Urinary neutrophil gelatinase-associated lipocalin as a clinical biomarker in patients with diabetic nephropathy in Beni-Suef Governorate, Egypt Heba H El Demellawy, Mohammed A El Feki, Hesham H Eissa, Mohamed S Tawfik, Dina F Elessawi Journal of The Egyptian Society of Nephrology and Transplantation 2019 19(4):101-108 Aim To demonstrate the importance of the marker of tubulointerstitial damage, urinary neutrophil gelatinase-associated lipocalin (uNGAL), in the follow-up of the progression of chronic kidney disease in patients with type 2 diabetes mellitus. Patients and methods A total of 60 patients with type 2 diabetes mellitus with various degrees of renal impairment were subdivided into three categories based on urine albumin/creatinine ratio (UACR): 20 patients with normoalbuminuria (<30 mg albumin/g Cr), 20 with microalbuminuria (30–300 mg albumin/g Cr), and 20 with macroalbuminuria (>300 mg albumin/g Cr). Few exclusion criteria were considered such as infections, neoplasia, and any inflammation that could interfere with uNGAL measurement. Twenty healthy individuals were taken as a control group. Serum creatinine, UACR, urine protein, and estimated glomerular filtration rate (eGFR) are measured to determine their correlation with uNGAL, which was measured using a suitable human NGAL ELISA kit. The Modification of Diet in Renal Disease formula was used to calculate the eGFR in patients. Results The differences between the means of uNGAL in the different patients’ groups were found to be highly statistically significant (P<0.05). There was a significant negative relationship (inverse correlation) between uNGAL levels and eGFR in the three patient groups (P<0.05) and also a converse correlation was noted between uNGAL and UACR in the various patient groups involved in the study (P<0.05). Conclusion NGAL may be useful as a clinical marker to predict and assess the progression of diabetic nephropathy in patients with type 2 diabetes mellitus with nephropathy.

Renal biopsy registry in Alexandria area Mahmoud S AbdElHady, Ahmed F Koraei, Mona A Salem, Nahed M Baddour, Yasser A Nienaa Journal of The Egyptian Society of Nephrology and Transplantation 2019 19(4):109-117 Background There is a paucity of registries on diseases found on renal biopsies, especially in Egypt. Therefore, in this study, we have attempted to identify the pattern of renal pathology among renal biopsy (RB) specimens and to study the clinicopathological correlation of RB in the Alexandria area, which is considered the biggest second city in Egypt after Cairo, with around six million inhabitants, as a step toward generating a national RB registry. Methods We evaluated all the available adult native renal biopsies that were performed in the Alexandria area during the years 2012 and 2015 from the two main nephropathology centers. Clinical presentations were asymptomatic urinary abnormalities, nephrotic syndrome (NS), nephritic syndrome, and unexplained acute kidney injury. Renal diseases were divided into four major categories: (a) primary glomerulonephritides (GN); (b) secondary GN; (c) tubulointerstitial nephropathies (TIN); and (d) vascular nephropathies. The distinction between primary and secondary GN was not established by a single histological approach, but by association of the morphological findings and available clinical data. A RB forum was designed to collect the clinical and pathological data. Results 861 native renal biopsies were included; the most common age interval during which RB was performed was 20–30 years (32.6%); female gender (51%) was slightly more prevalent than male sex (49%). The renal specimen was inadequate in 14.1% of the cases. Of all biopsies, primary GN was the most frequent (64.3%), followed by secondary GN (27.8%), TIN (4.2%), and vascular nephropathies (1.2%), where end stage renal disease (ESRD) cases represented 2.4%. The most common clinical syndrome as an indication for RB was NS (57.8%), followed by acute kidney injury (21.6%), chronic kidney disease (CKD) (9.3%), asymptomatic urinary abnormalities (8.9%), nephritic syndrome (1.2%), and nephritic nephrotic syndrome (1.2%). At the time of the biopsy, 53.2% of the patients presented with elevated kidney functions. Mesangioproliferative GN was the most common primary GN (24.8%), followed by membranoproliferative GN (23.7%), focal and segmental glomerulosclerosis (21.4%), membranous nephropathy (10.3%), IgA nephropathy (8.8%), minimal change disease (5.7%), and crescentic GN (5.3%). Lupus nephritis was the most common cause of secondary GN (56.3%), followed by amyloidosis (14.6%), diabetic nephropathy (12.6%), nodular GN (6.8%), cast nephropathy (4.4%), cryoglobulinemia (2.9%), gouty nephropathy (1.9%), and lymphomatous infiltration (0.5%). Acute TIN represented 65.5% of the TIN cases and chronic TIN represented 35.5%. Thrombotic microangiopathy represented 66.6% of the vascular diseases and hypertension (HTN) nephrosclerosis represented 33.3%. Conclusion Our RB registry represents an important contribution toward understanding the epidemiology of renal diseases in Alexandria city. We are hoping that this registry will be the basis for developing a national registry. Establishment of a trusted national registry that will help in preventing and treating renal diseases requires good cooperation between nephrologists and pathologists, with collection of all clinical, serological, and pathological data.

Intradialytic complications: a poor prognostic factor among patients with lassa fever with acute kidney injury undergoing hemodialysis Mojeed O Rafiu, Samuel A Dada, Chukwuemeka O Azubike, Sulaiman D Ahmed, Alphonsus O Aigbiremolen, Itohan B Alili, Peter E Akhideno, Cyril O Erameh, Ehinomen C Ifada, Agnes E Aigbiremolen-Alphonsus, Esther Omonzokpea, Kelly O Iraoyah, Joseph Okoeguale, Ephraim Ogbaini-Emovon, Sylvanus A Okogbenin, George O Akpede, Peter O Okokhere Journal of The Egyptian Society of Nephrology and Transplantation 2019 19(4):118-123 Background Acute kidney injury (AKI) is a frequent complication of Lassa fever (LF) that is notably associated with poor outcome. The study aimed at evaluating the relationship between the clinical parameters and outcome of hemodialysis-treated patients with AKI complicating LF and to highlight our experience between 2014 and 2018. Materials and methods This was a descriptive, observational, and retrospective study involving patients with LF complicated by AKI who had hemodialysis at the dedicated dialysis suite located in our hospital between January 2014 and September 2018. Information were extracted from the clinical and laboratory records of the patients during the period under review. Results A total of 83 patients had 199 sessions of hemodialysis. Male to female ratio was 2.5 : 1. The mean age was 34.3±13.7 years. The mean number of hemodialysis sessions per patient was 2.4±1.5. The frequency of intradialytic complication was 9.6%, whereas hypotension (62.5%) was the commonest. Occurrence of intradialytic complications was significantly associated with mortality (χ2=5.370, d.f.=1, P=0.020). A high incidence of anemia (65.1%) was observed among the patients. Sixteen (19.3%) of the patients died. There was no significant association between age, sex, number of dialysis session or anemia and outcome of LF. Compared with those who died, patients who recovered had significantly higher mean postdialysis diastolic blood pressure (t=2.382, P=0.020). Conclusion Intradialytic complication is infrequent in dialysis treated LF patients with AKI, but has significant association with mortality.

Gym nephropathy ‘bodybuilding versus kidney damaging’ Mohammed Abdel Gawad, Heba A Kalawy Journal of The Egyptian Society of Nephrology and Transplantation 2019 19(4):124-128 Nonnutritional and nutritional supplements are widely used by bodybuilders. Abuse of these supplements can cause kidney injury by different mechanisms. We refer to any kidney injury caused by any of these supplements as ‘gym nephropathy.’ Anabolic-androgenic steroids are taken by athletes to gain muscle, but they may induce kidney injury through multiple pathways. Creatine supplementation is safe to be used, and it is capable of increasing muscle strength and mass; however, the indiscriminate use of it may induce acute kidney injury. Many bodybuilders abuse oral and injectable vitamins, which may cause acute kidney injury. High protein improves the training adaptations to exercise with no harm as long as the renal functions are normal; however, the theoretical risks should be reviewed carefully with some individuals. Energy drink-induced renal failure has been also reported. In this article, we review different forms of kidney injury secondary to supplements abused by bodybuilders.

Heavy chain disease: a rare case report of adult nephrotic syndrome Sanjeev S Manjunath, Chettipunyam Sounderrajan Chetan, Satish Suchitha, Gangadhar Chirag Journal of The Egyptian Society of Nephrology and Transplantation 2019 19(4):129-132 Monoclonal immunoglobulin deposition disease is a systemic disorder characterized by the deposition of immunoglobulins as nonfibrillar material in various organs. Three subtypes have been reported: light chain deposition disease, light and heavy chain deposition disease and heavy chain deposition disease. Among these, light chain deposition disease is the most prevalent. Reports of light and heavy chain and heavy chain disease are rare, with fewer than two dozen documented cases in the world literature and very few from India. Heavy chain disease is characterized by glomerular, tubular, and vascular wall deposition of monoclonal heavy chains without associated light chains. We present the case of a 51-year man, who presented with a 3-month history of pedal edema, hypertension detected 3 months ago, and mild renal failure Estimated Glomerular filteration rate (eGFR) 66 ml/min/1.73 m2; histopathology showed heavy chain deposition disease. The case emphasizes the need for a thorough workup for plasma cell dyscrasias when we see membranoproliferative pattern in adult patients. This patient was treated with bortezomib-based regimen and after 3 months achieved near-complete remission of proteinuria with improvement in serum creatinine.