https://www.clinsurggroup.us/journals/archives-of-clinical-nephrology A Peertechz Open Access Journal en-us 14 Mar, 2025 https://www.clinsurggroup.us/articles/ACN-11-167.php A fungal infection, Pneumocystis jirovecii pneumonia (PJP) primarily affects immunocompromised individuals, particularly post-transplant patients, leading to high morbidity and mortality rates. This review covers the pathology, risk factors, clinical presentation, diagnostic methods, prophylaxis, and treatment of PJP, with a focus on its implications in kidney transplantation. Local transplantation practices report a low incidence of PJP due to effective prophylaxis and donor-matching strategies. The importance of vigilant monitoring and tailored prophylactic measures is emphasized in preventing PJP. 20 Jun, 2023 https://www.clinsurggroup.us/articles/ACN-9-165.php The Urofacial Syndrome or Ochoa is a very rare clinical condition, and is unknown by a large part of the medical community; it is characterized by an inverted facial expression, resulting from abnormal contraction of facial and ocular muscles, especially when smiling, in addition to the presence of urinary abnormalities. Patients with this syndrome are at a higher risk of developing urinary incontinence, changes in the bladder, vesicoureteral reflux, hydroureteronephrosis, and predisposition to severe urinary infections, in addition to chronic kidney disease. This article presents a case of a 22-year-old female, resident of Piauí/Brazil, who presented at the age of 5, the first symptoms of the disease mainly related to the urinary tract (such as urinary frequency), in addition to the sign of inverted face, in which the patient presents the inverted smile characteristic of the disease when commanded to smile, associated with nocturnal lagophthalmos. The patient evolved at 12 years of age, with end-stage chronic kidney disease and a need for renal replacement therapy. This is one of the rare cases of the disease, in which the patient presents the complete characteristics of the inverted smile pathology and complications in the urinary tract. The inverted facial expression is an easily recognized sign, and it is a very characteristic finding of the disease, not finding explanations of morphological alterations or lesions. therefore, it is evident that early diagnosis with the institution of appropriate treatment, avoids possible damage to the urinary tract from childhood, allowing better management and quality of life in these patients. 13 Jun, 2023 https://www.clinsurggroup.us/articles/ACN-9-164.php Cystinosis is a rare autosomal recessive lysosomal storage disorder affecting 1 in 100,000 – 200,000 live births. It is caused by a mutation in the Cystinosin (CTNS) gene, a cystine-proton cotransporter, the absence of which results in intra-lysosomal accumulation of cystine. Kidneys are affected first, presenting as Fanconi syndrome in infancy, followed by widespread involvement of the eyes, endocrine and neuromuscular system later in life. Cystinosis since being first described in 1903 to the discovery of CTNS gene defect a century later in 1998, has proven to be a complex disease. Clinical features are a manifestation of intra-lysosomal accumulation and interruption of cellular metabolic pathways in the affected organs. In this review, we explore the various pathophysiologic mechanisms underlying the manifestations of this complex disease. 16 Feb, 2023 https://www.clinsurggroup.us/articles/ACN-9-163.php Rates of kidney transplantation in patients over 70 years of age have steadily increased over the last 20 years, however age-appropriate immunosuppression regimens in the elderly remain unclear. Investigators utilized the SRTR database to evaluate elderly kidney transplant recipients’ outcomes against a younger population. Post-transplant outcomes measured at an approximately 1-year time interval included graft survival, patient survival, rejection, malignancy, and serum creatinine. Elderly patient survival was improved for those patients that were on dialysis for less than 1 year (95.4% vs. 91.4% p < .01). Patients able to be maintained on CNI immunosuppression regimens also had improved graft survival compared to those managed with other immunosuppression (95.5% vs. 91.1%, p < .01). Patients maintained on mTOR inhibitors had the lowest patient survival (85.5% vs. 92.6%, p < .01). The choice of induction therapy did not affect long term patient or graft survival. These results translated to investigators’ own centers in patients over 60. Results for the SRTR database showed that minimizing time on dialysis prior to transplant improved graft and patient survival, while the type of induction agent had minimal effect on all outcomes at the time of follow-up. The results also support the use of CNI’s and belatacept for maintenance immunosuppression but did not encourage the use of mTOR inhibitors. 28 Dec, 2022 https://www.clinsurggroup.us/articles/ACN-8-162.php The current article examines the effectiveness of nanoenterosorbent to correct violations of the functional state of the kidneys in the experimental renal failure model. The obtained data open up opportunities for further research aimed at studying the possibility of using nanoenterosorbent in practical medicine as a new nanoenterosorbent and a means of drug delivery. The study was conducted in the following groups of animals: group 1 - control group; group 2 - an experimental model of acute renal failure; group 3 - nanoenterosorbent was administered intragastrically at a dose of 650 mg/kg per day to animals with acute renal failure. During the experiment for 3, 14 and 21 days, an analysis of biochemical parameters was obtained from each group. During the investigation, intragastric administration of the nanoenterosorbent did not reduce the dynamics of experimental uremia but reduced the concentration of level of molecular of average mass within 3 days, it also did not improve the functional state of the kidneys according to the readings of urea and creatinine for 14 days after the formation of renal failure, however, it statistically reduced endogenous intoxication according to EI data. Daily intragastric administration of nanoenterosorbent at a dose of 650 mg/kg after the formation of renal failure reduced uremia (urea, creatinine levels) and endogenous intoxication (level of molecular of average mass) after 21 days. Based on the studies, it was found that animals that received nanoenterosorbent at a daily dose of 650 mg/kg, show an optimal improvement in some biochemical parameters. 17 Sep, 2022 https://www.clinsurggroup.us/articles/ACN-8-161.php Objective: To investigate the occurrence and influencing factors of fatigue and sleep disturbance in Maintenance Hemodialysis (MHD) patients. Methods: A total of 170 patients with end-stage renal disease who underwent MHD treatment in the hemodialysis room of Shaanxi Provincial Hospital of Traditional Chinese Medicine from October 2021 to March 2022 were selected as the research subjects. The basic information and laboratory indicators of the patients were collected by cross-sectional survey. The survey methods were evaluated by the revised Piper Fatigue Scale and the Pittsburgh Sleep Quality Rating Scale and the incidence and influencing factors of fatigue and sleep disturbance in MHD patients were analyzed. Results: Fatigue occurred in 135 cases, the incidence rate was 79.41%; sleep disturbance occurred in 124 cases and the incidence rate was 72.94%. After one-way analysis of variance, factors such as exercise, Albumin (ALB, serum Creatinine(CRE), Phosphorus(P) and Hemoglobin(HGB) in MHD patients can affect fatigue; while age, gender, exercise, primary disease, dialysis frequency, Phosphorus(P), Hemoglobin(HGB) and high-sensitivity C-Reactive Protein (hs-CRP) factors can affect sleep. A multiple linear regression model was constructed for the factors affecting fatigue (F = 81.110, p &lt; 0.001), and it showed that 70.3% of fatigue (adjusted R2 = 0.703) was related to albumin (ALB), serum creatinine(CRE), and hemoglobin(HGB) (all p &lt; 0.05); A multiple linear regression model was constructed based on the factors of 58% (F = 26.933, p &lt; 0.001), which showed that 58% of sleep disorders (adjusted R2 = 0.580) were significantly related to age, gender, exercise or not, phosphorus(P), high-sensitivity C-reactive protein(hs-CRP) (all p &lt; 0.05) related. Pearson correlation analysis was used to analyze sleep disturbance and fatigue in MHD patients and the results showed that there was a positive correlation between the two (r = 0.478, p &lt; 0.001). Conclusion: The proportion of fatigue and sleep disturbance in MHD patients is relatively high, mainly mild to moderate and the two influence each other. Exercise intervention and nutritional support can effectively improve the occurrence of fatigue and sleep disturbance in MHD patients. 05 Sep, 2022 https://www.clinsurggroup.us/articles/ACN-8-160.php Hyponatremia is the most common electrolyte disorder in clinical practice: Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is the most common cause of hyponatremia, especially in euvolemic patients. Drugs are among the most common causes of SIADH. While our patient was using hydroxyurea due to polycythemia vera, he was diagnosed with SIADH due to hydroxyurea treatment after investigation due to resistant hyponatremia. The improvement of hyponatremia after hydroxyurea is discontinued and the development of hyponatremia after the drug is re-started supports the development of drug-induced hyponatremia. Careful follow-up is required in terms of hyponatremia in patients using hydroxyurea. 13 May, 2022 https://www.clinsurggroup.us/articles/ACN-8-159.php Cellular interorganelle crosstalk in medical sciences is a new discussion of mechanisms and pathways of physiological functions and pathogenesis of diseases. The organelles (“mitochondria”, nucleus, lysosome, endoplasmic reticulum, Golgi apparatus) are members of such functional units that are needed to perform specific tasks. Mitochondria are essential metabolic organelles in cells, but they also contribute to iron and calcium homeostasis, as well as in the regulation of apoptosis, and they are increasingly recognized as key signaling platforms. In the kidney, crosstalk between mitochondria with endoplasmic reticulum is at mitochondria-associated endoplasmic reticulum membrane in regulating calcium homeostasis. Another crosstalk between these organelles is about autophagic mechanisms. Autophagy is triggered in the kidney in response to acute kidney injury and supports against kidney injury. High glucose-induced reactive oxygen species can be produced by both enzymatic and nonenzymatic pathways. The nucleotide-binding domain and leucine-rich repeat (NLR) family or nucleotide-binding and oligomerization domain (NOD)-like receptors family pyrin domain containing 3 (NLRP3) inflammasome plays a role in inducing infectious defenses via inflammatory cytokines. The NLRP3 inflammasome is activated by the mitochondria-associated endoplasmic reticulum membrane. It has a role in nephrocalcinosis-related chronic kidney disease. This review article is a summary of interorganelle crosstalk in health and disease states, especially in kidney and nephrology-related conditions. 17 Feb, 2022 https://www.clinsurggroup.us/articles/ACN-8-158.php Renal Infarction (RI), a rare cause of renal damage characterized by the abrupt interruption of flow in the renal artery, is often recognized late or may even remain undiagnosed since symptoms are non-specific and may be confused with other pathologies, such as pyelonephritis or nephrolithiasis. In situ thrombosis and thromboembolism are the main causes, but often the real cause is, gf unrecognized. The disease is often underdiagnosed and the diagnosis of certainty can be established with ultrasonography Doppler of renal arteries or with second-level diagnostic tools (contrast-enhanced computer tomography, magnetic resonance with gadolinium, and renal scintigraphy) or third level tests (renal arteriography). The therapeutic approach depends on the cause of RI, from the time from onset of ischemia, from the presence of kidney function impairment, and may include systemic anticoagulant therapy, renal angioplasty with or without stenting, loco-regional endovascular fibrinolytic therapy or surgery, as the last chance. In literature, there are neither guidelines nor evidence about any treatment superiority. Here we describe a paradigmatic case in a 51-years-old man hospitalized because of sudden flank pain: the clinical picture, the high serum level. Moreover, we report our 7-years’ experience with 24 cases of RI, mean age 70 /±15 years, 14/24 men, 16/24 presented with hematuria, frequently associated with the history of CKD (16/24). Fifteen of them (62%) were classified as idiopathic and 9 of them were successfully treated with endovascular fibrinolytic treatment. A review of the literature is also provided. 12 Oct, 2021 https://www.clinsurggroup.us/articles/ACN-7-157.php Diabetes Mellitus (DM) is a potent risk factor for post-transplant cardiovascular complications and infections. Management of diabetes and its complications in renal transplant recipients is a challenging task. This is a frequently encountered predicament in transplant setups. An erratic glycemic control during dialysis is a predictor of poor graft and patient outcomes after kidney transplantation. Literature review reveals majority studies explaining post-transplant diabetes and its role in graft and patient survival. However, a wide range of opinion exists about the impact of pre-transplant DM on transplant outcomes. Measurement of HbA1c levels is a significant tool for assessment of glycemic control. A target HbA1c level of &lt;7% is recommended for diabetic patients irrespective of presence or absence of Chronic Kidney Disease (CKD). However, diabetic patients with CKD are at risk of hypoglycemia owing to decreased insulin metabolism so it is safe to keep HbA1c levels between 7-8% in this population. Immunosuppressive medications have a strong contributory role in deterioration of glycemic control. So, it is imperative to achieve strict pre-transplant diabetes control in order to avoid post-transplant complications. Post-transplant diabetes mellitus (PTDM) has been a subject of a large number of trials and is not only considered a serious metabolic complication but also a predisposing factor of diabetic nephropathy in transplanted kidney. 06 Aug, 2021 https://www.clinsurggroup.us/articles/ACN-7-156.php Hyperuricemia management in chronic kidney disease is a challenging task. We encounter this dilemma on regular basis. Kidney disease patients have wide range (CKD population, Hemodialysis & peritoneal dialysis cohort and renal transplant patients). In clinical practice wide range of opinions exists. This dubious area intrigued us to look into it. Looking into available published data majority of studies are observational and few are randomized control trials. All studies favor that high uric acid level has accelerated effect on CKD progression. Controversy is on its management, whether by treating it we are able to slow down CKD progression or not. Data supports that CKD progression is not slowed down but needs more studies to give conclusive answer. In dialysis and renal transplant patients studies showed inverse relationship of high uric levels with all-cause mortality. However, in peritoneal dialysis data suggests linear relationship of hyperuricemia with mortality. A pro as well as anti-oxidant effect of uric acid has been discussed in literature. Variable cut off for hyperuricemia has been used but more census is on 7 mg/dl. Symptomatic gout definitely needs uric acid lowering therapy but in asymptomatic hyperuricemia no conclusion so far. There is paucity of data in maintenance dialysis and renal transplant patients. 17 Jun, 2021 https://www.clinsurggroup.us/articles/ACN-7-155.php Background: Ferric pyrophosphate citrate (FPC, Triferic®) is a unique form of iron therapy that is indicated to maintain iron balance and hemoglobin concentration in adult hemodialysis patients. We conducted an analysis of observational data from an independent dialysis facility that has administered FPC via the central delivery system to all patients in the facility over a 2‑year period to determine if FPC would offer pharmacoeconomic benefits over the current anemia management protocol that was used at the dialysis facility. Methods: FPC was administered in the dialysate to 61 patients via the central delivery system from first quarter 2017 through fourth quarter 2018.Anonymized data were obtained from the Electronic Medical Record of the dialysis facility. Data were summarized descriptively. The analysis used the last quarter (3 months) of data before initiation of FPC as baseline values. Data were aggregated by quarter and presented as total administered dose, average dose per patient or as average per patient‑year exposure. Results: FPC reduced the need for supplemental intravenous iron use by an average of 74% over the 2-year observation period and reduced the amount of erythropoietin‑stimulating agents needed to maintain hemoglobin levels within the target range of 10.0 to 11.0 g/dL. Small mean improvements in quality of life were observed, as assessed by the 36-item Kidney Disease Quality of Life Questionnaire (KDQoL-36™) mental and physical component scores. As compared with US Renal Data System &#40;USRDS&#41; data, all-cause hospitalizations, infection‑related hospitalizations, and deaths were reduced by approximately 50% after initiation of FPC. Conclusions: Implementation of FPC as an iron maintenance therapy for all patients in a chronic hemodialysis center may result in improvements in anemia management and patient outcomes and in pharmacoeconomic benefits to the dialysis center. 14 Jun, 2021 https://www.clinsurggroup.us/articles/ACN-7-154.php Background: Following shortage of Carmustine, BeEAM regimen (Bendamustine, Etoposide, Cytarabine and Melphalan) was used before autologous transplant in relapsed/refractory lymphoma patients. We evaluated safety and efficacy of BeEAM compared to BEAM. Patients and methods: Ninety consecutive patients receiving BeEAM (30pts) (Bendamustine 100, 120 or 200 mg/m²/d) or BEAM (60 pts) were retrospectively analyzed. Results: In the BEAM group, 68% had NHL and 32% HL compared to 87% and 13% in the BeEAM group (p = 0,014). Pts were in CR or PR at time of transplant. There was no difference regarding hematologic recovery and transfusion requirements. Highest dose of Bendamustine were associated with grade ≥ 2 kidney toxicity. We observed a significant higher incidence of symptomatic HHV-6 infection (53.3% versus 8.3%), digestive toxicity (36.6% versus 15%) and prolonged hospitalization (25 versus 21 days) with BeEAM. After a median follow up of 61 and 49 months for BEAM and BeEAM, 5y-OS and PFS (76% versus 67% and 56% versus 70%) and TRM (0% versus 3%) were not different. Conclusions: BeEAM with the highest doses of Bendamustine was associated with increased risk of HHV-6 infection, longer duration of hospitalization, higher rate of digestive toxicity and increased acute kidney failure while survival was comparable. 04 Jun, 2021 https://www.clinsurggroup.us/articles/ACN-7-153.php Background: Digoxin is a medication of Glycoside family which is commonly prescribed for patients with atrial fibrillation, atrial flutter, and heart failure. With a narrow therapeuticlevel(0.5–2 ng/mL), careful monitoring of digoxin blood level is necessary. Symptoms of digoxin toxicity include nausea, vomiting, visual changes, altered mental status, hyperkalemia, and cardiovascular collapse. As renal failure decreases the clearance of digoxin, and impaired renal function is common in heart failure, this population is at higher risk of toxicity. Methods & materials: In this prospective study, patients with chronic kidney disease- nondialysis (CKD-ND) who were admitted with heart failure or atrial fibrillation at university hospital, were enrolled. Digoxin-naive patients were treated with a 10 mcg/kg intravenous digoxin loading dose. Serum digoxin level was measured 6 to 12 hours after the last loading dose. Patients were followed for 48 hours for signs of toxicity. Correlation between therapeutic digoxin level and degree of renal failure was evaluated. The effect of serum electrolyte (magnesium, calcium, and potassium) concentration on digoxin level was determined. Pregnant women were excluded from study. Results: From 2018 to 2020, 87 CKD patients, (60 (69%) men and 27 (31%) women) aged from 31 to 92 years old, with a mean age of 70.51 ± 14.06 years were admitted to the cardiac unit. Near 80% of the cohort were CKD stage 3 and 4 patients. About half of patients had digoxin levels in therapeutic range (45 cases = 51.7%), followed by 24.1% with supra therapeutic and the other 24.1% with toxic levels. There was significant relationship between GFR and serum digoxin concentration (p-value = 0.038); the lower the GFR was, the higher was the digoxin level and also between serum creatinine and digoxin level (p value: .04). Serum digoxin concentration had significant correlation with serum magnesium level (p-value = 0.006). Conclusion: this study demonstrated that monitoring plasma Digoxin concentration after an intravenous loading dose in patients with renal failure can be very helpful to prevent digoxin toxicity. The lower the GFR was, the higher the digoxin level and the risk for toxicity if the bolus and even maintenance do not monitor meticulously. 29 May, 2021 The extracellular matrix (ECM) is an essential component of the network nearby the cells to guarantee their physiological function and homeostasis. Choosing the most appropriate ECM for mammalian cells, including human cells, is one of the most important criteria for qualifying the in vitro experiments of tissue engineering and functional analyses. While most previous studies examined several ECM components to optimization of ECMs proper for many mammalian cells, a comprehensive study with an integrated conclusion in this scope is still lacking.c The current review will discuss the factors which should be taken into account for designing or optimizing an optimal ECM for the development and maintenance of the kidney tissues. Besides, the components of the previously reported ECMs were compared to each other. 30 Apr, 2021 https://www.clinsurggroup.us/articles/ACN-7-151.php The purpose of this study was to evaluate the initial and long-term outcomes of Percutaneous Transluminal Angioplasty (PTA) for central venous stenosis or occlusion in chronic hemodialysis patients. A total of 363 central venous lesions (277 stenosis and 86 occluded lesions) of 146 patients were enrolled and analyzed retrospectively; these included 130 de novo lesions and 233 restenosis lesions. The procedural success rate in our cohort was 97.0% (352/363 lesions); success rate for stenosis was significantly higher than that for occluded lesions (99.3% vs. 89.5%, P &lt; 0.001). Complications during PTA procedures occurred in nine lesions (2.5%); however, there were no serious complications. A total of 120 stents were implanted for 111 lesions; the rate of stent placement for occluded lesions was significantly higher than that for stenosis lesions (68.8% vs. 18.4%, P &lt; 0.001). The primary patency of de novo lesions was significantly higher than that of restenosis lesions (P = 0.0004); the assisted patency of de novo lesions at 12 and 36 months were 94.4% and 89.0%, respectively. There was no significant difference of primary patency between balloon angioplasty and stent placement for de novo lesions, however, primary patency after stent placement for restenosis lesions was significantly higher than that after balloon angioplasty (P = 0.001). In conclusion, PTA for central venous stenosis or occlusion was safe procedure with low rate of technical failure. The patency of vascular access in long-term was maintained by the repeated intervention. Stent placement could help prolong the patency period for restenosis lesions. 06 Apr, 2021 https://www.clinsurggroup.us/articles/ACN-7-150.php In December 2019, there were 44 cases of an atypical pneumonia found to be related to a novel coronavirus, SARS-CoV-2. The disease was classified as a global health emergency one month later and reached pandemic proportion by March 11, 2020. By October 2020, it had killed over 1,000,000 people. By April 2021, there were nearly 3 million deaths. Not only has this virus been costly in terms of life but has had lasting side effects. It has been difficult to contain, sometimes resulting in overloading of hospital critical care services and disruption of regular care. It has also devastated the economy, particularly sectors related to tourism and transportation. Even the Summer Olympics were postponed. We have had severe pandemics throughout our history, but the last one this devastating was the Spanish Influenza of 1918. The world was unprepared for this onslaught. 18 Jan, 2021 https://www.clinsurggroup.us/articles/ACN-7-149.php APRT deficiency is a rare but under recognized genetic disease. Recurrent urolithiasis and DHA nephropathy are the two clinical manifestations of APRT deficiency and diagnosis can be made at any age and recurs after renal transplant. Allopurinol is the cornerstone in preventing recurrence. APRT activity assay and genetic testing are useful for confirmation of diagnosis, for family screening and in difficult cases of urolithias or crystalline nephropathy. 29 Dec, 2020 https://www.clinsurggroup.us/articles/ACN-6-148.php Introduction: To determine the effects of non-treated seronegative Rheumatoid Arthritis (RA) on proximal renal tubule, sensitivity of Alanine Aminopeptidase (AAP), γ-Glutamyltransferase (γ--GT), β2 Microglobulin in urine (β2M), as well as relation with Rheumatoid Factor (RF) and C-Reactive Protein (CRP), DAS 28 disease activity index. Methods: RF was determined by agglutination test (Latex) RF test, while kinetic methods were used for determination of Alanine Aminopeptidase (AAP) and γ-Glutamyltransferase (γ-GT), as well as MEIA (Microparticle Enzyme Immunoassay) to determine β2 microglobulin in urine. Samples (serum and urine) of 70 participants were examined (35 RA not treated, 35 health control group). Results: In 35 RF negative RA, AAP enzymuria was present in 12 (34.28%) patients, γ-GT was present in 7 patients (20%), while β2 microglobulin was present in 3 patients (8.57%). In the healthy control group, 4 patients showed AAP positivity (11.42%), 2 patients γ-GT positivity (5.71%) and 1 patient showed presens of b2 microglobulin in urine (2.85). RF was not present in any patient (0%). Conclusion: AAP has a higher sensitivity of γ-GT and b2 microglobulin in the detection of asymptomatic renal lesions in non trated seronegative RA. 26 Dec, 2020 https://www.clinsurggroup.us/articles/ACN-6-147.php Introduction: As an indicator of proximal tubular damage is used urinary excretion N-Acetyl-β-D-glucosaminidase (NAG), while Microalbuminuria is used as a tracer for glomerular damage. Aim: The aim of the study is to determined effect of toxicity of these medicals by affecting the enzymuria that correlate with the damage of the epithelium of proximal tubular. To quantifice effects of the treatment with Etoricoxib and Diclofenac on renal proximal tubular in patients with Rheumatoid Arthritis (RA). Methods: NAG is detected with colorimetric method. Microalbuminuria is detected with method od immunoturbidimetric. Tests were performed on 70 participants (35 RA treated with Etoricoxib, 35 RA patients with Diclofenac) in four time intervals in the eight weeks. Results: Correlation between NAG and microalbuminuria (r = 0.21) in the group of patients treated with Etoricoxib is moderate, while correlation (r = 0.28) in the group with Diclofenac was significant. NAG enzymuria, in volume, number of participants in whom it was registered and at the time of its occurrence was much faster during the use of Diclofenac in relation to Etoricoxib. Conclusion: Diclofenac is a potent NAG-inductor and gives a larger tubular enzymuria in comparison with Etoricoxib. 02 Dec, 2020 https://www.clinsurggroup.us/articles/ACN-6-146.php Background and aims: Nephrolithiasis is a widespread disease and it is the most frequent cause of hospitalisation within the urological field. Medical therapy has recently evolved in correcting lithogenous processes and prompting lytic and expulsive processes. Nowadays, among new litholytic drugs, there are phytotherapeutical agents such as the aqueous extract of Phyllantus niruri (Pn). The aim of our study was to evaluate the efficacy of new therapeutic protocols in a youth population affected by Nephrolithiasis. Methods: We evaluate 40 patients (24 females and 16 males), average age 23, affected by nephrolithiasis. All of 40 patients were randomized to take either a Phillantus niruri extract 2 gm/daily (n. 20), or placebo (n. 20, control group) for 3 months. Results: After 3 months of therapy in the treated group the stone free patients were about 65% while in the control group the stone free patients were about 20%. Moreover we observed that Pn intake reduced urinary calcium in 10 hypercalciuric patients. During the Pn treatment none of the patients has suffered from strong colic pain and there have not been drop-outs. Conclusions: In our experience the Pn represents an effective alternative to treatment and/or prevention of urolithiasis, although the acting mechanism is not clear. The drug has proven easy to handle, non toxic and cheap. 28 Nov, 2020 https://www.clinsurggroup.us/articles/ACN-6-145.php Contrast nephropathy is the third most common cause of hospital acquired acute renal failure. With the increasing use of contrast media in radiological procedures it has become one of the major challenges encountered during routine cardiology practice. Contrast nephropathy leads to undesirable clinical circumstances which may result in dead as well as increasing length of hospitalisation and high costs. For these reasons, we present contrast nephropathy in this mini review. 27 Nov, 2020 https://www.clinsurggroup.us/articles/ACN-6-144.php Williams-Beuren Syndrome (WBS) is a multisystemic disorder with prevalence of 1/7500 [1], affects both genders equally and it is caused by a microdeletion of 26-28 genes, including elastin and NCF1 genes, of the chromosome region 7q11.23 [1,2]. The disease is transmitted in an autosomal dominant fashion, but almost all cases are the result of de novo mutations [1]. 16 Sep, 2020 https://www.clinsurggroup.us/articles/ACN-6-143.php Atherosclerosis is one of the most significant yet unresolved problems in patients on regular Hemodialysis (HD) with major impact on morbidity and mortality of patients with end-stage renal disease (ESRD). There is growing evidence that atherosclerosis may-at least in part- result from autoimmune processes, in which the family of Heat-Shock Proteins (HSP) may be involved [1]. 19 Jun, 2020 https://www.clinsurggroup.us/articles/ACN-6-142.php Aim/Background: The aim of this study is to investigate the effects of the solutions used to preserve kidney during transplant surgeries on microbiological culture results and antimicrobial resistance and to evaluate this process from the perspectives of recipients and donors. 01 May, 2020 https://www.clinsurggroup.us/articles/ACN-6-141.php Pyonephrosis secondary to an obstructing calculus in renal pelvis, pelviureteric junction or ureter usually presents clinically with fever, loin pain and other signs of urinary tract infection 27 Apr, 2020 https://www.clinsurggroup.us/articles/ACN-6-140.php Introduction: Very often late diagnosis in spondylitis ankylosans (SA) in the period between 5 to 10 years is due to unstandardized diagnostic method besides established diagnostic criteria. But, they are very restrictive and not practical for early diagnosis of SA, because are based on proved radiographic changes. 16 Mar, 2020 https://www.clinsurggroup.us/articles/ACN-6-139.php Background: Chronic Kidney Diseases (CKD) is not uncommon in farmers working in a clay soil land in Buldana, amarvati and Akola districts called kharpan patta Maharashtra state India. We surveyed incidence of CKD in 246 villages. Methods and patients: We visited the villages were from CKD farmers are reported to media or news papers or reported in literature . Details were discussed with heads of village. On previous day of visit evening announced by head of villages the information regarding those families with history CKD ,other kidney problems or if any suspicions of CKD or member died of CKD, all the family members are invited for clinical examination, with available reports of CKD patients. Clinically suspected or known CKD patient’s blood, urine, drinking water and soil were investigated for content of heavy metals. The pesticide and manure used for farming were also studied. 06 Feb, 2020 https://www.clinsurggroup.us/articles/ACN-6-138.php Background: There is no curative therapy for many of the rare genetic disorders such as Bartter syndrome. Many patients with such disorders will be treated to a large extent with symptomatic therapies, and many of them will continue to have some symptoms, and growth and mental retardation despite the traditional therapies generally known by the treating physician. Because of the rarity of such disorders, many specialist physicians may have limited experience with treatment of such disorders and treatment side effects may be sometimes encountered. It is hoped that advances arising from the accumulating research evidence can contribute to improving treatment of such conditions. 28 Jan, 2020 https://www.clinsurggroup.us/articles/ACN-6-137.php Background: The replacement of the arterio-venous fistula with PTFE prostheses or central tunneled catheters is increasing due to the early exhaustion of autologous native accesses. The percentage of patients with tunneled catheters as vascular access for hemodialysis reaches between 15 to 25%, therefore, it is essential to improve the techniques used to avoid early and late complications, and to look for other possibilities due to early venous exhaustion. The use of tunneled femoral catheters is increasingly frequent due to the impossibility of using accesses of the superior venous axis. In this work we study and analyze the evolution and complications of tunneled catheters, both jugular and femoral, placed in the period from January 1, 2017 to May 30, 2018 in the Interventional Nephrology Unit, Nephrology Department of the Clinical Hospital of Santiago de Compostela. We also compared the evolution of femoral tunneled catheters with tunneled jugular catheters. 10 Jul, 2019 https://www.clinsurggroup.us/articles/ACN-5-136.php Occult Hepatitis C virus (HCV) infection (OCI) is characterized by the presence of HCV-RNA in liver or in peripheral blood mononuclear cells (PBMC) in the absence of serological markers. HCV infection in kidney transplant (KT) recipients is associated with lower patient and graft survival. However, the relationship between KT outcome and OCI is unknown. Our aim was to determine in KT recipients the prevalence, risk factors for OCI, and its prognostic implications. We tested 149 adults KT recipients for the presence of OCI. 22 Jun, 2019 https://www.clinsurggroup.us/articles/ACN-5-135.php Background: Diabetic nephropathy (DN) is one of the commonest etiologies for ESRD. Various studies suggest that diabetic nephropathy occurs due to the accumulation of advanced glycosylated end products (AGEs), the activation of isoforms of protein C kinase, etc. Correlation of renal arterial flow resistance, GFR, and progression towards ESRD in DN is not well narrated in literature. Therefore, the main object of the study was to assess renal arterial flow resistance in patients with DN and to compare it with patients having non-evident diabetic nephropathy. 08 May, 2019 https://www.clinsurggroup.us/articles/ACN-5-134.php Lesch-Nyhan disease is a heritable disorder of purine metabolism. Inheritance is X-linked and the disease occurs almost exclusively in males. Defective activity of hypoxanthine phosphoribosyltransferase leads to hyperuricemia and increased quantities of uric acid in the urine. All patients may develop urinary calculi, urate nephropathy, tophaceous deposits and clinical gout. Neurologic disability and abnormal aggressive behavior is characteristically self-injurious. We report 2 patients with this disease who have been observed to have multiple episodes of hyperthermia which appear to fit the definition of malignant hyperthermia. 29 Dec, 2018 https://www.clinsurggroup.us/articles/ACN-4-133.php Atraumatic spontaneous retroperitoneal haemorrhage is a distinct clinical entity with potentially life-threatening complications. The commonest aetologies include ruptured aortic or visceral aneurysm, spontaneous rupture of the kidney and patients with coagulopathies. Spontaneous rupture of the kidney can occur due to underlying renal pathologies such as malignancy, angiomyolipoma, vascular malformation, vasculitis and infection. Approximately 5% of such cases occur without an identifiable renal pathology and are termed as ‘idiopathic’. Idiopathic spontaneous rupture has been described among patients on chronic haemodialysis associated with acquired cystic disease of the kidney. We describe the extremely rare instance of a patient with a failed renal allograft and recently started on haemodialysis who suffered an idiopathic spontaneous rupture of his native kidney. 06 Dec, 2018 https://www.clinsurggroup.us/articles/ACN-4-132.php Introduction: Renal biopsy is a procedure in which a sample of renal tissue is obtained for microscopic examination. Renal biopsy has contributed greatly to the classification of intrinsic renal diseases and, therefore, to a better knowledge of the pathogenesis involved. Although there are many studies regarding Renal Biopsy. There is little literature regarding correlation between indications and histopathology Diagnosis especially from India. 11 Sep, 2018 https://www.clinsurggroup.us/articles/doi10.17352-acn.000031.php Deterioration of renal function in patients with acute decompensated heart failure (ADHF) influences the prognosis, suggesting that ADHF should be managed as an acute cardiorenal syndrome. Close collaboration between cardiologists and nephrologists is frequently crucial for management of this condition. It is noteworthy that renal congestion promotes worsening renal function (WRF). High-dose loop diuretics can cause WRF, but are often necessary for treatment of congestion, which is the main symptom of ADHF. However, it is controversial whether WRF associated with diuretic therapy actually has a poor prognosis. In this review, we focus on the mechanism of renal congestion related to WRF in patients with ADHF and on the current status of WRF. We also review the use of loop diuretics to treat ADHF and chronic heart failure, as well as the current role of selective vasopressin-2 receptor antagonist therapy. 11 May, 2018 https://www.clinsurggroup.us/articles/doi10.17352-acn.000030.php The following reviews [1,2], about continuous renal replacement therapies (CRRT) and echinocandins conclude that the membranes do not significantly adsorb these antifungals. 24 Apr, 2018 https://www.clinsurggroup.us/articles/doi10.17352-acn.000029.php Corticosteroid use as a component of immunosuppression protocol is widespread, even though their mechanisms of action are imprecise. The burden of metabolic side effects of steroids and the impact on quality of life in kidney allograft recipients has led to attempts in minimizing steroid exposure. 07 Dec, 2017 https://www.clinsurggroup.us/articles/doi10.17352-acn.000028.php Research in Tolerance and Chimerism by Transplant immunologists for over half a century is akin to the pursuit of the Holy Grail. Animal experiments for inducing tolerance may not have been successful initially but in that process, 18 Nov, 2017 https://www.clinsurggroup.us/articles/doi10.17352-acn.000027.php Background: Unroofi ng is a controversial procedure to avoid catheter removal in the treatment of the chronic exit site and tunnel infection, but is now rarely recommended. Here we aimed to evaluate the effects of the unroofi ng procedure on peritoneal catheter survival. 09 Oct, 2017 https://www.clinsurggroup.us/articles/doi10.17352-acn.000026.php About 30-40% of patients with chronic kidney disease (CKD) patients also have concomitant diabetes (1). Diabetes has been shown to have signifi cantly stronger association with CKD in patients with younger age (2). 05 Oct, 2017 https://www.clinsurggroup.us/articles/doi10.17352-acn.000025.php Encapsulating peritoneal sclerosis (EPS), is a rare but devastating complication of long-term peritoneal dialysis (PD) with a high mortality rate. The incidence is between 0.5 and 3.3%, decreasing with time. EPS is defi ned as a clinical syndrome with major signs of gastrointestinal obstruction, infl ammatory parameters, radiological and macroscopic changes. 03 Oct, 2017 https://www.clinsurggroup.us/articles/doi10.17352-acn.000024.php Induction therapy has established itself as an integral component of modern-day renal transplantation. Carefully selected induction therapy helps not only to avoid early rejection of grafts but also allows grafts with delayed function to recover prior to introduction of potentially nephrotoxic immunosuppressants. 23 Aug, 2017 https://www.clinsurggroup.us/articles/doi10.17352-acn.000023.php Phenazopyridine, an azo dye, is commonly used to relieve dysuria caused by bladder irritation or infection. We report the case of a 64-year-old lady who presented with unexplained sub-acute onset hemolytic anaemia followed by acute kidney injury (AKI) and jaundice. 24 Apr, 2017 https://www.clinsurggroup.us/articles/doi10.17352-acn.000022.php Introduction: The benefi t of combination immunosuppression versus steroid monotherapy in pure membranous lupus nephritis (MLN) remains unclear. 27 Mar, 2017 https://www.clinsurggroup.us/articles/doi10.17352-acn.000021.php Gemcitabine (2’,2’-difl uorodeoxycytidine) is a potent pyrimidine antimetabolite and was introduced in 1987. It is commonly used for various tumors including non-small cell lung cancer, pancreatic cancer, breast cancer, ovarian can cer and renal cell carcinoma at advanced stages. 13 Mar, 2017 https://www.clinsurggroup.us/articles/doi10.17352-acn.000020.php Sudden cardiac arrest (SCA) is defi ned as sudden, unexpected loss of heart function, breathing and consciousness, resulting from an electrical disturbance in the heart stopping its action and blood fl ow, and cardiovascular diseases are the major risk factors for SCA. It has been reported that more than 20% of all deaths in patients with advanced chronic kidney disease is due to arrhythmias and SCA [1]. 06 Mar, 2017 https://www.clinsurggroup.us/articles/doi10.17352-acn.000019.php Cardiac diseases are associated independently with decrease in kidney function and progression of existing kidney diseases. Conversely, chronic kidney disease (CKD) represents an independent risk factor for cardiovascular events and outcomes. 20 Feb, 2017 https://www.clinsurggroup.us/articles/doi10.17352-acn.000018.php Background: Procalcitonin (PCT) has been proposed as a novel biomarker for prediction of Vesicoureteral Refl ux (VUR). Since VUR is the most important risk factor for occurrence of pyelonephritis and renal tissue infl ammation 23 Jan, 2017 https://www.clinsurggroup.us/articles/doi10.17352-acn.000017.php Mucormycosis is one of the invasive fungal infections particularly in immunocompromised patients with impaired host defense. 19 Jan, 2017 https://www.clinsurggroup.us/articles/doi10.17352-acn.000016.php In the modern era of widespread utilisation of imaging procedures for preoperative diagnosis and minimal invasive surgeries, intravenous contrast plays a major role in delineation of variety of information related to vascularity of normal as well as abnormal tissues. 12 Nov, 2016 https://www.clinsurggroup.us/Clinical-Nephrology/ACN-2-115.php Background: ANCA-associated vasculitis is a small vessel necrotizing vasculitis with few or no immune deposits, necrotizing glomerulonephritis is very common in the microscopic poliangiitis subset. Systemic scleroderma renal involvement is included neither in the current classification criteria, nor in the definition of CREST-syndrome. 08 Nov, 2016 https://www.clinsurggroup.us/Clinical-Nephrology/ACN-2-114.php Background: Illness perception is useful in understanding the impact of hopelessness on ESRD patients. This perception has been found to be an important determinant of behavior and has been associated with a number of important outcomes such as treatment adherence and functional recovery and quality of life. 26 Oct, 2016 https://www.clinsurggroup.us/Clinical-Nephrology/ACN-2-113.php Aim: To compare diagnostic values and laboratory variables of alanine - aminopeptidase (microsomale AAP), γ-glutamyl transferase (γ−GT),β2-microglobuline (β2-M), C Reactive Protein (CRP) and index for disease activity (PASI) in early diagnosis in previously untreated Psoriatic arthritis (Psa). To determine the effect of untreated Psoriatic arthritis on tubular function, sensitivity of the Brush Border region as well as the diagnostic value of the enzymes originating from proximal renal tubules. 08 Oct, 2016 https://www.clinsurggroup.us/Clinical-Nephrology/ACN-2-112.php Aim: To estimate the effect of initial therapy with Paracetamol (Acetaminophenum) and nonsteroidal anti-inflamatory drugs (Ketoprofenum) on glomerular and tubular integrity in patients with Rheumatoid arthritis (RA), to quantify toxicity of these drugs through measurements of the enzyme excretion that correlates with the damage degree on the tubular epithelium. Microalbuminuria is used as marker for glomerular damage, and the urinary excretion of N-Acetyl-β-D-glucozaminidase (NAG) as an indicator of proximal tubular damage. To determine if there is a change in the clinical indicators of renal function (serum urea and creatinine, urine urea and creatinine, glomerular filtration rate - GFR) in the course of disease and if that change correlates with the dynamics of the quantity of excreted enzymes in urine, reactants of the acute pfase and index of disease activity (DAS28). 22 Aug, 2016 https://www.clinsurggroup.us/Clinical-Nephrology/ACN-2-111.php Lupus nephritis is a frequent manifestation of multisystem autoimmune disease - Systemic Lupus Erythematosus and a significant cause of both acute renal injury and the end stage renal disease. Renal involvement is observed in approximately 60% of patients with SLE. 16 Jun, 2016 https://www.clinsurggroup.us/Clinical-Nephrology/ACN-2-110.php Renovascular pathologies are one of the treatable causes of hypertension. Antiphospholipid syndrome develops owing to a heterogeneous group of antiphospholipid antibodies which causes various thrombotic problems. This entity may effects very small vessels and sometimes leads to hypertension. 28 May, 2016 https://www.clinsurggroup.us/Clinical-Nephrology/ACN-2-109.php Diabetes mellitus [DM] is the commonest endocrine disorder encountered in the clinical practice. It in fact, comprises of multiple disorders that manifest in the form of hyperglycemia. It is a multisystem disorder with pathophysiologic changes occurring in almost all the major systems and organs of the human body resulting in serious physical and mental disturbances and also posing tremendous burden on the health care resources of the country. The common sites of involvement include cardiovascular system, nervous system &#40;central and peripheral&#41;, eyes, gastrointestinal system, genitourinary system, nasal and paranasal sinus region, hepatopancreatobiliary system, etc. Radiological manifestations are directly proportional to the duration and severity of involvement of the various systems. Various imaging (diagnostic and invasive) techniques can be used to detect the various manifestations as well as subsequent complications occurring during the course of disease. The following imaging techniques can be utilized for the purpose of evaluating the patients of DM: 26 Apr, 2016 https://www.clinsurggroup.us/Clinical-Nephrology/ACN-2-108.php We report two cases of acute kidney failure (ARF) as the initial manifestation of sarcoidosis. Two patients were sent from their primary care physicians with hypercalcemia and progressive increase of serum creatinine. The renal biopsy revealed granulomatous interstitial nephritis (GIN). Both patients were started on Methylprednisolone pulse therapy, followed by administration of oral prednisolone and by a slow taper thereafter to a maintenance dose. The renal function has improved immediately in response to this therapy. Our cases demostrates thet GIN due to sarcoidosis, although a rare entity, can cause severe ARF and progressive ESRD. With early detection and appropriate therapy, the majority of patients will maintain adequate renal function. Therefore the diagnosis of renal sarcoidosis must be done quickly to prevent renal. 25 Feb, 2016 https://www.clinsurggroup.us/Clinical-Nephrology/ACN-2-107.php Vitamin D presents interesting pleiotropic effects for the CKD patient (effect and anti-inflammatory properties). Patients with chronic kidney disease (CKD) have impaired endothelial function and the Vitamin D and its analogs may play a role in regulation of endothelial function and inflammation. Therefore, it is increasingly observed that CKD is characterized by a state of chronic inflammation that appears to be linked to oxidative stress, endothelial dysfunction and vascular calcification. Previous studies have shown that vitamin D administration in chronic renal failure patients produces therapeutic effects suggesting an inverse relationship between the presence of 25-hydroxyvitamin D [25 (OH) D] and inflammatory biomarkers. It is emphasized so the importance of proper maintenance of the vitamin D status, since it plays an important role in the management of inflammation and immunity, contributing to the reduction of morbidity and mortality in patients with CKD. In addition there is cumulative evidence showing the low level of vitamin D associations with the development and progression of chronic kidney disease, cardiovascular complications and high mortality. 27 Jan, 2016 https://www.clinsurggroup.us/Clinical-Nephrology/ACN-2-106.php Introduction: Nephron sparing surgery is an effective treatment for RCC. Oncological outcome is equivalent to radical nephrectomy, with the added functional advantage. It is underutilized, especially in tumours in anatomically challenging positions like central and hilar positions. 07 Jan, 2016 https://www.clinsurggroup.us/Clinical-Nephrology/ACN-2-105.php The composition of the human body is considered a useful diagnostic tool in many medical specialties. The recognition of changes in nutrition and hydration of patients is useful in nephrology and in particular in chronic kidney disease where malnutrition and over hydration are conditions that affect the prognosis of these patients. Furthermore, the use of ‘traditional’ diagnostic tests based on clinical examination and biochemical tests often lead to inaccurate results [1,2]. 06 Jan, 2016 https://www.clinsurggroup.us/Clinical-Nephrology/ACN-2-104.php Background: Acute renal failure (ARF) continues to be a challenging problem in critically ill patients. We reviewed the nephrology consultations in our ICU to assess the necessity of those consultations and if there are any clinical criteria to indicate a necessary consultation. 15 Dec, 2015 https://www.clinsurggroup.us/Clinical-Nephrology/ACN-1-103.php Background: Acute renal failure (ARF) continues to be a challenging problem in critically ill patients. We reviewed the nephrology consultations in our ICU to assess the necessity of those consultations and if there are any clinical criteria to indicate a necessary consultation. 06 Nov, 2015 https://www.clinsurggroup.us/Clinical-Nephrology/ACN-1-102.php Background: Acute renal failure (ARF) continues to be a challenging problem in critically ill patients. We reviewed the nephrology consultations in our ICU to assess the necessity of those consultations and if there are any clinical criteria to indicate a necessary consultation. 01 Jun, 2015 https://www.clinsurggroup.us/Clinical-Nephrology/ACN-1-101.php Aim: Chronic kidney disease (CKD) is a risk factor for stroke and in-hospital mortality due to stroke. Stroke is highly prevalent in CKD patients. Our aim was to evaluate the impact of glomerular filtration rate in acute ischemic stroke (IS) patients after thrombolytic therapy.