Introduction: Crescentic glomerulonephritis is an essential kind of glomerulonephritis. According to its rapid progression and aggressiveness, recognizing its risk factors helps to manage a better treatment and outcome. Objectives: This study was designed to compare demographic, laboratory, and renal biopsy findings of patients with crescentic glomerulonephritis among males and females. Patients and Methods: This cross-sectional study compared age, gender, types of crescentic glomerulonephritis, serum creatinine, 24-hour proteinuria, the number of crescents, and percentage of fibrosis. Results: Of 169 patients with crescentic glomerulonephritis, 54.4% were males, and 45.6% were females. The mean age, serum creatinine level, and 24-hour proteinuria were 37.73±15.32 years, 2.06±1.35 mg/d, and 2084.82±1170.98 mg/d, respectively. Serum creatinine level and 24-hour proteinuria were not significantly different by gender. In addition, the number of crescents had no relationship with age and 24-hour proteinuria; however, it had a significant direct relationship with serum creatinine. Conclusion: According to our study, lupus nephritis affected women more than men, while other forms of crescentic glomerulonephritis were more common in males. Depending on the population, a significant relationship between the number of crescent and serum creatinine was detected. The mean age of females with crescentic glomerulonephritis was significantly lower than males.

The Oxford classification for IgA nephropathy (IgAN) does not currently include thrombotic microangiopathy (TMA) as a parameter, despite evidence that TMA can occur in IgAN patients and impact outcomes. Prior studies have found that a significant proportion of IgAN patients have histological evidence of TMA, either acute or organized, in their renal biopsies. Moreover, patients with TMA lesions in IgAN tend to have worse outcomes, including a greater percentage of sclerotic glomeruli, more tubulointerstitial fibrosis, and higher rates of doubling of serum creatinine or progression to end-stage renal disease compared to IgAN patients without TMA. Other researchers have suggested that TMA in IgAN is commonly located in the advanced steps of the disease and may be accompanying by severe hypertension and proteinuria. However, the Oxford system does not include TMA as a parameter. Therefore, further investigations are required to determine the clinical significance and optimal management of TMA in IgAN individuals. Renal arteriolar microangiopathic lesions can occur in immunoglobulin A nephropathy, but their role in disease progression has been unclear. Furthermore, the main limitation of the MEST-C classification is that it does not currently account for the presence and impact of TMA in IgAN, despite evidence that TMA is a common and clinically relevant histological finding in these patients.

Introduction: Focal segmental glomerulosclerosis (FSGS) is one of the most common causes of primary glomerular disease and its incidence is increasing worldwide. According to the morphological features, a group of nephropathologists proposed a standardized classification system, called the Columbia classification of FSGS in 2003. Objectives: This study was carried out to define the frequency of FSGS variants, and their relationship with demographic and clinicopathological factors. Patients and Methods: This cross-sectional study was conducted on renal biopsy reports at a nephropathology laboratory between 2009 to 2022. Out of 2100 patients, 345 renal biopsies had primary FSGS diagnosed by light and immunofluorescence microscopies, and classified according to the Columbia classification. The pathological, para-clinical, and demographic characteristics including gender and age were assessed. Results: The mean age of 345 patients was 40.05±14.98 years. Regarding gender, 60.9% (n=210) of the patients were males. The mean serum creatinine and proteinuria in all patients were 1.54±0.91 mg/dL and 2267.94±1501.22 mg/d, respectively. The classic or not otherwise specified (NOS) variant was the most frequent variant. In this study, serum creatinine was significantly different among the five variants in which collapsing variant had higher serum creatinine 2.83±1.12 mg/dL. Similarly, proteinuria was higher in the collapsing variant, 2666.67±568.03 mg/d. A comparison of the mean age, serum creatinine, and proteinuria among genders showed a significant difference between male and female patients with males having higher mean age, 42.28±15.71 years, serum creatinine, 1.6822±1.02 mg/dL and proteinuria, 2434.67±1735.60 mg/d. In this study, the NOS variant was more prevalent in males, followed by the perihilar variant (n=57) and tip variant (n=56). Interstitial fibrosis was compared among different variants. It was significantly different among the variants, in which collapsing variant had higher interstitial fibrosis at 58.50±25.24%. On comparing the variants frequency, serum creatinine, proteinuria, and interstitial fibrosis among the age groups (40 years and less versus above 40 years) of patients with FSGS, the results showed no significant difference. Conclusion: The results of this study showed that overall, the FSGS, NOS variant, was the most common morphological variant. However, the collapsing variant was more severe as compared to other variants. The disease was severe in males as compared with females. No significant difference was found in the frequency of variants or disease severity between elderly versus young FSGS patients.

Introduction: Diabetes mellitus (DM) is distinguished as a serious health problem worldwide. The universal outbreak of DM because of urban life and alteration of lifestyle, day to day is increasing. Objectives: The present investigation was designed to evaluate the nephroprotective effects of resveratrol (RSV) and silymarin (SM) on morphologic injury to renal tubular cells in adult male diabetic rats. Materials and Methods: Twenty-five male Wistar rats randomly were designated into five groups (n = 5) including group I (control); rats received normal saline by gavage for 14 days. Group II; rats received a single injection of STZ at a dose of 60 mg/kg intraperitoneally and were also given isotonic saline orally for 14 days. Group III; Rats, after STZ injection, received 100 mg/kg of SM by gavage for 14 days. Group IV; Rats, after STZ injection, received 100 ml/kg of RSV by gavage for 14 days. Group V; rats, after STZ injection, received the combination of SM and RSV at a dose of 100 mg/kg by gavage for 14 days. The kidneys were removed immediately after sacrificing and prepared for morphological examination. Kidney sections were examined for the intensity of kidney damage (vacuolization, flattening, degeneration and necrosis). Results: Significant differences were observed in types of morphologic injury to renal tubular cells (vacuolization, flattening, degeneration and necrosis) between groups (P<0.05). Significantly, both the SM and RSV reduced the injury of renal tubular cells in diabetic rats (P<0.05). Conclusion: The findings of the present study indicated that although the protective effect of SM and RSV was more significant on necrosis and flattening, respectively, SM and RSV produced a nephroprotective impact on the injury of renal tubular cells in diabetic rats than their combination influences.

Ankylosing spondylitis is a chronic inflammatory illness that initially involves the spine and sacroiliac joint. It rarely presents with kidney disease. Various biochemical and morphological alterations have been described, consisting of hematuria, proteinuria, and low GFR across immunoglobulin A nephropathy, renal amyloidosis, focal segmental glomerulosclerosis, and chronic interstitial nephritis with different frequencies among populations.

IgA nephropathy (IgAN) is a kidney disease that is characterized by the deposition of IgA (immunoglobulin A) in the kidney tissue, leading to inflammation and damage. This disease is a common chronic glomerulopathy that affects people worldwide (1). Therefore, it is crucial to identify factors that worsen the disease, monitor its activity, and predict appropriate treatments. Complement component 4d (C4d) is a protein that is involved in the activation of the complement system, which is a part of the immune system.

Implication for health policy/practice/research/medical education: This study found a difference in the immune response to the COVID vaccine between men and women. Women will have a more robust immune response and show more complications.

Implication for health policy/practice/research/medical education: The brown tumor is a rare benign tumor developed by autonomous osteoclastic activity in hyperparathyroidism. In this photo-clinic, we present a 36-year-old man on chronic hemodialysis presented with a jaw mass. Radiography of the mandible showed a soft tissue mass lesion. Neck computed tomography showed a lytic lesion. A needle biopsy of the mandible showed a lobular design comprised of groups and clusters of osteoclast-like multinucleated giant cells, hemorrhage, and hemosiderin deposits and vascular fibroblastic stroma that were indicative of the brown tumor. Please

Introduction: Chronic kidney disease (CKD) is defined by glomerular filtration rates (GFR) of less than 60 mL/min per 1.73 m2 or albumin to creatinine ratios of greater than 30 mg/g in urine for at least three months. Patients with CKD are at risk of developing the condition, leading to end-stage renal disease (ESRD). On the other hand, hyperuricemia can result in renal failure, increased blood pressure, fibrosis, and the progression of failure. In this study, using the meta-analysis method, we are looking to investigate the effect of allopurinol on the treatment of chronic renal failure. Materials and Methods: In this meta-analysis, which was written based on PRISMA (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol, International databases including Cochrane, Web of Science, Scopus, PubMed, and Google Scholar search engine were searched. The data were analyzed using STATA (version 14) software, and the significance level of tests was considered P<0.05. Results: In 13 studies with a sample of 1172 people, allopurinol significantly reduced the serum level of uric acid (SMD: -1.28; 95% CI: -1.74, -0.82) more than the control group (SMD: -0.96; 95% CI: -2.09, 0.17). Additionally, allopurinol reduced the systolic blood pressure level by (SMD: -0.32; 95% CI: -0.54, -0.11) mm Hg and it was effective in reducing diastolic blood pressure level by (SMD: -0.39; 95% CI: -0.60, -0.17) mm Hg. However, the difference in scores GFR, proteinuria, cystatin C, before and after allopurinol were not statistically significant. In the control group, the difference in scores before and after the intervention was not significant in any of the above-mentioned cases. Conclusion: In CKD, allopurinol is effective in reducing blood pressure and uric acid levels. However, due to the limited number of studies and the different type of treatment in the control group of the studied studies, it is suggested to conduct more studies in this field. Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO website (ID=CRD42022371439, regional ethical code #IR.IAU. NAJAFABAD.REC.1399.140).

Background: Contrast-induced nephropathy (CIN) is nephrotoxicity due to contrast media characterized by elevated serum creatinine levels. The formation of oxygen free radicals is one of the causes of CIN. Objective: Given the antioxidant properties of Pimpinella anisum L and Dracocephalum moldavica L, this study aimed to investigate the effects of their hydroalcoholic extracts on kidney tissue histopathology and CIN biochemical factors. Methods: In this experimental study, 40 male Wistar rats were randomly divided into four groups: 1) control, 2) contrast agent, 3) P. anisum+contrast agent, and 4) D. moldavica+contrast agent. After the tests, kidney tissue histopathological damages and related biochemical factors were evaluated. Results: Kidney tissue damage, levels of aspartate aminotransferase (GOT/AST), alanine aminotransferase (GPT/ALT) and blood urea nitrogen, serum creatinine (P<0.001), and malondialdehyde (P<0.01) of kidney tissue were lower in both extract-treated groups than in contrast agent group, but the decrease in serum MDA was significant only in the group given P. anisum extract (P<0.01). Serum antioxidant capacity was higher in P. anisum+contrast agent group than in the contrast agent group (P<0.01). Kidney tissue antioxidant capacity was significantly higher in the groups given P. anisum and D. moldavica than in the contrast agent group (P<0.01 and P<0.001, respectively). In addition, hydroalcoholic extracts of P. anisum and D. moldavica resulted in a decrease in CIN. Conclusion: Given the decrease in CIN by P. anisum and D. moldavica extracts in rats, it seems that these plants are beneficial for people at risk who need to use contrast agents.

Implication for health policy/practice/research/medical education Various studies suggest an increased possibility of malignancy in primary hyperparathyroidism compared to the normal individuals which leads to increase mortality and morbidity; since, the location of the tumors is different. Several studies showing that the association between primary hyperparathyroidism and malignancy is more general in nature than emerge of a specific tumor, an issue which needs more investigations..

Implication for health policy/practice/research/medical education Mechanistic impact of vitamin D therapy in glomerulopathies consists of preservation of morphological integrity of slit diaphragm, which leads to restoration of tight junction proteins. Vitamin D also avoids the loss of nephrin component of the glomerular basement membrane.

Introduction: Sleep disorders are one of the most common disorders among hemodialysis patients which is associated with the demographic and laboratory factors of such patients. Objectives: The present study aims to investigate the quality of sleep and its relationship with some demographic and biochemical factors in a group of hemodialysis patients. Patients and Methods: This study is cross-sectional conducted on end-stage renal disease (ESRD) patients who underwent regular and continuous hemodialysis in Amin hospital of Isfahan. The Pittsburgh Sleep Quality Index (PSQI) was completed face-to-face for each individual. Other data included age, hemoglobin and hematocrit, adequacy of hemodialysis, serum alkaline phosphatase, ferritin, iron, calcium, phosphorus, parathyroid hormone and body mass index were receded too. Results: In this study, 110 hemodialysis patients were investigated (71 men). In this study, 41.8% of the patients had sleep disorder. We found, no difference between demographic and laboratory factors of patients with and without sleep disorder (P>0.05 for all parameters). No significant difference was detected among men and women regarding sleep disorder (P>0.05). Accordingly, no significant difference in sleep disorder between patients with and without diabetes was found too (P>0.05). However, our study showed a significant direct relationship between age and sleep disorder (P=0.026) particularly in women (P=0.011). Conclusion: Sleep disorder is common in patients undergoing hemodialysis and is directly related to the patients’ age; however, larger studies in this field are necessary.

Implication for health policy/practice/research/medical education Middle East pain syndrome is a novel disease, which requires more knowledge on its pathogenesis, prevention, and treatment.Possible cadmium contamination should also be considered.Notably, symptoms of this syndrome improved by fibromyalgia therapy consisting of muscle relaxants and vitamin D3 supplementation, and other related drugs.Therefore, we suggest more attention to this syndrome, in patients with various complaints as mentioned above.

Implication for health policy/practice/research/medical education: The mechanisms interacted as the etiologies of hypocalcemia in SARS-CoV-2 are impaired intestinal absorption of calcium, disturbed secretion or impaired response to parathormone due to increased concentration of inflammatory cytokines, vitamin D insufficiency and hypoalbuminemia.Moreover, hypoxia-induce tissue injury with consequent rise in calcium influx are another possible mechanism.However, the effect of SARS-CoV-2 on parathormone secretion could explain the hypocalcemia of COVID-19 patients.

Implication for health policy/practice/

The consequences of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection vary among persons, while some individuals are at high risk. Patients with systemic lupus erythematosus (SLE) and COVID-19 necessitate particular attention. SLE cases may be at particular risk for SARS-CoV-2 due to their dysregulated immune system and immunosuppressive treatments. Organ injury and administration of systemic glucocorticoids and other immunosuppressive agents are the risk factors for severe SARS-CoV-2. Additionally, SLE is not uncommon and could be severe in some ethnicities like African and Hispanic individuals and may be accompanied by poor outcomes of SARS-CoV-2. Thus, knowledge of the triggering immune response and therapeutic modalities in SLE and SARS-CoV-2 is necessary to guide treatment of this serious infectious disease in the background of SLE and vice versa.