Global variability of vascular and peritoneal access for chronic dialysis.

AIM: Vascular and peritoneal access are essential elements for sustainability of chronic dialysis programs. Data on availability, patterns of use, funding models, and workforce for vascular and peritoneal accesses for dialysis at a global scale is limited. METHODS: An electronic survey of national leaders of nephrology societies, consumer representative organizations, and policymakers was conducted from July to September 2018. Questions focused on types of accesses used to initiate dialysis, funding for services, and availability of providers for access creation. RESULTS: Data from 167 countries were available. In 31 countries (25% of surveyed countries), >75% of patients initiated haemodialysis (HD) with a temporary catheter. Seven countries (5% of surveyed countries) had >75% of patients initiating HD with arteriovenous fistulas or grafts. Seven countries (5% of surveyed countries) had >75% of their patients starting HD with tunnelled dialysis catheters. 57% of low-income countries (LICs) had >75% of their patients initiating HD with a temporary catheter compared to 5% of high-income countries (HICs). Shortages of surgeons to create vascular access were reported in 91% of LIC compared to 46% in HIC. Approximately 95% of participating countries in the LIC category reported shortages of surgeons for peritoneal dialysis (PD) access compared to 26% in HIC. Public funding was available for central venous catheters, fistula/graft creation, and PD catheter surgery in 57%, 54% and 54% of countries, respectively. CONCLUSION: There is a substantial variation in the availability, funding, workforce, and utilization of vascular and peritoneal access for dialysis across countries regions, with major gaps in low-income countries.

Secretome proteins regulate comparative osteogenic and adipogenic potential in bone marrow and dental stem cells.

INTRODUCTION: Dental stem cells (DMSC) have been studied extensively since their early discovery. However, the data regarding osteogenic potential of DMSC with other cell types is sparse and the secretome proteins underlying these differences have not been explored. In this study, we have compared the osteogenic and adipogenic potential of DMSC with Bone Marrow Stem cells (BMSC) and reported the contribution of secretome proteins in controlling their differentiation. METHODS: Osteogenic potential of these stem cells was compared by mineralization assay, alkaline phosphatase (ALP) assay, immunofluorescence of dentine sialo phosphoprotein (DSPP) & qPCR for osteogenic genes. Adipogenic potential was compared by Oil Red O staining and qPCR for PPAR-γ, leptin & adipsin. Proteomic analysis of secretome was performed by employing WATERS nano Lc-MS/MS system. RESULTS: We observed a higher osteogenic potential in DMSC, especially dental pulp stem cells (DPSC) as compared to BMSC population but adipogenic potential was found to be better in BMSC as compared to DMSC. Deeper investigations into secretome of these cells by Lc-MS/MS revealed the presence of proteins pertaining to osteogenic and adipogenic lineage. Presence of some important proteins regulating osteogenic (DSPP, BMP7, DDR2, USP9X) and adipogenic differentiation (NCOA2, PEG10, LPA) in secretome of BMSC and DMSC reflected the role of paracrine factors during differentiation. CONCLUSION: Our study provides first evidence regarding regulation of osteogenic/adipogenic potential by secretome proteins in DMSC and BMSC. DMSC especially DPSC and its secretome show an inherent tendency for higher osteogenic differentiation and lower adipogenic differentiation, these may be potential candidates for effective future therapy in osteoporosis where disturbance of osteocyte/adipocyte homeostasis is reported.

Molecular spectrum of secretome regulates the relative hepatogenic potential of mesenchymal stem cells from bone marrow and dental tissue.

Liver regeneration is a spontaneous process that occurs after liver injury, but acute liver failure is a complex and fatal disease which is difficult to treat. Cell-based therapies are promising alternative therapeutic approach for liver failure and different cell sources have been tested in this regard. We investigated the comparative hepatogenic potential of human bone marrow stem cells (BMSC) with stem cells derived from human dental pulp (DPSC), apical papilla (SCAP) and follicle (DFSC) during this study. Hepatogenic potential of stem cells was assessed by functional assays at both genetic and protein level. We observed higher expression of most of the hepatic markers post differentiation in DPSCs compared to other cell types. LC-MS/MS analysis of stem cell secretome revealed the presence of different proteins related to hepatogenic lineage like growth arrest specific protein 6, oncostatin M, hepatocyte growth factor receptor etc. Interactome and Reactome pathway analysis revealed the interaction of DPSC/SCAP secretome proteins and these proteins were found to be associated with various pathways involved in lipid transport and metabolism. To the best of our knowledge, this is the first study regarding detailed investigation of hepatogenic potential of BMSCs v/s DMSCs (DPSC, SCAP & DFSC) along-with secretome characterization.

Heavy-chain deposition disease: a morphological, immunofluorescence and ultrastructural assessment.

Heavy-chain deposition disease (HCDD) is the least common of the monoclonal immunoglobulin deposition diseases with only 24 reported cases in English literature, including the present case. The rarity of this disease merits its documentation. We present a case of HCDD from our archival material, who presented with rapidly progressive renal failure and nephrotic syndrome and was found to have nodular glomerulosclerosis on renal biopsy which on immunofluorescence and electron microscopy confirmed HCDD of immunoglobulin G1 type without any light-chain deposition. We also present an in-depth literature review on HCDD.

Acute pyelonephritis with renal vein and inferior vena cava thrombosis in a case of hyperhomocysteinemia.

Acute pyelonephritis is not considered a common cause of renal vein (RVT) and inferior vena caval thrombosis (IVCT). Apart from malignancy, RVT is not an uncommon condition amongst patients with nephrotic syndrome, most commonly seen in patients with membranous glomerulonephritis. However, RVT occurring in association to acute pyelonephritis is rare. Clinically, it is difficult to distinguish between acute pyelonephritis and RVT because both present with fever, flank pain, and hematuria. We report a case of acute pyelonephritis with RVT and IVCT with underlying hyperhomocysteinemia. The patient was treated with systemic anticoagulation, antibiotics, and B complex therapy. At 3 months follow-up, there was complete resolution of thrombus but the left kidney was nonfunctioning.