Correlation between Random Urinary Protein-to-creatinine Ratio and 24-h Urinary Protein Excretion in Preeclampsia.

This study aimed to determine the correlation between random urinary protein-to-creatinine ratio in single-voided urine samples and 24-h urinary protein excretion in pregnant women with preeclampsia. A cross-sectional study was conducted at the Department of Gynecology and Obstetrics, Abbasi Shaheed Hospital, Karachi, Pakistan, from July 2019 to June 2020. Fifty women with singleton pregnancy after 20 weeks of gestation with hypertension and 2+ proteinuria or more, according to a dipstick test, were included. Those with chronic hypertension; preexisting renal disease; gestational diabetes; eclampsia; hemolysis, elevated liver enzymes, a low platelet count syndrome; and coexisting urinary tract infections were excluded. Two random urine samples taken at 9:00 a.m. and 2:00 p.m. and 24-h urine samples were collected to evaluate the random urinary protein-to-creatinine and the 24-h protein excretion, respectively. The correlation coefficient (r) between them was calculated using Pearson's correlation test. The patients' mean age was 28.58 ± 5.09 years and their mean gestational age was 32.74 ± 4.44 weeks. Twenty-eight (56%) women were primigravidas, and 22 (44%) were multiparous. The average serum creatinine was 0.80 ± 0.16 mg/dL. The mean random urinary protein-to-creatinine ratio was 0.93 ± 0.7 mg/mg, and the mean 24-h urine was 481.08 ± 20.10 mL. A strong positive correlation was found between the protein-to-creatinine ratio and 24-h urinary protein excretion (r = 0.655; P = 0.01). We concluded that the protein-to-creatinine ratio in spot urine samples could be used as an alternative to in 24-h collection of urine to determine protein excretion in preeclamptic pregnant women.

TCF7L2 rs7903146 Is Associated With Increased Risk of New-Onset Diabetes After Transplant: A Meta-analysis of Literature.

BACKGROUND: Single nucleotide polymorphisms may influence the risk of development of new-onset diabetes after transplant (NODAT), a post-transplant clinical complication that is often implicated in allograft rejection and mortality. We performed a meta-analysis of association between transcription factor 7-like-2 (TCF7L2) rs7903146 and risk of NODAT. METHODS: A systematic search was conducted using PubMed and ScienceDirect electronic databases for studies published between January 2001 and January 2021. Case-control or cohort studies reporting association between NODAT (diagnosis based on American Diabetes Association criteria) and TCF7L2 rs7903146 were included. MetaGenyo was used for meta-analysis (random-effects model). Pooled odds ratios with 95% confidence intervals were reported to evaluate the strength of association. RESULTS: Two reviewers independently screened for articles. A total of 6 case-control studies were included for full-text review and quantitative analysis after screening for eligibility. Genotypic distributions were in Hardy-Weinberg equilibrium for included studies. All articles reported statistically significant association of TCF7L2 rs7903146 for risk of NODAT except for 1 study. There was moderate heterogeneity among studies (I2 = 60.6%). Pooled analysis revealed 51% odds of developing NODAT with TCF7L2 rs7903146 T allele (allele contrast model: odds ratio, 1.51; 95% confidence interval, 1.13-2.02; P = .005). CONCLUSIONS: The present meta-analysis demonstrated association between TCF7L2 variant rs7903146 and risk of developing NODAT. This finding suggest clinical implications for individuals undergoing kidney transplant.

Clinical Characteristics, Biochemical Markers, and Outcomes of Postrenal Transplant Patients with Coronavirus Diseases 2019: A Single-Center Experience.

The transplant recipient stays in an immunocompromised state for a definite period of time to reduce the risk of rejection and hence has more susceptibility to acquiring infections given the current coronavirus disease 2019 (COVID-19) pandemic. This study is aimed to document the clinical features of COVID-19 and biochemical markers in postrenal transplant population. This study was conducted at the renal transplant department of Dow University Hospital, Karachi, for a duration of one month and was designed as a retrospective observational study. It included all postrenal transplant patients who were assessed for COVID-19 through either nasopharyngeal or oropharyngeal swab for polymerase chain reaction. A total of 159 individuals were assessed and 28.30% were found COVID-19 positive. The mortality rate was 8.88% out of the 45 infected patients. The mean age of COVID-19-infected patients was 34.75 ± 11.50 years with 60% of males and 40% of females. The most frequent comorbidities were hypertension and diabetes mellitus. The current use of immunosuppressants either tacrolimus or cyclosporine was independently associated with acquiring COVID-19 (P <0.001) with an adjusted odds ratio [aOR] [95% confidence interval (CI)] of 1.703 (0.842-2.683) while diabetes was not associated with acquiring COVID-19 (P = 0.001) with an aOR (95% CI) of 0.513 (0.240-1.095). The frequent symptoms were fever, dry cough, sore throat, dyspnea, and arthralgia/myalgia. Diabetes mellitus was associated with early onset (P = 0.031), while the use of mycophenolate mofetil (P = 0.008) and corticosteroids (P = 0.002) was associated with delayed onset of bilateral pulmonary infiltrates. Our study brings the most recent data on postrenal transplant COVID-19 infection.

Incidence and Risk Factors of Sudden Cardiac Death in End-Stage Renal Disease Patients Undergoing Hemodialysis: A Retrospective Study.

End-stage renal disease (ESRD) patients undergoing long-term hemodialysis (HD) are at increased risk of suffering from sudden cardiac death (SCD). ESRD patients on HD are distinctively vulnerable to SCD owing to periodic fluid and electrolyte imbalances, uremic environment, and foregoing cardiovascular injury. The present study was sought to evaluate the magnitude of incidence and risk factors of SCD in ESRD patients on HD in Pakistani population. A retrospective research study was undertaken at Tertiary Care Hospital in Karachi, Pakistan from May 2016 to April 2019. The study recruited 202 eligible ESRD patients undergoing long-term HD. Baseline characteristics of the study participants with and without sudden cardiac arrest (SCA) were recorded using self-reported questionnaires. Brief history was documented for comorbid such as diabetes mellitus (DM), hypertension (HTN), and family history of cardiac disease. SCA and SCD events were identified by reviewing medical records and death certificates. The study recruited 261 patients during the study duration; however, on the basis of exclusion criteria, 59 patients were ruled out. Out of 202 patients enrolled in the final analysis, 37 (18.3%) patients suffered from the episode of SCA. Of those 37, 18 (48.6%) of the subjects succumbed to death. ESRD patients who endured SCA were statistically older in comparison with their non-SCA counterparts (58.2 ± 11.4 years vs. 52.3 ± 9.3 years, P <0.001). When compared for comorbidities, HTN (67.6% vs. 64.8%, P = 0.001), DM (62.2% vs. 59.4%, P = 0.004), coronary artery disease (CAD) (45.9% vs. 41.8%, P = 0.001), and congestive heart failure (35.1% vs. 34.5%, P = 0.002) were significantly prevalent in ESRD cohort with SCA in contrast to non-SCA. We also found left ventricular hypertrophy (LVH) (62.2% vs. 48.5%, P <0.001), ventricular tachycardia (51.4% vs. 30.9%, P <0.001) and ventricular fibrillation/flutter (56.8% vs. 25.5%, P <0.001) to be statistically higher in ESRD patients on HD with SCA event. Through multivariate logistic regression analysis, we evidenced body mass index [odds ratio (OR) = 1.141, confidence interval [CI] 1.694-2.243, P = 0.004]; hypokalemia (OR = 1.247, CI 1.214-1.278, P <0.001); CAD (OR = 1.886, CI 1.469-2.342, P <0.001); LVH (OR 1.861, CI 1.392-1.953, P <0.001); ventricular tachycardia (OR = 1.253, CI 1.012-1.386, P <0.001); ventricular fibrillation/flutter (OR = 0.547, CI 0.518-0.773, P <0.001), and duration of dialysis (OR = 1.555, CI 1.427-1.852, P <0.001) significantly and independently associated with SCD in ESRD patients on HD. In conclusion, the prevalence of SCD among ESRD patients on HD with SCA episode is very high. CAD, ventricular tachyarrhythmias, and duration of dialysis were statistically significant among ESRD patients on HD with SCA in comparison with non-SCA and were independently associated with the prevalence of inpatient SCD among ESRD patients with SCA on HD.

Multiple Drug Resistant Urinary Tract Infection in Kidney Transplant Recipients: A Retrospective Cohort Study.

Urinary tract infection (UTI) is the most common infectious disease in post-kidney transplantation patients. The objective of the study was to investigate the prevalence, impact and risk factors of multiple drug resistant (MDR) UTI in kidney transplant recipients. This retrospective cohort study recruited 72 kidney transplant recipients between March 2017 and February 2018. Urine cultures performed during the 1st year of posttransplantation with reference to clinical data were evaluated. Predesigned questionnaire was used to collect data regarding demographic, transplant related, and microbiological information. Multivariate analysis was performed to ascertain risk factors of MDR UTI. Out of 72 patients, 28 (38.9%) had culture guided clinical UTI. Overall, 59 UTI episodes were noted throughout the duration of this study. Eschericia coli were found to be the most frequent uropathogen of UTI among kidney transplant recipients (n = 32, 54.2%). MDR bacteria were responsible for 27.1% (n = 16) of the post-transplantation UTI episodes among patients, with E. coli (n = 9, 56.3%) being the predominant bacterial pathogen. Most of the MDR strains of E. coli (n = 7, 77.8%) were extended spectrum beta-lactamase positive. Female gender (P <0.001), prolonged Foley's catheterization (P = 0.002), coexisting diabetes mellitus (DM) (P <0.001) and induction of anti-thymocyte globulin (ATG) therapy (P <0.001) were independently associated with high risk of MDR UTI. The allograft rejection was found to be significantly higher in patients of posttransplantation UTI with MDR uropathogen (P = 0.009). In conclusion, E. coli were the most prominent uropathogen of UTI with and without MDR pathogen in the present study. Female gender, prolonged Foley's catheterization, coexisting DM, and induction of ATG therapy were the risk factors independently associated with MDR UTI in kidney transplant recipients. MDR organisms were significantly associated with allograft rejection.

Relation of Copeptin with Diabetic and Renal Function Markers Among Patients with Diabetes Mellitus Progressing Towards Diabetic Nephropathy.

BACKGROUND: Arginine vasopressin (AVP) plays an important role in the pathophysiology of Diabetes Mellitus (DM) and its related complications like diabetic nephropathy. Copeptin is considered as a reliable surrogate biomarker of AVP. If raised levels of copeptin in diabetic patients are detected earlier, prognosis of DM can be improved by timely modulating the treatment strategy. AIMS OF THE STUDY: The study is therefore planned to assess copeptin levels in different groups of DM and in healthy controls to suggest a better and reliable biomarker for progressive stages of DM. METHODS: Subjects were recruited as controls, pre diabetes, DM without nephropathy and diabetic nephropathy. Serum copeptin levels were measured by ELISA. While, Blood Urea Nitrogen (BUN), creatinine, Glycosylated Hemoglobin (HbA1c) and spot urinary albumin creatinine ratio (UACR) were done using spectrophotometry. Statistical analysis was done using ANOVA and Pearson's correlation tests on SPSS. RESULTS: The average copeptin levels were 215.096 pg/mL. Copeptin levels were significantly elevated in subjects with positive family history of DM (p = 0.025), levels were also raised in pre diabetes kpatients (252.85 pg/mL) as compared to other groups. Copeptin levels were also correlated with HbA1c r = 0.171 (p = 0.101), BUN r = 0.244 (p = 0.007), creatinine r = 0.215 (p = 0.018), UACR r = 0.375 (p = <0.001) and GFR r = 0.215 (p = <0.019). CONCLUSION: The significant correlation of copeptin with diabetic and renal biomarkers, along with its positive association with family history of DM support its' role as an early and reliable biomarker of DM and its associated nephropathy.

Successful desensitization and kidney transplantation in the presence of donor-specific anti-human leukocyte antigen antibodies in kidney transplant recipients.

Kidney transplantation has indisputably revamped renal medicine and restored hope among patients coming across fatal end-stage renal disease. However, sensitization of human leukocyte antigen (HLA) triggers extensive immunological fences to successful kidney transplantation and henceforth, transplant candidates are frequently demoted to the ever-growing waiting list owing to preformed donor specific antibodies (DSAs). Over the past few years, the advent of desensitization protocols has significantly overpowered the immunological barriers and enhanced the outcomes of kidney transplant recipients with DSAs against HLA. Those desensitization protocols include combination of plasmapheresis, high-dose intravenous immunoglobulin (IVIG), low-dose IVIG, rituximab, and/or bortezomib. These immunomodulatory treatments either eliminate DSAs or prevent their production. Lately, our transplant center developed and used a desensitization protocol (Two sessions of plasmapheresis on day 1 and 2 → injection rituximab on day 2 after plasmapheresis →no plasmapheresis on day 3 → eight sessions of plasmapheresis after day 3 and IVIG 100 mg/Kg/dose after each session of plasmapheresis → repeat HLA antibody detection test to confirm if DSAs are present against HLA with median fluorescence intensity (MFI)values <1000 and complement dependent cytotoxicity (CDC) crossmatch is negative for both T and B lymphocytes; if NO then continue plasmapheresis sessions with IVIG 100 mg/kg/dose till MFI values are <1000 and CDC crossmatch is negative for both T and B lymphocytes or if YES then proceed for transplantation → repeat dose of rituximab post-transplantation) to evaluate its effectiveness in improving kidney function in patients post-desensitization and kidney transplantation.

Living-unrelated kidney donor transplantation: Legalization in exceptional circumstances?

The prevalence of end-stage renal disease (ESRD) morbidity and mortality is mounting. Kidney transplantation offers a good means of survival and improves longevity of patients with ESRD. However, not everyone is fortunate to benefit from this lifesaving renal replacement therapy due to the lack of available kidneys, one of the many reasons. It eventually expands the number of patients on waiting list of kidney transplantation. At present, deceased and living-related kidney donor transplantation models are widely used, but with limited success to keep up with the pace of burgeoning ESRD. A debate over the legalization of unrelated living kidney donor transplantation has erupted lately. This short review articles focuses on issues surrounding kidney transplantation in Pakistan and draws an informed conclusion regarding pragmatic legalization of unrelated living kidney donor transplantation in exceptional circumstances. Finally, this article also offers a food for thought for countries facing analogous picture in the field of kidney transplantation.