नेफ्रोलॉजी और थेरेप्यूटिक्स जर्नल

Acute renal failure after kidney transplantation frequently occurs and often represents a real challenge for the clinician. Acute rejection is the first diagnostic suspect but many other conditions, mimicking rejection, should be considered. A prompt diagnosis is recommended to avoid treatment delay or mistreatments. Page kidney phenomenon is a well-known condition in which an extrinsically compressed kidney results in hypertension and loss of renal function. It should be always considered among the acute complications of renal transplantation. Prompt recognition and early intervention are essential to restore renal function before irreversible damage occurs. We describe a Page kidney phenomenon as an acute complication due to a lymphocele compression.Proximal TEC-CD44 influenced the renal inflammatory milieu and TEC-CD44v3 associated with expression of anti-inflammatory molecules.

Purpose: To detect the differences in age, weight and height between three major stone groups.

Materials and Methods: We retrospectively reviewed all patients with a diagnosis of nephrolithiasis in a large healthcare network from January 2000 to July 2014, for whom information on stone composition, age, sex, weight and height was available. Patients less than 18 years were excluded. Patients were characterized by gender and the major component of their stone analysis. We used Wilcoxon rank-sum test for continuous variables to detect the significant differences and multiple logistic regression analysis to evaluate the relative risk between stone groups.

Results: 14,961 adult patients were identified. The Distribution of pure (≥ 90%) calcium oxalate, phosphate and uric acid stones in men, was (71%), (7%) and (22%) while in women it was (65%), (19%) and (16%) respectively. Males with calcium oxalate stones were taller than those with calcium phosphate by 2 cm (p=0.0006). Women with calcium phosphate stones were younger than those with calcium oxalate stones by 5 years (p=0.0001).

Conclusions: Calcium phosphate stone composition is associated with a shorter stature in men and younger age in women in relation to those with calcium oxalate stones.

We came across a somewhat peculiar case of terminal renal insufficiency in an elderly lady. We believe this case
illustrates well the difficulties that a clinician faces on daily basis regarding the evaluation of glomerular filtration rate
building on serum Creatinine level measurement alone. We have witnessed a creatinine clearance plunging till less than
2 ml/min without real need for renal replacement therapy. We have performed a Cystatine c serum level measurement
for comparison.

Systemic inflammatory response syndrome (SIRS) typically causes multiple-organ dysfunction/failure, including acute kidney injury (AKI). CD44 comprises a family of 85–200 kDa transmembrane glycoproteins that are widely expressed by multiple cell types and involved in a variety of inflammatory diseases. The multiple functions of CD44 have been attributed to the existence of numerous CD44 isoforms generated by alternative mRNA splicing as well as by extensive post-translational modifications. Renal CD44 expression is minimal in healthy adult kidneys, whereas in inflammatory renal disorders CD44 expression is markedly induced particularly in injured tubular epithelial cells (TEC) both in human diseases and in animal models. The function of CD44 on TEC remains unclear; previously we showed that the shortest isoform CD44 standard (CD44s) and the long CD44 variant 3-10 (CD44v3) exert opposite effects in fibrotic settings. To assess the contribution of tubular expression of CD44s and CD44v3 in SIRS-associated AKI, we used WT and unique transgenic mice expressing CD44s or CD44v3 specifically on proximal TEC. Mice were subjected to intraperitoneal injection of LPS and were sacrificed 4 and 24 hours later. The presence of CD44-isoforms in TEC did not alter the onset of kidney dysfunction or lymphocyte influx but affected the induction of KIM-1 and pro-/anti-inflammatory cytokines after LPS injection. Transgenic kidneys expressing CD44s/CD44v3 displayed more KIM-1 expression, less TNF-α and IL-1β at 4 hours compared to WT kidneys. At 24 hours, CD44v3-expressing kidneys showed elevated IL-10 and TLR4 negative regulator mRNA levels. Proximal TEC-CD44 influenced the renal inflammatory milieu and TEC-CD44v3 associated with expression of antiinflammatory molecules.

In this study, we sought to investigate the morbidity and mortality due to chronic renal failure (CRF) in a hospital with very limited access to renal replacement therapy. We did a retrospective study conducted at the Department of Nephrology at Donka National Hospital in Conakry (Guinea) over a period of 6 years, from January 1st 2006 to December 31st, 2011. Were included into the study, all patients hospitalized in the ward for chronic renal failure whose records were complete; 484 records (H 56.40% F 43.60%) were used. The average age was of 41.9 ± 15.17 years (15- 80 years). Three hundred and thirty-seven patients (69.63%) were under educated. Housewives and workers accounted for 55.60% of the population. Renal failure was moderate in 14%, severe in 21% and renal failure in 65%. Proteinuria was positive in 359 patients. Probable causes were chronic glomerulonephritis (37.8%), vascular nephropathy (31.2%), interstitial nephropathy (9.9%), diabetic nephropathy (7.4%), a HIVAN (3.3%), polycystic kidney disease (1.9%); the nephropathy was undetermined in 8.5% of cases. The risk factors for renal disease were hypertension in 371 cases (76.65%), consumption of nephrotoxic drugs in 328 cases (67.76%), smoking in 99 cases (12.39%) and diabetes in 51 cases (10.5%). Only 315 patients underwent hemodialysis; 20% died. Among the causes of death: anemia, heart failure, HIV, pericarditis, and stroke were statistically significant.

Objective: Urinary tract infection diagnosis by urine culture can be time- and labor- consuming. In the National Kidney and Transplant Institute, up to 75% of urine culture samples sent to the laboratory yield no growth or insignificant growth. A rapid and reliable screening method to rule out bacterial UTI could reduce culture workload, turnaround time of negative results and also unnecessary antibiotic prescription. Sysmex UF-1000i is urine flow cytometry analyzer which is capable of quantifying urine particles including bacteria and leukocytes. We evaluated the UF-1000i performance for ruling out UTIs and its bacterial scattergram feature to estimate the causative bacterial group, using standard urine culture results as reference method.

Methods: 293 urine samples were analyzed using Sysmex UF-1000i analyzer and compared with urine culture results. Bacterial cluster distribution in the bacterial scattergram of positive cultures was also analyzed for causative bacterial class estimation.

Results: Out of 293 urine samples, 104 (35.5%) samples had bacterial growth of more than 103 CFU/ml on culture and most common organism isolated was Escherichia coli (28.8%). The optimum bacterial cut off value of 55/μl and/or leukocytes cut-off value of 27/μl were observed using ROC analysis to rule out UTI. The bacterial scattergram analysis showed 82.7% concordance with the results of the urine culture, with only 5.8% discordant results, and 11.5% had results showing non-specific or wide distribution patterns near the 30° angle.

Conclusions: Urine samples can be routinely screened for UTI using the Sysmex UF-1000i, and this can improve the overall turnaround time of negative results and reduce laboratory culture workload