Renal Disease
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2021 ◽  
Vol 13 (1) ◽  
Debashree Roy ◽  
Subhajit Guha ◽  
Dimple Shah ◽  
Indranil Ghosh

Abstract Background End-stage renal disease has a high prevalence worldwide. Quiet often, we come across patients with end-stage renal disease surviving on haemodialysis or peritoneal dialysis who need surgery. The management of such patients is a challenging task for the anaesthesiologist. Case presentation A patient suffering from end-stage renal disease on peritoneal dialysis was posted for removal of supratentorial space occupying lesion in our operation theatre. We describe the successful management of this case by the technique of awake craniotomy. Conclusion Awake craniotomy can be a safe alternative for high-risk patients undergoing craniotomy for brain tumours.

2021 ◽  
Jessica M Vanslambrouck ◽  
Sean B Wilson ◽  
Ker Sin Tan ◽  
Ella Groenewegen ◽  
Rajeev Rudraraju ◽  

While pluripotent stem cell-derived kidney organoids represent a promising approach for the study of renal disease, renal physiology and drug screening, the proximal nephron remains immature with limited evidence for key functional solute channels. This may reflect early mispatterning of the nephrogenic mesenchyme or insufficient maturation. In this study, prolonged differentiation and modification of media conditions to enhance metanephric nephron progenitor specification resulted in the induction of nephrons containing elongated and aligned proximal nephron segments together with SLC12A1+ loops of Henle. Nephron proximal segments showed superior HNF4A gene and protein expression, as well as upregulation of key functional transporters, including SLC3A1/2, SLC47A1, and SLC22A2. The striking proximo-distal orientation of nephrons was shown to result from localised WNT antagonism originating from the centre of the organoid. Functionality of such transporters was evidenced by albumin and organic cation uptake, as well as appropriate KIM-1 upregulation in response to the nephrotoxicant, cisplatin. PT-enhanced organoids also possessed improved expression of receptors associated with SARS-CoV2 entry, rendering these organoids susceptible to infection and able to support viral replication without co-location of ACE2 and TMPRSS2. These PT-enhanced organoids provide an accurate model with which to study human proximal tubule maturation, inherited and acquired proximal tubular disease, and drug and viral responses.

Kazuo Kobayashi

2021 ◽  
Vol 49 (7) ◽  
pp. 596-597
Ali Coner ◽  

2021 ◽  
Vol 12 ◽  
Arnaud Molin ◽  
Sandrine Lemoine ◽  
Martin Kaufmann ◽  
Pierre Breton ◽  
Marie Nowoczyn ◽  

Mutations in CYP24A1 (vitamin D 24-hydroxylase) and SLC34A1 (renal phosphate transporter NPT2a) cause autosomal recessive Infantile Hypercalcemia type 1 and 2, illustrating links between vitamin D and phosphate metabolism. Patients may present with hypercalciuria and alternate between chronic phases with normal serum calcium but inappropriately high 1,25-(OH)2D and appropriately low PTH, and acute phases with hypercalcemia with suppressed PTH. Mutations in SLC34A3 and SLC9A3R1 have been associated with phosphate wasting without hypercalcemia. The aims of this study were to evaluate the frequency of mutations in these genes in patients with a medical history suggestive of CYP24A1 mutation to search for a specific pattern. Using next generation sequencing, we screened for mutations in 185 patients with PTH levels < 20 pg/mL, hypercalcemia and/or hypercalciuria, and relatives. Twenty-eight (15%) patients harbored biallelic mutations in CYP24A1 (25) and SLC34A3 (3), mostly associated with renal disease (lithiasis, nephrocalcinosis) (86%). Hypophosphatemia was found in 7 patients with biallelic mutations in CYP24A1 and a normal phosphatemia was reported in 2 patients with biallelic mutations in SLC34A3. Rare variations in SLC34A1 and SLC34A3 were mostly of uncertain significance. Fifteen patients (8%) carried only one heterozygous mutation. Heterozygous relatives carrying SLC34A1 or SLC34A3 variation may present with biochemical changes in mineral metabolism. Two patients’ genotype may suggest digenism (heterozygous variations in different genes). No variation was found in SLC9A3R1. As no specific pattern can be found, patients with medical history suggestive of CYP24A1 mutation should benefit from SLC34A1 and SLC34A3 analysis.

Anjana Sharma

Background: One of the most common etiological factors leading to chronic kidney disease and acute renal failure in the present clinical scenario is drug-induced renal disease. By direct toxicity and immunologic mechanism virtue, certain stereotyped renal responses are initiated by various drugs. Objectives: The present study was conducted to retrospectively assess the prevalence and incidence of drug-induced nephrotoxicity at the Department of Pathology, Sri Shankaracharya Institute of Medical Sciences, Bhilai, and Chhattisgarh. The study was conducted for 6 months on 120 subjects having drug-induced nephritis. The study subjects were within the age range of 30-70 years and had 50% females. Methods: The study screened 500 subjects of a defined age group where anthropometric and demographic records were obtained followed by serum creatinine measurement and protein analysis using the dipstick method. Glomerular filtration rate was estimated (eGFR) using the 4-variable modification of diet in renal disease (MDRD) equation and Cockcroft-Gault equation corrected to the body surface area (CG-BSA). Results: In 2.8% of subjects proteinuria was seen with DIN in 6.3% (n=120) subjects using MDRD for GFR assessment. The DIN prevalence was found to be 24% using the CG-BSA method. DIN was found to be significantly associated with hypertension, diabetes, smoking, abdominal obesity, advanced age, and gender. The large difference in Din prevalence between CG-BSA equations and MDRD shows that there is a need for having better measures for assessing the kidney function in the population of central India. Also, CG-BSA equations suggest a similar need for having better measures for assessing the kidney function in the population of central India. Keywords: Body mass index (BMI), Cockcroft-Gault (CG), chronic kidney disease  (CKD), drug-induced nephrotoxicity (DIN), Proteinuria, Glomerular filtration rate (GFR),

2021 ◽  
Claire E. Cook ◽  
Xiaoqing Fu ◽  
Yuqing Zhang ◽  
John H. Stone ◽  
Hyon K. Choi ◽  

Michiaki Abe ◽  
Tetsuya Akaishi ◽  
Koto Ishizawa ◽  
Hirohisa Shinano ◽  
Hiroshi Ohtomo ◽  

Abstract Background Disaster-related stress can increase blood pressure and the incidence of cardiovascular diseases. However, the role of massive disasters in the development of end-stage kidney disease (ESKD) remains unknown. We investigated the incidence and different causes of dialysis initiation in patients with chronic kidney disease in a city affected by the Great East Japan Earthquake. Methods This was a single-center, retrospective observational study. All patients who initiated or were treated with dialysis at Kesennuma City Hospital between 2007 and 2020 were enrolled. The year of dialysis initiation was retrospectively determined based on the initiation date. The causative renal diseases that led to the need for dialysis initiation were divided into four groups: diabetic nephropathy, hypertensive renal disease, glomerulonephritis, and others. Results Age at dialysis initiation differed significantly among the four groups (p = 0.0262). There was a significant difference in the numbers of the four groups before and after the Great East Japan Earthquake (p = 0.0193). The age of hypertensive renal disease patients was significantly higher than those of patients with diabetic nephropathy (p = 0.0070) and glomerulonephritis (p = 0.0386) after the disaster. The increasing number of dialysis initiations after the Great East Japan Earthquake appeared to be associated with changes in hypertensive renal diseases; the number peaked after 10 years. Conclusions There was an increase in the number of dialysis initiations, especially caused by hypertensive renal diseases, for up to 10 years after the Great East Japan Earthquake. Graphic abstract

Nur Fithriyanti Imamah ◽  
Hung-Ru Lin

End-stage renal disease is the last stage of chronic kidney disease and is associated with a decreased quality of life and life expectancy. This study aimed to explore palliative care with end-stage renal disease. Qualitative meta-synthesis was used as the study design. The search was performed for qualitative studies published until June 2021 and uses reciprocal translation and synthesis of in vivo and imported concepts. Five themes were included: Struggling to face the disease, experiencing deterioration, overcoming the challenges of dialysis, leading to a positive outlook, and preparing for the end of life. In facing chronic disease with life-limiting potential, patients experienced some negative feelings and deterioration in their quality of life. Adaptation to the disease then leads patients to a better outlook through increased spirituality and social status. Furthermore, by accepting the present condition, they started to prepare for the future. Increasing awareness of mortality leads them to discuss advance care (ACP) planning with healthcare professionals and families.

2021 ◽  
Vol 69 (1) ◽  
Tülay Becerir ◽  
Münevver Yılmaz ◽  
İlknur Girişgen ◽  
Neslihan Yılmaz ◽  
Dolunay Gürses ◽  

Abstract Background Although acute coronary syndrome is rare in children, it is the most important cause of mortality in children with end-stage renal disease. Case presentation Here, a 16-year-old pediatric patient, who has been on dialysis since the age of 3, and who was diagnosed with acute coronary syndrome and placed an emergency percutaneous transcatheter stent in the left anterior descending branch of the left coronary artery is presented. It is important that the present patient does not have any electrocardiography findings in favor of cardiovascular disease and that he cannot fully explain the complaint of chest pain due to his mental retardation. Conclusions Early detection of acute coronary syndrome is life-saving, especially in children with chronic kidney disease.

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