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Abstract We investigated the effect of two dosing regimens of oral iron on iron status and hematological parameters in patients with CKD. In this single center, open label, randomized, active controlled clinical trial, stable adult patients with CKD stage G3–4 with percentage transferrin saturation (%TSAT) ≤ 30% and serum ferritin ≤ 500 ng/ml were eligible. Participants were randomized to receive either 100 mg of ferrous ascorbate once daily (OD group) or 100 mg of ferrous ascorbate twice daily (BD group, total daily dose 200 mg). The primary outcome was change in %TSAT between groups over 12 weeks. The secondary outcomes were changes in other iron status and hematological parameters, serum interleukin-6 (IL-6) and hepcidin. 80 participants were enrolled out of which 76 completed the study. Change in %TSAT was not significantly different between groups (β = − 1.43, 95% CI − 3.99 to 1.12, BD group as reference). The rise in serum ferritin was less in the OD group as compared to BD group (β = − 0.36, 95% CI − 0.61 to − 0.10) whereas MCHC increased in the OD group as compared to decrease in the BD group (β = 0.37, 95% CI 0.067–0.67). These observations need exploration to ascertain the impact of different oral iron dosing strategies in CKD.

The preferential use of convective modes of hemodialysis (HD) for targeting hyper-cytokinemia state in sepsis-related acute kidney injury (AKI) has been questioned for its efficacy. Several studies have used predilution hemodiafiltration (HDF) in critically ill AKI patients with mixed results. In this study, we compared intermittent online postdilution HDF with the standard high-flux (HF) intermittent HD in non-critically ill patients with community-acquired (CA) AKI. In this pilot study, stable patients with CA AKI and systemic inflammatory response syndrome were included and given either postdilution online-HDF (OL-HDF) or standard HF HD outside intensive care units. The primary objectives were to assess the feasibility of conducting the study at a larger scale and to detect the differential impact of convective clearance on the rates of independence from dialysis at discharge or after 30 days. Plasma cytokine clearance was assessed as a secondary objective. Eighty consecutive AKI patients were randomized to receive dialysis in one of the treatment arms after fulfilling the eligibility criteria. The baseline parameters of clinical severity, etiology, and indications of dialysis, plus the baseline plasma cytokine profiles, were comparable. Moreover, 83% in the control arm and 71.1% in the intervention arm became independent from dialysis at discharge or at 30 days (P = 0.189). No survival advantage of postdilution OL-HDF was observed (P >0.05). Similar plasma cytokine clearance levels were noted in both arms. The current study confirms the feasibility; however, it does not support the preferential use of postdilution OL-HDF over HF-HD in non-critical patients.

Primary membranous nephropathy (PMN) is a common cause of adult-onset nephrotic syndrome. Anti-M-type phospholipase A2 receptor (PLA2R) antibodies are pathogenic and correlate with clinical outcomes. The role of anti-PLA2R in recurrent PMN is unclear. In the present manuscript, we report five cases of PMN who underwent kidney transplantation (KT) with varying titers of anti-PLA2R pre-kidney transplantation (KT). Two patients with anti-PLA2R in the second and third tertiles had a recurrence of PMN, whereas patients with a negative or anti-PLA2R in the first tertile had no recurrence. The report signals a heightened risk of PMN recurrence in patients with elevated anti-PLA2R antibody titer at KT.

Membranous nephropathy (MN) is the most common cause of primary nephrotic syndrome among adults. The identification of phospholipase A2 receptor (PLA2R) as target antigen in most patients changed the management of MN dramatically, and provided a rationale for B-cell depleting agents such as rituximab. The efficacy of rituximab in inducing remission has been investigated in several studies, including 3 randomized controlled trials, in which complete and partial remission of proteinuria was achieved in approximately two-thirds of treated patients. Due to its favorable safety profile, rituximab is now considered a first-line treatment option for MN, especially in patients at moderate and high risk of deterioration in kidney function. However, questions remain about how to best use rituximab, including the optimal dosing regimen, a potential need for maintenance therapy, and assessment of long-term safety and efficacy outcomes. In this review, we provide an overview of the current literature and discuss both strengths and limitations of “the new standard.”

The primary objective of the current study was to create a mathematical model utilizing fractional-order calculus for the purpose of analyzing the symmetrical characteristics of Wolbachia dissemination among Aedesaegypti mosquitoes. We investigated various strains of Wolbachia to determine the most sustainable one through predicting their dynamics. Wolbachia is an effective tool for controlling mosquito-borne diseases, and several strains have been tested in laboratories and released into outbreak locations. This study aimed to determine the symmetrical features of the most efficient strain from a mathematical perspective. This was accomplished by integrating a density-dependent death rate and the rate of cytoplasmic incompatibility (CI) into the model to examine the spread of Wolbachia and non-Wolbachia mosquitoes. The fractional-order mathematical model developed here is physically meaningful and was assessed for equilibrium points in the presence and absence of disease. Eight equilibrium points were determined, and their local and global stability were determined using the Routh–Hurwitz criterion and linear matrix inequality theory. The basic reproduction number was calculated using the next-generation matrix method. The research also involved conducting numerical simulations to evaluate the behavior of the basic reproduction number for different equilibrium points and identify the optimal CI value for reducing disease spread.

This manuscript is concerned with the stability and synchronization for fractional-order delayed gene regulatory networks (FODGRNs) via Razumikhin approach. First of all, the existence of FODGRNs are established by using homeomorphism theory, 2-norm based on the algebraic method and Cauchy Schwartz inequality. The uniqueness of this work among the existing stability results are, the global Mittag-Leffler stability of FODGRNs is explored based on the fractional-order Lyapunov Razumikhin approach. In the meanwhile, two different controllers such as linear feedback and adaptive feedback control, are designed respectively. With the assistance of fractional Razumikhin theorem and our designed controllers, we have established the global Mittag-Leffler synchronization and adaptive synchronization for addressing master-slave systems. Finally, three numerical cases are given to justify the applicability of our stability and synchronization results.

This paper inspects the issues of synchronization stability and robust synchronization stability for fractional order coupled complex interconnected Cohen-Grossberg neural networks under linear coupling delays. For investigation of synchronization stability results, the comparison theorem for multiple delayed fractional order linear system is derived at first. Then, by means of given fractional comparison principle, some inequality methods, Kronecker product technique and classical Lyapunov-functional, several asymptotical synchronization stability criteria are addressed in the voice of linear matrix inequality (LMI) for the proposed model. Moreover, when parameter uncertainty exists, we also the investigate on the robust synchronization stability criteria for complex structure on linear coupling delayed Cohen-Grossberg type neural networks. At last, the validity of the proposed analytical results are performed by two computer simulations.

Renal cell carcinoma (RCC) is a common solid malignancy among renal transplant recipients. While it commonly involves the native kidneys, renal allograft RCC is increasingly being reported in renal transplant recipients. Most often, renal allograft RCCs are locally confined and nephron-sparing interventions are successful treatments. Immunosuppression is typically reduced in transplant recipients who develop malignancies; however, there is no consensus on the same for transplant recipients with a diagnosis of RCC. We report two cases of renal allograft RCC who were successfully managed with ablative therapy and reduction of immunosuppression. However, both the patients developed irreversible graft dysfunction and are wait-listed in the deceased donor program for the second transplant. We highlight the deficiency of evidence and the need for further studies on the aspect of immunosuppression modification after the diagnosis of RCC in transplant recipients.

There is a paucity of data on epidemiology along with an incomplete registry of end-stage kidney disease (ESKD), nephrologist workforce, and variability among the countries of Gulf Cooperation Council (GCC). The study is an observation, descriptive study which aimed to describe current ESKD burden, nephrologist density, and kidney care infrastructure in GCC. Responses to a questionnaire-based survey obtained from representatives of the Nephrology Societies of GCC countries were analyzed. The categorical variables were compared using Chi-square test. A P = 5% was considered as significant. The mean prevalence of ESKD per million populations (pmp) was 551, highest in Oman (1000/pmp), least in Qatar (347/pmp). Predominant etiology in GCC was diabetes mellitus (DM) and hypertension (HTN) (100%, each), followed by chronic glomerulonephritis (66.7%). A transplant registry was maintained by all GCC countries. Hemodialysis (HD) (67.2%) was the most opted modality of kidney replacement therapy (KRT), followed by kidney transplantation (22%) and peritoneal dialysis (9.6%); 1.0% of patients opted for conservative management. Unplanned initiation of HD was three times more common. The access distribution among incident and prevalent HD patients respectively was (i) nontunneled central catheter (nTCC) (58.7 ± 36.6 vs. 1.5 ± 1.5), (ii) tunneled central catheter (23.5 ± 29.9 vs. 33.6 ± 10.0), and (iii) arteriovenous fistula (17.3± 14.4 vs. 57.8 ± 11.86). Death and transplantation were the reasons for dropout from HD. GCC has adequate kidney care infrastructure. There are 1686 nephrologists [range: Bahrain 9, Kingdom of Saudi Arabia (KSA) 1279]. Qatar, KSA, and Kuwait provide training in kidney biopsy; all countries except Bahrain have formal training programs for nTCC placement. ESKD prevalence is high, DM, HTN; glome-rulonephritis (GN) is the most common causes. The need for KRT is expected to rise in GCC. HD is the predominant KRT modality with a high prevalence of dialysis catheters as vascular access.

Novel coronavirus disease 2019 (COVID-19) has emerged as a threat to the human population worldwide. Old age and presence of comorbidities are risk factors for severe complications of the disease, as many of these patients are not able to mount effective or have an aberrant antiviral response. Patients with chronic kidney disease are at high risk of COVID-19 and its complications, especially those with end-stage renal disease (ESRD). Patients have repeated exposure to crowding in dialysis units, and face the uncertainties of health care system sustainability during periods of increasing demand and scarce supply. Acute kidney injury (AKI) is a notable complication in patients with COVID-19 with an incidence of up to 25% in specific populations. Patients with AKI have a higher mortality rate. The etiology and pathogenesis of AKI in COVID-19 are multifactorial. Direct viral invasion and cytopathic effects on renal tubular cells and indirect factors like hypovolemia, rhabdomyolysis, renal vein congestion, and hypercoagulable state play a role in causing AKI in these patients. Renal replacement therapy in the form of continuous renal replacement therapy is most widely used worldwide mostly due to hemodynamic instability of critically sick patients with COVID-19. Anticoagulation therapy is critical as most COVID-19 patients have increased clotting tendency and extracorporeal circuit thrombosis is common. ESRD patients in China had mild-to-moderate symptoms commonly. However, the data from Spain and Italy report a higher mortality rate in ESRD patients than the general population. Strict screening and uniform adherence to infection control practices have led to a decreased risk of cross-infection among other patients and dialysis personnel in dialysis units. The association between nephrology and COVID-19 is unique and focus on further research on kidney pathology along with the strengthening of existing dialysis facilities are needed.

Introduction: Fungi are ubiquitous organisms and significantly alter the post-transplant course. They are a major cause of morbidity and mortality and more so in developing countries. Aims: To study the clinical profile, etiology, risk factors, treatment, and outcome of fungal infections in post-renal transplant recipients. Materials and Methods: This was a cross-sectional observational retrospective study from January 2014 to June 2017 wherein renal transplant recipients with invasive fungal infection were included and were followed. Results: Amongst 550 renal transplant recipients, 56 (10.2%) patients developed invasive fungal infection. Mean age of patients was 40.61 ± 10.06 (13-66) years and mean duration of acquiring infection post-transplant was 25.33 ± 23.65 (1-96) months. Male to female ratio was 3:1. Fever was the commonest presentation observed in 89.3% patients. Cough (76.8%), breathlessness (64.3%), sputum (55.3%), hypoxia (50%), and hemoptysis (10.7%) were other common clinical symptoms at presentation. Mean serum creatinine at presentation was 1.70 mg/dl. Most common invasive fungal infection isolated was Mucormycosis 15 (26.7%), foolwed by Aspergillosis 13 (23.2%), Pneumocystis jiroveci 12 (21.4%), Cryptococcus 6 (10.7%), Candida 4 (7.1%), Histoplasmosis 3 (5.3%), Phaeohypomycosis 2 (3.5%), and 5 (8.9%) patients had undetermined fungal etiology. Twenty (35.7%) patients had evidence of dual infection. Use of antithymocyte globulin 27 (48.2%), post-transplant diabetes mellitus 18 (32.1%), Cytomegalovirus (CMV) infection 16 (28.5%), anti-rejection therapy 9 (16%), and Hepatitis C infection 7 (12.5%) were some identified risk factors. Ten (17.8%) patients had graft loss and 12 (21.4%) patients died in the study period. Conclusions: Invasive fungal infection is a serious threat to renal transplant recipients. Patient and graft survival is significantly affected by fungal infection in developing world.

Bilateral renal cortical necrosis (RCN) as a cause of acute kidney injury is very rare in the pediatric population. Progression to end-stage renal disease is seen virtually in every patient with RCN. There are many causes for the occurrence of cortical necrosis in children, with severe pancreatitis being a rarity. In this report, we describe a child with severe acute pancreatitis complicated by bilateral RCN.

Sensitized patients, who constitute a considerable proportion of kidney-transplant recipients, often have poor allograft outcomes. Only cell-based complement-dependent cytotoxicity (CDC) assays are typically used to quantify donor-specific antibodies (DSAs) in patients in developing nations, owing to financial restraints. We report the clinical outcomes of ten sensitized patients who were stratified and managed based on Luminex single-antigen beads (SAB) method for the DSA detection in a cost-limited set-up. Sensitization events included a history of blood transfusion, multiple pregnancies, and previous allograft loss. Anti-human leukocyte antigen antibodies, measured by SAB and reported as mean fluorescence intensity (MFI), were considered positive if the value was > 1000 MFI for single antigen. Three best approaches, (1) cadaveric transplants using virtual cross-match for kidney allocation in five patients, (2) desensitization before living donor transplants for four donor–recipient pairs with immunological incompatibility (high DSAs but cross-match compatible), and (3) combined kidney paired exchange with desensitization for one donor–recipient pair with cross-match incompatibility (positive CDC cross-match), resulted in successful allograft outcomes in all the 10 patients during follow-up (range: 3–55 months). DSA by SAB to assess pretransplant immunological risk (in a sensitized recipient) is useful even in cost-limited settings, largely due to reduction of posttransplant rejection rates and avoidance of mortality while on the waitlist.

Background. Allograft rejection postkidney transplantation (KTx) is a major clinical challenge despite increased access to a healthcare system and improvement in immunosuppressive (IS) drugs. In recent years, mesenchymal stromal cells (MSCs) have aroused considerable interest in field of transplantation due to their immunomodulatory and regenerative properties. This study was aimed at investigating safety, feasibility, and immunological effects of autologous MSCs (auto-MSCs) and allogeneic MSCs (allo-MSCs) as a complement to IS drug therapy in KTx patients. Methods. 10 patients undergoing KTx with a living-related donor were analysed along with 5 patients in the control group. Patients were given auto-MSCs or allo-MSCs at two time points, i.e., one day before transplant (D-0) and 30 days after transplant (D-30) at the rate of 1.0-1.5×106 MSCs per kg body weight in addition to immunosuppressants. Patients were followed up for 2 years, and 29 immunologically relevant lymphocyte subsets and 8 cytokines and important biomarkers were analysed at all time points. Results. Patients displayed no signs of discomfort or dose-related toxicities in response to MSC infusion. Flow cytometric analysis revealed an increase in B regulatory lymphocyte populations and nonconventional T regulatory cells and a decrease in T effector lymphocyte proportions in auto-MSC-infused patients. No such favourable immune responses were observed in all MSC-infused patients. Conclusion. This study provides evidence that auto-MSCs are safe and well tolerated. This is the first ever report to compare autologous and allogeneic MSC infusion in KTx patients. Importantly, our data demonstrated that MSC-induced immune responses in patients did not completely correlate with clinical outcomes. Our findings add to the current perspective of using MSCs in KTx and explore possibilities through which donor/recipient chimerism can be achieved to induce immune tolerance in KTx patients.

Cryptococcal infection constitutes 2.8% of opportunistic infections in solid-organ transplant recipients. The most common organ affected in renal transplant recipients (RTRs) is central nervous system and usually presents with chronic meningoencephalitis. Rapid neurological deterioration in RTR with chronic meningitis despite antimicrobial therapy should alert towards the possibility of either alternative/polymicrobial etiology or complications including hydrocephalus. In this context, we report a RTR with chronic meningitis initiated on empirical antitubercular therapy in the absence of conclusive microbiological diagnosis despite serial cerebrospinal fluid analysis and later admitted with complication in form of obstructive hydrocephalus requiring external ventricular drainage which proved to be therapeutic (decreasing raised intracranial hypertension) as well as diagnostic (yielding Cryptococcus), thereby confirming alternative etiology of chronic meningitis.

Although rare, polymicrobial meningitis has been infrequently reported in renal transplant recipients (RTRs). In this context, we describe a RTR on triple immunosuppression therapy, with stable graft function, who had presented with fever and altered sensorium of 2 days' duration. Evaluation revealed polymicrobial meningitis, which was initially attributed to concurrent infection by Cryptococcus neoformans and Acinetobacter baumannii and was later superinfected with Elizabethkingia meningoseptica. The overall prognosis in polymicrobial meningitis remains dismal, re-emphasizing the importance of early suspicion and prompt microbiological diagnosis for targeted antimicrobial therapy.

Transplantation-associated thrombotic microangiopathy (TMA) is one of the most disastrous complications of renal transplantation. It may be either de novo (more common with a poor prognosis) or recurrent (with genetic background due to underlying mutations). Varied presentation mandates a high index of clinical suspicion, and the diagnosis usually requires allograft biopsy demonstrating TMA with or without underlying etiology. It has never been reported to mimic hyperacute rejection. In this context, we describe an end-stage renal disease patient with underlying IgA nephropathy, who underwent blood group incompatible renal transplant following successful desensitization and after that had systemic TMA in the 1st-h posttransplant itself, with allograft biopsy revealing florid TMA with no evidence of rejection, tacrolimus toxicity, or infection. Etiology remained elusive despite exhaustive workup and all possible attempts to salvage the allograft went in vain, with subsequent graft nephrectomy at 3 months. The patient after that has undergone a blood group compatible deceased-donor renal transplant and fortunately has normal graft function at 2 years follow-up, enthralling us to hypothesize possible interaction between the endothelial cells of renal allograft and anti-donor hemagglutinin antibodies; a mechanism already avowed for graft loss in blood group incompatible liver transplantation. We, therefore, suggest that patients willing for blood group incompatible renal transplantation need to be counseled beforehand about this, although a rare but devastating entity.

Invasive mycosis is a serious complication of solid organ transplantation. Fungal infections even if appropriately diagnosed and treated with current antifungal agents, have a high mortality rate. A high index of suspicion is required and an attempt should be made to confirm the microbiological diagnosis from each site involved to rule out multiple infections. We report here a 41-year-old allograft recipient, who presented with fever associated with chills and one episode of generalized tonic clonic seizure 1-year post transplantation. Neuroimaging revealed a brain abscess, stereotactic biopsy from which yielded Scedosporium apiospermum on fungal culture. Whole blood quantitative cytomegalovirus (CMV) polymerase chain reaction done was positive. He also developed pulmonary aspergillosis and secondary hemophagocytosis later in the course of his hospital stay. His tacrolimus and mycophenolate were stopped and he was managed with i.v ganciclovir, amphoterecin b, voriconazole, high dose i.v immunoglobulins and surgical draingae of abscess. With all measures, he showed improvement in his general and neurological condition and maintained good graft function. Scedosporium is a rare cause of brain abscess. CMV co-infection leads to increased chances of other opportunistic infections. Good microbiological workup from each site involved in immunosuppressed subjects is the need of the hour as early diagnosis can lead to lesser mortality and morbidity.

Expanding use of ABO-incompatible kidney transplant (ABOiKT) globally and in India demands harmonized protocols. With an aim to provide unified and standardized consensus for ABOiKT in Indian setting, a 14-member working group formulated this document on key critical areas to guide ABOiKT. The recommendations include the following: (i) Gel column agglutination test is a method of choice for antibody (Ab) titer assessment with tube method as acceptable alternative. Immunoglobulin G measurement is advised for clinical decision making. (ii) Assessment of one Ab titer before subjecting patient to Ab removal is recommended. Postplasmapheresis (PP) titers to be monitored anywhere between 2 and 12 h. (iii) Target Ab titer recommended is ≤1:16 irrespective of the method used for titer assessment. (iv) If cost and availability are not a concern, immunoadsorption (IA) should be preferred. (vi) Choice of replacement fluid depends on the method employed for Ab removal. (vii) Donor or AB-positive plasma transfusion can be considered to avoid coagulopathy and bleeding in posttransplant period. It also decreases the risk of coagulopathy associated with greater number of PP cycles performed during and after transplant. (viii) IA column can be reused if cleaned, sterilized and stored properly. (ix) Intravenous immunoglobulin (IVIG) is optional for use in ABOiKT. Choose IVIG batch with lowest ABO- Ab titers and use in low dose (~ 100 mg/kg). (x) Rituximab in a low dose of 100–200 mg is effective and its use (at-least 2 weeks prior to transplant) is at the discretion of treating renal transplant physician. (xi) Avoid, if possible, the combined used of antithymocyte globulin and rituximab as it increases risk of infections significantly. (xii) Posttransplant PP is needed if there is Ab mediated rejection with increasing titers. (xiii) Standard immunosuppression should be followed. These recommendations are first of a kind that aims to standardize the practice of ABOiKT, serve as a guiding tool to the transplant physicians in India.

Introduction: Treatment options for recurrent C3 glomerulopathy (C3G) are not explored in large trials. Only Eculizumab has been successfully used to improve the renal function in patients with recurrent C3G. In the current report, we are sharing our experience with plasma exchange (PLEX) in the management of early recurrent C3G post-renal transplantation. Materials and Methods: A total of four patients underwent PLEX. Time to recur was less than two weeks in all the patients. Serology levels, autoantibody testing and limited genetic workup was done in all the four patients. The clinical details of patients were recorded. Results: All the patients underwent 5 PLEX (40 ml/kg/session) with fresh frozen plasma as the replacement. The median time for post-transplant recurrence was 3-days. Immediate reduction in serum creatinine was seen in three (75%) patients. After a median last follow-up of 8.5 (range: 4-18) months, two (50%) patients achieved remission and the other two (50%) had resistant disease resulting in graft loss. Three patients tested positive for autoantibodies (two cases had positive C3-nephritic factor and one had anti-complement factor-H autoantibodies. Complement factor H gene analysis revealed rs1061170; p.His402Tyr (missense variant), rs1061147; p.Ala307= (synonymous variant) and rs2274700; p.Ala473= (synonymous variant) in three cases. All the three patients who had immediate response to PLEX had positive autoantibodies against complement pathway regulators. Conclusion: In the present report, we performed extensive workup for complement pathway abnormality and found that patients with recurrent C3G following transplantation having autoantibodies benefited with PLEX.

Background. The association between economic status and kidney disease is incompletely explored even in countries with higher economy (HE); the situation is complex in lower economies (LE) of South Asia and Southeast Asia (SA and SEA). Methods. Fifteen countries of SA and SEA categorized as HE and LE, represented by the representatives of the national nephrology societies, participated in this questionnaire and interview-based assessment of the impact of economic status on renal care. Results. Average incidence and prevalence of end-stage kidney disease (ESKD) per million population (pmp) are 1.8 times and 3.3 times higher in HE. Hemodialysis is the main renal replacement therapy (RRT) (HE-68%, LE-63%). Funding of dialysis in HE is mainly by state (65%) or insurance bodies (30%); out of pocket expenses (OOPE) are high in LE (41%). Highest cost for hemodialysis is in Brunei and Singapore, and lowest in Myanmar and Nepal. Median number of dialysis machines/1000 ESKD population is 110 in HE and 53 in LE. Average number of machines/dialysis units in HE is 2.7 times higher than LE. The HE countries have 9 times more dialysis centers pmp (median HE-17, LE-02) and 16 times more nephrologist density (median HE-14.8 ppm, LE-0.94 ppm). Dialysis sessions >2/week is frequently followed in HE (84%) and 10% in all the HE countries except Taiwan, 10%–20% in the majority of LE countries. Conclusion. Economic disparity in SA and SEA is reflected by poor dialysis infrastructure and penetration, inadequate manpower, higher OOPE, higher dialysis dropout rates, and lesser renal transplantations in LE countries. Utility of RRT can be improved by state funding and better insurance coverage.

This paper concerns the issues of exponential stability in Lagrange sense for a class of stochastic Cohen–Grossberg neural networks (SCGNNs) with Markovian jump and mixed time delay effects. A systematic approach of constructing a global Lyapunov function for SCGNNs with mixed time delays and Markovian jumping is provided by applying the association of Lyapunov method and graph theory results. Moreover, by using some inequality techniques in Lyapunov-type and coefficient-type theorems we attain two kinds of sufficient conditions to ensure the global exponential stability (GES) through Lagrange sense for the addressed SCGNNs. Ultimately, some examples with numerical simulations are given to demonstrate the effectiveness of the acquired result.

This research paper deals with the passivity and synchronization problem of fractional-order memristor-based competitive neural networks (FOMBCNNs) for the first time. Since the FOMBCNNs’ parameters are state-dependent, FOMBCNNs may exhibit unexpected parameter mismatch when different initial conditions are chosen. Therefore, the conventional robust control scheme cannot guarantee the synchronization of FOMBCNNs. Under the framework of the Filippov solution, the drive and response FOMBCNNs are first transformed into systems with interval parameters. Then, the new sufficient criteria are obtained by linear matrix inequalities (LMIs) to ensure the passivity in finite-time criteria for FOMBCNNs with mismatched switching jumps. Further, a feedback control law is designed to ensure the finite-time synchronization of FOMBCNNs. Finally, three numerical cases are given to illustrate the usefulness of our passivity and synchronization results.

Aim: Recurrence of focal segmental glomerulosclerosis (FSGS) in the post-transplant setting is variable with high rates of graft loss. Risk factors of recurrence include young age and Caucasian race. Data on outcome of recurrent FSGS from South Asia is scanty. We describe our experience of managing adults with recurrent FSGS with different therapies. Settings and Design: The study was conducted at the Department of Nephrology and Renal transplant surgery, Post Graduate Institute of Medical education and Research Institute, Chandigarh, India, and this was an observational study. Methods: We analyzed outcomes of patients with biopsy-proven recurrent FSGS over the last 5 years (2012–2017). Recurrence was defined as significant proteinuria (albuminuria ≥ 3+) and a demonstrable FSGS lesion on light microscopy and/or electron microscopy suggestive of diffuse foot process effacement. Results: Thirteen patients with 14 recurrences of FSGS post-renal transplant were identified. Mean age of the patients was 33.15 (±8.32) years. Median time to recurrence of FSGS was 45 days. Plasma exchange (PLEX) alone was used in two patients with 50% in remission. Combined PLEX and rituximab were used in six recurrences with remission in 83.3% of them. Five recurrences were treated with only angiotensin-converting enzyme inhibitor/angiotensin receptor blockade (ACEi/ARB) due to financial constraints. Of them, 4 (80%) achieved remission in proteinuria. One patient did not receive any therapy and expired in the 1st month of follow-up. Conclusion: The present series is one of the largest reports of recurrent FSGS from South Asia. Furthermore, the current report strengthens the use of ACEi/ARB in patients with recurrent FSGS.

Although rare, both Cladophialophora bantiana (C. bantiana) and Toxoplasma gondii have been known to be associated with brain abscess in renal transplant recipients (RTRs), however co-infection has never been reported till date. In the present case, 40 years old renal transplant recipient on curtailed immunosuppressive therapy presented with progressive headache and altered sensorium. The computed tomography of head showed multiple ring-enhancing discrete lesions in the left frontal lobe, with moderate perilesional oedema. Left frontal craniotomy and aspiration revealed thick yellowish brown pus, which on culture showed the growth of dematiaceous fungal hyphae “C. bantiana” and co-infection with “Toxoplasma” was confirmed by PCR as well as serology (both IgM and IgG – Toxoplasma) positivity. Stereotactic aspiration/open craniotomy and drainage is imperative to arrive at microbiological diagnosis and provide timely therapy to the patient. Keywords: Brain abscess, Renal transplantation, Cladophialophora bantiana, Toxoplasma

Both cCTX/GCs and CNIs are recommended as first-line agents in the management of PMN. The present study is an extended report of patients randomized to receive TAC/GCs or cCTX/GCs at 2 years post randomization. Methods: Seventy patients enrolled in the clinical trial Tacrolimus Combined With Corticosteroids Versus Modified Ponticelli Regimen in Treatment of Idiopathic Membranous Nephropathy: Randomized Control Trial were followed quarterly between 12 and 24 months. At the end of 24 months, 3 patients were lost to follow-up. Results: At 18 months, 66% and 89% (P = 0.04) were in remission in TAC/GCs and cCTX/GCs groups, respectively. At 18 and 24 months, 60% and 86% (P = 0.03) of cases were in remission in the TAC/GCs and cCTX/GCs groups, respectively. At 18 months, 57% and 83% (P = 0.03) of the patients in TAC/GCs and cCTX/GCs groups were in remission without need of any additional immunosuppression (persistent remission) and, at 24 months, 43% and 80% (P = 0.002) were in persistent remission in TAC/GCs and cCTX/GCs groups, respectively. Relapse rate after any remission was 40% and 6.7% in TAC/GCs and cCTX/GCs groups, respectively (P = 0.007). There was an association of aPLA2R titers with remission or resistance (P = 0.006) in relapsing PMN. The significant decrease in eGFR after 12 months of TAC/GCs therapy normalized at 18 and 24 months. Discussion: At 2 years after randomization, relapse rates are higher for TAC/GCs compared with cCTX/GCs in PMN patients. Thus, cCTX/GCs are better than TAC/GCs in the longer term in PMN patients.

Background: Living donor renal transplantation is the dominant type of renal transplantation in developing countries such as India. We looked at factors affecting allograft and patient survival in such circumstances as these could be different owing to unique socioeconomic, demographic, and patient characteristics. Methods: We retrospectively analyzed data of living donor renal transplantation done at Postgraduate Institute of Medical Education and Research, Chandigarh, over 5 years (2002–2007) to ascertain the factors that affect allograft and patient survival. The relationship of pretransplant characteristics of patient and donor, comorbid conditions, posttransplant immunosuppressive drug regimens, and infectious and noninfectious complications to allograft survival and patient survival were assessed. Results: A total of 554 living donor renal transplantation surgeries were performed during this period. Rates of death-censored renal allograft survival at 1, 3, and 5 years after transplant were 94%, 90%, and 79%, respectively. Independent predictors of death-censored graft loss were BK virus nephropathy, episodes of rejection, and use of immunosuppressive drug protocols other than triple drug regimen of tacrolimus, mycophenolate mofetil, and prednisolone. The patient survival at 1, 3, and 5 years after transplant in our study was 92%, 87%, and 83%, respectively. Presence of cytomegalovirus disease, recipient age ≥50 years, unrelated transplant (spousal donor or donor beyond first-degree relative), and presence of any opportunistic infection were found to be significant independent predictors of patient survival. Conclusions: Although retrospective, our data have shown comparable rates for allograft and patient survival for living donor renal transplantation in India.

In practical applications, stochastic effects are normally viewed as the major sources that lead to the system’s unwilling behaviours when modelling real neural systems. As such, the research on network models with stochastic effects is significant. In view of this, in this paper, we analyse the issue of robust stability for a class of uncertain complex-valued stochastic neural networks (UCVSNNs) with time-varying delays. Based on the real-imaginary separate-type activation function, the original UCVSNN model is analysed using an equivalent representation consisting of two real-valued neural networks. By constructing the proper Lyapunov–Krasovskii functional and applying Jensen’s inequality, a number of sufficient conditions can be derived by utilizing It o ^ ’s formula, the homeomorphism principle, the linear matrix inequality, and other analytic techniques. As a result, new sufficient conditions to ensure robust, globally asymptotic stability in the mean square for the considered UCVSNN models are derived. Numerical simulations are presented to illustrate the merit of the obtained results.

In this manuscript, we consider the finite-time H ∞ control for nonlinear systems with time-varying delay. With the assistance of a novel Lyapunov-Krasovskii functional which includes some integral terms, a matrix-based on quadratic convex approach, combined with Wirtinger inequalities and some useful integral inequalities, a sufficient condition of finite-time boundedness is established. A novel feature presents in this paper is that the restriction which is necessary for the upper bound derivative is not restricted to less than 1. Further a H ∞ controller is designed via memoryless state feedback control and a new sufficient conditions for the existence of finite-time H ∞ state feedback for the system are given in terms of linear matrix inequalities (LMIs). At the end, some numerical examples with simulations are given to illustrate the effectiveness of the obtained result.

We study the robust dissipativity issue with respect to the Hopfield-type of complex-valued neural network (HTCVNN) models incorporated with time-varying delays and linear fractional uncertainties. To avoid the computational issues in the complex domain, we divide the original complex-valued system into two real-valued systems. We devise an appropriate Lyapunov-Krasovskii functional (LKF) equipped with general integral terms to facilitate the analysis. By exploiting the multiple integral inequality method, the sufficient conditions for the dissipativity of HTCVNN models are obtained via the linear matrix inequalities (LMIs). The MATLAB software package is used to solve the LMIs effectively. We devise a number of numerical models and their empirical results positively ascertain the obtained results.

In this typescript, we concerned the problem of delay-dependent approach of impulsive genetic regulatory networks besides the distributed delays, parameter uncertainties and time-varying delays. An advanced Lyapunov–Krasovskii functional are defined, which is in triple integral form. Combining the Lyapunov–Krasovskii functional with convex combination method and free-weighting matrix approach the stability conditions are derived with the help of linear matrix inequalities (LMIs). Some available software collections are used to solve the conditions. Lastly, two numerical examples and their simulations are conferred to indicate the feasibility of the theoretical concepts.

Granulomatous interstitial nephritis (GIN) is reported in 0.9% of the native renal biopsies. GIN occurrence in renal allograft is rare and a proton-pump inhibitor-induced GIN is infrequent. Our patient, a 36-year-old renal transplant recipient (2002), on triple immunosuppression with normal renal function, after 16 years of renal transplant, presented with raised serum creatinine (1.9 mg/dl), biopsy revealed GIN, workup for secondary causes were negative, on detailed inquiry, the patient was receiving pantoprazole for the last 1 month on the prescription of his primary physician for dyspeptic symptoms. On stopping pantoprazole, serum creatinine reduced to baseline (1 mg/dl) at 15 days, confirming the diagnosis of pantoprazole-induced GIN.

Sexual and gonadal dysfunction/infertility are quite common in patients with chronic kidney disease. Forty percent of male and 55% of female dialysis patients do not achieve orgasm. The pathophysiology of gonadal dysfunction is multifactorial. It is usually a combination of psychological, physiological, and other comorbid factors. Erectile dysfunction in males is mainly due to arterial factors, venous leakage, psychological factors, neurogenic factors, endocrine factors, and drugs. Sexual dysfunction in females is mainly due to hormonal factors and manifests mainly as menstrual irregularities, amenorrhea, lack of vaginal lubrication, and failure to conceive. Treatment of gonadal dysfunction in chronic kidney disease is multipronged and an exact understanding of underlying pathology is essential in proper management of these patients.

Kidney transplantation (KT) is only viable renal replacement option for most patients in India. Most patients do not have health insurance and meet treatment expenditure from their own resources. We prospectively evaluated the expenses associated with KT and its impact on the socioeconomic status of families in a public hospital. All direct and indirect expenses incurred by the patients from the time of diagnosis of chronic kidney disease to KT were recorded. Direct expenses included physician fees, cost of drugs and disposables, dialysis, and expenses on investigations and hospitalization. Indirect expenses included travel, food, stay, and loss of income suffered by the family. Educational dropout and financial loss were also recorded. There were 43 males and 7 females between the ages of 12 and 57 years. Direct expenses ranged from US$ 2,151-23,792 and accounted for two-thirds of the total expenses. Pre-referral hospitalization, dialysis and medication accounted for majority of direct expense. Indirect expenses ranged from US$ 226-15,283. Travel expenses and loss of income accounted for most of indirect expense. About 54%, 8%, and 10% of families suffered from severe, moderate, and some financial crisis respectively. A total of 38 families had job losses, and 1 patient and 12 caregivers dropped out of studies. To conclude, KT is associated with catastrophic out-of-pocket expenditure and pushes a majority of the patients who come for treatment to public hospitals into severe financial crisis. Educational dropout and loss of jobs are other major concerns. Systematic efforts are required to address these issues.