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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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.

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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.

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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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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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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.

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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.

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