Integrative Nephrology and Andrology

Acute kidney injury: A definition with a rich past and an evolution Dimitrios C Karathanasis, C Androula Karaolia Journal of Integrative Nephrology and Andrology 2018 5(4):121-125 The term acute kidney injury (AKI) appeared in the society of nephrology in 2004 mirroring a key station of the constant development of the whole entity of acute renal failure. The long route from “acute Bright's disease” in the 19th century to modern “acute kidney stress” reflects the continuous effort of the society of nephrology to set the appropriate criteria and finally to formulate a precise and consensus definition in nomenclature of kidney injury. The most important definitions were the Risk, Injury, Failure, Loss of Kidney Function, and End-Stage Kidney Disease in 2004, Acute Kidney Injury Network (AKIN) in 2007, and Kidney Disease Improving Global Outcomes (KDIGO) in 2012 which had been proposed by the committees of Acute Dialysis Quality Initiative, AKIN, and KDIGO, respectively. Common basis of the above definitions was the clinical-laboratory criteria of urine output and serum creatinine while the target of every newer attempt was to increase the sensitivity of AKI and to offer a globally unified perception in terms of diagnosis and prevention. Since the emersion of KDIGO definition, the interest in defining AKI has been focused on the stage that precedes renal damage by the detection of clinically reliable biomarkers. Subsequently, the concept of acute injury is being lately realized as an attack in correspondence with heart attack or even more as an acute stress which can only be witnessed by the appropriate biomarkers. Recent research is focusing on the discovery of the ideal biomarker which must meet the requirements of high specificity, low cost, and ease of application.

To study the prevalence of thyroid disorders in chronic renal disease patients Upendra Nath Gupta, Apoorva Jain, Prashant Prakash, Prabhat Agrawal, Ravi Kumar, Maaz Farooqui Journal of Integrative Nephrology and Andrology 2018 5(4):126-129 Background and Objectives: The high prevalence of thyroid dysfunction in chronic kidney disease (CKD) patients reveals significant association between CKD progression and thyroid dysfunction. The aim was to study the thyroid dysfunction in patients of CKD for the prevalence of subclinical hypothyroidism (SCH) and clinical hypothyroidism and study the correlation between thyroid dysfunction and severity of renal diseases. In view of the variability of thyroid profile in CKD patients in previous studies, a prospective study of various thyroid function has been undertaken to establish a correlation if any between thyroid dysfunction and severity of renal diseases. Materials and Methods: A total of 100 patients with CKD on conservative management fulfilling the criteria for CKD who were admitted at the Department of Medicine, SNMC, Agra, Uttar Pradesh, India, during the period of July 2016–June 2017, were selected in this study. Descriptive analysis of the collected data was done and association of various parameters with the presence or absence of SCH or overt hypothyroidism was studied using Chi-square test and correlated. Results: Results showed that out of the 100 patients with CKD, 53 patients had thyroid dysfunction which accounted for 53%. The prevalence of SCH and clinical hypothyroidism was 33% and 20%, respectively. The number of patients with hypothyroidism progressively increased with increased severity of renal failure. Conclusions: We observed a high prevalence of thyroid dysfunction in our CKD patients and revealed significant association between CKD progression and thyroid dysfunction.

Clinical profile of acute kidney injury in a tertiary care center in the Tropical Region Utkarsh Rajesh Patel, Amit S Pasari, Manish Ramesh Balwani, Amol Bhawane, Priyanka R Tolani, Shaurya Acharya Journal of Integrative Nephrology and Andrology 2018 5(4):130-133 Objective: The objectives of the study were to study etiology, manifestations, and outcome of acute kidney disease in the tropical region in a tertiary care center. Materials and Methods: In the present prospective study, patients with acute kidney disease admitted to JNMC, Wardha, India, between January 2017 and December 2017 were studied with a detailed history, general physical examination, and systemic examination. Data were collected and analyzed. Statistical analysis was performed using descriptive and inferential statistics using the Chi-square test and Student's unpaired t-test and software used in the analysis was SPSS 22.0 version and Graph Pad Prism 6.0 version. Results: This study showed male-to-female ratio of 1.8:1. Maximum incidence was seen in patients aged >60 years. As per the Kuppuswamy's scale, most of the patients belonged to lower-middle and upper lower class. The study showed various etiological factors associated with acute kidney injuries (AKIs) such as renal causes (most common), heart failure, respiratory failure, cirrhosis, malaria, snake bite, acute gastroenteritis, poisoning, drug nephrotoxicity, and sepsis. Common symptoms were oliguria followed by pedal edema and dyspnea. The most common comorbid illness was hypertension followed by diabetes mellitus which may have made them prone to AKI. About 81.42% of patients survived and 18.58% expired. Of 70, 56 patients were managed conservatively, whereas 14 underwent hemodialysis. Mean duration of hospitalization was 11.01 ± 8.60 days. Conclusion: Intrinsic renal causes followed by heart failure were the common causes of AKI as against infective causes a few years earlier. This shows the changing trend of AKI causes in a developing nation. Average duration of hospitalization was 11 days in the study.

Study of some electrocardiographic and echocardiographic data in toddelers and children with primary glomerulonephropathy Mohamed Abdelaziz El-Gamasy, Walid El-Shehabi Journal of Integrative Nephrology and Andrology 2018 5(4):134-139 Background and Objective: Primary glomerulonephropathy mainly acute poststreptococcal glomerulonephritis (APSGN) is the most common cause of hypertensive heart failure in the pediatric age as APSGN may involve various systems including cardiovascular system. There are few research publications on electrocardiographic (ECG) and echocardiographic (two-dimensional [2D]-echo) data in childrenwith primary glomerulonephropathy. The aim is to study some ECG and 2D-echo data in Egyptian pediatric patients with ANS). Subjects and Methods: Sixty children with ANS were included and subjected to clinical, laboratory, ECG for corrected QT (QTc) interval and 2D echocardiographic study on admission and repeated at 6 and 12 weeks using GE Vivid 7 (GE Medical System, Horten, Norway with a 3.5-MHz multifrequency transducer) to measure left ventricular ejection fraction (LVEF), left atrium to aorta ratio and E/A ratio. Results: Prolonged QTc interval was reported in 22 patients (37%), of whom 18 had hypertension. Fourteen of the 60 children had LVEF <60%. The same children also had left atrium/aorta ratio >2 and E/A ratio more than two. LVEF became within normal values by 1½ month (6 weeks) in 12 patients, two become normal by three months of follow-up. Four (28.6%) from 14 children with low LVEF had normal arterial blood pressure. All the 14 children had completely recovered on follow-up period of 3 months. Conclusion: Changes in ECG and echo data which were reported in the acute phase of ANS appear to be temporary (transient) as they became within normal values in almost all children by 12 weeks period of follow-up. Although elevated blood pressure was the most common etiology of congestive heart failure in children with ANS, the impact of primary myocardial functional disturbance could also be put into consideration.

Paroxysmal nocturnal hemoglobinuria manifesting as hemolytic anemia with acute kidney injury Amol Bhawane, Manish Ramesh Balwani, Amit S Pasari, Priyanka R Tolani Journal of Integrative Nephrology and Andrology 2018 5(4):140-142 Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired disorder characterized by low-grade, chronic hemolytic anemia accompanied by either thrombocytopenia or leukopenia with usually benign kidney involvement secondary to chronic tubular deposition of hemosiderin. Acute kidney injury (AKI) may be seen during hemolytic crisis. We report the case of a 45-year-old man with PNH who developed reversible AKI requiring temporary hemodialysis support following herpes zoster infection.

Serum magnesium concentration a need for revision especially in renal failure Majid Malaki Journal of Integrative Nephrology and Andrology 2018 5(4):143-144

Alexandros Sfakianakis
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