Open Access Case Report

The Incidental Finding of Horseshoe Kidney in a 31-Year-Old Male Patient with Lupus Nephritis

Khurram Khaliq Bhinder, Nishwa Azeem, Azza Sarfraz, Sameer Saleem Tebha, Humaira Bashir, Zenab Farooq, Zouina Sarfraz

Asian Journal of Research in Nephrology, Page 28-32

We describe the case of a 31-year-old-male who presented with an acute flare of SLE, gross hematuria, left lumbar pain, fever, and burning micturition. He had a history of systemic lupus erythematosus, hypertension, myocardial infarction, and weight loss. Radiological examinations with ultrasound and computed tomography imaging revealed fusion of the lower poles of the kidneys rotated at the renal hilum forming a U-shape, in addition to a definite diagnosis of lupus nephritis. The patient subsequently underwent three sessions of plasmapheresis. The final diagnosis was consistent with a co-morbidity of horseshoe kidney and lupus nephritis in the adult male patient who was discharged and advised regular follow-up.

Open Access Original Research Article

Association between D Dimer and Inflammatory Markers in COVID-19 Patients with Preexisting Chronic Kidney Disease

N. S. Madhura, R. Kowsalya, S. Mythri, N. Shashikala, K. M. Mythri

Asian Journal of Research in Nephrology, Page 1-10

Background: Renal involvement in Covid 19 disease is an independent predictor of mortality in Covid 19 patients. Hyperinflammation and hypercoagulability  are the important key factors for assessing severity of Covid 19 disease. Management of Covid 19 infection in preexisting CKD patients is a challenge.

Aim:  1. To compare D- Dimer, CRP, PCT, Lactate, LDH and Ferritin  of  Covid 19  CKD patients with that of  Covid 19 patiets without CKD

2.To evaluate the correlation between D-Dimer levels and Inflammatory markers in Covid 19 CKD patients. 

Study Design: An observational cross sectional study

Place and Duration of Study: Dept of Biochemistry, Institute of nephrourology,  Bangalore, India. from July 2020 to Dec 2020

Methodology: Study popoulation were categorised into 3 groups, Group 1 (Covid 19 with preexisting CKD), Group 2 (Covid 19 without CKD) and Group 3 (CKD without Covid 19) . All the groups were assayed for D dimer, CRP, PCT, Lactate and LDH using Abbott ci4000 chemistry and immuno assay analyser,  in Biochemistry laboratory. Student t test was  used to to analyse the significance between Group 1&2 also Group 1&3. Pearson correlation was done to analyse the association between d dimer and inflammatory markers in Group 1.

Results : In our study, a peaked and statistically significant (P value = <0.0001)  D-Dimer values were observed in Group 1 (7.4±2.5), compared to Group 2 (3.4±2.1)  and Group 3 (1.5±0.4)]. Similarly CRP, PCT, LDH, Ferritin, and Lactate levels were higher in Group 1 compared to other two groups.

D- Dimer had strong positive correlation with CRP (r= 0.702), PCT (r= 0.66) , LDH (r=0.67) and moderately positive correlation with Lactate  (r=0.42) in Group1.

Conclusion: This study shows Covid -19 patients with preexisting CKD  had significantly higher levels of hypercoagulability marker (D-Dimer ) and of  hyperinflammatory markers (CRP. PCT, Lactate, and Ferritin). Therefore, it is possible that COVID-19 infection in CKD is  more likely to cause severe hyperinflammatory and hypercoagulable state with a worse prognosis.

Open Access Original Research Article

Assessment of Urinary Kidney Injury Molecule-1 in the Early Post-Burn Period to Predict Acute Kidney Injury for Various Degrees of Burn

Nizam Uddin Ahmed Chowdhury, Md. Nizamuddin Chowdhury, Md. Nazrul Islam, Sharif Qamar Uddin, Jubaida Khanam Chowdhury, Mohammad Zahir Uddin, Maksuda Begum Mony, Kowser Hossain Chowdhury

Asian Journal of Research in Nephrology, Page 18-27

Background: Acute kidney injury (AKI) is defined as a sudden and rapid decline in renal excretory function within hours to days, accompanied by an accumulation of nitrogenous waste products such as creatinine, urea, and other clinically unmeasured products. Historically acute kidney injury has carried a bad prognosis in the burn population.

Objective: To evaluate urinary kidney injury molecule-1 in the early post-burn period to predict acute kidney injury for various degrees of burn.

Methods: This prospective observational study was conducted in the Department of Nephrology, Dhaka Medical College Hospital, over one year from July 2016 to June 2017. 43 burn patients were enrolled in this study. Serum creatinine, BUN, and KIM-1 were measured on admission and within 48 hours of admission. SPSS 22.0 was used to analyze data. Kappa statistics were done, and AUC was calculated for KIM-1 to predict AKI.

Results In this study, most of the burn patients were below 35 years old. The mean age of the burn patients was 31.39±10.69 years. Males were predominant in burn patients. Maximum burns were due to flame (67.9%), and seven were from scald (13.2%). Mean TBSA was 30.62±14.89%. TBSA, serum creatinine, KIM-1 were significantly high in severe burn patients comparing mild and moderate burn patients. In this study, AKI was developed among 12 (27.9%) burn patients. TBSA was significantly high in AKI patients. Within 2 hours of admission, serum creatinine and BUN were normal in AKI and non-AKI patients, but the KIM-1 level was increased in AKI patients. By 48 hours of admission, urinary KIM-1, serum creatinine, and blood urea nitrogen were significantly higher in AKI patients comparing non-AKI patients.

Conclusion: Urinary KIM-1 is a valuable biomarker in predicting early AKI in burn patients. Our study suggests that urinary KIM-1 may be used as early, sensitive indicators of AKI in patients with burns of varying degrees and provide clinical clues for early AKI prevention.

Open Access Original Research Article

The Relationship of Chronic Kidney Diseases Stages and Dipstick Proteinuria for Bangladeshi Patients

Mahbuba Yesmin, M. A. Jalil Chowdhury, Afroja Alam, Nirmol Kumar Biswas

Asian Journal of Research in Nephrology, Page 33-38

Background: It is established that proteinuria is associated with kidney dysfunction. The endeavor in this study was to observe whether the degree of dipstick proteinuria was related to the progressive stages of chronic kidney disease (CKD) for Bangladeshi patients.

Methods: This observational study was carried out on a total of 100 patients above 18 years of either sex with chronic kidney disease in the Department of Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Data were collected through semi-structured questionnaire. p-value <0.05 was considered statistically significant. The data were analyzed by SPSS version 25.

Results: The mean age of the study population was 43.26 ±13.07 years with male predominance (63%). Serum creatinine increased with ages. The major symptoms were swelling of face, feet and ankle; nausea, vomiting and loss of appetite; breathlessness, urinary complaints, and also weakness. The causes for CKD were diabetes, hypertension, glomerular disease, systemic Inflammatory disease, previous history of kidney disease, and tubulointerstitial disease. The number of CKD patients in stage 3 was 16%, in stage 4 was 32% and in stage 5 was 52%. The dipstick proteinuria increased significantly with progressive stages of CKD.

Conclusion: The range of proteinuria increased with the progressive stages of CKD.

Open Access Review Article

Prevalence and Burden of Chronic Kidney Disease in Developing Countries: A Review

Farah Azhar, Rabeeya Saeed, Syed Hasan Danish, Sadaf Anwar

Asian Journal of Research in Nephrology, Page 11-17

Chronic kidney disease (CKD) is becoming more widely accepted as a public health issue around the world. However, there is a scarcity of data from low- and middle-income countries on the prevalence, challenges, and management of CKD. People in developed countries are expected to bear the impact of the consequences due to economic hardship and high treatment costs. Due to numerous environmental, racial, socioeconomic, and rural-urban variations, the prevalence of CKD varies greatly around the world. Rather than hypothesizing or making assumptions based on Western evidence, it is critical for developing countries to recognize the true nature of the disease and its prevalence. Understanding the situation in a developing country like Pakistan is important so that recommendations can be made for policymakers to revamp our health care system. Just a few studies have looked into the prevalence of CKD and its risk factors in Pakistan.

Objectives: To determine the importance of finding prevalence of CKD in countries of South Asia and challenges that are being faced by the burden of CKD.

Methods: A literature search was done using key words related to CKD burden, its challenges and prevalence accordingly to geographical locations conducted by various case reports, cohort and observational studies through authentic search engines like; PubMed, Google Scholar, Research gate, RCT and meta-analysis.

Results: CKD burden in middle and low-income countries is high, prevalence of CKD in Karachi, the biggest urban city of Pakistan is very high and there are less researches available who have looked into the prevalence of CKD and it’s risk factors.

Conclusion: There are few studies done in Pakistan related to the burden of chronic kidney disease, the prevalence of CKD is high in lower and middle-income countries. It is recommended that there should be a systematic approach for the management of CKD burden with successful intervention and public awareness for lifestyle changes and screening and management of disease, as well as better medical practitioner training and improved chronic kidney disease testing and screening systems should be available.