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.
Сва права задржана (c) 2026 Dr. Rubina Naqvi https://creativecommons.org/licenses/by-nc/4.0
Peritoneal Dialysis in Pakistan: Getting out of Second Gear
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.
Сва права задржана (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
Histopathological Pattern of Live Related Renal Allograft Biopsy in A Tertiary Care Hospital of Dhaka, Bangladesh
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.
Сва права задржана (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
Dietary Protein and Fiber Intake in Relation to Nutritional Status among Peritoneal Dialysis Patients – A Descriptive study
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.
Сва права задржана (c) 2026 Ayesha Azhar, Komal Khalid, Bilal Basit https://creativecommons.org/licenses/by-nc/4.0
Rituximab Rescue in Pregnancy: Triumph over Membranous Nephropathy
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 time, at the age of 22 and 24. At 25 years of age, she achieved complete clinical remission (UPCR of 0.06g/g). At her next presentation to us, she was in her 5th week of gestation with UPCR of 4.8g. Given that her proteinuria had increased before the 20th week mark and her blood pressure was normal, the increase was attributed to relapse of her primary disease. Tacrolimus trough levels were confirmed to be optimal. Based on available evidence of Rituximab in pregnancy, potential risks and benefits were discussed with the patient and she subsequently opted for it. She was offered a low dose regime of Rituximab 100mg/week for 4 weeks which was administered at weeks 13, 14 16 and 17. Tacrolimus was continued at the same dose of 2mg twice a day. Her UPCR, albumin and LDL were followed closely throughout her pregnancy. At 34 weeks of gestation, due to low Amniotic Fluid Index (AFI), labour was induced and a baby boy was born. He required admission in the nursery for a week due to prematurity. Post discharge, he remained stable. He is currently 2.5 years old, healthy and developing normally. The mother was started on Valsartan 80mg once a day post-delivery and Diltiazem was discontinued. She achieved complete remission (UPCR 0.17g/g) 1-year post Rituximab administration and is in remission to date.
Сва права задржана (c) 2026 Dr. Merina Khan, Dr. Mahnoor Ali, Dr. Syed Nayer Mahmud https://creativecommons.org/licenses/by-nc/4.0
The Burden of CKD–Mineral and Bone Disorder in Maintenance Hemodialysis: Insights from a Longitudinal Registry
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.
Сва права задржана (c) 2026 Muhammad Bilal Basit, Omer Sabir, Noor ul Ain, Ateka Mansoor Ahmed, Muhammad Ali Nouman https://creativecommons.org/licenses/by-nc/4.0
Patient-Reported Social Frailty and Its Relationship with Depression In End-Stage Renal Disease
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
Сва права задржана (c) 2026 MahRukh Riaz, Mahtab Asif, Muhammad Umar Rafique, Abdul Rehman Arshad, Muhammad Iqbal, Aimen Karamat https://creativecommons.org/licenses/by-nc/4.0
Compliance with Anemia Management Indicators Among Maintenance Hemodialysis Patients: A Clinical Audit from a Tertiary Center
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.
Сва права задржана (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
Peritoneal Transport Characteristics Among Pakistani Patients Undergoing Peritoneal Dialysis
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.
Сва права задржана (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
Nephropathology quiz Postpartum hemolytic uremic syndrome
Сва права задржана (c) 2026 Muhammed Mubarak https://creativecommons.org/licenses/by-nc/4.0
Hyponatremia in Congestive Heart Failure (CHF): Harnessing the Horse with Tolvaptan
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
Сва права задржана (c) 2026 Chaudhry Adeel Ebad https://creativecommons.org/licenses/by-nc/4.0
Сва права задржана (c) 2026 Dr Rubina Naqvi https://creativecommons.org/licenses/by-nc/4.0
Peritonitis rates among Automated peritoneal dialysis patients: Underlying factors and outcomes.
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.
Сва права задржана (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
Histopathological Patterns of Renal Biopsy and their Treatment Outcomes at A tertiary hospital in Dhakka: An Observational Study
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.
Сва права задржана (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
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
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.
Сва права задржана (c) 2026 DR IQRA AHMED, Merina Khan, DR SYED NAYER MAHMUD https://creativecommons.org/licenses/by-nc/4.0
A No Alarm on ECG: A Case of Severe Asymptomatic Hyperkalemia with No Significant ECG Changes
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.
Сва права задржана (c) 2026 Namrah Namrah Nasir, Dr. Zahid Nabi, Dr. humayun Rashid https://creativecommons.org/licenses/by-nc/4.0
Сва права задржана (c) 2025 Rubina Naqvi https://creativecommons.org/licenses/by-nc/4.0
Сва права задржана (c) 2025 Professor Dr. Muhammed Mubarak https://creativecommons.org/licenses/by-nc/4.0
Incidence of Catheter-Related Infections in Maintenance Hemodialysis Patients: A Critical Challenge in Balochistan, Pakistan
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.
Сва права задржана (c) 2025 Abdul Wali, Dilawar Khan, Syed Mohkumuddin, Farooq Aslam, Saifuddin Khan, Sajidud Din https://creativecommons.org/licenses/by-nc/4.0
An Effectiveness of RNA interference therapies in reducing urine and plasma oxalate levels among patients with primary hyperoxaluria- A systematic review
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.
Сва права задржана (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
Contribution of Acute Renal Cortical Necrosis to Acute Kidney Injury: A 25-year experience from a tertiary care renal unit in Pakistan
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.
Сва права задржана (c) 2025 Rubina Naqvi; Nazrul Jafry, Sana Shaikh, Rahma Rashid, Shaheera Malik, Muhammad Mubarak https://creativecommons.org/licenses/by-nc/4.0
Laparoscopic Peritoneal dialysis catheter insertion and its outcome in a cohort of automated peritoneal dialysis patients.
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.
Сва права задржана (c) 2025 Pakistan Journal of Kidney Diseases https://creativecommons.org/licenses/by-nc/4.0
Pinch Off effect: A lethal Unusual complication of Subclavian Hemodialysis Catheter in a Child
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.
Сва права задржана (c) 2025 Mohammed AlbLooshi, Dalia Abdulrahman , vipul gupta https://creativecommons.org/licenses/by-nc/4.0
A Frequency, Risk Factors, and Outcome of Acute Kidney Injury in Idiopathic Childhood Nephrotic Syndrome: A Systematic Review
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.
Сва права задржана (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
Frequency and Resistance pattern of clinical isolates of Enterococcus Species in a Tertiary Care Hospital.
. 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.
Сва права задржана (c) 2025 Muhammad Bilal Basit, Dr. Alia Batool, Dr Omer Sabir, Dr. Mohsin Riaz https://creativecommons.org/licenses/by-nc/4.0
Сва права задржана (c) 2025 Dr. Rubina Naqvi https://creativecommons.org/licenses/by-nc/4.0
Acute Kidney Injury in Patients Receiving Anti-Tuberculosis Treatment
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.
Сва права задржана (c) 2025 Madiha Mehmood, Dr Muhammad Anees https://creativecommons.org/licenses/by-nc/4.0
Prevalence of Pulmonary Hypertension in Chronic Kidney Disease Patients at a Tertiary Hospital
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.
Сва права задржана (c) 2025 Syed Ehtesham Ali Shah, Maliha Jauhar Zahidi https://creativecommons.org/licenses/by-nc/4.0
Frequency Of Anti Double Stranded Dna Seropositivity In Patients With Lupus Nephritis
INTRODUCTION: Renal involvement affects approximately 38% of patients with systemic lupus erythematosus (SLE), with increased frequency and severity among African, Hispanic, and Asian populations. Lupus nephritis (LN) may present early or remain silent until progressing to end-stage renal disease (ESRD), contributing to significant morbidity. Variability in the prevalence of anti-double stranded DNA (anti-dsDNA) antibodies has been reported, and local data are scarce. This study aimed to assess the frequency of anti-dsDNA antibodies in patients with LN in our setting. OBJECTIVE: To determine the frequency of anti-dsDNA antibodies among patients with lupus nephritis. METHODS: A cross-sectional study was conducted at the Department of Nephrology, IKD, Peshawar, over six months (June–July 2020). A total of 139 patients meeting the American College of Rheumatology criteria for SLE and confirmed to have LN were evaluated. ELISA was used to detect anti-dsDNA antibodies. RESULTS: The mean age was 38 ± 9.91 years. Females comprised 66% of the cohort. Anti-dsDNA antibodies were present in 41% of patients. CONCLUSION: Anti-dsDNA antibodies were detected in 41% of patients with lupus nephritis, highlighting the importance of routine screening for early detection and management.
Сва права задржана (c) 2025 Dr Saad Hanan, Dr Syed Munib, Dr Waqas Sardar, Dr Abdul Haseeb https://creativecommons.org/licenses/by-nc/4.0