Background and Objective: Sjogren's syndrome represents a group of diseases characterized by inflammation and destruction of exocrine glands. Renal involvement in Sjogren's syndrome has been reported in 18.4%–67% of patients. Distal renal tubular acidosis (RTA) was reported more common than proximal RTA which can present as acute hypokalemic paralysis. The aim of the present study was to investigate the clinical picture and the outcome in patients with primary Sjogren's syndrome (PSS) with significant renal involvement. Materials and Methods: We conducted a retrospective study of PSS patients with significant renal involvement in our department. Results: A total of 27 patients were included in the study. The mean age was 39.3 ± 4.5 with a mean follow-up of 42 ± 4.8 months. About 18 patients had hypokalemia associated with paralysis, and 4 patients had hypokalemia without paralysis. Female: male ratio was 12.5:1. Number episodes of hypokalemic paralysis range from 1 to 4. The mean time of recovery was 20.4 ± 4 h, and mean potassium requirement was 190 ± 45 mEq intravenously. The mean serum potassium was 2.51 ± 0.55, mean urinary potassium 32 ± 2.3 mEq/day, mean serum bicarbonate 15.03 ± 1.05 mEq/l, and mean blood pH 7.28 ± 0.9. About twenty had distal RTA, and two had proximal RTA. The clinical symptoms were myalgia in 24 (88%), ocular symptoms in 20 (74%), muscular paralysis (66%), oral in 18 (66%), and dental caries in 12 (44%). Five patients underwent renal biopsy of which two showed acute interstitial nephritis, one showed chronic interstitial nephritis, one showed membranoproliferative glomerulonephritis, and one acute tubular injury. Conclusion: The clinical implication of our study is that distal RTA is a common feature of Sjogren's syndrome presenting predominantly as hypokalemic paralysis.

Background and Objective: Cyst infections often develop as a complication in patients with autosomal dominant polycystic kidney disease (ADPKD). Although this complication has significant clinical implications, reports of cyst infection are extremely limited. Herein, we report on the status of cyst infection in patients with ADPKD to clarify this. Materials and Methods: Among 90 patients with ADPKD admitted to our hospital from 2010 to 2017, we selected those diagnosed with cyst infection. We collected the data from medical record retrospectively. Results: A total of 22 patients, comprising 12 men and 10 women, were included in the study. Infected cysts were identified on imaging in six (27.3%) patients. Bacterial culture was positive in 12 (54.5%) patients. The initial antibiotic treatment was quinolone, cephalosporin, carbapenem, and vancomycin in 7 (31.8%), 11 (50%), 3 (13.6%), and 3 (13.6%) patients, respectively. The mean hospitalization period was 12.0 days (range, 9.25–14.75), while the mean antibiotic treatment period was 26.5 days (range, 21.25–29.50). No patient died. Nine (40.9%) patients had previous episodes of cyst infection, and 11 (50.0%) had recurrence during the study period. The rate of prolonged hospitalization longer than the median of 12 days was higher in patients with maintenance dialysis, although the difference was not significant (80.0% vs. 50.0%, P = 0.1453). In multiple regression analysis, the albumin value showed a negative correlation with the hospitalization period (β-coefficient: −0.4835, 95% confidence interval: −15.5757–−0.9460, P = 0.0290). Conclusion: Patients with ADPKD who have a poor nutritional status may require additional medical attention to avoid prolonged hospitalization.

Background and Objective: The aim is to study the efficacy and safety of flexible ureteroscopic lithotripsy (fURSL) for renal stone with persistent urinary tract infection (UTI). Materials and Methods: We retrospectively included 15 cases of patients diagnosed with renal stone together with persistent UTI, who were treated with fURSL from October 2011 to June 2015. A group of 15 patients diagnosed with renal stone, without any sign of persistent UTI, were set as control group. Standard fURSLs were performed by two experienced urologists. Vital signs, routine blood test and kidney, urine, and bladder were observed as well. The double J stent was removed 2–4 weeks after the operation. Results: All operations were done in one-stage. In UTI group, the average operation time was 30 ± 21 min (15–50 min). The stone-free rate (SFR) was 93.3% (14/15). Two cases (13.3%) of fever were observed after the operation, all happened within 6 h postoperatively, with the highest temperature of 39°C. All patients were cured with antibiotics. Conclusions: It is safe to perform fURSL on renal stone patients with persistent UTI under the protection of sensitive antibiotics. The SFR and postoperative complications were acceptable. Low-pressure irrigation and careful postoperative observation are of great importance for these patients.

Background and Objective: Urinary tract infections lead to increased hospitalization, direct patient costs, and mortality. Data on the prevalence of common uropathogens and antimicrobial (AM) susceptibility pattern are sparse and it varies geographically. Our aim was to determine AM resistance patterns in a tertiary urological center. Materials and Methods: Data on bacterial uropathogens and AM susceptibility between January 2015 and January 2016 in 1080 significant bacterial isolates were analyzed. Results: The most commonly isolated bacteria were Escherichia coli in 720 (66.6%), Klebsiella species in 170 (15.7%), and Pseudomonas aeruginosa in 80 (7.4%) patients. E. coli from inpatients was susceptible to imipenem (260; 97%), amikacin (212; 79%), piperacillin–tazobactam (206; 77%), nitrofurantoin (198; 73%), and cefoperazone–sulbactam (206; 77%). Klebsiella isolates were sensitive only to imipenem, piperacillin–tazobactam, and cefoperazone–sulbactam. Pseudomonas and Proteus species were sensitive only to imipenem and piperacillin–tazobactam. In outpatients, the common uropathogens showed lesser resistance only to nitrofurantoin (15%–47%). Conclusions: E. coli and Klebsiella are the most common uropathogens. Nitrofurantoin should be the drug of choice in outpatients. In inpatients, beta-lactamase inhibitors and amikacin have good AM sensitivity. Carbapenems should be the first choice AM agents in the intensive care unit.

Objectives: This study aimed to evaluate the demographic features, clinical presentations, sexual aspects, and possible risk factors of genital warts (GWs) among patients treated at Outpatient Clinics of the Dermatology, Venereology, and Andrology Department, Faculty of Medicine, Sohag University, Egypt. Patients and Methods: In a prospective cross-sectional clinical study, it conducted on 85 patients with clinically evident GWs. All patients were subjected to clinical assessments included a detailed medical history and full general and local examinations. All patients were investigated to exclude other sexually transmitted diseases (STDs). Results: This study included 85 patients with clinically evident GWs; 65 (76.5%) were male and 20 (23.5%) were female. Of male patients, 44.5% were university graduate, 73.8% were urban, 90.8% were smoker, 64.6% had a single sexual partner, 75.4% preferred intravaginal sex, 100% were circumcised, 80% had occasional history of condom use, and 95.4% had a history of illegal sexual relation. Of female patients, 40% were university graduate, 55% were suburban, 100% were nonsmoker, 45% had a single sexual partner, 65% preferred intravaginal sex, 100% were circumcised, 50% had an occasional history of partner use of condom, and 35% had a history of illegal sexual relation. All patients had neither other STDs nor warts in other body sites. Conclusion: Like all STDs , GWs have important effects on the health of society and quality of life. So, awareness of clinical presentations, sexual aspects, and possible risk factors of GWs leads to the use of effective protection measures and decrease the cost of treatment.

Background and Objectives: This observational study was conducted to evaluate and compare the efficacy of calcineurin inhibitors in frequently relapsing nephrotic syndrome (FRNS) and steroid-resistant nephrotic syndrome (SRNS). Subjects and Methods: Each group comprised 15 patients who were studied prospectively. These patients were treated with tacrolimus (Tac) or cyclosporine (CSA) concomitant with prednisone, which was subsequently tapered off and stopped. The primary outcome variable was the number of patients who attained a complete remission (CR) or partial remission (PR). Results: Out of 15 patients with FRNS, 11 were children and 4 were adults. In SRNS, out of total 15 patients 7 were children and 8 were adults. There was male preponderance in FRNS children, whereas in SRNS, gender distribution was almost equal. Hypertension was more common in steroid-resistant group (80%) as compared to FRNS (33%). In FRNS, focal segmental glomerulosclerosis (FSGS), and immunoglobulin M variant of minimal change disease were the most common cause, each accounting for 5 patients, whereas FSGS (8 patients) was the most common etiology in SRNS. In FRNS, out of total 4 patients who were treated with CSA, 2 achieved CR and 2 achieved PR. Mean time to achieve remission was 3.2 months. In FRNS, out of 13 patients who were treated by Tac, 7 patients achieved CR and 6 patients achieved PR. Mean time to achieve remission was 2.1 months. In SRNS, out of 3 patients treated with CSA, 1 achieved PR whereas 2 patients did not respond. Time to achieve remission was 5 months. In SRNS, 11 of 14 patients achieved CR and 2 achieved PR. Mean time to achieve remission was 2.5 months. Among 2 patients resistant to CSA 1 achieved CR with Tac and one did not respond to Tac also. Conclusion: Thus, in FRNS patients, both CSA and Tac are almost equally effective whereas in SRNS patients Tac was more effective than CSA and was also effective in 1 patient resistant to CSA.

Objectives: The objectives are to study the clinical profile of patients admitted with acute kidney injury (AKI) and to study the determinants of the outcomes of patients with AKI. Subjects and Methods: The study was done in setting of tertiary care hospital in Department of Nephrology. It is a prospective observational study. A total of 220 patients who were admitted with community AKI in a tertiary care hospital were evaluated, and data were collected and analyzed. Patients were evaluated and followed up and if indicated were dialyzed until recovery. Primary outcomes were in-hospital mortality, complete recovery, and dialysis dependency at 3 months. Apart from these etiological profile, mortality of patients with various etiology, their RIFLE staging was assessed. Results: of 220 patients studied, 191 (86.81%) survived and 29 (13.19%) expired, 93 (42.27%) patients required dialysis and 123 (57.7%) did not require dialysis with oligoanuria being the most common (24.5%) indication for dialysis and gastroenteritis was the most common etiology of AKI in 60 (27.3%) reflecting the high incidence of disease in community, followed by sepsis 31 (14.1%), pyelonephritis 27 (12.3%), and snakebite and obstetrics 19 (8.6%) each. Among patients who died, patients with sepsis had highest mortality 11 (35.5%) and gastroenteritis and acute febrile illness had least mortality (1.7% and 0%), respectively, majority of patients (59.5%) were in RIFLE Stage 3 and they had the highest mortality 23 (17.6%). A significant association was observed between the etiology and mortality (P < 0.005). Conclusions: We conclude that underlying cause of AKI is important determinant of the clinical outcome where we found that patients with gastroenteritis had better outcome than other etiology of AKI.

Objective: The objective of the study is to analyze the health-care costs of the hemodialysis (HD) patients in a charitable hospital. Subjects and Methods: A prospective observational study was carried out in an outpatient HD unit of nephrology department in a charitable hospital for a period of 8 months from August 2016 to March 2017. The collected direct medical and nonmedical cost data were analyzed for the median interquartile (Q3–Q1) cost incurred in treating the HD patients. Results: A total of 39 outpatients were included in the study. Of 39 patients, majority of the HD patients were males (66.2%) followed by females (33.8%). Most of the patients underwent HD for twice a week (89.7%) followed by thrice a week (10.3%). The median direct medical costs (85,999.2 Indian rupee [INR]) were found to be higher than direct nonmedical costs (14,437.1 INR). Conclusions: The study revealed that the total median direct cost was found to be uppermost for the age group of 41–60 years (1,12,438.8 INR) when compared to all other age groups, and it was also observed that the total median direct cost for males (1,07,522.4 INR) was higher than females (1,03,170.7 INR). The factors such as type of comorbidities, age, and number of HD per week may affect the cost of illness.

Objectives: To identify a better animal model that more closely mimics early renal interstitial fibrosis induced by long-term recurrent urinary tract infection (UTI), as occurs in humans, three different murine models were compared. Methods: Three different murine models of upper UTI were established, including direct injection of bacteria into renal tissues, ascending urinary infection with partial unilateral ureteric obstruction, and repeated infusion of bacteria into the bladder. The histopathology of the kidneys was assessed by hematoxylin and eosin staining. Masson's trichrome staining and immunohistochemistry for α-smooth muscle actin (α-SMA) expression were used for the detection of fibrosis. Results: All three models developed different levels of inflammation in the kidney. However, in contrast to the severe renal interstitial fibrosis in the other two models, the model of repeated infusion of bacteria into the bladder demonstrated early renal interstitial fibrosis by Masson's trichrome staining and immunohistochemistry for α-SMA. Conclusions: The model of repeated infusion of bacteria into the bladder developed low levels of renal interstitial fibrosis, which resembles the early tissue damage in the kidney induced by recurrent UTI s in humans. This model may therefore offer a better way to study the early therapeutic intervention of renal interstitial fibrosis caused by inflammation.

Background and Objectives: Prostate cancer is the second most common cause of cancer and the sixth leading cause of cancer death among men worldwide. In India, it is the second most common cancer in males as per the Indian Council of Medical Research and various state cancer registries. This study was designed to investigate the effect of dyslipidemia, elevated insulin levels, and insulin resistance on the risk of prostate cancer. Materials and Methods: This case–control study was conducted on a total of 200 individuals. Cases were 100 males under the age of 80 (range, 50–80 years), newly diagnosed with histologically confirmed primary adenocarcinoma of the prostate. Controls were 100 age-matched disease-free males, without any complications. Mean ± standard deviation in case and control groups was compared using the unpaired Student's t-test. Pearson's correlation analysis was used to determine the association between variables of interest and prostate-specific antigen (PSA), Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), and body mass index (BMI) among prostate cancer patients. Unadjusted and adjusted odd ratios with 95% CI were calculated using logistic regression models for prostate cancer risk in relation to dyslipidemia and IR. Results: Data showed that serum PSA significantly positively associated with BMI, total cholesterol, triglycerides (TGs), low-density lipoprotein-cholesterol (LDL-C), insulin, HOMA-IR and significantly negatively associated with high-density lipoprotein-cholesterol (HDL-C). HOMA-IR significantly positively associated with BMI, TGs, glucose, and insulin. The binary logistic regression analysis showed a significant adjusted* Odds Ratio (OR) with 95% confidence interval (P < 0.001) between total cholesterol (5.27 [1.87–14.8]), HDL-C (1.73 [1.02–3.42]), TGs (1.24 [1.05–1.37]), HOMA-IR (2.68 [1.53–4.62]), and prostate cancer. Conclusion: This study confirms the association between dyslipidemia, IR, and increased prostate cancer risk.

Background and Objectives: The importance of arteriosclerotic diseases has increased in recent years owing to population aging. Increased in the incidence of catheter intervention and vascular surgery has also resulted in a corresponding increase of cholesterol crystal embolism (CCE). Patients with chronic kidney disease are often diagnosed with arteriosclerotic disease. Although the severity of CCE varies widely, because it exacerbates renal function, treatment options should be established based on CCE severity. Methods: In this retrospective study, we examined 43 patients (37 men and 6 women; mean age, 74.9 ± 7.2 years) who were admitted to our department from 2002 to 2017 because of deteriorating renal functions. We assessed these patients at admission and followed up 1-year later. Results: The causes of CCE included treatment for ischemic heart disease (41.9%), aortic aneurysm (23.3%), and the administration of warfarin (11.6%). Thirty-one patients (72.1%) were diagnosed pathologically. The mean level of creatinine (Cr) at baseline was 1.84 ± 0.83 mg/dL. The mean level of Cr on admission was 4.90 ± 2.2 mg/dL. Steroid therapy was performed in 27 patients (62.8%) and lipoprotein apheresis was performed in one patient (2.3%). During the observational period, 9 patients (20.9%) died and the increase in Cr rates was significantly higher in these individuals (P = 0.0044). After adjustment for various factors, the Cr increase rate was significantly related to mortality (hazard ratio: 2.9581, 95% confidence interval: 1.1179–7.8271, P = 0.0289). Conclusion: The deterioration rate of renal function is associated with mortality in patients with CCE, which is accompanied by renal manifestation.

Background and Objectives: Acute kidney injury (AKI) is one of the major complications of snake envenomation, especially in the developing countries. The most common renal histology in snakebite-induced AKI is acute tubular injury (ATI), but acute interstitial nephritis (AIN) is rarely reported. Materials and Methods: We did a prospective observational study between January 2012 and May 2017 to analyze the demographic, clinical, and laboratory data, response to treatment, and outcome of patients with snakebite-induced AIN. Results: About twenty patients were included in the study with mean follow-up of 24 ± 6 months. Of them, 6 (30%) were males. Mean age was 50.9 ± 22.1 years. All the patients received anti-snake venom. AKI developed after a mean duration of 24.1 ± 11.2 h and 15 patients were oliguric. Cellulitis was seen in 65% of patients, anemia in 65%, leukocytosis and thrombocytopenia in 40%, and coagulopathy in 80%. Mean peak serum creatinine was 7.8 ± 3.2 mg/dL. Peripheral eosinophilia was seen in 7 (35%) patients. All the patients were managed with hemodialysis and all except one received oral steroids. Six patients (30%) progressed to chronic kidney disease (CKD) with mean follow-up creatinine of 1.49 ± 0.8 mg/dL. Conclusion: It is prudent to do renal biopsy in patients with snakebite-induced AKI when there is a suspicion of pathology other than ATI. Identification and treatment of AIN with steroid will avoid progression to CKD which has an impact on growing health burden in tropical countries.

Background and Objectives: The testosterone and estradiol sex hormones are susceptible to significant pathophysiological alterations in children with chronic renal failure under regular hemodialysis, leading to delayed pubertal maturation. This study aims to evaluate the plasma levels of testosterone and estradiol hormones in children and adolescents with end-stage renal disease (ESRD) under regular hemodialysis. Materials and Methods: This study was carried out on 40 children with ESRD under regular hemodialysis (20 males and 20 females) who were attending the Pediatric Department of Tanta University Hospital. Forty children, age- and sex-matched, were chosen and served as controls. All patients and controls were subjected to full history taking, thorough clinical examination including weight, height, body mass index (BMI), mid-arm circumference (MAC), arterial blood pressure, pubertal assessment according to Tanner's classification, routine laboratory investigation including complete blood count, blood urea, blood urea nitrogen, serum creatinine, serum albumin, serum electrolytes (ionized calcium, potassium, and phosphorus), serum total testosterone levels in boys, and serum estradiol levels in girls. Results: The mean values of weight, height, BMI, and MAC of patients' group was significantly lower than that of control group. The total male serum testosterone level in the male patients' group and the serum estradiol level in the female patients' group was significantly lower than that in control group. There were significant positive correlations between the age development and Tanner's stage development, male total serum testosterone level and female serum estradiol levels in both patients and control groups. Conclusions: The pubertal development of children and adolescents with ESRD is usually delayed as proven by decreased serum male total testosterone and female Estradiol hormones levels which suggest a state of hypogonadism. Nutritional therapy especially optimizing protein intake to prevent hypoproteinemia, adequate dialysis and correction of anemia are clinical trials.