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Ashraf O Oweis,1 Sameeha A Alshelleh,2 Lubna Hawasly,3 Ghalia Alsabbagh,3 Karem H Alzoubi4,5 1Department of Internal Medicine, Nephrology Division, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Internal Medicine, Nephrology Division, University of Jordan, Amman, Jordan; 3Department of Internal Medicine, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates; 5Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Ashraf O Oweis, Department of Internal Medicine, Nephrology Division, Jordan University of Science and Technology, Irbid, Jordan, Tel +962-79-145-5505, Email aooweis@just.edu.joObjective: During the COVID-19 pandemic, many patients have been admitted to hospitals with severe respiratory disease and suffered complications. Acute kidney injury (AKI) is among the more dangerous complications contributing to morbidity and mortality among patients.Methods: This retrospective study focused on all hospital-admitted COVID-19 patients between September and December 2020. A total of 1,044 patients were enrolled. Patient demographics, medical records, and laboratory data were gathered. Patients were split into two groups: AKI and non-AKI. Comparisons comprised demographics, labs, ICU transfer, need for ventilation and oxygen therapy, medications, hospital stay, and deaths.Results: AKI incidence in the cohort was 25.3%, and a majority were stage 1 (53.3%). Among these, hemodialysis was started in 1.8%. Higher age (P< 0.001), diabetes mellitus (P=0.001), hypertension (P=0.001), ACEI/ARB use (P=0.008), erythrocyte-sedimentation rate (P=0.002), CRP (P< 0.0001), and ferritin (P=0.01) were predictors of AKI. Among all admitted COVID-19 patients, 30.2% died in hospital. Among those with AKI, 75.9% died in comparison to 24.1% of non-AKI patients (P< 0.001). Among COVID-19 patients admitted to the ICU, 80.5% died: 70.5% were from the AKI group and 29.5% from the non-AKI group (P< 0.001).Conclusion: High mortality and morbidity is associated with COVID-19 infection, and AKI is contributing significantly to the outcomes of hospitalized patients with the infection. Early recognition of and treatment for AKI will decrease mortality and hospitalization in patients with COVID-19.Keywords: acute kidney injury, COVID, mortality, dialysis

Arabic gum (AG) is a dietary additive widely used in food manufacture and drugs; it has also gained popularity as herbal tea that can cure diseases such as diabetes, hypertension, and chronic kidney disease. Studies showed its antioxidant and anti-inflammatory effects. In a retrospective study design, we included CKD patients taking AG for at least three months. Data were collected over one year for each patient: age, co-morbidities, duration, amount of AG used, serum creatinine, inflammatory markers, lipid profile, blood sugar, hemoglobin A1C, and blood pressure readings. For the changes in values and trends, we compared the values individually for each patient separately. A total of 30 patients consisted of 20 males (66.7%) and 10 females (33.3%), with a mean age of 63.2 years. The mean (M) eGFR pre-enrollment in the study was 23.5 ml/min (standard deviation [SD]=15.8), and the mean eGFR at the end of the study was 26.1 ml/min (SD=18.9, p=0.56). There was a significant difference in the eGFR after using AG between diabetics (M=31.3 ml/min, SD=18.5) and non-diabetics (M=20.5 ml/min, SD=18.2, p=0.03). With a history of catheterization, there was a significant difference in eGFR between patients who had catheterization (M=31.76, SD=20.86) and patients without catheterization (M=18.36, SD=13.08, p=0.04). No significant effect on lipid profile, or CRP, yet significant effect on blood sugar control (fasting blood sugar 0.0001, and HBAa1c 0.01). In conclusion, AG is a promising natural material that affects decreasing eGFR in CKD diabetics patients.

Ashraf O Oweis,1 Heba N Zeyad,1 Sameeha A Alshelleh,2 Karem H Alzoubi3,4 1Department of Internal Medicine, Nephrology Division, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Internal Medicine, Nephrology Division, The University of Jordan, Amman, Jordan; 3Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates; 4Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Ashraf O Oweis, Department of Internal Medicine, Nephrology division, Jordan University of Science and Technology, Irbid, Jordan, Tel +962791455505, Email aooweis@just.edu.joBackground: Acute kidney injury (AKI) is a well-known complication for hospitalized patients. Sepsis and various infections play a significant role in increasing the incidence of AKI. The present study evaluated the risk for Multidrug-resistant (MDR) infections and its effect on the incidence of AKI, hospitalization, need for dialysis, and mortality.Methods: In a retrospective study design, data were collected from all adult patients with a positive multi-drug resistant culture who were admitted to King Abdullah University Hospital (KAUH). Records of 436 patients were reviewed between January 2017 – December 2018 with at least one year of follow-up.Results: The mean age was 57.3 years (SD± 23.1), and 58.5% were males. The most common source of positive cultures was sputum, with 50% positive cultures. The incidence of AKI was 59.2%. The most isolated microorganism was Acinetobacter baumannii (76.8%), followed by Pseudomonas aeruginosa (14.9%).On multivariate analysis, age (OR 1.1, 95% CI 1.1– 1.2, P=0.001), HTN (OR 1.8, 95% CI 1.0– 3.3, P=0.02), DM (OR 1.1, 95% CI 0.6– 1.9, P=0.69) and the use of Foley catheter on chronic bases (OR 4.3, 95% CI 2.6– 6.8, P< 0.0001) were strong predictors of AKI. Among patients with AKI, 74.4% died compared to 44.4% among non-AKI patients (p< 0.001).Conclusion: In patients with MDR, AKI incidence, hospitalization, and mortality were high. Early detection and addressing the problem may decrease bad outcomes, and health education for reducing antibiotic abuse is needed to lower MDR.Keywords: infection, multi-drug resistant, mortality, acute kidney injury

Background Rheumatoid arthritis (RA) is a common rheumatological disease which can involve a variety of different renal manifestations. This may be explained by disease effect itself or by medications used for treatment that may lead to renal dysfunction and its complications. We aimed to identify the prevalence and factors that played a role in renal dysfunction among RA Jordanian patients. Method 285 patients with RA visiting outpatient clinic between March 2016 and March 2017 were included in a retrospective study design. Age, gender, comorbidities, duration of the disease, medications and laboratory results were gathered and scoring of RA activity was done. Results Data gathered from the 285 patients showed a female predominance with 88.4% female and 11.6% male. The average disease duration was 6.7 years. Age, DM, HTN, and serum CRP were associated with worse renal function on univariate analysis. 44 patients (18.8%) presented with microscopic hematuria, 16 (6.9%) with proteinuria and only 5 (2.1%) patients presented with both microscopic hematuria and proteinuria. Patients with eGFR 90 ml/min (P = 0.001). Conclusion Renal dysfunction is not common in RA Jordanian population and has variable presentations. Age and the duration of illness play a major role in the progression of CKD if present. Future prospective studies evaluating renal biopsies in RA patients are needed., Highlights • First study in the country to discuss the prevalence of renal involvement in rheumatoid arthritis. • Renal involvement is rare in rheumatoid arthritis patients. • Different drugs can affect renal outcome in a different ways.

Introduction. Approximately 15 to 33% of all dialysis treatments are complicated by intradialytic hypotension (IDH). In this study, we tested the hypothesis that the intravenous administration of hydrocortisone prior to HD treatment could prevent IDH or at least decrease the drop in the blood pressure resulting from IDH. Methods. This study was approved by our local ethics committee/IRB (2017/87) and by the Jordan Food and Drug Administration (7/clinical/18). Additionally, it is registered on ClinicalTrials.gov (NCT03465007). In this preliminary investigational study, we screened all chronic hemodialysis patients at our clinic who were 18 years of age or older (n=82) for IDH. There were 14 patients included in the interventional part of this study; patients were given IV hydrocortisone for 3 consecutive HD sessions, followed or preceded by 3 intervention-free sessions where they were given 5 ml of saline as a placebo. Results. The initial total sample size was 82 patients. The frequency of IDH at our clinic was 24.4%. Fourteen out of the 20 patients who were diagnosed with IDH agreed to enroll in the interventional part of our study. The mean age of the patients in the interventional part of our study was 53.5 years (±10.3). These patients included 5 (35.7%) men and 9 (64.3%) women. Upon comparing the number of hypotensive attacks with and without the hydrocortisone administration, we found a significant difference (p=0.003) between the hydrocortisone and placebo treatments in which 12 (85.7%) patients had fewer IDH episodes with the hydrocortisone treatment than with placebo. Conclusion. This preliminary investigational study found that the administration of a stress dose of hydrocortisone prior to hemodialysis could be an effective measure for preventing or minimizing the risk of IDH episodes. Additional prospective studies on this subject are needed. Ruling out adrenal insufficiency in patients diagnosed with IDH is also crucial.

Objectives This study aims to evaluate the clinical phenotypic features of sarcoidosis in a single-center academic hospital in Jordan. Patients and methods A retrospective file review was performed at an academic medical center in Jordan that included all patients diagnosed with sarcoidosis between January 2000 and December 2018. A total of 150 patients with sarcoidosis (38 males, 112 females; mean age 47.8±11.7 years; range, 17 to 79 years) were evaluated. Clinical data extracted from the files included the sex of the patient, the age at time of diagnosis, diagnosis date, the season during which the diagnosis was established, and smoking history. Biopsy histopathology, spirometry, nerve conduction, echocardiography, and imaging reports including plain radiographs, ultrasonographic, magnetic resonance and computed tomography reports were reviewed. Data including laboratory values, medication usage, clinical outcomes, and morbidity/mortality were collected. Pulmonary function tests including spirometry and lung volumes along with the diffusing capacity for carbon monoxide were reviewed for the presence of restriction, obstruction or reduction in the diffusion capacity of carbon monoxide. Identification of extra-thoracic organ involvement was determined in each patient in accordance with the criteria suggested by the updated World Association of Sarcoidosis and Other Granulomatous Disorders. Results A total of 77.3% of the patients were diagnosed by biopsy. One case of Lofgren's syndrome was identified. Of the patients, 18.0% had isolated pulmonary sarcoidosis, 75.3% had pulmonary and extra-pulmonary sarcoidosis and 6.7% had isolated extra-pulmonary sarcoidosis while 81.3% had respiratory symptoms, mostly shortness of breath and cough. Extra-thoracic organ involvement mostly involved the musculoskeletal system (33%) followed by the skin (20%). Female patients had more extra-thoracic involvement but the sex difference was only statistically significant for cutaneous involvement. Of the patients, 84% received treatment while 20% had disease remission during the first two years after diagnosis and 70% required treatment beyond two years after diagnosis. Conclusion Various sarcoidosis clinical phenotypes are seen among Jordanian patients. Jordanian females are more affected by the disease and have more extra-thoracic involvement compared to male patients. A large number of the study patients received treatment.

Background: Several epidemiological studies have assessed various components of Metabolic Syndrome (MS) in different populations, but only a few compared the prevalence of metabolic syndrome in dialysis and transplant patients. Aim: The aim of this study is to compare the prevalence of MS in dialysis and transplant patients. Two groups of patients were included; hemodialysis patients and patients with transplanted kidneys. Methods: Demographic and clinical history, and lab data were collected. A total of 108 patients were included in this study with a mean age of 52.3 (±16.29) years. Study groups included 61 (56.5%) dialysis patients, and 47 (43.5%) patients with transplanted kidneys. Results: Upon comparing the prevalence of metabolic syndrome between the two study groups, transplant patients had significantly lower prevalence of metabolic syndrome (34%) compared to that of metabolic syndrome in patients on dialysis (55.7%; P=0.016). Conclusion: As metabolic syndrome plays an important role in the pathology of elderly patients, especially those with transplanted kidneys, such findings indicate the need for close monitoring of kidney transplant patients for the manifestations of metabolic syndrome.

Background. Acute kidney injury (AKI) is a common serious problem affecting critically ill patients in intensive care unit (ICU). It increases their morbidity, mortality, length of ICU stay, and long-term risk of chronic kidney disease (CKD). Methods. A retrospective study was carried out in a tertiary hospital in Jordan. Medical records of patients admitted to the medical ICU between 2013 and 2015 were reviewed. We aimed to identify the incidence, risk factors, and outcomes of AKI. Acute kidney injury network (AKIN) classification was used to define and stage AKI. Results. 2530 patients were admitted to medical ICU, and the incidence of AKI was 31.6%, mainly in stage 1 (59.4%). In multivariate analysis, increasing age (odds ratio (OR) = 1.2 (95% CI 1.1–1.3), P = 0.0001) and higher APACHE II score (OR = 1.5 (95% CI 1.2–1.7), P = 0.001) were predictors of AKI, with 20.4% of patients started on hemodialysis. At the time of discharge, 58% of patients with AKI died compared to 51.3% of patients without AKI (P = 0.05). 88% of patients with AKIN 3 died by the time of discharge compared to patients with AKIN 2 and 1 (75.3% and 61.2% respectively, P = 0.001). Conclusion. AKI is common in ICU patients, and it increases mortality and morbidity. Close attention for earlier detection and addressing risk factors for AKI is needed to decrease incidence, complications, and mortality.

Introduction: Uremic pruritus is a multifactorial devastating complication of renal failure, which has a significant negative impact on patients’ quality of life including medical, psychological, as well as social aspects. It is also associated with an increased mortality in dialysis patients. Methods: A cross sectional study evaluating the traditional risk factors for uremic pruritus (UP) – using pruritus grading system (PGS) and visual analogue scale (VAS) - as well as measuring the serum levels of different inflammatory cytokines (ILs 13, 31 and 33) in chronic hemodialysis and healthy controls, in a tertiary referral hospital. Results: 65 hemodialysis (HD) patients and 49 heathy controls were enrolled in the study. The mean age for the HD patients was 43.4 years (SD ± 21.3), and 31.5 years (SD ± 11.1) for the control group. The most common cause for End Stage Renal Disease (ESRD) was diabetes mellitus (DM) 27.7%. The mean PGS score in HD patients was 5.92 (SD ± 2.9); 50% had mild itch, 43.8% moderate itch and 6.2% had severe itch. The mean serum levels for IL-13 was 8674.3 pg/ml (SD ± 4353.9), serum levels of IL-31 were 150.7 pg/ml (SD ± 178.2) and for IL-33 it was 42850.5 pg/ml (SD ± 11370.7) in hemodialysis patients; in comparison to serum levels of 7913.4 pg/ml (SD ± 3454.1), 67.1 pg/ml (SD ± 71.9) and 44875.9 pg/ml (SD ± 12114.6), respectively in the control group. IL-31 level was significantly higher in HD patients than in the control group (P = 0.0001), while the difference in the levels of IL-13 and IL-33 between the two groups were not statistically significant (P = 0.41 and 0.18, respectively). IL-13 had a statistically significant relationship with the itch score (P = 0.014) and the severity of itch (P = 0.03), while IL-31 and IL-33 were not statistically significant. Conclusion: UP is a complex and multifactorial problem. In patients with UP the high levels of IL-31 indicates a possible role in pathogenesis. IL-13 serum level on the other hand may be related to the severity of itch in these patients. Optimizing dialysis and targeting these cytokines may provide a potential therapeutic option especially in refractory UP. Further studies addressing these cytokines and their levels in response to various treatments may provide additional information on UP.

Background and Aims Contrast induced acute kidney injury (CI-AKI) is potentially preventable and reversable cause of acute kidney injury (AKI). Multiple factors are associated with the development of CI-AKI, some are modifiable such as drugs, type and amount of contrast, others are not like preexisting chronic kidney disease (CKD), heart failure. Though it’s usually a reversable condition, there is increasing evidence of adverse long-term outcome (increasing morbidity and mortality). The aim of this study to evaluate the long-term outcome of CI-AKI on mortality, the rate of re-catheterization and the development of CKD. Method In a prospective observational study design, we evaluated all patients admitted for cardiac catheterization between June 2015 and January 2016. A total of 326 patients signed the consent to participate in the study. Patients had blood withdrawn 48 hours after the procedure for their creatinine level. CI-AKI was defined as an increase in serum creatinine by >25% or 44 mmol/l from the baseline level (48-72) hours after contrast administration, without any other obvious cause. We used only low osmolality contrast media (CM) (Lopamidol, Bayer, Germany). Of the 326 patients included, 202 patients had their second sample taken, thus, were eligible to continue in the study. Patients were followed for at least 3 years. Results The incidence of CI-AKI was 14.8% (30 patients), for baseline characteristics see table 1. At the end of follow up; a total of 7 patients died; 6 in the non CI-AKI group vs. 1 in the CI-AKI group (p= ), though the difference between the mean eGFR was not statistically significant by the end of the follow up (85.4ml/min for the CI-AKI vs. 79.2ml/min for the other group (P=0.31)), but the decline in eGFR for the CI-AKI was significant ( a drop from 105.4 ml/min to 85.4ml/min vs. 85.2ml/min to 79.2ml/min, P=0.004). The rate of re-catheterization was not statistically significant between the two groups (61 for the non CI-AKI vs. 12 for the other group; P=0.63). Conclusion CI-AKI carries a higher negative long-term effect on eGFR, while did not affect the mortality in our cohort.

Introduction. Contrast-induced acute kidney injury (CI-AKI) is a worldwide known complication related to the use of contrast media with either imaging or angiography; it carries its own complications and effect on both morbidity and mortality; early identification of patients at risk and addressing modifiable risk factors may help reducing risk for this disease and its complications. Methods. This was a prospective observational study, where all patients admitted for cardiac catheterization between June 2015 and January 2016 were evaluated for CI-AKI. There were two study groups: contrast-induced acute kidney injury (CI-AKI) group, and noncontrast-induced acute kidney injury (non-CI-AKI) group. Results. Patients ( n = 202 ) were included and followed up for 4 years. Death and development of chronic kidney disease (CKD) need for another revascularization were the end points. The incidence of CI-AKI was 14.8%.In univariate analysis, age ( P = 0.016 ) and serum albumin at admission ( P = 0.001 ) were statistically significant predictors of overall death. Age ( P = 0.002 ), HTN ( P = 0.002 ), DM ( P = 0.02 ), and the use of diuretics ( P = 0.001 ) had a statistically significant impact on eGFR. The rate of recatheterization was not statistically significant between the two groups (61 (35.5%) for the non-CI-AKI vs. 12 (40%) for the other group; P = 0.63 ). Some inflammatory markers (NGAL P = 0.06 , IL-19 P = 0.08 ) and serum albumin at admission P = 0.07 had a trend toward a statistically significant impact on recatheterization. Death ( P = 0.66 ) and need for recatheterization ( P = 0.63 ) were not statistically different between the 2 groups, while the rate of eGFR decline in for the CI-AKI was significant ( P = 0.004 ). Conclusion. CI-AKI is a common complication post percutaneous catheterization (PCI), which may increase the risk for CKD, but not death or the need for recatheterization. Preventive measures must be taken early to decrease the morbidity.

Sameeha A Alshelleh,1 Ashraf O Oweis,2 Karem H Alzoubi3 1Division of Nephrology, Department of Medicine, The University of Jordan, Amman, Jordan; 2Division of Nephrology, Department of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan Background: Improvements in health care systems worldwide have had notable effects on the life expectancy of older individuals. As a result, nonagenarians are emerging as a separate age group with distinct health care needs. The aim of this study was to evaluate the incidence of acute kidney injury (AKI), the mortality rates, and length of in-hospital stay among nonagenarians.Methods: This is a retrospective case–control chart review of patients of age 90 years and above who were admitted to hospital. Patients with Stage I, II, or III chronic kidney disease were included in the analysis. The incidence of AKI was determined using data from the Acute Kidney Injury Network (AKIN) classification. Primary outcome variables included length of in-hospital stay and mortality rates.Results: Of the 253 patients who were included in the study, the mean age was 91.5 years, 61 of the patients (25.9%) developed AKI, and 41 patients (66.1%) were in Stage I AKI according to AKIN criteria. Fifty-seven patients died during the study period; 57.9% of those patients had AKI. Hospital stay was longer in patients with AKI with a mean length of stay of 8.1 days. Congestive heart failure, cancer, and use of non-steroidal anti-inflammatory drugs were the main risk factors for AKI among those patients.Conclusion: AKI is common in nonagenarians. It was associated with increased length of hospital stays and increased risk for mortality. Keywords: acute kidney injury, elderly, geriatric, outcomes&nbsp

Hypertension is one of the major risk factors associated with cardiovascular diseases. In this study, we will assess the frequency of hypertension among healthy university students and its association with gender, body mass index, smoking, and family history of both hypertension and cardiovascular diseases. We screened healthy university students ranging from 18 to 26 years of age. For each participant, we performed blood pressure measurements using a previously validated device and obtained demographic data, body mass index (BMI), smoking status, and family history of both hypertension and cardiovascular diseases. Out of the total number of 505 participants included in this study, 35.2% have blood pressure between 130/80 and 139/89, and 13.5% have blood pressure of more than 140/90. We found significant gender differences in both systolic pressure (p = 0.003) with mean difference = 18.08 mmHg (CI: 16.13 to 19.9) and diastolic pressure (p = 0.011) with mean difference = 3.6 mmHg (CI: 2.06 to 5.14), higher in males than in females. Upon comparing the mean difference in both systolic and diastolic blood pressure with BMI, we found significant differences in both systolic (p < 0.001) and diastolic (p = 0.002) blood pressure. We also found that smokers have significantly (p = 0.025) higher systolic blood pressure (mean difference = 4.2 mmHg, CI: 3.2 mmHg to 8.8 mmHg), but no significant difference for diastolic blood pressure (p = 0.386), compared to nonsmokers. First-degree family history of both hypertension and cardiovascular diseases affected systolic but not diastolic blood pressure. Taking into account the adverse short- and long-term effect of hypertension, we recommend adopting an awareness program highlighting the importance of screening blood pressure in young adolescent populations, keeping in mind that both high BMI and smoking are important modifiable factors.

Ashraf O Oweis,1 Sameeha A Alshelleh,2 Ammar K Daoud,1 Mahmoud M Smadi,3 Karem H Alzoubi4 1Department of Internal Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Internal Medicine, the University of Jordan, Amman, Jordan; 3Department of Mathematics and Statistics, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan Background: Acute kidney injury (AKI) caused by contrast exposure is a common problem, which may cause a significant increase in patients in-hospital stay and therefore the cost of treatment. This study was conducted to evaluate the role of inflammation, inflammatory markers in predicting contrast induced nephropathy (CIN). This is a prospective study that was carried out in a major tertiary referral hospital in Jordan. Methods: Clinical data, blood and urine samples were collected from all patients admitted to the cardiology unit. All patients who agreed to participate in the study had creatinine level analysis 48–72 hours after the procedure. The CIN was defined as an increase in serum creatinine by 25% or 44 μmol/L from the baseline within 48–72 hours after the contrast administration. Patients with stage 4, 5 renal failure, patients on dialysis, and patients with recent intravenous contrast use, active infection or cancer were excluded from the study. Results: Of the total 202 patients, 30 (14.8%) developed CIN. The incidence rate was 21.1% among females and 12.4% among males. In the multivariate analysis, beside eGFR, diuretics, and alkaline phosphatase, IL-33 was significantly associated with CIN, while the other cytokines did not to show this an association. Conclusion: Serum level of IL-33 was a significant predictor for development of CIN. Good clinical judgment and high serum levels of IL-33 may stratify patients into low and high risk for CIN. Keywords: acute kidney injury, contrast, cytokines, cardiac catheterization

Objective Improvements in the health care system, resulted in a greater number of geriatric patients diagnosed with acute kidney injury (AKI). We evaluated the incidence and outcome of AKI in octogenarians, as studies in the Middle-East region are few; moreover, treatment approaches, in addition to medical decisions, may require special consideration for advanced age to improve the outcomes. Results At King Abdullah II teaching and referral hospital, we recruited patients aged 80–90 years who were admitted to the medical floor between January 2010 and December 2013. Patients were followed-up for at least 1 year after discharge.850 patients were admitted during the study period. Of these, 135 were excluded from our analysis. The most common admission diagnoses were uncontrolled diabetes mellitus and acute coronary syndrome. AKI occurred in 216 patients (30.2%). Using the acute kidney injury network classification; stage 1, stage 2, and stage 3 disease were present in 59, 17.5, and 23.5% of patients, respectively. Of the 115 patients who died before discharge (16.1%), 87 (75.6%) had developed AKI. Hypertension, the use of angiotensin receptor blockers and non-steroidal anti-inflammatory drugs, heart failure, and exposure to radiologic contrast media were significant risk factors for AKI.

We present a case of circumferential fracture of aortic coarctation stent with severe re-stentosis presenting 16 years after initial stent implantation with end-stage renal disease. The patient was treated with a covered stent using the stent-in-stent technique. The use of an ultra-high-pressure balloon was proved necessary to overcome the tight, non-compliant stenosis.