Nephrology

The renal segmental distribution of claudins changes with defunctions as a fence that maintains a polarized distribuvelopment. tion of lipids and proteins between the apical and basolat-Background. Permeability properties of mammalian nepheral plasma membrane [1, 2]. Although the biochemical ron are tuned during postnatal maturation. The transepithelial nature of TJs remained elusive for a long time, the diselectrical resistance (TER) and complexity of tight junctions covery of several TJ and TJ-associated molecules pre-(TJs) vary along the different tubular segments, suggesting that the molecules constituting this structure change. We studied sented the opportunity of studying the relationship bethe differential expression of occludin and several claudins in tween structure and function of these cell-cell junctions isolated renal tubules from newborn and adult rabbits. with improved precision. Using conventional freeze-fracture, tight junctions have rabbits were processed for occludin, claudin-1 and claudin-2 been described as a series of strands and grooves that immunofluorescence, and Western blot detection of claudin-1 and -2. Claudin-5 was detected in whole kidney frozen sections. anastomose to form a meshwork that encircles the cells RT-PCR from isolated tubules was performed for claudins-1 at the uppermost portion of the lateral membrane [3]. to -8. The recent development of sodium dodecyl sulfate-Results. Immunofluorescence revealed that occludin, claudigested freeze-fracture replica labeling (SDS-FRL) aldin-1 and -2 were present at the cell boundaries at the neonatal stage of development. Claudin-1 was detected in the tighter lowed the immunocytochemical detection of the proteins segments of the nephron (distal and collecting duct), while constituting TJ strands [4]. This procedure thus permitclaudin-2 was found in the leaky portions (proximal). Claudin 5 ted the identification of occludin and claudins for the was found in the kidney vasculature. PCR amplification refirst time as TJ filament components [5-7]. vealed the presence of claudins-1 to -4 in tubules of newborns. Occludin, with a molecular mass of ϳ65 kD, is comprised In adults, claudins-1, -2 and -4 were present in proximal, Henle's loop and collecting segments; claudin-3 was in proximal and of four transmembrane domains, a long COOH-terminal collecting tubules, while claudins-5 and -6 were absent from all cytoplasmic region, a short NH 2 -terminal cytoplasmic dotubular portions. Claudin-7 was restricted to proximal tubules, main, two extracellular loops and one intracellular turn. while claudin-8 was present in proximal and Henle's segments. Occludin is a functional component of TJs as (1) its over-Conclusions. The pattern of occludin distribution is present expression in epithelial cells augments the transepithelial from the neonatal age. Claudins-7 and -8 are up-regulated after electrical resistance (TER) [8, 9]; (2) introduction of a birth. Each tubular segment expresses a peculiar set of claudins that might be responsible for the permeability properties of carboxyl truncated occludin increases paracellular leaktheir TJs. age [10]; (3) addition of a synthetic peptide homologous to the second extracellular loop of occludin down-regulates the TER [11]; and (4) introduction of terminally The tight junction (TJ) constitutes the main barrier in truncated occludin into epithelial cells alters the mainteepithelia to the passive movement of electrolytes and manance of the polarized distribution of lipids and proteins cromolecules through the paracellular pathway. It also in the plasma membrane [5, 9]. Despite this evidence, the structure and function of TJs cannot be explained by occludin alone, as endothelial and Sertoli cells possess TJs

Practicing clinical nephrologists are performing fewer diagnostic kidney biopsies. Requiring biopsy procedural competence for graduating nephrology fellows is controversial. An anonymous, on-line survey of all Walter Reed training program graduates (=82; 1985-2017) and all United States nephrology program directors (=149; August to October of 2017), regarding kidney biopsy practice and training, was undertaken. Walter Reed graduates' response and completion rates were 71% and 98%, respectively. The majority felt adequately trained in native kidney biopsy (83%), transplant biopsy (82%), and tissue interpretation (78%), with no difference for ≤10 versus >10 practice years. Thirty-five percent continued to perform biopsies (13% did ≥10 native biopsies/year); 93% referred at least some biopsies. The most common barriers to performing biopsy were logistics (81%) and time (74%). Program director response and completion rates were 60% and 77%. Seventy-two percent cited ≥1 barrier to...

Background: Hepatorenal syndrome (HRS) is a frequent and serious complication in decompensated cirrhosis. The objective of this study was to describe the epidemiology, clinical profiles and outcomes of hepatorenal syndrome (HRS). Methods: This was a retrospective and descriptive study over a period of 75 months, from January 2011 to March 2017, carried out at

Background: Although there has been increasing interest in assessing patient satisfaction with health care during the past year, relatively few studies investigated hemodialyzed patient satisfaction. Study Design: Cross-sectional study of the relationship between burnout in nephrologists and nurses and patient satisfaction with their care. Setting & Participants: Nephrologists (n ϭ 68), nurses (n ϭ 334), and hemodialyzed patients (n ϭ 695) from 10 dialysis centers across northern Italy. Predictor: Staff burnout was assessed using the Maslach Burnout Inventory. Three staff burnout subscales were developed by using factor analysis: Emotional Exhaustion, Depersonalization, and Personal Accomplishment. Outcomes: Patient satisfaction was assessed by means of a multichoice questionnaire that incorporated 4 patient satisfaction dimensions: (1) completeness of medical information, (2) emotional relationship with health care staff, (3) performance of dialysis center staff, and (4) organizational aspects of health care service. Each item was scored on a 4-point scale ranging from 1 (very dissatisfied) to 4 (very satisfied). Spearman rank-order correlation was used to examine relationships between patient satisfaction and each of the 3 staff burnout subscales for each dialysis center. Results: Overall, burnout scores were lower than the Italian normative sample, with no significant differences between physicians and nurses. However, considering each dialysis center separately, in 2 centers, nurses registered higher emotional exhaustion levels compared with physicians, with statistically significant differences (P ϭ 0.004 and P ϭ 0.003, respectively). Analysis of patient overall satisfaction assessments showed general appreciation for the "courtesy" and "kindness" of staff, but evidence of problems regarding organizational aspects and structural factors. However, the most critical dimension was for "information." There was a significant positive correlation between staff personal accomplishment and client satisfaction (P Ͻ 0.01) and a significant negative correlation between staff emotional exhaustion and patient satisfaction (P Ͻ 0.01). No significant correlation was found between staff depersonalization and patient satisfaction level. Limitations: Factor analysis should be considered exploratory and confirmed in future use of the questionnaire. Our results suggest that high levels of burnout in physicians and nurses are associated with poor patient satisfaction in dialysis units. Identifying and preventing staff burnout may increase patient satisfaction with health care.

Purpose: We present our combined experience with a simplified posterior urethroplasty technique to determine the necessity and usefulness of ancillary reconstructive maneuvers. We reviewed the records of 135 men and 7 boys who underwent reconstruction of traumatic posterior urethral defects with greater than 1 year of followup from 5 tertiary teaching hospitals. Prior treatments, surgical approach and ancillary techniques required during reconstruction were compiled. Results: Direct anastomosis following scar excision and urethral mobilization alone was performed in 95 of the 142 males (67%). Formal corporal splitting was performed in 24 patients (17%) and inferior pubectomy in was done in 14 (10%). Supracrural urethral rerouting was performed in only 4 patients (3%), of whom 3 (75%) experienced recurrent stenosis. Abdominoperineal reconstruction, which was reserved mainly for salvage and pediatric cases, was required to reconstruct complex defects in 5 of the 142 cases (4%) and it was successful in 4 (80%). Early urethral realignment was associated with successful subsequent reconstruction in all patients in whom this maneuver was achieved (17 of 17 or 100%). This maneuver tended to be straightforward. Overall successful posterior urethral reconstruction was achieved in 130 of 142 cases (92%). Eight failures were successfully salvaged by internal urethrotomy (3) or repeat urethroplasty (5). Conclusions: Ancillary maneuvers such as corporal splitting or inferior pubectomy are seldom required for successful posterior urethral reconstruction. Urethral rerouting appears to be inferior to the abdominoperineal approach as a salvage maneuver for complex cases. Primary realignment appears to promote more simplified and successful surgical repair.

The epidermal growth factor receptor (EGFR) and hedgehog cascades provide a critical role in prostate cancer progression and contribute to the resistance to clinical therapies and disease relapse. Therefore, we evaluated, for the first time, the antiproliferative and cytotoxic effects induced by a combination of selective inhibitors of EGFR tyrosine kinase and smoothened hedgehog signaling element, gefitinib and cyclopamine, with a current chemotherapeutic drug used in the clinics, docetaxel, on some metastatic prostate cancer cell lines. Immunohistochemical analyses revealed that sonic hedgehog (SHH) expression was enhanced in 39% of primary prostatic adenocarcinomas (Gleason scores 4 -10) compared with the corresponding normal tissues of the same prostate gland from 32 prostate cancer patients. The confocal microscopy and Western blot analyses have also indicated the high expression levels of SHH and EGFR in metastatic LNCaP, DU145, and PC3 cells. Moreover, the results revealed that the drugs, alone or in combination, at lower concentrations inhibited the growth of EGF plus SHH -stimulated and serum-stimulated androgenresponsive LNCaP-C33 and androgen-independent LNCaP-C81, DU145, and PC3 cells. Importantly, the combined docetaxel, gefitinib, and cyclopamine also caused a higher rate of apoptotic death of prostate cancer cells compared with individual agents. The cytotoxic effects induced by these drugs in PC3 cells seem to be mediated in part through the cellular ceramide production and activation of caspase cascades via a mitochondrial pathway and the release of cytochrome c into the cytosol. Additionally, the combined agents were more effective at suppressing the invasiveness of PC3 cells through Matrigel in vitro than the single drugs. These findings indicate that the combined use of inhibitors of EGF-EGFR and hedgehog signaling with docetaxel could represent a more promising strategy for treatment in patients with metastatic and androgen-independent prostate cancer. [

Table 1: KDIGO staging of AKI Stage Creatinine Urine output 1 1.5 -1.9 times baseline, or ≥ 26.5µmol/l increase < 0.5ml/kg/hr for six to twelve hours 2 2.0 -2.9 times baseline < 0.5ml/kg/hr for ≥ twelve hours 3 3.0 or more times baseline, or creatinine ≥ 353.6 µmol/l, or initiation of RRT, or < 0.3ml/kg/hr for ≥ twenty four hours, or in patients < 18 years, decrease in eGFR to 35ml/min per 1.73 m 2 anuria for ≥ twelve hours RRT: Renal replacement therapy. eGFR: Estimated glomerular filtration rate. From Kellum et al., 2012.

Safe and effective vaccination of patients living with chronic kidney disease requires an understanding of the unique immunological milieu of this population and of their potential for disease-specific side effects. This Position Statement, issued on behalf of the South African Nephrology Society, provides recommendations for local policy development and for individual practice administration and monitoring of SARS-CoV-2 vaccinations in patients living with chronic kidney disease.

Introduction: Acute kidney injury (AKI) in hospitalized patients infected with COVID-19 is associated with an elevated mortality rate compared to non-infected patients (39% versus 24%). This is despite a lower prevalence of AKI in COVID-19-infected patients (17 vs 22%). The reasons are multifactorial and have been well documented in developed countries, whereas in developing countries there are scant data. Methods: This study aimed to document the mortality in COVID-19-infected South African patients who required dialysis for AKI. Exclusion criteria included any chronic kidney replacement therapy (transplantation or dialysis). A REDCap survey of South African nephrologists and nephrology fellows registered with the South African Nephrology Society was conducted. The primary outcome was all-cause in-hospital mortality, while additional points of interest included comorbidities, dialysis modality and intervention required. Univariate analysis of mortality predictors was performed. Res...

Congenital thrombotic thrombocytopenia purpura (cTTP) is a very rare disorder worldwide. Standard treatment of recognized cases has been to administer fresh frozen plasma as the source of ADAMTS13, to replenish the absent ADAMTS13 enzyme. An alternative source, a plasma-derived factor VIII concentrate used for hemophilia A, and found to contain this enzyme, was reported to be effective in 1 patient in the United States. We now report details on a US cohort of 8 cTTP patients who have been successfully treated for varying periods with a marketed antihemophilic factor concentrate Koate-DVI. This biological product has been used successfully on demand in varying doses to treat acute exacerbations, as well as prophylactically (3 to 6 U ADAMTS13 every 3 to 21 d). Self-infused at home, in lieu of fresh frozen plasma therapy in the hospital setting, this product has effectively prevented episodes of thrombocytopenia, microangiopathic hemolytic anemia, and the concomitant organ damage in these patients. This specific virus inactivated product can be used to prevent further manifestations of this congenital enzyme deficiency.

Acute renal impairment is observed in 11%-23% of patients with congenital thrombotic thrombocytopenic purpura (TTP) and deficiency of a disintegrin and metalloprotease with thrombospondin motifs 13 (ADAMTS13, a metalloprotease that cleaves von Willebrand factor [VWF] multimers), a substantial percentage of whom develop CKD during follow-up. Here we investigated whether, in 18 patients with congenital recruited from 1996 to 2013 who fulfilled inclusion criteria, acute renal involvement occurred during bouts segregated with lower secretion and activity levels of ADAMTS13 mutants. We performed expression studies and a sensitive recombinant VWF (rVWF) A1-A2-A3 cleavage test (detection limit, 0.78% of normal ADAMTS13 activity). A higher risk of acute renal impairment during bouts was observed in patients with childhood (&lt;18 years) onset (odds ratio [OR], 24.6 [95% confidence interval (CI), 1.11 to 542.44]) or a relapsing (≥1 episode per year) disease (OR, 54.6 [95% CI, 2.25 to 1326.28...

Several abnormalities in complement genes reportedly contribute to atypical hemolytic uremic syndrome (aHUS), but incomplete penetrance suggests that additional factors are necessary for the disease to manifest. Here, we sought to describe genotype-phenotype correlations among patients with combined mutations, defined as mutations in more than one complement gene. We screened 795 patients with aHUS and identified single mutations in 41% and combined mutations in 3%. Only 8%-10% of patients with mutations in CFH, C3, or CFB had combined mutations, whereas approximately 25% of patients with mutations in MCP or CFI had combined mutations. The concomitant presence of CFH and MCP risk haplotypes significantly increased disease penetrance in combined mutated carriers, with 73% penetrance among carriers with two risk haplotypes compared with 36% penetrance among carriers with zero or one risk haplotype. Among patients with CFH or CFI mutations, the presence of mutations in other genes did not modify prognosis; in contrast, 50% of patients with combined MCP mutation developed end stage renal failure within 3 years from onset compared with 19% of patients with an isolated MCP mutation. Patients with combined mutations achieved remission with plasma treatment similar to patients with single mutations. Kidney transplant outcomes were worse, however, for patients with combined MCP mutation compared with an isolated MCP mutation. In summary, these data suggest that genotyping for the risk haplotypes in CFH and MCP may help predict the risk of developing aHUS in unaffected carriers of mutations. Furthermore, screening patients with aHUS for all known disease-associated genes may inform decisions about kidney transplantation.

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are highly effective in managing blood glucose and offer cardiorenal benefits. However, real-world adherence remains a challenge. This consensus paper, developed by 14 national experts through literature review and virtual discussions, addresses factors behind nonadherence and discontinuation. Key findings highlight demographic and clinical risk factors, and propose actionable strategies including personalized patient education, better selection criteria, and improved communication between doctors and patients to enhance long-term adherence and reduce withdrawal.

Background: C1q nephropathy also known as seronegative lupus nephritis,
is a relatively rare form of glomerulonephritis which is less understood
till now. With the advancement of immunofluorescence and electron
microscopic histopathological examination more and more new cases are
being diagnosed now a days. Previously it was considered as a diseases
of children and young adults but in practical point of view a large number
of adult patients are affected by these diseases. The aim of this study is to
review the incidence, clinical features, histolopathological morphology of
C1q nephropathy in adult Bangladeshi population in BSMMU.
Methods and Material: This is a retrospective study done in nephrology
department of BSMMU. Out of 180 biopsy reports which were done in
between 2020 to 2025, 10 reports of C1q nephropathy were retrieved.
Results: This study shows the incidence of C1q Nephropathy is 5.5%,
mostly females are affected (80%). Mean age at presentation was 35.5
year. Most common presentation was hematuria with sub nephrotic
range proteinuria(50%), Nephrotic range proteinurea was present in 20%
cases, 2 patients presentd with isolated proteinuria(20%). 1 patient (10%)
presented with renal impairments. Regarding histopathological findings all
patients had mesangeal proliferation, 70% patients had dominant and 30 %
patients had co-dominant deposition of C1q in the mesangium.
Conclusion: This study gives an idea regarding the clinicopathological
findings of C1q nephropathy in Bangladeshi population.

Background: Lower back pain (LBP) is a prevalent and debilitating condition among healthcare professionals and students, significantly affecting their quality of life, work productivity, and mental well-being. Non-specific LBP, which accounts for approximately 90% of all cases, is characterized by pain without an identifiable structural or neurological cause. This case report explores the diagnosis, management, and prevention strategies for non-specific LBP in healthcare professionals and students, with a focus on the role of proper body mechanics and ergonomics in mitigating the risk of injury. Case Presentation: A 38-year-old female registered nurse (RN) with 12 years of experience and a 24-year-old nursing student presented with non-specific LBP. Both cases were linked to improper body mechanics during patient care activities, such as lifting and transferring patients. The RN reported pain localized to the lower lumbar region, worsened by prolonged standing and bending, while the nursing student described similar symptoms following intensive clinical rotations. Both individuals were diagnosed with non-specific LBP based on clinical examination and imaging studies, which showed no structural abnormalities. A multimodal treatment approach was adopted, including pharmacological therapy (NSAIDs, muscle relaxants), physical therapy focusing on core and lumbar muscle strengthening, and education on ergonomic practices to improve posture and prevent further injury. Discussion: Non-specific LBP is a common issue among healthcare professionals and students, often exacerbated by physical strain and poor body mechanics during clinical tasks. The cases presented demonstrate the importance of early diagnosis and the integration of both pharmacological and non-pharmacological treatments. Pharmacological interventions, including NSAIDs and muscle relaxants, provide immediate relief, while physical therapy and ergonomic education address the root causes and help prevent recurrence. It is crucial to incorporate ergonomics and body mechanics training into healthcare curricula to reduce the incidence of musculoskeletal injuries and improve long-term health outcomes for both professionals and students. Conclusion: This case report underscores the effectiveness of a comprehensive, multimodal approach to managing non-specific LBP in healthcare professionals and students. Early intervention, proper ergonomic education, and a combination of pharmacological and rehabilitative treatments can significantly improve both pain management and functional recovery. Proactive measures, such as integrating ergonomics training into healthcare education, are essential for reducing the burden of LBP in this high-risk population.

Congenital nephrogenic diabetes insipidus (NDI) is a rare disorder of the kidney characterized by the failure to concentrate urine despite normal or elevated plasma concentrations of the antidiuretic hormone arginine vasopressin (AVP). The identification, characterization, and mutational analysis of two different genes, i.e., the AVP receptor 2 gene (AVPR2) and the vasopressinsensitive water channel gene (aquaporin-2 [AQP2]), provide the basis for our understanding of two different hereditary forms of ND!: X-linked ND! and autosomal recessive NDI. A majority (&gt;90%) of congenital ND! patients have AVPR2 mutations: Of 1 15 families with congenital ND! that were referred to our laboratories in Montreal and Berlin, 105 families had A VPR2 mutations and 10 had AQP2 mutations. When studied in vitro, most AVPR2 mutations lead to receptors that are trapped intracellularly and are unable to reach the plasma membrane. A minority of the mutant receptors reach the cell surface but are unable...

Background Chronic kidney disease (CKD) is a progressive disease that causes a permanent impairment of renal function and premature mortality. The associated prognosis may result in serious psychological distress to the affected individual. However, there are limited data on the psychological correlates, and in particular depression, in Chinese CKD patients. This study aimed to examine the prevalence of depression, as well as the influence of other psychosocial factors on depression, among Taiwanese CKD patients. Methods We used a cross-sectional research design to recruit 270 CKD patients who were not undergoing dialysis treatment at a hospital in southern Taiwan during 2011. The structured questionnaire used in this study gathered information on respondent demographic and disease characteristics, and information obtained from the Taiwanese Depression Questionnaire. Factors associated with depression were examined by a multiple logistic regression analysis. Results The crude and ag...

Background-In spite of intensive efforts, understanding of the genetic aspects of familial prostate cancer remains largely incomplete. In a previous microsatellite-based linkage scan of 1233 prostate cancer (PC) families, we identified suggestive evidence for linkage (i.e. LOD≥1.86) at 5q12, 15q11, 17q21, 22q12, and two loci on 8p, with additional regions implicated in subsets of families defined by age at diagnosis, disease aggressiveness, or number of affected members. Methods-In an attempt to replicate these findings and increase linkage resolution, we used the Illumina 6000 SNP linkage panel to perform a genome-wide linkage scan of an independent set of 762 multiplex PC families, collected by 11 ICPCG groups. Results-Of the regions identified previously, modest evidence of replication was observed only on the short arm of chromosome 8, where HLOD scores of 1.63 and 3.60 were observed in the complete set of families and families with young average age at diagnosis, respectively. The most significant linkage signals found in the complete set of families were observed across a broad, 37 cM interval on 4q13-25, with LOD scores ranging from 2.02 to 2.62, increasing to 4.50 in families with older average age at diagnosis. In families with multiple cases presenting with more aggressive disease, LOD scores over 3.0 were observed at 8q24 in the vicinity of previously identified common PC risk variants, as well as MYC, an important gene in PC biology. Conclusions-These results will be useful in prioritizing future susceptibility gene discovery efforts in this common cancer.

We aimed to determine the prevalence of chronic kidney disease (CKD) and its cross-country variation among hypertensive individuals in rural Bangladesh, Pakistan and Sri Lanka. We also explored the factors associated with CKD in these populations. We studied baseline data from the Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan and Sri Lanka (COBRA-BPS) trial, an ongoing cluster randomized controlled trial on 2643 hypertensive adults ≥40 years of age from 30 randomly selected rural clusters, 10 in each of the three countries. CKD was defined as an estimated glomerular filtration rate (eGFR) &lt;60 mL/min/1.73 m2 or a urine albumin:creatinine ratio (UACR)  ≥30 mg/g. Determinants for CKD were assessed using logistic regression analysis. The overall prevalence of CKD was 38.1% (95% confidence interval 36.2-40.1%): 21.5% with eGFR &lt;60 mL/min/1.73 m2 and 24.4% with UACR ≥30 mg/g. CKD prevalence varied across the three countries (58.3% in Sri Lanka, 36.4% Bangladesh...

OBJECTIVETo investigate the primary pharmacology of fesoterodine (a novel antimuscarinic drug developed for treating overactive bladder) and SPM 7605 (its active metabolite, considered to be the main pharmacologically active principle of fesoterodine in man) against human muscarinic receptor subtypes, and to investigate in vitro and in vivo functional activity of these agents on the rat bladder compared with existing standard agents.MATERIALS AND METHODSThe displacement of radioligand binding by fesoterodine, SPM 7605 and standard agents in membrane preparations of Chinese hamster ovary (CHO) cells expressing the different human muscarinic receptors (M1–M5) was characterized. Agonistic and antagonistic activities were studied using different CHO cell lines stably expressing the human recombinant muscarinic receptor subtypes. The effects of fesoterodine and SPM 7605 on isolated bladder strips contracted by carbachol or electrical field stimulation (EFS) were investigated. In vivo the...

Introduction: Preeclampsia is a risk factor for maternal hypertension, including postpartum hypertension. However, postpartum hypertension is often missed, due to the suboptimal quality of postpartum care and the lack of follow-up in women with a history of preeclampsia. Objective: This systematic review aims to synthesize and evaluate existing interventions for preventing postpartum hypertension in women with a history of preeclampsia, using a narrative synthesis approach to assess their effectiveness and methodological quality. Methods: This systematic review used articles from Scopus, CINAHL, and PubMed. The search focus was postpartum care for hypertension prevention, particularly in women with a history of preeclampsia. Articles published between 2019 and 2024 were selected based on predefined eligibility criteria. We selected fully accessible articles that focused on postpartum care. The keywords used in the article search were "history of preeclampsia" OR "hypertensive disorder during pregnancy" AND "postpartum" AND "hypertension." The selected articles came from various countries in five continents (Asia, Africa, Europe, America, Australia, and Europe). The selection process adhered to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Results: There were 28 articles reviewed. Postpartum care involving education and regular follow-up increased knowledge and ability to control hypertension risk in women with a history of preeclampsia. There were six articles involving participants performing blood measurements independently and reporting them through an online application or in a text based format. Conclusion: This review confirms that women with a history of preeclampsia, especially severe preeclampsia, are at higher risk of postpartum hypertension. Tailored postpartum care is needed to mitigate the risk of postpartum hypertension and reduce rehospitalization. Continuous follow-up by health workers, either through face-to-face or telehealth monitoring, is important to ensure that mothers receive information and support in managing hypertension risk.

There is variable emphasis on dialysis-specific training among US nephrology fellowship programs. Our study objective was to determine the association between nephrology training experience and subsequent clinical practice. We conducted a national survey of clinical nephrologists using a fax-back survey distributed between March 8, 2010 and April 30, 2010 (N = 629). The survey assessed the time distribution of clinical practice, self-assessment of preparedness to provide care for dialysis patients at the time of certification examination, distribution of dialysis modality among patients, and nephrologists' choice of dialysis modality for themselves if their kidneys failed. While respondents spent 28% of their time caring for dialysis patients, 38% recalled not feeling very well prepared to care for dialysis patients when taking the nephrology certification examination. Sixteen percent obtained additional dialysis training after fellowship completion. Only 8% of US dialysis patients use home dialysis; physicians very well prepared to care for dialysis patients at the time of certification or who obtained additional dialysis training were significantly more likely to provide care to home peritoneal dialysis patients. Even though 92% of US dialysis patients receive thrice weekly in-center hemodialysis, only 6% of nephrologists selected this for themselves; selection of therapy for self was associated with dialysis modalities used by their patients. Nephrology training programs need to ensure that all trainees are very well prepared to care for dialysis patients, as this is central to nephrology practice. Utilization of dialysis therapies other than standard hemodialysis is dependent, in part, on training experience.

Article History Received: 20.11.2018 Accepted: 28.11.2018 Published: 30.12.2018 Abstract: Chronic kidney disease (CKD) is one among the slowly progressive diseases of kidney function characterized generally by low glomerular filtration rate (GFR). The replacement therapy of renal failure by hemodialysis involves the removal of excessive toxic fluids and toxic metabolic end products from the body. The present study aimed to assess serum Cystatin c and creatinine (pre and post) in CKD patients undergoing hemodialysis. The study included 50 patients with CKD who undergo dialysis. Serum creatinine and urea measured in pre and post-dialysis by colorimetric method, cystatin c was measured by using metric immunoassay. The data were analyzed using SPSS version 21. The results revealed that the mean of serum creatinine level in post-hemodialysis patients (3.05±1.12) were lower significant compared to pre-hemodialysis (8.76±2.26) pvalue 0.000, also serum urea level in post-hemodialysis patien...

To present our experience with laparoscopic rectourinary fistula (RUF) repair. RUF is a rare entity that can develop after ablative or extirpative prostate surgery. Successful management often requires an aggressive approach. Several techniques have been described for surgical correction. From October 2004 to October 2005, 3 patients were treated for RUF. The mean age was 63 years (range 58 to 68). RUF developed after open simple prostatectomy, open radical prostatectomy, and transurethral prostate resection. The operative steps were dependent on the location of the fistulous tract (bladder-prostate-urethra). When the fistula involved the prostatic capsule, the technique included capsulectomy and urethrovesical anastomosis. When the bladder was involved, a transvesical approach was used, involving dissection of the fistulous tract, closure of the rectum, tissue interposition, and bladder closure. The mean operative time was 247 minutes (range 230 to 270). The mean hospital stay was 2.6 days (range 2 to 3). No complications occurred. At a mean follow-up of 12 months (range 7 to 19), all patients were free of fistula recurrence. Laparoscopic repair of RUF is feasible and represents an attractive alternative to the standard approaches. The laparoscopic technique facilitates concomitant colostomy and tissue interposition without the need for patient repositioning or an additional incision. UROLOGY 70:

Hyperglycemia, oxidative stress and renin-angiotensin system (RAS) dysfunction have been implicated in diabetic nephropathy (DN) progression, but the underlying molecular mechanisms are far from being fully understood. In addition to the systemic RAS, the existence of a local intrarenal RAS in renal proximal tubular cells has been recognized. Angiotensinogen is the sole precursor of all angiotensins (Ang). Intrarenal reactive oxygen species (ROS) generation, Ang II level and RAS gene expression are up-regulated in diabetes, indicating that intrarenal ROS and RAS activation play an important role in DN. The nuclear factor erythroid 2-related factor 2 (Nrf2)-Kelch-like ECH-associated protein 1 (Keap1) pathway is one of the major protective processes that occurs in response to intracellular oxidative stress. Nrf2 stimulates an array of antioxidant enzymes that convert excessive ROS to less reactive or less damaging forms. Recent studies have, however, revealed that Nrf2 activation migh...

Objective: To described a needle renal lifting technique using an 18-gauge needle to adjunct ureterorenoscopy (URS) in the management of complicated proximal ureteral stones. Case(s) Presentation: A 46 years old man presented with right flank pain for 1 month. This patient was diagnosed with ureteral stone and ureteral kinking that prohibits access to the proximal side of the ureter. Due to difficult access to the proximal ureter, we perform a needle renal lifting technique which is initialized by puncturing the middle renal calyx with 18-gauge needle. Then, the proximal end of the needle was pushed to the caudal direction to move the kidney to the cephalic direction and straighten the kinked ureter. After that procedure, the URS sheat can easily enter the proximal ureter to the stone site. Discussion: The success rate of this procedure is based on the operator skills to access the calyx and perform URS simultaneously. Like a previous technique, needle renal lifting is effective onl...

Background/Aim: Benign prostatic hyperplasia (BPH) is characterized by the abnormal proliferation of prostate stromal cells, resulting in the enlargement of the prostate gland and the manifestation of troublesome symptoms, such as nocturia, urinary retention, and urinary incontinence. Dihydrotestosterone (DHT) and interleukin-17 (IL-17) are known to be key factors in promoting the overproduction of transforming growth factor-beta (TGF-β) in prostate stromal cells, contributing to their excessive proliferation, leading to BPH. Materials and Methods: In this study, selected plant extracts traditionally used to alleviate urinary symptoms were subjected to primary screening for their anti-proliferative activity by evaluating DHT-and IL-17-induced proliferation in WPMY-1 prostate stromal cells. This was followed by a secondary screening using TGF-β induction.

Medical records of 63 patients operated on for renal cell carcinoma (RCC) between 1986 and 1996 in the Karlovac General Hospital were studied retrospectively. In 23 (36.5%) patients, the tumor was incidentally detected. The median patient age was 62 in the incidental group and 64 years in the symptomatic group (P > 0.05). Ultrasonography was the leading technique for incidental detection of RCC. The median tumor diameter was 6 cm in the incidental group and 9 cm in the symptomatic group (P < 0.001). Incidental carcinomas had a lower stage (P 0.022) and a lower nuclear grade (P < 0.001) than the symptomatic ones. The incidental cases were associated with a more favorable ploidy status (P 0.027) and a lower proliferative activity (P 0.005). The 5-year survival rate was signi®cantly higher in incidental (81.4%) than in symptomatic cases (44.3%) (P 0.020). Univariate analysis showed that tumor stage, ploidy status, and proliferative activity were good prognostic parameters, while patient age, tumor size, and nuclear grade were not. Tumor stage was the only independent prognostic parameter in multi-variate analysis. In conclusion, the incidentally detected RCC show more favorable clinical, histopathological, and ¯ow-cytometric characteristics and their prognosis is signi®cantly better than in symptomatic cases.

Peritoneal dialysis (PD) for acute kidney injury (AKI) has been available for nearly 80 years and has been through periods of use and disuse largely determined by availability of other modalities of kidney replacement therapy and the relative enthusiasm of clinicians. In the past 10 years there has been a resurgence in the use of acute PD globally, facilitated by promotion of PD for AKI in lower resource countries by nephrology organizations effected through the Saving Young Lives program and collaborations with the World Health Organisation, the development of guidelines standardizing prescribing practices and finally the COVID-19 pandemic. This review highlights the history of PD for AKI and looks at misconceptions about efficacy as well as the available evidence demonstrating that acute PD is a safe and lifesaving therapy with comparable outcomes to other modalities of treatment.

staff and peers in order to share and maximize knowledge and selfcare skills. Some insights on how to improve health literacy programmes in ESRD can be drawn. Interventions targeted to improve interaction and communication between patients and renal professionals can be of benefit. Designing e-health education modules can also enable patients and families to successful obtain relevant and rigorous information about ESRD and its treatments.

do Porto. O percurso académico tem sido sempre coordenado com os objectivos profissionais, razão pela qual a aprendizagem ao longo da vida tem sido valorizada como forma de obtenção de competências e conhecimentos, para o desenvolvimento de uma carreira profissional nos domínios da Economia e Gestão Internacional. No campo profissional, desenvolve desde 1995 responsabilidades profissionais nas áreas da Gestão e Finanças. Entre 1995 e 2003, desenvolveu funções de Gestão Financeira em PME's nacionais de diferentes sectores de actividade, nomeadamente na Indústria Electromecânica e Comércio de Mobiliário. Entre 2004 e 2005 residiu em Fortaleza (CE) Brasil, onde desenvolveu funções de Controlo Financeiro Internacional num investimento directo de um grupo de empresas portuguesas na área da indústria de beneficiamento e acabamento têxtil. Desde 2006, e até à data, é Responsável Financeiro da subsidiária portuguesa do Grupo ABC Itália, multinacional de referência no sector do têxtil lar. iii Agradecimentos A presente Tese de Dissertação encerra um período de dois anos de exaustivo trabalho e dedicação para atingir os objectivos a que me propus, comprovando a importância para o futuro do ciclo de estudos que agora termina. Caso não tivesse tido o apoio geral de todos os que de um modo ou de outro contribuíram com o seu apoio para que eu pudesse terminar com sucesso esta etapa acredito que seria muito difícil manter o rigor e a motivação até ao final. À minha esposa, Patrícia, aos meus filhos Leonardo e Leonor, pelo apoio constante e pela compreensão por todo o tempo e atenção que lhes tirei nos últimos 24 meses; À minha mãe, Joaquina Rosa, pela forma como sempre esteve presente quando era necessário ajudar os meus filhos e ao meu pai, João, pelo apoio e força espiritual sempre sentida; Ao meu irmão, Sidónio, à minha cunhada, Ana, e aos meus sogros Jessica e Fernando, pelo apoio e ajuda para tomar conta dos meus filhos; À Direcção do MEGI, na pessoa da Prof. Dra. Ana Paula Africano, pela qualidade do ciclo de estudos e pela certeza da mais-valia das competências adquiridas para a minha vida profissional; Ao Prof. Dr. Rui Henrique Alves, pela orientação do presente trabalho e pelo apoio no esclarecimento das dúvidas e incertezas que sempre surgiram; Ao Grupo Jerónimo Martins, nas pessoas da Dra. Ana Franco e Dra. Rita Cardoso, pela prontidão na disponibilização da informação solicitada e prestação de esclarecimentos. A decisão de internacionalizar por meio de investimento directo em outros países implica que a empresa tem de cooperar directamente com parceiros com uma estrutura cultural diferente. Neste sentido, as diferenças culturais entre os países emissores e receptores de Investimento Directo Estrangeiro potenciam dificuldades à implementação de projectos de investimento, criando clivagens que podem comprometer o desenvolvimento de estratégias de cooperação nos mercados internacionais. Por esta razão as diferenças culturais entre países têm sido amplamente estudadas, existindo ao nível da literatura sobre IDE, diferentes estudos que abordam esta temática. O principal objectivo do presente trabalho é avaliar o impacto das diferentes dimensões culturais na performance da empresa e suas subsidiárias e de que modo diferentes opções de entrada poderão maximizar o sucesso dos projectos, nomeadamente ao nível do IDE nacional. A partir de um estudo de caso e da medição do seu desempenho, é pretendido perceber quais as dimensões culturais que maior impacto têm na performance do investimento, contribuindo positivamente para a literatura relacionada. Neste estudo, as hipóteses sobre o impacto da distância cultural no sucesso das parcerias internacionais, são testadas com base nos trabalhos de Geert Hofstede. A metodologia de estudo está focada no modo como as diferentes dimensões culturais afectam a longevidade dos investimentos, realçando a interligação entre distância cultural, modo de entrada e performance da subsidiária. Os resultados apontam para uma crescente necessidade de avaliar a distância cultural na tomada de decisão, maximizando a rentabilidade e o sucesso de cada IDE nacional. Palavras-chave: dimensão cultural, investimento directo estrangeiro, distância cultural, modo de entrada, performance.

Background. Nephrologists develop their work in diverse scenarios. A training programme must qualify trainees to assist different kinds of problems. The aim of this study was to characterize patients and pathologies that Spanish nephrology fellows face while on-call. Methods. This is a descriptive study with clinical and demographic data gathered with a form by 10 nephrology fellows of five university hospitals of Madrid (Spain), throughout their in-hospital 24 h on-call shifts in February and March 2013. Results. We collected 409 episodes over 338 patients, through 72 shifts. Among these, 16.7% had previous normal renal function, 24.6% chronic kidney disease, 39.5% were on dialysis and 18.2% had a kidney transplant. Most of the consults came from the emergency room (35.9%) or the previous on-call team (13.7%). Afterwards, the most usual destiny was admittance to a nephrology department (32.8%) or discharge (20.5%). The most frequent reason for consulting was a decline in renal function (31.6%) and the second motive an infection. Thirty-four episodes (8.3%) were related to dialysis access problems. Medical treatment was prescribed in 79.2% of the cases, primarily fluids (47.2%) and antibiotics (42.2%). The fellow had to place a central venous catheter in 24 cases (5.9%). Renal replacement therapy was prescribed in 19.8% of the episodes. Conclusions. Specific renal reasons for consulting nephrologists are common, such as acute kidney injury or dialysis access complications. These patients benefit from a specialized approach to their problems. Clinical activities during in-hospital out-of-hours shifts are a priceless tool as part of the training programme of nephrology fellows.

Background Little is known about pregnancy in women with Alport syndrome (AS), as only four cases have been reported in the literature. We herein describe the course of pregnancy in two sisters with overt forms of AS. Cases Both women were diagnosed as having autosomal recessive AS. Before pregnancy, their renal function and their blood pressure were normal, and proteinuria values were below 2 g/24 h. Both patients faced a progressive and remarkable increase in proteinuria during pregnancy, with subsequent hypoproteinemia. The clinical condition worsened, particularly in the first case, who was managed with some success with a combination of diuretics. She delivered at 32 weeks of pregnancy. The second patient was less challenging and she delivered at 36 weeks. Proteinuria returned to pre-pregnancy levels in both cases, after delivery. Conclusion Management of pregnant women with overt AS is challenging and worsening of renal disease has to be expected. The use of diuretic therapy may be of benefit.

-Human immunodeficiency virus (HIV)-infected persons have increased risk of chronic kidney disease (CKD). Serum creatinine may underestimate prevalence of CKD in subjects with decreased lean body mass or liver disease. Serum cystatin C, an alternative kidney function marker, is independent of lean body mass. Study Design-Cross-sectional Setting and Participants-250 HIV-infected subjects taking highly active antiretroviral therapy in the Nutrition for Healthy Living (NFHL) cohort; 2628 NHANES 2001-2002 subjects. Predictors and Outcomes-Comparison of serum creatinine in NFHL to NHANES subjects; comparison of CKD in NFHL subjects ascertained using serum creatinine versus cystatin C.

content validity of the instrument were established and an exploratory factor analysis used to guide restructuring of the tool. Internal consistency/reliability was calculated using Cronbach's a . Using the scale showed that men with prostate cancer placed considerable importance on a broad range of information needs, most of which had been inadequately met. Age had a significant influence on the overall importance attributed to information, with younger patients having more need for information. The construct and content validity of the instrument were established. The factor analysis revealed four discrete factors which together explained > 68% of the variance, termed 'basics of prostate cancer care', 'disease management', 'physical well-being' and 'self-help' . Internal consistency/reliability was satisfactory ( a = 0.91). The basis of a tool capable of ascertaining the information needs of patients with prostate cancer was developed; it may offer clinicians a valid means of ascertaining information preferences and hence potentially enhance the quality of service provided. Further research is now required to refine the tool and test the effect of its longitudinal use in clinical practice on patient satisfaction and outcome. To design, from first principles, a valid and reliable scale for assessing the importance of specific items of information needed by patients with prostate cancer that would be straightforward to use in clinical settings, as despite its prevalence, there is little research focusing specifically on the information needs associated with prostate cancer. Several stages of consultation and modification were used to inform the development of a scale which was then piloted on 96 patients with prostate cancer. Respondents were asked to rate the importance they placed on a range of prostate cancer-related topics of information, and the extent to which they felt these information needs had been met. The construct and

The Kidney Disease Outcome and Quality Initiative (KDOQI) Group recommended guidelines for the monitoring and treatment of chronic kidney disease (CKD) in 2002. These recommendations were based on the prevalence of known complications as seen in adults. In children, the exact prevalence of these complications is unknown. We therefore conducted a cross-sectional study of 366 patients with CKD in a single center to analyze the prevalence of these complications across all stages of kidney disease. Patients were categorized to their KDOQI stage of CKD according to their estimated renal function as determined from serum cystatin C. Fifty seven percent of patients had CKD stage 1, 29.0% stage 2, 10.4% stage 3 and 4.1% stages 4 þ 5. Uropathies (31%) were the most prevalent causes of CKD. Glomerular disease accounted for 27%. The overall prevalence of complications was as follows: hypertension 70.2%, anemia 36.6%, proteinuria 11.5%, and metabolic bone disease 16.9%. Metabolic bone disease and anemia occurred frequently, even with a glomerular filtration rate 460 ml/ min/1.73 m 2 . Growth failure (11.5%) was also common and is not a component of the KDOQI guidelines for CKD in children. The prevalence of all complications increased with worsening stage of kidney disease (all P-values significant). In summary, this study supports the KDOQI guidelines in defining and staging CKD in children. This study also highlights the differences in the causes and complications that occur in CKD between adults and pediatrics. We recommend modification of the KDOQI guidelines for children to reflect the differences described in this paper.

While there is a great deal of research updating methods for estimating renal function, many of these methods are being developed in either adults with CKD or younger children. Currently, there is limited understanding of the agreement between the modified new bedside Schwartz estimated glomerular filtration rate (eGFR) formula and the adult CKD-EPI formula in adolescents and young adults (AYAs) with chronic kidney disease (CKD) measured longitudinally. Longitudinal cohort study of 242 patients (10-30 years) with CKD, followed retrospectively in a single tertiary centre as they transitioned from the paediatric- to adult-focused settings. The study population came from a longitudinal cohort of AYAs undergoing healthcare transition at the STARx Program at the University of North Carolina, in the South-Eastern USA, from 2006 to 2015. We calculated and compared the eGFR using the new bedside Schwartz formula and the CKD-EPI eGFR. Measurements were repeated for each age in years. Agreeme...

Although measuring creatinine to determine kidney function is currently the clinical standard, new markers such as beta-trace protein (BTP) and beta-2-microglobulin (B2M) are being investigated in an effort to measure glomerular filtration rate more accurately. In their recent publication, Inker et al. (Am J Kidney Dis 2015; 67:40-48) explored the use of these two relatively new markers in combination with some commonly available clinical characteristics in a large cohort of adults with chronic kidney disease. Their research led them to develop three formulae using BTP, B2M, and a combination of the two. The combined formula is particularly attractive as it removes all gender bias, which applies to both serum creatinine and cystatin C. Using data from a cohort of 127 pediatric patients from our center, we sought to determine whether these formulae would be equally as effective in children as in adults. Unfortunately, we found that the formulae cannot be applied to the pediatric popu...

The Kidney Disease Outcome and Quality Initiative (KDOQI) Group recommended guidelines for the monitoring and treatment of chronic kidney disease (CKD) in 2002. These recommendations were based on the prevalence of known complications as seen in adults. In children, the exact prevalence of these complications is unknown. We therefore conducted a cross-sectional study of 366 patients with CKD in a single center to analyze the prevalence of these complications across all stages of kidney disease. Patients were categorized to their KDOQI stage of CKD according to their estimated renal function as determined from serum cystatin C. Fifty seven percent of patients had CKD stage 1, 29.0% stage 2, 10.4% stage 3 and 4.1% stages 4 þ 5. Uropathies (31%) were the most prevalent causes of CKD. Glomerular disease accounted for 27%. The overall prevalence of complications was as follows: hypertension 70.2%, anemia 36.6%, proteinuria 11.5%, and metabolic bone disease 16.9%. Metabolic bone disease and anemia occurred frequently, even with a glomerular filtration rate 460 ml/ min/1.73 m 2 . Growth failure (11.5%) was also common and is not a component of the KDOQI guidelines for CKD in children. The prevalence of all complications increased with worsening stage of kidney disease (all P-values significant). In summary, this study supports the KDOQI guidelines in defining and staging CKD in children. This study also highlights the differences in the causes and complications that occur in CKD between adults and pediatrics. We recommend modification of the KDOQI guidelines for children to reflect the differences described in this paper.