Background and objectives: The associations of pathological features with renal outcomes in adult Idiopathic Membranous Nephropathy (IMN) are still controversial. A meta-analysis was performed to assess whether pathological features could independently predict risk of progressive kidney disease in adult IMN patients. Methods: The PubMed database (January 2000 to September 2013) was searched to identify cohort studies of adult IMN patients (≥ 50 patients for each study) in which at least one of the following pathological features was assessed: segmental sclerosis, tubular atrophy/interstitial fibrosis, arteriosclerosis, C3 deposits by immunofluorescence, and the stage or heterogeneity of electron dense deposits by electron microscopy. Renal outcomes included development of renal insufficiency or progression to ESRD. Results: Nine cohort studies were included. A total of 2080 patients with 252 hard endpoints (renal insufficiency or ESRD) were reported. Segmental sclerosis was significantly associated with poor renal outcomes (8 studies with 1622 patients: hazard ratio, 1.59 [95% confidence interval, 1.07-2.37], P=0.02). Tubular atrophy/interstitial fibrosis and arteriosclerosis were also significantly associated with poor renal outcomes (7 studies with 1569 patients: 3.85 [2.16-6.87], P<0.000001; and 5 studies with 1349 patients: 1.83 [1.17-2.86], P=0.008). There were insufficient data to systematically assess the independent predictive value of C3 deposits and the stage and heterogeneity of electron dense deposits. Conclusions: Significant associations of renal outcomes with segmental sclerosis, chronic tubule interstitial injury, and arteriosclerosis were only confirmed in two, five, and one of nine included studies, respectively. However, this meta-analysis indicated that each of these pathological features was significantly associated with progression of kidney disease. More methodologically sound and sufficiently powered prospective cohort studies with adequate number of patients and length of follow-up are still urgently needed to address the questions regarding prognostic utility of pathological features in adult IMN patients.

Background: Although there are numerous publications on multiple myeloma in black people, it seems sub- Saharan literature particularly Senegalese’ one is silent about Light chain deposition disease (LCDD) which is linked to immunoglobulin light chain deposition in glomerulus. The authors report the first three observations of LCDD collected in Nephrology department of Aristide Le Dantec hospital in Dakar, Senegal.
Cases: we report three cases a man and two women of 61, 69 and 47 years old respectively, admitted to the Nephrology department of Aristide Le Dantec hospital for rapidly progressive renal failure in one case and a nephrotic syndrome in 2 other cases. The renal biopsy showed a nodular glomerulosclerosis and immunofluorescence microscopy, revealed deposition of IgG light chains suggesting LCDD. On the other hand, the diagnosis of multiple myeloma of IgG kappa type in 2 cases and IgG lambda type in the other one was done. A combination of chemotherapy (Mephalan Prednisone) and hemodialysis was instituted for all 3 cases. The evolution was marked by the appearance of an end stage renal disease in 2 cases and the third one was expired due to an infected bed sore secondary to a pathological fracture of the neck of the femur.
Conclusion: Although the LCDD is rare, the prognosis of this syndrome seems to be poor as more than half of the patients die or progress to ESRD within 2 years.

Background: Various reasons for “Peritoneal Dialysis (PD) First” rather than hemodialysis (HD) have been presented, such as better preservation of residual renal function (RRF), longer survival, and lower incidence of hospitalization. In spite of these advantages for “PD First”, in Japan as well as in the United States the annual rate of patients receiving PD has been reduced to less than 10%. One of the major reasons against selecting PD is that a large proportion of PD patients are transferred from PD to HD in less than 5 years. Our “PD First” policy is based on the diversity of modalities available after discontinuing PD therapy. The purpose of this study was to examine the follow-up of patients who selected “PD First” as the initial treatment of end-stage renal disease (EDRD) between April 1997 and December 2010.
Methods: Sex, age, primary underlying diseases and selection of modalities were collected retrospectively.
Results: A total of 377 (59.2 ± 8.3 years old; female/male: 255/122) patients were introduced to PD therapy as “PD First.” Patients who were very old, with cardiovascular problems, senile dementia, and neoplasms that were forced to select PD were excluded. One hundred and sixty patients started HD as complementary dialysis therapy and then continued with PD + HD in combination until transfer to HD, transplantation or home HD. Among them, 10 patients received transplants and 22 patients were transferred to home HD. One hundred and twenty eight patients were switched from PD to HD for various reasons. Overall patients’ survival after 5 and 10 years was 84.8% and 55.8%, respectively.
Conclusion: Our data shows a diversity of modalities for selection after discontinuing PD therapy alone, as well as providing a rationale to support PD as the initial renal replacement modality for end-stage renal disease patients.

New-onset diabetes after transplantation [NODAT] is well known complication after organ transplantation especially after solid organ transplantation, bone marrow and hematopoietic stem cells. The incidence of NODAT was observed to be different over post-transplant intervals. It has many risk factors and adverse clinical outcomes include allograft dysfunction, infections, cardiovascular morbidities, and increased mortalities among renal transplant patients. Its management should start before transplantation with special stress on risk factors, modulation of immunosuppressive agents and role of diabetes education before during and after transplantation.

Background: The introduction of erythropoietinn stimulating agent (ESA) in clinical practice has completely altered the management of patients with chronic kidney disease. However, the successful correction of anemia has not always resulted in improvement of mortality in CKD patients. One of the main reasons for failure of preservation of renal function is excessive elevation of hemoglobin (Hb) levels for CKD patients. This indicates the need for maintaining appropriate target levels of Hb to preclude the progression of CKD. The aim of this study was to compare the effects of two Hb levels on progression of CKD patients in a 2 year period. Subjects: A total of 167 patients with chronic kidney disease (2mg

Background: Recently, a newly developed Angiotensin Receptor Blocker (ARB), azilsartan, has been shown to have a persistent depressor action throughout the day in hypertensive patients. However, there have been few reports discussing the efficacy of azilsartan in patients on Hemodialysis (HD). Methods: Blood Pressure (BP) measurements in the HD center, and at home and ambulatory monitoring during the night were carried out before and after the change from other ARBs to azilsartan. All patients who were persistently hypertensive despite the treatment with antihypertensive drugs including ARB were considered as candidates. All patients were on antihypertensive treatment (12 on calcium channel blockers (CCBs), 6 on alpha blockers, and 2 on beta blockers and 4 on centrally acting antihypertensive drugs). Initially, azilsartan was started at 20 mg once daily in the evening, and increased up to 40 mg once daily in the evening. Results: Pre-dialytic systolic BP (SBP), SBP in the morning at home and during night were all significantly reduced by 3 months’ administration of azilsartan: (167.3 ± 10.3 to 145.3 ± 9.6 (pre-dialytic); 167.1 ± 11.0 to 151.8 ± 10.4 (at home); 150.5 ± 13.1 to 134.0 ± 10.3 (during night); mmHg). Conclusion: The present study demonstrated that azilsartan reduced SBP of pre-and post HD session measured at a dialysis center, on the morning of HD days and at the night time after HD. In addition to reduction of SBPs, azilsartan stabilized BP during the night. Furthermore, azilsartan significantly attenuated reduction of SBP from the start to the end of HD session.

Background: Sarcoidosis is a multi-system disorder characterized by noncaseating epitheloid granuloma in multiple organs. However, granulomatous interstitial nephritis in the absence of extrarenal renal lesions is very rare. Case presentation: A 64-year-old male presented with a weight loss of 10 kg and an increase in serum creatinine from 1.1 to 4.8 mg/dl over a 1-year period. At admission, no proteinuria or hematuria was found, although serum creatinine was 5.1 mg/dl and was associated with slight increases in serum angiotensin converting enzyme and calcium levels. Renal biopsy revealed granulomatous interstitial nephritis with noncaseating epitheloid cells. The patient was diagnosed with sarcoidosis, although no extrarenal sarcoid lesion was found. Oral prednisolone was effective, with normalization of serum creatinine levels 2 weeks later. A review of the literature showed that isolated granulomatous renal sarcoidsosis preferentially affected elderly males, and their serum angiotensin converting enzyme levels were normal or mildly increased in many cases. Conclusions: This paper describes a rare case of isolated renal sarcoidosis with acute granulomatous interstitial nephritis. This case and a relevant review of the literature demonstrate that sarcoid granulomatous interstitial nephritis should be considered as one of differential diagnoses in elderly male patients with suspected tubulointerstitial nephritis irrespective of angiotensin converting enzyme levels.

Objective: To study the efficacy of rituximab in children with focal sclerosing glomerulonephritis (FSGS). Case Report: Before treatment, blood biochemistry, hepatic and renal function, differential white cell counts, immunoglobulins and the complement system were assessed. Promethazine (0.5-1 mg/kg) and methylprednisolone (0.1-0.3 mg/kg) were administered intravenously 30 min and 5-10 min before the rituximab infusion. Rituximab (0.27 g) was diluted in 300 ml glucose solution and initially administered at 50 ml/hr the rate increased to 50 ml/hr every 30 min after no side effects occurred in the first hour. A second dose was given one month later. During treatment, prednisone (30mg) was taken on alternate days. Benazepril (3.3 mg) was administered every day with one chongcao capsule. Homemade ershenkang was given three times a day. Outcome: Eyelid and limb edema declined two weeks after the first application of rituximab and resolved after the second treatment. Urinary protein levels decreases, serum albumin increased, and white cell counts, hepatic function and renal function remained constant. After 3 months of followup, urine protein decreased significantly, and serum albumin (35.2 g/L) and cholesterol (5.4 mmol/L) normalized. Parameters of immune activation also reduced, and the patient remained well. Conclusion: In this case, rituximab was a safe and efficacious treatment for FSGS.

Background and objectives: The associations of pathological features with renal outcomes in adult Idiopathic Membranous Nephropathy (IMN) are still controversial. A meta-analysis was performed to assess whether pathological features could independently predict risk of progressive kidney disease in adult IMN patients.
Methods: The PubMed database (January 2000 to September 2013) was searched to identify cohort studies of adult IMN patients (≥ 50 patients for each study) in which at least one of the following pathological features was assessed: segmental sclerosis, tubular atrophy/interstitial fibrosis, arteriosclerosis, C3 deposits by immunofluorescence, and the stage or heterogeneity of electron dense deposits by electron microscopy. Renal outcomes included development of renal insufficiency or progression to ESRD.
Results: Nine cohort studies were included. A total of 2080 patients with 252 hard endpoints (renal insufficiency or ESRD) were reported. Segmental sclerosis was significantly associated with poor renal outcomes (8 studies with 1622 patients: hazard ratio, 1.59 [95% confidence interval, 1.07-2.37], P=0.02). Tubular atrophy/interstitial fibrosis and arteriosclerosis were also significantly associated with poor renal outcomes (7 studies with 1569 patients: 3.85 [2.16-6.87], P<0.000001; and 5 studies with 1349 patients: 1.83 [1.17-2.86], P=0.008). There were insufficient data to systematically assess the independent predictive value of C3 deposits and the stage and heterogeneity of electron dense deposits.
Conclusions: Significant associations of renal outcomes with segmental sclerosis, chronic tubule interstitial injury, and arteriosclerosis were only confirmed in two, five, and one of nine included studies, respectively. However, this meta-analysis indicated that each of these pathological features was significantly associated with progression of kidney disease. More methodologically sound and sufficiently powered prospective cohort studies with adequate number of patients and length of follow-up are still urgently needed to address the questions regarding prognostic utility of pathological features in adult IMN patients.

Background: Although there are numerous publications on multiple myeloma in black people, it seems sub-Saharan literature particularly Senegalese’ one is silent about Light chain deposition disease (LCDD) which is linked to immunoglobulin light chain deposition in glomerulus. The authors report the first three observations of LCDD collected in Nephrology department of Aristide Le Dantec hospital in Dakar, Senegal.
Cases: we report three cases a man and two women of 61, 69 and 47 years old respectively, admitted to
the Nephrology department of Aristide Le Dantec hospital for rapidly progressive renal failure in one case and a nephrotic syndrome in 2 other cases. The renal biopsy showed a nodular glomerulosclerosis and immunofluorescence microscopy, revealed deposition of IgG light chains suggesting LCDD. On the other hand, the diagnosis of multiple myeloma of IgG kappa type in 2 cases and IgG lambda type in the other one was done. A combination of chemotherapy (Mephalan Prednisone) and hemodialysis was instituted for all 3 cases. The evolution was marked by the appearance
of an end stage renal disease in 2 cases and the third one was expired due to an infected bed sore secondary to a pathological fracture of the neck of the femur.
Conclusion: Although the LCDD is rare, the prognosis of this syndrome seems to be poor as more than half of the patients die or progress to ESRD within 2 years.

Background: Various reasons for “Peritoneal Dialysis (PD) First” rather than hemodialysis (HD) have been presented, such as better preservation of residual renal function (RRF), longer survival, and lower incidence of hospitalization. In spite of these advantages for “PD First”, in Japan as well as in the United States the annual rate of patients receiving PD has been reduced to less than 10%. One of the major reasons against selecting PD is that a large proportion of PD patients are transferred from PD to HD in less than 5 years. Our “PD First” policy is based on the diversity of modalities available after discontinuing PD therapy. The purpose of this study was to examine the follow-up of patients who selected “PD First” as the initial treatment of end-stage renal disease (EDRD) between April 1997 and December 2010.
Methods: Sex, age, primary underlying diseases and selection of modalities were collected retrospectively.
Results: A total of 377 (59.2 ± 8.3 years old; female/male: 255/122) patients were introduced to PD therapy as “PD First.” Patients who were very old, with cardiovascular problems, senile dementia, and neoplasms that were forced to select PD were excluded. One hundred and sixty patients started HD as complementary dialysis therapy and then continued with PD + HD in combination until transfer to HD, transplantation or home HD. Among them, 10 patients received transplants and 22 patients were transferred to home HD. One hundred and twenty eight patients were switched from PD to HD for various reasons. Overall patients’ survival after 5 and 10 years was 84.8% and 55.8%, respectively.
Conclusion: Our data shows a diversity of modalities for selection after discontinuing PD therapy alone, as well as providing a rationale to support PD as the initial renal replacement modality for end-stage renal disease patients.

New-onset diabetes after transplantation [NODAT] is well known complication after organ transplantation especially after solid organ transplantation, bone marrow and hematopoietic stem cells. The incidence of NODAT was observed to be different over post-transplant intervals. It has many risk factors and adverse clinical outcomes include allograft dysfunction, infections, cardiovascular morbidities, and increased mortalities among renal transplant patients. Its management should start before transplantation with special stress on risk factors, modulation of immunosuppressive agents and role of diabetes education before during and after transplantation.

Background: The introduction of erythropoietinn stimulating agent (ESA) in clinical practice has completely altered the management of patients with chronic kidney disease. However, the successful correction of anemia has not always resulted in improvement of mortality in CKD patients. One of the main reasons for failure of preservation of renal function is excessive elevation of hemoglobin (Hb) levels for CKD patients. This indicates the need for maintaining appropriate target levels of Hb to preclude the progression of CKD. The aim of this study was to compare the effects of two Hb levels on progression of CKD patients in a 2 year period. Subjects: A total of 167 patients with chronic kidney disease.

Background: Recently, a newly developed Angiotensin Receptor Blocker (ARB), azilsartan, has been shown to have a persistent depressor action throughout the day in hypertensive patients. However, there have been few reports discussing the efficacy of azilsartan in patients on Hemodialysis (HD). Methods: Blood Pressure (BP) measurements in the HD center, and at home and ambulatory monitoring during the night were carried out before and after the change from other ARBs to azilsartan. All patients who were persistently hypertensive despite the treatment with antihypertensive drugs including ARB were considered as candidates. All patients were on antihypertensive treatment (12 on calcium channel blockers (CCBs), 6 on alpha blockers, and 2 on beta blockers and 4 on centrally acting antihypertensive drugs). Initially, azilsartan was started at 20 mg once daily in the evening, and increased up to 40 mg once daily in the evening. Results: Pre-dialytic systolic BP (SBP), SBP in the morning at home and during night were all significantly reduced by 3 months’ administration of azilsartan: (167.3 ± 10.3 to 145.3 ± 9.6 (pre-dialytic); 167.1 ± 11.0 to 151.8 ± 10.4 (at home); 150.5 ± 13.1 to 134.0 ± 10.3 (during night); mmHg). Conclusion: The present study demonstrated that azilsartan reduced SBP of pre-and post HD session measured at a dialysis center, on the morning of HD days and at the night time after HD. In addition to reduction of SBPs, azilsartan stabilized BP during the night. Furthermore, azilsartan significantly attenuated reduction of SBP from the start to the end of HD session.

Background: Sarcoidosis is a multi-system disorder characterized by noncaseating epitheloid granuloma in multiple organs. However, granulomatous interstitial nephritis in the absence of extrarenal renal lesions is very rare.
Case presentation: A 64-year-old male presented with a weight loss of 10 kg and an increase in serum creatinine from 1.1 to 4.8 mg/dl over a 1-year period. At admission, no proteinuria or hematuria was found, although serum creatinine was 5.1 mg/dl and was associated with slight increases in serum angiotensin converting enzyme and calcium levels. Renal biopsy revealed granulomatous interstitial nephritis with noncaseating epitheloid cells. The patient was diagnosed with sarcoidosis, although no extrarenal sarcoid lesion was found. Oral prednisolone was effective, with normalization of serum creatinine levels 2 weeks later. A review of the literature showed that isolated granulomatous renal sarcoidsosis preferentially affected elderly males, and their serum angiotensin converting enzyme levels were normal or mildly increased in many cases.
Conclusions: This paper describes a rare case of isolated renal sarcoidosis with acute granulomatous interstitial nephritis. This case and a relevant review of the literature demonstrate that sarcoid granulomatous interstitial nephritis should be considered as one of differential diagnoses in elderly male patients with suspected tubulointerstitial nephritis irrespective of angiotensin converting enzyme levels.

Objective: To study the efficacy of rituximab in children with focal sclerosing glomerulonephritis (FSGS). Case Report: Before treatment, blood biochemistry, hepatic and renal function, differential white cell counts, immunoglobulins and the complement system were assessed. Promethazine (0.5-1 mg/kg) and methylprednisolone (0.1-0.3 mg/kg) were administered intravenously 30 min and 5-10 min before the rituximab infusion. Rituximab (0.27 g) was diluted in 300 ml glucose solution and initially administered at 50 ml/hr the rate increased to 50 ml/hr every 30 min after no side effects occurred in the first hour. A second dose was given one month later. During treatment, prednisone (30mg) was taken on alternate days. Benazepril (3.3 mg) was administered every day with one chongcao capsule. Homemade ershenkang was given three times a day. Outcome: Eyelid and limb edema declined two weeks after the first application of rituximab and resolved after the second treatment. Urinary protein levels decreases, serum albumin increased, and white cell counts, hepatic function and renal function remained constant. After 3 months of followup, urine protein decreased significantly, and serum albumin (35.2 g/L) and cholesterol (5.4 mmol/L) normalized. Parameters of immune activation also reduced, and the patient remained well. Conclusion: In this case, rituximab was a safe and efficacious treatment for FSGS.