Gemcitabine (2’,2’-difl uorodeoxycytidine) is a potent pyrimidine antimetabolite and was introduced in 1987. It is commonly used for various tumors including non-small cell lung cancer, pancreatic cancer, breast cancer, ovarian can cer and renal cell carcinoma at advanced stages. Thrombotic microangiopathy (TMA) is characterized by microangiopathic hemolytic anemia (MAHA), thrombocytopenia and acute kidney injury. We report here a 45-year-old male patient with duodenal cancer, who developed acute onset breathlessness, oliguria, accelerated hypertension and acute kidney injury (AKI) after having received chemotherapy with gemcitabine for six months. Renal biopsy showed features of TMA. He was treated with plasmapheresis and his renal function recovered near normal. New-onset/exacerbated hypertension, declining renal function, pulmonary/cardiac symptoms and neurological signs in patients with gemcitabine therapy should consider as warning signs of impending TMA. The primary goal of management is discontinuation of drug and prognosis is generally unfavorable. Hence a high degree of suspicion is needed for early diagnosis of gemcitabine induced TMA.

In the modern era of widespread utilisation of imaging procedures for preoperative diagnosis and minimal invasive surgeries, intravenous contrast plays a major role in delineation of variety of information related to vascularity of normal as well as abnormal tissues. Vascular structures may themselves be focus of attention for various vascular interventional procedures, again requiring intravenous contrast. Since the intravenous contrast agent used in the imaging procedures is primarily excreted through kidneys, hence pre-procedural renal function should be adequate not only to facilitate its excretion for preventing effects related to contrast retention in body but also contrast-induced nephrotoxicity. As contrast-induced nephropathy is being increasingly encountered in day-to-day practice recently, hence this article focuses on the different facets of contrast-induced nephropathy secondary to iodinated contrast from etiology, risk factors to management.

Mucormycosis is one of the invasive fungal infections particularly in immunocompromised patients with impaired host defense. It is characterized by fungal rhino sinusitis with invasion of adjustment structures including brain, pulmonary, or gastrointestinal systems or can be presented as a disseminated disease. Predisposing factors are diabetic ketoacidosis, neutropenia, corticosteroid or deferoxamine use, iron overload, malnutrition and skin macerations. We present a known case of end-stage renal disease patient under hemodialysis without history of diabetes or other risk factors listed above, who admitted because of fever and diagnosed with invasive rhino -sinusitis mucormycosis.

Cardiac diseases are associated independently with decrease in kidney function and progression of existing kidney diseases. Conversely, chronic kidney disease (CKD) represents an independent risk factor for cardiovascular events and outcomes. Renal dysfunction frequently accompanies cardiac failure and that cardiac dysfunction frequently accompanies renal failure. This interdependent relationship has come to be known as the “cardiorenal syndrome”. Direct and indirect effects of each organ that is dysfunctional can initiate and perpetuate the combined disorder of the two organs through a complex combination of neurohormonal feedback mechanisms. In this review pathophysiology and management of fi ve different subtypes of cardiorenal syndrome is discussed.

Sudden cardiac arrest (SCA) is defi ned as sudden, unexpected loss of heart function, breathing and consciousness, resulting from an electrical disturbance in the heart stopping its action and blood fl ow, and cardiovascular diseases are the major risk factors for SCA. It has been reported that more than 20% of all deaths in patients with advanced chronic kidney disease is due to arrhythmias and SCA [1].

Introduction: The benefi t of combination immunosuppression versus steroid monotherapy in pure membranous lupus nephritis (MLN) remains unclear. Steroid monotherapy could potentially reduce exposure to excessive immunosuppression in patients achieving remission with this strategy. The aim of this study was to defi ne patient characteristics and outcomes in MLN treated with steroid monotherapy. Method: A retrospective, observational study identifi ed all biopsy-proven pure MLN cases followed since 1990 in a single center. Demographic, clinical and histological data were gathered for patients treated with daily steroid monotherapy. The primary outcome of interest was the reduction in proteinuria, reported as complete remission (CR), partial remission (PR) or no response.

Background: Procalcitonin (PCT) has been proposed as a novel biomarker for prediction of Vesicoureteral Refl ux (VUR). Since VUR is the most important risk factor for occurrence of pyelonephritis and renal tissue infl ammation, serum PCT level may have a relationship with VUR. However, literature about the relationship between procalcitonin level and VUR is scanty.