Journal of Renal and Hepatic Disorders (eISSN: 2207-3744) is a peer-reviewed, online-only, open-access journal that publishes basic science and clinical research articles on disorders of the kidneys and the liver. In addition to considering disorders of each organ separately, the journal aims to be a scholarly forum for discussing how disorders of one organ influence the other. Chronic liver disease is associated with primary and secondary kidney diseases. Similarly, renal disorders are associated with hepatic disorders. Original articles, reviews, and case reports on any aspects of nephrology and hepatology are suitable for submission.
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Are we monitoring enough? Addressing hepatic and renal safety gaps in rheumatologic therapy
The maintenance of rheumatologic diseases is heavily dependent upon pharmacologic interventions that, though effective, pose substantial risks of hepatotoxicity and nephrotoxicity. Though guidelines for monitoring these patients have been established, compliance with these measures in real-world practice is inconsistent. Some studies show that many patients do not get the needed laboratory tests, especially in resource-limited regions. The following editorial points out the shortcomings in the practice of surveillance for these patients, especially in low-income settings including Pakistan.
Copyright (c) 2026 Nauman Ismat Butt https://creativecommons.org/licenses/by-nc-sa/4.0
Integrating hepatotoxicity monitoring with pharmacogenetics in HIV and tuberculosis treatment: a narrative review
Drug-induced hepatotoxicity represents a major clinical challenge in the management of patients with Human Immunodeficiency Virus (HIV), tuberculosis (TB), and HIV–TB coinfection, largely due to prolonged and combined therapeutic regimens that increase exposure to potentially hepatotoxic drugs. Early detection and appropriate classification of liver injury remain essential to prevent severe complications and treatment interruptions. This narrative review aims to examine the integration of hepatotoxicity monitoring with pharmacogenetic determinants in the context of HIV and tuberculosis therapy. Current evidence on the epidemiology, pathophysiological mechanisms, diagnostic approaches, and pharmacogenetic predictors of hepatotoxicity is summarized, with particular emphasis on genetic polymorphisms in drug-metabolizing enzymes such as N-acetyltransferase 2 (NAT2) and cytochrome P450 2B6 (CYP2B6), which influence susceptibility to liver injury associated with isoniazid and efavirenz. The available literature indicates that systematic biochemical monitoring, combined with pharmacogenetic information, may improve risk stratification, facilitate early detection of hepatotoxicity, and support more individualized therapeutic strategies. Integrating clinical assessment with pharmacogenetic data could therefore contribute to optimizing treatment safety and advancing personalized medicine approaches in populations affected by HIV and tuberculosis.
Copyright (c) 2026 Yair Lara-Blanco , José R. Chavez-Méndez , Genaro Rodríguez-Uribe https://creativecommons.org/licenses/by-nc-sa/4.0
Impact of Obesity and Insulin Resistance on Diabetic Kidney Disease Progression
One of the primary microvascular outcomes of Type 2 Diabetes is Diabetic Kidney Disease (DKD), and it causes a significant burden on the global health care system along with the increasing prevalence of insulin resistance and obesity. Epidemiological investigation found that about one-third of people who have T2DM can acquire chronic kidney disease, with insulin sensitivity and obesity acting as key drivers of kidney injury. Obesity is related to lipotoxicity, low-grade inflammation, adipokine dysregulation, and oxidative stress, while impaired insulin sensitivity leads to renal hemodynamics, progressive glomerular injury, and hyperinsulinemia. These pathways together promote glomerular hyperfiltration, albuminuria, and ultimately a decrease in glomerular filtration rate (GFR). Several studies indicate that RAAS blockade, SGLT2 inhibitors, and weight loss can reduce Diabetic Kidney Disease progression, yet persistent risk remains. The existing research gaps have a limited pathophysiological understanding, a shortage of understanding of renal ectopic fat deposition, and insufficient stratification of patients by impaired insulin sensitivity phenotypes and obesity. To develop targeted interventions, it is essential to address the gaps through clinical research and comprehensive mechanisms. The evaluation of the collaborative impact of impaired insulin sensitivity and obesity in the advancement of diabetic kidney disease is the aim of this study. In addition, rapid diagnosis and targeted treatments are the most important goals for lowering cardiovascular and renal complications.
Copyright (c) 2026 Ameen Heshmat Ali Rasheedee, Amit Kumar Singh https://creativecommons.org/licenses/by-nc-sa/4.0
The oncogenic implications of metabolic dysfunction-associated steatotic liver disease
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly termed non-alcoholic fatty liver disease (NAFLD), is receiving growing attention as a major public health issue globally, primarily because of its association with the development of hepatocellular carcinoma (HCC). MASLD is predominantly caused by obesity, type 2 diabetes mellitus, and lack of exercise, and has a broad clinical spectrum ranging from benign hepatic steatosis to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and ultimately HCC. The pertinent problem is that HCC due to MASLD typically develops in patients without cirrhosis, making diagnosis and follow-up exceedingly challenging. MASLD is described as a multi-faceted condition involving insulin resistance, lipid deposition, oxidative stress, and chronic inflammation. Recent molecular studies related to lipid metabolism, mitochondrial dysfunction, and oncogenic pathways have identified candidate molecules, including microRNA-33 (miR-33), and Interferon Gamma Inducible Protein 16 (IFI16) variants. Emerging non-invasive diagnostic technologies, including liquid biopsies, next-generation sequencing (NGS), and machine learning-based models, are becoming important for early detection and individualized risk assessment. Currently, therapeutic interventions target oxidative stress, inflammatory responses, fibrosis, and lipid dysregulation. Some of the potentially useful interventions include bioactive flavonoids, repurposed medications (metformin and statins), and a novel nanotechnology-based drug delivery system that could slow disease progression and reduce cancer risk. Treating MASLD while addressing the risk of malignancy will require a precision medicine approach with a focus on lifestyle intervention, directed pharmacotherapy, and advanced diagnostic approaches implemented in a multidisciplinary fashion.
Copyright (c) 2026 Aditya Kamboj, Amit Kumar Singh https://creativecommons.org/licenses/by-nc-sa/4.0
Metastasis from metastasis -- Bizarre route of a metastatic cell : Case reports and Review of literature
In cancer biology, Metastasis is one of the most important hallmarks of tumour progression. Cancer cells undergo a series of genetic mutations in order to acquire invasive characteristics that allow them to spread to secondary sites and become a metastatic foci. These tumour cells from the metastatic focus again undergoing genetic mutations and spreading to another site is a rare phenomenon. We report two such cases with a rare phenomenon of metastasis arising from the metastatic focus i.e, patients with metastatic renal cell carcinoma and gastric carcinoma respectively.
Copyright (c) 2026 Mohammed Sameer, Vipul Goyal, Madhu Muralee https://creativecommons.org/licenses/by-nc-sa/4.0
Depression in prevalent maintenance hemodialysis patients
Background: Depression is a common mental health issue among patients on maintenance hemodialysis (MHD), significantly impacting their quality of life and overall prognosis. While prior studies have reported variable prevalence rates globally, data specific to MHD patients in our regional tertiary care setting remain limited. This study addresses this gap byevaluating prevalence, severity, and associated factors of depression, thereby supporting evidence-based health strategies in this at-risk population. Methods: This cross-sectional study evaluated the prevalence and severity of depression in 74 patients undergoing MHD at a tertiary care center in North India. The Montgomery-Åsberg Depression Rating Scale (MADRS) was used to assess the symptoms of depression. Results: The overall prevalence of depression was 59.5%. Among the participants 33.8% had mild depression, 23.0%had moderate depression, and 2.7% had severe depression. Patients dialyzed via tunneled hemodialysis catheters exhibited significantly higher rates of depression compared to those with arteriovenous fistulas (p < 0.05). Patients with a transplant prospect had lower rates of depression compared to those without (p < 0.05). Conclusions: Depression is highly prevalent in patients on MHD. This study highlights the need for routine depression screening and appropriate management in this vulnerable population to improve their overall well-being and treatment outcomes.
Copyright (c) 2026 Jawad Iqbal Rather, Amir Farooq, Muzamil Ahmad Wani, Nuha Saleem, Zeeza Hussain Shah, Muzafar Maqsood Wani, Imtiyaz Ahmad Wani, Imran Khan https://creativecommons.org/licenses/by-nc-sa/4.0
Hepatic glycogenosis in glycogenic hepatopathy and Metabolic dysfunction associated fatty liver disease
Background: Glycogenic hepatopathy (GH) is a rare complication of uncontrolled type 1 diabetes mellitus (T1DM) in children and was originally described as Mauriac syndrome. Identified as a prominent glycogenosis of hepatocytes, it has also been reported in adults in other conditions, including type 2 diabetes mellitus (T2DM). It clinically mimics Metabolic dysfunction associated fatty liver disease (MAFLD). The study describes five cases of glycogenic hepatopathy and compares the clinicopathological findings with that of MAFLD. Methods: Cases with hepatic parenchymal glycogenosis diagnosed during the study period were included. These cases were grouped into glycogenic hepatopathy and MAFLD based on their histological features and corresponded with their transaminase levels. Results: Out of 261 liver biopsies received during the study period (3 years), 16 cases with parenchymal glycogenosis were included in the study. Cases with pale, rarefied, enlarged hepatocytes (periodic acid Schiff-positive, diastase sensitive) with prominent plasma membranes with diffuse glycogenosis were diagnosed as GH (Group 1). Five cases of GH were identified, all females, associated with T2DM (n = 3), hypothyroidism (n = 1) and elevated liver enzymes (n = 5). Normalization of enzymes after glycemic control was seen in n = 3/5 cases. The remaining 11 cases (Group 2) showed hepatic steatosis, focal hepatic glycogenosis & fibrosis with persistent elevation of liver enzymes following treatment. Conclusions: All cases of glycogenic hepatopathy in this study were females and none of them were associated with type 1 diabetes mellitus, which is implicated as the most common underlying etiology worldwide. This study suggests that glycogenic hepatopathy may be more common in adults with T2DM or other metabolic derangements than anticipated and have a female preponderance.
Copyright (c) 2026 Monica Chandrasekar, Sakthisankari Shanmugasundaram https://creativecommons.org/licenses/by-nc-sa/4.0
Emergence of antibiotic resistance in bloodstream infections associated with catheters in hemodialysis patients: a prospective observational study
Background: Catheter-related bloodstream infections (CRBSIs) are a significant cause of hospitalization and mortality among hemodialysis patients. Incidence rates and resistance patterns vary widely. Recent studies show a rise in CRBSIs caused by multidrug-resistant organisms (MDROs). This study aims to determine the incidence, microbiological profile, antibiogram and outcomes of CRBSIs in hemodialysis patients at our institution. Methods: This prospective single center observational study included all patients initiating hemodialysis with central venous double-lumen catheters. Results: During the study, 240 catheters were inserted in 240 patients. A total of 48/240 (20%) developed CRBSI with 41/48 (85.4%) having culture-positive probable CRBSI and 07/48 (14.6%) having culture-negative possible CRBSI. Concomitant exit site infection was present in 09/48 (18.8%). The CRBSI incidence rate was 1.46 episodes per 1000 catheter days, based on 48 episodes over 32,782 catheter days. The mean time to CRBSI was 204.6 ± 87.1 days. Gram-positive bacteria were cultured in 15 cases (31.3%), Gram-negative bacteria in 26 cases (54.2%), and 7 cases (14.6%) had negative culture. Coagulase negative Staphylococcus Aureus (CoNS) was the most common Gram-positive pathogens isolated, making up 46.7% of the cases. Klebsiella pneumonia, Pseudomonas, and Acinetobacter species were identified as the most prevalent Gram-negative pathogens (n = 06/26 each; 23.1%. Among 8 cultured Gram-negative bacterial species, resistance patterns observed was Ampicillin: 4/4 tested (100.0%), Quinolones: 4/6 tested (66.7%), Clotrimazole: 3/5 tested (60.0%), Carbapenems: 3/6 tested (50.0%), Gentamicin: 2/5 tested (40.0%), Amikacin: 1/3 tested (33.3%), and Piperacillin-Tazobactam: 1/5 tested (20.0%). A total of 39/48 catheters were salvaged. Conclusions: CRBSI remains a significant issue in patients using central venous catheters. The rise of multidrug-resistant Gram-negative infections necessitates stricter measures, including improved hygiene, surveillance and long-term vascular access. Proper cultures should precede empirical antibiotic therapy, and healthcare centers should tailor their antibiotic policies to local susceptibility patterns.
Copyright (c) 2025 Rayees Yousuf, Mohammad Ashraf Bhat, Danish Muqbool, Manzoor Ahmad Parry, Amir Farooq, Muzamil Ahmad Wani, Imran Khan, Imtiyaz Wani, Muzafar Wani https://creativecommons.org/licenses/by-nc-sa/4.0
An update on current clinical pathogenesis, prevention,and nutritional aspects of nephrolithiasis: a review
Nephrolithiasis, commonly known as kidney stone disease, is a prevalent condition characterized by the formation of hard crystalline deposits within the renal system, primarily due to metabolic abnormalities in urinary composition. In India, the prevalence of urinary stone disease is estimated to be around 12%, with a significant proportion at risk of progressing to renal impairment if left untreated. This review explores both pharmacological and nutritional strategies for the prevention and management of recurrent kidney stones. A comprehensive literature search was conducted using databases such as PubMed and Google Scholar, and major publishers including Springer Nature, Bentham Science, Taylor & Francis, and Elsevier. Pharmacological interventions such as thiazide diuretics, indapamide, allopurinol, and potassium citrate have been shown to reduce urinary calcium and uric acid levels, thereby mitigating stone formation. In parallel, several medicinal plants, including Asparagus racemosus, Virataradigana, and Boerhaavia diffusa, exhibit diuretic and antiurolithiatic properties and have shown promising outcomes in traditional medicine and preliminary clinical studies. Although the pharmacological agents demonstrate well-established mechanisms of action and clinical efficacy, the supportive role of herbal remedies offers a complementary pathway, particularly in populations with limited access to conventional therapies. However, the current body of clinical evidence for herbal therapies remains limited in scope and rigor. Thus, while the combined approach of pharmaceutical and plant-based interventions offers a comprehensive strategy for reducing stone recurrence and preserving renal function, further large-scale, randomized clinical trials are necessary to validate these findings and to establish standardized protocols for effective nephrolithiasis management.
Copyright (c) 2025 Pranjal Sachan, Anjali Pandey https://creativecommons.org/licenses/by-nc-sa/4.0
Chaos in the diagnosis of hepatitis C virus inhemodialysis patients
Background: In India, a broad range of prevalence of Hepatitis C virus (HCV) infection in hemodialysis (HD) patients was reported. Variations in screening methods and regional differences in the HCV genome render challenges in the accurate detection of HCV. In this background, the present study was undertaken to assess the prevalence of HCV by HCV RNA PCR (Ribose nucleic acid Polymerase Chain Reaction) and HCV antibody detection by immunochromatography (ICT) and ELISA (Enzyme Linked Immuno-Sorbent Assay). Methods: A total of 50 patients with chronic kidney disease (CKD) on maintenance HD for more than six months were included in the study. Blood sample was collected and subjected to HCV RNA PCR, and HCV antibody by ICT and ELISA. Results: Of the 50 samples tested, ICT for HCV antibody was detected in 22 (44%) patients. They were positive for ELISA also. HCV RNA was positive in 15 (30%) patients. PCR positive was also positive for HCV antibody. Conclusions: This study concludes, that HCV antibody screening should be performed monthly and RNA PCR once every three months among HD patients.
Copyright (c) 2024 Ananthapadmanabasamy Indira, Gomathinayagam Velvizhi1, Koshy M Koshy, Santhana Kumarasamy Poongodi http://creativecommons.org/licenses/by/4.0
Clinical profile, response and outcome of variousimmunosuppressive regimens used for treatment ofidiopathic membranous nephropathy—a retrospective cohort study
Background: Membranous nephropathy (MN) is a glomerular disease commonly presenting as a nephrotic syndrome in adults. Various immunosuppressive medications have been used in the treatment of the same with different levels of success. Hence we have undertaken a retrospective analysis of “Clinical profile, response and outcome of various immunosuppressive regimens used for treatment of membranous nephropathy” to determine the efficacy of each treatment regimen. Methods: A retrospective observational cohort study was conducted in a single tertiary care centre in southern India. Patients with proven primary membranous nephropathy from 2010 to June 2020 with a minimum duration of follow-up of one year and treated with different immunosuppressive regimens were included in the study. Results: The total number of patients in the study was 129. Mean age of onset was 39 years with a follow-up of a minimum of 1 year and a maximum of 10 years, the mean follow-up being 3 years. 46.5% achieved complete remission, 23.3% had partial remission and 10.9% had relapse, doubling of serum creatinine was seen in 5 (3.9%) and chronic kidney failure requiring kidney replacement therapy in 3 (2.3%) respectively. Presence of interstitial fibrosis and tubular atrophy (IFTA) had a significant correlation p-value 0.02, patients with IFTA less than 30% performed the best with 54/71 patients (60%) achieving remission. Conclusions: Hypertension and IFTA at presentation were predictors for worse outcomes. modified Ponticelli, followed by rituximab, were the most effective in inducing and maintaining remission.
Copyright (c) 2024 Megha Saigal, Swarnalatha Guditi, Gangadhar Taduri http://creativecommons.org/licenses/by/4.0
Liver biopsies in pediatric patients—a histopathologicalreview of common entities
With the advent of sophisticated non-invasive assays and advanced radiologic techniques, there has been a significant evolution in the role of liver biopsy in the evaluation and management of hepatic diseases. Liver biopsy has a vital role in establishing the diagnosis, staging and prognostic evaluation of various pediatric liver diseases. It is an essential tool in deciding therapeutic management and treatment response. Liver biopsy when used in combination with clinical findings and other diagnostic modalities is useful in guiding treatment and predicting prognosis in the pediatric population. Here we discuss the indications of liver biopsy in various common pediatric liver diseases.
Copyright (c) 2025 Maria Kamal, Zhongxin Yu, Neha Varshney https://creativecommons.org/licenses/by-nc-sa/4.0
Clinical and histopathological profile of patients with multiple myeloma and renal involvement
Background: Multiple Myeloma (MM) is a malignant disorder of plasma cell characterised by the clonal expansion of aberrant plasma cells within the bone marrow. This leads to the excessive production of monoclonal immunoglobulins (M-protein) and associated with organ dysfunction. Renal disease is a frequent and a potentially significant complication of multiple myeloma. The range of renal lesions observed in the patients with multiple myeloma is diverse. The aim of present study is to find the clinical and histopathological profile of patients with multiple myeloma and renal involvement and their clinico-pathological correlation. Methods: This was an observational hospital based study where 33 patients with multiple myeloma as well as renal involvement who agreed for renal biopsy were included. Demographic data, mode of presentation and need for dialysis were noted. Appropriate laboratory tests and radiological survey were done. Results: The median age of the patients in our study was 56 years. Fatigue was the most common clinical feature. The indications for renal biopsy were acute kidney injury (AKI), chronic/progressive reduction in glomerular filtration rate (GFR) with normal sized kidneys and nephrotic syndrome. Histopathological findings in the patients with acute kidney injury included myeloma cast nephropathy, acute tubulointerstitial nephropathy, acute tubular necrosis and IgA (Immunoglobulin A) nephropathy. In cases with chronic decline in GFR, observed lesions were myeloma cast nephropathy, monoclonal immunoglobulin deposition disease, membranoproliferative glomerulonephritis, chronic interstitial nephropathy and diabetic nephropathy. For patients presenting with nephrotic syndrome, amyloidosis and monoclonal immunoglobulin deposition disease were predominant. Conclusions: Renal involvement is considered as one of the main feature of multiple myeloma and is often the initial manifestation of the disease. Renal biopsy is crucial for establishing a specific diagnosis and providing valuable prognostic and therapeutic insights.
Copyright (c) 2025 Manjuri Sharma, Arunima Mahanta, Jina Bhattacharyya https://creativecommons.org/licenses/by-nc-sa/4.0
Prevalence of dysmagnesemia among CKD patients in North India
Magnesium is the second-most common intracellular cation after calcium with 99% of total body magnesium distributed intracellularly in bones, muscles, and soft tissues. Only 1% of total body magnesium is present extracellularly that contributes to the normal serum magnesium concentration of 1.8–2.6 mg/dL. Recently, many studies have focused on the role of magnesium homeostasis and human health. Diabetes and hypertension are the leading causes of chronic kidney disease (CKD), and the significance of magnesium in CKD has been astonishing in medical practice. In this study, we investigated the serum levels of magnesium and its prevalence at different stages of CKD. This cross-sectional descriptive study was conducted over a period of 2 months. Serum magnesium levels were analysed in 224 patients with CKD and were grouped into five stages of CKD according to the guidelines of the Kidney Disease: Improving Global Outcomes (KDIGO) based on glomerular filtration rate. Laboratory data of patients was analysed using the IBM SPSS V23 software (Chicago, USA) for statistical relationship between serum magnesium levels and stages of CKD in patients with CKD. Mean serum magnesium level of the study population was 2.21 ± 0.75 mg/dL; 50.9% of the patients were normomagnesemic (normal level of magnesium ions in the blood), followed by 30.4% hypomagnesemic and 20.5%, hypermagnesemic. CKD was more common in males (63.4%), compared to females (36.6%). Mean age of patients in G5 stage was significantly higher than in G3a, G3b, and G4 stages (P = 0.001). A progressive decline in renal function and retention of uraemic solutes was observed with progression of CKD. Multiple factors, both inherited or acquired, such as diuretics and alcohol, are implicated in controlling serum magnesium levels. Magnesium deficiency leads to 2.12-fold higher risk of progression to end-stage renal disease (ESRD).
Copyright (c) 2024 Shailata Prisi, Kajal Nandi, Elvia Jamatia, Biplob Kumar Biswas, Vatsala Khurana, Binita Goswami http://creativecommons.org/licenses/by/4.0
Mitochondrial Impairment and Oxidative Stress Are Essential Mechanisms Involved in the Pathogenesis of Acute Kidney Injury
Acute kidney injury (AKI) is an emergency condition that requires restrictive and appropriate clinical interventions. Identifying mechanisms of organ injury is a critical step in developing clinical interventions. Unilateral ureter obstruction (UUO) is widely used as an animal model for investigating AKI. The current study was designed to evaluate the role of mitochondrial impairment and oxidative stress in the pathogenesis of renal injury in UUO model. Mice underwent UUO surgery. Then, kidney tissue histopathological changes, plasma biomarkers of renal injury, oxidative stress, and different renal mitochondrial indices were evaluated at scheduled time intervals (3, 7, 14, and 21 days after UUO surgical procedure). Significant increase in plasma creatinine and blood urea nitrogen levels was evident in UUO mice. The UUO surgery induced severe kidney tissue histopathological alterations, including necrosis, severe tubular atrophy, and interstitial inflammation. Moreover, kidney biomarkers of oxidative stress included reactive oxygen species formation, lipid peroxidation, protein carbonylation, decreased glutathione reservoirs (GSH), and increased oxidized glutathione (GSSG) observed in UUO mice. On the other hand, significant mitochondrial depolarization, decreased mitochondrial dehydrogenases activity, mitochondrial permeabilization, and decreased adenosine triphosphate and GSH/GSSG levels were discovered in mitochondria isolated from the kidneys of UUO mice. The data obtained from the current study demonstrated a pivotal and interconnected role for oxidative stress and mitochondrial dysfunction in the pathogenesis of renal injury in UUO model. Therefore, these directions could serve as therapeutic targets in animal models or patients of acute renal failure.
Copyright (c) 2023 Heresh Rezaei, Zahra Honarpishefard , Fatemeh Ghaderi, Ayeh Rouhani, Akram Jamshidzadeh, Seyyed Mohammad Amin Kashani, Narges Abdoli , Forouzan Khodaei , Omid Farshad , Abdollah Arjmand, Issa Sadeghian , Negar Azarpira , Mohammad Mehdi Ommati, Reza Heidari http://creativecommons.org/licenses/by/4.0
Acute Hepatitis by Bartonella henselae Infection in an Adult Patient with Decompensated Liver Cirrhosis
Hepatitis caused by Bartonella henselae in adults is a condition that is seldom reported in the literature, as well as its current incidence and prevalence. While there is a broad spectrum of well-defined and established clinical entities, hepatic involvement represents the third most frequent clinical manifestation of infection by this genus of bacteria. It may or may not be characterized by the presence of hepatosplenic granulomas. Diagnosis requires a high level of clinical suspicion, exclusion of additional etiologies, and a causal relationship with risk factors. Polymerase chain reaction is the diagnostic test with the highest diagnostic yield, and treatment varies depending on the clinical expression. We describe the case of an adult patient with hepatitis secondary to Bartonella henselae infection.
Copyright (c) 2023 Jorge Alonso Garay Ortega, Louis Fernando Robles Fernandes, Vianey Guadalupe Tellez Bolaños, Karla Paulina Sandoval Mosqueda, Karla Daniela Salgado Guizar http://creativecommons.org/licenses/by/4.0
The Interplay of Iron and Lipid Homeostasis in Non-Alcoholic Fatty Liver Disease
The liver is essential for numerous metabolic functions and is the primary site of iron storage and regulation in addition to maintaining critical functions in lipid metabolism. Both iron deficiency and overload have been demonstrated as being involved with metabolic dysfunction; hence, tight regulation of iron absorption is essential to maintain health. Approximately one-third of individuals suffering from non-alcoholic fatty liver disease have elevated hepatic iron concentrations, with increased iron associated with increased disease severity, suggesting a convergence in dysregulation between lipid and iron metabolism. Increasingly, the literature is demonstrating, using a myriad of model organisms and iron-loading methods, that iron loading induces dysregulation in multiple aspects of hepatic lipid metabolism. However, the molecular mechanisms involved, and their subsequent effects on human diseases, are unclear. As iron is a fundamental component of many enzymes and proteins involved in lipid metabolism and is involved in the production of free radicals and oxidative stress, the mechanisms are numerous. In this review, we examine and summarise the dysregulation that iron loading elicits on hepatic lipid availability, de novo synthesis, catabolism, and export. We propose that understanding the interplay between iron and lipid metabolism holds the key to unlocking the complexities of disease development and progression, ultimately leading to improved therapeutic avenues.
Copyright (c) 2024 Clinton J Kidman, Cyril DS Mamotte, Keea R Inder-Smith, Mark J Tobin, Mark J Hackett, Ross M Graham http://creativecommons.org/licenses/by/4.0
Incidence, Histopathological Pattern, and Predictors of Non-Diabetic Renal Disease in Type 2 Diabetes Mellitus: A Single-Center Prospective Observational Study
Patients with type 2 diabetes mellitus (T2DM) may have renal involvement because of isolated diabetic nephropathy (DN), isolated non-diabetic renal disease (NDRD), or mixed lesions (DN combined with NDRD). This study was conducted to find out incidence, histopathological pattern, and clinical predictors of NDRD in the Kashmiri population. This is a single-center prospective observational study conducted from August 2015 to July 2017. Patients with T2DM presenting with atypical clinical features of renal involvement underwent kidney biopsy. A total of 33 patients were included. Isolated NDRD was found in 16/33 (48.5%) patients, isolated DN was discovered in 10/33 (30.3%), and mixed lesions in 7/33 (21.2%) patients. NDRD with or without DN was present in 23/33 (69.7%) patients. Overall, the most common renal histopathological lesion in NDRD was immunoglobulin A (IgA) nephropathy present in 7/23 (30.4%) patients. In mixed lesions, FSGS and TMA were the most common renal lesions present in 2/7 (28.57%) patients. The mean duration of diabetes in NDRD and isolated DN groups was 4.4±3.6 and 7.0±2.9 years, respectively (P = 0.04). NDRD was present in 21/23 (91.3%) patients without diabetic retinopathy (P = 0.016). Our data demonstrated that more than half of the patients with T2DM with atypical features had NDRD upon renal biopsy. The absence of diabetic retinopathy and a shorter duration of diabetes were indicators of NDRD. IgA nephropathy was the most prevalent renal pathology. Clinicians must consider kidney biopsy liberally, especially in patients with unclear etiology of a kidney disease. Patients with type 2 diabetes mellitus (T2DM) may have renal involvement because of isolated diabetic nephropathy (DN), isolated non-diabetic renal disease (NDRD), or mixed lesions (DN combined with NDRD). This study was conducted to find out incidence, histopathological pattern, and clinical predictors of NDRD in the Kashmiri population. This is a single-center prospective observational study conducted from August 2015 to July 2017. Patients with T2DM presenting with atypical clinical features of renal involvement underwent kidney biopsy. A total of 33 patients were included. Isolated NDRD was found in 16/33 (48.5%) patients, isolated DN was discovered in 10/33 (30.3%), and mixed lesions in 7/33 (21.2%) patients. NDRD with or without DN was present in 23/33 (69.7%) patients. Overall, the most common renal histopathological lesion in NDRD was immunoglobulin A (IgA) nephropathy present in 7/23 (30.4%) patients. In mixed lesions, FSGS and TMA were the most common renal lesions present in 2/7 (28.57%) patients. The mean duration of diabetes in NDRD and isolated DN groups was 4.4±3.6 and 7.0±2.9 years, respectively (P = 0.04). NDRD was present in 21/23 (91.3%) patients without diabetic retinopathy (P = 0.016). Our data demonstrated that more than half of the patients with T2DM with atypical features had NDRD upon renal biopsy. The absence of diabetic retinopathy and a shorter duration of diabetes were indicators of NDRD. IgA nephropathy was the most prevalent renal pathology. Clinicians must consider kidney biopsy liberally, especially in patients with unclear etiology of a kidney disease.
Copyright (c) 2023 Aabid Hussain, Rayees Sheikh, Murtaza Pala, Manzoor Parry http://creativecommons.org/licenses/by/4.0
Pulmonary Hypertension in Patients of Chronic Kidney Disease on Maintenance Hemodialysis: Study from a Tertiary Care Center in Central India
To study the incidence of pulmonary hypertension (PH) in chronic kidney disease (CKD) stage V patients on maintenance hemodialysis (HD) at our center. To compare clinical and metabolic variables among CKD patients with and without PH to search for possible etiologic factors. Comparison of PH in CKD patients at baseline and after 3 months of sildenafil therapy. The study was conducted in the Department of Nephrology, Sri Aurob-indo Institute of Medical Sciences, Indore, for a period of 1 year from December 2021 to November 2022. All CKD patients on maintenance HD at our center were included in the study. A pre-structured proforma was used to record patient data. Detailed clinical examination, 2DECHO, and Biochemical tests were done. All patients with mean pulmonary artery pressure (mPAP) > 25 mmHg on 2D echocardiography were considered to have PH and were started on sildenafil therapy 20 mg three times a day for 3 months. PH was classified as mild PH (mPAP > 25 up to 40 mmHg), moderate PH (mPAP > 40 mmHg to 60 mmHg), and severe PH (mPAP > 60 mmHg). Patients were then followed for 3 months to look for episodes of dyspnea and emergency admissions and reassessed after 3 months by repeat 2D echocardiography to find improvement in PH. A total of 102 patients were analyzed during the study period; among them, 40 patients (39.2%) had PH. Out of them, 18 patients (45%) had mild PH, 14 patients (35%) had moderate PH, and 8 patients (20%) patients had severe PH. Average age of our patients was 48.8 ± 9.4 years, the majority being men. On comparing the clinical features between patients with and without PH, none of the clinical parameters had any statistically significant impact on PH. Also, none of the laboratory parameters had statistical significance among PH and non-PH groups. Among the patients with PH, 25 patients (62.5%) had Arteriovenous (AV) fistula, 10 patients (25%) had temporary dialysis catheters. Eight patients (20%) had jugular catheters, two patients (5%) had femoral catheters, and 5 (12.5%) patients had tunneled jugular catheters. Initially, 102 patients were enrolled in the study. Of these, 40 (39.2%) had PH and 62 (60.7%) did not. Patients who had PH started sildenafil 20 mg three times a day. Of these 40 patients, at 3 months, eight patients were lost to follow-up, and 32 patients with PH remained in the study. Emergency admissions in each group of PH declined after 3 months, and the result was statistically significant. Echocardiographic findings were compared in patients with PH and without PH, but the difference in patients on HD with PH and without PH was not statistically significant. PH is a significant problem in CKD patients on HD. This issue needs to be evaluated in a timely manner to avoid the risk of morbidity and mortality. It is vital to treat them at the earliest to prevent life-threatening complications.
Copyright (c) 2023 Trishala Chhabra, Naresh Pahwa, Shraddha Goswami, Riyaz Asad, Mohit Mahajan, Sharada Chandrashekhar Aher http://creativecommons.org/licenses/by/4.0
IgA Nephropathy Associated with IgA Vasculitis Coexisting with Focal Segmental Glomerulosclerosis Tip Variant: A Case Report
IgA vasculitis (IgAV), previously known as Henoch–Schönlein purpura, is a form of small vessel vasculitis that affects the skin, joints, intestines, and kidneys. The clinical presentation in adults is usually infrequent, more severe, with a worse prognosis and a higher recurrence rate. Due to limited scientific evidence, IgAV is viewed similarly to IgA nephropathy (IgAN), and the renal histopathological lesions are indistinguishable between the two. IgAN is the most prevalent glomerular diseases worldwide. The diagnosis of IgAN is confirmed through a renal biopsy. The most frequently found histopathological lesions are mesangial proliferation and concurrent IgA deposition confirmed by direct immunofluorescence. Focal segmental glomerulosclerosis (FSGS) appears as a glomerular pattern of injury in up to 40% of renal biopsies with IgAN, although there are few reported cases in the international literature where both diseases coexist as primary etiologies. We report a case of a female patient presenting with vasculitic lesions, abdominal pain, and nephrotic syndrome, whose cause is confirmed by a renal biopsy with a diagnosis of IgAN secondary to IgAV and coexistence of FSGS, an unusual presentation with few case reports.
Copyright (c) 2023 Zitlali Guadalupe Paulín Zepeda, Karla Daniela Salgado Guizar, Vianey Guadalupe Tellez Bolaños, Louis Fernando Robles Fernandes, María Inés Gil Arredondo http://creativecommons.org/licenses/by/4.0
Clinicopathologic Spectrum of Nephrotic Syndrome in the Elderly
The elderly population is affected by a wide range of kidney diseases like young adult patients. However, their clinical course and morphological manifestations are affected by aging. Recognition, diagnosis, and management of glomerular disease in elderly persons have several unique challenges. We aimed to study the clinicopathologic spectrum of elderly patients with nephrotic syndrome (NS). In this retrospective study, we looked at 234 patients of adult NS who were biopsied during the last 5 years. Among them, 31 patients were above the age of 60 years (Elderly). Mean age in elderly patients was 67.48 ± 6.11 years, with age range from 60 to 86 years. Elderly NS patients constituted 13.2% of total adult NS patients. Nineteen patients (61.2%) were males and 12 (38.7%) were females. Hematuria was observed in 19% and hypertension in 48% patients. Mean serum albumin was 2.79 ± 0.39 g/dl and mean 24 h urinary protein was 3.77 ± 0.8 grams. Membranous nephropathy (MN) followed by minimal change disease (MCD) was the most common diagnosis. No major complication with biopsy was reported in our study as has been the case with most studies.
Copyright (c) 2023 Sheikh Zubair, Junaid Ahmed, Syed Mubashir Nissar, Muzamil Rashid Pala, Aabid Hussain , Murtaza Rashid Pala, Muzamil Latief http://creativecommons.org/licenses/by/4.0
A Prospective Non-Randomised Interventional Study of Goal-Directed Ultrafiltration Compared With Clinical Dry-Weight Assessment in Achieving Euvolemic Status of Patients on Maintenance Hemodialysis
An accurate assessment of intravascular volume status in hemodialysis (HD) patients presents a significant challenge. Current clinical practices to determine dry weight is flawed due to interobserver variability and nonreproducibility. This miscalculation results in either chronic hypervolemia or hypovolemia with intra or interdialytic hypotension. The quest for noninvasive volume assessment tools to aid in the estimation of dry weight still continues. This study aims at goal-directed ultrafiltration removal compared with clinical dry-weight assessment in achieving euvolemic status of patients on chronic HD. It is a prospective, single-centered, nonrandomized, noninvasive interventional study on HD patients, for 12 months. Fifty two patients participated out of which 46 completed the study. Ultrasound-guided inferior vena cava collapsing index (IVCCI) and B lines were measured at intervals along with cardiac parameters. Dry weight was first estimated clinically by trial and error method. New dry weight target was set when B-lines were less than four in the eight site lung ultrasound and IVCCI between 50 and 75%, after 30 min post dialysis. Approximately 23.9% of the patients did not require dry-weight modification throughout the study. About 19% patients did not achieve dry weight in spite of all interventions. Overall, 56.5% of the patients achieved dry weight during the study period. A total of 46.3% of patients with NYHA Grade 3 dyspnoea observed at the start of study was reduced to 2.2%, showing statistical significance. Clinical assessment when bundled with noninvasive technology of assessment of dry weight showed encouraging results. B-lines and IVCCI estimation could be additional tools to achieve target weight goals, reducing complications and increasing compliance.
Copyright (c) 2023 Dr Pankaj Ganvir, Dr Sudhiranjan Dash, Dr Amjad Khan Pathan, Dr Rushi Deshpande, Dr Ashay Shingare, Dr M M Bahadur, Dr Ashwin Patil http://creativecommons.org/licenses/by/4.0
A Comprehensive Overview of In-patients Treated for Hepatocellular Carcinoma at a Tertiary Care Facility in Tanzania
Hepatocellular carcinoma (HCC) is one of the commonest causes of cancer-related morbidity and mortality worldwide. However, only a limited number of studies on HCC have been conducted in Tanzania. We therefore conducted a cross-sectional study among in-patients treated for HCC in a tertiary referral hospital located in Dar es Salaam, Tanzania, in order to provide a concise description of the clinical characteristics and treatment options offered in the study setting. We identified 36 in-patients treated for HCC over a 6-month data collection period. Seventy-seven percent (n = 28) of the participants were males and about two-thirds (61.2%) were aged between 40 and 60 years. Majority (44.4% [n = 16]) of the patients had Child-Pugh class B and an Eastern Cooperative Oncology Group (ECOG) performance status of 2 (33.3% [n = 12]). Patients with tumors >6.5 cm and multinodular tumors (>3 nodules) accounted for 69.4% (n = 25) and 55.6% (n = 20), respectively. Portal vascular invasion and extrahepatic metastasis were respectively present in 27.8% (n = 10) and 25% (n = 9) of the patients. Of the study participants, only two had early-stage disease as per the Barcelona Clinic Liver Cancer (BCLC) staging system, corresponding to the observed tumor resection rate of 5.6%. The most frequently reported inoperable factor among the study participants was an ECOG performance status > 0 (n = 30 [83.3%]). Findings thus reveal a high proportion of late-stage diseases among participants that could have resulted in the observed low tumor resection rate. Initiatives to facilitate identification of the disease at an early stage are therefore paramount in optimizing care.
Copyright (c) 2023 Ally H. Mwanga, James D. Mwakipesile, Daniel W. Kitua, Yona E. Ringo http://creativecommons.org/licenses/by/4.0
L-Ornithine-L-Aspartate and Intermittent Renal Replacement Therapy in Fulminant Hepatitis A: A Case Report
Hepatitis A is a common viral infection worldwide that is transmitted via the fecal-oral route. Since the introduction of an efficient vaccine, the incidence of infection has decreased but the number of cases has risen due to widespread community outbreaks among unimmunized individuals. Classic symptoms include fever, malaise, dark urine, and jaundice, and are more common in older children and adults. People are often most infectious 14 days prior to and 7 days following the onset of jaundice. We will discuss the case of a young male patient, diagnosed with acute hepatitis A, leading to fulminant hepatitis refractory to conventional therapy and the development of subsequent kidney injury. The medical treatment through the course of hospitalization was challenging and included the use of L-ornithine-L-aspartate and prolonged intermittent hemodialysis, leading to a remarkable outcome. Hepatitis A is usually self-limited and vaccine-preventable; supportive care is often sufficient for treatment, and chronic infection or chronic liver disease rarely develops. However, fulminant hepatitis, although rare, can be very challenging to manage as in the case of our patient.
Copyright (c) 2023 Nourhane Obeid, Khaled H. Soukarieh, Jessy G. Fadel, Rayyan M. Wazzi-Mkahal, Marianne A. Alwan, Jessica J. Fakhir, Paul W. Rassam, Najat I. Joubran, Mona H. Hallak http://creativecommons.org/licenses/by/4.0
Impact of Induction Therapy on Clinical Outcomes of Kidney Transplant Recipients: A Single-Centre Cohort Study
The purpose of this study was to evaluate long-term efficacy of immunosuppressive drugs based on the type of induction therapy given to kidney transplant recipients, and determine the occurrence of graft dysfunctions or rejections. We compared the safety and efficacy of anti-thymocyte globulin (ATG) and basiliximab (BAS) in high-risk patients and analyzed the cumulative incidence of immediate, slow, and delayed graft function in kidney transplant recipients to determine their initial short-term graft function. Evaluation of the long-term efficacy after 3 years post-transplantation by assessment of patients and graft survival, incidence of infections, and risks of rejection were the primary endpoints. Patients with stable graft survival were observed more with ATG (85%) than BAS (70%); in contrast, graft dysfunctions, graft nephrectomy, rejection episodes, and patient deaths were more prevalent with BAS than ATG, with statistically significant differences in long-term graft functioning. Patient survival at 3 years in ATG group was 90.4%, compared to 88% in BAS group, and graft survival was 90.4% in the ATG group and 81.3% in the BAS group (P < 0.001). The use of both induction therapies resulted in good patient and graft survival outcomes than placebo, and the results showed that there was a significant difference in both patient and graft survival after 3 years between induction of ATG and BAS, suggesting that ATG can be safer, effective, and preferable drug over BAS for high-risk recipients.
Copyright (c) 2023 Vijaya Madhuri Devraj, Gangadhar Taduri, Swarnalatha Guditi, Uttara Das, MP Shamsudheen, Megha Saigal, Karthik Kalidindi http://creativecommons.org/licenses/by/4.0
Indications for Percutaneous Ultrasound-Guided Renal Biopsy and Complications Associated with it: An Observational Study
Renal biopsy is performed for various reasons depending on the clinical manifestations presented. Although percutaneous kidney biopsy is a safe procedure, major or minor complications could occur. Our study aimed to assess the indications for percutaneous renal biopsy and complications associated with the procedure. This was a prospective observational study conducted in the Department of Nephrology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India. Patients who underwent percutaneous ultrasound-guided renal biopsy at the institute between October 2017 and June 2019 were enrolled in the study. Data regarding indications for performing a percutaneous renal biopsy and incidence of minor and major post-biopsy complications were collected. A total of 229 patients who underwent ultrasound-guided percutaneous renal biopsy were enrolled in the study. The most common indications for ultrasound-guided percutaneous renal biopsy were nephrotic syndrome (33.3%), subnephrotic proteinuria with azotemia (14%), and unexplained azotemia with proteinuria and hematuria (13.5%). Post-biopsy complications were observed in 89 (37.55%) patients. Minor complications developed in 83 (36.22%) patients and major complications in six (2.62%) patients. Among patients with major complications, two (0.87%) patients underwent invasive procedures (embolization and cystoscopic removal of bladder clot) and four patients developed hemodynamic instability. No procedure-related mortality was reported in the study. The most common indications for renal biopsy were nephrotic syndrome, subnephrotic proteinuria with azotemia, unexplained azotemia with proteinuria, and hematuria. The incidence of major complications was low.
Copyright (c) 2022 Mohammad Ashraf Bhat, Shahid Sulayman, Manzoor Parry, Muzaffar Wani, Imtiyaz Wani http://creativecommons.org/licenses/by/4.0
Quality of Life of Patients on Peritoneal Dialysis and Contributing Factors: A Cross-Sectional Study
In recent years, interest in Health-Related Quality of Life (HRQoL) as a major indicator of clinical efficacy and treatment outcome in patients of End-Stage Renal Disease (ESRD) has grown significantly. This study aimed to determine the contributing factors affecting the quality of life (QoL) of ESRD patients undergoing peritoneal dialysis (PD). A cross-sectional study was conducted on PD patients presented at PD centres of Al-Zahra and Noor hospitals in Isfahan, Iran, from May to August 2019. A total of 173 patients having peritoneal dialysis for more than 3 months filled the validated 36-item short-form health survey questionnaire (SF-36). Baseline demographic details and dialysis-related factors were collected from patients’ medical records. The overall QoL score of patients was 50.28 ± 20.87. Male patients had a higher QoL score than female patients (58.18 in males, compared to 48.18 in females; P = 0.04). A significant association between frequency of dialysis and quality of life was observed, where three sessions of dialysis per day yielded the highest quality of life (QoL score = 59.62; P = 0.047). A significant positive correlation was discovered between QoL score and residual renal function (P = 0.013). In addition, a higher QoL score was observed in self-employed patients (60.95), compared to housewives (46.49) (P = 0.001). QoL assessment should be included as an integral part of patient follow-up to evaluate treatment outcomes and implement possible interventions to improve patient’s quality of life.
Copyright (c) 2023 Niloofar Nili, Shiva Seirafian, Sayed Mohsen Hosseini, Abdolamir Atapour, Maryam Kazemi Naeini, Mojgan Mortazavi http://creativecommons.org/licenses/by/4.0
Paraquat-associated Severe Acute Kidney Injury—Study from India
To analyze the outcomes of severe acute kidney injury in patients with paraquat ingestion. This retrospective analysis of case records was done in our institute, a tertiary care government teaching hospital, over a period of 4 years. Of the total 1310 acute paraquat poisonings during this period, severe acute kidney injury (AKI), referred for nephrology management was observed in 60 patients. Common symptoms at presentation include vomiting, oral ulcers, and abdominal pain. Oliguric AKI was present in 26%. Need for renal replacement therapy was observed in 95% of the cases. Mortality was observed in 38 of the 60 patients (68%). Factors associated with mortality on Cox regression analysis include amount of consumption. Estimated duration of survival on analysis curves was 8 days in 50% after admission and 15 days after consumption in 50%. Paraquat poisoning is associated with grave outcomes of morbidity and mortality. Severity of AKI is significant in this poisoning. Amount of consumption, latency of referral play a major role in outcomes.
Copyright (c) 2022 Manjusha Yadla, Manu K, KV Anupama, B Rajasekhar http://creativecommons.org/licenses/by/4.0
Fibrolamellar Carcinoma with DNAJB1-PRKACA Fusion in a 16-Year-Old: Case Report and Review of Literature
Fibrolamellar hepatocellular carcinoma (FLC) is a unique primary liver malignancy arising in noncirrhotic livers of young adults with an incidence of 0.02 per 100,000 in the USA (1). In the 5th edition of the WHO classification of the digestive system tumors published in 2019, fibrolamellar carcinoma is categorized as a subset of hepatocellular carcinoma (HCC). In 2014, the unique DNAJB1-PRKACA chimeric fusion protein was identified. Later studies proved this chimeric fusion protein as the main pathological driver in the disease manifestation of fibrolamellar carcinoma. Despite the invention of specific molecular genetic alteration in FLC, its oncogenic role and implication in FLC treatment remain an enigma. Surgical resection remains the primary therapeutic option, and the recurrence rate is extremely high (1). We present a case of fibrolamellar carcinoma in a pediatric patient with the PRKACA rearrangement resulting in DNAJB1-PRKACA fusion.
Copyright (c) 2022 Varsha Prakash, Neha Varshney http://creativecommons.org/licenses/by/4.0
Differences in Urinary Calculi Characteristics among the Three Main Racial Groups in KwaZulu-Natal, South Africa
Racial differences in the characteristics of urinary calculi are poorly described in the South African context, limiting our local understanding of urolithiasis pathology and thwarting our efforts in designing appropriate preventative interventions. We sought to investigate differences in urinary calculi characteristics among the main racial groups in KwaZulu-Natal, South Africa. We conducted a retrospective chart review of patients with urinary calculi at a quaternary hospital in KwaZulu-Natal, South Africa, during 2018–2019. We collected data on the patient’s age, sex, race (Caucasian, Asian, Black African), residence, and pre-stenting. Five study outcomes were investigated across racial groups: number of calculi, location of the calculi, size of the calculi, density of the calculi (Hounsfield Unit measurement >600), and the number of operative interventions performed. Data were analyzed with descriptive statistics, the chi-squared test, and unadjusted/adjusted logistic regression. Our study sample consisted of 147 patients (10.9% Caucasian, 55.8% Asian, and 33.3% Black African). Most patients (86.4%) were from urban areas. A higher proportion of Black Africans had urinary calculi with Hounsfield Unit measurements >600 (P = 0.002). In the logistic regression models, Black Africans had a higher probability of having urinary calculi with Hounsfield Unit measurements >600 (Unadjusted Odds Ratio: 7.17, 95% Confidence Interval: 2.00–27.80; Adjusted Odds Ratio: 18.75, 95% Confidence Interval: 3.37–157.57). Our analysis suggests that Black Africans are at higher risk of having harder urinary calculi than other race groups. This has implications for urolithiasis management and highlights the importance of primary prevention in this group. We recommend additional research to confirm our findings.
Copyright (c) 2023 Dhesigan Naidoo, Vishan Ramloutan http://creativecommons.org/licenses/by/4.0