Acute kidney injury (AKI) causes significant morbidity and mortality. This experimental animal study investigated the simultaneous impact of iron and vitamin D on AKI induced by Iohexol, an iodinated, non-ionic monomeric radiocontrast agent in Wistar rats. Out of 36 healthy male Wistar rats, saline was injected into six control rats (group 1) and Iohexol into the remaining 30 experimental rats (groups 2 to 6 comprising six rats each). Biochemical, renal histological changes, and gene expression of iron-regulating proteins and 1 α-hydroxylase were analyzed. Urinary neutrophil gelatinase-associated lipocalin (NGAL), serum creatinine, urine protein, serum and urine catalytic iron, 25-hydroxyvitamin D3, 1,25-dihydroxyvitamin D3, and tissue lipid peroxidation were assayed. Rats injected with iohexol showed elevated urinary NGAL (11.94±6.79 ng/mL), serum creatinine (2.92±0.91 mg/dL), and urinary protein levels (11.03±9.68 mg/mg creatinine) together with histological evidence of tubular injury and iron accumulation. Gene expression of iron-regulating proteins and 1 α-hydroxylase was altered. Serum and urine catalytic iron levels were elevated (0.57±0.17; 48.95±29.13 µmol/L) compared to controls (0.49±0.04; 20.7±2.62 µmol/L, p<0.001). Urine catalytic iron positively correlated with tissue peroxidation (r=0.469, CI 0.122 to 0.667, p=0.004) and urinary NGAL (r=0.788, CI 0.620 to 0.887, p<0.001). 25-hydroxyvitamin D3 (61.58±9.60 ng/mL) and 1,25-dihydroxyvitamin D3 (50.44±19.76 pg/mL) levels increased simultaneously. On multivariate linear regression analysis, serum iron, urine catalytic iron, and tissue lipid peroxidation independently and positively predicted urinary NGAL, an AKI biomarker. This study highlights the nephrotoxic potential of catalytic iron besides demonstrating a concurrent induction of vitamin D endogenously for possible renoprotection in AKI.

 To find out the possibility of using natural zeolites and plant resources to correct kidney functions in acute renal failure (ARF), two series of experiments were conducted on adult male Wistar rats. In each series, animals with experimentally induced ARF were divided into 2 groups. The first group consisted of animals with ARF who received standard feed, the second group included animals with ARF who received additives in addition to the feed in the form of a) powdered natural zeolite at the mass of 5% by weight of feed (first series, ARF + Z); b) Galega Orientalis plant powder (ARF + GO) in the amount of 2% by weight of feed (second series). In addition, a common control group (K) was organized, consisting of intact animals on a standard diet. Analysis of background urine samples in both series revealed the presence of polyuria in rats with ARF (control - 0.2±0.02; ARF - 0.3±0.04∆ ml/100g h), despite a significant decrease in GFR (control - 17.7±2.9; ARF - 6.8±1.0∆ ml/100g h). The diuretic reaction was probably due to a decrease in the water reabsorption (control – 99.2 ± 0.1; ARF – 95.6± 0.8∆%). In rats, after three days of per oral intaking zeolites, only a reduced level of relative reabsorption of fluid was observed compared to the control (97.2± 0.9∆%), while diuresis (0.2±0.1 ml/100g h) and GFR (15.0± 5.8 ml/100g h) did not differ from similar parameters of healthy animals. Against the background of taking the powder of the Galega Orientalis plant, only an increase in the volume of background diuresis was noted (0.5 ± 0.06∆ ml/100g h). After per oral intake of water load (5% of body weight), the level of diuresis in animals with ARF was 2 – 2.5 times lower than in the control group (K – 1.6 ± 0.3; ARF - 0.7± 0.3∆; ARF+ Z - 0.6± 0.3∆ ml/100g h), which was probably due to a reduced level of GFR (K – 20.3±3.1; ARF – 12.7±2.2∆; ARF+Z - 14.9±5.3 ml/100g h) and increased reabsorption of fluid (control – 91.7±1.1; ARF – 92.3±2.0; ARF+Z - 95.2±1.3Δ %), respectively. Intake of the Galega Orientalis plant powder did not give any significant differences in renal response compared to the ARF group. It can be concluded that natural zeolites caused an improvement in filtration and reabsorption processes in rats with acute renal failure, contributing to the normalization of the functional state of the kidneys. At the same time, the Galega Orientalis plant powder did not have a nephroprotective effect. _________________ Significant differences from rats with ARF and/or control.

Background and Aims: In chronic kidney disease (CKD) elevated pulse wave velocity was associated with renal micro-vascular damage. In this study, we aimed to address the association between estimated pulse wave velocity (ePWV) and classified albuminuria in pre-dialysis chronic kidney disease patients. Methods and Results: Two hundred thirty-two subjects with mean age of 68.5 ± 15.03 years old were enclosed. Our participants were classified in both estimated glomerular filtration rate (eGFR) and albuminuria categories according to the Kidney Disease Improving Global Outcomes 2012 criteria. ePWV was calculated using an equation from age and mean blood pressure (MBP). High-density lipoprotein cholesterol (HDL-C), triglycerides, waist circumference, and uric acid were measured. X2 tests and an adjusted model were applied to investigate the ePWV association with albuminuria entering covariates. We divided the patients in two groups according to mean ePWV value. The patients with a high ePWV had significantly higher uric acid levels and albuminuria, but significantly lower eGFR and HDL-C than the patients with a lower ePWV.X2 tests showed a significant association between high ePWV and classified albuminuria, classified eGFR and diabetes mellitus (x2=18.7, p=0.001, x2=62.2, p=0.001 and x2=8.6, p=0.003 respectively ). The adjusted model showed the ePWV value to remain a significant independent risk factor for the occurrence of albuminuria controlling for diabetes mellitus and eGFR less than 60ml/min/1.73m2, even though these both variables were proved excessively significant for manifested albuminuria. Conclusion: Our findings suggest a significant association between ePWV and moderate/severe albuminuria in patients with pre-dialysis chronic renal disease.

Chronic kidney disease (CKD) is a global public health concern attracting international attention due to its rapid spread. However, CKD of unknown etiology is also prevalent and creates rapid progress in certain regions of the world, particularly in Africa, Central America, and Asia. An intimate relationship between the quality of the water, soil, and food and the underlying geology has been recorded repeatedly in different geographical regions of the world. Many risk factors are hypothesized for prevailing CKDu, such as unidentified environmental toxins, chronic pesticide exposure, increased levels of nephrotoxic heavy metals in water and soil, high fluoride levels, potential impacts of AlFx on soil and water, and growth of cyanobacteria in water resources. Our investigation's overall intention is to risk assessment of drinking water, agricultural soil, rice (Oryza sativa), and fish species (Etroplus suratensis) by evaluating the toxic metal contents in CKDu endemic areas in Sri Lanka. Further, findings were compared with a CKDu non-endemic area to grab better clarifications. With the Ministry of Health's aid in Sri Lanka, CKDu hotspots have been identified for the sampling process. An adequate number of drinking water, paddy soil, rice, and fish samples were collected during the dry season (August 2019). As CKDu hotspots, Eppawala GN (Grama Niladhari) division, Medirigiriya GN division, and Giradurukotte GN division were selected, and the Dambethalawa division was selected as the reference site in Sri Lanka. Results depict that, Mean concentrations of heavy metals/metalloids such as Mn, Co, As, Cd, Pb, Cu, Zn, Fe in drinking water of selected CKDu endemic areas were far below Sri Lankan water quality standards. Besides, all sampling locations dropped below the medium range of the Heavy Metal Pollution Index of water (HPI 15 – 40). Geo accumulation indexes (Igeo) of paddy soil reveal that agricultural soil in selected CKDu endemic areas is moderately polluted with toxic metals/metalloids such as As, Pb, Cu, Ni, Cr, Zn, and Cd. However, the concentrations of Cr (p=0.44), As (p=0.36), and Cd(p=0.37) of paddy soil in CKDu hotspots were significantly higher than the reference. Among the trace metals analyzed in rice grains in the CKDu endemic areas, mean Cr, Cd, As, and Pb contents were recorded as 0.342 mg/kg, 0.011 mg/kg, 0.035 mg/kg, and 0.112 mg/kg, respectively. The mean concentrations of Cd, Pb, As, and Cr in Etroplus suratensis were 84.31, 45.20, 206.85, and 115.62 μg/kg, respectively, in the Ulhitiya reservoir (in CKDu endemic area). But significantly lower Cd level contents were observed in the CKDu hotspot than in the reservoir in the reference area. Application of fertilizers that contained high doses of toxic metals could be the driving force for the agricultural soil pollution with heavy metals and long-term exposure to the toxic metals via drinking water and frequently consumed foods may generate a risk for kidney tissue damage.

Objective: To investigate the effects of 10-week resistance exercise-based intervention on muscular strength, cardiorespiratory fitness, muscle mass and structure, and quality of life in kidney transplant recipients. Design and setting: All participants underwent a familiarization period of the tests, which were conducted one week later and after a 10-week period. Subjects: Sixteen kidney transplant recipients were recruited and voluntarily participated in the study. Main outcomes measures: At each time point participants completed: (i) a quality of life questionnaire (KDKoL), (ii) muscle thickness assessment by ultrasonography (iii) lower limb muscle strength tests, (iv) fitness tests, and (v) routine biochemical analyses. Results: The classical SF-36 domains did not differ between groups after the intervention. There were no between-group differences after the intervention in most of the domains related to the kidney disease-specific, with the exception of the scales of “effects of kidney disease” and “burden of kidney disease” that significantly improved after the intervention as compared to placebo. There were significant differences in handgrip levels after intervention in the training group vs. control (delta handgrip strength in controls -0.38 ± 1.50 (95% confidence interval CI, -2.50 to 0.43 kg) vs. 1.87±0.835 (-0.64 to 3.28 kg) in the training group; P=0.01). Patients in the intervention group improved by 54.6 ± 24.4 meters in the six minutes walk test, whereas patients in the control group improved by 8.6 ± 26.2 meters (P<0.006 for group differences). Patients in the intervention group employed less time in the get-up and go test after the intervention (-0.2 ± 0.4 seconds) whereas patients in the control group took more time (0.2 ± 0.4 seconds; P=0.003 for group differences). Conclusions: Ten weeks of resistance training improved several measures of physical function in kidney transplant patients, and the patients perceived this as a reduction in the burden felt by their disease.

A fourteen-month-old Labrador dog (BRUNO) was presented to the pet hospital with a recent history of viper envenomation. The dog was vocalising and restless. On the day of presentation, seem creation and blood nitrogen (BUN) values were 3.7mg/dL and 89.1 mg/dL respectively. The serum creatinine and blood urea nitrogen values elevated within two days to BRUNO IN PET HOSPITAL KOCHIN 6.7mg/dL and 138.6mg/dL respectively. The doy become oliguria. The clinical signs and laboratory values were consistent with acute kidney injury. Intermittent haemodialysis (IHD) was carried out as the dog was refractory to medical management. Post IHD creatinine and BUN values were 6.7 mg/dL and BUN Values 101 mg/dL, respectively. Serum creatinine and BUN value increased to 7 mg/dL and 130 mg/dL, the next day after IHD. The second session of IHDreduced serum creatinine and BUN values to 6 mg/dL and 97.8 mg/dL. The dog continued to be dull, and anorexic with oliguria. The third session of IHD helped in the reduction of serum creatinine and Oliguria resolved. The dog resumed his appetite and was clinically stable. The dog was observed for the next 24 hours and discharged. On review after three days, the dog exhibited considerable improvement; creatinine and BUN values were 3.1 mg/dL and 54.4 mg/dL, respectively. Ten days later follow-up revealed that creatinine and BUN values stabilised at 1 mg/dL and 24 mg/dL. The dog showed alow and steady recovery from acute kidney injury over a period of 20 days. Viper envenomation induces kidney injury (Hrovat et al 2013) Intermittent haemodialysis is a renal replacement therapy which is used to alleviate lifethreatening azotaemia electrolyte and acid-base imbalances and control intravascular volume (Cowgill) and Elliott, 2000). This article describes a case viper envenomation induced acute kidney injury in a dog, which was successfully managed with three sessions of intermittent haemodialysis.

BP increases gradually with age and height, therefore standard normograms are necessary for the interpretation of hypertension in children. Most children track in a constant percentile around the mean

The development of a national database and Saudi centiles is going to be discussed. Prevalence is not known but our prevalence might be high due to the high prevalence of obesity. The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidential development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks. However, supporting data is lacking. Secondary HTN is more common in young children, while essential HTN is more common in older children and adolescents, a steadfast reason why clinicians should be alert to possibility of identifiable causes in young children .most hypertensive children are asymptomatic or have a variety of non-specific symptoms; measurements of BP with the appropriate sized cuff should be a part of the routine pediatric evaluationin every clinic with visits in children of 3 years or older and of all age level’s, and in children < 3 years with specific clinical conditions. Management is multifaceted. Nonpharmacological treatments include weight reduction, exercise, and dietary modifications. Recommendations for pharmacologic treatment are based on symptomatic hypertension, evidence of end-organ damage, stage 2 hypertension, stage 1 hypertension unresponsive to lifestyle modifications, and hypertension with diabetes mellitus.

The COVID-19 pandemic affected more than 40 million people on Earth, of which more than 1 million died. However, even among the survivors, many have long-term consequences, fraught with serious health disorders.

The kidneys are one of the target organs for COVID-19 infection. Signs of proteinuria and hematuria can be found in 75% of patients. Moreover, 52% of patients requiring artificial ventilation of the lungs develop acute kidney damage within 24 hours after intubation. The mortality rate in this case reaches 30-70%, despite the conduct of renal replacement therapy. The predisposing factors are diabetes and arterial hypertension, as well as previous chronic liver and kidney disease, which is accompanied by a higher mortality rate - up to 53%. The main pathogenetic factor in this case is endotoxemia with an increase in the levels of C-reactive protein, interleukin-6, impaired T- and B-cell immunity. Both the glomerular apparatus and the tubular epithelium with significant disorders of their functions, requiring renal replacement therapy, are subject to toxic damage. These disorders are associated not so much with their direct viral damage, but with the body's inflammatory immune response with the release of a number of cytokines and complement, which contributes to the development of vasculitis, like those that cause kidney diseases such as ANCA vasculitis (microscopic polyangiitis, granulomatous vasculitis - diseases of Wegener and Goodpasture). A kidney biopsy is sometimes the first time a true crescentic proliferative glomerulonephritis is diagnosed.

It should be considered that changes in the renal parenchyma remain for a long time after formal recovery and often turn into a chronic form and even to the so-called delayed mortality. There is a lot of evidence to support the autoimmune nature of such long-term complications after COVID-19 infection. One of the factors contributing to them is the proximity of the antigenic structure of the proteins of the virus and humans. The severity of the complications caused makes it necessary to carry out serious measures for the rehabilitation of such patients after their recovery. Given the autoimmune nature of these complications, it is most advisable to use plasmapheresis for this, with the help of which it is possible to remove not only autoantibodies and cytokines but also many other toxic substances accumulated during the course of the illness, including hepato- and nephrotoxic drugs. And if you use these methods of extracorporeal detoxification during illness, you can prevent critical conditions and all long-term complications.