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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.

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Chronic kidney disease (CKD) is characterized by progressive loss of renal function. Although the burden of CKD in India cannot be assessed accurately, its approximate prevalence is believed to be 800 per million populations (pmp), and the incidence of end-stage renal disease (ESRD) is 150–200 pmp. Diabetic nephropathy is a leading cause of ESRD worldwide. Another cause of ESRD is dyslipidemia, which is one of the most common quantitative lipid abnormalities in patients with CKD. In diabetes, the total cholesterol and triglyceride levels rise as the albumin excretion rate increases, leading to renal injury. Oxidative stress generated by hyperglycemia increases reactive oxygen species production, which causes cellular dysfunction and damage, and ultimately results in diabetic micro- and macro-vascular complications. Therefore, lipids may represent a useful clinical tool for not only identifying patients at a high risk of developing CVD but also assessing the development and progression of renal disease. In this review, we summarize the effects of lipid abnormalities and oxidative stress in patients with diabetes and nephropathy.

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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.

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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.

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Background: Infections of urinary tract were considered as the most common hospital-acquired infections in hospitalized patients. Area-specific monitoring studies aimed to assess the prevalence of causative organisms of urinary tract infections (UTIs) and their responsiveness to different available antimicrobials in a sample of Arab children, which may help the clinician to choose the correct empirical treatment. We aimed to study the type of urinary pathogens isolated from hospitalized patients with first-episode UTI in our locality and its antibiotic susceptibility pattern. Materials and Methods: Urine samples were collected from 320 clinically suspected cases of UTI from inpatient wards and outpatient clinic of Pediatric Department of Tanta University Hospital during the period from June 2016 to June 2017. The samples were tested microbiologically by standard procedures. Antibiotic susceptibility of the isolated pathogens was tested for commonly used antibiotics by disc diffusion method according to hospital policy. Results: Significant bacteriuria was present in 75% of the samples, 16.25% were sterile, and 8.75% showed insignificant bacteriuria. The most common pathogens were Escherichia coli (55%), Klebsiella spp. (26.6%), and Proteus mirabilis (14.2%). The mean susceptibility was high for amikacin (85%), ceftriaxone (82%), cefotaxime (80%), nitrofurantoin (80%), and nalidixic acid (78%) but low for ampicillin (21%), cephalexin (30%), and sulfamethoxazole + trimethoprim (37%). Conclusions: The antibiotics which are commonely used in UTIs such as trimethoprim/sulphamethoxazole,ampicillin and cephalexin are not appropriate for embrical treatment of common UTIs.This may be attributed to high rate of bacterial resistance .Regular monitering of these patients is recommended to establish reliable information about patterns of urinary pathogens aiming optimal embrical therapy for children with UTI.

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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.

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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.

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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.

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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.

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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.

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Purple urine bag syndrome is a rare, striking medical phenomenon observed in patients having indwelling urinary catheters having urinary tract infection. It is commonly observed in elderly patients having constipation and long-standing indwelling urinary catheters and indicates bacterial urinary tract infection. The purple discoloration of the urinary bag is reported to be due to the presence of indigo and indirubin pigment produced by tryptophan metabolism by Gram-negative Bacteria. The authors present a case of 67-year-old female with purple discoloration of her urine bag due to urinary tract infection caused by Klebsiella pneumoniae.

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Background and Objective: Diabetic nephropathy is the most common cause of microvascular chronic complication of Type 2 diabetes mellitus (T2DM), which is associated with considerable morbidity and mortality. Chronic kidney diseases (CKD) may result from diabetes mellitus (34%), hypertension (29%), glomerulonephritis (14%), and others (23%). The present study was undertaken to explore the possibility of the serum cystatin C level as a marker of early renal impairment in T2DM patient. Materials and Methods: The study was conducted in 75 patients of T2DM and 75 healthy individuals were included as control in this study. After 12 h fasting, 8 mL venous blood sample was collected and allowed to clot for ΍ h and serum was separated. Lipid profile and cystatin C level of serum were measured by using commercially available kit of auto analyzer. Results: The level of serum cystatin C was significantly increased in T2DM patients as compared to control. In T2DM patients, high-density lipoprotein cholesterol significantly decreased (P < 0.001), while other parameters of lipid profile were significantly increased (P < 0.001) as compared to control group. Conclusion: Present study suggests that cystatin C measurement in serum is a useful, practical, noninvasive tool for the evaluation of renal involvement in the course of diabetes, especially patients, and the study also shows significant lipoprotein abnormalities in T2DM patients when compared to control.

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Objectives: To assess the accuracy of Prader's orchidometer and ultrasonography in estimating the volume of testis against the actual volume of testis as measured by Archimedes principle of water displacement. Subjects and Methods: Fifty-six patients with advanced prostate cancer had an estimation of testicular volume by Prader's orchidometer by the same urologist and ultrasonography by the same radiologist. Lambert's formula was used for calculating the volume of testis. All patients underwent bilateral orchiectomy, and the actual volume of the testes was estimated by the water displacement method. Results: Mean age of patients was 71.53 years. The reliability of both the methods was calculated by Bland-Altman plot. The discrepancy of individual measurement and the bias (average discrepancy) was calculated for each method separately, and the plot was derived. In both the plots, the values were more concentrated around the value 0, showing that both were reliable in measuring the volume accurately. Conclusions: The volume of testis measured by Prader's orchidometer correlated with that measured by ultrasonography as well as the actual volume measured by water displacement method. This method is hence useful in office practice, community screening, adolescent clinics, and teen clinics.

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Purpose: The aim of the study was to identify correlation between DNA damage marker 8-hydroxy 2-deoxy guanosine (8-OHdG) and other prognostic factors such as Gleason's score, serum prostate-specific antigen (PSA), and stage in carcinoma prostate and to assess a probability-correlation between DNA damage and benign prostatic hyperplasia (BPH) and control. Materials and Methods: A study has been carried out prospectively. Forty patients of carcinoma prostate, 34 BPH, and 14 healthy controls were included in the study between the period of July 2010 to July 2012. Serum 8-OHdG level was measured in all subjects as a marker of DNA damage. Results: Serum 8-OHdG level was significantly raised in patient with prostate cancer (313.39 ± 69.48 ng/mL) as compared with BPH patients (204.42 ± 40.97 ng/mL) and control group (198.94 ± 15.74 ng/mL) with P< 0.001. Serum 8-OHdG level in BPH patients was higher than the controls, but the mean difference was statistically insignificant (P = 1.000). The patients with serum PSA >20 ng/mL, Gleason's score >6 had higher mean 8-OHdG levels as compared to serum PSA ≤20 and Gleason score ≤6, as P< 0.05. There was also direct association found between prostate volume and stage of the tumor though it was not significant. Conclusions: These findings suggest that oxidative stress level was significantly raised in prostate cancer patients. It was also observed that a significant direct association exists between oxidative stress and certain clinicopathologic factors, including serum PSA, Gleason score, and metastasis which show that with progression of disease, there was increase in oxidative stress level.

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Cell phones are a relatively novel and evolving technology. Mobile communication is now essentially ruling in our daily activities through better connectivity and intelligent, smart phone services. While the potential benefits of this technology continue to emerge, so do the potential health risks. There is increasing concern that the use of mobile phones may be associated with decreased semen quality and infertility. The most sensitive tissues to the damaging effects of cell phones are testicular tissues through increased oxidative stress, heating and radiation. Cell phone radiation may negatively affect sperm quality in men by decreasing the semen volume, sperm concentration, sperm count, motility, and viability, thus impairing male fertility. This should be supported by mass media to raise awareness among people regarding the possible health effects of radiofrequency emissions from mobile phones and to minimize its exposure. This study is a brief review of the recent data about the effect of cell phones in male infertility.

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Although renal disease has been present for over 200 millennia of Homo sapiens' existence, knowledge of the causes and management of these disorders has only emerged during the last 4000 years. Brilliant insights into human disease probably emerged from time to time over the long period of human existence, but observations could only be advanced after writing began in 3200 BC. Humans could then make observations, record these thoughts, and have others in their present and future critique them leading to improvement in this information. This discussion selectively considers some of the medical giants who led the way to clinical nephrology of the 21^st century. It reflects on who taught us basic principles of renal disease that led to our current knowledge. Attention is given to the ancient Egyptians, Ancient Greeks, Galen of Pergamon, the Byzantine Greeks of the 5^th-9^th centuries, the Arab/Persian Physicians of the 9^th-12^th centuries, Moses Maimonides of the 12^th century, selective Renaissance Physicians, and the father of modern nephrology - Richard Bright MD. This reflection celebrates au courant renal sagacity by celebrating the past clinicians who led the way from their eras to ours.

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Priapism is common urologic emergency that may lead to permanent erectile dysfunction. It is frequently idiopathic in etiology, but there is a known complication of pharmacologic agents such as intracavernosal agents, antihypertensives, and anticoagulants. Polysaccharide sulfate (PPS) is a new type of heparinoid drugs that extracted from phylum phaeophyta with function of anticoagulant, antilipemics, and improvement of microcirculation. PPS-induced priapism is a kind of serious side effects and is rising. General practitioners and traditional Chinese doctors should learn about the serious complication and all patients with PPS should be warned about of erectile dysfunction. Patients presenting with priapism deserve special counseling, beginning with the first episode of priapism. Patients must understand that a poor outcome is possible despite appropriate and timely management.

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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.

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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.

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The elderly are at high risk of chronic kidney disease, who has become a major population in the newly admission to dialysis treatment. So the elderly will be the focus of CKD prevention task in future. At present, challenges still remain in the diagnosis and treatment of CKD in the elderly: there is no unified criteria for CKD diagnosis in the elderly, un-settled treatment target of CKD complications in the elderly; complicated theraputic strategies in the elderly ESRD patients. We particularly stress the importance of patient-centered, instead of disease-oriented, individualized treatment in the prevention and treatment of CKD in the elderly.

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Human immunodeficiency virus (HIV)/AIDS is unique for its devastating impact on social, economic, and demographic developments. Recent studies have thrown more light on the reasons for the mortality and morbidity associated with HIV/AIDS in general and on its renal complications in particular. The classic involvement of the kidney by HIV infection in HIV-associated nephropathy (HIVAN) was reported in New York in 1984. HIVAN clinically presents with proteinuria and renal dysfunction and pathologically with focal segmental glomerulosclerosis. The imaging modality most commonly used in the assessment of renal dysfunction is ultrasonography, followed by computerized tomography. These renal lesions manifest in a protean number of ways in sonography. Renal survival has improved with the introduction of highly active antiretroviral therapy.

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