Journal of nephropathology
Volume:11 Issue: 4, Oct 2022

IgA nephropathy (IgAN) is one of the most common forms of glomerulonephritis worldwide. It leads to end-stage renal disease (ESRD) in many patients. At the time of diagnosis, risk stratification is of paramount importance in planning proper management in individual cases. Several studies have been conducted to determine the utility of various demographic, clinical, laboratory, and pathological features on renal biopsy to stratify the risk of disease progression and predict the likely outcome. This review summarizes the emerging data on demographic, clinical, laboratory, and histological prognosis along with risk factors associated with renal outcomes in patients with IgAN.

For this review, we searched DOAJ (Directory of Open Access Journals), PubMed/Medline, Web of Science, Scopus, Embase, and Google Scholar, using keywords including; “IgA nephropathy,” “IgA nephritis,” “IgAN,” “Berger’s disease,” “Berger’s syndrome,” “chronic glomerulonephritis, “prognostic factors,” “risk factors,” “risk stratification,” “renal survival,” “ESRD,” “MEST classification,” “MEST-C classification” and “Oxford Classification.” To identify other relevant studies, we manually scanned the bibliographic lists of the identified studies and reviewed articles from January 2009 through December 2020. All relevant articles were carefully reviewed, and relevant information was extracted for this narrative review.

A total of 152 articles were retrieved from the above literature database searches. The abstracts were carefully reviewed to identify 35 articles containing information on prognostic factors and longterm renal survival in IgAN patients. Relevant information was collected and summarized for this review. The main focus was on using demographic, clinical, and laboratory features, especially serial changes in these parameters during follow-up, for this purpose. Recently a standardized, evidencebased formulation has been devised to evaluate and categorize pathological features on renal biopsy to augment and refine the risk stratification and prognostic value of traditional risk factors; it is popularly known as the Oxford classification of IgAN. There have been numerous validation studies in various ethnic groups that have proven its clinical utility.

In conclusion, the clinicians should also take into account the pathologic variables according to the revised Oxford classification in addition to demographic, clinical, and laboratory parameters for early and reliable risk stratification and prognostication in individual patients at the time of diagnosis in IgAN for optimal management and ultimate improvement in long-term outcomes.

Acute kidney injury (AKI) is the second prevalent organ damage among COVID-19 infected individuals, which mainly affects those with critical diseases or underlying kidney disorders. Emerging data have suggested that AKI is associated with adverse outcomes, severe COVID-19 disease, and high mortality. However, the true nature and pathophysiology of COVID-19-associated kidney injury, and its effect on patients with underlying kidney diseases and transplant recipients, still remains controversial. Accordingly, this review study aimed primarily to describe the history of AKI in COVID-19 infected patients and to achieve a robust understanding of the latest findings on the mechanism of the injury. Secondly, this systematic and precise review of the literature concerning the aspects of AKI in infected patients with chronic kidney disease and transplant recipients provided a comprehensive report of mortality in these individuals. Finally, the present research suggested the possible protective measures that physicians can take to prevent, control, and treat this condition. Our study paves the way for future works with a more robust methodology to better understand COVID-19-related kidney injury

 Freehand renal biopsy represents a valid alternative to the most widespread ultrasonography-guided technique, although some concerns can derive from the possible increased complication rate and lower adequacy rate.

 In the present audit study, efficacy of freehand method have been established through the analysis of 328 consecutive renal biopsies in 322 patients, instead the safety of the procedure was assessed in 196 patients.

 We retrospectively reviewed hospital databases of all patients who underwent a percutaneous renal biopsy over an 18 years’ period at Santa Marta and Santa Venera hospital in Acireale.

 The procedure led to a definitive diagnosis in the majority of cases (98.48%), being uninformative only in 5 out of 328 cases (1.52%). Comparing these results against a Proforma, resulting from analysis of best literature reports for the items studied, adverse event rates were similar.

 Freehand renal biopsy resulted a good option to obtain renal tissue, without serious side effects. We argue about safety and we prefer to reserve this invasive procedure to selected cases, avoiding renal biopsy if biochemical and instrumental data allow a definitive diagnosis as well as in high risk patients. Our policy protects patients from the adverse effects that can result from kidney biopsy.

 HIV-associated kidney diseases continue to be a major problem in South Africa.

 We aimed to determine the kidney outcomes of immune-complex associated mesangiocapillary glomerulonephritis (MCGN) in patients with and without HIV.

 A retrospective cohort study was conducted on all adult patients with a kidney biopsy diagnosis of immune-complex associated MCGN from 1 January 2000 to 31 December 2016. We compared the proportion of HIV-positive and HIV-negative patients that reached the composite endpoint of either doubling of the serum creatinine or end-stage kidney disease. Cox proportional hazards models were employed to examine the association between the composite endpoint and predictor variables.

 A total of 79 patients were included of which 20 (25.3%) were HIV-positive. Twenty-four patients (30.4%) reached the composite endpoint. The cumulative proportions reaching the composite endpoint at one and four years were 25.3% and 30.4% with no difference between HIV-positive and HIV-negative patients (45.0% versus 25.4%, respectively; P= 0.10). Multivariable Cox proportional hazards model identified estimated glomerular filtration rate at biopsy (hazard ratio [HR] = 0.92; 95% confidence interval [CI]: 0.84-1.00, P=0.04) and proteinuria at follow-up (HR = 1.60; 95% CI: 1.21-2.11, P<0.01) as predictors of the composite endpoint at one-year. On survival analysis, there was no difference in the composite endpoint for HIV status (P=0.09; log-rank).

 Immune-complex associated MCGN continues to be a common histopathological pattern of injury at our center. Due to late presentation, kidney outcomes remain poor, regardless of HIV status.

 Adequate and effective dialysis can improve patients’ quality of life and reduce kidney failure complications and mortality in end-stage renal disease on hemodialysis.

 This study aimed to evaluate dialysis adequacy based on Kt/V and its related factors among patients undergoing hemodialysis.

 This cross-sectional, multi-center study was conducted during six months on hemodialysis patients referred to dialysis centers of the Guilan province in the north of Iran. Dialysis adequacy was evaluated using Kt/V (>1.2) criteria.

 The mean Kt/V was 1.24±0.36 with a median of 1.2. Adequacy of dialysis was desirable in 51.2% of the patients. There was a significant and inverse relationship between body mass index (BMI) and Kt/V (r=-0.139, P=0.013). The relationship between Kt/V criterion and pre-dialysis weight (r=-0.310, P=0.00) and post-dialysis weight (r=-0.314, P=0.00) were inverse. The Kt/V criterion was significantly associated with calcium (Ca) level and the patients with normal Ca level had a higher adequacy than those in the other levels of Ca [normal versus low level, mean difference (MD]: 0.19±0.06; normal versus high level, MD: 0.07±0.04, P<0.001). The Kt/V criterion was inversely related to blood pressure and temperature before and after dialysis (P<0.05).

 The present study showed a close correlation between blood pressure, Ca level and BMI with dialysis adequacy based on Kt/V criteria. The findings obtained here suggested treatment strategies based on correction of Ca levels, BMI and blood pressure prior to dialysis to increase the adequacy of dialysis.

 Today, hypertension is a significant public health problem globally, widely recognized as a major risk factor for death. Blood pressure-lowering herbal medicines and natural products have been used for centuries. The protocol aims to determine the effect of natural product use on blood pressure in Iran using data from previously published randomized controlled trials. The current protocol for a systematic review and meta-analysis is designed to determine the effect of natural product use on blood pressure in Iran.

 The protocol is developed using PICO (participants, interventions, comparisons, and outcomes) items to assess the effect of natural products on blood pressure reduction in randomized clinical trials (RCTs) in Iran. Specific MESH terms will be used to search Google Scholar, PubMed, and the Cochrane Central Register for randomized controlled clinical trials, as well as national databases such as Barekat Gostar, SID, Magiran, and IranDoc. The I2 index and the Q-test will be used to examine heterogeneity in the effect sizes of individual studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) of RCTs will be reported per Cochrane guidelines, and all forms will be based on validated Cochrane templates.

 This protocol will detail the effects of natural products (interventions) in comparison to a placebo or other control group (comparators).

Successful conception in a female patient on hemodialysis (HD) is considered a high-risk pregnancy and associated with maternal and fetal complications. Thus, most such pregnancies lead to abortion or termination to preserve maternal health. Here, we report a successfully-delivered case of a 19th-week-diagnosed pregnancy in a 35-year-old mother with end-stage renal disease (ESRD). We present the case of a 35-year-old female with ESRD, diagnosed 10 years ago secondary to glomerulonephritis. The patient underwent the deceased–donor renal transplantation once, which unfortunately was rejected. During the initial tests for second-time kidney transplantation, a human chorionic gonadotropin-beta (beta-hCG) positive with a level of 9953 mIU/mL was reported, suggesting the pregnancy. The transvaginal ultrasonography confirmed the pregnancy at an approximate gestational age of 19 weeks. As a result, the patient underwent four and half hours of intensive HD five times a week and continued until 36 weeks of pregnancy. At 36 weeks, the patient presented to Shariati hospital, Tehran, Iran, with low- back pain. Consequently, a cesarean section (C/S) was performed, and the baby boy was born with a nine of ten Apgar score. Although successful pregnancy is possible for women with ESRD, it requires special multidisciplinary care. Intensive HD and regular fetal monitoring have improved the pregnancy outcome in this population. However, the risk of severe complications is still for the health of the mother and her offspring.