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The term acute kidney injury (AKI) has replaced the historical term acute renal failure for renal damage occurring over a short period of time (hours to days) because it is thought to better describe the pathophysiologic changes and duration of the different phases of injury. There are many potential causes of AKI in dogs and cats, and the prognosis has been shown to vary with the cause as well as with therapy. This article reviews current concepts of the pathophysiology, causes, clinical presentation, approach to diagnosis, and medical management of AKI in dogs and cats.

Objective The purpose of the current study was to describe the clinico-pathological characteristics and outcomes in patients with lupus nephritis with IgA deposits in the kidneys. Materials and Methods A total of 258 patients with lupus nephritis with complete clinical data and follow-up was enrolled. They were divided into two groups: the IgA deposits group and the non-IgA deposits group. Their clinico-pathological features and outcomes between the two groups were further compared. Results Patients with IgA deposits had significantly lower prevalence of acute kidney failure, higher eGFR, lower plasma levels of C3a, and lower renal pathological chronicity indices scores than those with non-IgA deposits (19.4% vs. 31.8%, 80.9±35.6 vs. 69.1±39.6 ml/min/1.73m2, 1045.48 [559.41, 1796.34] vs. 1920.77 [1155.08, 2986.96]ng/ml, and 2 [1, 3] vs. 2.5 [2, 4], respectively, all P Conclusions Patients with IgA deposits presented with milder renal damage and a good prognosis, which suggested its protective role in lupus nephritis.

Background and Purpose: Drainage of obstructed kidney due to extrinsic ureteral obstruction (EUO), required to prevent renal damage, is often achieved using double-J ureteral stents. But these stents fail frequently, and there is considerable debate regarding what stent size, type and configuration offer the best option for sustained drainage. Here, we examine the impact of stent diameter and choice of single/tandem configuration, subject to EUO and various degrees of stent occlusion, on stent failure. Methods: Computational fluid dynamics (CFD) simulations and an in vitro ureter-stent experiment enabled quantification of flow behavior in stented ureters subject to EUO and stent occlusions. Various single and tandem stents under EUO were considered. In each simulation and experiment, changes in renal pressure were monitored for different degrees of stent lumen occlusion, and onset of stent failure as well as simulated distributions of fluid flow between stent and ureter lumina were determined. Results: For an encircling EUO that completely obstructs the ureter lumen, with or without partial stent occlusion, the choice of stent size/configuration has little effect on renal pressure. The pressure increases significantly for ~90% stent lumen occlusion, with failure at >95% occlusion, independent of stent diameter or a tandem configuration, and with little influence of occlusion length along the stent. Conclusions: Stent failure rate is independent of stent diameter or single/tandem configuration, for the same percentage of stent lumen occlusion, in this model. Stent failure incidence may decrease for larger diameter stents and tandem configurations, because of the larger luminal area.

The objective of this study is to assess the role of the 2019-European League Against Rheumatism/American College of Rheumatology (2019-EULAR/ACR) classification criteria at diagnosis and its domains in predicting long-term damage in systemic lupus erythematosus(SLE). We performed a retrospective analysis using an electronic chart database utilized in routine clinical care of SLE patients and established in 2000 in a tertiary hospital. Two hundred and nine consecutive SLE patients with disease onset ≥18 years old and long disease duration were included. Cumulative damage at the last visit was scored using the SLICC/ACR-Damage Index (SDI). The median age at SLE diagnosis was 28 years (18-63), disease duration was 14 years (8-25), and 88% were females. Damage (SDI≥1) was observed in 116/209 (55%). Patients with (SDI≥1, n=116) and without damage (SDI=0, n=93) had similar median disease duration [14 (8-25) vs. 12 (8-25) years, p=0.090] and age at diagnosis [23 (18-55) vs. 23 (18-56) years, p=0.998]. No correlation was observed between total 2019-EULAR/ACR score at diagnosis and SDI at last visit (r=0.007, p=0.913). Presence of renal domain at diagnosis was associated with renal damage at last visit (OR=3.6, 95%CI 1.2-10.4, p=0.017) and antiphospholipid antibodies domain predicted neuropsychiatric damage (OR=3.0, 95%CI 1.2-7.6, p=0.015). A ROC analysis identified that a cut-off >24 in 2019-EULAR/ACR score could predict a trend for renal damage (p=0.077) with a lower renal survival (Kaplan-Meier curve) for patients above this limit (p=0.029). A multivariate logistic regression analysis revealed that 2019-EULAR/ACR score >24 at diagnosis (OR 4.583, 95%CI 1.052-19.962, p=0.043) was independently associated with renal damage. Specific domains in the 2019-EULAR/ACR criteria at diagnosis were associated with long-term organ-specific damage, particularly renal and neuropsychiatric harm. A 2019-EULAR/ACR score >24 predicted worse renal survival. Key Points • Presence of renal domain of the 2019-EULAR/ACR classification criteria at diagnosis was associated with long-term renal damage. • Presence of antiphospholipid antibodies domain at diagnosis was associated with long-term neuropsychiatric damage. • A 2019-EULAR/ACR overall score >24 at diagnosis was independently associated with renal damage and predicted worse renal long-term survival.

BACKGROUND Anaemia is common in patients with chronic kidney disease (CKD) and is a major risk factor that contributes to mortality in such patients. Type 2 diabetes mellitus (T2DM) is one of the leading causes of CKD. The association between admission hemoglobin levels and renal damage in patients with T2DM remains unclear. AIM To evaluate the relationship between admission hemoglobin levels and prognosis in patients with T2DM. METHODS We performed a retrospective analysis of 265 consecutive patients presenting with T2DM between 2011 and 2015. The composite endpoint was end-stage renal disease or a 50% reduction in the estimated glomerular filtration rate. RESULTS In multivariable-adjusted Cox proportional hazards models (adjusting for demographic factors, traditional risk factors, lipids), the adjusted hazard ratios (HRs) for the highest and middle tertiles compared to the lowest tertile of hemoglobin were 0.82 (95%CI: 0.11-6.26, P = 0.8457) and 0.28 (95%CI: 0.09-0.85, P = 0.0246), respectively. However, after further adjustment for glycaemia control, hemoglobin was positively related to the risk of the composite endpoint (HR: 1.05, 95%CI: 0.14-8.09, P = 0.9602) when the highest tertile was compared to the lowest tertile of hemoglobin. We found a U-shaped relationship between hemoglobin levels and the composite endpoint. The curve tended to reach the lowest level at an optimal hemoglobin level. CONCLUSION Among patients with T2DM, a U-shaped relationship was observed between hemoglobin levels and renal damage. A lower admission hemoglobin level (hemoglobin < 13.3 g/dL) is an independent predictor of renal damage.

La etiología de diversos tipos de cáncer, además de patologías relacionadas con el sistema cardiovascular y respiratorio, reside en el consumo de tabaco. Hoy en día, los nuevos estudios apuntan a que el tabaco produce un daño renal que puede degenerar en insuficiencia renal crónica a largo plazo. No obstante, los parámetros utilizados en clínica para la detección del daño renal, como la creatinina plasmática, no son útiles para evidenciar la disfunción. Por ello, los métodos de diagnóstico más innovadores incluyen los biomarcadores urinarios de daño renal temprano, que permitirían prevenir la evolución de la enfermedad renal. Por otra parte, basándonos en estudios previos de nuestro laboratorio, se ha desarrollado el concepto de predisposición adquirida al daño renal, así como la existencia de biomarcadores urinarios asociados a esta condición. Nuestro objetivo es estudiar si determinados biomarcadores de predisposición son capaces de detectar entre los pacientes fumadores a aquellos que están predispuestos a sufrir daño renal. Nuestros resultados demuestran que algunos de estos biomarcadores se excretan en orina de un modo significativamente superior en individuos fumadores respecto a no fumadores. La mayor excreción de dichos biomarcadores podría estar relacionada con una predisposición de los individuos fumadores a sufrir disfunción renal, aspecto clave a tener en cuenta en clínica.

Purpose: Urinary tract infection (UTI) is one of the important infectious diseases of childhood age. It causes serious late-term complications by leading to development of renal scarring in some pediatric patients. In the present study, it was aimed to determine the risk factors in development of renal damage in the pediatric patients that admitted with clinical of acute pyelonephritis. Materials and methods: In our study, the medical files of the patients were admitted to the pediatric nephrology polyclinic of Pamukkale University Medical Faculty and followed-up with the diagnosis of urinary tract infection were retrospectively evaluated. The study included 197 patients diagnosed with acute pyelonephritis (confirmed by urine culture and clinical evidence) and undergoing dimercaptosuccinic acid (DMSA) scintigraphic imaging. The clinical evidence (fever, recurrent UTI, voiding dysfunction etc.), laboratory evidence (C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, polymorphonuclear leukocyte (PNL) count, mean platelet volume (MPV), platelet count, serum urea and creatinine levels) and imaging evidence (urinary tract system ultrasonography (USG), voiding cystourethrography (VCUG) and DMSA scintigraphy) of the patients detected at admission and obtained by anamnesis were evaluated. Results: The number of the female patients (n=153) was found significantly higher than number of the male patients (n=44) (p

The second part of this review is devoted to the issues of modern and promising diagnosis of RN in children. The advantages and limits of the available methods for recording the structural and functional state of the kidneys in childhood are considered. Particular attention is paid to possibilities non-invasive methods for diagnosis and prediction of the disease course. Data on promising biomarkers of the early stages of RN formation and progression are presented. For the purpose of a comprehensive and adequate assessment of morphological changes in the kidneys, the necessity of studying various combinations of cytokines in biological media with the subsequent determination of the optimal spectrum is shown. The sensitivity and specificity of molecular indicators of renal damage reviewed as potential targets for renoprotective therapy in the nearest future.

Usually, malignant high blood pressure and severe renal damage are main characters in SSc. SRCs is a relatively rare condition, found in approximately 5% of all SSc patients. This study was carried out to summarize the contemporary evidence regarding the causes, risk factors, manifestations, management and prognosis of Sclerodermal Renal Crisis‎.‎ a simple review was carried out, searching databases PubMed, Google Scholar, and EBSCO. The authors extracted the needed data and stated that SRCs continues to be a rare diagnosis affecting up to six percent of SSc patients, but has a high morbidity and death influence. SRCs presentation is varied, with hypertension, normal BP and renal insufficiency. Medics should be minded by potential SRCs presentations. Early detection and initiation of aggressive ACEi antihypertensive medication in ED could enhance patient outcomes and around 60% of SRCs patients need dialysis.

Hypertension and diabetes are the greatest factors influencing the progression of chronic kidney disease (CKD). Investigation into the role of nephron number in CKD alone or with hypertension has revealed a strong inverse relationship between the two; however, not much is known about the connection between nephron number and diabetic kidney disease. The heterogeneous stock-derived model of unilateral renal agenesis (HSRA) rat, a novel model of nephron deficiency, provides a unique opportunity to study the association between nephron number and hypertension and diabetes on CKD. HSRA rats exhibit failure of one kidney to develop in 50−75% of offspring, whereas the remaining offspring are born with two kidneys. Rats born with one kidney (HSRA-S) develop significant renal injury with age compared with two-kidney littermates (HSRA-C). The induction of hypertension as a secondary stressor leads to significantly more renal injury in HSRA-S compared with HSRA-C rats and nephrectomized HSRA-C (HSRA-UNX) rats. The present study sought to address the hypothesis that nephron deficiency in the HSRA rat would hasten renal injury in the presence of a secondary stressor of hyperglycemia. HSRA animals did not exhibit diabetes-related traits at any age; thus, streptozotocin (STZ) was used to induce hyperglycemia in HSRA-S, HSRA-C, and HSRA-UNX rats. STZ- and vehicle-treated animals were followed for 15 wk. STZ-treated animals developed robust hyperglycemia, but in contrast to the response to hypertension, neither HSRA-S nor HSRA-UNX animals developed proteinuria compared with vehicle treatment. In total, our data indicate that hyperglycemia from STZ alone does not have a significant impact on the onset or progression of injury in young one-kidney HSRA animals. NEW & NOTEWORTHY The HSRA rat, a novel model of nephron deficiency, provides a unique opportunity to study the association between nephron number and confounding cardiovascular complications that impact kidney health. Although hypertension was previously shown to exacerbate renal injury in young HSRA animals, diabetic hyperglycemia did not lead to worse renal injury, suggesting that nephron number has limited impact on kidney injury, at least in this model.

Background: Among aflatoxins, the subtype aflatoxin G1 is one of the most toxic, commonly found in cereals, legumes, dairy and non-alcoholic beers. Aflatoxins have been known as nephrotoxic compounds. In this study, changes in the expression of aquaporin-1, the histopathology of renal tissue and plasma biochemical factors after exposure to aflatoxin G1 were investigated in mice. Methods: Twenty-four adult male mice (weighing 20±2 g) were divided into four groups of six. The control group received the vehicle (0.2 ml) and the three experimental groups were injected intraperitoneally with aflatoxin G1 at 20 μg/kg for 7, 15 or 35 days, respectively. On days 7, 15 and 35, blood samples were drawn from the mice for biochemical analysis of plasma and the kidney tissues were sampled for real-time PCR and histopathological studies. Results: The real PCR results showed a reduction in aquaporin-1 expression in the experimental groups compared to those in the controls (P

Background Children with β-thalassemia major (β-TM) suffer from tubular dysfunction even before the onset of any renal impairment symptoms and/or clinical signs. Therefore, identifying innovative biomarkers allowing early renal damage detection has focused attention. Aim This study aims to preliminary assess Netrin-1(NTN-1) and clusterin (CLU) in β-TM children and explore their possible roles as surrogate noninvasive biomarkers of renal tubular dysfunction. Subjects and methods In this study, 40 β-TM children and 30 healthy children were enrolled. Routine serum and urinary biochemical variables were determined. Urinary NTN-1 and CLU levels were measured using ELISA and their mRNA expression in PBMCs were assayed using real-time PCR. Serum TNF-α, MDA levels and GST activity were measured. Results Urinary NTN-1 and CLU concentrations and mRNA relative expression levels in PBMCs were significantly increased in β-TM children relative to controls. Oxidative stress and inflammatory markers revealed significant elevation in β-TM children compared to controls. The change in these parameters correlated significantly with other renal parameters. ROC curves analysis showed that urinary NTN-1 and CLU levels are of promising diagnostic performance. Conclusion Our results suggest that NTN-1 and CLU are qualified as new noninvasive biomarker panels for early detection of renal injury in β-TM children. Moreover, urinary NTN-1 is recommended as a precise one during the clinical practices.

Gross hematuria, besides being a serious renal disorder, is quite worrisome for the patients. It merits evaluationto determine the underlying cause and initiate timely management in order to prevent long term complications as well as permanent renal damage in some cases. Anatomical abnormalities causing gross hematuria are rare and often asymptomatic, hence not diagnosed routinely. Here we present two cases of gross hematuria with underlying anatomical abnormality known as the Nut Cracker Syndrome (NCS). Keywords: Gross hematuria, Children, Non glomerular, Nut Cracker Syndrome

As the long-term effects of COVID-19 on patients and services continue to be assessed, nurses working in renal care are concerned about a potential increase in cases of kidney damage caused by the virus. [ABSTRACT FROM AUTHOR] Copyright of Primary Health Care is the property of RNCi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study sought to explore the related factors of orthostatic hypotension (OH) in elderly patients with essential hypertension, and analyze the relationship between early renal damage and OH in elderly hypertensive patients.The demographic and clinical data of 511 elderly patients with essential hypertension (EH) were collected from September 2017 to September 2018.These patients were divided into group with OH and group without OH. The data were compared between the two groups to analyze correlations between OH and early renal damage indicators [urine microalbumin (mAlb)30 mg/L].In the study, 118 were in the OH+ group, and 393 were in the OH-group. The proportion of patients with coronary heart disease, atherosclerosis, grade 3 hypertension, persistent rapid atrial fibrillation, left ventricular diastolic dysfunction, and left ventricular hypertrophy in OH+ group was significantly higher than in OH- group (P0.05). Further, logistic regression analysis showed that coronary heart disease, carotid atherosclerosis, and grade 3 hypertension are independent associated factors for OH in elderly EH patients. In the 511 patients, 249 had urine mAlb30 mg/L, and 262 had urine mAlb ≤30 mg/L. The 24-hour systolic blood pressure (SBP)-coefficient of variation (CV), the 24-hour diastolic blood pressure (DBP)-coefficient of variation (CV), the drop difference of both SBP and DBP from supine to standing position in 3-minute were higher in patients with urine mAlb30 mg/L than in patients with urine mAlb ≤30 mg/L (P0.05). The urine mAlb of patients with OH was higher than that of patients without OH, and the urine mAlb of patients with elevated blood pressure variability (BPV) was also higher than that in patients with normal BPV (P0.05). Further groupings revealed that patients with both OH and elevated BPV had the highest urine mAlb levels (P0.05).Coronary heart disease, atherosclerosis, and grade 3 hypertension are independent associated factors of OH in elderly EH patients. In elderly hypertensive patients with both OH and elevated BPV, the urine mAlb is much higher than that in patients with OH or elevated BPV alone. OH is associated with early renal damage.

Purpose: Split renal function (SFR) and frusemide washout (FWO) are assessed by the DTPA renogram to measure the renal parenchymal functions as well as the evidence of obstruction, both for diagnosis and to treat the pelviureteric junction obstruction. In good number of renal units, both these parameters remain unaltered even after surgery and cause anguish to parents and referring physicians and are usually attributed toward “defective pyeloplasty.” In this study, we have tried to single out the bona fide responsible factor for the bad outcome; either the nonreversible kidney or the restenosis of pyeloplasty. Patients and Methods: We studied file of 69 patients in whom a double “J” (DJ) stent was left in situ for internal drainage for a duration of 8 weeks in the postoperative period. DTPA scans were performed preoperative, at 8 weeks with a stent in place, and at 12 and 24 months postremoval of the stent to assess renal function. Results: In our study, 45 patients (65.2%) showed improvement either in SRF or in FWO or in both after 8 weeks following pyeloplasty and 24 of 69 units (34.8%) did not show any change in renal function with DJ stent in place. Only in six units (8.7%), out of 69 units had deterioration of renal function after removal of DJ stent. Conclusions: In our opinion, no improvement of renal function found in 24 units (34.8%) even with internal drainage with DJ indicates irreversible renal damage. In 45 units (65.2%), renal function reversed after pyeloplasty and DJ stent. However, after the removal of the DJ, functions deteriorated in six units (8.7%) due to restenosis following pyeloplasties.

Summary: This research was planned to assess the protective effect of aqueous green tea extract (AGTE) in alcohol treated diabetic rats. This study was examined, whether 20% v/v of 5 g/kg.b.w alcohol intake exacerbates diabetes-induced renal damage associated with an escalated nitroxidative stress and glucose homeostasis in comparison with diabetic condition alone. The present study is primarily focused to investigate the possible toxic effects of chronic alcohol intake on kidney of streptozotocin (STZ)-induced diabetic rats. Forty albino male Wistar rats were used and randomly allocated into five groups. Diabetes was induced by a single intraperitoneal injection of STZ (50 mg/kg) in rats. Alcohol was administered through orogastric tube once daily for a period of 60 days. Impact of chronic alcohol treatment on renal function and selected metabolites of catecholamines and antioxidant metabolisms have been investigated in the kidney of STZ-induced diabetic rats. Biochemical analysis of kidneys demonstrated that chronic alcohol induced alterations in vitro gluconeogenesis, significant decrease in the body weight, and activities of antioxidant enzymes in diabetic rats. A significant increase in the levels of epinephrine and sertonine was observed between alcohol treated, diabetic control and alcohol treated diabetic rat groups. Further, excessive chronic alcohol treatment caused additive deterioration of the kidney function as evidenced by increased inducible nitric oxide synthase (iNOS) protein expression and thus nitroxidative stress and histopathological aberrations leading to aggravation of diabetic nephropathy under alcohol intoxication. Treatment with aqueous green tea extract (300 mg/kg.b.w) to diabetic rats treated with alcohol renders the protection against the decreased body weight, increased hyperglycemia, hyperlipidemia, catecholamines, nitroxidative stress and further tissue damage.

Background: Acute Kidney Injury is a complication in children with heart disease undergoing cardiac surgery with cardiopulmonary bypass. The aim of this study is to describe the behavior of KIM-1 (Kidney Injury Molecule) and NGAL (Neutrophil Gelatinase Associated Lipocalin) as early predictors of renal damage, comparing them with serum creatinine and creatinine clearance, in neonates undergoing cardiac surgery. Methods: Twenty-one (21) neonates, under 4 kg, with complex congenital heart diseases, RACHS-1 > 3, without preoperative renal failure, were studied. Serum creatinine and creatinine clearance were measured preoperatively and at 24, 48, 72, 96 hours postoperatively. Urinary samples of KIM-1(pg/ml) and NGAL (ng/ml) were collected after induction of anesthesia at 24 and 48 hours post-operatively. Results: nRIFLE criteria were used to divide cohorts in “NO AKI” (12 patients) and “AKI” (nine patients). In the AKI group, serum creatinine increased significantly and creatinine clearance decreased significantly at 24, 48, and 72 hours compared with their respective baseline values. There was no difference in KIM-1 and NGAL values between patients who developed AKI and those who did not at any measured time. Conclusions: The deterioration of renal function continues to be one of the most frequent complications in this population. In our study, biomarkers did not show any correlation with the appearance of AKI. It remains to be seen whether this behavior of the biomarkers is linked with the non-consistent release of these types of molecules in immature kidneys. It is likely that a larger panel of biomarkers together with other glomerular filtration rate assessment methods will provide more information about AKI diagnosis.

Aim: This study was aimed at investigating the effect of methanol extract of Napoleonae imperialis leaves against methotrexate renal histology in albino rats. Methodology: Thirty (30) male albino rats of mean weight 130 g were used for this study. The animals for the study were grouped into five (5) of six (6) rats each. Group A received feed and water only and Group B was induced with methotrexate without treatment. Groups (C and D) were orally given 250 mg and 500 mg/kg b.wt of leaves extract, and group E was orally given the extract only (500 mg/kg b.wt) respectively for 28 days. All the rats used in this study were initially subjected to renal damage using 0.5 ml/kg of methotrexate except the normal control group. The rats were sacrificed after 28 days, and the kidney were carefully dissected from the abdominal region. They were fixed in normal saline for 72 hours and sliced into a thickness of 2.1mm samples of and processed for histopathological examination. Results: The photomicrographs result showed that in group A, (normal control group) evenly distributed glomeruli of smaller size, with normal mesangial cellularity. In group B, (positive control group) there is a significant pathology and mild interstitial inflammation. In groups (C and D) (tests group that received 250 and 500 mg/kg b.wt of the extract) there is no significant pathology, in group E, there is no significant pathology. Conclusion: The results of this study indicate that the leaves extract may have exerted nephroprotective effects in albino rats, and may also be used pharmacologically in the management of organ toxicity.

Objective Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is an accurate method to document changes in blood pressure (BP) and is more predictive than office and home BP monitoring for cardiovascular outcomes in elderly people. We aimed to determine the relationship between ABPM indices and renal damage in elderly Chinese male patients with essential hypertension. Methods We investigated 998 Chinese men (mean age of 78.44 ± 12.02 years) with essential hypertension. Renal function, laboratory testing, and ABPM, including ABP, BP variability, and BP circadian rhythms were investigated. Data were shown according to BP controlling status. The relationships between ABPM indices and renal damage [expressed by urine protein, urine albumin/creatinine ratio (uACR), estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN)] were assessed using multiple regression analysis. Results After adjustments for age, common cardiovascular risk factors, and medications, uACR level was positively associated with 24-h mean systolic blood pressure (SBP), 24-h mean pulse pressure (PP), and 24-h SBP percent time of elevation. eGFR level was negatively associated with the 24-h mean SBP and 24-h mean PP. BUN level was positively correlated with the 24-h mean SBP, 24-h mean PP, and 24-h SBP percent time of elevation, whereas the BUN level was negatively associated with the 24-h DBP SD. Conclusion The ABPM indices associated with renal damage may be regarded as an early predictive marker for renal function impairment in Chinese elderly male patients with hypertension.

Background: Microvascular dysfunction (MVD) contributes to stroke, dementia, depression, retinopathy and chronic kidney disease. However, the determinants of MVD are incompletely understood. Greater blood pressure variability (BPV) may be one such determinant.Methods and results: We used cross-sectional data of The Maastricht Study (n = 2773, age 59.9 years; 51.9% men) to investigate whether greater very short- to mid-term BPV is associated with various MVD measures. We standardized and averaged within-visit, 24-h and 7-day BPV into a systolic and a diastolic BPV composite score. MVD measures included a composite score of MRI cerebral small vessel disease (CSVD) features (total brain parenchymal volume, white matter hyperintensity volume, lacunar infarcts and cerebral microbleeds), a composite score of flicker light-induced retinal arteriolar and venular dilation response, albuminuria, heat-induced skin hyperemia and a composite score of plasma biomarkers of MVD (sICAM-1, sVCAM-1, sE-selectin and von Willebrand Factor). We used linear regression adjusted for age, sex, glucose metabolism status, mean 24-h systolic or DBP, cardiovascular risk factors and antihypertensive medication. We found that higher systolic and diastolic BPV composite scores (per SD) were associated with higher albuminuria [higher ratio, 1.04 (95% CI 1.00–1.08) and 1.07 (1.03–1.11), respectively], but not with other measures of MVD tested.Conclusion: Greater systolic and diastolic BPV was associated with higher albuminuria, but not with CSVD features, flicker light-induced retinal arteriolar and venular dilation response, heat-induced skin hyperemia and plasma biomarkers of MVD. This suggests that the microvasculature of the kidneys is most vulnerable to the detrimental effects of greater BPV.

Objective To assess the predictive abilities of serum and urinary cystatin C levels for glomerular lesions in pregnant women with pre-eclampsia. Methods In this study, kidney function markers were compared between38 pregnant women with pre-eclampsia and 22 healthy pregnant women. Results The serum and urine levels of cystatin C and urea were significantly higher in the pre-eclampsia group than in the control group. Receiver operating characteristic curve analysis demonstrated that the serum cystatin C level (91.7%) had a superior diagnostic accuracy for pre-eclampsia than the other markers. Conclusion Serum cystatin C level maybe a significant marker of pre-eclampsia.

Objective: To study the predictors of renal complications following hematotoxic snakebite in children. Methods: This comparative study was conducted in the pediatric ward of a tertiarycare centre among 364 consecutively children admitted with hematotoxic snakebite between January 2016 and December 2017. Clinical and laboratory indicators were compared between children who developed acute kidney injury and those who did not. Results: Acute kidney injury was seen in 139 children (38.2%), majority being stage 2 (55, 39.5%). 59 children (16.2%) developed permanent renal damage and 16 (4.4%) died due to envenomation. Acute tubular necrosis was the most common (25, 39.1%) histopathological change. Conclusion: Receiving anti-snake venom more than one hour after bite was the most significant adverse prognostic indicator, both for renal complications and mortality.

Background Obstructive sleep apnea syndrome (OSAS) is associated with a variety of systemic diseases. Among patients with chronic kidney diseases (CKD), the prevalence of OSAS is high. OSAS can induce progression of CKD. However, whether or not OSAS can cause renal damage in healthy people is not clear. Thus, the purpose of this meta-analysis was to elucidate whether or not there was an association between OSAS and early renal damage. Methods PubMed, Embase Database, Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Biology Medicine Database, Chinese Scientific Journals Database, and Wanfang Database were searched systematically. The relative risk (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were used to evaluate the relationship between OSAS and early renal damage. Funnel plot and Egger’s test were used to evaluate publication bias, and trial sequential analysis (TSA) was employed to verify the sufficiency of the research conclusions. Results A total of 18 studies were analyzed comprising 4,567 participants. Compared with the healthy control group, levels of cystatin C (MD = 0.530, 95% CI 0.423, 0.637, P P Conclusion In this meta-analysis, OSAS was associated with a higher risk of early renal damage. Patients with OSAS and comorbid hypertension and/or diabetes appear to suffer from severe renal damage.

Background Patients with primary hyperoxaluria (PH) often develop kidney stones and chronic kidney disease. Noninvasive urine markers reflective of active kidney injury could be useful to gauge the effectiveness of ongoing treatments. Methods A panel of biomarkers that reflect different nephron sites and potential mechanisms of injury (clusterin, neutrophil gelatinase-associated lipocalin (NGAL), 8-isoprostane (8IP), monocyte-chemoattractant protein 1(MCP-1), liver-type fatty acid binding protein (L-FABP), heart-type fatty acid binding protein (H-FABP), and osteopontin (OPN)) were measured in 114 urine specimens from 30 PH patients over multiple visits. Generalized estimating equations were used to assess associations between biomarkers and 24 h urine excretions, calculated proximal tubular oxalate concentration (PTOx), and eGFR. Results Mean (±SD) age at first visit was 19.5 ± 16.6 years with an estimated glomerular filtration rate (eGFR) of 68.4 ± 21.0 ml/min/1.73m2. After adjustment for age, sex, and eGFR, a higher urine MCP-1 concentration and MCP-1/creatinine ratio was positively associated with CaOx supersaturation (SS). Higher urine NGAL and NGAL/creatinine as well as OPN and OPN/creatinine were associated with higher eGFR. 8IP was negatively associated with PTOx and urinary Ox, but positively associated with CaOx SS. Conclusion In PH patients greater urine MCP-1 and 8IP excretion might reflect ongoing collecting tubule crystallization, while greater NGAL and OPN excretion may reflect preservation of kidney mass and function. CaOx crystals, rather than oxalate ion may mediate oxidative stress in hyperoxaluric conditions. Further studies are warranted to determine whether urine MCP-1 excretion predicts long term outcome or is altered in response to treatment.

Background: Although artery-only (AO) clamping has been proposed to minimize ischemic renal damage compared with artery-vein (AV) clamping, the benefit of AO clamping during laparoscopic partial ne...

Background Our aim was to investigate the clinical efficacy and complications of antibiotic treatment regimens for patients with bone infection. Methods We retrospectively analysed patients with bone infection admitted to our hospital between March 2013 and October 2018. After surgical debridement was performed, the patients were divided into three groups: IV group (intravenous antibiotics for 2 weeks); oral group (intravenous antibiotics for 2 weeks followed by oral antibiotics for 4 weeks); and rifampicin group (intravenous antibiotics for 2 weeks followed by oral antibiotics plus rifampicin for 4 weeks). The infection control rate and complications were compared among the three groups. Results A total of 902 patients were enrolled. The infection sites included 509 tibias, 228 femurs, 32 humeri, 23 radii and ulnae, 40 calcanei, and 47 miscellaneous sites, as well as 23 multiple-site infections. After at least 6 months of follow-up, 148 (16.4%) patients had an infection recurrence. The recurrence rate of the IV group was 17.9%, which was not significantly higher than the recurrence rates of the oral group (10.1%) and rifampicin group (10.5%), P = 0.051. The incidence of abnormal alanine aminotransferase (ALT) levels in the IV group was 15.1%, which was lower than that in the oral group (18.0%) and rifampicin group (27.4%), P = 0.026. The rates of proteinuria in the three groups were 3.2, 4.5, and 9.3%, respectively, P = 0.020. Conclusions After debridement of bone infection, short-term antibiotic treatment regimens might offer similar rates of infection eradication while avoiding the risk of renal and hepatic damage associated with prolonged antibiotic use. The level of clinical relevance Stage III.

Necrotizing enterocolitis of newborns (NEC) is a severe intestinal disease that occurs against the background of acute hypoxia, violations of normal colonization of the intestine by microflora, leading to necrosis and perforation of the intestinal wall, peritonitis. Frequency of occurrence of 1-5 cases per 1000 live-born children. Most often, premature babies and children with low birth weight get sick. The development of NEC in a child significantly worsens the prognosis and increases mortality. Modern development of medical technology has made it possible to provide assistance to extremely premature newborns, which has led to an increase in the number of patients with NEC who are in a critical condition due to the course of multi-organ failure, including kidney failure, which requires renal replacement therapy (RRT). The main method of RRT used in newborns and young children is peritoneal dialysis (PD). NEC in the initial stages is considered an absolute contraindication for performing invasive manipulations on the abdominal cavity, since the risk of disease progression with the development of complications requiring surgical intervention increases at times. Recently, peritoneal dialysis has also become widespread in deeply premature newborns, who are the main risk group for developing NEC. Peritoneal dialysis in the continuous flow modification eliminates high intra-abdominal tension, one of the provoking factors for the progression of NEC, and in foreign expert studies, there are reports that the dialysis solution improves the intestinal wall trophism. This article presents a clinical case of peritoneal dialysis in flow modification in a 1-month-old child with acute renal damage and necrotizing enterocolitis.

Diabetes mellitus (DM) is a public health problem worldwide. Despite the presence of various sugar-lowering drugs, correcting hyperglycemia and preventing late DM complications remain a difficult task. Unfortunately, DM complications are often detected at late stages, when there are irreversible changes and a global decrease in the function of damaged organs and systems. One of the most dangerous complications leading to early death of patients is diabetic nephropathy. However, the problem of finding early markers of renal damage that can detect the earliest renal damage in global clinical practice remains unresolved. The following are the modern markers that are likely to be able to timely reflect the preclinical manifestations of diabetic nephropathy (DN): Type-IV collagen, NGAL, b2MG, cystatin C, E-cadherin, podocalyxin, and nephrin. Heparan sulfate, mindin, TGF-β, ICAM-1, KIM-1, uromodulin, and LFABP are also being studied. The task of modern medicine is to find the most sensitive of these markers to diagnose DN in a timely manner.

Background and Aim: Hypertension is closely related to oxidative stress conditions, which increases malondialdehyde (MDA) expression and renal damage. Tilapia viscera hydrolysate extract (TVHE) contains compounds and peptides that act as antioxidants. This study aimed to investigate TVHE therapy effect on MDA levels and renal histological conditions in deoxycorticosterone acetate (DOCA)-salt-induced hypertension rats. Materials and Methods: Tilapia viscera were defatted and hydrolyzed using Alcalase enzyme to obtain TVHE. TVHE antioxidant activity was measured using the 1,1-diphenyl-2-picrylhydrazyl method. Fifteen Wistar male rats were divided into five groups: Normal control (without induced DOCA-salt), DOCA-salt, DOCA-salt+Captopril 5 mg/kg body weight (BW), DOCA-salt+TVHE 150 mg/kg BW, and DOCA-salt+TVHE 300 mg/kg BW. MDA level and renal histology were observed in each group. Results: TVHE half maximal inhibitory concentration values ranged from 3.87±0.35 μg/mL to 42.03±3.55 μg/mL, which were identified as in the very strong Blois category. TVHE and captopril therapy reduced MDA expression significantly (p

The prevalence of chronic kidney disease (CKD) is increasing worldwide, and the mortality rate continues to be unacceptably high. The biomarkers currently used in clinical practice are considered relevant when there is already significant renal impairment compromising the early use of potentially successful therapeutic interventions. More sensitive and specific biomarkers to detect CKD earlier on and improve patients' prognoses are an important unmet medical need. The aim of this review is to summarize the recent literature on new promising early CKD biomarkers of renal function, tubular lesions, endothelial dysfunction and inflammation, and on the auspicious findings from metabolomic studies in this field. Most of the studied biomarkers require further validation in large studies and in a broad range of populations in order to be implemented into routine CKD management. A panel of biomarkers, including earlier biomarkers of renal damage, seems to be a reasonable approach to be applied in clinical practice to allow earlier diagnosis and better disease characterization based on the underlying etiologic process. info:eu-repo/semantics/publishedVersion

High-fat diet (HFD) is the primary cause of metabolic syndrome associated chronic kidney disease. This study aimed to investigate the pathogenesis of HFD-induced kidney injury. ApoE−/− mice were fed with HFD and kidney damage was examined. In addition, HK-2 human renal proximal tubular epithelial cells were treated with fructose and receptor of advanced glycation end products (RAGE) siRNA. The results showed that HFD increased body weight, blood glucose and insulin resistance in ApoE−/− mice. The kidney damage was associated with increased oxidative stress and strong staining of RAGE and NF-κB in kidney tissues, as well as high serum levels of TNF-α, IL-1β and IL-6. Western-blot analysis showed that HFD increased the levels of RAGE, p-IκBα, p-NF-κB, bax, caspase-3 and caspase-9 but decreased the levels of Bcl-2 in kidney tissues. In HK-2 cells, fructose promoted the secretion of TNF-α, IL-1β and IL-6 and increased the levels of RAGE, p-IκBα, p-NF-κB, bax, caspase-3 and caspase-9, but decreased the levels of Bcl-2. Moreover, RAGE siRNA could attenuate increased levels of p-IκBα, p-NF-κB, bax, caspase-3 and caspase-9 while restore decreased levels of Bcl-2 in fructose-treated HK-2 cells. In conclusion, HFD causes kidney injury by promoting oxidative stress, inflammation and apoptosis possibly through the activation of RAGE/NF-κB pathway.

Background:Astragalus polysaccharide extract (APS) has been shown to exhibit antioxidant and anti-inflammatory potential in the treatment of several diseases. However, whether APS could protect against renal damage in hypertensive mice is unknown.Methods: Hematoxylin and eosin staining, immunohistochemistry, real-time polymerase chain reaction, and Western blotting were used to investigate the effect of APS on the renal damage in deoxycorticosterone acetate- (DOCA) salt- and angiotensin II- (Ang II-) induced hypertensive mice and to elucidate the underlying mechanisms.Results: Our data demonstrated that APS significantly reduced blood pressure in DOCA-salt- and Ang II-treated mice. Furthermore, APS reduced the inflammatory response and renal fibrosis, thereby improving renal function. Furthermore, the levels of serum creatinine, urea nitrogen, and uric acid increased in DOCA-salt-treated mice, alleviated by APS administration. At the molecular level, DOCA-salt and Ang II increased the mRNA levels of IL-1β, IL-6, α-SMA, collagen I, and collagen III, while APS significantly inhibited these effects. APS inhibited the TGF-β1/ILK signaling pathway, which was activated in hypertensive mice due to the administration of DOCA-salt.Conclusion: Our results suggest that APS plays a beneficial role in improving renal dysfunction in hypertensive mice.

Aim:To investigate the relationship between fibrinogen/albumin ratio (FAR) and early renal damage in hypertensive patients.Patients & methods:A retrospective study included 626 patients with hypertension, grouped according to the FAR tertiles and the presence or absence of early renal impairment. Early renal damage indicators[Serum cystatin c and β2 microglobulin] were detected in each group, and the differences between groups were compared, and the factors affecting early renal damage indicators were analyzed.Results:Serum cystatin c(CysC) and β2 microglobulin(β2-MG) levels in patients increased with FAR. In the renal impairment group, the fibrinogen and FAR were significantly increased, and serum albumin was decreased. FAR was positively correlated with β2-MG and CysC. Regression analysis showed that FAR level was a factor affecting blood β2-MG(β=6.632, p＜0.001)and CysC(β=1.991, p＜0.001).Conclusion:Elevated FAR is an independent risk factor for early renal damage in hypertensive patients

Primary vesicoureteral reflux often spontaneously resolves in children. However, in select patients, untreated reflux can contribute to recurrent pyelonephritis leading to irreversible renal damage. Management is therefore based on a given child's likelihood of recurrent urinary tract infections and risk of subsequent renal parenchymal injury. Therapeutic options for urinary reflux are diverse, ranging from observation with or without continuous low-dose antibiotic prophylaxis to a variety of operative interventions.

Background High‐fructose diet (HFr) induces hypertension and renal damage. However, it has been unknown whether the HFr‐induced hypertension and renal damage are exaggerated in subjects with salt sensitivity. We tested impacts of HFr in Dahl salt‐sensitive (DS) and salt‐resistant (DR) rats. Methods and Results Male DS and DR rats were fed control diet or HFr (60% fructose) with normal‐salt content. After 12 weeks, plasma and urinary parameters, renal histological characteristics, and renal expression of renin‐angiotensin system components were examined. Furthermore, effects of renin‐angiotensin system inhibitors were also examined in DS rats fed the HFr. HFr elevated blood pressure in DS rats but not in DR rats. HFr increased urinary albumin and liver type fatty acid binding protein excretions in both rats, but the excretions were exaggerated in DS rats. HFr increased plasma lipids and uric acid in both rats, whereas HFr increased creatinine clearance in DS rats but not DR rats. Although HFr decreased plasma renin activity in DS rats, HFr‐induced glomerular injury, afferent arteriolar thickening, and renal interstitial fibrosis were exaggerated in DS rats. HFr increased renal expression of angiotensinogen, renin, (pro)renin receptor, angiotensin‐converting enzyme, and angiotensin II type 1 receptor in DS rat, whereas HFr increased only angiotensin‐converting enzyme expression and decreased renin and angiotensin II type 1 receptor expressions in DR rats. Enalapril and candesartan attenuated the HFr‐induced hypertension, albuminuria, glomerular hyperfiltration, and renal damage in DS rats. Conclusion HFr‐induced hypertension and renal damage are exaggerated in DS rats via renal renin‐angiotensin system activation, which can be controlled by renin‐angiotensin system inhibitors.

The COVID-19 pandemic created a worldwide debilitating health crisis with the entire humanity suffering from the deleterious effects associated with the high infectivity and mortality rates. While significant evidence is currently available online and targets various aspects of the disease, both inflammatory and noninflammatory kidney manifestations secondary to COVID-19 infection are still largely underrepresented. In this review, we summarized current knowledge about COVID-19-related kidney manifestations, their pathologic mechanisms as well as various pharmacotherapies used to treat patients with COVID-19. We also shed light on the effect of these medications on kidney functions that can further enhance renal damage secondary to the illness.

Simple Summary This work shows that renal damage produced by the demonstration of unilateral ureteral obstruction (UUO) is not related to cardiac dysfunction or the change in mitochondrial bioenergetics parameters, despite the inflammatory state. Abstract Our work evaluated cardiac function and mitochondrial bioenergetics parameters in hearts from male Wistar rats subjected to the UUO model during 28 days of progression. We measured markers of kidney damage and inflammation in plasma and renal fibrosis by histological analysis and Western blot. Cardiac function was evaluated by echocardiography and proteins involved in cardiac damage by Western blot. Oxygen consumption and transmembrane potential were monitored in cardiac mitochondria using high-resolution respirometry. We also determined the activity of ATP synthase and antioxidant enzymes such as glutathione peroxidase, glutathione reductase, and catalase. Our results show that, although renal dysfunction is established in animals subjected to ureteral obstruction, cardiac function is maintained along with mitochondrial function and antioxidant enzymes activity after 28 days of injury evolution. Our results suggest that renocardiac syndrome might develop but belatedly in obstruction-induced renal damage, opening the opportunity for treatment to prevent this condition.

Background Primary aldosteronism (PA) is highly prevalent in hypertensive population. Adrenal vein sampling (AVS) is the only procedure to assess adrenal aldosterone hypersecretion in PA. PA patients without aldosterone-producing adenomas (APA) frequently have unilateral aldosterone hypersecretion (UAH). These patients could bear inappropriate adrenalectomy without AVS. This study aims to identify which clinical characteristics should be recommended to perform AVS in these PA patients. Methods This study was performed from January 2018 to July 2019 at a center for hypertension and metabolic diseases. Adrenal computed tomography (CT) scan, biochemical evaluation, and AVS were performed. Results Total 141 patients were included in this study. Aldosterone to renin ratio (ARR) after confirmatory test is highly associated with adrenal laterality. The specificity of ARR > 10 (ng/dL)/(mU/L) after confirmatory test is 100%. After confirmatory test, patients with ARR > 10 (ng/dL)/(mU/L) had higher plasma aldosterone concentration and incidences of ischemic heart diseases and renal damage(p Conclusions After confirmatory tests, ARR > 10 (ng/dL)/(mU/L) indicates adrenal laterality, with increasingly cardiorenal damage in PA patients without APA. Thus, AVS should be recommended in these patients before surgery. Trial registration NCT03398785, Date of Registration: December 24, 2017.

We experienced a case in which improving the renal damage caused by warfarin‐related nephropathy took a long time. It is important to follow up for a long time after the initiation of dialysis due to warfarin‐related nephropathy.

The Dahl salt-sensitive (SS) rat is an established model of SS hypertension and renal damage. In addition to salt, other dietary components were shown to be important determinants of hypertension in SS rats. With previous work eliminating the involvement of genetic differences, grain-fed SS rats from Charles River Laboratories (SS/CRL; 5L2F/5L79) were less susceptible to salt-induced hypertension and renal damage compared with purified diet-fed SS rats bred at the Medical College of Wisconsin (SS/MCW; 0.4% NaCl, AIN-76A). With the known role of immunity in hypertension, the present study characterized the immune cells infiltrating SS/MCW and SS/CRL kidneys via flow cytometry and RNA sequencing in T-cells isolated from the blood and kidneys of rats maintained on their respective parental diet or on 3 weeks of high salt (4.0% NaCl, AIN-76A). SS/CRL rats were protected from salt-induced hypertension (116.5±1.2 versus 141.9±14.4 mm Hg), albuminuria (21.7±3.5 versus 162.9±22.2 mg/d), and renal immune cell infiltration compared with SS/MCW. RNA-seq revealed >50% of all annotated genes in the entire transcriptome to be significantly differentially expressed in T-cells isolated from blood versus kidney, regardless of colony or chow. Pathway analysis of significantly differentially expressed genes between low and high salt conditions demonstrated changes related to inflammation in SS/MCW renal T-cells compared with metabolism-related pathways in SS/CRL renal T-cells. These functional and transcriptomic T-cell differences between SS/MCW and SS/CRL show that dietary components in addition to salt may influence immunity and the infiltration of immune cells into the kidney, ultimately impacting susceptibility to salt-induced hypertension and renal damage.

Hydrogen sulfide (H2S) attenuates N-methyl-d-aspartate receptor-R1 (NMDA-R1) and mitigates diabetic renal damage; however, the molecular mechanism is not well known. Whereas NMDA-R1 facilitates Ca2+permeability, H2S is known to inhibit L-type Ca2+channel. High Ca2+activates cyclophilin D (CypD), a gatekeeper protein of mitochondrial permeability transition pore (MPTP), thus facilitating molecular exchange between matrix and cytoplasm causing oxidative outburst and cell death. We tested the hypothesis of whether NMDA-R1 mediates Ca2+influx causing CypD activation and MPTP opening leading to oxidative stress and renal injury in diabetes. We also tested whether H2S treatment blocks Ca2+channel and thus inhibits CypD and MPTP opening to prevent renal damage. C57BL/6J and Akita (C57BL/6J-Ins2Akita) mice were treated without or with H2S donor GYY4137 (0.25 mg·kg−1·day−1ip) for 8 wk. In vitro studies were performed using mouse glomerular endothelial cells. Results indicated that low levels of H2S and increased expression of NMDA-R1 in diabetes induced Ca2+permeability, which was ameliorated by H2S treatment. We observed cytosolic Ca2+influx in hyperglycemic (HG) condition along with mitochondrial-CypD activation, increased MPTP opening, and oxidative outburst, which were mitigated with H2S treatment. Renal injury biomarker KIM-1 was upregulated in HG conditions and normalized following H2S treatment. Inhibition of NMDA-R1 by pharmacological blocker MK-801 revealed similar results. We conclude that NMDA-R1-mediated Ca2+influx in diabetes induces MPTP opening via CypD activation leading to increased oxidative stress and renal injury, and H2S protects diabetic kidney from injury by blocking mitochondrial Ca2+permeability through NMDA-R1 pathway.

To compare the serum level of the chemokine, CXCL 16, in preeclamptic and healthy pregnant patients.This prospective case control study was conducted between January and December 2018 in a tertiary level hospital. The study group was formed of 70 pregnant women diagnosed with preeclampsia, and the control group was formed of 70 healthy pregnant women matched to the study group in respect of age, gestational week and body mass index (BMI). The study group was separated into two subgroups of mild preeclampsia (No statistically significant difference was determined between the study and control groups in respect of maternal age, gravida, parity, BMI, and gestational age at sampling. Neonatal birth weight was significantly lower in the study group than in the control group. Mean serum alanine aminotransferase (ALT), aspartate amino transferase (AST) and creatinine levels of the study group were significantly higher than those of the control group (This is the first study in literature to show a significantly higher level of CXCL 16 in patients with severe preeclampsia compared to those with mild preeclampsia. The study can also be considered of value in respect of showing that CXCL 16 could play a role in the etiopathogenesis of preeclampsia and the emergence of renal-hepatic damage. Blocking the CXCL 16/CXCR six axis in preeclampsia treatment could lay the ground for the development of new drugs which could be used in the treatment of preeclampsia.

Background: It is not unusual for the pathologist to encounter various drug crystals in urine sediment which are morphologically different from the ones in his cognitive domain. Paucity of literature on crystals of all the drugs, makes it difficult to identify them. This study aims at exploring the microscopic appearance of crystals of common drugs. Material and Methods: Forty common drugs administered orally were included for the study. These drugs were mixed with distilled water on a slide, coverslipped and observed by two pathologists who were blinded. Of which one was a telepathologist who reported on images sent. Results: Crystals varied in their appearance and birefringence, few resembled architecture of known structures in urine sediment. Acetaminophen with hexagonal architecture resembled cysteine, broad colourless rectangular ceftriaxone crystals mimicked waxy cast. No definite answer was available for few, These data along with the light and polarising microscopic features are discussed in detail. Conclusion: Crystals of unusual appearance should alarm the pathologist to think of a drug and alert the physician in case of drugs causing renal damage.