Adenomatoid tumor is a rare neoplasm of mesothelial origin commonly seen in male and female genital tract. In this case report, the authors present a case of adenomatoid tumor in a 36-year-old male who presented with a 1-year history of scrotal swelling. A clinical diagnosis of testicular neoplasm was made, but the final diagnosis of adenomatoid tumor was made after testicular cancer radical.

We report the case of a 49-year-old man presenting with a recurrent penile fracture 1-year after undergoing delayed repair for a previous penile fracture. To the authors' knowledge, this case represents the first documented instance of repeat fracture occurring after delayed repair. Risk factors for repeat penile fracture are not well documented due to the rarity of this condition. A review of literature regarding repeat penile fracture and the impact of delayed repair is discussed.

Background and Objective: The prevalence of benign prostatic hyperplasia (BPH) in Shanghai, China, has not been updated in over 20 years. Here, we conducted a study in the community health system to get current BPH prevalence. Materials and Methods: All males older than 50 years old with lower urinary tract symptoms (LUTS) in five randomly selected communities in Shanghai were included in this study and were grouped according to their age. Group A was men with ages between 50 and 59, Group B 60-69, Group C 70-79, and Group D over 80. Results of international prostate symptom scores (IPSS), urinalysis, digital rectal examination, ultrasound scan, uroflowmetry, prostate specific antigen level, and any complications related to BPH were collected and analyzed. Results: The ages ranged from 50 to 92 (68.7 ± 9.6, mean ± standard deviation). The average IPSS in each group increased with aging, from 15.13 ± 2.87 in Group A to 19.95 ± 7.43 in Group D. However the quality of life scores (QoL) did not correlate with IPSS in Group A (r = 0.263, P < 0.001). The prevalence rate of BPH increased with aging. The growth rate of the prostate slowed from 27.86% to 8.84% from Group A to Group D. Conclusions: The overall prevalence rate of BPH in our study is 11.99%, LUTS symptoms develop with aging, and the result of the single-question QoL questionnaire should be carefully considered while dealing with patients in Shanghai older than 60.

Nephrotic syndrome is a common clinical type of glomerular diseases in the elderly and has its own characteristics in the pathological types, clinical manifestations, and diagnoses. Renal biopsy is an important diagnostic method for elderly patients with nephrotic syndrome. Membranous nephropathy is the most common primary pathology while amyloidosis and diabetic nephropathy are common secondary causes. Individualized treatments should be performed according to ages and physical characteristics of the elderly patients.

A suitable evaluation and management structure is important for slowing and delaying the progression of chronic kidney disease (CKD) and improving the quality of life in the elderly patients. Due to the special features of the elderly CKD patients, there also exist some problems to be solved or researched currently. According to the latest guideline for clinical practice, we discuss some aspects in diagnosis and prognosis of the elderly CKD patients as well as the management of common complications, so as to reduce over-diagnosis, and better predict the risks of progression to end stage renal failure and take necessary measures for clinical intervention as soon as possible.

Metabolic syndrome is a common global problem. This condition is also multifaceted and potential precursor to significant disturbance of numerous physiologic processes. The interconnected complexities of this disorder may varies from, life threatening risk of cardiovascular atherosclerotic diseases, type 2 diabetes, and hypertension to many of other metabolic diseases like male or female infertility. This review article cogitate the literature regarding metabolic syndrome and male reproductive health. The association between abdominal obesity, insulin resistance, systemic hypertension, and dyslipidemia are each examined with regard to their interconnected deleterious effects on male fertility. At the conclusion of this manuscript, we propose a new metabolic syndrome with male infertility paradigm. Supplementary acquisition particularly addressing the components of metabolic syndrome and their impact on male reproduction will enhance our understanding of the underlying pathophysiology. These studies may also help elucidate the role for therapeutic intervention.

Estimation of the prevalence of high-risk human papillomavirus (HR-HPV) genotypes and cervical intraepithelial neoplasia (CIN) in female renal transplant recipients (RTRs) is important for formulating strategies for the prevention and screening of cervical cancer in this susceptible group. A systematic review of cohort studies was conducted to evaluate the prevalence of HR-HPV cervical infection and CIN in female kidney graft recipients in comparison to healthy controls. This study adhered to the meta-analysis of observational studies in epidemiology guidelines. Studies had to meet the following criteria: (1) Cohort studies of female RTRs that assessed results of cervical cytology and/or HPV prevalence, (2) studies including adult and nonpregnant subjects, (3) the description of the study's methodological and statistical methods is provided, and (4) the prevalence of HPV was clearly stated. The prevalence of HPV infection and CIN reported in the assessed studies ranged, respectively, from 4% to 45% and 0% to more than 48% in female RTR groups, while in the control groups the prevalence ranged from 17.5% to 38% and 0% to 13%. There are relatively few publications dealing with the prevalence of CIN and HPV infection in the population of transplant recipients, and the current available studies show important methodological differences. Therefore, new observational studies with larger numbers of transplanted women, proper design and control of these biases are needed to see if, among this population, the prevalence of HR-HPV infection and CIN is greater.

Renal tubular acidosis is a known clinical entity, in which type I distal renal tubular acidosis (dRTA type I), also known as classical dRTA, is second most common type after dRTA type IV. We report 21-year-old female presenting as polymorphic ventricular tachycardia (VT), which on evaluation was found to have the type I dRTA with idiopathic etiology. Polymorphic VT as presentation of type I dRTA has not been reported in the literature in human beings so far but has been reported in animal models.

Primary hypothyroidism refers to a systemic hypometabolic status due to hypothyroxinemia or thyroid hormone resistance caused by pathologic changes to the thyroid gland. The main role of thyroid hormone is to promote energy metabolism and facilitate growth and development processes within the body. In a hypothyroidism state caused by thyroid hormone deficiency, the body's thermogenic effect is down-regulated and metabolisms of protein, sugar, and fat were slowed down, which might further lead to cardiovascular disease, hyperlipidemia, myocardial damage and myxedema, as well as other changes. Hypothyroidism tends to be neglected or misdiagnosed due to its trivial and nonspecific clinical manifestations, and a combined renal dysfunction is rarely reported. Herein a case of kidney dysfunction caused by hypothyroidism is reported and relevant literature was reviewed.

Ambiguous genitalia is a birth defect where the external genitals do not have the typical appearance of either a boy or girl. An 8-week-old infant presented with persistent vomiting, failure to thrive, and genital ambiguity. On the basis of clinical presentation, a salt-losing variety of congenital adrenal hyperplasia (CAH) was suspected. Hormonal levels were tested and 3 beta-hydroxysteroid dehydrogenase II (HSD3B2) deficiency, a rare CAH variant was suspected. This was confirmed by molecular analysis of the HSD3B2 gene from the affected baby. It revealed the presence of the homozygous P222Q mutation which was found to be heterozygous in both parents.

Objective: To study and describe the utilization pattern of various classes of drugs including antibiotics in patients with chronic kidney disease (CKD). Materials and Methods: A total of 185 CKD patients were finally recruited after strictly obeying the selection criteria in this cross-sectional, observational study that was conducted over a period of 6 months in Nephrology Department of a tertiary care teaching hospital. Relevant data were extracted by interviewing the patients and from prescriptions, case records, and investigational reports. Results: Mean age of CKD patients was 45.81 ± 11.16 with male predominance (58%). CKD Stage III comprised of the maximum number (28%) of patients. Polypharmacy was executed in 83% of these patients. Hypertension (95%), diabetes (87%), and anemia (86%) are the most common co-morbidities. The five most frequently prescribed drugs were diuretics (100%), anti-ulcer agents like proton pump inhibitors and H ₂ blockers (98%), anti-hypertensives (95%), vitamins and minerals supplements including calcium (92%), and hematinics (85%). Infectious diseases like respiratory tract infection (37%) and urinary tract infection (34%) had shown to have a high prevalence in CKD patients. Cefoperazone, metronidazole, piperacillin + tazobactam were the most prescribed parenteral antibiotics. Azithromycin and levofloxacin were the extensively used oral antibiotics. Conclusion: This study demonstrates the variability of drug utilization in CKD patients. Drug utilization studies on a regular basis give a framework to pharmaceutical companies and healthcare providers and help to build management strategies. However, the right choice of drugs and inappropriate doses will reduce the incidence of nephrotoxicity and ultimately result better clinical outcomes. Managing infections and prescribing antibiotics in CKD are crucial and hence claim rationalization of the use of antibiotics to improve the quality of life of CKD patients.

Background and Objectives: Lupus nephritis (LN) is one of the serious manifestations of systemic lupus erythematosus (SLE). It has diversities of clinical and histological presentations. Hence, the main objective of this study is to sort out the clinical and histological varieties of LN in a tertiary care setting of Bangladesh. Materials and Methods: For the study, 30 patients of SLE with renal involvement were selected. Diagnosis of SLE was done on the basis of American Rheumatological Criteria (ACR). After consent, all patients were undergone renal biopsy and tissue was analyzed for histological type and presence or absence of immunoglobulin were also analyzed by direct immuneflurescence study. Data after compilation analyzed by SPSS version 20. Results: All the patients found to have LN were female and most (73.2%) of the patients were at child bearing age between 21 and 40 years. Anti-ds DNA was positive among all (100%) patients and antinuclear antibody was positive among 19 (63%). Among all patients 6 (20%) had ≥3 g proteinuria. The common histological type was found class IV, which was 40% of total patients. A patient of LN found to have histological feature of acute glomerulonephritis. Conclusion: In conclusion, it can be said that LN have varied clinical profile with different histological types.

Deterioration of renal function is closely related to renal interstitial fibrosis (RIF). With animal models, we can simulate the pathological changes and progression of disease. Various animal models of RIF are pivotal for clinical treatment and investigation of new drugs. Reviewed here are methods of establishment and mechanism of commonly used animal models of RIF to help researchers select the optimal animal model for different research purposes.

We report a case of a 55-year-old female diabetic patient admitted with uremia. An attempt for insertion of a temporary dialysis into right internal jugular vein was not successful. Next day, the patient developed hoarseness of voice. Indirect laryngoscopy showed that right vocal cord was in paramedian position suggestive of palsy due to injury to recurrent laryngeal nerve. Vocal cord palsy, as a complication of central vein catheterization, is very rare.

Insect stings belonging to Hymenoptera defined as wasps, yellow jackets, bees, or hornets by humans. Hymenoptera stings may result in a wide range of clinical spectra ranging from localized pain to systemic reaction and organ dysfunction and multiple organ failure. We report a patient with membranoproliferative glomerulonephritis (MPGN) which is immune secondary to a stimulus, which can also be added to the onset of secondary MPGN.

We report a 67-year-old woman with osteoarthritis (OA) of knees. She also had past histories such as dyslipidemia and hypertension. She was sometimes treated by hyaluronan-injection into the knees for OA at the nearby clinic. She was admitted to our hospital because of acute pyelonephritis in July 2014. We treated her successfully with ceftriaxone first empirically and de-escalated to cefazolin along with the results of urinary and blood cultures. Urinary and blood cultures revealed Escherichia coli. She recovered from pyelonephritis, however, began to complain pain and swelling of the right knee. Culture of the right knee-joint fluid also revealed E. coli. We diagnosed septic arthritis of the right knee and performed arthroscopic lavage, followed by continuous washout with saline for 7 days. She recovered from septic arthritis of the right knee and discharged from our hospital. Although rare, it is important that pyelonephritis-derived sepsis cause septic arthritis of the knee.

The placement of artificial urinary sphincters (AUSs) is a common procedure for stress incontinence following treatment for prostate cancer. Complications are relatively rare, and the most common reasons for device removal and revision are cuff erosion, infection, and mechanical failure. We present a case of a 66-year-old male with a history of radiation therapy for prostate cancer that developed a deep venous thrombosis (DVT) and pulmonary embolism (PE) following his second AUS due to compression by a pressure regulating balloon (PRB). Compression of the femoral vein was not originally diagnosed as the cause for DVT on initial hospitalization, and there was an additional hospitalization due to worsening symptoms prior to identification of PRB compression. This is the first published case of migrating PRB causing femoral DVT and PE following the placement of a second AUS in an irradiated tissue field, and one of two published cases of DVT due to PRB compression.

Background and objectives: Chronic kidney disease (CKD) is an important, chronic, noncommunicable disease epidemic that affects the world. Lack of registries precludes an accurate estimation of the number of patients with CKD. Only a few studies are done in our country to assess etiology of CKD in young patients. This study was aimed to assess the etiology of CKD in young patients. Materials and Methods: Data were collected from 50 patients of CKD between 15 and 40 years age who presented to Government General Hospital, Kurnool from July 2012 to June 2013. They were clinically evaluated and underwent relevant investigations including renal biopsy in indicated cases. Results: Of the 50 patients studied, there was an overall male preponderance over all age groups with a mean age of 27.6 ± 4.9 years. Small kidneys were seen in 70% of patients. 92% of patients had proteinuria. Most common symptoms of presentation were related to gastrointestinal disturbances, breathlessness, easy fatigability, and urinary disturbances. Pallor, pedal edema, and facial puffiness were major clinical features. Majority (62%) had CKD of unknown etiology. In this unknown etiology patients, majority were found to have glomerular disease (42%) based on clinical presentation and other supporting investigations. 92% presented in stage IV or stage V CKD. Histopathologically etiology was proven among 19 patients (38%) with renal biopsy. Conclusion: It is concluded that male patients in the third and fourth decades were in the majority requiring medical care. Chronic Glomerulonephritis of unknown causes constitutes a major etiology among the young presenting in late stages of CKD.

Myoglobin is a heme protein present in muscle tissues and responsible for binding and delivery of oxygen in the muscle cells for oxidative metabolism. Whenever muscle tissue is injured, that is, rhabdomyolysis occurs free myoglobin enters into circulation along with other enzymes and electrolytes and myoglobinuria occurs when the renal threshold is crossed. There are many causes of rhabdomyolysis including physical damage, infective, inflammatory, toxic, and metabolic problems. Clinically, myoglobinuria presents as muscle pain, weakness, cola colored urine, and laboratory diagnosis is done by elevated serum creatine kinase, urine dipstick positive for blood without RBC in microscopy examination. These myoglobin molecules can cause renal injury by renal vasoconstriction, proximal tubular necrosis, and distal tubular obstruction. Early anticipation of myoglobinuria and aggressive fluid resuscitation during the initial stage of injury is the mainstay of management of myoglobinuric acute kidney injury (AKI). There is lesser role of forced alkaline diuresis and mannitol than diuresis by normal crystalloid solution in myoglobinuric AKI. Renal replacement therapy should be considered in cases with life-threatening dyselectrolytemia and acidosis.

Genetic factor plays an important role in the progression of chronic kidney diseases and in the development of end-stage renal disease (ESRD). Present studies on ESRD, estimated glomerular filtration rate, and renal fibrosis have demonstrated a great number of genetic variants that are associated with the susceptibility to ESRD by different genetic study strategies. These results may provide novel insights about the development and prevention of ESRD.

Penile epithelioid hemangioma is a very rare benign vascular neoplasm of unclear etiology. To the best of our knowledge, only 28 cases in the literature have been reported to date. We report a case of epithelioid hemangioma of the penis in a 41-year-old man with a painful penile mass. The presented case exemplifies the importance of establishing a correct diagnosis through appropriate histologic analysis, as epithelioid hemangiomas are often misdiagnosed as two highly malignant tumors, epithelioid hemangioendothelioma and epithelioid angiosarcoma. Establishing benignancy is crucial in order to avoid inappropriate and overly aggressive treatment.

Objective: To discuss the establishment and stability of passive Heymann nephritis (PHN) in order to provide help for experimental study of membranous nephropathy (MN). Materials and Methods: We used 20 male rats of Sprague-Dawley weighing 120 to 150 g to prepare renal antigen Fx1A based on hypotonic lysis, Ca ²⁺ aggregation of contaminants and differential centrifugation and used six male New Zealand white rabbits for preparing anti-serum which was injected to SD rats to establish the model in different dosages (1 mL/100 g and 0.5 mL/100 g). The proteinuria of six model making rats were tested after 1st Week and then sacrificed and studied by direct immunofluorescence (IF) for deposition of rat IgG and electron microscopy (EM) in different time (1 ^st week and 7 ^th week ) with or without a booster injection. Results: After 7 days (1 ^st week) of model making, all six rats showed proteinuria (higher than 100 mg/dL). IF and EM study showed a typical pathological features of PHN (MN) but the intensity of IF intensity and electron dense deposits decreased in the rats without a booster injection. Conclusions: A PHN model could be successfully prepared according to the method we reported while a spontaneous remission may appear several weeks after the model making.

Objective: Urinary tract infection (UTI) is a common cause of morbidity in patients attending our hospital. Recently UTI has become more complicated and difficult to treat because of appearance of pathogens resistant to the commonly used antimicrobial agents. The main aim of the study was to determine the causative agents and antibiotic susceptibility pattern of UTI patients attending our hospital. Materials and methods: A prospective cross sectional study was conducted in asymptomatic and symptomatic UTI patients attending medicine and nephrology clinics of Jawaharlal Nehru Medical College Hospital, Aligarh from June 2012 to July 2014. A total of 1843 patients were investigated for urinary tract infection. Clean catch mid-stream urine specimens collected were subjected to urine culture and sensitivity tests. Results: Significant bacteriuria was detected in 19.3% and 55.4% of asymptomatic and symptomatic patients, respectively. The overall prevalence of significant bacteriuria in both groups was 33.4% with female sex, diabetes, obstructive uropathy, previous instrumentation and chronic kidney disease being the major risk factors. The most common pathogens isolated were Escherichia coli (52.4%) followed by Klebsiella pneumoniae (12.3%), Citrobacter spp (9.1%), Enterococcus (6.9%), Proteus spp (5.3%), Coagulase negative staphylococcus (5.3%) and Staph Aureus(4.0%). Most susceptible antibiotic was Amikacin, Cefoperazone-sulbactum, Piperacillin-tazobactum and Nitrofurantoin for most of the isolates. E. coli which was the main isolate was found to be most susceptible to Amikacin (78.3%), Cefoperazone-sulbactum 72.8%, Piperacillin-tazobactum (70.5%), Gentamicin (69.3%) and Nitrofurantoin (67.3%). Conclusion: This study highlights the common pathogens causing UTI in our area and their antibiotic sensitivity patterns which could help clinicians in starting rational empirical antibiotic therapy for such patients while awaiting urine culture reports.

Objective: The aim was to study the possible impact of uremia and hemodialysis on tumor markers including carcinoembryonic antigen, carbohydrate antigen (CA)19-9, neuron-specific enolase, CA242, ferritin, β-human chorionic gonadotropin, alpha 1-fetoprotein, human growth hormone, CA153, CA125, prostate-specific antigen (PSA), and free PSA (fPSA). Materials and Methods: Under a controlled study design, we assigned 143 uremia patients receiving maintenance hemodialysis into hemodialysis group, 143 uremia patients (chronic kidney disease phase 5) who did not receive hemodialysis into nonhemodialysis group, and 429 healthy people into the control group. Serum levels of tumor markers were determined using protein chip and were compared among groups. Patients in hemodialysis group were further divided into two subgroups according to the duration of hemodialysis: Group A (maintenance hemodialysis was over 3 mo), Group B (maintenance hemodialysis was <3 mo), and serum levels of tumor markers were compared between these two subgroups. Results: Ferritin levels were 22.1% and 5.8% in hemodialysis and nonhemodialysis groups, respectively, with statistically significance (P < 0.05), but any of the other tumor marker levels in these two groups were without statistical differences (P > 0.05). In hemodialysis group, 12.23% of patients were found with higher serum levels of CA125 than normal, 9.75% with higher levels of PSA than normal, and 11.3% with higher levels of fPSA than normal. In nonhemodialysis group, 14.91% of patients were found with higher levels of CA125 than normal, 8.76% with higher levels of PSA than normal, and 10.8% with higher levels of fPSA than normal. In the control group, patients with higher levels of the above markers accounted for <5%. Conclusion: Ferritin, CA19-9 and CA125 are elevated to various degrees in patients with uremia who are receiving hemodialysis or do not receive hemodialysis. Hemodialysis is not able to eliminate tumor markers.

Kidney diseases are a serious hazard to human health, and many different molecular signaling pathways are involved in the complex pathogenesis. Recently the Wnt signaling pathway, one of the most conserved intercellular signaling cascades, has been considered as an effective regulator in various kidney diseases, including ischemic kidney injury, glomerular diseases, diabetic nephropathy, interstitial fibrosis and cystic kidney diseases. Besides, more and more evidence have suggested that the altered Wnt signaling pathway is correlated with the pathological process of kidney diseases, which might offer a novel therapeutic strategy. Therefore, to enhance understanding, here we reviewed the major roles of Wnt signaling cascades and their roles in kidney diseases.

Due to the increase in erectile dysfunction (ED) and infertility in world population, there is growing interest in the integrative treatment of these diseases. Therefore, it is raising a market with non-prescription natural supplements. Especially in menu of internet, online shops come increasingly to light new natural over the counter products. Recent sale and use of medicinal plants and their extracts in the treatment of ED are according to the declaration of the producers first of all on a number of the thousand-year-old traditions in some nations, based on the efficacy and safety of these plants, verified in the long-time healing practice. The aim of this article was to make an extensive review of the scientific and professional medical literature and to find out which medicinal plants, minerals and other active substances, sold in the natural products for ED, were evaluated in relevant clinical trials as statistically significant in their efficacy and safety. The review of the literature shows that some marketed medicinal plants and active substances lack clinical studies, the results of some clinical studies related to the same medicinal plant are controversial and some bring significantly positive effects, but their number is minimal (maximum two to five clinical studies). The future is therefore open to starting the number of new clinical trials testing the medicinal plants for the treatment of ED with possible inclusion of some of these plants in evidence-based medicine, if confirming their efficacy and safety.