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Diala M Alshiyab,1 Firas A Al-qarqaz,1 Enas Alhaje,1 Jihane A Mayou,1 Saja Jaradat,1 Ansam Asaad,1 Jihan M Muhaidat,1 Yousef Khader,2 Safa’ M Alsheyab,3 Ashraf O Oweis,4 Basheer Y Khassawneh,4 Suleiman M Momany,4 Shaher M Samrah,4 Musa Al-Ali4 1Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Public Health, Community Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Mathematics and Statistics, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Diala M Alshiyab, Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, P.O.BOX 3030, Irbid, 22110, Jordan, Tel +962798608037, Email dmalshiyab@just.edu.joBackground: COVID-19 pandemic hit the entire world with severe health and economic consequences. Although the infection primarily affected the respiratory system, it was soon recognized that COVID-19 has a multi-systemic component with various manifestations including cutaneous involvement.Objective: The main objective of this study is to assess the incidence and patterns of cutaneous manifestations among moderate-to-severe COVID-19 patients who required hospitalization and whether there was a prognostic indication for cutaneous involvement and the outcome in terms of recovery or death.Methods: This is a cross-sectional observational study that included inpatients who were diagnosed with a moderate or severe COVID-19 infection. The demographic and clinical data of patients were assessed including age, sex, smoking, and comorbidities. All patients were examined clinically for the presence of skin manifestations. Patients were followed for the outcome of COVID-19 infection.Results: A total of 821 patients (356 females and 465 males) aged 4– 95 years were included. More than half of patients (54.6%) aged > 60 years. A total of 678 patients (82.6%) had at least one comorbid condition, mostly hypertension and diabetes mellitus. Sixty-two patients (7.55%) developed rashes; 5.24% cutaneous and 2.31% oral. The rashes were then grouped into five major types: group A, Exanthema: morbilliform, papulovesicular, varicella-like. Group B, Vascular: Chilblain-like lesions, purpuric/petechial, livedoid lesions. Group C, Reactive erythemas: Urticaria, Erythema multiforme. Group D, other skin rashes including flare-up of pre-existing disease, and O for oral involvement. Most patients (70%) developed rash after admission. The most frequent skin rashes were reactive erythema (23.3%), followed by vascular (20.9%), exanthema (16.3%), and other rashes with flare-ups of pre-existing diseases (39.5%). Smoking and loss of taste were associated with the appearance of various skin rashes. However, no prognostic implications were found between cutaneous manifestations and outcome.Conclusion: COVID-19 infection may present with various skin manifestations including worsening of pre-existing skin diseases.Keywords: COVID-19, cutaneous manifestations, vitiligo-like hypopigmentation, pigmented purpuric dermatosis

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.

Background Pruritus is the most common symptom in patients with skin disease. Psoriasis and atopic dermatitis are clinically distinct inflammatory diseases. Interleukins are cytokines which play key roles in inflammatory signaling pathways. Materials and methods Cross-sectional study was conducted among patients with psoriasis and atopic dermatitis: 59 psoriatic patients, 56 AD patients, and 49 matched healthy controls. Interleukins 4, 13, 31, 33 serum levels were assayed by ELISA and results were compared using SPSS. Itch severity and disease severity were measured and correlation with interleukin levels was determined using SPSS. Results The serum levels of IL-4, -13, -31, -33 were elevated in atopic dermatitis patients compared to controls. Itch and disease severity were not correlated with elevated serum levels of these interleukins. In psoriasis, the levels of IL-4 and -31 were elevated compared to controls, whereas the levels of IL-13 and -33 were lower than controls. The levels of measured interleukins in psoriasis did not correlate with itch and disease severity. Conclusion IL-31 is the key mediator for pruritus in both AD and Ps patients. IL-4/31 axis and IL-33/13 axis play distinct roles in the pathogenesis of Atopic dermatitis and Psoriasis. Interleukin serum levels were not correlated with itch and disease severity in both conditions.

Background: High-grade prostatic intraepithelial neoplasia (HGPIN) is the most likely precancerous lesion for prostatic adenocarcinoma (PCa). Recent molecular studies have shown that HGPIN can harbor TMPRSS2-ERG fusion, a genetic marker also associated with PCa, which may provide an additional risk stratification tool for HGPIN, especially when present as an isolated lesion. Our aim was to assess the frequency of HGPIN and ERG expression in a cohort of prostatic needle core biopsies from Jordanian-Arab patients with PCa. Materials and methods: We studied 109 needle core biopsies from patients with PCa. Clinical data, including age and preoperative prostate specific antigen (PSA) level, were obtained from patients' medical records. Results: HGPIN was present in 31 (28.4 %) of the 109 cases. Of the HGPIN cases, 13 (41.9%) expressed ERG immunostain. ERG expression in HGPIN was independent of patient age at presentation (P=0.4), pre-operative PSA (P=0.9), and the grade, using the novel Grade Groups (P=0.5). Conclusion: The frequency of HGPIN in our cohort appears similar to the one found in the Western patient populations and demonstrates a comparable frequency of ERG expression in these lesions.

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.

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

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.

This study assessed the possible association of serum brain-derived neurotrophic factor (BDNF) and interleukin-6 (IL-6) with depressive and anxiety symptoms in hemodialysis (HD) patients.An analytical cross-sectional study was conducted over 274 HD patients from March to October 2017. The Hospital Anxiety and Depression Scale (HADS) was utilized to evaluate depressive (HADS-D) and anxiety (HADS-A) symptoms. The HADS-D/A is a self-report instrument that has a maximum score of 21. Serum BDNF and IL-6 were measured using enzyme-linked immunosorbant assay (ELISA).Serum IL-6 was significantly higher in patients with depressive symptoms compared to normal (20.47 ± 4.27 pg/mL for HADS-D ≥11 versus 9.26 ± 1.59 pg/mL for HADS-D7, p = 0.014). Multivariable regression analysis revealed that IL-6, education level, hypertension, and dialysis duration were significant predictors of HADS-D. Also, gender, education level, hypertension, and the number of dialysis sessions/week were significant predictors of HADS-A. Significant positive correlation was shown between HADS-D and IL-6 (r = 0.1729, p = 0.004).Collectively, HD patients with depressive symptoms showed higher levels of IL-6, supporting previous findings that the circulating inflammatory mediator IL-6 can be used as a biomarker for prediction of depressive symptoms in HD patients. Further longitudinal or interventional studies are needed to further validate this association.

Background: High-grade prostatic intraepithelial neoplasia (HGPIN) is the most likely precancerous lesion for prostatic adenocarcinoma (PCa). Recent molecular studies have shown that HGPIN can harbor TMPRSS2-ERG fusion, a genetic marker also associated with PCa, which may provide an additional risk stratification tool for HGPIN, especially when present as an isolated lesion. Our aim was to assess the frequency of HGPIN and ERG expression in a cohort of prostatic needle core biopsies from Jordanian-Arab patients with PCa. Materials and methods: We studied 109 needle core biopsies from patients with PCa. Clinical data, including age and preoperative prostate specific antigen (PSA) level, were obtained from patients’ medical records. Results: HGPIN was present in 31 (28.4 %) of the 109 cases. Of the HGPIN cases, 13 (41.9%) expressed ERG immunostain. ERG expression in HGPIN was independent of patient age at presentation (P=0.4), pre-operative PSA (P=0.9), and the grade, using the novel Grade Groups (P=0.5). Conclusion: The frequency of HGPIN in our cohort appears similar to the one found in the Western patient populations and demonstrates a comparable frequency of ERG expression in these lesions.

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

Patient: Male, 48 Final Diagnosis: Multiple myeloma Symptoms: Back pain Medication: — Clinical Procedure: — Specialty: Hematology Objective: Rare disease Background: Focal segmental glomerulosclerosis (FSGS) is a common cause of nephrotic syndrome in adults, which can be primary, or secondary to various causes. Unlike membranous nephropathy, FSGS is less likely to be associated with malignancy. Few cases have been reported of the occurrence of FSGS with hematological malignancies like multiple myeloma (MM). Case Report: A 48-year-old man presented with nephrotic syndrome and renal impairment and was diagnosed with primary FSGS after kidney biopsy, which showed a segmental scar with diffuse effacement of foot processes on electron microscopy. Treatment with steroids reduced proteinuria and stabilized the renal function. A few months later, the patient presented with acute Kidney Injury, bone pain, and anemia. A diagnosis of MM was made based on the bone marrow biopsy. Treatment of MM decreased proteinuria and improved renal function. Conclusions: There is an association between FSGS and MM through an unclear mechanism.

BACKGROUND The nonrenal clearance of drugs mediated by hepatic reduction is selectively altered by kidney disease. This study evaluated the influence of uremic serum on the expression and activity of reductase enzymes. METHODS Human hepatocellular carcinoma cells (HepG2) were incubated with 5% pooled serum collected from patients with hemodialysis (pre- and post-dialysis session) or control subjects. The mRNA expression of various aldo-keto (AKR1C) and carbonyl (CBR) reductases were measured. Reductase metabolic activity was assessed in human liver cytosol or HepG2 cells using naltrexone as a substrate. RESULTS Incubation of cells with pre-dialysis serum resulted in significant upregulation of AKR1C4 (by 63.2%) and CBR1 (by 34.6%) versus control serum. This increase was not observed for AKR1C1 and CBR1 with serum collected post-dialysis. While uremic serum had no effect on reductase activity, some instances with differences in metabolite formation among individual's pre- and post-dialysis samples were observed. CONCLUSION Although uremic serum can upregulate mRNA expression of several reductases, this effect was not observed at the activity level. Future studies are necessary to improve our understanding of the mechanistic effects of impaired kidney function on drug reduction.

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.

Psychological symptoms are prevalent in hemodialysis (HD) patients. Previous investigations showed that brain-derived neurotrophic factor (BDNF) and interleukin-6 (IL-6) as well as the interaction with neuropeptide S receptor 1 (NPSR1) are linked to the development of psychological distress. This study examined the association of polymorphisms of genes encoding these proteins with depression and anxiety in a representative group of Jordanian HD patients.A total of 302 HD patients were involved in the study and categorized into three groups based on the Hospital Anxiety and Depression Scale, HADS-D or HADS-A scores as follows: normal (7), mild (8-10) and moderate-severe (11-21). Single nucleotide polymorphism (SNP) of NPSR1 Asn107Ile (rs324981), IL-6 G174C (rs1800795), and BDNF Val66Met (rs6265) was genotyped using blood samples.The frequency of Ile-allele of NPSR1 Asn107Ile was significantly higher in patients with moderate-severe HADS-A scores versus normal (53% vs. 40.8%, p = .035). Using ordinal regression analysis, Asn-allele of NPSR1 polymorphism was nominally significantly associated with a lower risk of anxiety (OR = 0.57, CI: 0.33-0.97, p = .038) after adjusting for other covariates. A marginally significant difference in genotype distribution of IL-6 G174C was observed among patients according to HADS-D scores (p = .05). Furthermore, carriers of IL-6174 CC genotype showed lower median IL-6 serum concentration versus carriers of GG genotype (5.2 vs. 1.35 pg/mL, p .05).The results support the genetic role of NPSR1 in the pathogenesis of anxiety and suggest that carriers of NPSR1 Ile-allele are at increased risk of anxiety in HD patients. Neither BDNF Val66Met nor IL-6 G174C were linked to psychological symptoms. Future studies among other ethnicities are necessary to verify the observations.