Journal of nephropathology
Volume:10 Issue: 3, Jul 2021

Prune-Belly syndrome (PBS) is a rare congenital disease characterized by a clinical triad; abdominal muscle’s hypoplasia, severe urinary tract abnormalities and cryptorchid-ism. PBS consists of a multisystem disease, which includes cardiopulmonary, gastrointestinal, musculoskeletal and urinary anomalies in varying degree. The cause and pathogenesis of PBS is unknown and the severity of symptoms can diverge greatly. On one hand, this condition may cause severe renal and pulmonary disorders, sometimes incompatible with life; on the other hand, it may origin few and tenuous urological abnormalities. Treatment is variable; it usually includes surgical management of symptoms. Renal replacement therapy for those patients with end-stage kidney disease may be necessary and it includes dialysis and kidney transplantation. The kidney failure is the main cause of postnatal death.

Coronavirus disease 2019 (COVID-19), the currently prevailing pandemic that has besieged the whole world, is caused by a novel coronavirus, named as, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Initially, there was a focus on respiratory disease, which was and is the most predominant presentation. However, with increasing spread of the infection and consequent increasing knowledge and experience about the disease, it has become apparent that the virus has wide-ranging effects on other organs and systems, including heart, blood, kidney and gastrointestinal tract. A variety of mechanisms are involved in viral damage of these organs. Blood vessels, particularly the microvasculature, and blood clotting systems are also frequently targeted by the virus, especially in severe cases. This review narrates the available evidence on the mechanisms underlying hypercoagulability and thrombotic tendency in COVID-19 disease.

Graft dysfunction (GD) is the major complication of renal transplantation, and may result in graft loss. The major causes of GD are immunological rejection and non-rejection injury (NRI), which have different prognostic and therapeutic connotations. Meticulous renal allograft biopsy (RAB) evaluation and its correlation with clinico-laboratory features are crucial for timely identification of the varied NRI.

To evaluate the clinico-laboratory characteristics and histopathologic features of NRI in "clinically indicated" RABs in our institution. Patients and

This was a prospective study conducted over a period of five years on renal transplant recipients who underwent "clinically indicated" RAB for GD.

A total of 192 biopsies were evaluated which showed NRI, rejection and NRI with concurrent rejection in 57.3%, 26.6% and 3.6% cases respectively. The NRI category, with or without concurrent rejection, comprised of acute tubular injury (ATI) (44%), calcineurin inhibitor induced (CNI) toxicity (19.7%), infections (12.8%), recurrent glomerulonephritis (GN) (7.7%), de novo GN (1.7%), chronic interstitial nephritis (9.4%), thrombotic microangiopathy (2.6%) and renal vein thrombosis (1.7%). Mean patient age was 34.9 years with male: female ratio of 8:1.

Timely differentiation between rejection and NRI is indispensable for improved allograft survival. Acute tubular injury is the major NRI causing delayed graft function (DGF), and is commonly associated with deceased donor renal transplantation. The blood concentration of CNI does not correlate with the extent of renal damage. Acute tubular injury and CNI toxicity are the major NRI, in the first six months post-transplantation and after six months post-transplantation, respectively.

Chronic hypertension and related cardiovascular diseases are some of the leading causes of maternal and perinatal morbidity and mortality in the world.

The aim of the study was to evaluate the diagnostic value of purine metabolism products in plasma and blood erythrocytes in pregnant women with chronic hypertension with superimposed preeclampsia. Patients and

Around139 patients were examined, including 110 pregnant women and 29 healthy non-pregnant women of childbearing age (control group). The content of purine metabolism intermediates was determined; guanine, hypoxanthine (HX), adenine, xanthine (X) and uric acid (UA) - in plasma and erythrocytes. We also determined the level of blood platelets, proteinuria in the general analysis of urine in pregnant women with chronic arterial hypertension, severe preeclampsia, and in pregnant women with chronic hypertension with superimposed preeclampsia.

The level of purine catabolism intermediates significantly exceeds in the blood of pregnant women with chronic hypertension and superimposed preeclampsia compared to control group. It was determinate that purine intermediates a significant increase in pregnant women with chronic hypertension with superimposed preeclampsia compared to pregnant women with isolated chronic hypertension, pregnant women with severe preeclampsia. An analysis of correlations showed that the increase in purine intermediates in blood in pregnant women with chronic hypertension and superimposed preeclampsia is associated with an increase in proteinuria and thrombocytopenia. It indicates a diagnosis of preeclampsia to chronic hypertension. It can be an additional diagnostic criterion, along with proteinuria and thrombocytopenia.

Determination of purine intermediates can be used as an additional diagnostic criterion in pregnancy with chronic hypertension.

For human, the resolution of images is important for diagnosis. Many clinical applications of artificial intelligence have been studied, however there are few reports on the difference in diagnosis between humans and artificial intelligence on the point of the renal pathological image resolution.

We examined whether the resolution of renal pathological images affects diagnosis of artificial intelligence and human. Patients and

From 885 renal biopsy patients, we collected renal IgA immunofluorescent pathological images that resolution is 4, 16, 32, 64, 128, 256 and 512 pixels for each patient, and divided into training data set and validation data set, and created optimum deep learning models for each resolution. To compare with artificial intelligence nephrologist also tried to diagnose by using the same validation data set images.

We inputted IgA immunofluorescent pathological images into each optimum model. Human could not identify specific staining site with four pixels images, however, each resolution optimum model showed high accuracy, average over 80%. The each accuarcy was observed higher depending on the resolution. The area under the curve (AUC) showed higher diagnosis ratio depending on the resolution, too. Nephrologist performed high diagnosis sensitivity depending on resolution images as same as artificial intelligence. However, nephrologists’ diagnosis observed large variations in specificity depending on resolution. These results suggested that the resolution might affect specificity for human not artificial intelligence

The resolution of images might be important for not AI but human on the point of specificity.

Alcohol use has been identified as a major risk factor for disease burden and premature mortality.

We studied the serum neutrophil gelatinase-associated lipocalin (NGAL) and advanced oxidation protein product (AOPP) concentrations in neutrophils to assess the possibility of their using for the early detection of kidney damage in patients with acute alcohol poisoning (AAP). The impact of eGFR (estimated glomerular filtration rate) on the NGAL and AOPP levels was also studied. Patients and

The study included 89 patients with AAP. Healthy individuals and patients with chronic kidney disease (CKD) served as comparison groups. Participants were represented by men, aged between 20 and 40 years. Results of laboratory tests of kidney function were also taken into account. Serum NGAL level was measured using ELISA kit. AOPP was determined using the method of Witko-Sarsat et al.

We detected a significant increase in serum NGAL and AOPP level both in toxic nephropathy with a clinical picture of acute kidney injury (AKI) and in the "preclinical stage" of kidney damage. Hence a single trend in the changes of these indicators existed in patients with AAP. At the same time, our study revealed opposite trends in patients with CKD. There was no significant increase in serum NGAL in patients with CKD.

We propose to consider an increased eGFR together with an increased serum NGAL concentration in patients with AAP as the stage, preceding the nephropathy or AKI, even in the absence of clinical and laboratory signs of impaired renal function.

Renal transplantation has been mainly studied in coastal cities or low-altitude areas, which is a significant limitation of the field.

The objective of this study was to determine the survival rates, and characteristics associated with the type of donor, in patients with renal transplantation at a high-altitude Peruvian hospital. Patients and

We performed a retrospective cohort study of 63 transplanted patients in Cusco, Peru. Depending on the type of donor (living or cadaveric), associations were found according to sociocultural characteristics of the donor and recipient, and according to physio-anthropometry and characteristics of the disease. It was used analytical statistics.

Fifty-one percent (32) of kidney transplants came from a cadaveric donor. Statistically significant differences were found according to the kinship of the donor (P<0.001), recipient age (P=0.042), cold ischemia time (P<0.001), and blood urea value (P=0.008). A year after the transplant, there was a 98% patient survival rate (CI: 89-100%) and a 97% graft survival rate (CI: 87-99%). Ten years later, the survival rate was 92% for patients (CI: 75-98%) and 53% for grafts (CI: 33-70%); there were no differences in patient survival (P=0.654) or graft survival (P=0.851) between donor types.

The results indicate that in a high-altitude population study, survival rate is slightly higher than in studies performed at sea level, and this does not depend on donor type (living or cadaveric). In addition, statistically significant differences in survival rates were found depending on the kinship of the donor, recipient age, and cold ischemia time.

Hepatitis C virus (HCV) infection is strongly associated with chronic kidney disease (CKD). It is an independent risk factor for developing CKD and significantly increases morbidity and mortality in CKD patients. Treatment with newer direct-acting antiviral (DAA) regimens in patients with CKD is showing conflicting results as regards safety and efficacy.

To evaluate the safety and efficacy of DAAs and their impact on kidney function in CKD patients. Patients and

We conducted a prospective observational study on 100 CKD patients stages 3-4, receiving treatment for HCV at MASRI (Faculty of Medicine Ain Shams University Research Institute), with two different DAAs regimens (sofosbuvir/daclatasvir with or without ribavirin and ombitasvir/paritaprevir/ritonavir [OMV/PTV/RTV] with ribavirin), completed over six months follow up. Serum creatinine, estimated glomerular filtration rate (eGFR), and proteinuria were followed during and after treatment.

Sustained virological response (SVR) was achieved in all patients. Improvement of eGFR (8-15 mL/min/1.73 m2) and proteinuria was found in both study groups. Acute kidney injury (AKI) was uncommon; it occurred in three (3%) patients, out of them, two patients showed complete recovery. Adverse events were common (43%), but serious adverse events were uncommon (2%).

DAA regimens were effective and well-tolerated for HCV infected patients with stage 3-4 CKD, where viral clearance caused improvement in eGFR and proteinuria.

The interrelation between the type of interstitial inflammatory cells and the severity of glomerulonephritis was not considered in most of the relevant medical literature.

To investigate the relationship between the type of interstitial cell infiltrate and the morphological severity of glomerular injury in different types of proliferative glomerulonephritides. Patients and

We retrospectively reviewed 138 native kidney biopsies and assessed the relationship between the type of interstitial inflammatory cell infiltrate and the severity of glomerular injury in the form of cellular crescents and fibrinoid necrosis.

The predominant type of interstitial inflammatory cell infiltrate was lymphocytic, noted in more than half of the cases. Lymphoplasmacytic inflammatory cell infiltrate was the second most common type which observed. Fifty-five of patients had inflammation in areas of fibrosis. Cellular/fibrocellular crescents were observed in 44% of cases, and fibrinoid necrosis in 30% of cases. As compared to the ‘lymphocytic’ group, patients in the ‘lymphoplasmacytic’ group had ~3 times higher probability of presenting with crescents and fibrinoid necrosis.

Our study highlights the significance of morphological correlations that may predict the severity of glomerular injury. Such findings would be helpful in limited or inadequate renal biopsy samples where the pathologist can alert the clinician, in the appropriate clinical context, to the possibility of having crescents and/or necrotizing lesions in the unsampled glomeruli.

Drug induced kidney disorder is a frequent adverse event which contributes to morbidity and even incapacitation. The discovery and development of novel biomarkers and local (renal) response mechanisms, are needed for effective prevention of drug-induced nephrotoxicity.

The main purpose of our study was to investigate the oxidative modifications of proteins in blood plasma and erythrocytes of patients with drug-induced nephropathies. Patients and

Around105 patients were divided into two groups: first group was represented by patients with psychotropic drug-induced nephropathy; the second one consisted of patients received nonsteroidal anti-inflammatory drugs (NSAIDs). Advanced oxidation protein products (AOPPs) were measured by Witko-Sarsat method. Protein reactive carbonyl derivatives (PRCD) were assayed in blood plasma and erythrocytes by the Levine method. Neutrophil gelatinaseassociated lipocalin (NGAL) was determined with the use of a commercially available ELISA kit.

Carbonyl derivatives are significantly higher in red blood cells of the 1st and 2nd group patients compared to the control subjects. AOPP statistically increased both in patients with various types of drug nephropathy and in patients with chronic kidney disease (CKD) compared with the control group. The NGAL was significantly higher in all groups compared to the control subjects.

The patients with drug-induced nephropathy have increased level of oxidative stress products and response NGAL reaction. The mechanisms that lead to the development of oxidative stress and the production of modified proteins are different in patients treated with different drugs. Establishing patterns of cell-molecular interaction permit the drug-induced nephropathy to be timely diagnosed and therapeutic programs to be optimized.

The kidney is exposed to a variety of crystalline substances which can cause tissue damage. There are limited studies on the frequency of crystal deposits in renal allograft biopsies especially from our part of the world.

The objective of this study was to find out the prevalence of crystal deposits among the allograft biopsies received at our centre over five years, and to identify its clinicopathological implications. Patients and

We have retrospectively searched the records of renal biopsies reported during the period from 2014 to 2018, to identify allograft biopsies with crystal deposits. The histopathological findings including the density of deposits were noted and correlated with demographic and clinical profile in the light of available literature.

Of 1225 transplant biopsies received during the study period, 1.5% had crystal deposits reported on morphology. These biopsies were from 13 patients evaluated for graft dysfunction; 10 had oxalate crystals while three had the rare 2,8-dihydroxyadenine (DHA) crystals. Crystal density varied from 1 to 26/mm2 and all showed acute tubular injury. Around 39% of the biopsies with crystals, included in this study, were taken within a month of transplant and those cases with subsequent biopsies showed progressive interstitial fibrosis/tubular atrophy (IF/TA). All three cases of DHA nephropathy were first diagnosed only on allograft biopsies.

In the process of graft dysfunction, interpretation of allograft biopsy should include a careful search for crystals including polarised microscopy as this might not only explain deterioration of renal function, but also clinch the diagnosis of native kidney disease. Though our study has limitations, it addresses a less discussed issue and further studies are required to reinforce the significance of crystal induced allograft injury.

IgA nephropathy (IgAN) is the most common glomerulonephritis and one of the most common causes of chronic kidney disease worldwide. Although IgAN has been classically linked with respiratory tract infections (RTIs), little studies have examined the epidemiology of this condition in terms of seasonal variations in presentations. We present the first study in one of Australia’s largest hospitals looking at the seasonality of this common condition. In summary, we surprisingly do not find any seasonal variations in the biopsy-proven presentation of this condition across 6 years of data.

Renal cell carcinoma (RCC) accounts for 3.0% of all malignant lesions of the human body. The World Health Organization (WHO) has classified renal malignant epithelial tumors as-clear cell, papillary, chromophobe and collecting duct RCCs and benign tumors as oncocytoma and angiomyolipoma. Chromophobe RCC is a distinct and rare variant of RCC. It shows equal preponderance in males and females and most commonly presents in the 6th decade of life. Because of overlapping clinical and microscopic features in different variants of RCC and considering the significant implications of the subtypes in the prognosis and treatment of these tumors, the histological classification of RCCs is extremely important. Here we report a case of a 56-year-old male, who presented with urinary complaints of hematuria, and was diagnosed as chromophobe RCC with clear cell features on histopathology and radiographic imaging.

Monoclonal gammopathies can produce a variety of glomerular, tubular, vascular and interstitial lesions. The spectrums of renal lesions produced by these monoclonal gammopathies include AL/AH amyloidosis, light chain cast nephropathy or myeloma kidney and various proximal tubulopathies. Out of these, proximal tubule centered lesions are much less identified and diagnosed and light chain proximal tubulopathy (LCPT) is one among them. In LCPT the excess free light chains (mostly kappa type by immunofluorescence microscopy) in serum are filtered by the glomeruli and are reabsorbed by proximal tubules causing its damage. These monoclonal light chains when sequestered in the proximal tubules can give rise to crystalline and noncrystalline histological variants. Here we present a rare case of noncrystalline variant of LCPT with lambda light chain restriction who presented with renal insufficiency which on later investigations revealed to be multiple myeloma.