A rare case: Vesicoureteral reflux in Indonesian young adult with neurogenic bladder and chronic kidney disease stage 4.

BACKGROUND: Vesicoureteral reflux (VUR) is one of the main causes of chronic kidney disease (CKD) in adolescence and young adult. It can be a congenital or an acquired anomaly and its uncommon in adult life. CASE PRESENTATION: A 19th years old male with neurogenic bladder, VUR grade 4, CKD stage 4, malnutrition, and short stature. Radiological examinations show a spastic neurogenic bladder, cystitis, right VUR grade 4. Abdominal ultrasonography (USG) results were bilateral severe hydronephrosis due to post-renal causes. This patient had a history of myelocele excision at the age of 1.5 years. He had recurrent urinary tract infection with CKD stage 4. DISCUSSION: The diagnosis of VUR and neurogenic bladder in CKD stage 4 is a rare case in nephrology. CONCLUSION: Indonesian male confirms of diagnosis VUR grade 4, neurogenic bladder, and CKD stage 4.

Dietary management of haemodialysis patients with chronic kidney disease and malnourishment.

BACKGROUND AND OBJECTIVES: Dietary supplementation for haemodialyzed (HD) patients with chronic kidney disease (CKD) and its benefits for the anthropometric profiles remain contentious. This study analysed changes in the albumin levels and anthropometric profiles of HD patients within 3 months of nutritional therapy. METHODS AND STUDY DESIGN: Sixty-three malnourished HD patients (Subjective Global Assessment nutrition status B or C) were enrolled. Twenty patients received counselling, 17 patients received oral therapy, 26 patients received intradialytic parenteral nutrition (IDPN), and were evaluated at month 0, month 1, and month 3. Five patients withdrew before completing the trial. The patients' albumin levels and anthropometric profiles (biceps and triceps skinfold thickness, upper arm circumference, body weight, and body mass index) were analysed before and after treatment. We performed multivariate analysis to determine the effect of each treatment on serum albumin and anthropometric profiles. RESULTS: At months 1 and 3, nutritional therapy was associated with different mean serum albumin level among three nutritional intervention groups (p<0.05). Significant increases in serum albumin, upper arm circumference, and triceps and biceps skinfold thickness were identified in the counselling and IDPN groups. Multivariate linear regression revealed significant differences between oral and nonoral groups in albumin and biceps and triceps skinfold thickness at months 1 and 3. These variables were affected by age and duration of haemodialysis (p<0.05). CONCLUSIONS: Nutritional therapy for malnourished CKD patients receiving HD ameliorated serum albumin and their anthropometric profiles within 3 months.

Severe COVID-19 infection in a kidney transplant recipient treated with lopinavir/ritonavir, hydroxychloroquine and dexamethasone.

Severe COVID-19 infection management for a recipient of kidney transplant has debatable prognosis and treatment. We described the case of a COVID-19 infected 70 year old female, previously had renal transplantation in 2017. The patient took immunosuppressive agents as routine drugs for transplant recipient status and received lopinavir/ritonavir, hydroxychloroquine, and dexamethasone daily at the hospitalization. Specific question arises about renal transplant recipients being infected by COVID-19 - whether the infection will get worse compared to those without immunosuppresive agent. In this case, author decided to stop the immunosuppressive agent followed administration of combination lopinavir/ritonavir, hydroxychloroquine, and dexamethasone that gives a good clinical impact change to patient's condition after once getting worsened and mechanically ventilated. Nevertheless, the assessment of risk and benefit in continuing immunosuppressive drugs is concurrently essential due to the prevention of transplant rejection.