Journal of nephropathology
Volume:3 Issue: 2, Apr 2014

The current literature indicates that maintaining adequate vitamin D levels may be an important consideration in the treatment of hypertension, especially in individuals with vitamin D insufficiency and deficiency.

Glomerular collapse is one of the morphological patterns of response of kidney parenchyma to a variety of noxious agents. As such, it is commonly observed on renal biopsies showing a variety of diseases. It is important to report this lesion in the context of underlying major pathology so as not to confuse it with idiopathic collapsing glomerulopathy. The prognosis of this lesion is determined in such cases by the underlying pathology.

Oculocutaneous albinism may be similar to two related syndromes (Hermansky-Pudlak and Chediak-Higashi) and could lead to more widespread lysosome excretory defects. These defects could lead to accumulation of some intracellular material, leading to the gross discoloration of the kidney.

Context: Contrast–induced nephropathy (CIN) is a common cause of acute kidneydysfunction.Evidence Acquisitions: Directory of Open Access Journals, Google Scholar, PubMed, EBSCOand Web of Science have been searched. It is necessary to identify at risk patients at early stages to implement preventivestrategies to decrease the incidence of this nephropathy. However, mechanisms of CINhave not fully explained yet. It seems that mechanisms which mediated by nitric oxideand prostaglandin-induced vasodilatation have been played a crucial role in the CIN.Hemodynamic changes of renal blood flow, which causes hypoxia in the renal medullaand direct toxic effects of contrast media on renal cells, are thought to contribute to thepathogenesis of CIN. Contrast media is normally divided into iso-osmolar, low-osmolar,and high-osmolar. N-acetylcysteine is considered as one of the best choices to prevent CINin high-risk groups. The first aim to prevent CIN is identifying high-risk subjects and controllingassociate risk factors. As significant differences existed between contrasts agents due to theirphysicochemical properties, low-osmolar or iso-osmolar contrast media should be used toprevent CIN in at-risk patients. The volume of contrast media should be as low as possible.

Context: A mosquito-borne viral illness highly prevalent in the tropics and subtropics, dengueis considered a major global health threat by the World Health Organization.Evidence Acquisitions: Directory of Open Access Journals (DOAJ), Google Scholar, PubMed(NLM), LISTA (EBSCO) and Web of Science have been searched. An RNA virus from the genus Flavivirus, dengue virus is transmitted by Aedes aegypti,the yellow fever mosquito. Dengue is asymptomatic in as many as one half of infectedindividuals. Dengue fever is an acute febrile illness accompanied by constitutional symptoms.Dengue hemorrhagic fever and dengue shock syndrome are the severe forms of dengue infection.Dengue infection has been associated with a variety of renal disorders. Acute renalfailure is a potential complication of severe dengue infection and is typically associated withhypotension, rhabdomyolysis, or hemolysis. Acute renal failure complicates severe dengueinfection in 2-5% of the cases and carries a high mortality rate. Proteinuria has been detectedin as high as 74% of patients with severe dengue infection. Hematuria has been reported inup to 12.5% of patients. Various types of glomerulonephritis have been reported during orshortly after dengue infection in humans and mouse models of dengue infection. Mesangialproliferation and immune complex deposition are the dominant histologic features of dengue-associated glomerulonephritis. On a rare occasion, dengue infection is associated withsystemic autoimmune disorders involving the kidneys. In the vast majority of cases, dengue infection and associated renal disorders areself-limited.

Monoclonal immunoglobulin deposition disease (MIDD) is a rare disease, usuallymanifesting between the 5th and 6th decades of life but can also occur earlier. Characteristic featureof MIDD is a non-fibrillar, Congo red negative deposition of monoclonal immunoglobulins invarious organs, including the kidneys. Depending on the composition of the deposits, MIDD isclassified into 3 types; light chain deposition disease (LCDD), which is the most common form,heavy chain deposition disease (HCDD) and light and heavy chain deposition disease (LHCDD).Kidney involvement is common in MIDD. Renal biopsy reveals nodular sclerosing glomerulopathyon light microscopy and diffuse linear staining of glomerular and tubular basement membranes onimmunofluorescence (IF) microscopy. A 38-year-old male patient recently diagnosed with hypertension presented withlower extremity edema, shortness of breath, and fatigue. The workup that was performed in a differenthospital prior to this admission, demonstrated the presence of significant proteinuria and renal failure.He was intermittently dialyzed and a renal biopsy was obtained, which showed LCDD. Furtherlaboratory workup revealed an increase of IgM, kappa chain and ß2 microglobulin chain, in additionto proteinuria and renal insufficiency. Bone marrow biopsy demonstrated an involvement of 30%with plasma cells. The flow cytometry test showed monotypic plasma cells expressing intracytoplasmickappa light chain restriction with kappa to lambda ratio of 35/1. The diagnosis of LCDD wasestablished. Treatment with steroids and bortezomib was initiated. MIDD is an unusual disease and LCDD is the most common form of MIDD. The peakincidence is around the 5th and 6th decade of life, however, LCDD can also be found in younger patients.Renal involvement, proteinuria, hematuria, and hypertension are markers of the initial clinicalpresentation. Nodular sclerosing glomerulopathy is found in about 60% of the affectedpatients. Early diagnosis and early treatment improve the prognostic course of LCDD.

Chronic allograft nephropathy (CAN) is a common cause of delayed allograftfailure throughout the world. Its prevalence and risk factors vary depending on a number offactors. There is little information on the prevalence and risk factors for early CAN in liverelated renal transplant patients. We aimed to determine the prevalence and the risk factors of early CAN in our setup.Patients and The study was conducted at Sindh Institute of Urology & Transplantation(SIUT), Karachi, from 2002 to 2005 on patients who had live related kidney transplantationand underwent at least one allograft biopsy within 18 months of transplantation. Thebiopsies were performed and prepared in accordance with established indications andguidelines. The Banff 97 classification and its updates were used to diagnose and categorizethe biopsy pathology. Patients were divided into two groups depending on the presence orabsence of CAN on biopsies. Following parameters were compared among the groups: age,sex, human leukocyte antigen (HLA) match, immunosuppression used, acute rejection (AR)episodes, urinary tract infections (UTIs), viral infections, cyclosporine levels, early and lategraft function monitored by serum creatinine. A total of 164 patients fulfilled the study inclusion criteria. The mean age of recipientsand donors was relatively young. The majority of the donors were siblings. The overallprevalence of CAN was 25.6% (42/164), between 3 and 18 months post transplantation.The median time to the appearance of CAN was 9 months post-transplant. The prevalenceof CAN increased as post-transplant duration increased. In 39 (92.8%) subjects, CAN wasdetected on the second or subsequent graft biopsy. Only 3 (7.2%) patients showed CAN onthe first graft biopsy. The majority of cases belonged to moderate degree or grade II CAN.The mean serum creatinine values were higher in the CAN group at the time of dischargeand all times post-transplantation. In conclusion, the results show that serum creatinine at the time of discharge isa useful predictor of later development of chronic changes in the allograft. Further studiesare needed to identify the risk factors for the early development of chronic changes in livingrelated renal transplant program.

Crocus sativus, known as saffron crocus, is best known for the spice saffron.Saffron use spans more than 3500 years, however, its toxicity on neonates during lactationhas not yet evaluated. This study was aimed to examine the acute toxicity of saffron on adult mice and itsnephrotoxicity and hepatotoxicity on neonates of lactating mothers that used saffron duringlactation. In this experimental study, following acute toxicity evaluation, 32pregnant mice were randomly designated into four equal groups. Following delivery, themothers of groups 1 to 4 were administered orally (by gavage) normal saline (control group),500, 1000 or 2000 mg/kg/day of saffron for three weeks, respectively. The newborns’kidney and liver parameters were assessed at the end of the study for possible nephrotoxicityand hepatotoxicity evaluation. The kidney and liver tissue samples of newborns werehistopathologically studied after staining with Hematoxylin & Eosin. Data were analyzedusing ANOVA and Scheffe’s tests The LD50 value of saffron was calculated to be 4120±556 mg/kg in mice. To evaluatelactating toxicity, saffron was administered orally to the mothers once daily for 21 days, afterdelivery, during lactating period. Saffron increased serum urea nitrogen (p< 0.05). Histologicalstudies indicated that saffron did not have any toxic effect on liver, however, histopathologychanges were seen in the kidney of neonates. From the results of present study, it might be concluded that saffron is a nearlysafe spice, however, nursing mothers should avoid high doses of this spice.