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Background: The high incidence of acute kidney injury (AKI) requiring dialysis associated with COVID-19 led to the use of peritoneal dialysis (PD) for the treatment of AKI. This study aims to compare in-hospital all-cause mortality and kidney recovery between patients with AKI who received acute PD versus extracorporeal dialysis (intermittent haemodialysis and continuous kidney replacement therapy). Methods: In a retrospective observational study of 259 patients with AKI requiring dialysis during the COVID-19 surge during Spring 2020 in New York City, we compared 30-day all-cause mortality and kidney recovery between 93 patients who received acute PD at any time point and 166 patients who only received extracorporeal dialysis. Kaplan–Meier curves, log-rank test and Cox regression were used to compare survival and logistic regression was used to compare kidney recovery. Results: The mean age was 61 ± 11 years; 31% were women; 96% had confirmed COVID-19 with median follow-up of 21 days. After adjusting for demographics, comorbidities, oxygenation and laboratory values prior to starting dialysis, the use of PD was associated with a lower mortality rate compared to extracorporeal dialysis with a hazard ratio of 0.48 (95% confidence interval: 0.27–0.82, p = 0.008). At discharge or on day 30 of hospitalisation, there was no association between dialysis modality and kidney recovery ( p = 0.48). Conclusions: The use of PD for the treatment of AKI was not associated with worse clinical outcomes when compared to extracorporeal dialysis during the height of the COVID-19 pandemic in New York City. Given the inherent selection biases and residual confounding in our observational study, research with a larger cohort of patients in a more controlled setting is needed to confirm our findings.

Peritoneal dialysis (PD) patients are at high risk for peritonitis, an infection of the peritoneum that affects 13% of PD users annually. Relying on subjective peritonitis symptoms results in delayed treatment, leading to high hospitalisation costs, peritoneal scarring, and premature transition to haemodialysis. We have developed and tested a low-cost, easy-to-use technology that uses microscopy and image analysis to screen for peritonitis across the effluent drain tube. Compared to other technologies, our prototype is made from off-the-shelf, low-cost materials. It can be set up quickly and key stakeholders believe it can improve the overall PD experience. We demonstrate that our prototype classifies infection-indicating and healthy white blood cell levels in clinically collected patient effluent with 94% accuracy. Integration of our technology into PD setups as a screening tool for peritonitis would enable earlier physician notification, allowing for prompt diagnosis and treatment to prevent hospitalisations, reduce scarring, and increase PD longevity. Our findings demonstrate the versatility of microscopy and image analysis for infection screening and are a proof of principle for their future applications in health care.

Rationale & Objectives: Previously we reported a cohort of patients with coronavirus disease 2019 (COVID-19)–associated acute kidney injury (AKI) with striking biochemical evidence of tissue breakdown in the absence of apparent rhabdomyolysis. We sought to quantify the extent of tissue catabolism in similar patients. Study Design: During acute peritoneal dialysis (PD) in patients with COVID-19–associated AKI, we measured urea Kt/V adequacy and calculated the daily urea nitrogen generation rate while quantifying daily protein intake. Setting & Population: We did calculations in 8 patients with COVID-9–associated AKI undergoing acute PD at Mount Sinai Hospital in New York City. As a comparator, we obtained urea kinetic parameters from our database of ambulatory patients receiving maintenance PD. Exposure or Predictors: 8 patients with COVID-19–associated AKI undergoing acute PD. Outcomes: Urea nitrogen generation rate in relation to daily protein intake. Analytical Approach: Urea nitrogen generation rate from urea kinetics was related to measured daily dietary protein intake in these patients and we compared it with this relationship in ambulatory maintenance PD patients for whom both parameters were calculated from urea kinetics. Results: Urea nitrogen generation rate in patients with AKI was 10.2 ± 5 g/d, which is more than 2-fold higher than for stable outpatients receiving maintenance PD (4.7 ± 3 g/d) despite similar dietary protein intake (74.8 ± 11 vs 67.2 ± 29 g/d, respectively). This strongly suggests endogenous protein breakdown, probably from muscle. Urea nitrogen generation rate in these patients with AKI corresponds to 315 g/d of ongoing muscle breakdown and cumulative 2.5 kg of muscle breakdown during the early course of AKI. Limitations: Small number of participants and assumptions in comparing urea nitrogen generation rate with protein intake. Conclusions: In highly catabolic patients, an endogenous source of urea generation such as muscle protein breakdown seems to be the most likely explainable cause for our findings. This is the first study that we are aware of to quantify the degree of endogenous protein breakdown induced by COVID-19–related cytokine storm.

Introduction: When choosing a modality for outpatient renal replacement therapy, patients and medical providers have 3 options to choose from in-center hemodialysis (HD), home HD (HHD), and peritoneal dialysis (PD). In 2017, just over 10% of incident ESKD patients were on a home dialysis modality. We set out to determine outcomes of dialysis modality education in both pre-dialysis and dialysis patients. Moreover, we examined barriers that preclude patients from choosing home dialysis. Methods: This was a single-center, retrospective study looking at patients who were referred to the CKD educator for dialysis modality education between January 1, 2019, and March 31, 2020. Patient demographics, preferred language of communication, stage of renal disease, and reasons for patients’ refusal to undertake a home dialysis modality were recorded. Patients’ average household income and driving distance to our home dialysis unit were calculated using their home zip code. Results: 167 patients were referred for CKD education. Mean age was 60 years, and 59% male, 42% African American, 22% White, 7% Asian, and 28% were Hispanic or Latino. Only 23% of the total cohort chose in-center HD, while 74% chose a home dialysis modality (59% PD and 15% HHD), and the remaining patients remained undecided. 56% of in-center HD patients chose a home dialysis modality. The most commonly cited barriers to home dialysis were lack of a care partner, lack of home space, and patient preference. Limitations: Over 90% of our patients reside in NY City where home space is limited. We require in our home HD program that patients have a trained care partner present during their treatments. We cannot assume that all CKD stage-4 patients or higher were either referred for CKD education or followed through on the referral. Conclusions: A large discrepancy between informed patients’ choices and the reality of the current dialysis landscape. Absence of a care partner, lack of home space, and patients not deemed appropriate surgical candidates were the main driving forces in their not opting for a home modality.

Peritonitis is a complication in patients on peritoneal dialysis that frequently results from touch contamination. Most cases of peritoneal dialysis-related peritonitis are caused by skin organisms. Herein, we are presenting a series of peritonitis cases with unusual organisms in a single home dialysis center at an academic hospital in New York City.The records of five patients with an unusual cause of peritonitis were reviewed by a clinician. We have chronologically tabulated the cell count of the dialysate, microbiologic cultures, and antibiotics received by each patient. Additionally, both a table and figure detail the microbiologic organisms that our dialysis unit encountered over the 3-year period concurrent with the infections reported.The first patient presented with refractory polymicrobial peritonitis due to a liver abscess. Another patient presented with diverticulitis and developed enteric peritonitis with various organisms. The following patient had peritonitis in the setting of bowel pathologies and from Rhizobium after exposure to plants. The next patient developed Pasteurella peritonitis from his cat. The final patient developed multiple episodes of peritonitis from organisms including flora native to soil and water.These uncommon cases of peritonitis with unusual circumstances bring awareness to various elements that can lead to peritonitis.

Coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had devastating effects worldwide. Patients with kidney failure on dialysis may have a higher risk of worse outcomes. Reports from China found that these patients with SARS-CoV-2 had fewer

INTRODUCTION A previous study demonstrated that the surface area-normalized standard Kt/V (SAstdKt/V) was better associated with mortality than standard Kt/V (stdKt/V). This study investigates the association of SAstdKt/V and stdKt/V with mortality, anemia, and hypoalbuminemia in a larger patient cohort with a longer follow-up period. METHODS We included adult patients on thrice-weekly hemodialysis in the USRDS database and excluded amputated patients. StdKt/V and SAstdKt/V were calculated from the available single-pool Kt/V. Patients were categorized into five groups according to their stdKt/V and SAstdKt/V

Objective: Obesity is a modern-day epidemic. Body mass index (BMI) is an easily computed surrogate marker of obesity. The incidence of obesity has paralleled the incidence of male infertility. The evidence of the association between BMI and semen parameters stays rather inconclusive. The aim of this study was to understand the association between BMI and semen parameters of male subjects evaluated at the infertility clinic. Materials and Methods: A prospective study was conducted on 410 male subjects (>18 years of age) who were referred to clinical pathology from the infertility clinic. Semen analysis for macroscopic parameters – total sperm concentration, motility, morphology, and viability, was done as per the guidelines laid by the WHO (WHO-5th edition 2010). Results: All the semen parameters showed higher aberrations in the obese group than the normal BMI group. However, on Pearson Chi-square analysis, none of these differences were found to be statistically significant (P > 0.05). On Pearson correlation analysis, none of the parameters showed a statistically significant correlation with BMI. Conclusion: The present study did not find any statistically significant differences for the commonly measured semen parameters, among the three BMI groups. We thus conclude that increased BMI or obesity has no significant impact on the semen parameters.

BACKGROUND: Accessibility to dialysis facilities plays a central role when deciding on a patient’s long-term dialysis modality. Studies investigating the effect of distance to nearest dialysis-providing unit on modality choice have yielded conflicting results. We set out to investigate the association between patients’ dialysis modality and both the driving and straight-line distances to the closest HD- and PD-providing units. METHODS: All patients with ESKD who initiated in-center HD and PD in 2017, were 18–90 years old, and were on dialysis for ≥30 days were included. Patients in residence zip codes in nonconterminous United States or lived >90 miles from the nearest HD-providing unit were excluded. RESULTS: A total of 102,247 patients in the United States initiated in-center HD and PD in 2017. Compared with patients on HD, patients on PD had longer driving distances to their nearest PD unit (4.4 versus 3.4 miles; P30 miles from the nearest HD unit were more likely to be on PD if the nearest PD unit was a distance equal to/less than that of the HD unit. PD utilization increased with increasing distance from patients’ homes to the nearest HD unit. No change in this association was found regardless of if the PD unit was farther from/closer than the nearest HD unit. This association was not seen with straight-line distance analysis. CONCLUSIONS: With increasing distances from the nearest dialysis-providing units (HD or PD), PD utilization increased. Using driving distance rather than straight-line distance affects data analysis and outcomes. Increasing the number of PD units may have a limited effect on increasing PD utilization.

Background: AMIA cycler is a new automated peritoneal dialysis (APD) system, which was approved by FDA in 2015, which is more patient centric due to its features of voice guidance and touch screen. We retrospectively studied if these patient-centric features translated into better patient outcomes. Methods: We compared 18 patients on AMIA cycler to 18 patients on conventional APD system. Data regarding training duration, dialysis adequacy, laboratory data, and peritonitis incidence were obtained using chart review and compared between the 2 groups. Results: The AMIA group had 33% reduction in the duration of training period compared to the conventional group. All other end points including dialysis adequacy, electrolytes, peritonitis incidence, exit site infections, and dropout rates were not found to be different between both the groups. Conclusion: AMIA cycler is superior to the conventional cycler in significantly reducing the training time while having similar clinical outcomes. Further studies are needed to validate this data.

Key Points Question What are effective quality improvement strategies (patient-, clinician-, and health system–level) for improving outcomes in patients with cardiovascular disease (CVD), and how are these strategies best implemented? Findings In this systematic scoping review, 456 studies were identified from 45 countries involving 150 148 patients that used 186 unique interventions to improve outcomes in patients with CVD. Strategies of patient support, information communication technology for health, and training were evaluated the most often for clinical end points and showed modest associations with several clinical outcomes. Meaning These findings may inform decision makers and clinicians on the selection of quality improvement strategies to improve CVD outcomes., Importance Clinical care quality improvement (QI) strategies are critical to prevent and control cardiovascular disease (CVD). However, there is limited evidence regarding which components of the health system–, clinician-, and patient-based QI strategies contribute to their impact on CVD. Objectives To identify, map, and organize evidence on the effectiveness and implementation of cardiovascular QI strategies that seek to improve outcomes in patients with CVD. Evidence Review Eight electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library, ProQuest, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform) were searched for studies published between January 1, 2009, and October 25, 2019. Eligible study designs included randomized trials and preintervention and postintervention evaluations. Descriptive findings of included studies were reported using several frameworks to map the intervention components stratified by target population, setting, outcomes, and overall results. Findings From 8066 screened titles and abstracts, 456 unique studies with 150 148 unique patients (38.1% women and 61.9% men; mean [SD] age, 64.6 [7.1] years) were identified, including 427 randomized trials, 21 quasi-randomized studies, and 8 preintervention and postintervention studies. Of 336 studies from 45 countries that were classified, 255 (75.9%) were from high-income countries; 68 (20.2%), upper-middle–income countries; 13 (3.9%), lower-middle–income countries; and 0, low-income countries, with diverse clinical settings and target patient populations (post–myocardial infarction, stroke, heart failure). Patient support (311 studies), information communication technology (ICT) for health (78 studies), community support (18 studies), supervision (15 studies), and high-intensity training (14 studies) were the most commonly evaluated QI strategies. Other strategies were group problem-solving (7 studies), printed information (5 studies), strengthening infrastructure (4 studies), and financial incentives (3 studies). Patient support, ICT for health, training, and community support were strategies that had been evaluated the most for clinical end points and showed modest associations with several clinical outcomes. The other strategies did not have outcome-driven evaluations reported. Group problem-solving was associated with improved patient self-care and quality of life. Strengthening infrastructure was associated with improved treatment satisfaction. Printed information and financial incentives showed no meaningful effect. Conclusions and Relevance This systematic review found that substantial variations exist in the types, effectiveness, and implementation of QI strategies for patients with CVD. A comprehensive map of QI strategies created by this study would be useful for researchers to identify where new knowledge is needed to improve cardiovascular outcomes. Outcome-driven evaluations and long-term studies are needed, particularly in low-income settings, to better understand the effects of QI strategies on prevention and control of CVD., This systematic and scoping review assesses evidence on the effectiveness and implementation of quality improvement strategies to improve outcomes in patients with cardiovascular disease (CVD).

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented and historic public health crisis that continues to expand and evolve. The National Kidney Foundation held a 2-part continuing medical education live virtual symposium on July 16 and July 24, 2020, to address the multiple challenges of COVID-19 in the context of advanced chronic kidney disease. Faculty addressed the pathophysiology, impact, risks, and management of COVID-19 as it relates to advanced kidney disease. Testing, risk mitigation, and inpatient and outpatient management were also addressed. This concise review addresses major findings of the symposium along with certain updates regarding vaccinations since then. These findings include: (1) severe COVID-19 infection has been associated with acute kidney injury, (2) it is essential to prevent and actively manage acute kidney injury to decrease mortality in these critically ill patients, (3) management of patients with advanced kidney disease should be geared toward minimizing their risk for exposure while making sure they are receiving adequate treatments, and (4) patients with kidney disease, especially ones in advanced stages, should be prioritized for vaccination.

To demonstrate feasibility of acute peritoneal dialysis (PD) for acute kidney injury during the coronavirus disease 2019 (COVID-19) pandemic, we performed a multicenter, retrospective, observational study of 94 patients who received acute PD in New York City in the spring of 2020. Patient comorbidities, severity of disease, laboratory values, kidney replacement therapy, and patient outcomes were recorded. The mean age was 61 ± 11 years; 34% were women; 94% had confirmed COVID-19; 32% required mechanical ventilation on admission. Compared to the levels prior to initiation of kidney replacement therapy, the mean serum potassium level decreased from 5.1 ± 0.9 to 4.5 ± 0.7 mEq/L on PD day 3 and 4.2 ± 0.6 mEq/L on day 7 (P 0.001 for both); mean serum bicarbonate increased from 20 ± 4 to 21 ± 4 mEq/L on PD day 3 (P = 0.002) and 24 ± 4 mEq/L on day 7 (P 0.001). After a median follow-up of 30 days, 46% of patients died and 22% had renal recovery. Male sex and mechanical ventilation on admission were significant predictors of mortality. The rapid implementation of an acute PD program was feasible despite resource constraints and can be lifesaving during crises such as the COVID-19 pandemic.

Reports of the incidence of acute kidney injury in patients with coronavirus disease 2019 (COVID-19) have varied greatly from 0.5% to as high as 39%, with onset generally within 7 days from time of admission. The nature of the kidney insult is acute tubular necrosis, immune cell infiltration, or rhabdomyolysis, as demonstrated in autopsy reports. Moreover, infection with COVID-19 has been associated with coagulation abnormalities, as well as complement-mediated generalized thrombotic microvascular injury. These patients have been found to have high D-dimer, fibrin degradation product, and fibrinogen values, an elevated international normalized ratio, normal partial thromboplastin time, and normal platelet count values. Renal artery thrombosis is a rare condition, the most common cause of which is atrial fibrillation. However, bilateral completely occlusive renal artery thrombosis is even rarer. We present a case of a patient with COVID-19 on systemic anticoagulation therapy who presented with a serum creatinine level of 6.04 mg/dL requiring the initiation of kidney replacement therapy and was found to have bilateral renal artery thrombosis.

The temples are most outstanding form of India’s sacred architecture. Temples are conceived as a receptacle for an image of the saviour or deity who is worshiped there. Generally, temple is defined as a building dedicated to deity and worship or it is a place of worship. Masrur, in the Kangra district, is an important site in the Himalayan region with a view to study Hindu temple architecture. Masrur is amazing monolithic rock-cut curvilinear Shikhara type temple; probably it is singular example in the North India of its kind. The temple of Masrur is an extensive rock-cut temple complex with the central part, roughly 160X105 ft., showing a large east-facing Shiva temple as nucleus enclosed by eight subsidiary shrines. On the extremities of the longer side are excavated two medium sized temples, each facing the transverse direction and surmounted by four satellite shrines. The architectural and iconographical plan of the complex, the Masrur complex fits in between the Gupta architecture and the typology of overall character of the temples dated to the tenth and eleventh centuries those of Central India, Rajsthan and Gujrat. Regarding the dating of the Masrur, Professor C Shivarammurthi writes “Since the carving is very pleasing and follows the Gupta idiom- though very much more advanced in style- this must be eight-century work”. KEYWORDS: Kangra, Temple Architecture, Nagar Temple, Vastushastra&nbsp

Himalayas known as abode of snow is not only a geographical feature for India rather it is abode of gods, and entrusted India a unique cultural and aesthetic dynamism. Sumptuous in forest and cultural heritage, the western part of Himalayas forming modern Himachal Pradesh preserves a rich tradition of woodcarving since hoary past. There are age-old temples made in cedar wood, which still exist in the valley of river Spiti presenting marvels of woodcarving in classical sophisticated style patronized by the royalty and other side indigenous style of native people. Thus, the said valley presents a wide range of artistic woodcarvings and a legacy of unique traditional building practice known as kath-khuni construction. Now, in recent years’ modernization and developmental programme besides linking remote parts of Himachal to the main stream of Indian national development has threatened the traditional arts and heritage. This study mainly confines to the wooden temple of Mirkula Devi survived in the region of Spiti valley. The study presents holistic aesthetic view on the classical and indigenous Architecture known as Kath-Kuni and woodcarvings. There has hardly been any in depth study on folk and aboriginal art in the said area. Therefore, data collection and photographic documentation fully depended on extensive fieldwork. This became only possible with the help of local people and civil authorities in concerned region. KEYWORDS: Himalayan architecture, Temple architecture, Spiti Valley, wood carvings&nbsp

No abstract available Keywords: COVID-19; acute renal failure; dialysis; peritoneal dialysis.

ImportancePreliminary reports indicate that acute kidney injury (AKI) is common in coronavirus disease (COVID)-19 patients and is associated with worse outcomes. AKI in hospitalized COVID-19 patients in the United States is not well-described.ObjectiveTo provide information about frequency, outcomes and recovery associated with AKI and dialysis in hospitalized COVID-19 patients.DesignObservational, retrospective study.SettingAdmitted to hospital between February 27 and April 15, 2020.ParticipantsPatients aged ≥18 years with laboratory confirmed COVID-19ExposuresAKI (peak serum creatinine increase of 0.3 mg/dL or 50% above baseline).Main Outcomes and MeasuresFrequency of AKI and dialysis requirement, AKI recovery, and adjusted odds ratios (aOR) with mortality. We also trained and tested a machine learning model for predicting dialysis requirement with independent validation.ResultsA total of 3,235 hospitalized patients were diagnosed with COVID-19. AKI occurred in 1406 (46%) patients overall and 280 (20%) with AKI required renal replacement therapy. The incidence of AKI (admission plus new cases) in patients admitted to the intensive care unit was 68% (553 of 815). In the entire cohort, the proportion with stages 1, 2, and 3 AKI were 35%, 20%, 45%, respectively. In those needing intensive care, the respective proportions were 20%, 17%, 63%, and 34% received acute renal replacement therapy. Independent predictors of severe AKI were chronic kidney disease, systolic blood pressure, and potassium at baseline. In-hospital mortality in patients with AKI was 41% overall and 52% in intensive care. The aOR for mortality associated with AKI was 9.6 (95% CI 7.4-12.3) overall and 20.9 (95% CI 11.7-37.3) in patients receiving intensive care. 56% of patients with AKI who were discharged alive recovered kidney function back to baseline. The area under the curve (AUC) for the machine learned predictive model using baseline features for dialysis requirement was 0.79 in a validation test.Conclusions and RelevanceAKI is common in patients hospitalized with COVID-19, associated with worse mortality, and the majority of patients that survive do not recover kidney function. A machine-learned model using admission features had good performance for dialysis prediction and could be used for resource allocation.Key PointsQuestionWhat is incidence and outcomes of acute kidney injury (AKI) in patients hospitalized with COVID-19?FindingsIn this observational study of 3,235 hospitalized patients with COVID-19 in New York City, AKI occurred in 46% of patients and 20% of those patients required dialysis. AKI was associated with increased mortality. 44% of patients discharged alive had residual acute kidney disease. A machine learned predictive model using baseline features for dialysis requirement had an AUC Of 0.79.MeaningAKI was common in patients with COVID-19, associated with increased mortality, and nearly half of patients had acute kidney disease on discharge.

Peritoneal dialysis (PD) is currently underutilized in the United States (US), even within resource-rich neighborhoods. We analyzed data from US Renal Data Service to determine PD utilization within the US, New York State (NYS), selected boroughs within New York City (NYC), and Boston, Massachusetts. We then compared the odds of selecting PD with hemodialysis (HD) and analyzed how diabetes mellitus status, age65 years, gender, and race influenced PD utilization between 2010 and 2016. We then compared a high-volume PD center (HVC) with a low-volume PD center (LVC). The odds of starting PD vs HD were as follows: Brooklyn 0.30 (0.25-0.36;0.0001), Bronx 0.56 (0.47-0.67;0.0001), Queens 0.66 (0.54-0.80;0.0001), and Manhattan 0.61 (0.52-0.71;0.0001). In 2016, the odds of starting PD compared with the rest of the US were as follows: Brooklyn 0.14 (0.08-0.22;0.0001), Bronx 0.39 (0.27-0.56;0.0001), Queens 0.32 (0.23-0.45;0.0001), Manhattan 0.54 (0.36-0.79; 0.002), and Boston 0.89 (0.58-1.4; 0.624). Analysis of influencing factors showed that only age65 significantly (0.0001) influenced PD modality selection in Brooklyn and Boston. Differences between HVC and LVC in terms of modality transition, peritonitis rate, or provider:patient ratio were not statistically significant. Factors that influence PD utilization in urban neighborhoods are discussed and remediation measures are proposed.

Background: Liquid-based cytology (LBC) is becoming an independent processing modality for cytology specimens. Decreased obscuration, single-slide examination, lesser screening time, and potential application of ancillary techniques are the various advantages it offers. Aim: To study and compare the cytological features of fine-needle aspirates from thyroid swellings on LBC with conventional smears (CS). Materials and Methods: Fine-needle aspiration was performed on 150 patients with thyroid nodule. The aspirate was first used to prepare a minimum of two CS and the remaining aspirate was used to prepare one SurePath smear. The final diagnosis was given according to the Bethesda system for reporting thyroid cytopathology (2007). Cytomorphological parameters were semi-quantitatively scored. Pearson's Chi-square test was used and P value was calculated. A P value

Obstructive Uropathy remains an important cause of acute kidney injury. The etiology of obstructive uropathy can be very variable ranging from extrinsic compression of the urinary tract by tumors or surrounding structures to intraluminal obstruction by crystals and stones. Patients with obstructive uropathy manifest symptoms based on the area of obstruction within the urinary tract. Flank pain, hematuria, and suprapubic discomfort are some of the associated symptoms. The diagnosis of obstructive uropathy requires a high index of suspicion and, depending on its nature, can be confirmed clinically and/or with an imaging modality. Prompt diagnosis and treatment with effective relief of obstruction is important in preventing long-term and permanent damage to the kidneys.

Rationale & Objectives Previously we reported a cohort of patients with coronavirus disease 2019 (COVID-19)–associated acute kidney injury (AKI) with striking biochemical evidence of tissue breakdown in the absence of apparent rhabdomyolysis. We sought to quantify the extent of tissue catabolism in similar patients. Study Design During acute peritoneal dialysis (PD) in patients with COVID-19–associated AKI, we measured urea Kt/V adequacy and calculated the daily urea nitrogen generation rate while quantifying daily protein intake. Setting & Population We did calculations in 8 patients with COVID-9–associated AKI undergoing acute PD at Mount Sinai Hospital in New York City. As a comparator, we obtained urea kinetic parameters from our database of ambulatory patients receiving maintenance PD. Exposure or Predictors 8 patients with COVID-19–associated AKI undergoing acute PD. Outcomes Urea nitrogen generation rate in relation to daily protein intake. Analytical Approach Urea nitrogen generation rate from urea kinetics was related to measured daily dietary protein intake in these patients and we compared it with this relationship in ambulatory maintenance PD patients for whom both parameters were calculated from urea kinetics. Results Urea nitrogen generation rate in patients with AKI was 10.2±5g/d, which is more than 2-fold higher than for stable outpatients receiving maintenance PD (4.7±3g/d) despite similar dietary protein intake (74.8±11 vs 67.2±29g/d, respectively). This strongly suggests endogenous protein breakdown, probably from muscle. Urea nitrogen generation rate in these patients with AKI corresponds to 315g/d of ongoing muscle breakdown and cumulative 2.5kg of muscle breakdown during the early course of AKI. Limitations Small number of participants and assumptions in comparing urea nitrogen generation rate with protein intake. Conclusions In highly catabolic patients, an endogenous source of urea generation such as muscle protein breakdown seems to be the most likely explainable cause for our findings. This is the first study that we are aware of to quantify the degree of endogenous protein breakdown induced by COVID-19–related cytokine storm.

Mammary Analogue Secretory Carcinoma (MASC) is a rare salivary gland tumour. It clinically presents as a painless mass in the parotid gland affecting mainly males. A 17-year-old male presented with 18 month history of a painless swelling of left parotid region. Physical examination showed a 3×3 cm, firm, non tender mass in the left parotid region. FNAC diagnosis of mucoepidermoid carcinoma was made. Final diagnosis of MASC was made on the basis of characteristic histopathology and immunohistochemistry. This tumour is considered as a low-grade carcinoma with a potential for high-grade transformation.

Proliferation of glomerular epithelial cells, including podocytes, is a key histologic feature of crescentic glomerulonephritis. We previously found that retinoic acid (RA) inhibits proliferation and induces differentiation of podocytes by activating RA receptor-α (RARα) in a murine model of HIV-associated nephropathy. Here, we examined whether RA would similarly protect podocytes against nephrotoxic serum–induced crescentic glomerulonephritis and whether this effect was mediated by podocyte RARα. RA treatment markedly improved renal function and reduced the number of crescentic lesions in nephritic wild-type mice, while this protection was largely lost in mice with podocyte-specific ablation of Rara (Pod-Rara knockout). At a cellular level, RA significantly restored the expression of podocyte differentiation markers in nephritic wild-type mice, but not in nephritic Pod-Rara knockout mice. Furthermore, RA suppressed the expression of cell injury, proliferation, and parietal epithelial cell markers in nephritic wild-type mice, all of which were significantly dampened in nephritic Pod-Rara knockout mice. Interestingly, RA treatment led to the coexpression of podocyte and parietal epithelial cell markers in a small subset of glomerular cells in nephritic mice, suggesting that RA may induce transdifferentiation of parietal epithelial cells toward a podocyte phenotype. In vitro , RA directly inhibited the proliferation of parietal epithelial cells and enhanced the expression of podocyte markers. In vivo lineage tracing of labeled parietal epithelial cells confirmed that RA increased the number of parietal epithelial cells expressing podocyte markers in nephritic glomeruli. Thus, RA attenuates crescentic glomerulonephritis primarily through RARα-mediated protection of podocytes and in part through the inhibition of parietal epithelial cell proliferation and induction of their transdifferentiation into podocytes.

The Notch pathway is an evolutionary conserved cell-cell communication mechanism that plays a key role in kidney development. Here, we will discuss a number of recently published papers describing the role of Notch signaling in kidney development, homeostasis, injury and repair.Recent gene expression studies identified regulation of the Notch pathway in patients with chronic kidney disease (CKD). Mechanistic experiments performed using transgenic and knock-out mouse models indicate that Notch plays an important functional role in the development of proteinuria and renal fibrosis. Inhibition of the Notch pathway ameliorated diabetic kidney disease, nephrotic syndrome and fibrosis in different rodent models.An increasing amount of evidence suggests that Notch plays a role in CKD development. Understanding the role of Notch signaling in the kidney can aid in the development of new therapeutics for CKD.

Hypertensive disorders of pregnancies remain a central public health concern throughout the world, and are a major cause of maternal mortality in the developing world. Although treatment options have not significantly changed in recent years, insight on the pathogenesis of preeclampsia/eclampsia has been remarkable. With improved animal models of preeclampsia and large-scale human trials, we have embarked upon a new era where angiogenic biomarkers based on mechanism of disease can be designed to assist in early diagnosis and treatment. There is also a growing recognition of how elusive the diagnosis of eclampsia can be, especially in the postpartum period. Proper treatment of these patients depends heavily on the correct diagnosis, especially by the emergency physician. Finally, large epidemiologic studies have revealed that preeclampsia, once thought to be a self-limited entity, now appears to portend real damage to the cardiovascular and other organ systems in the long term. This review will present the latest update on our understanding of the various hypertensive disorders of pregnancies and their treatment options.

In this study of the free axisymmetric vibrations of non-homogeneous polar orthotropic annular plates of exponentially varying thickness, on the basis of the classical theory of plates, the Chebyshev collocation technique has been employed to solve the differential equation governing the transverse motion of such plates. The non-homogeneity of the plate material is assumed to arise due to the variation of Young's moduli and density which are assumed to vary exponentially with the radius vector. The effect of various plate parameters such as radii ratio, rigidity ratio, non-homogeneity and thickness variation, on the vibrational characteristics of the plate have been studied for three different boundary conditions. Normalized displacements are presented for a specified plate for the first three modes of vibration. A comparison of results with those available in the literature has been presented.

Background: Accurate diagnostic tests to identify fetuses at risk for in-utero death or injury have long been an important goal for obstetricians and perinatologists. Umbilical Artery Doppler and biophysical profile score are two tests available for antepartum fetal surveillance.Methods: The study consisted of 100 patients with either presence of PIH (30) or IUGR (28) or both (42). Testing was begun was at 33 weeks. UAD was performed; S/D, RI and PI indices were calculated. Fetal BPS was determined.Results: Fetal weight was estimated to be less than 2kg in last scan was 23.52% cases in pih/ iugr group versus 6.4% in controls whereas incidence of oligohydramnios was 29.5% versus 91.17% respectively, and number of babies admitted to NICU was 11.47% versus 70.58% respectivelyConclusions: Doppler and biophysical studies can greatly help in arriving at an appropriate strategy for management.

Preeclampsia, a hypertensive multisystem disease that complicates 5-8% of all pregnancy, is a major cause for maternal and fetal mortality and morbidity. The disease is associated with increased spontaneous and evoked preterm birth and remote cardio-renal disorders in the mother and offspring. Thus the ability to predict the disease should lead to earlier care and decreased morbidity. This has led to fervent attempts to identify early predictive biomarkers and research endeavors that have expanded as we learn more regarding possible causes of the disease. As preeclampsia is associated with specific renal pathology including podocyte injury, early urinary podocyte (podocyturia), or the podocyte specific proteinuria nephrin in the urine (nephrinuria), as well as the more easily measured urinary albumin (albuminuria), have all been suggested as predictive markers. We performed a prospective study recruiting 91 pregnant women (78 of whom were high risk) and studied the predictive ability of these three urinary biomarkers. The subjects were recruited between 15-38 weeks of gestation. Fourteen patients, all in the high-risk obstetric group, developed preeclampsia. The levels of podocyturia, nephrinuria, and albuminuria were variably higher in the high-risk pregnant patients who developed preeclampsia. The sensitivities and specificities for podocyturia were 70% and 43%, for albuminuria were 36% and 96%, and for nephrinuria were 57% and 58%, respectively. Also, abnormal nephrinuria (69%) and podocyturia (38%) were detected in low risk women who had uncomplicated gestations; none of these women exhibited albuminuria. In our study, none of the three urinary markers achieved the minimum predictive values required for clinical testing. The lack of excessive albuminuria, however, may indicate a preeclampsia-free gestation. Given a discrepant literature, further studies with larger sample size should be considered.

In the setting of injury, podocytes can undergo dedifferentiation and proliferation, apoptosis, or cell detachment, resulting in proteinuria. Significant injury resulting in a loss of podocytes contributes to progressive kidney disease. Consequently, therapies that prevent podocyte injury and promote their regeneration will have a major clinical impact on glomerular disease. All-trans-retinoic acid (RA), which is a derivative of vitamin A, has many cellular functions including induction of cell differentiation, regulation of apoptosis, and inhibition of inflammation and proliferation. In addition to its established role in the treatment of variety of cancers, RA has been demonstrated to provide protection in various experimental models of kidney diseases with podocyte injury. RA produces its beneficial effects in the kidney due to its anti-inflammatory and antiproliferative effects. Also, RA helps maintain the normal morphology and preserves the differentiation markers of the podocytes. RA produces its effects in the podocytes via retinoic acid receptor-α (RAR-α). Treatment with RAR-α agonist, Am580, has a similar efficacy as RA in a mouse model of HIVAN. However, due to its systemic toxicity, clinical studies evaluating the use of RA have been challenging. Therefore, novel RAR-α agonist such as BD4 has been synthesized, which has a similar efficacy as RA and Am580, with lower toxicity.

Recent studies indicate that the Notch signaling pathway plays an important role in the development of diabetic kidney disease and focal segmental glomerulosclerosis (FSGS). Here we analyzed the degree of expression and localization of Notch ligands (Jagged1 and Delta1) and activated (cleaved) receptors (Notch1 and Notch2) in healthy human kidneys and in renal biopsies from a wide variety of kidney diseases. These included patients with minimal change disease, membranous nephropathy, lupus nephritis ISN/RPS classes III/IV/V, hypertensive nephrosclerosis, crescentic glomerulonephritis, tubulointerstitial fibrosis, IgA nephropathy, diabetic kidney disease, and FSGS. We found that cleaved Notch1, Notch2, and Jagged1 are expressed on podocytes in proteinuric nephropathies and their level of expression correlated with the amount of proteinuria across all disease groups. The degree of glomerulosclerosis correlated with podocyte expression of cleaved Notch1, while the severity of tubulointerstitial fibrosis and the estimated glomerular filtration rate correlated with expression of cleaved Notch1 in the tubulointerstitium. Hence, our results raise the possibility that Notch pathway activation is a common mechanism in the pathophysiology of a wide range of acquired renal diseases.