Penile Calciphylaxis - A Rare, Yet Medically Treatable Disease.

Calciphylaxis or calcific uremic arteriolopathy (CUA) is an infrequent complication in patients with renal failure. Its manifestations range from ischemia to gangrene especially in areas of adiposity. Penile calciphylaxis is very rarely seen. Treatment can be medical or surgical. Sodium thiosulphate has shown to be an efficient treatment. Here were present a case of 74-year-old male who presented with penile calciphylaxis and was treated successfully with oral sodium thiosulphate.

Near-infrared photoactive Ag-Zn-Ga-S-Se quantum dots for high-performance quantum dot-sensitized solar cells.

The high light-harvesting ability of quantum dots (QDs) plays an eminent role in the performance of solar cells. In this study, we synthesized Ag-Zn-Ga-S-Se-based alloyed QDs by colloidal hot injection and characterized them. The X-ray photoelectron spectrum analysis confirms the +1, +2, +3, -2, and -2 oxidation states of, respectively, Ag, Zn, Ga, S, and Se in the QDs, and the energy-dispersive X-ray spectrum analysis confirms the 1:1:1:1.5:1.5 stoichiometric ratio of, respectively, Ag, Zn, Ga, S, and Se. These two results indicate the formation of I-II-III-VI3-type alloyed crystals (AgZnGaS1.5Se1.5 nanocrystals). TEM image analysis reveals the QD nature of the synthesized Ag-Zn-Ga-S-Se nanocrystals. The X-ray diffraction pattern confirms the hexagonal structure. Due to the near-infrared light absorption capability, the synthesized QDs were used as the sensitizer to fabricate QDSCs. The fabricated QDSCs were characterized by using electrochemical impedance spectroscopy and photovoltaic performance studies. The fabricated QDSC have superior electrochemical activity with a photoconversion efficiency of 4.91%.

Enzobiotics-A Novel Therapy for the Elimination of Uremic Toxins in Patients with CKD (EETOX Study): A Multicenter Double-Blind Randomized Controlled Trial.

Design, participants, setting, and measurements: Predialysis adult participants with chronic kidney disease (CKD) and mean estimated glomerular filtration rate (eGFR) <45 mL/min per 1.73 m2) were recruited in 2019 to a multicentric double-blinded randomized controlled trial of enzobiotic therapy (synbiotics and proteolytic enzymes) conducted over 12 weeks. The primary objective was to evaluate the efficacy and safety of enzobiotics in reducing the generation of p-cresol sulfate (PCS) and indoxyl sulfate (IS), stabilizing renal function, and improving quality of life (QoL), while the secondary objective was to evaluate the feasibility of the diagnostic prediction of IS and PCS from CKD parameters. Results: Of the 85 patients randomized (age 48.76 years, mean eGFR 23.24 mL/min per 1.73 m2 in the placebo group; age 54.03 years, eGFR 28.93 mL/min per 1.73 m2 in the enzobiotic group), 50 completed the study. The absolute mean value of PCS increased by 12% from 19 µg/mL (Day 0) to 21 µg/mL (Day90) for the placebo group, whereas it decreased by 31% from 23 µg/mL (Day 0) to 16 µg/mL (Day 90) for the enzobiotic group. For IS, the enzobiotic group showed a decrease (6.7%) from 11,668 to 10,888 ng/mL, whereas the placebo group showed an increase (8.8%) from 11,462 to 12,466 ng/mL (Day 90). Each patient improvement ratio for Day 90/Day 0 analysis showed that enzobiotics reduced PCS by 23% (0.77, p = 0.01). IS levels remained unchanged. In the placebo group, PCS increased by 27% (1.27, p = 0.14) and IS increased by 20% (1.20, p = 0.14). The proportion of individuals beyond the risk threshold for PCS (>20 µg/mL) was 53% for the placebo group and 32% for the enzobiotic group. The corresponding levels for IS risk (threshold >20,000 ng/mL) were 35% and 24% for the placebo and enzobiotic groups, respectively. In the placebo group, eGFR decreased by 7% (Day 90) but remained stable (1.00) in the enzobiotic group. QoL as assessed by the adversity ratio decreased significantly (p = 0.00), highlighting an improvement in the enzobiotic group compared to the placebo group. The predictive equations were as follows: PCS (Day 0 = −5.97 + 0.0453 PC + 2.987 UA − 1.310 Creat; IS (Day 0) = 756 + 1143 Creat + 436.0 Creat2. Conclusion: Enzobiotics significantly reduced the PCS and IS, as well as improved the QoL.

Effect of intestinal dialysis using polyethylene glycol on fluid balance and thirst in maintenance hemodialysis patients: A comparative study.

High inter-dialytic weight gains (IDWG) and Hyperkalemia have been associated with adverse outcomes like poor quality of life and high mortality. Thirst remains an unsolved problem in hemodialysis (HD) patients. The aim of this study was to evaluate the effect of polyethylene glycol (PEG) based intestinal dialysis on IDWG, thirst and biochemical parameters. A prospective interventional evidenced based paired comparative single center study was conducted. Thirty-five anuric patients on weekly thrice HD were studied for four consecutive dialysis weeks. Before the mid-week dialysis day of week 3, Patients received 2 L PEG solution. The primary end points were change in mean relative IDWG and change in mean subjective thirst feeling as measured on visual analog scale (VAS) with secondary endpoints being change in small molecule clearance. There was significant reduction in IDWG after the therapy from 3 ± 0.81 L to 2.35 ± 0.72 (P = 0.002). The therapy also reduced the % IDWG BW from 5.1 ± 1.7% to 4.15 ± 1.6% (P = 0.017). No change in thirst was seen, that is, 6.16 ± 0.66, 6.14 ± 0.64, and 6.16 ± 0.65 (P = 0.986). A multivariate linear regression did not reveal any effect of age, gender, and co-morbidities on the reduction of IDWG and thirst. The therapy achieved a significant urea, creatinine, and potassium reduction of 8.23%, 8.13%, and 8.33% respectively with an increase in sodium levels by 0.86%. This modality reduced the IDWG, was found to be a potent treatment modality for hyperkalemia but did not affect thirst sensation even after consumption of 2 L solution.

A Rare Case of Type 4 Rapidly Progressive Glomerulonephritis (Atypical) with Mesangial IgA Deposits: A Case Report.

Rapidly progressive glomerulonephritis can result from glomerular deposition of anti-GBM antibody, immune complexes, or may involve pauci-immune mechanisms. The coexistence of IgA nephropathy, anti-GBM, and anti-neutrophilic cytoplasmic antibodies is unheard of, and the pathogenic role of these antibodies in IgA nephropathy or vice versa remains unclear. Herein, we describe a case of a patient with type 4 rapidly progressive glomerulonephritis who was found to have significant mesangial IgA deposits. The prognosis of this remains unclear but our patient responded well to cytotoxic therapy and plasmapheresis and achieved remission by 6 months. The findings suggest an overlap syndrome of IgA nephropathy-associated type 4 crescentic glomerulonephritis that resembles the former histologically and the latter in its potential to respond to aggressive therapy if detected relatively early in its course.

Body composition monitoring and nutrition in maintenance hemodialysis and CAPD patients--a multicenter longitudinal study.

Hydration and nutritional status of end stage renal disease (ESRD) patients are linked to increased morbidity and mortality. Body composition monitoring (BCM) by multi-frequency bioimpedance spectroscopy (MFBS) is considered to be a superior modality of fluid assessment in chronic kidney disease (CKD) dialysis. We did a longitudinal prospective study in South India on maintenance hemodialysis (MHD) and continuous ambulatory peritoneal dialysis (CAPD) patients over 24 months and looked at impact of baseline nutritional parameters and body composition parameters on 24-month mortality. Ninety-nine patients stable on dialysis for at least 3 months were recruited (MHD 85, CAPD 14) at baseline and at 24 months, 41 were alive and 33 had expired, 12 had undergone renal transplant and 13 were lost to follow-up. BCM and nutritional assessment were done at baseline and at follow-up. Baseline overhydration (OH) differed significantly between surviving and dead patients (p < 0.05). Receiver operating characteristic (ROC) curve between OH and mortality showed that the best cut-off point to differentiate between survived and expired patients was 3.15 L. ROC curve for BMI showed lower than cut-off of 22.65 kg/m(2) to predict mortality with sensitivity 41.30% and specificity 81.81%. At follow-up, triceps skin fold thickness (TSF), biceps skin fold thickness (BSF) and mid arm circumference (MAC) increased significantly from baseline (p < 0.001, p = 0.001 and p < 0.001, respectively). Overhydration and BMI are important predictors of mortality in dialysis patients. Improvement in anthropometric markers TSF, BSF and MAC in MHD patients was associated with survival.

Plasmablastic multiple myeloma following clear cell renal cell carcinoma.

We aim to describe the clinicohaematological profile of an elderly male with plasmablastic multiple myeloma (MM) (IgG λ, International System Stage II) with an unfavourable outcome following chemotherapy. The serum interleukin-6 level was found to be markedly elevated (2464 pg/mL, reference; <50 pg/mL). Thirty-six months prior to MM diagnosis, he underwent left radical nephrectomy for a stage III (pT3N0M0) clear cell renal cell carcinoma (RCC, Fuhrman grade 2). The unique MM-RCC association, shared risk factors, myeloma pathobiology and clinical implications are discussed with a brief literature review.

Hypothyroidism complicating nephropathy in a diabetes patient.

We describe a patient with type 2 diabetes mellitus and autoimmune hypothyroidism who presented with elevated serum creatinine possibly due to subclinical rhabdomyolysis induced by hypolipidemic drug therapy in the background of diabetic nephropathy. Both hypothyroidism and rhabdomyolysis were asymptomatic in this case as evidenced by lack of classical clinical features of hypothyroidism despite elevated serum TSH and absent pigment cast in renal biopsy. The combination of diabetes mellitus and hypothyroidism is common in the general population and should not be forgotten in patients with diabetes and kidney disease.