Kidney with lower pole simple cysts - is it an absolute contraindication for renal biopsy

A percutaneous renal biopsy is an essential tool for diagnosis, prognosis, and choice of treatment for primary and secondary renal disease, as well as transplant kidney. It is a core procedure of nephrologists done under ultrasound-guided. The lower pole of the left kidney is our usual approach as the risk of injury to the major vessels will be very minimal. However, the presence of renal cyst at the lower pole of the kidney may increase the difficulty of biopsy as there is the possibility of puncturing the renal cyst during the procedure causing unstoppable bleeding. Here we present two case reports in which we were able to do percutaneous renal biopsy under ultrasound-guided for patients with simple renal cysts at the lower pole of the the hand of expert personnel, a lower pole cyst can be avoided under ultrasound-guided biopsy

Clinical outcome of malaria cases and malarial acute kidney injury in Hospital Serdang. A single center experience from 2007 till 2016

Introduction: Malaria, a common health problem in certain parts of the world, has a considerable morbidity and mortality. This study reports its clinical outcome as well as Acute Kidney Injury (AKI) outcome from a single tertiary hospital from 2007 till 2016. Methods: All registered malaria cases with positive Plasmodium (P) sp from blood smears patients from hospital infection control database, were included in this study. History, examination, and baseline investigations recorded. Clinical outcome and AKI during stay was ana-lysed using SPSS version 23, with Pearson Chi Square test. Statistical significance taken when p value<0.05. Results: Seventy six malaria patients were recorded from January 2007 till December 2016 in Hospital Serdang. Majority were male (90.8%), young (31.9±10 years), from Selangor (89.5%) and foreigners (74%). Foreigners were mainly (75%) from Africa (27%), Pakistan (27%) and Indonesia (21%). P. Vivax species recoreded highest (55.3%), followed by P. Falciparum (28.9%), P.Knowlesi (7.9%), P. Malariae (6.6%), and P.Ovale (1.3%). All patients had fever, gastrointestinal symptoms (65.8%), central nervous symptom (43.4%), hepatosplenomegaly (25%) andoliguria (5.3%). Baseline laboratorary investigations showed Hemoglobin 13.1 ±2.1g/dL, Platelet 86.9±76.3, Lactate Dehydrogenase 393.5±176.1 U/L, Prothrombin time (PT) 17.1±8.8 x 10 9/L, Bilirubin 31.5±17.8, Aspartate Trans-Aminase (AST) 51.4±40.7 U/L, Alanine Aminotransferase (ALT) 52.9 ±47.5 U/L, urea 5.1 ±3.3 mmol/L, sodium (Na) 133.3 ±3.7mmol/L and Creatinine 86.0 ±30.2umol/L. Mean hospital stay was 6.3±2.8 days. Two ICU ad-missions (2.6%) were recorded. Mortality rate and cerebral malaria were 1.3% each. Hemolysis and hepatitis seen in 35.5% and 27.6% patients respectively. Malarial AKI were recorded in 13 patients (17.1 %) with KDIGO AKI stage 1(84.6%), stage 2 (7.7%) and stage 3 (7.7%). Among malarial AKI patients, one patient (7.7%) received dialysis, and twelve patients (92.3%) recovered renal function. Majority of laboratory features of malaria AKI showed proteinuria (100%), and hyperbilirubinemia (84.6%). Analysis of risk factors showed significant association of AST and male gender with malarial AKI. Conclusion: Malaria may lead to significant morbidity and mortality. Prompt management with volume replacement, antimalarial and dialysis brings about recovery of renal function in malarial AKI

Current clinical practice in adapted automated peritoneal dialysis (aAPD)-A prospective, non-interventional study

Insuficiència renal crònica; Diàlisi peritonealFallo renal crónico; Diálisis peritonealChronic Kidney Failure; Peritoneal DialysisAdapted automated peritoneal dialysis (aAPD), comprising a sequence of dwells with different durations and fill volumes, has been shown to enhance both ultrafiltration and solute clearance compared to standard peritoneal dialysis with constant time and volume dwells. The aim of this non-interventional study was to describe the different prescription patterns used in aAPD in clinical practice and to observe outcomes characterizing volume status, dialysis efficiency, and residual renal function over 1 year. Prevalent and incident, adult aAPD patients were recruited during routine clinic visits, and aAPD prescription, volume status, residual renal function and laboratory data were documented at baseline and every quarter thereafter for 1 year. Treatments were prescribed according to the nephrologist's medical judgement in accordance with each center's clinical routine. Of 180 recruited patients, 160 were analyzed. 27 different aAPD prescription patterns were identified. 79 patients (49.4%) received 2 small, short dwells followed by 3 long, large dwells. During follow-up, volume status changed only marginally, with visit mean values ranging between 1.59 (95% confidence interval: 1.19; 1.99) and 1.97 (1.33; 2.61) L. Urine output and creatinine clearance decreased significantly, accompanied by reductions in ultrafiltration and Kt/V. 25 patients (15.6%) received a renal transplant and 15 (9.4%) were changed to hemodialysis. Options for individualization offered by aAPD are actually used in practice for optimized treatment. Changes observed in renal function and dialysis efficiency measures reflect the natural course of chronic kidney disease. No safety events were observed during the study period.The study has been funded by Fresenius Medical Care. The funder was involved in the design, analysis, decision to publish and preparation of the manuscript

Factors associated with poor nutritional status among hemodialysis patients in Malaysia

Introduction: Poor nutritional status is prevalent among hemodialysis patients, with limited studies available on how it is being influenced by other factors in the local context. The current study aimed to determine the nutritional status and its associated factors among hemodialysis patients. Methods: This was a study undertaken in a total of 455 hemodialysis patients (256 men and 199 women). The main outcome measure was Malnutrition Inflammation Score (MIS), which was utilized to identify nutritional and inflammatory status of the hemodialysis patients. Other evaluation tools included anthropometry and biochemical measurements as well as dietary assessment. Results: A high proportion of hemodialysis patients were malnourished (64.4%) and presented with inflammation (67.5%). Using multiple linear regression analysis, factors contributing to malnutrition were older age, lower lean body mass, higher interdialytic weight gain (IDWG), inadequate intakes of energy and protein, as well as presence of comorbidities and inflammation. Conclusion: The presence of malnutrition and inflammation were prevalent among hemodialysis patients. Several determinants of poor nutritional status of hemodialysis patients were modifiable and should be recognized while formulating and implementing appropriate intervention plans for this vulnerable group

Rapid detection and identification of pathogens in patients with continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis by 16s rRNA gene sequencing

Peritonitis still remains a serious complication with high rate of morbidity and mortality in patients on CAPD. Rapid and accurate identification of pathogens causing peritonitis in a CAPD patient is essential for early and optimal treatment. The aim of this study was to use 16S rRNA and ITS gene sequencing to identify common bacterial and fungal pathogens directly from the peritoneal fluid without culturing. Ninety one peritoneal fluids obtained from 91 different patients on CAPD suspected for peritonitis were investigated for etiological agents by 16S rRNA and ITS gene sequencing. Data obtained by molecular method was compared with the results obtained by culture method. Among the 45 patients confirmed for peritonitis based on international society of peritoneal dialysis (ISPD) guidelines, the etiological agents were identified in 37(82.2%) samples by culture method, while molecular method identified the etiological agents in 40(88.9%) samples. Despite the high potential application of the 16S rRNA and ITS gene sequencing in comparison to culture method to detect the vast majority of etiological agents directly from peritoneal fluids; it could not be used as a standalone test as it lacks sensitivity to identify some bacterial species due to high genetic similarity in some cases and inadequate database in Gene Bank. However, it could be used as a supplementary test to the culture method especially in the diagnosis of culture negative peritonitis

Isolated renal sarcoidosis with acute kidney injury - a rare entity

Sarcoidosis is a multisystem inflammatory disorder that commonly affecting the lungs. However, isolated renal sarcoidosis without lung involvement is a rare condition. Sarcoidosis is known to cause kidney involvement via different mechanisms. Hypercalcemia and hypercalciuria may trigger renal stones formation and result in obstructive uropathy. Sarcoidosis can also cause interstitial nephritis with or without granuloma formation in the kidneys. The true incidence of renal involvement in sarcoidosis is unknown as renal biopsy is not routinely performed unless there is presence of renal impairment. Renal sarcoidosis is a diagnosis of exclusion supported by the typical histopathological findings. Due to the scarcity of this disease, there is no universal guideline or recommendation regarding the diagnosis and treatment for renal sarcoidosis. Here we present a case that initially presented to us with rapid deterioration of kidney function, which was later proven to be renal sarcoidosis, followed by a literature review

Rapid decline of renal function in patients with type 2 diabetes with heavy proteinuria: a report of three cases

Background: Although there is a large volume of literature regarding the definition and epidemiology of type 2 diabetes nephropathy (T2DN). There has been a paucity of data focused on the rate of transition of T2 DN. Based on our personal observation a certain percentage of our incident end stage renal disease (ESRD) patients from T2DN experienced a rapid decline of renal function. Their rapid decline nature of glomerular filtration rate (GFR) of 46 to 60 mL/min per 1.73m2 per year have far exceeded the KDIGO definitions of acute kidney injury (abrupt decrease in kidney function occurring over 7 days or less), acute kidney disease (acute or subacute damage and/or loss of kidney function for a duration of between 7 and 90 days after exposure to an acute kidney injury initiating event (Chawla et al Nat Rev Nephrol 241–57 2017) or even rapid decliner (eGFR declines > 5 mL/min per 1.73m2 per year) (Chawla et al Nat Rev Nephrol 241–57 2017; Andrassy Kidney Int 622–623 2013). Case presentation: We describe here three cases of type 2 diabetic patients that have rapid renal deterioration with rate of decline 46 - 60 mL/min per 1.73m2 per year. All the patients are heavily nephrotic. All of the renal biopsies done showed the classical diabetic changes, hypertensive changes, diffuse tubulointerstitial damage, and interstitial nephritis. All of the patients admitted to taking various form of traditional medications in hope of curing their renal disease. Conclusion: We wish to highlight that type 2 diabetics with massive nephrotic range proteinuria have enhanced risk of rapid renal function deterioration. The patients should be educated about the risks of rapid renal function deterioration when there is presence of heavy proteinuria. High grade proteinuria is likely to inflict the diffuse tubulointerstitial inflammation. The interstitial nephritis could be further worsened by traditional supplements consumption. Timely health education and advice must be undertaken to retard this unwanted rapid renal disease progression

A multicentre, multi-national, double-blind, randomised, active-controlled, parallel-group clinical study to assess the safety and efficacy of PDA10 (Epoetin-alpha) vs. Eprex® in patients with anaemia of chronic renal failure

Background Erythropoietin stimulating agent (ESA) has been standard of care in treating renal anaemia for the past 20 years. Many patients have limited access to ESA in view of long-term costs leading to suboptimal ESA dosage. Biosimilar epoetin is a potential cost-effective alternative to originator for optimal renal anaemia management. Objective To determine efficacy and safety of PDA10 in treating renal anaemia in haemodialysis patients, in comparison to the originator epoetin-α, Eprex®. Methods A phase 3, multicentre, multi-national, double-blind, randomised, active-controlled and parallel group study conducted over 40 weeks in Malaysia and Korea. End stage kidney disease patients undergoing regular haemodialysis who were on erythropoietin treatment were recruited. The study has 3 phases, which included a 12-week titration phase, followed by 28-week double-blind treatment phase and 24-week open-label extension phase. Results The PDA10 and Eprex® were shown to be therapeutically equivalent (p < 0.0001) with mean absolute change in haemoglobin from baseline of − 0.176 (± 0.91) g/dl and − 0.118 (± 1.114) g/dl, respectively. Weekly dose change was 10.01 IU/kg/week in PDA10 group and 10.30 IU/kg/week in Eprex® group, which has no significant difference. There were no significant differences in the safety profile between PDA10 and Eprex® groups. Conclusion This study has confirmed the therapeutic equivalence between PDA10 and Eprex® in terms of efficacy, dosage requirement and safety profile in haemodialysis patients with renal anaemia. Trial registration The study was registered with the National Medical Research Register ( NMRR-13-400-16313 ). This study has been registered retrospectively with Clinical Research Information Service ( CRiS ), Republic of Korea on 25 March 2021.This study was supported by a grant from Duopharma Biotech Bhd. (Malaysia) and Pangen Biotech Inc. (Korea)

Association of dietary patterns with serum phosphorus in maintenance haemodialysis patients: a cross-sectional study

Sources of dietary phosphate differentially contribute to hyperphosphatemia in maintenance haemodialysis (MHD) patients. This cross-sectional study in Malaysia investigated association between dietary patterns and serum phosphorus in MHD patients. Dietary patterns were derived by principal component analysis, based on 27 food groups shortlisted from 3-day dietary recalls of 435 MHD patients. Associations of serum phosphorus were examined with identified dietary patterns. Three dietary patterns emerged: Home foods (HFdp), Sugar-sweetened beverages (SSBdp), and Eating out noodles (EO-Ndp). The highest tertile of patients in HF (T3-HFdp) pattern significantly associated with higher intakes of total protein (p = 0.002), animal protein (p = 0.001), and animal-based organic phosphate (p  2.00 mmol/l was significantly 2.35 times higher (p = 0.005) with the T3-SSBdp. The SSBdp was associated with greater consumption of inorganic phosphate and higher serum phosphorus levels