Background: Percutaneous kidney biopsy is the primary diagnostic tool used in kidney diseases. In general, it is a low-risk procedure in a majority of the patients, however, complications do occur and the most common complications are pain abdomen and bleeding which may be microscopic or macroscopic hematuria or perirenal hematoma. We aim to assess all the biopsies performed by following the patients postprocedure. Materials and Methods: All patients were evaluated before renal biopsy with prebiopsy investigations like Hemoglobin percentage, platelet count, and other test for coagulation. Following which patients underwent ultrasound guided renal biopsy. post renal biopsy they were followed clinically for pulse rate , blood pressure and laboratory monitoring by repeat hemoglobin levels, and by ultrasound scan for any hematoma and visible hematuria. The results were compared to prebiopsy values and tabulated and difference in values were assessed. Results: We enrolled 88 patients in our study done over 3 years; out of 88 patients enrolled, we found that 58% of the patients were male and 42% were female; following biopsy, pain abdomen was the most common symptom reported in 50% of the patients, followed by hematuria in 33% of the patients. Out of 88 patients, 57 patients (64%) had a decrease in Hb from their prebiopsy levels, but the range was 0.1g/dl-3.4g/dl drop with a mean value of 0.932 ± 0.819 g%. Seventeen patients (19.3%) developed hematoma on day 1 following biopsy with a size ranging from 1 cc to 25 cc hematoma with a mean size of 3 cc, which decreased in size on follow-up scans to 3 (3.4%) patients on day 3 having persistent hematoma with a Median size of 4cc on day 3. The odds ratio (O.R) for developing hematoma following kidney biopsy was assessed in different groups. It was found that those patients who had their baseline serum creatinine >3mg/dl had O R of 1.66 95% C.I, [0.53-5.07]. And those patients whose systolic blood pressure was >160 mm of Hg had an Odds Ratio of developing hematoma of O.R 2.77 95% C.I [0.43-11.08]. Conclusion: Renal biopsy is a relatively safe procedure with some morbidity and occasional mortality if performed by screening of patients thoroughly for bleeding parameters, and patients may require monitoring postprocedure by repeated ultrasound scans if needed. Moreover, bleeding in many patients is clinically insignificant rarely requiring any transfusion postprocedure. Moreover, patients with high prebiopsy creatinine have some risk of bleeding than other patients with normal kidney function.
Background Dialysis adequacy is an important and effective factor in reducing mortality and morbidity among patients with end-stage kidney disease. This study aims to assess the current clinical situation of hemodialysis (HD) patients, to monitor the established quality-of-care indicators, and to identify the unachieved quality-of-care goals. Patients and methods This is an observational study in which all patients underwent chronic HD program (>1 year) at the nephrology center in Benghazi, Libya. It was conducted between January and June 2018. Mean levels were collected for the following indicators: hemoglobin, dialysis dose, serum calcium and phosphorus, parathyroid hormone, systolic and diastolic blood pressure, interdialytic hypotension, and vascular access. Results A total of 292 dialysis patients were reviewed and followed over a 6-month period. Overall, 170 (58.2%) were males and 122 (41.8%) were females. Mean age was 51.1±14 years. Hypertension was the most common cause of end-stage kidney disease in 76 (26.0%) patients followed by diabetes mellitus in 32 (11.0%) patients. Our patients failed to achieve adequate HD, as laboratory value results were as follows: mean hemoglobin level less than 10 g/dl in 61% of patients, serum Ca+2 was less than 8.4 mg/dl in 48.6%, serum PhO4 was more than 5.5 mg/dl in 50%, and serum parathyroid hormone was more than 300 ng/dl in 60.3%. Conclusion Dialysis insufficiency was seen in a significant percent of patients in this study. More extensive research studies for finding the causes of low dialysis quality are suggested.
Background: Oxidative stress is one of the main causes of cataract and can be induced by selenite administration in rats. In experimentally induced cataract, sodium selenite may affect the reproductive system in young animals because of induction of oxidation condition. Methods: Sixty-four male 8-day-old Sprague Dawley rats were divided into five groups: control; pomegranate peel extract (PPE) 500 mg/kg; sodium selenite 30 μmol/kg; PPE and sodium selenite simultaneously on day 8; and PPE on day 6 and sodium selenite on day 8. A histopathological study was performed after 4 weeks. Results: Cataract was induced in all treated rats with selenite sodium. The volume and weight of the right and left testicles, the weight of the right and left epididymis, and the weight of the Cowper's gland, seminal vesicles, and prostate were significantly different between the sodium selenite group and other groups. On the other hand, the histopathological examination revealed tissue damage, interstitial edema, and the degeneration of spermatogenic cells in seminiferous tubules in the group which had received sodium selenite. There was a significant difference in all of the morphometric parameters of the genital system in rats, except the weight of the prostate between the PPE group and PPE and sodium selenite simultaneously group. Conclusion: The consumption of PPE improves the testis pathology indices in immature male rats with cataract induced by sodium selenite.
Leydig cell tumors form 1%-3% of all testicular tumors. We report a case of incidental Leydig cell tumor in a case of detorted testis.
Background and Objectives: Pausinystalia yohimbe is an evergreen (tree) medicinal plant that is being used across the globe in ethnomedicine to enhance libido in male. Therefore, this study is to investigate the in vitro aphrodisiac potential and acute toxicological effect of P. yohimbe roots in male Wistar rats. Materials and Methods: Forty-five male albino rats were randomly divided into five groups of nine rats each. Rats in Group 1 (control) were administered 1 mL/kg body weight distilled water (vehicle), Group 2 received 5 mg/kg body weight sildenafil citrate (Viagra), while those in Groups 3, 4, and 5 were given 25, 50, and 100 mg/kg body weight, respectively, of methanol extract of P. yohimbe root in the same volume. Female albino rats were made receptive by hormonal treatment. Sexual behavior parameters in male rats were monitored on days 1, 7, and 14 by pairing with receptive females. Computed male sexual behavioral parameters, male serum testosterone concentrations, and acute toxicological assay of the plant were also determined. Results: Oral administration of P. yohimbe root extract at the doses evaluated, except the lowest dosed group on day 1, significantly increased mount, intromission, and ejaculation frequencies (P < 0.05). The latencies of mount and intromission were significantly decreased and ejaculation latency was prolonged. Administration of the extract also reduced the postejaculatory interval significantly. The standard drug (sildenafil citrate) was not effective than the extract. The extract significantly increased the computed male sexual behavioral parameters as well as serum testosterone concentrations, compared with the distilled water control. The toxicity studies showed that there were no acute behavioral changes with zero mortality. Conclusions: The result of this study demonstrates that methanol extract of P. yohimbe root enhances sexual behavior in male rats. The aphrodisiac effects of the plant extract may be related to the increased blood testosterone concentrations caused by the action of bioactive compounds present in the extract, acting via a multitude of central and peripheral mechanisms. Data from this study thus support the folk use of the plant material as an aphrodisiac in males.
Background and Objectives: Nephrotic syndrome, characterized by the presence of heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia, is a common renal disorder in pediatric population. The aim of this study was to find out the prevalence of urinary tract infection (UTI) in nephrotic syndrome, bacterial etiologies, and antibiotic sensitivity pattern. Subjects and Methods: After matching the criteria, 82 cases were taken for this prospective, single-center, observational study. The diagnosis was confirmed by bacterial culture. This is an institution-based, cross-sectional, descriptive observational study. All newly diagnosed and relapse cases of nephrotic syndrome based on the inclusion exclusion criteria were included in the study. Respondent was either of the parents or caregiver of the study subjects. Analysis of all data was done by appropriate statistical software (SPSS-23). Results: Among 82 participants evaluated with nephrotic syndrome, 29.3% of participants had UTI, majority (66.7%) were asymptomatic, and 33.3% were symptomatic. Significant microscopic hematuria was found in 20.7% of study subjects and significant pyuria was found in 58.54%. Majority (33.3%) of UTIs were caused by Escherichia coli, followed by Klebsiella 25%, Proteus 16.7%, and Staphylococcus aureus 12.5%, and Citrobacter, Acinetobacter, and mixed growth were found in 4.2% each. The mean serum cholesterol of group with UTI was 422.13 ± 34.65 and group without UTI was 307.43 ± 26.13. The variation among the two groups was found to be statistically significant (P = 0.0001). Conclusions: The children with nephrotic syndrome are frequently predisposed to UTI, and in most cases, it is asymptomatic and often undiagnosed. Higher serum cholesterol level may predispose the nephrotic child for UTI.
Background and Objectives: Several studies show that most infants with posterior urethral valve (PUV) do not fully recover their renal function, despite postnatal interventions to obviate the consequences of lower urinary tract obstruction. This systematic review assesses the future risks of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) in infants with postnatally-repaired PUV. Methods: We electronically searched PubMed, Medline, Embase, and Google Scholar databases for articles published between 2000 and 2020 (Date of the last search: September 12, 2020) using appropriate descriptors. We selected the studies based on adopted eligibility and exclusion criteria. We independently retrieved relevant data from the selected studies using a preconceived data-extraction form. We analyzed the aggregate data among the selected studies that signified future CKD and ESKD after the postnatal intervention and computed their mean prevalence rates. We also calculated the average point estimate of CKD and ESKD relative risks (RR) as the effect estimate at a 95% confidence interval. Results: Eleven studies were selected and reviewed, in which a total of 1362 patients were managed and followed up for variable periods. The aggregate data on ESKD prevalence from seven studies showed that a total of 112 patients developed ESKD out of a total patient-population of 446, giving a calculated mean ESKD prevalence of 24%. The CKD prevalence data in nine studies showed that 210 patients had CKD, out of 741 patients that were followed up, with a calculated mean CKD prevalence of 28%. The pooled RR of ESKD in seven studies and RR of CKD in nine studies was 0.5 (−0.48, 1.48) and 0.57 (−0.41, 1.55), respectively. Conclusions: Future risks of CKD and ESKD are still high in patients with postnatally-repaired PUV. We advocate a management approach that involves a synergy between pediatric nephrologists and urologists to ensure prompt renoprotective strategies and timely surgical intervention.
Background and Objectives: Nephrotoxicity has characterized the use of isoniazid–rifampicin (INH-RIF). Selenium (Se) has potential to protect tissues from damage. This study evaluated the protective activity of Se against INH-RIF-induced nephrotoxicity in rats. Methods: Forty-five adult male albino rats (200-230 g) randomized into nine groups of n = 5 were used. Group A (placebo control) and Group B (solvent control) were treated with normal saline (0.2 mL/day/per oral [p.o]) and corn oil (0.2 mL/day/p.o) for 21 days, respectively. Groups C–E were treated with Se (0.1, 0.2, and 0.4 mg/kg/day/p.o, respectively) for 21 days. Group F was treated with INH-RIF (50/100 mg/kg/day/p.o) for 21 days. Groups G–I were supplemented with Se (0.1, 0.2, and 0.4 mg/kg/day/p.o, respectively) before treatment with INH/RIF (50/100 mg/kg/day/p.o) for 21 days. After treatment, the rats were anesthetized. Blood samples were collected and evaluated for serum renal function markers (creatinine, urea, uric acid, total protein, and albumin). Kidneys were assessed for histology, malondialdehyde (MDA), and antioxidants (superoxide dismutase, glutathione, catalase, and glutathione peroxidase). Results: Body weight was decreased whereas kidney weight was increased significantly (P < 0.01) in INH-RIF-treated rats when compared to control. INH-RIF caused significant (P < 0.001) increases in serum renal function markers and kidney MDA level when compared to control. INH-RIF caused significant (P < 0.001) decreases in kidney antioxidants when compared to control. Kidneys of INH-RIF-treated rats showed tubular necroses and widened Bowman's space. INH-RIF-induced nephrotoxicity was significantly reduced in a dose-dependent fashion in rats supplemented with Se (0.1, 0.2, and 0.4 mg/kg) at P < 0.05, P < 0.01, and P < 0.001, respectively, when compared to INH-RIF. Se may clinically protect against INH-RIF-induced nephrotoxicity. Conclusion: This study showed that Se may clinically prevent INH-RIF-related nephrotoxicity.
Background and Objective: Data on early-stage of chronic kidney disease (CKD) and the prevalence of CKD are very limited, especially more scanty in our female population. Hence, data from a kidney screening program organized at the Chattagram Maa-O-Shishu Hospital premises in connection with the observance of World Kidney Day 2018 were looked at for renal function among a group of female health personnel. Methods: This was a cross-sectional study among a group of female health personnel working at the hospital. Age, body weight, height, Body mass index (BMI), and blood pressure were documented, and serum creatinine was measured at a single sitting. The kidney function was estimated by calculating the glomerular filtration rate (GFR) using the Modified Diet in Renal Disease formula. Kidney function was classified according to estimated GFR (eGFR) and Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines. Results: A total of 101 female health personnel were studied – physicians - 23; nurses - 45, and health assistants - 33. Majority participants (51%) were in the age group of 20–29 years; 5% were 90 mL/min category. An inverse relation between the age and eGFR and a direct relation between the BMI and eGFR were observed in the study. Conclusion: The results indicate that low GFR levels and consequently a high burden of likely CKD are prevailing in our female population. It is not clear whether such observations are the result of the transportability problems associated with the GFR prediction equations or with the suitability of K/DOQI guidelines for the classification of CKD in our population or both. Well-planned, larger, and community- and hospital-based studies are warranted to clarify these issues, especially for our female population.
Background and Objective: Advanced chronic renal failure leads to changes in calcium metabolism that cause disturbances in the parathyroid, vascular system, and bones. The 25(OH) Vitamin D plays a key role in regulating calcium metabolism and preventing these complications. The objective of this study was to determine 25(OH) Vitamin D levels in dialysis patients and to relate to clinical and sociodemographic characteristics. Methods: This was a cross-sectional study. The data collection was given by interview and consultation in electronic records, and the dosage of 25(OH) Vitamin D was performed on heparinized plasma samples collected at the beginning of the dialysis session. Results: Of the 77 patients studied, noted that seven (9.1%) showed poor values of 25(OH) Vitamin D and 19 (24.7%) showed insufficient values. As for the presence of comorbidities, 31 (40.3%) reported having diabetes mellitus, and 54 (70.1%) reported having arterial hypertension. It was also observed that the serum levels of 25(OH) Vitamin D are inferior in the carriers of diabetes mellitus and decrease with the increase of age and with the elevation of serum creatinine. The use of Vitamin D supplements presented positive correlation with serum calcium levels. Conclusion: The insufficiency of 25(OH) Vitamin D is frequent in dialysis patients especially in the carriers of diabetes mellitus.
Urinary Retention Secondary To The Use Of Selective Serotonin Reuptake Inhibitors Is A Rare Event. We Report The Case Of A Man With Benign Prostatic Hyperplasia (Bph), Who Began To Experience Urinary Retention After Starting Treatment With Relatively Higher Starting Dose Of Sertraline For Panic Disorder. He Required Foley Catheterization And Was Maintained On Indwelling Catheter For 7 Days. Our Report Recommends Monitoring Of Urinary Symptoms In Bph Patients On Sertraline.
Alport syndrome (AS) is a type of inherited nephropathy characterized by hematuria, proteinuria, and progressive renal failure; often associated with extrarenal manifestations such as sensorineural deafness and anterior lenticonus. X-linked AS causes end-stage kidney disease in young male patients, sometimes without prominent clinical manifestation beforehand due to its heterogeneous phenotype. Here, we report a case of AS where ignorance of visual and auditory symptoms led to progression to end-stage renal disease.
Objectives: This study aimed to evaluate the demographic features, clinical presentations, sexual aspects, and possible risk factors of genital warts (GWs) among patients treated at Outpatient Clinics of the Dermatology, Venereology, and Andrology Department, Faculty of Medicine, Sohag University, Egypt. Patients and Methods: In a prospective cross-sectional clinical study, it conducted on 85 patients with clinically evident GWs. All patients were subjected to clinical assessments included a detailed medical history and full general and local examinations. All patients were investigated to exclude other sexually transmitted diseases (STDs). Results: This study included 85 patients with clinically evident GWs; 65 (76.5%) were male and 20 (23.5%) were female. Of male patients, 44.5% were university graduate, 73.8% were urban, 90.8% were smoker, 64.6% had a single sexual partner, 75.4% preferred intravaginal sex, 100% were circumcised, 80% had occasional history of condom use, and 95.4% had a history of illegal sexual relation. Of female patients, 40% were university graduate, 55% were suburban, 100% were nonsmoker, 45% had a single sexual partner, 65% preferred intravaginal sex, 100% were circumcised, 50% had an occasional history of partner use of condom, and 35% had a history of illegal sexual relation. All patients had neither other STDs nor warts in other body sites. Conclusion: Like all STDs , GWs have important effects on the health of society and quality of life. So, awareness of clinical presentations, sexual aspects, and possible risk factors of GWs leads to the use of effective protection measures and decrease the cost of treatment.
Background and Objective: Cyst infections often develop as a complication in patients with autosomal dominant polycystic kidney disease (ADPKD). Although this complication has significant clinical implications, reports of cyst infection are extremely limited. Herein, we report on the status of cyst infection in patients with ADPKD to clarify this. Materials and Methods: Among 90 patients with ADPKD admitted to our hospital from 2010 to 2017, we selected those diagnosed with cyst infection. We collected the data from medical record retrospectively. Results: A total of 22 patients, comprising 12 men and 10 women, were included in the study. Infected cysts were identified on imaging in six (27.3%) patients. Bacterial culture was positive in 12 (54.5%) patients. The initial antibiotic treatment was quinolone, cephalosporin, carbapenem, and vancomycin in 7 (31.8%), 11 (50%), 3 (13.6%), and 3 (13.6%) patients, respectively. The mean hospitalization period was 12.0 days (range, 9.25–14.75), while the mean antibiotic treatment period was 26.5 days (range, 21.25–29.50). No patient died. Nine (40.9%) patients had previous episodes of cyst infection, and 11 (50.0%) had recurrence during the study period. The rate of prolonged hospitalization longer than the median of 12 days was higher in patients with maintenance dialysis, although the difference was not significant (80.0% vs. 50.0%, P = 0.1453). In multiple regression analysis, the albumin value showed a negative correlation with the hospitalization period (β-coefficient: −0.4835, 95% confidence interval: −15.5757–−0.9460, P = 0.0290). Conclusion: Patients with ADPKD who have a poor nutritional status may require additional medical attention to avoid prolonged hospitalization.
Primary IgA nephropathy (IgAN) is the most common primary glomerulonephritis globally. Its epidemiology, clinical presentation, histology, and prognosis vary widely. Focal segmental glomerulosclerosis is frequently seen in IgAN and is an indicator of poor prognosis. Collapsing glomerulopathy (CG) associated with IgAN is rarely seen, and its treatment and prognosis are largely unknown. We present here, two male patients presented with renal failure and nephrotic syndrome. Renal biopsy in the first patient revealed CG with IgAN with significant interstitial fibrosis and tubular atrophy and hence treated with supportive therapy. In the second patient, concomitant CG and IgAN were diagnosed and started on oral steroids and had partial improvement.
Background and Objective: The aim is to study the efficacy and safety of flexible ureteroscopic lithotripsy (fURSL) for renal stone with persistent urinary tract infection (UTI). Materials and Methods: We retrospectively included 15 cases of patients diagnosed with renal stone together with persistent UTI, who were treated with fURSL from October 2011 to June 2015. A group of 15 patients diagnosed with renal stone, without any sign of persistent UTI, were set as control group. Standard fURSLs were performed by two experienced urologists. Vital signs, routine blood test and kidney, urine, and bladder were observed as well. The double J stent was removed 2–4 weeks after the operation. Results: All operations were done in one-stage. In UTI group, the average operation time was 30 ± 21 min (15–50 min). The stone-free rate (SFR) was 93.3% (14/15). Two cases (13.3%) of fever were observed after the operation, all happened within 6 h postoperatively, with the highest temperature of 39°C. All patients were cured with antibiotics. Conclusions: It is safe to perform fURSL on renal stone patients with persistent UTI under the protection of sensitive antibiotics. The SFR and postoperative complications were acceptable. Low-pressure irrigation and careful postoperative observation are of great importance for these patients.
