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.

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.