Asian Journal of Research in Nephrology

A Case Report of Hyponatremia Due to Primary Polydipsia in Kidney Transplant Recipient

2026-01-16T11:45:31+00:00

Background: Hyponatremia is a common electrolyte abnormality in kidney transplant recipients and may result from a variety of etiologies, including infections, drug effects, rejection, and hormonal disturbances. Hyponatremia due to polydipsia, however, is rarely reported in the post-transplant setting.

Case Presentation: We report the case of a 40-year-old woman with end-stage kidney disease secondary to presumed chronic interstitial nephritis who underwent deceased donor kidney transplantation. Her post-transplant course was complicated by antibody-mediated rejection, which was successfully treated with corticosteroids, plasma exchange, intravenous immunoglobulin, and rituximab, resulting in stable graft function. Seven months after transplantation, she was found to have asymptomatic severe hyponatremia (serum sodium 119 mEq/L). Evaluation revealed hypotonic hyponatremia with low urine osmolality (88 mOsm/kg) and low urine sodium (23 mEq/L), normal thyroid and adrenal function, and euvolemic clinical status. Detailed history revealed excessive water intake of approximately 5 liters per day over the preceding two weeks. The cause of polydipsia in the patient was the thought that intake of more water will lead to reduced creatinine as reinforced by one of her acquaintance, who was also a kidney transplant recipient. Fluid restriction led to immediate correction of serum sodium and normalization of urine osmolality, confirming a diagnosis of polydipsia-induced hyponatremia. The patient remained normonatremic on follow-up with stable graft function after behavioural counselling.

Conclusion: Polydipsia is an uncommon but important cause of hyponatremia in kidney transplant recipients. Careful history taking and appropriate biochemical evaluation are critical for diagnosis. Early recognition and fluid restriction with counselling can effectively prevent recurrence and serious complications.

Severe Metabolic Alkalosis in a Patient with Growth Retardation, Malnutrition and Induced Vomiting

2026-06-02T10:33:45+00:00

Metabolic alkalosis is maybe the most common and serious acid-base disorder in clinical practice (the life of any patient with pH>7.55 is at serious risk). It is accompanied by hypochloremia and hypokalemia. Its most common cause is the use of diuretics, the use of which is quite common, but also in the presence of vomiting, although there are rare cases due to hereditary diseases (Bartter, Gitelman). All these conditions are characterized by low blood pressure. However, there are also diseases with hypertension, which appear themselves with the same characteristics (conditions with intense mineralocorticoid action). A patient with impaired growth (short stature and underweight) is presented, with severe metabolic alkalosis, hypokalemia, hypochloremia, hyponatremia and hypotension, which concealed the presence of induced vomiting from her history. The case is described and a differential diagnosis from Bartter syndrome is made.

The Rise of GLP-1 Agonists: The Paradigm-shifting Frontier in Diabetic Kidney Disease, Cardio-renal Protection and Beyond

2026-06-02T10:49:27+00:00

GLP 1 agonists have evolved into one of the most potent weapons in the arsenal to tackle diabetes and metabolic disease, while providing significant cardiorenal outcomes, as cemented by the FLOW trial. Their pleiotropic action extends into spheres of immune regulation, alleviation of autophagy and pyroptosis, in addition to their multi-organ action encompassing diabetic control and weight reduction. The fact that their potential extends beyond the frontiers of diabetes or chronic kidney disease into realms of neuroprotection, musculoskeletal disorders and metabolic dysfunction-associated steatohepatitis (MASH), obstructive sleep apnoea, amongst several other disorders provides promising prospects that make this molecule a literal shapeshifting all-rounder in Medicine. This review aims to trace the journey of this multifaceted drug, while exploring evidence regarding its therapeutic applications, particularly diabetes, weight loss management, and cardiorenal outcomes; evidence from clinical trials, highlighting practical considerations, major challenges and roadblocks in their use, dual and triple GLP-1 agonists in development as well as the future horizons of GLP-1 agonists.

Pharmacotherapy for Diabetes in Chronic Kidney Disease: A Basic Overview

2026-06-03T09:50:47+00:00

Diabetes mellitus (DM) is one of the most common causes and comorbidities in chronic kidney disease (CKD) globally. Particularly, DM in CKD patients increases the overall risk for kidney failure, atherosclerotic cardiovascular disease, heart failure, and premature mortality. Recent clinical studies support new approaches to treat diabetes and CKD. Recent clinical practice guidelines provide evidence-based recommendations for screening and diagnosis, monitoring of glycemia with individualized glycated hemoglobin (HbA1c) targets, and reduction of cardiovascular disease risk. Besides, various holistic approaches, treatment goals, and pharmacological and non-pharmacologic management of DM in CKD patients are also reported. The present review emphasizes pharmacotherapy for DM targeting individual goals of managing hyperglycemia, achieving HbA1c targets, improving kidney and cardiovascular outcomes, and reducing severe complications. Various pharmacotherapeutic choices for managing hyperglycemia and HbA1c include the use of various insulin formulations and delivery modifications. Especially, the focus is on the use of first-line agents, metformin and sodium-glucose cotransporter-2 inhibitors, and the second-line agents, glucagon-like peptide-1 receptor agonists, for additional benefits of cardiorenal protection and reducing the risk of cardiovascular disease, in addition to managing hypoglycemia. Furthermore, significant evidence-based advancements in the management of DM in CKD patients are discussed.

Clinician’s Perspectives on the Management of Anemia in Chronic Kidney Disease in Indian Settings

2026-02-24T10:46:44+00:00

Objective: The study aims to gather clinicians’ perspectives on the management of anemia in patients with chronic kidney disease (CKD).

Methods: In this cross-sectional study, a 23-item, multiple-response questionnaire gathered expert opinion on current practices, clinical observations, and experiences related to the management of anemia in CKD patients in India. The survey respondents were specialists with expertise in managing CKD. Data were analysed using descriptive statistics.

Results: The study included 288 clinicians. Inadequate production of erythropoietin by the kidneys was the primary cause of anemia in the majority of patients with CKD, as reported by 36% of respondents. More than half (55.56%) of the respondents reported that the preferred iron supplementation for patients with hemoglobin (Hb) <9% was the intravenous (IV) route, while 42% reported that tablets were the preferred iron supplementation. Oral iron supplements were the most preferred treatment option for anemia in CKD patients, as indicated by 39% of the clinicians, while 36% of them stated erythropoiesis-stimulating agents (ESAs) were the preferred treatment option for CKD. A majority (78.82%) of the participants stated ferric carboxymaltose as their preferred IV iron formulation. About 56% of the clinicians opined that highly bioavailable liposomal iron bypasses the extremely restrictive normal intestinal barriers and achieves a much higher plasma iron concentration, were true regarding liposomal iron.

Conclusion: This study reported that reduced erythropoietin production was the leading cause of anemia, with iron therapy and ESAs as the primary treatments. IV iron was preferred for more severe anemia, while oral iron remained widely used. Liposomal iron was the preferred choice due to its perceived bioavailability.

The Clinical and Comorbidity Profile of Acute Kidney Injury in Critically Ill Patients: A Multi-Center Cross-Sectional Study from Sudan

2026-03-02T07:37:41+00:00

Background: The demographic and etiological landscape of Acute Kidney Injury (AKI) varies significantly across regions, influenced by local disease burdens and healthcare access. Data on AKI characteristics from Sudan and similar sub-Saharan African settings are scarce. This study describes the clinical presentation, age distribution, and comorbidity profile of critically ill patients with AKI in Sudan.

Methods: A prospective, multi-center, cross sectional study was conducted in four major Sudanese hospitals between July and September 2022. All consecutively admitted adult ICU patients meeting KDIGO criteria for AKI were enrolled. Data on demographics and comorbidities were collected using a structured checklist. Descriptive statistics were used for analysis.

Results: Forty-two patients were included. The cohort was notably young age distribution, with 41.5% aged 18-39 years. A significant gender-age interaction was noted: younger patients were predominantly female (80%), while elderly patients (≥60 years) were predominantly male (71%). The comorbidity burden was substantial, with 83.4% of patients having at least one chronic condition, a mean of 1.9 comorbidities per patient, and hypertension (43.9%) and diabetes mellitus (34.1%) being most prevalent.

The overall 30-day mortality rate was 29.3%, demonstrating a clear age-dependent gradient. Comorbidity burden was a critical prognostic factor; mortality was 62.5% in patients with ≥3 comorbidities versus 14.3% in those with none. Specific combinations, particularly diabetes + hypertension + cerebrovascular disease, were associated with extremely high mortality (75%). Among survivors, 74.2% recovered normal renal function, while 25.8% progressed to chronic kidney disease.

Conclusion: This study reveals that AKI in this setting is strongly linked to a high burden of non-communicable diseases, leading to significant mortality. The young age of the cohort and the unique gender-age interaction suggest distinct, age-specific risk pathways. The catastrophic outcomes associated with multiple comorbidities, especially the cardio-metabolic triad, identify a high-risk subgroup requiring intensive management. The study underscores the urgent need for integrated chronic disease management to prevent AKI and for vigilant recognition of high-risk profiles to improve outcomes.

Renal Function Assessment in a Cohort of HIV Patients: Comparing Estimated Glomerular Filtration Rate Equations in a Cross-Sectional Study

2026-03-10T11:27:13+00:00

Introduction: The glomerular filtration formulae are important in staging and determining renal function in HIV patients, and in the general population at large.

Aim: The main objective of this study is to evaluate the performance of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and the Modification of Renal Diet (MDRD) equation in determining renal function in HIV-infected patients.

Methods: A cross-sectional study was conducted among 118 adult HIV patients on antiretroviral therapy (ART) attending clinic at the University of Calabar Teaching Hospital. Participants were recruited in a consecutive manner and data were collected using standard structure questionnaire, including clinical and laboratory investigations. The CKD-EPI and MDRD equations were used to calculate estimated glomerular filtration rate (eGFR) and evaluate renal function according to GFR staging. Data were analyzed using descriptive statistics, Chi-square test, ANOVA and P < .05 was accepted to be significant.

Results: One hundred and eighteen HIV-infected patients were studied and 82(60.5%) were females. The median age was 39.0 years (IQR 18.0 – 73.0), while the median eGFR were 84.0mL/min (IQR 26.0 - 192.0) and 82.0mL/min (IQR 22.0 – 124.0) using the CKD-EPI and MDRD equation respectively. The mean eGFR was significantly lower based on MDRD equation (81.13±22.15, P = .001) as compared to CKD-EPI equation (85.29±26.47, P = .06). Also, 22(18.6%) of the participants had CKD (eGFR < 60mL/min) based on MDRD as compared to 17(14.4%) using CKD-EPI equation, and this was statistically significant. This may possibly imply that MDRD may overestimate the severity of renal impairment in HIV patients.

Conclusion: There was a fairly good comparison between CKD-EPI and MDRD in estimating renal function in HIV positive cohort. CKD-EPI equation showed a better staging of renal function without overestimating advanced renal impairment. Although no gold standard method was employed for comparison.

The Impact of Haemodialysis and Age-related Changes on Coagulation Parameters among Patients with Chronic Kidney Disease (CKD) Attending a Dialysis Centre in Southern Nigeria

2026-03-20T05:55:18+00:00

Chronic kidney disease (CKD) is a major global public health challenge, affecting hundreds of millions of adults worldwide. The Global Burden of Disease 2023 study estimated that approximately 788 million adults aged 20 years and older were living with CKD in 2023. This study evaluated the impact of haemodialysis on some coagulation parameters among patients with chronic kidney disease (CKD) attending a dialysis centre in Southern Nigeria. Out of the one hundred and seventy (170) subjects recruited for the study, seven (7) subjects died after pre-dialysis sample collection, and the remaining one hundred and sixty-three (163) were subsequently grouped following age ranges: 18–39, 40–59, 60–69, 70–79, and ≥80 years. Data obtained from this study were entered and analysed using SPSS version 25. Continuous variables, including coagulation parameters, were presented as mean ± standard deviation (Mean ± SD). For the comparison of the overall CKD patient population, paired t-tests were used to determine statistically significant differences for pre- and post-haemodialysis parameters. To assess age-related variations in coagulation parameters, a one-way analysis of variance (ANOVA) was performed across the defined age groups, while, a post-hoc analysis using the Waller–Duncan test was conducted to identify the specific age groups that differed significantly. A p<0.05 was considered statistically significant for all analyses. There was no significant difference in prothrombin time, activated partial thromboplastin time and international normalised ratio between the pre and post-dialysis subjects across all age groups (P>0.05). The prothrombin time(PT) shortened slightly from 14.01 ± 1.75seconds pre-dialysis to 13.90 ± 1.64seconds post-dialysis (Δ −0.11 s), APTT shortened from 34.94 ± 5.53 s to 34.70 ± 5.63 s (Δ −0.24 s), and INR remained essentially unchanged at 1.19 ± 0.18 pre-dialysis and 1.19 ± 0.17 post-dialysis. None of these changes were statistically significant (PT: t = 0.558, p = 0.577; APTT: t = 0.394, p = 0.694; INR: t = 0.211, p = 0.833), indicating that haemodialysis did not markedly alter coagulation status in the studied cohort.

Effect of Crude Musa acuminata Sap on Doxorubicin Hydrochloride Induced Nephrotoxicity in Wistar Rat

2026-04-17T11:17:16+00:00

Background: Nephrotoxicity remains a major clinical challenge, particularly in patients undergoing chemotherapy with agents such as doxorubicin (DOX). Doxorubicin-induced renal damage is largely mediated through oxidative stress, inflammation, and tubular epithelial cell injury, leading to impaired renal function. Aim: This study evaluates the effect of crude Musa acuminata sap against DOX-induced nephrotoxicity in Wistar rat. Methods: Thirty (30) adult male Wistar rats of body weight 150-250g were assigned into six (6) groups (A - F) of 5 rats each. Group A rats served as normal control and received feed and distilled water ad libitum. Group B rats served as positive control induced with DOX only at single dose of 10mg/kg i.p per day and remained untreated and received feed and distilled water ad libitum. Group C, D, E and F were nephrotoxicity induced with DOX and treated with 50, 100, 200 and 400 mg/kg b.w of DOX for 7 days. Serum urea and creatinine and body weights were assayed. Results: The results show that DOX administration significantly (P<0.05) elevated serum urea and creatinine levels, confirming renal impairment. There was also a significant (P<0.05) increase in body weight among the untreated nephrotoxicity group. However, treatment with crude Musa acuminata sap significantly reduced serum urea and creatinine concentrations in groups C, D, E and F compared to the group B, The curative effect was more prominent in group F and C while groups B and D showed no statistically (P>0.05) significant difference and shows that the effect wasn’t dose dependent while improving the renal function parameters. The treated groups also demonstrated better weight stability most especially in groups F. Conclusion:The findings indicate that crude MAS possess nephroprotective properties, likely due to its antioxidant and anti-inflammatory phytochemicals property. The study supports the potential therapeutic role of plant-derived interventions in mitigating chemotherapy-induced renal toxicity. Further investigations involving histopathological and molecular analyses are recommended to elucidate the precise mechanisms of action.

Comparative Analysis of Renal Biomarkers and Derived Uric Acid Ratios among Pregnant and Non-Pregnant Women in Port Harcourt, Nigeria

2026-05-05T04:07:43+00:00

Background: Pregnancy is associated with significant physiological changes in renal function, which influence the interpretation of biochemical markers. However, population-specific data on renal biomarkers and derived indices among pregnant women in sub-Saharan Africa remain limited.

Objective: This study aimed to comparatively assess renal biomarkers, electrolyte profiles, and derived ratios among pregnant and non-pregnant women in Port Harcourt, Nigeria.

Methods: A cross-sectional study was conducted involving 150 women, comprising 90 pregnant participants and 60 non-pregnant controls. Pregnant women were stratified equally across the three trimesters. Serum urea, creatinine, uric acid, and electrolytes (sodium, potassium, chloride, and bicarbonate) were analyzed using standard laboratory methods. Derived indices, including urea-to-creatinine and uric acid-to-creatinine ratios, were calculated. Statistical analysis was performed using SPSS version 24, with significance set at p < 0.05.

Results: Pregnant women exhibited significantly higher levels of serum creatinine, urea, uric acid, potassium, chloride, and bicarbonate compared to non-pregnant controls (p < 0.05), while sodium levels showed no significant difference. The uric acid-to-creatinine ratio was significantly elevated, whereas the urea-to-creatinine ratio was significantly reduced among pregnant women. Serum creatinine increased significantly across trimesters, while other biomarkers remained relatively stable. Chloride levels decreased significantly in the third trimester.

Conclusion: Pregnancy is associated with significant alterations in renal biomarkers and derived indices. These findings underscore the importance of population-specific reference ranges and support the clinical relevance of biomarker ratios in maternal health assessment and early detection of renal dysfunction.

Prevalence and Patterns of Urinalysis Abnormalities in HIV Patients on Highly Active Antiretroviral Therapy in a Tertiary Hospital in Calabar, South-South Nigeria

2026-05-09T11:18:57+00:00

Introduction: Urinalysis is a useful screening tool that provides a simple, cost-effective, and non-invasive method for assessing kidney function and early detection of kidney involvement in HIV patients with or without antiretroviral therapy. The use of highly active antiretroviral therapy (HAART) is associated with urinalysis abnormalities which may precede deterioration in renal function.

Aim: The main objective of this study is to determine urinalysis abnormalities in HIV-infected patients on highly active antiretroviral therapy (HAART) using the urine dipstick, which is a simple diagnostic tool.

Methods: A hospital-based cross-sectional study was conducted among 131 adult HIV-infected patients on antiretroviral therapy (ART) attending clinic at the University of Calabar Teaching Hospital. Participants were recruited in a consecutive fashion and data were collected using standard structure questionnaire, including clinical and laboratory investigations. Urinary dipstick tests were performed using combur 10 test strips ((Roche Diagnostics GmbH, Mannheim, Germany) on the freshly collected urine samples from the participants. Data were analyzed using descriptive statistics, chi-square test; student t-test and binary logistic regression analysis. P < .05 was accepted to be significant.

Results: In the 131 HIV-infected patients studied, 75.6% were females, majority (80.2%) were on tenofovir based regimens, the mean age was 43.2±9.6 years and 37.4% had urinalysis abnormalities. The specific urinalysis abnormalities were proteinuria (32.1%), leukocyturia (21.4%), and haematuria (7.6%). Urinalysis abnormalities including proteinuria and leukocyturia were associated with older age (51.5±6.2 years, 50.0±7.4 years, P = .0001) and lower CD₄ cell count (260.5±107.3µ/L, 270.2±117.3µ/L, P = .0001), but haematuria was associated with shorter duration of HIV (3.1±2.9 years, P = .003). Moreso, increasing age (CI 1.092-1.261, P = .0001), female gender (CI 0.080-0.976, P = .046), and lower CD₄ cell count (CI 0.989-0.996, P = .0001) predicted urinalysis abnormalities.

Conclusion: Urinalysis abnormalities was prevalent in HIV-infected patients on HAART and the associated risk factors were older age and lower CD₄ cell count. Furthermore, urinalysis abnormalities was predicted by increasing age, female gender, and lower CD₄ cell count.

Ex vivo Stone Clearance During Kidney Transplantation: A Single-Center Case Series to Expand Living Donor Eligibility

2026-05-12T12:05:07+00:00

Background: The growing disparity between the demand for kidney transplantation and the availability of suitable grafts has prompted expansion of living donor acceptance criteria.

Objective: To evaluate the feasibility and safety of ex vivo stone clearance in living donor kidneys during transplantation and its role in expanding donor eligibility.

Methods: This retrospective single-center case series included five living kidney donors with incidentally detected, non-obstructive renal calculi who underwent ex vivo stone clearance at the time of transplantation between June 2024 and October 2025. Donors were selected based on solitary or limited stones ≤15 mm without hydronephrosis, infection, or metabolic abnormality. Following laparoscopic donor nephrectomy and cold perfusion, bench pyelolithotomy or ex vivo flexible ureteroscopy was performed. Primary outcomes were stone-free status and early graft function. Secondary outcomes included cold and warm ischemia times and perioperative complications graded by Clavien–Dindo classification.

Results: Complete stone clearance was achieved in all grafts (100%). Mean stone size was 8.4 mm (range 5–14 mm). Bench pyelolithotomy was performed in three cases and ex vivo ureteroscopy in two. Mean cold ischemia time was 65.6 minutes, and mean warm ischemia time was 3.8 minutes. All recipients demonstrated immediate graft function with serum creatinine declining to a mean of 1.1 mg/dL at discharge. No delayed graft function, major complications, or stone recurrence were observed at a median follow-up of nine months.

Conclusion: Ex vivo stone clearance in carefully selected living donor kidneys is safe and effective. Bench stone surgery allows complete calculi removal without compromising early graft outcomes and may represent a practical strategy to responsibly expand living donor eligibility.