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Introduction BKV nephropathy (BKVN) is one of the major causes of graft loss with the advent of potent immunosuppressive drugs. The literature on the co-existence of acute rejection (AR) and BKVN is scarce. Materials and methods This is a single-center retrospective analysis, where the allograft biopsies of patients transplanted between 2011 and 2021 were reviewed. The biopsies, which showed evidence of coexistent AR and BKVN, were included. In addition, demographic profiles, clinical presentation, treatment details, response to therapy, and follow-up were analyzed. Results Out of 1175 live transplants done between January 2011 and March 2021, 49 had BKVN representing 4.17%. Only seven patients (0.59%) had coexistent BKVN with AR. The mean serum creatinine at presentation was 2.3 mg/dl. The mean duration to diagnosis from transplant was seven months (range 3–22 months). All had significant viremia at presentation (17450–4,750,000 copies/ml). All biopsies showed type 1 inclusion bodies with SV40 positivity except one. Coexistent acute T cell-mediated rejection (TCMR) was found in five and acute ABMR in two patients. Three patients received pulse IV methylprednisolone, five received 2 g/kg IVIG, two received plasma exchange as upfront therapies. Maintenance immunosuppression reduction was made in all. Viremia clearance was noted at a mean duration of 3.5 months. However, three patients lost their grafts on follow-up. Four had stable graft function with a mean serum creatinine of 1.54 mg/dl. Conclusion Intensifying immunosuppression to treat AR followed by a reduction in maintenance immunosuppression and IVIG and antiviral therapies seems better strategy and showed good long-term graft survival in patients with coexistent BKVN and AR. [ABSTRACT FROM AUTHOR]

Acute pancreatitis after renal transplantation is seldom seen yet a dreadful complication. The causes include traditional causes and immunosuppressive medications and viral infections. Classical symptoms are not always present at onset, causing delay in diagnosis. The available literature on pancreatitis in renal transplants is either as case reports or case series. Large studies with longer follow-up periods and outcome in renal transplant patients with pancreatitis are lacking. We conducted this retrospective study to analyze the incidence, clinical features, and causes of pancreatitis in our institute in post-azathioprine era. We conducted a single center retrospective study of renal transplant recipients who suffered at least 1 episode of acute pancreatitis during a period from January 2002 to September 2018. We followed International Association of Pancreatology/American Pancreatic Association evidence-based guidelines for confirming diagnosis of acute pancreatitis and included only patients who fulfilled these criteria. Once the diagnosis is confirmed we retrospectively analyzed the etiology, clinical features, management and outcomes of renal transplant recipients with pancreatitis. Twenty-six patients (men 81%; mean age 38.5 years) were included. Etiology included gallstones (19.3%), structural lesions (11.5%), viral infections (7.8%), and drugs. Clinical presentations, laboratory parameters were like pancreatitis in non-transplant patients. Graft dysfunction was noted in 20 patients (77%) and all showed either partial or complete recovery. Patient survival was high with 88% of the patients surviving the episode. Pancreatitis after renal transplantation is a rare complication with outcomes better than what has been reported in the past. • Pancreatitis after renal transplantation is a rare complication with outcomes better than what have been reported in the past. • Etiology included gallstones (19.3%), structural lesions (11.5%), viral infections (7.8%), and drugs. • A significant number of patients presented with acute graft dysfunction. • Immediate survival is good after episode. [ABSTRACT FROM AUTHOR]

Abstract: In patients with primary hypertension, elevated blood pressure (BP) is considered to be a consequence of multiple factors. The 2 major factors involved are environmental factors and genes. A steady progress has been made from experimental animal studies to human genetic studies. Except for the rare monogenic hypertensive diseases, the association of genes and BP are yet to be confirmed, and the quest for “the blood pressure gene” continues. This review briefly discusses the role of genetics in HTN. [Copyright &y& Elsevier]

Abstract: Uremic myopathy is a common problem in patients on dialysis however the pathogenesis of this entity is poorly understood. The aim of this review is to discuss briefly about its epidemiology, pathogenesis and management. [Copyright &y& Elsevier]

Abstract: The kidney is a major organ in the human body carrying out the essential metabolic functions. Metabolism and excretion of exogenously administered therapeutic and diagnostic agents as well as environmental exposures are other major functions of kidneys. Kidney is vulnerable to develop various form of injury via virtue of its role as the primary eliminator of exogenous drugs, and toxins. Toxic kidney injury is an important and relatively common category of kidney damage. Several classes of dissimilar toxicants target the kidney. Despite the widespread appreciation of the role of nephrotoxic agents in their contribution to acute kidney injury (AKI), these drugs continue to have an ongoing etiological role. Tubular injury initiated by toxins often results from a combination of acute renal vasoconstriction and direct cellular toxicity due to intracellular accumulation of the toxin, or, alternatively, may be mediated immunologically in case of interstitial nephritis. Patients with reduced renal functional reserve, cardiovascular co-morbidity, diabetes mellitus, and advanced age are at increased risk. Awareness of the range of toxins on the one hand and simple measures such as adequate pre-hydration of the patient and drug monitoring on the other hand may be sufficient to avoid drug-induced AKI or minimize its clinical severity in susceptible patients. [Copyright &y& Elsevier]

A highly sensitive single antigen bead assay (SAB) by luminex is a very useful tool for post-transplant monitoring of HLA antibodies for diagnosing antibody-mediated rejection ABMR. Donor-specific anti-HLA antibodies that arise de-novo (de-novo DSA) after transplantation, indicate the highest risk for acute antibody-mediated rejection (AMR) and graft loss. The return of pre-existing antibodies after transplantation or the development of new de-novo anti-HLA or non-HLA DSA may also confer an increased risk for graft loss. A case with de-novo donor-specific antibody (DSA) against HLA-DQ antigens resulting in acute antibody-mediated rejection (ABMR) in a renal transplant patient is presented along with review of literature. [ABSTRACT FROM AUTHOR]

Abstract: Glomerular hyperfiltration associated with early diabetes mellitus (DM) is a risk factor for the development of progressive diabetic nephropathy. Though pathogenesis of hyperfiltration is not well-known but has been attributed to glomerular hemodynamic and tubular factors. Renal hyperfiltration due to hemodynamic function abnormalities are seen in animal models of DM, including increased intraglomerular capillary pressure and glomerular hyperfiltration and thought to be due to afferent arteriolar vasodilatation, efferent vasoconstriction, and suppression of tubuloglomerular feedback. [Copyright &y& Elsevier]

Background Renal graft cortical necrosis (GCN) is a catastrophic cause of graft failure. We evaluated the incidence, causes, management, and outcome of GCN across two decades from our center. Methods This is a retrospective analysis of transplant patients who had biopsy-proven GCN transplanted between 2000 and 2020. The clinical details, immunological workup, induction, maintenance regimen, causes of cortical necrosis, and the outcomes were compared between the first period 2000–2012, and the second period 2013–2020, when Flow cytometric and Luminex based crossmatch were included in the workup plan. Results Among 2333 live ABO-compatible renal transplants, 37 (0.015%) patients (36 patients between 2000 and 2012 and 1 between 2013 and 2020) developed GCN (60% had diffuse and 40% patchy GCN) at a median of 8 days after transplantation.Twenty-six (60%) received ATG, 4 received plasmapheresis and ATG (10.8%) as antirejection therapy. The cyclosporine-based regimen was associated with a higher risk of GCN (RR 2.54; 95% CI 1.26 to 5.12, p = 0.009), whereas tacrolimus-based therapy had a lower risk (RR 0.39; 95% CI 0.19 to 0.79, p = 0.009). The introduction of flow cytometry and DSA assay has significantly decreased the incidence of acute rejection and GCN. Only one patient had GCN during the 2013–2020 period because of graft's mucormycosis. Twenty-five (67.56%) patients had no recovery, and 12 (32.43%) had partial recovery of graft function. Conclusion GCN is mainly associated with rejection, and cyclosporin-based maintenance regimen had a higher incidence. The remarkable decrease in GCN after 2012 onwards could be attributed to the use of Flowcytometry, Luminex-based DSA assays, and tacrolimus-based regimens. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 53-year-old man with diabetes and with end-stage renal disease. The hemodialysis patient had a six-week history of fever, multiple swellings over chest and lower limbs, cough, and dyspnea. Aspiration of the swellings over his chest and foot as well as blood cultures and sputum cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA).