Acute Kidney Injury Due to Obstetric Complications.

OBJECTIVE: To evaluate the factors, causes, and outcomes of acute kidney injury (AKI) among pregnant females admitted to a tertiary care hospital. STUDY DESIGN: An observational study. Place and Duration of the Study: Department of Nephrology, Liaquat University Hospital, Hyderabad, from April to October 2022. METHODOLOGY: Patients with AKI due to obstetric complications were enrolled and followed for three months. AKI was defined as a rise in serum creatinine of 0.3 mg/dl within 48 hours, an increase in serum creatinine of 1.5 times baseline value within the previous 7 days, or a decrease in urine output of 0.5 ml/kg/hr for 6 hours. Good antenatal care was defined as at least one visit to a healthcare provider during pregnancy. Patients with the history of diabetes or hypertension, chronic kidney disease or history of renal stones were excluded from the study. Favourable outcomes such as complete recovery were assessed at the time of discharge in terms of renal function testing. Patients who had normal renal function, adequate urine output, and became dialysis independent were labelled as completely recovered. Unfavourable outcomes were assessed in terms of progress towards either chronic kidney disease or death. RESULTS: Of the initially enrolled 66 patients, 6 were lost to follow-up and 60 patients were included in the final analysis. The mean age was 28.67±5.41 years. Only 2 patients had received good antenatal care (3.3%). Puerperal sepsis was the primary aaetiology of AKI in 20 patients (33.3%), antepartum haemorrhage in 14 patients (23.3%), and postpartum haemorrhage in 16 (26.7%) patients. In eight cases, there was combined haemorrhage and sepsis. Other causes of AKI were pre-eclampsia and placentae abruption. Nine of 60 patients were treated conservatively, while 51(85%) were treated with dialysis. Five patients died (8.3%), fifteen recovered (25%), and 40(66.7%) patients who needed dialysis at the time of discharge acquired chronic renal disease throughout the three-month follow-up period. CONCLUSION: An overwhelming majority of obstetric-related AKI patients had a suboptimal antenatal care history. The most frequent aetiology was puerperal sepsis, followed by haemorrhage. Majority of the patients with required hemodialysis and most of them did not recover in three months resulting in dialysis-dependent chronic kidney disease. KEY WORDS: Acute kidney injury, Obstetric acute kidney injury, Pregnancy, Obstetric complications, Antenatal care, Haemorrhage, Puerperal sepsis.

Efficacy and Safety of Checkpoint Inhibitors in Clear Cell Renal Cell Carcinoma: A Systematic Review of Clinical Trials.

Renal cell carcinoma (RCC) is the most common kidney cancer in adults (approximately 90%), and clear cell RCC (ccRCC) is the most frequent histologic subtype (approximately 75%). We reviewed the safety and efficacy of checkpoint inhibitors (CPIs) in ccRCC, identifying 5927 articles in PubMed, Embase, Cochrane, and Web of Science. Ten randomized control (N = 7765) and 10 non-randomized (N = 572) studies were included. Overall, 4819 patients treated with CPI combinations were compared with everolimus, sunitinib, or placebo. Overall response rates (ORR) were 9-25% with nivolumab (niv), 42% with niv + ipilimumab (ipi), 55.7% with niv + cabozantinib, 56% with niv + tivozanib vs. 5% with everolimus. ORR was 51.5-58% with avelumab + axitinib vs. 25.5% with sunitinib. ORR was 59.3-73% with pembrolizumab + tyrosine kinase inhibitor vs. 25.7% with sunitinib. ORR was 32-36% with atezolizumab + bevacizumab vs. 29-33% with sunitinib. In patients with PD-L1+ve and -ve ccRCC, niv, atezolizumab, ipi, and pembrolizumab were safe and effective alone and when combined with cabozantinib, tivozanib, axitinib, levantinib, and pegilodecakin. Atezolizumab + bevacizumab was safe and effective in ccRCC with high PD-L1 expression. Pembrolizumab was safe and effective in preventing recurrence in ccRCC patients with nephrectomy. Additional randomized, double-blind, multicenter clinical trials are needed to confirm these results.

The Role and Efficacy of Coenzyme Q10 in the Management of Erectile Dysfunction in a Hypertensive Male: An Interventional Study.

Introduction Erectile dysfunction (ED) is a prevalent medical condition that affects millions of men globally. A number of pharmacological and complementary options are used in the management of ED, including Coenzyme Q10 (CoQ10). Oxidative stress has been linked to the progression of ED, and Co Q10 protects against oxidative damages and improves erectile function as well as the activity of antioxidant enzymes. This study aimed to determine the efficacy of CoQ10 in the treatment of erectile dysfunction in hypertensive males. Method An open-labeled parallel arm interventional study was conducted in the cardiology unit of Hayatabad Medical Complex Hospital, Peshawar, Pakistan, from March 2020 to March 2021. Hypertensive male patients (n = 230) were randomly allocated to either receiving 200-gram CoQ10 daily along with their current antihypertensive therapy (n=104) or anti-hypertensive treatment only (n=105). The patient's erectile function was assessed at baseline and three months using the International Index of Erectile Function Test (IIEF-5) during the study period. Result Of the total 230, 209 (90.87%) patients were included in the final analysis. There were no significant differences in demographics, history of illness, co-morbid conditions, and current medication of both groups. After three months, 21 (20.1%) participants scored more than 17 in the IIEF-5 and no longer had ED. Overall, no significant difference was found in the mean IIEF-5 score between the study group and control group (14.41 ± 4.49 Vs. 15.61 ± 4.82; p=0.06). However, in subgroup analysis, significant improvement in the study group was seen in participants with mild ED (p=0.03). Conclusion With the demonstration of its efficacy in hypertensive patients with mild ED, co-enzyme Q10 supplementation can be proposed as a potential candidate in patients with long-term hypertension and can play a role in erectile dysfunction.