జర్నల్ ఆఫ్ నెఫ్రాలజీ & థెరప్యూటిక్స్

An 81-year-old female patient suffered from End-Stage Renal Disease (ESRD) and on regular hemodialysis since 2012, was observed to have intense itching and cutaneous furunculoid lesions. The lesions on both legs were found infested with fly larvae (maggots). The amplification of the mitochondrial Cytochrome c Oxidase subunit I gene (COI) was successful with the annealing temperature of 51.8oC but sequencing was of poor quality that did not allow species identification. The case was treated by applying debridement with irrigation of chloroform and vegetable oil to eliminate the larvae from the wound under local anesthesia and it was effective. The study presented the first case of myiasis in ESRD and a diabetic patient in asir region of Saudi Arabia.

Introduction: Hypertension is a major public health problem. Parenchymal nephropathy is the leading cause of secondary hypertension, with glomerulopathy leading the way. In sub-Saharan Africa, little data are available on hypertension secondary to primary glomerulopathy.

Aim: To describe the epidemiological, diagnostic, therapeutic and progressive aspects of hypertension during primary glomerulopathy and to investigate the factors associated with the occurrence of this hypertension.

Patients and methods: This was a seven-year descriptive and analytical retrospective study carried out within the Nephrology Department of the Aristide Le Dantec University Hospital. We collected epidemiologic, clinical, paraclinical, therapeutic and progressive data from records of patients with hypertension caused by primary glomerulopathy.

Results: We included 172 patients. The prevalence of hypertension was 46%. The mean age was 33.9 ± 13.7 years and the sex ratio was 2.07. The mean systolic blood pressure was 158.93 ± 21.57 mmHg. The mean diastolic blood pressure was 98.23 ± 14.8 mmHg. The most frequent HBP grade was grade II, noted in 36% of cases. The most observed sign of hypertension was headache in 53.8% of cases followed by acute lung oedema in 38.5% of cases. Renal oedema was noted in 80.8% of cases. End-stage renal disease was found in 45.9% of cases. Nephrotic syndrome was noted in 62.7% of cases. Left ventricular hypertrophy was noted in 42.8% of cardiac ultrasound cases. Focal and Segmental Glomerulosclerosis (FSGS) was the most frequent lesion observed in 48.7% of cases. Angiotensin Converting Enzyme inhibitors (ACE inhibitors) were prescribed in 79% of cases. Combination therapy was prescribed in 64.5% of cases. Triple therapy was prescribed in 25% of cases. The evolution of hypertension at 1 month was favorable in 29.8% of cases and unfavorable in 47% of cases; at 12 months, this was favorable in 84.6% of cases and unfavorable in 11.5% of cases. Factors associated with the occurrence of hypertension were hypoalbuminemia below 30 g/L (P=0.018) and stage 1 chronic kidney disease (P=0.0001).

Conclusion: Hypertension secondary to glomerulopathy was common in our study. Nephrotic syndrome was the most commonly observed glomerular syndrome. The histological lesion most involved was FSGS. This hypertension can develop on its own account, leading to complications, hence the importance of screening for it as soon as possible.

Osteoclast-like goliath cell cancers are uncommon mesenchymal cancers that regularly present in rigid tissue and are striking a result of their sluggish development. Dangerous osteoclast like goliath cell growth essential to the kidney of a 81-year-old. Post nephrectomy investigation of the growth, including immunohistochemical stains and electron microscopy, affirmed the conclusion. Although the patient died of unrelated complications, metastatic disease was suspected.

Snakebite is a common medical emergency and occupational hazards particularly in tropical areas. Viper bites are more common than other poisonous snakebites in humans. The World Health Organization has estimated that there are approximately 1,25,000 deaths among 2,50,000 poisonous snake bites worldwide every year, of which India accounts for 10,000 deaths. Acute kidney Injury (AKI) is an important consequence of snakebite and its proper supportive management after the anti-venom administration is of utmost importance, for a good patient outcome. Renal involvement following snakebite envenomation has not been explored in Saudi Arabia. This is a retrospective study which was carried out at Aseer Central Hospital, a tertiary and referral hospital located in the southern part of Saudi Arabia where envenomation with snake is common medical health problem. The aim of the study is to determine the frequency of renal involvement following envenomation with snake and to determine the risk factors that contribute to the development of such complications. 134 cases of snakebites were identified during the 5-year period (100 male patients and 34 females). The mean age was 30 ± 19 y. Hematuria was seen in 19.7% and mild proteinuria was observed in 39.4%of the cases. Acute Kidney Injury (AKI) occurred in 17 cases (12.7%) and supportive renal replacement therapy was required in 4 cases. The cause of renal failure was based mainly on clinical ground: 6 cases due to pre-renal (volume loss due to bleeding), 10 due to tubulo-interstitial lesions and one case had heavy proteinuria and hematuria and glomerulonephritis was suspected. Full recovery was seen in 15 cases (88.2%) and partial recovery with permanent damage was observed in 2 cases (11.8%) after follow up for 24 months. The most important risk factors of development of AKI are older age, duration of symptoms before treatment initiated i.e. the late presentation to hospital and the abnormal coagulation in the form of disseminated intravascular coagulation. In conclusion, this study concludes that acute kidney injury occurs in 12.7% of the victims of snakebite and hemodialysis and a supportive treatment appear to be the mainstay of the therapy in the cases which are complicated by renal failure.

An intrathoracic kidney is a very rare form of ectopic kidney. Though increasingly recognized in the literature, impact on renal function is less well described. Bochdalek hernia is an inborn diaphragmatic deformity that permits stomach viscera to herniate into the thorax. Intrathoracic kidney is an exceptionally uncommon finding addressing under 5% of every single renal ectopia. Intrathoracic kidney is a halfway or complete bulge of the kidney over the hemidiaphragm into the back mediastinal compartment of the thorax. Methodical audit of the accessible writing on intrathoracic kidney, to portray the regular clinical elements, and depict likely clinical course and conceivable renal and extra-renal intricacies related with this type of ectopia.