Pakistan Journal of Kidney Diseases
type: channel
description: Pakistan Journal of Kidney Diseases (PJKD) is the official journal of Pakistan Society of Nephrology (PSN). PJKD is committed to publishing articles related to kidney diseases and transplantation. It provides a forum for the nephrology community in Pakistan and internationally to publish so as to understand the local scenarios of kidney diseases and its management issues.
publisher: Nauman Tarif
language: ro
publication name: Pakistan Journal of Kidney Diseases
issn: 2617-0329
items: Chief editor note
items: Peritoneal Dialysis in Pakistan: Getting out of Second Gear
items: Histopathological Pattern of Live Related Renal Allograft Biopsy in A Tertiary Care Hospital of Dhaka, Bangladesh
items: Dietary Protein and Fiber Intake in Relation to Nutritional Status among Peritoneal Dialysis Patients – A Descriptive study
items: Association of Metabolic Diseases with Renal Stones among Patients with Chronic Kidney Disease and Non-Chronic Kidney Disease
items: From The Desk of Editor in Chief
items: Rituximab Rescue in Pregnancy: Triumph over Membranous Nephropathy
items: The Burden of CKD–Mineral and Bone Disorder in Maintenance Hemodialysis: Insights from a Longitudinal Registry
items: Patient-Reported Social Frailty and Its Relationship with Depression In End-Stage Renal Disease
items: Compliance with Anemia Management Indicators Among Maintenance Hemodialysis Patients: A Clinical Audit from a Tertiary Center
items: Peritoneal Transport Characteristics Among Pakistani Patients Undergoing Peritoneal Dialysis
items: Nephropathology quiz Postpartum hemolytic uremic syndrome
items: Hyponatremia in Congestive Heart Failure (CHF): Harnessing the Horse with Tolvaptan
items: Peritonitis rates among Automated peritoneal dialysis patients: Underlying factors and outcomes.
items: Histopathological Patterns of Renal Biopsy and their Treatment Outcomes at A tertiary hospital in Dhakka: An Observational Study
items: Successful Treatment of Acute Kidney Injury on Chronic Kidney Disease Due to Tubulointerstitial Nephritis and Acute Tubular Necrosis With Steroids and Mycophenolate Mofetil: A Case Report
items: A No Alarm on ECG: A Case of Severe Asymptomatic Hyperkalemia with No Significant ECG Changes
items: Nephro-Pathology Quiz
items: Incidence of Catheter-Related Infections in Maintenance Hemodialysis Patients: A Critical Challenge in Balochistan, Pakistan
items: An Effectiveness of RNA interference therapies in reducing urine and plasma oxalate levels among patients with primary hyperoxaluria- A systematic review
items: Contribution of Acute Renal Cortical Necrosis to Acute Kidney Injury: A 25-year experience from a tertiary care renal unit in Pakistan
items: Laparoscopic Peritoneal dialysis catheter insertion and its outcome in a cohort of automated peritoneal dialysis patients.
items: Pinch Off effect: A lethal Unusual complication of Subclavian Hemodialysis Catheter in a Child
items: A Frequency, Risk Factors, and Outcome of Acute Kidney Injury in Idiopathic Childhood Nephrotic Syndrome: A Systematic Review
items: Frequency and Resistance pattern of clinical isolates of Enterococcus Species in a Tertiary Care Hospital.
items: From the Desk of Editor in Chief
items: Acute Kidney Injury in Patients Receiving Anti-Tuberculosis Treatment
items: Prevalence of Pulmonary Hypertension in Chronic Kidney Disease Patients at a Tertiary Hospital

Chief editor note
type: item
subject: From The Desk of Editor in Chief
  topic: section
creator: rubina Naqvi
rights: Copyright (c) 2026 Dr. Rubina Naqvi https://creativecommons.org/licenses/by-nc/4.0
date: 2026-06-30
publication date: 2026-06-30
starting page: 1
ending page: 2
doi: 10.53778/pjkd102372

Peritoneal Dialysis in Pakistan: Getting out of Second Gear
type: item
description: Pakistan has huge burden of patients requiring renal replacement therapy. It is noteworthy that renal transplantation and hemodialysis services have grown exhaustingly and exponentially to meet this huge demand. Paradoxically the utilization of peritoneal dialysis as modality of renal replacement therapy has remained less than 1 per cent since its introduction in the 1980s to-date. However, initiatives in the last decade have led to an 8-fold increase in the number of peritoneal dialysis patients. This article highlights the barriers to PD utilization in Pakistan, their potential solutions, what have been sorted and what hurdles remain to be addressed. Additionally this articles sheds light on the need for governmental support, innovation potential of private sector and formulating a win-win situation for all stakeholders.
subject: Review Article
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creator: Ahad Qayyum
creator: Faiza Saeed
creator: Mohsin Riaz
creator: Salman Imtiaz
creator: Roshina Anjum
creator: Maliha Jauhar
creator: Javeria Chugtai
creator: HameedUllah Tareen
creator: Farya Moon
creator: Aimal Khan
creator: Mateen Akram
creator: Syed Munib
creator: Malik Abdur Rehman
creator: Warda Riaz
creator: Ayousha Burki
creator: Abrar Ud Din
rights: Copyright (c) 2026 Ahad Qayyum, Faiza Saeed, Nauman Tarif, Mohsin Riaz, Salman Imtiaz, Roshina Anjum, Maliha Jauhar, Javeria Chugtai, HameedUllah Tareen, Farya Moon, Aimal Khan, Mateen Akram, Syed Munib, Malik Abdur Rehman, Warda Riaz, Ayousha Burki, Abrar Ud Din https://creativecommons.org/licenses/by-nc/4.0
date: 2026-06-30
publication date: 2026-06-30
starting page: 3
ending page: 13
doi: 10.53778/pjkd102367

Histopathological Pattern of Live Related Renal Allograft Biopsy in A Tertiary Care Hospital of Dhaka, Bangladesh
type: item
description: Background: Renal allograft dysfunction is a significant challenge in kidney transplantation, often leading to graft failure. Histopathological evaluation of renal biopsies plays a critical role in identifying the underlying causes of dysfunction. This study aimed to analyze the histopathological patterns of renal biopsies in live-related renal allograft dysfunction. Methods: This retrospective cross-sectional study was carried out at the Department of Nephrology, Evercare Hospital, Dhaka, Bangladesh, over a period spanning from January 2018 to December 2024. The study included 96 adult patients who had undergone renal transplantation and subsequently underwent allograft biopsies. These biopsies were performed to investigate graft dysfunction without any obvious cause. The pathological findings were categorized based on the updated Banff classification system. Data analysis was conducted using SPSS version 23.0. Results: In this study of 96 renal allograft recipients, the majority were male (78%) with a mean age of 36.4±3.8 years. The mean serum creatinine increased from 1.33±0.21 mg/dL to 2.39±0.37 mg/dL during biopsy. According to Banff classification, 34.4% had antibody-mediated rejection (ABMR), 26.0% had T-cell-mediated rejection (TCMR), and 7.3% showed interstitial fibrosis/tubular atrophy (IF/TA). Conclusion: Renal biopsy in live-related renal allograft dysfunction revealed common patterns of antibody-mediated rejection, T-cell-mediated rejection, and interstitial fibrosis/tubular atrophy. Elevated serum creatinine levels correlated with graft dysfunction, emphasizing the importance of early detection for improved management.
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creator: Rezoyana Nazim
creator: Tabassum Samad
creator: Ebadur Rahman
creator: Masum Kamal Khan
creator: Ahmed Khaled
creator: SM Mahbub Alam
creator: Fahmida Begum
rights: Copyright (c) 2026 Dr. Rezoyana Nazim, Tabassum Samad, Dr. Ebadur Rahman, Dr. Masum Kamal Khan, Dr. Ahmed Khaled, Brig. Gen.Dr. SM Mahbubul Alam, Dr. Fehmida Begum https://creativecommons.org/licenses/by-nc/4.0
date: 2026-06-30
publication date: 2026-06-30
starting page: 14
ending page: 19
doi: 10.53778/pjkd102368

Dietary Protein and Fiber Intake in Relation to Nutritional Status among Peritoneal Dialysis Patients – A Descriptive study
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description: ABSTRACT: Malnutrition remains an under-recognized complication in peritoneal dialysis patients, driven by inadequate dietary intake. This study aimed to assess dietary protein and fiber intake in relation to their nutritional status among PD patients. Methods: A retrospective study was conducted using medical records of 56 PD patients followed at PD Clinic from 2024–2026. Dietary intake was assessed using documented 24-hour dietary recall records. Dietary protein, fiber, potassium, and phosphorus intake were assessed using USDA food composition values. Nutritional status was evaluated using serum albumin, BMI, and clinical records. Results: A significant positive correlation of dietary fiber was observed with dietary protein (p = 0.041) potassium (p = 0.045), phosphorus (p = 0.001), and serum albumin levels (p = 0.047). Significant positive associations were found between protein and phosphorus intake (p = 0.012). Regression analysis showed a significant association between dietary phosphorus intake and hyperphosphatemia (p = 0.018). PD patients demonstrated inadequate protein intake compared with recommended renal nutrition guidelines. Increased dietary fiber intake was associated with higher potassium and phosphorus intake. Conclusion: Higher protein intake was associated with greater dietary fiber intake and patients dietary counselling should specifically emphasize on these two parameters. Constipation was the most commonly reported gastrointestinal symptom among our patients and the dietary counselling should also address this important clinical issue for a successful PD experience. Larger longitudinal studies are recommended to further evaluate the relationship between dietary intake, serum albumin, and nutritional outcomes among PD patients.
subject: Original Article
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creator: Ayesha Azhar
creator: Komal Khalid
creator: Bilal Basit
rights: Copyright (c) 2026 Ayesha Azhar, Komal Khalid, Bilal Basit https://creativecommons.org/licenses/by-nc/4.0
date: 2026-06-30
publication date: 2026-06-30
starting page: 20
ending page: 28
doi: 10.53778/pjkd102366

Association of Metabolic Diseases with Renal Stones among Patients with Chronic Kidney Disease and Non-Chronic Kidney Disease
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description: ABSTRACT Introduction: Significant associations have been observed between obesity, diabetes mellitus, hyperlipidemia, and renal stone formation. This association is highlighted by shared risk factors such as insulin resistance and dyslipidemia. Its specific impact on patients who progress to chronic kidney disease (CKD) remains under-explored. Recognizing this interplay is vital for comprehensive management and prevention strategies for renal stones in both CKD and non-CKD patients. Methods: This cross-sectional prospective study was conducted over 178 adult patients of both genders visiting Nephrology CKD-Stone disease OPD at The Indus Hospital, Karachi July 10, 2023 to January 9, 2024. After taking the informed consent, Patients were categorized into two groups i.e. renal stone with reduced glomerular filtration rate (GFR) renal stone with normal GFR. Metabolic disease screening was conducted for all patients. Data was recorded in the provided proforma and used electronically for research. Results: The mean age of kidney stone with reduced and normal GFR were as 49.64 ± 14.41 and 39.33 ± 14.24 years. Male and female were 74.2% and 25.8% in former and 57.3% and 42.7% later group. Metabolic disease was found 21.9% in former and 69.5% in later group with statistically significant difference -p value of <0.001 (95% CI: 0.062–0.246) Conclusion: An inverse association between metabolic disease and renal stone occurrence was observed in the study population. However, these findings differed from previously published literature and should therefore be interpreted cautiously. Further large-scale studies are needed to better clarify this relationship. Keywords: Association, Chronic Kidney Disease, Metabolic Disease, Renal Stones
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creator: Shoukat Memon
creator: Gohar Rehman
creator: Faiza Saeed
creator: Ashar Alam
creator: Javeria Chughtai
creator: Shahzaib sheikh
creator: Salman Imtiaz
rights: Copyright (c) 2026 Shoukat Memon, Gohar Rehman, Faiza Saeed, Ashar Alam, Javeria Chughtai, Shahzaib sheikh, Salman Imtiaz https://creativecommons.org/licenses/by-nc/4.0
date: 2026-06-30
publication date: 2026-06-30
starting page: 29
ending page: 33
doi: 10.53778/pjkd102362

From The Desk of Editor in Chief
type: item
subject: From The Desk of Editor in Chief
  topic: section
creator: Rubina Naqvi
rights: Copyright (c) 2026 Dr. Rubina Naqvi https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-31
publication date: 2026-03-31
starting page: 1
ending page: 2
doi: 10.53778/pjkd101359

Rituximab Rescue in Pregnancy: Triumph over Membranous Nephropathy
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description: A 18-year-old South Asian female developed nephrotic syndrome. Subsequent renal biopsy showed thickened glomerular basement membrane on light microscopy Periodic Acid Schiff (PAS) stain, with spikes on silver stain. Immunofluorescence showed IgG and C3 deposits while IgA, IgM and C1q were negative. This led to a diagnosis of Membranous Nephropathy (MN). As IgG4 staining was not introduced in the country at that time, and rest of the findings were typical for MN, patient was presumed to have Primary Membranous Nephropathy(PMN). She was treated with oral Prednisolone (60mg/day) along with Tacrolimus (0.05mg/kg/day). Prednisolone was successfully tapered off however attempting to taper tacrolimus, albeit prematurely, resulted in relapse twice. Her first presentation to us was at the age of 20. At that time, she was normotensive with pitting edema to her mid-shins. Urine routine examination showed 3+ proteinuria with no active sediment. She had a urine protein to creatinine Ratio (UPCR) of 5.8g/g, albumin of 2.47g/dl, LDL of 150 mg/dl and creatinine 0.5mg/dl. Phospholipase A2 Receptor Antibodies (anti-PLA2R) could not be checked due to unavailability of the assays at our setup at that time. Further workup was ordered to exclude secondary causes of MN. Hepatitis serology (for Hepatitis B and C) were negative. Complement levels were ordered that were normal. Erythrocyte Sedimentation Rate(ESR) was elevated at 35mm/hr. Her tacrolimus trough levels were suboptimal and her dose was optimized at 2mg twice a day. Ramipril 2.5mg twice a day was continued for proteinuria, furosemide 40 mg once a day for her pitting edema and rosuvastatin 20 mg at night for primary prevention of cardiovascular disease. She achieved partial clinical remission the following year with UPCR of 0.56g/g. After that, at the age of 21, she got married and wished to conceive. Ramipril was switched to Diltiazem. She was advised to wait till further reduction in proteinuria. She miscarried twice during this…
subject: Case report
  topic: section
creator: Dr. Merina Khan
creator: Dr. Mahnoor Ali
creator: Dr Syed Nayer Mahmud
rights: Copyright (c) 2026 Dr. Merina Khan, Dr. Mahnoor Ali, Dr. Syed Nayer Mahmud https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-31
publication date: 2026-03-31
starting page: 44
ending page: 47
doi: 10.53778/pjkd101341

The Burden of CKD–Mineral and Bone Disorder in Maintenance Hemodialysis: Insights from a Longitudinal Registry
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description: Background Chronic kidney disease–mineral and bone disorder (CKD–MBD) is a frequent complication in patients receiving maintenance hemodialysis and is associated with adverse skeletal and cardiovascular outcomes. Real-world longitudinal data describing biochemical burden and guideline target attainment remain limited. Methods We conducted a retrospective, registry-based descriptive study of adult maintenance hemodialysis patients between January 2021 and September 2025. Laboratory measurements of calcium, phosphate, calcium–phosphate product, and intact parathyroid hormone (iPTH) were extracted from monthly registry tables. Test-level analyses included all available measurements. For patient-level categorization, the most recent available value per patient per analyte was used. Parameters were classified according to KDIGO guideline-based targets, with iPTH interpreted using an upper limit of normal (ULN) of 65 pg/mL. Results A total of 1,042 calcium, 1,037 phosphate, 966 calcium–phosphate product, and 141 iPTH measurements were analysed. Mean serum calcium was 8.38 ± 1.02 mg/dL, mean phosphate 5.65 ± 2.17 mg/dL, mean calcium–phosphate product 47.2 ± 18.2 mg²/dL², and mean iPTH 593 ± 518 pg/mL, indicating substantial biochemical variability. At the patient level, calcium was within target in 59.3% of patients, while phosphate was above target in 46.3%. An elevated calcium–phosphate product (>55 mg²/dL²) was observed in 27.0%. Among patients with iPTH measurements, 43.2% were within the KDIGO-recommended range (2–9×ULN), 36.5% were above target, and 20.3% were below target. Conclusion Maintenance hemodialysis patients in this registry demonstrated a persistent burden of CKD–MBD abnormalities with suboptimal attainment of KDIGO targets, particularly for phosphate and iPTH, highlighting the need for improved monitoring and guideline-aligned management.
subject: Original Article
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creator: Muhammad Bilal Basit
creator: Omer Sabir
creator: Noor ul Ain
creator: Ateka Mansoor Ahmed
creator: Muhammad Ali Nouman
rights: Copyright (c) 2026 Muhammad Bilal Basit, Omer Sabir, Noor ul Ain, Ateka Mansoor Ahmed, Muhammad Ali Nouman https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-31
publication date: 2026-03-31
starting page: 37
ending page: 43
doi: 10.53778/pjkd101344

Patient-Reported Social Frailty and Its Relationship with Depression In End-Stage Renal Disease
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description: Background and Objectives: Due to the associated impact on quality of life, chronic kidney disease leads to the development of depression. This study was done to assess the relationship between social frailty and depression in End-Stage Renal Disease patients. Materials and Methods: This study was conducted at the Combined Military Hospital Lahore, including patients aged> 13 years of either gender with ESRD. All patients were evaluated for depression using the Patient Health Questionnaire-9 and for frailty using the Social Frailty Index-7 questionnaire. The effect modifiers such as age, duration of dialysis, concern regarding serum creatinine, fear of disability, dialysis-associated fatigue, and haematological parameters were also assessed using binary logistic regression analysis. Results: A total of 150 patients with a mean age of 56.93 ± 13.78 years were enrolled. Among these, 106 (70.6%) were males, 61 (40.67%) had diabetes mellitus, 71 (47.33%) often felt fatigued, 103 (68.67%) had unintentional weight loss, and 59 (39.33%) reported slight concern about serum creatinine levels. Frailty and depression showed a significant correlation (r = -0.305, p<0.001). Similarly, socially frail patients had markedly higher odds of depression (adjusted OR 105.74, 95% CI 13.38–835.00; p < 0.001) compared with non-frail individuals. Associations observed for education, income, fear of disability or death, unintentional weight loss, polypharmacy, and serum albumin were no longer significant after adjustment for confounders; however, fatigue frequency and concerns about serum creatinine levels remained significant. Conclusions: Frailty, fatigue, and psychological concern about serum creatinine levels were independently associated with depression in ESRD patients
subject: Original Article
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creator: MahRukh Riaz
creator: Mahtab Asif
creator: Muhammad Umar Rafique
creator: Abdul Rehman Arshad
creator: Muhammad Iqbal
creator: Aimen Karamat
rights: Copyright (c) 2026 MahRukh Riaz, Mahtab Asif, Muhammad Umar Rafique, Abdul Rehman Arshad, Muhammad Iqbal, Aimen Karamat https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-31
publication date: 2026-03-31
starting page: 18
ending page: 27
doi: 10.53778/pjkd101335

Compliance with Anemia Management Indicators Among Maintenance Hemodialysis Patients: A Clinical Audit from a Tertiary Center
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description: Background Anemia is a major complication among patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis (MHD). Effective management requires consistent adherence to guideline-recommended practices, including hemoglobin monitoring, iron assessment, and appropriate erythropoiesis-stimulating agent (ESA) titration. This audit aimed to evaluate compliance with key anemia management indicators in a tertiary hemodialysis unit. Methods A cross-sectional clinical audit was conducted among 62 adult MHD patients at Evercare Hospital Dhaka. Data were collected using a structured checklist based on KDIGO 2021 anemia guidelines. Eight indicators were assessed: anemia screening, iron status documentation, correction of iron deficiency, post-ESA hemoglobin monitoring, maintenance of target hemoglobin, quarterly iron profile checks, ESA dose adjustments, and completion of patient education. Compliance levels were analyzed descriptively and compared across genders. Results High compliance (82–100%) was observed in anemia screening, ESA dosing, post-ESA hemoglobin monitoring, and patient education. Hemoglobin maintenance within target ranges showed moderate adherence (62.9%). Iron documentation (35.5%) and quarterly iron monitoring (8.1%) demonstrated critically low compliance. Male patients achieved better hemoglobin control than females (80.8% vs. 50%). A strong positive correlation was found between appropriate ESA titration and hemoglobin stability. Conclusion The audit identified strong adherence to ESA-related processes and patient education but highlighted major gaps in iron assessment and routine monitoring. Strengthening iron management practices is essential to optimize anemia outcomes in MHD patients. Targeted quality-improvement interventions are recommended to enhance overall compliance and align practice with international standards.
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creator: Mehadi Hasan
creator: Ebadur Rahman
creator: A.F.M. Noman
creator: Ummay Farwa Hoque
creator: Asma Jalal Panjery
creator: Md. Mahbubur Rahman
creator: Rubiya Rahim
creator: Tarim Mahmood
rights: Copyright (c) 2026 Ebadur Rahman, Mehadi Hasan, A.F.M. Noman, Ummay Farwa Hoque, Asma Jalal Panjery, Md. Mahbubur Rahman, Rubiya Rahim, Ummay Farwa Hoque, Ummay Farwa Hoque, Tarim Mahmood https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-31
publication date: 2026-03-31
starting page: 10
ending page: 17
doi: 10.53778/pjkd101340

Peritoneal Transport Characteristics Among Pakistani Patients Undergoing Peritoneal Dialysis
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description: Background: The peritoneal membrane acts as a biological filter to remove solutes and fluids during peritoneal dialysis, a well-known kind of renal replacement treatment. Dialysis prescriptions and clinical results are directly influenced by the four transport categories that the peritoneal equilibration test assigns to patients: low, low-average, high-average, and high. The published literature still lacks population-specific transport data from Pakistan. Objective: To determine the distribution of peritoneal transport types among Pakistani patients undergoing peritoneal dialysis and to evaluate the demographic, clinical, and biochemical variables associated with transport status. Materials and Methods: Four tertiary care hospitals in Lahore participated in a multicenter, cross-sectional, observational study. One hundred adult patients receiving continuous ambulatory peritoneal dialysis underwent a standard peritoneal equilibration test six weeks after dialysis began. Transport categorization was done using the Twardowski criterion and the 4-hour dialysate-to-plasma creatinine ratio. Results: High-average and high transporters collectively constituted 77% of the study population (57% and 20%, respectively). Older age (p = 0.02), lower body mass index (p = 0.02), diabetic nephropathy (p = 0.03), hypoalbuminemia (p < 0.001), raised C-reactive protein (p < 0.001), and decreased net ultrafiltration volume (p < 0.001) were all substantially correlated with higher transport status. Conclusion: A marked predominance of high peritoneal transport phenotypes was identified in this Pakistani population, attributed to the compounding influence of diabetic nephropathy, systemic inflammation, and nutritional deficits. These findings underscore the need for transport-guided dialysis prescription in this clinical setting.
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creator: Muhammad Irfan Jamil
creator: ROSHINA ANJUM
creator: AHAD QAYYUM
creator: Muhammad Mohsin Riaz
creator: Uzair Ahmed
creator: Fatima Saleemi
creator: MUHAMMAD BILAL BASIT
rights: Copyright (c) 2026 Muhammad Irfan Jamil, ROSHINA ANJUM, AHAD QAYYUM, Muhammad Mohsin Riaz, Uzair Ahmed , Fatima Saleemi, MUHAMMAD BILAL BASIT https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-31
publication date: 2026-03-31
starting page: 28
ending page: 36
doi: 10.53778/pjkd101346

Nephropathology quiz Postpartum hemolytic uremic syndrome
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description: NA
subject: Renal Pathology
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creator: Muhammed Mubarak
rights: Copyright (c) 2026 Muhammed Mubarak https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-31
publication date: 2026-03-31
starting page: 48
ending page: 52
doi: 10.53778/pjkd101354

Hyponatremia in Congestive Heart Failure (CHF): Harnessing the Horse with Tolvaptan
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description: Hyponatremia in Congestive Heart Failure (CHF) is a complex and ominous clinical entity that transcends simple electrolyte imbalance. It serves as a profound indicator of advanced neurohormonal derangement and stands as one of the most reliable predictors of morbidity and mortality in the heart failure population [12, 20]. While traditional loop diuretics remain the cornerstone of decongestion, they frequently exacerbate hyponatremia by causing natriuresis and further activating the renin-angiotensin-aldosterone system (RAAS), leading to a state of "diuretic resistance" [5, 15]. Tolvaptan—an oral, selective vasopressin V_2-receptor antagonist—offers a physiologically targeted alternative. By inducing "aquaresis" (the excretion of solute-free water) rather than natriuresis, tolvaptan allows clinicians to "harness" the runaway vasopressin response [7, 18]. This article provides a comprehensive exploration of the pathophysiology of hypervolemic hyponatremia, the foundational clinical evidence supporting vaptan therapy, and a structured, safe approach to managing these high-risk patients
subject: Review Article
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creator: Chaudhry Adeel Ebad
rights: Copyright (c) 2026 Chaudhry Adeel Ebad https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-31
publication date: 2026-03-31
starting page: 3
ending page: 9
doi: 10.53778/pjkd101350

From The Desk of Editor in Chief
type: item
subject: From The Desk of Editor in Chief
  topic: section
creator: Rubina Naqvi
rights: Copyright (c) 2026 Dr Rubina Naqvi https://creativecommons.org/licenses/by-nc/4.0
date: 2026-01-01
publication date: 2026-01-01
starting page: 1
ending page: 2
doi: 10.53778/pjkd94333

Peritonitis rates among Automated peritoneal dialysis patients: Underlying factors and outcomes.
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description: Back ground: Peritonitis among peritoneal dialysis (PD) patients is a major impediment for patient and physician acceptance of peritoneal dialysis as an alternate to hemodialysis. We look at our peritonitis rates among Automated peritoneal dialysis (APD) patients. Methods: All patients undergoing APD were included in the analysis since January 2025 till now and had undergone at least a month of PD. Peritonitis rate was calculated and all factors were closely evaluated. Results: Among 82 APD patients the majority were males. A peritonitis rate was calculated to be 0.62 episodes per patient years. Single mortality among 22 patients who died, was directly attributed to severe sepsis after an episode of peritonitis. Conclusion: The peritonitis rates are better as the experience with the PD is improving. Attention to simple infection prevention protocols and retraining of the patients will further improve the targets to international standards.
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creator: Muhammad Shakir
creator: Muhammad Anees
creator: Irfan Munir
creator: Hina Akbar
creator: Madiha Mahmood
creator: Shahbaz Pervaiz
creator: Irfan Elahi
creator: Sana Kifayat
creator: Minahil Ismael
creator: Haroon Pervaiz
creator: Ali Hasan
creator: Naseem Sohail
rights: Copyright (c) 2025 Muhammad Shakir, Prof Dr. Muhammad Anees, dr. Irfan Munir, Dr. Hina Akbar, Dr Madiha Mahmood, Dr. Shahbaz Perviz, Dr. Irfan Elahi, Minahil Ismail, Haroon Pervaiz, Ali Hasan, Naseem Sohail https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 3
ending page: 6
doi: 10.53778/pjkd94331

Histopathological Patterns of Renal Biopsy and their Treatment Outcomes at A tertiary hospital in Dhakka: An Observational Study
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description: Background: Renal biopsy is the gold standard for diagnosing the underlying cause of renal diseases. It provides critical insights into histopathological patterns, enabling tailored management and prognostic assessment. In this study, we have assessed the histopathological patterns of renal biopsy and their treatment outcome at our tertiary care hospital in Dhakka. Method: This was a retrospective observational study among patients who underwent renal biopsies from June’24 to September’25 (16 months) at department of Nephrology. Result: Total of 60 patients were included in the study. Mean age was 39 (±2) years, with a male to female ratio of 2:3. The most common co-morbidity observed was Hypertension (42%), followed by Diabetes Mellitus (18%). ​Renal biopsy was most frequently indicated for proteinuria (48.33%, 29/60), with Nephrotic Syndrome accounting for 62% (18/29) of these cases. IgANw s the commonset diagnosis followed by FSGS, 26.9% and 15% respectively. ​Complete or partial remission was achieved in 38.3 % of patients at one year. Tubule-interstitial involvement at presentation was associated with a poorer outcome. Conclusion: This study highlights that among our cohort of patients at a tertiary hospital the most frequent diagnosis was IgAN. Complete and partial remission was observed in one third of our patients. It is therefore important to diagnose the GN at an early stage with prompt treatment that may help to improve the clinical outcome of our patients.
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creator: Fairooz Raisa
creator: Ebadur Rahman
creator: Muhammad Masum Kamal Khan
creator: Fahmida Begum
creator: Tabassum Samad
creator: SM Mahbub Alam
creator: Ahmed Khalid
creator: Rezoyana Nazim
creator: Rubiya Rahim Rahim
creator: Arif Mahmud
rights: Copyright (c) 2026 Ebadur Rahman, Dr. Muhammad Masum Kamal Khan, Dr. Fahmida Begum, Dr. Tabassum Samad, Brig. Gen.Dr. SM Mahbubul Alam, Dr. Ahmed Khalid, Dr. Fairooz Raisa, Dr. Rezoyana Nazim, Dr. Rubiya Rahim, Dr. Arif Mahmud https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 7
ending page: 14
doi: 10.53778/pjkd94329

Successful Treatment of Acute Kidney Injury on Chronic Kidney Disease Due to Tubulointerstitial Nephritis and Acute Tubular Necrosis With Steroids and Mycophenolate Mofetil: A Case Report
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description: Acute tubulointerstitial nephritis causes interstitial inflammation and tubular injury leading to acute kidney injury which can present as rapid decline in renal function. Early diagnosis and prompt treatment is essential. After taking informed consent from our patient we present a case report where a patient with chronic kidney disease presented with rapid decline of renal function. Furthermore, renal biopsy revealed the diagnosis of tubulointerstitial nephritis. She was later started on steroids and mycophenolate mofetil, to which she responded adequately. From this case we conclude that steroids and mycophenolate mofetil are helpful in treatment in acute tubulointerstitial nephritis.
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creator: Iqra Ahmed
creator: Merina Khan
creator: Syed Nayer Mahmud
rights: Copyright (c) 2026 DR IQRA AHMED, Merina Khan, DR SYED NAYER MAHMUD https://creativecommons.org/licenses/by-nc/4.0
date: 2026-01-01
publication date: 2026-01-01
starting page: 19
ending page: 25
doi: 10.53778/pjkd94328

A No Alarm on ECG: A Case of Severe Asymptomatic Hyperkalemia with No Significant ECG Changes
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description: Hyperkalemia usually produces characteristic ECG changes due to its effects on myocardial membrane potential. When these accompany high serum potassium levels, they indicate a medical emergency. However, ECG findings do not always correlate with biochemical severity—sometimes even profound hyperkalemia presents with a normal ECG. We present a case of a 47-year-old woman with chronic kidney disease who exhibited a serum potassium level of over 8 mmol/L yet remained asymptomatic with a normal ECG. This case highlights the diagnostic limitations of ECG in hyperkalemia and emphasizes that management should be guided by biochemical results and clinical context rather than ECG appearance alone.
subject: Case report
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creator: Namrah Namrah Nasir
creator: Zahid Nabi
creator: Humayun Rashid
rights: Copyright (c) 2026 Namrah Namrah Nasir, Dr. Zahid Nabi, Dr. humayun Rashid https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 15
ending page: 18
doi: 10.53778/pjkd94323

From The Desk of Editor in Chief
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subject: Editorial
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creator: Rubina Naqvi
rights: Copyright (c) 2025 Rubina Naqvi https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-30
publication date: 2025-09-30
starting page: 1
ending page: 2
doi: 10.53778/pjkd93319

Nephro-Pathology Quiz
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subject: Renal Pathology
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creator: Muhammed Mubarak
rights: Copyright (c) 2025 Professor Dr. Muhammed Mubarak https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-30
publication date: 2025-09-30
starting page: 41
ending page: 45
doi: 10.53778/pjkd93320

Incidence of Catheter-Related Infections in Maintenance Hemodialysis Patients: A Critical Challenge in Balochistan, Pakistan
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description: Background: Catheter-related infections (CRIs) represent a critical complication in haemodialysis patients, particularly in resource-limited settings. This study investigated the incidence, risk factors, and predictors of CRIs among haemodialysis patients at Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan. Methods: A cross-sectional observational study was conducted from January 2023 to December 2024, enrolling 357 adult patients with end-stage renal disease undergoing maintenance haemodialysis via central venous catheters. Data were collected using structured questionnaires covering demographics, clinical parameters, catheter characteristics, and institutional factors. Statistical analyses included descriptive statistics, chi-square tests, Mann-Whitney U tests, logistic regression, and Kaplan-Meier survival analysis. Results: The CRI incidence was exceptionally high at 82.1% (293/357 patients), with exit-site infections predominating (96.2%) and catheter-associated bloodstream infections accounting for 22.9%. Diabetes mellitus emerged as the strongest predictor (adjusted OR = 6.3, P < 0.001), followed by non-sterile gauze use (OR = 4.2) and hypertension (OR = 3.1). Femoral catheters were associated with higher bloodstream infection rates compared to subclavian access (P = 0.023). Critical institutional gaps included suboptimal hand hygiene compliance (73%), minimal staff training rates (2.2-10.9%), and zero utilization of antibiotic lock therapy. Conclusions: CRI rates at this facility far exceed international benchmarks, driven by modifiable patient-specific, procedural, and institutional factors. Urgent implementation of evidence-based interventions including improved infection control protocols, staff training, and catheter care bundles is essential to reduce this preventable burden in Balochistan's vulnerable haemodialysis population.
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creator: Abdul Wali
creator: Dilawar Khan
creator: Syed Mohkumuddin
creator: Farooq Aslam
creator: Saifuddin Khan
creator: Sajidud Din
rights: Copyright (c) 2025 Abdul Wali, Dilawar Khan, Syed Mohkumuddin, Farooq Aslam, Saifuddin Khan, Sajidud Din https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-30
publication date: 2025-09-30
starting page: 30
ending page: 35
doi: 10.53778/pjkd93310

An Effectiveness of RNA interference therapies in reducing urine and plasma oxalate levels among patients with primary hyperoxaluria- A systematic review
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description: Background: Primary hyperoxaluria is a rare genetic disorder of hepatic oxalate over production. Standard of care was largely supportive with hyperhydration, urinary alkalinization and pyridoxine. RNA interference therapies have recently shown promising results. Material and Methods: The systematic review was prospectively registered with PROSPERO and followed PRISMA guidelines. Pubmed, EMBASE and CENTRAL were searched from January 1974 to July 2024 for randomized controlled trials and single arm intervention studies on use of RNAi therapies in primary hyperoxaluria. Results: We found 127 records across the databases, with 12 of them included in the final analysis. A total of 140 patients were enrolled in Lumasiran (9 trials) and Nedosiran (3 trials). Most studies demonstrated a significant reduction in the oxalate burden. Injection site reaction was the most common adverse event with a largely acceptable safety profile. Quality of studies assessed through ROB-2 and ROBINS-I showed a low risk of bias. Conclusion: This systematic review emphasizes the effectiveness and safety of RNA interference therapies, Lumasiran and Nedosiran, in treating primary hyperoxaluria by lowering urinary and plasma oxalate levels.
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creator: Sabeeta Khatri
creator: Irshad Ali Bajeer
creator: Madiha Aziz
creator: Mir Alyaan Hashmi
creator: Seema Hashmi
rights: Copyright (c) 2025 Dr. Sabeeta Khatri, Dr. Irshad Ali Bajeer, Dr. Madiha Aziz, Mir Alyan Hashmi, Dr. Seema Hashmi https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-30
publication date: 2025-09-30
starting page: 7
ending page: 16
doi: 10.53778/pjkd93312

Contribution of Acute Renal Cortical Necrosis to Acute Kidney Injury: A 25-year experience from a tertiary care renal unit in Pakistan
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description: Background: Acute cortical necrosis (ACN) is a rare contributing factor to acute kidney injury (AKI). The present study aims to report clinico-pathological profile and outcome of ACN in the setting of AKI. Patients and Methods: This study was carried out at XXXXXXXXX. Subjects for the study comprised a cohort of 349 patients, (6.2% of total AKI) seen over a period of 25 years. AKI was defined according to KDIGO guidelines and diagnosis of ACN was based on radiological or histological findings. Results: From January 1990 to December 2014, 5,623 adult patients presented with AKI. Among these, 349 (6.2%) were found to have ACN. The mean age of ACN cohort was 29.33 ± 7.85 years. The major contributing cause was obstetrical AKI 286 (82%). On presentation 342 (98 %) were oligo-anuric. Histological diagnosis was available in 89 (25.50 %) cases, in 47 (53%) the pattern was diffuse and in 42 (47%) it was patchy. In rest, diagnosis was based on radiological findings. Hemodialysis was done in 346 (99.4 %). Complete recovery was seen in 9 (2.6 %), partial recovery in 76 (22%), chronic kidney disease (CKD) developed in 57 (16 %), end stage renal failure (ESRF) in 202 (58 %) while 5 (1.4 %) died during acute phase of illness. Conclusion: ACN is still encountered as a cause of AKI. Some patients may remain dialysis free even with diffuse pattern on histological examination and this population should be closely monitored to avoid nephrotoxic exposure.
subject: Original Article
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creator: Rubina Naqvi
creator: Nazrul Jafry
creator: Sana Shaikh
creator: Rahma Rashid
creator: Shaheera Malik
creator: Muhammad Mubarak
rights: Copyright (c) 2025 Rubina Naqvi; Nazrul Jafry, Sana Shaikh, Rahma Rashid, Shaheera Malik, Muhammad Mubarak https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-30
publication date: 2025-09-30
starting page: 22
ending page: 29
doi: 10.53778/pjkd93314

Laparoscopic Peritoneal dialysis catheter insertion and its outcome in a cohort of automated peritoneal dialysis patients.
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description: Background: Reliable peritoneal dialysis (PD) access is critical to technique survival. We describe early outcomes from a single-center series of PD catheter insertions and summarize durations and reinsertion events. Methods: Consecutive patients undergoing PD catheter placement were analysed. The primary outcome was any catheter reinsertion or documented malfunction. Durations from index insertion to 1 September 2025 were computed. Descriptive statistics were generated. Results: Among 21 patients (mean age 54.9±18.9 years), laparoscopic placement was used in 21 cases. Reinsertion/malfunction occurred in 4 (19.0%). Mean duration was 260.2±169.6 days; median 235 (range 10-601). Duration categories: ≤30 days: 2 (9.5%), 31–90 days: 2 (9.5%), 91–180 days: 2 (9.5%), >180 days: 15 (71.4%). Conclusions: Laparoscopically placed PD catheter resulted in an overall successful maintenance of PD catheter short term and long term. Further long term studies are needed for a local experience in PD catheter placement laparoscopically and a comparative analysis with other techniques.
subject: Original Article
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creator: Shahzad Ashraf
creator: Ahad Qayyum
creator: Muhammad Saleem
creator: Irtiqa Rehan
creator: Sadia Hussain
creator: Wardah Riaz
creator: Haroon Pervaiz
rights: Copyright (c) 2025 Pakistan Journal of Kidney Diseases https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-30
publication date: 2025-09-30
starting page: 3
ending page: 6
doi: 10.53778/pjkd93318

Pinch Off effect: A lethal Unusual complication of Subclavian Hemodialysis Catheter in a Child
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description: Pinch-off effect is reported as potential complications of subclavian venous access in 14 years old male child with hemodialysis catheter. Patient presented with features of luminal obstruction 8 months after insertion of hemodialysis catheter. X ray chest confirmed diagnosis of Pinch off syndrome. Replacement of Hemodialysis catheter through supraclavicular subclavian approach resulted in achieving safe and functional venous access for last 12 months.
subject: Case report
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creator: Mohammed AlbLooshi
creator: Dalia Abdulrahman
creator: vipul gupta
rights: Copyright (c) 2025 Mohammed AlbLooshi, Dalia Abdulrahman , vipul gupta https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-30
publication date: 2025-09-30
starting page: 26
ending page: 40
doi: 10.53778/pjkd93309

A Frequency, Risk Factors, and Outcome of Acute Kidney Injury in Idiopathic Childhood Nephrotic Syndrome: A Systematic Review
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description: Background and Objectives: Idiopathic nephrotic syndrome is a common glomerular disease with a good prognosis in the long term. However, the development of acute kidney injury may complicate the disease course. This systematic review was conducted to evaluate the frequency, risk factors and outcome of AKI in children with idiopathic nephrotic syndrome. Methods: PubMed, EMBASE, and CENTRAL were systematically searched from January 1974 to July 2024 for retrospective and prospective observational studies. The systematic review was prospectively registered with PROSPERO and written in compliance with PRISMA guidelines. The quality assessment tool was used to evaluate the quality of included studies. Results: Out of 271 identified studies, 14 were included in the systematic review. Most studies were retrospective in design. The most common risk factors for acute kidney injury in children were infections (sepsis, spontaneous bacterial peritonitis, pneumonia, and urinary tract infections) and nephrotoxic drug exposure (e.g., nephrotoxic antibiotics, renin-angiotensin modifiers, methylprednisolone, and calcineurin inhibitors). Recovery from AKI occurred in 48–100% of cases, while chronic kidney disease development ranged from 0 - 41.2% and a maximum reported mortality rate of 23%. The quality assessment through NHLBI rated 85% studies as good. Conclusion: Acute kidney injury is a relatively frequent and serious complication in children with nephrotic syndrome, often associated with infections and nephrotoxic drug exposure. This systematic review, conducted using a structured approach highlights the need of preventive strategies and further research in this vulnerable population.
subject: Original Article
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creator: Irshad Ali
creator: Sabeeta Khatri
creator: Pawan Kumar
creator: Habib Qaiser
creator: Aasia Zubair
creator: Ali Asghar Lanewala
rights: Copyright (c) 2025 Irshad Ali, Dr Sabeeta Khatri, Dr Pawan Kumar, Dr Habib Qaiser, Dr Aasia Zubair, Professor Ali Asghar Lanewala https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-30
publication date: 2025-06-30
starting page: 5
ending page: 15
doi: 10.53778/pjkd92299

Frequency and Resistance pattern of clinical isolates of Enterococcus Species in a Tertiary Care Hospital.
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description: . Introduction: Hospital acquired infections are becoming a major concern for health care providers and especially nephrology patients where a lots of interventions and frequent admissions are observed. Objective of this study was to evaluate one of the emerging multidrug resistant enterococcus organisms with significant healthcare implications. Methods: This was a retrospective study evaluating the isolates from different samples from May 2018 to Sep 2019. All isolates growing enterococci were identified and evaluated for sensitivity pattern. Results: Out of 1500 samples 86 cases of Enterococci were isolated and 8 samples had resistance to Vancomycin. 2 isolates were also resistant to linezolid. Conclusion: Vancomycin resistance among Enterococci isolates is a major concern for health care providers dealing with complex and prolonged hospital stay patients. Furthermore, the emergence of Linezolid resistance is a cause of concern highlighting the judicious use of antibiotics.
subject: Original Article
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creator: Muhammad Bilal Basit
creator: Alia Batool
creator: Omer Sabir
creator: Mohsin Riaz
rights: Copyright (c) 2025 Muhammad Bilal Basit, Dr. Alia Batool, Dr Omer Sabir, Dr. Mohsin Riaz https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-30
publication date: 2025-09-30
starting page: 17
ending page: 21
doi: 10.53778/pjkd93304

From the Desk of Editor in Chief
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subject: From The Desk of Editor in Chief
  topic: section
creator: Rubina Naqvi
rights: Copyright (c) 2025 Dr. Rubina Naqvi https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-30
publication date: 2025-06-30
starting page: 1
ending page: 2
doi: 10.53778/pjkd92308

Acute Kidney Injury in Patients Receiving Anti-Tuberculosis Treatment
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description: Although life-saving, anti-tuberculosis therapy (ATT) carries the risk of acute kidney injury (AKI), potentially complicating its management. Methods: 102 subjects starting on ATT were followed for 2 months. Presence of AKI was documented with monitoring of kidney functions. Results: AKI was observed among 14.7% patients, predominantly affecting middle-aged males. Conclusion: Early recognition of AKI by monitoring for kidney function is crucial for reducing the risk of long-term sequelae of kidney failure among patients taking ATT.
subject: Original Article
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creator: Madiha Mehmood
creator: Muhammad Anees
rights: Copyright (c) 2025 Madiha Mehmood, Dr Muhammad Anees https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-30
publication date: 2025-06-30
starting page: 16
ending page: 19
doi: 10.53778/pjkd92302

Prevalence of Pulmonary Hypertension in Chronic Kidney Disease Patients at a Tertiary Hospital
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description: Background: Pulmonary hypertension (PH) is a recognized cardiovascular complication in patients with chronic kidney disease (CKD), particularly in advanced stages. Its presence is associated with increased morbidity, hospitalizations, and mortality. Despite its clinical significance, data on PH prevalence in CKD patients in low-resource settings remain limited. Objective: To determine the prevalence of PH among patients with CKD presenting to a tertiary care nephrology department and to assess its association with demographic and clinical characteristics. Methods: This descriptive cross-sectional study was conducted at the Department of Nephrology, XXXX, from December 2020 to June 2021. A total of 194 patients aged 20–60 years with CKD stage III to V were included. PH was diagnosed using transthoracic echocardiography based on pulmonary artery systolic pressure >35 mmHg and tricuspid regurgitant velocity >3.4 m/s. Patient demographics, comorbidities (diabetes, hypertension), and disease duration were recorded. Statistical analysis was performed using SPSS version 22, with p ≤ 0.05 considered significant. Results: Among 194 patients, 118 (60.8%) were male and the mean age was 49.2 ± 7.14 years. PH was identified in 91 patients (46.9%). Significant associations were observed between PH and male gender (p=0.001), DM (p=0.002), smoking history (p=0.026), disease duration >1 year (p=0.015), and advanced CKD stage (p=0.001). No statistically significant relationship was found with hypertension or obesity. Conclusion: PH is highly prevalent in patients with CKD and correlates with several modifiable and disease-related factors. Routine screening for PH in high-risk CKD patients is recommended for early diagnosis and timely management to reduce cardiovascular complications and improve patient outcomes.
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creator: Syed Ehtesham Ali Shah
creator: Maliha Jauhar Zahidi
rights: Copyright (c) 2025 Syed Ehtesham Ali Shah, Maliha Jauhar Zahidi https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-30
publication date: 2025-06-30
starting page: 20
ending page: 23
doi: 10.53778/pjkd92305