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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Objectives: This study aimed to assess the role of varicocelectomy in the improvement of premature ejaculation (PE) in patients with clinical varicoceles and PE. Materials and Methods: In a prospective clinical study, it conducted on 85 male patients with clinical varicoceles and PE. Those patients were selected from whom attending the Outpatient Clinics of Andrology and General Surgery at Sohag University Hospital, Upper Egypt, between February 2015 and May 2016. All patients were subjected to preliminary assessment included a detailed medical and sexual history and general and genital examination. Patients were treated with open bilateral subinguinal varicocelectomy under spinal anesthesia. All patients were evaluated before and 6 months after the varicocelectomy by PE diagnostic tool (PEDT). The intravaginal ejaculatory latency times (IELTs) per minute and overall sexual satisfaction scores were evaluated before and 6 months after varicocelectomy. All patients were asked to indicate their sexual satisfaction on a scale of 0-5, with 0 being extremely dissatisfied and 5 being extremely satisfied. Results: The mean scores of the five questions of the PEDT measuring ejaculation control, frequency of inability of ejaculation control, ejaculation with minimal stimulation, feel of distress, and interpersonal difficulty owing to PE had statistically significant improvements at 6 months after varicocelectomy. The mean IELTs per minute and overall sexual satisfaction scores were significantly improved at 6 months after varicocelectomy. Conclusions: The study concluded that varicocelectomy improve PE in patients with bilateral clinical varicoceles and PE. Further prospective, controlled studies are needed to provide further characterization of this potential relationship.

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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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Renal lymphangiomas are rare benign mass-like renal conditions that refer to the presence of multiple cysts in both the renal sinus and the renal parenchyma. It has been found in both adults and children. The etiology is unknown, but it has been thought to be the result of lymphatic obstruction. Renin-dependent hypertension may be the presenting clinical complaint. The purpose of this study is to describe the radiological appearances of a rare case of renal lymphangioma that we encountered in our hospital.

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Background and Objectives: Chronic kidney disease (CKD) is a common health problem in Bangladesh. Etiological factors of CKD are very vital for management but largely unknown in our setting. Hence, the main objective of the study is to identify etiology of CKD of patients who are on maintenance hemodialysis (MHD) at different dialysis units of Chittagong. Methods: This descriptive study was conducted on 107 patients of CKD who were on MHD in different dialysis centers of Chittagong town, Bangladesh. A pretested questionnaire was adopted from previous study addressing different etiology of the CKD. This study was based solely on history and previous health records. After collection of data, it was compiled and analyzed manually. Results: In the present study, there were 61.62% males and 38.31% females and male-female ratio was 1.61:1. Majority (42 [39.25%]) of the patients were in the age group of 50-60 years, next to which was 40-50 years (23 [21.49%]). Diabetes mellitus (DM) with or without hypertension (HTN) was found as the most common etiology (70 [65.45%]) of CKD in our study, next to which was HTN (53 [49.53%]), nonsteroidal anti-inflammatory drug (NSAID) (15 [14.1%]), chronic glomerulonephritis (7 [6.54%]), polycystic kidney disease (6 [5.60]), systemic lupus erythematosus (1 [0.93%]), contrast-induced (1 [0.93%]), and following acute kidney injury (1 [0.93%]). Only 4 (3.73%) cases were found to have biopsy-confirmed nephritis. Conclusion: DM was found the most common etiology of CKD among patients who are on MHD in Bangladesh, next to which was HTN. Maximum patients had no biopsy proof of CKD and NSAID constituting a significant segment of etiology which is a potentially preventable etiology, in our setting.

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The incidence of end-stage renal disease (ESRD) increases in the elderly population. Patients received kidney transplantation have better long-term survival and quality of life than those received maintaining dialysis. However, only a smaller proportion of the elderly patients receive kidney transplantation because of the concerns about high posttransplant complications such as infections and diabetes. In this review, we make a discussion on treatment strategies including prophylaxis of risk factors, donor selection, and postoperative monitoring to raise awareness and improve long-term prognosis in the elderly patients with ESRD.

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We report a series of cases with multiple presentations of postpartum acute kidney injury presented to the NIMS Kidney Institute, Jaipur, India.

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Background and Objectives: Pruritus is an unpleasant cutaneous sensation prompting a desire to scratch. It can be very disturbing and is common in patients on maintenance hemodialysis (HD). Its pathogenesis is not very clear but has been attributed to diverse factors including uremia and iron deficiency anemia. The aims and objectives of this study are to determine the frequency of pruritus in HD patients in Benin City, to evaluate the relationship of pruritus in these patients with age, sex, body mass index (BMI), skin changes, peripheral neuropathy, duration of dialysis, and laboratory findings including packed cell volume (PCV), creatinine, urea, calcium, and phosphate, and to get the percentage of patients with increasing pruritus during and after dialysis. Methods: Consenting patients on maintenance HD were consecutively recruited into the study. Some relevant clinical and laboratory parameters (age, sex, BMI, skin changes, neuropathy, presence of pruritus, severity and intensity of pruritus, serum urea, creatinine, calcium, and phosphate) were evaluated using the SPSS version 17 package. Results: A total of fifty patients participated in the study. Twenty-four (48%) of these patients had pruritus. Of the 24 patients with pruritus, 14 (58.3%) were males while 10 (41.7%) were females. The mean age, BMI, and duration of HD of the patients with pruritus were 51.0 ± 13.61 years, 23.3 ± 1.77 kg/m ² , and 7.4 ± 9.31 months, respectively. In addition, the mean serum urea, calcium, and PCV of the patients were 252.1 ± 65.10 mg/dL, 7.0 ± 1.04 mg/dL, and 25.5% ±4.38%, respectively. Eight (33.3%) had an increasing intensity of pruritus during and after HD. Twelve (50%) of the patients had mild pruritus while another 12 (50%) had moderate pruritus. There was no case of severe pruritus. Anemia, serum urea, duration of HD and increasing the age of patients were found to be significantly related to pruritus. Conclusion: Pruritus is relatively prevalent among our patients on maintenance HD and factors significantly associated with this condition include anemia, serum urea, and increasing the age of the patient as well as duration on HD.

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