, BAA destroyed the expression of Nrf2 antioxidant reaction genes (Nrf2, Keap1, HO-1, NQO1, GCLM, GCLC). Furthermore, renal oxidative damage led to disorder in uric acid metabolism genes (Mrp2, Mrp4, Bcrp, OAT1, OAT2, OAT3) and exacerbated destruction in renal function. Overall, our study provided insights into the potential mechanism of BAA-induced nephrotoxicity, which were important for the clinical monitoring and prevention of BAA.

The Role of Testosterone Hormone on Crystal Formation Through the Renal Expression of Osteopontin in Male Wistar Rat

This study aims to investigate the role of testosterone hormone on crystal formation through osteopontin expression. This was an experimental study with post-test only control design. A total of 12 rats aged 10 weeks were divided into two groups which are male rats group fed with water containing EG (Ethylene Glycol) 0.75% and male rats group fed with water containing EG (Ethylene Glycol) 0.75% and were injected with testosterone hormone. Furthermore, the rats were observed and fed with standard diet for 30 days. Then, both groups were terminated. The kidneys were extracted and examined for Osteopontin expression. Histopathology examination was also performed in both groups The result of the study showed that the mean kidney osteopontin expression in male rats fed with water containing EG 0.75% and received testosterone hormone injection were significantly higher (29.16 ± 9.072) compared to male rat groups fed with water containing EG 0.75% alone (11.42 ± 3.692) with p value 0.001. Histopathology examination with HE stain revealed that both groups demonstrated the presence of stone in kidney tubules, kidney swelling and pelvic ectasis. This feature suggested the presentation of hydronephrosis as a result of stone obstruction. As a conclusion, this study shed light on the role of hormonal sex of testosterone involving in crystal formation through osteopontin expression. Keywords: urolithiasis, testosterone, sex hormone, osteopontin

The Flavonoid Hesperidin Methyl Chalcone Targets Cytokines and Oxidative Stress to Reduce Diclofenac-Induced Acute Renal Injury: Contribution of the Nrf2 Redox-Sensitive Pathway.

Hesperidin is derived from citrus fruits among other plants. Hesperidin was methylated to increase its solubility, generating hesperidin methyl chalcone (HMC), an emerging flavonoid that possess anti-inflammatory and antioxidant properties. The nuclear factor erythroid 2-related factor 2 (Nrf2) is a powerful regulator of cellular resistance to oxidant products. Previous data evidenced HMC can activate Nrf2 signaling, providing antioxidant protection against diverse pathological conditions. However, its effects on kidney damage caused by non-steroidal anti-inflammatory drugs (NSAIDs) have not been evaluated so far. Mice received a nephrotoxic dose of diclofenac (200 mg/kg) orally followed by intra-peritoneal (i.p.) administration of HMC (0.03–3 mg/kg) or vehicle. Plasmatic levels of urea, creatinine, oxidative stress, and cytokines were assessed. Regarding the kidneys, oxidative parameters, cytokine production, kidney swelling, urine NGAL, histopathology, and Nrf2 mRNA expression and downstream targets were evaluated. HMC dose-dependently targeted diclofenac systemic alterations by decreasing urea and creatinine levels, and lipid peroxidation, as well as IL-6, IFN-γ, and IL-33 production, and restored antioxidant properties in plasma samples. In kidney samples, HMC re-established antioxidant defenses, inhibited lipid peroxidation and pro-inflammatory cytokines and upregulated IL-10, reduced kidney swelling, urine NGAL, and histopathological alterations. Additionally, HMC induced mRNA expression of Nrf2 and its downstream effectors HO-1 and Nqo1, as well as reduced the levels of Keap1 protein detected in renal tissue. The present data demonstrate HMC is a potential compound for the treatment of acute renal damage caused by diclofenac, a routinely prescribed non-steroidal anti-inflammatory drug.

Ameliorative Effects of Anti-Clostridial Egg Yolk Antibodies (IgYs) in Experimentally-Induced Avian Necrotic Enteritis.

Simple SummaryNecrotic enteritis (NE) is an important enteric infection in poultry. Since the ban on the use of antimicrobials growth promoters, NE has re-emerged significantly in commercial poultry. The current study aimed to evaluate the ameliorative effects of anti-clostridial egg yolk antibodies (EYAs) in NE. Passively immunized birds showed improved behavioral signs and gross and microscopic lesions. Although EYAs showed ameliorative potential in our study, studies regarding safe production and reliable application remain overdue. The present study was planned to evaluate the ameliorative effects of egg yolk antibodies (EYAs) in broiler chicken. For this purpose, 80-day-old broiler chickens were divided into four groups (A–D), where group A was kept as negative control. Experimental infection with C. perfringens (1 × 108 cfu/mL) was induced via oral route on days 17, 18 and 19 of the experiment in groups B, C and D. Groups C and D were passively immunized by anti-clostridial IgYs @ 1 mL per bird via oral and oral and intramuscular (I/M) routes respectively, on days 21 to 24, and on days 22 and 24 of the experiment, respectively. Two necropsies were performed (the first on day 26th and the second on day 35th). Birds in group B showed behavioral signs e.g., laziness, depression and diarrhea, gross post-mortem lesions e.g., increase in the relative weights (RW), due to acute swelling and congestion of liver and kidneys and ballooning and hemorrhages of jejunum and microscopic lesions e.g., congestion and necrosis in liver and kidneys’ parenchyma and disrupted epithelium with fewer goblet cells in jejunum, compared to the group A. Birds in groups C and D, showed significant improvements in clinical and behavioral signs, RW of liver, kidneys and jejunum, swelling, congestion and mononuclear cells’ infiltration in liver and kidneys and damages in the jejunal-wall, compared to group B. The most significant changes were found in birds of group C. Our study revealed ameliorative effects of EYAs on certain biological parameters however, further studies would be needed to justify a safer production and a reliable application of EYAs in NE outbreaks.

Semaphorin class 3C, vascular permeability, and the swollen injured kidney

Class 3 semaphorins (SEMA3) are secreted glycoproteins with established roles in the developing brain, heart, and kidney. In this issue of Kidney International, Cai etal. show that in acutely injured kidneys, semaphorin isoform SEMA3C is expressed de novo in glomeruli and the nephron, secreted into the circulation, and excreted into the urine. Compelling evidence is provided for SEMA3C promoting microvascular permeability, kidney swelling, and acute injury. SEMA3C antagonism may be a treatment option for acute kidney injury.

Goose nephritic astrovirus infection increases autophagy, destroys intercellular junctions in renal tubular epithelial cells, and damages podocytes in the kidneys of infected goslings

Goose nephritic astrovirus (GNAstV) has recently been identified, which causes kidney swelling and visceral gout in goslings. However, the pathological changes in kidney tissue due to GNAstV infection have not yet been described. In the study, fifty goslings were orally infected with GNAstV, and fifty goslings received PBS as a control. Kidney tissue was collected at different days following infection (dpi) to assess the injury. GNAstV infection reduced body weight, increased the relative weight of the kidney, and increased serum uric acid and creatinine levels. GNAstV was found within renal epithelial cells, and the viral load in the kidney peaked at 7 dpi. Pale and swollen kidney tissue was observed in infected goslings, especially at 5 and 7 dpi. GNAstV infection caused degeneration and necrosis of renal epithelial cells, structural destruction of the brush border, glycogen deposition in the glomerular mesangium, increased fibrosis, and infiltration of inflammatory cells into the renal interstitium. Moreover, swollen mitochondria, broken mitochondrial ridges, autophagosomes, and autophagolysosomes were observed under ultrahistopathological examination. GNAstV infection increased levels of LC3B, ATG5, and Beclin 1, and decreased p62, and downregulated WT1 mRNA and upregulated desmin mRNA. At early stages, GNAstV infection decreased expression of intercellular junction-related genes, including ZO-1, occludin, claudin-10, and catenin-α2. In conclusion, GNAstV infection causes renal epithelial cell autophagy, destruction of brush border and intercellular junctions, podocyte damage, and increased fibrosis, ultimately resulting in damage to the kidney.

Isolation and evolutionary analyses of gout-associated goose astrovirus causing disease in experimentally infected chickens

Astroviruses are a common cause of gastroenteritis in humans and animals. They are also associated with extraintestinal infections, including hepatitis in ducklings, nephritis in chickens, as well as fatal meningitis and encephalitis in humans and other mammals. Since 2014, outbreaks of disease characterized by visceral gout and swelling of kidneys have been reported in goslings and ducklings in China, with the causative agent revealed to be a novel avian astrovirus designated goose astrovirus (GoAstV). In the present study, this novel gout-associated GoAstV was identified in diseased goslings from 2 farms in Hunan province, China. Three genomes were successfully sequenced and analyzed and were shown to have high identities of 99.7 to 99.8% between each other, with some specific amino acid alterations revealed in open reading frame 2 when compared with other gout-associated GoAstVs. Two strains were further efficiently isolated in the DF-1 chicken fibroblast cell line with high virus titers of 1011 viral genomic copies per mL of culture media. A pilot virus challenge study using GoAstV in chickens demonstrated that this virus can cause clinical visceral gout in chickens, indicating its ability to cross the species barrier. Based on the phylogenetic analyses of capsid sequences, the identified GoAstVs were proposed to be classified into 2 genotypes, GoAstV1 and GoAstV2, and the novel gout-associated GoAstVs were all clustered in GoAstV2. Further Bayesian inference analyses indicated a nucleotide substitution rate of 1.46 × 10−3 substitutions/site/year for avian astrovirus based on open reading frame 2 sequences, and the time to the most recent common ancestor of GoAstVs was estimated to be around 2011. This is the first report to confirm GoAstV can infect chickens while also providing an estimation of the evolutionary rates of Avastroviruses.

Pathogenesis and expression profile of selected immune genes to experimental Edwardsiella tarda infection in iridescent shark Pangasianodon hypophthalmus

Pathogenesis and immune gene expression of the iridescent shark catfish Pangasianodon hypophthalmus to experimental Edwardsiella tarda infection was studied. Healthy Pangasianodon were inoculated intramuscularly with a sub-lethal dose of 1.77 × 107 cells/fish of E. tarda to induce edwardsiellosis. Petechial haemorrhages, inflammation at the site of injection, vertical hanging from the water surface, swollen abdomen and anorexia were the common signs observed in challenged catfish fingerlings. The morbid catfish also exhibited typical signs of septicaemia with haemorrhages on ventral parts of the body and fin bases and congested vent prior to death. The mortality was observed 48 h post injection. The average percent morality was 42 % in fish exposed to 1.77 × 107 cells of E. tarda, whereas, only6.6 % mortality was observed in placebo control (catfish received 0.1 mL of 0.85 % sterile physiological saline) and no mortality in negative control group (catfish received no injection) over an observational period of 20 days. The kidney and liver of moribund fish demonstrated different necrobiotic changes. In kidney, cellular and cloudy swelling, degeneration of renal tubules, necrosis of glomerulus, dilation of Bowman’s space, hypertrophy, fibrosis of renal tubules and increased melano-macrophage reaction were frequently observed. In liver, disorganized hepatocytes, blood congestion and nuclear pyknosis were evident. To ascertain the host response to E. tarda infection, mRNA levels of three different classes of innate immune components viz. cytokine interleukin-1β (IL-1β), acute phase protein transferrrin and complement C3 were assessed by quantitative real-time PCR. Significant up-regulation (P < 0.05) of IL-1β and C3 gene expression was observed in infected fish upto 15 days post infection (dpi) in liver, kidney, spleen and blood though the level of increase differed among organs and dpi. Significant up-regulation (P < 0.05) of transferrin gene expression was seen at 1 dpi in kidney, spleen and blood while no significant variation could be observed in liver. The tissue specific pathology and changes in immune gene expression may help to improve the knowledge of E. tarda pathogenesis and role of the innate immune genes in this tropical catfish. The innate immune response of host to E. tarda which is evident from increased expression of innate immune genes may be further enhanced through immunostimulants and nutraceuticals to prevent disease onset and use of antibiotics.

Bupleurum polysaccharides ameliorated renal injury in diabetic mice associated with suppression of HMGB1-TLR4 signaling.

Bupleurum polysaccharides (BPs) is isolated from Bupleurum smithii var. parvifolium, a key traditional Chinese medicine. The study was to investigate the effects of BPs on diabetic kidney injury. After two intraperitoneal injections of streptozotozin (STZ) 100 mg·kg-1, renal injury in diabetic mice was induced and BPs was orally administrated at dosages of 30 and 60 mg·kg-1·d-1. The STZ injected mice developed renal function damage, renal inflammation and fibrosis known as diabetic kidney disease (DKD). BPs significantly reduced serum creatinine level and urinary albumin excretion rate, with the attenuated swelling of kidneys. BPs treatment obviously alleviated the pathological damage of renal tissue. The progression of renal injury in BPs treated mice was inhibited with less expression of type IV collagen (Col IV), fibronectin (FN) and α-smooth muscle actin (α-SMA). The inhibition of inflammation in kidney was associated with the reduced level of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). BPs administration suppressed the over-expression of toll like receptor 4 (TLR4) and high-mobility group box 1 (HMGB1) with lowered activity of nuclear factor kappa B (NF-κB) in renal tissue of diabetic mice. Oral administration of BPs effectively prevented the development ofrenal injury in diabetic mice. This study suggested that the protection provided by BPs might affect through the interruption of HMGB1-TLR4 pathway, leading to the inhibition of renal inflammation and fibrotic process.

Endoscopic Removal of Gastric Perforating Fish Bone

Introduction: A foreign body ingestion in adults is usually diagnosed by medical history. In most cases, the foreign body passes through the gastrointestinal tract uneventfully. Complications such as perforation are rare and usually occur in areas of angulation or narrowing such as the gastric antrum. We present a case of an unintentional perforating fish bone ingestion that was found incidentally on cross-sectional imaging and was managed endoscopically. Case description: A 51-year-old woman presented to the hospital for subacute upper abdominal pain. The patient described the pain as crampy, accompanied by waxing-waning nausea and dry heaves. She had melena 2 weeks prior, for which she underwent a colonoscopy and an EGD which revealed polyps that were removed endoscopically. Her prior surgical history included open nephrectomy for a right kidney swelling. On examination, the patient was afebrile, hemodynamically stable and in no apparent distress. Her abdomen was soft, non-distended with mild epigastric tenderness, and no guarding or rebound tenderness. Lab tests revealed a white cell count of 12,600/mm3 and hemoglobin of 13.1 g/dl. A CT scan of the abdomen revealed a 3.2 cm intramural curvilinear foreign body within the gastric antrum, with an associated thickened antrum and pylorus and no evidence of extra-luminal air or bowel obstruction. After further questioning, the patient reported having eaten fish 3 weeks ago and had a fish bone stuck in her throat, which she was able to cough out. An urgent upper endoscopy was performed - revealing a large fish bone perforating through the gastric incisura. An overtube was placed and the fish bone was removed using a rat tooth forceps. The defect was closed with an over-the-scope clip. The patient post-endoscopy course was uneventful and she was discharged home. Discussion: Since foreign body ingestion is usually uneventful, conservative treatment is warranted in the majority of cases. Complications are more likely with foreign bodies that are sharp such as fish bones. CT is the most sensitive in locating the causal fish bone, most often appearing as a high-density linear structure within inflamed tissue. In our case, the foreign body finding on abdominal CT and the history of ingested fish bone, raised a high index of suspicion for a perforating fish bone, indicating urgent endoscopic intervention. Fish bone migrating into solid organs or intraperitoneal areas would require surgical intervention.1865_A Figure 1. Abdominal CT1865_B Figure 2. No Caption available.1865_C Figure 3. Endoscopic clip

Synovial Cell Sarcoma of the Kidney: A Case Report

Background: Primary renal sarcomas are rare neoplasm that accounts about 1% of malignant renal tumors. Prevelance of primary renal Synovial cell sarcoma is rare and comprise 1-3% of all malignant renal neoplasm. Synovial cell sarcoma overlaps with multiple spindle cell neoplasms affecting the kidney, this need immunohistochemical panel to can diagnose it. This paper reports a case of Renal Synovial cell sarcoma. We report a case of 32 year old female presented with presented by upper pole left kidney swelling. Computarized tomography (CT) revealed a heterogeneous, well marginated soft tissue mass 8x7 cm arising in the upper pole of left kidney with solid necrotic components and heterogeneous enhancement. Left radical nephrectomy was done. Methods: The kidney was excised and gross examination revealed that upper pole of the kidney was replaced completely by grayish tan firm mass with cystic areas measuring 6x6x3 cm in diameter and shows areas of hemorrhage and necrosis. Microscopic evaluation and immunohistochemistry study were performed. Results: The mass was Renal Synovial cell sarcoma. Conclusion: Although Renal Synovial cell sarcoma is rarely diagnosed in kidney but it should be considered in the differential diagnosis of spindle cell tumors affecting the kidney and must be excluded by immunohistochemical studies as it has poor prognosis in the kidney