Journal of Clinical and Translational Nephrology
Journal of clinical and translational nephrology (JCTN) is the official online journal of Malaysian Society of Nephrology. JCTN is a fully open access, online only journal publishing biannually. The journal will serve as an essential nephrology educational and training resource and it publishes original peer-reviewed research articles in all aspects of the basic clinical science research, prevention, diagnosis and management of kidney and associated disorders, translational research as well as related molecular genetics, pathophysiology, and epidemiology.
Malaysian Society Of Nephrology (ROS: 82/84)
THE IMPACT OF HYPERUREMIA TO THE RENAL SURVIVAL IN MALAYSIAN CKD POPULATION
Background Chronic kidney disease (CKD) has a global prevalence of 9%. Studies have reported an association of hyperuricemia with the progression of CKD, but their conclusions are often contradictory. In this study, we aim to analyse the association between serum uric acid with rapid renal function decline in a tertiary centre in Asia. Methods This is retrospective study conducted in a tertiary nephrology clinic. 416 patients were recruited and follow up from 2007 until June 2019. Data were extracted from the electronic health information system. This research has received the necessary ethical clearance by the NMRR and MREC. The Kaplan-Meier survival curve was used to analyse the renal outcomes, which consisted of 50% deterioration of GFR, doubling of the baseline serum creatinine, initiation of kidney replacement therapy (KRT) and mortality. Results There is a significant association between hyperuricemia with GFR, serum creatinine and proteinuria. A Kaplan Meier analysis showed a significant association between serum uric acid and the various kidney outcomes, namely the halving of GFR (p = 0.057) and mortality (p = 0.005) but not significant with regards to the need for initiation of kidney replacement therapy or doubling of serum creatinine (57% decline in GFR). Conclusion Our study showed hyperuricemia is associated with worsening renal outcomes. Study postulate there may be a certain threshold point of uric acid induced kidney damage which is irreversible. A larger multicentre prospective study is suggest to validate this finding and to study the optimal time to start uric acid lowering agent.
Copyright (c) 2025 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
A Journey from Thrombocytosis to Nephrology: Unmasking Amyloidosis
CASE PRESENTATION A 62-year-old construction worker, presented with incidental thrombocytosis of 587 × 109L during a GP visit in March 2022. His symptoms also included myalgia, chronic constipation, intermittent cough with exertional dyspnoea. He also complained of frothy urine since 2019. He was referred to the nephrology team for worsening proteinuria starting in February 2024. On physical examination, blood pressure was 140/80, the patient was noted to be cachexic but with normal lung findings, no hepatosplenomegaly and no pedal oedema. There was also incidental finding of palpable cervical lymph nodes.
CASE PRESENTATION A 21-year-old woman presented with a 2-week history of fever, associated with anorexia and bilateral eye swelling. She had a history of dengue fever and herpes zoster infection, occurring 4 months and 2 months prior to this presentation, respectively. On examination, she was febrile, lethargic, and had bilateral periorbital oedema.
Copyright (c) 2024 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
Rare Renal Manifestation of Plasma Cell Disorder
A 48-year-old woman presented with intermittent fever, dyspnea, hand and limb swelling, and purplish plantar spots. Initially diagnosed with pneumonia, she was later found to have mixed connective tissue disease and interstitial lung disease. She required oxygen support, had stable vitals, and exhibited lung crepitations and bilateral pedal edema. Patient had elevated white blood cells, platelets, CRP, creatinine, positive c- Antineutrophil Cytoplasmic Antibody (Anca) and significant proteinuria and hematuria. Initial impression was mixed connective tissue disease with pre renal Acute Kidney Injury (AKI) with differentials of sepsis induced AKI , Anca related Glomerulonephritis (GN) or Infection related GN. Renal biopsy shows a diffuse sclerosing pattern changes with granulomatous nephritis. Negative Immunofluorescence (IF) study concluded sclerosing and granulomatous form of ANCA related pauci-immune glomerulonephritis. A. B. C. D. Final diagnosis of Wegener's Granulomatosis@ Granulomatosis Polyangiitis (GPA) was made. Recurrent chest infections with concurrent AKI should indeed raise suspicion for pulmonary-renal syndromes.
Laparoscopic Tenckhoff catheter insertion using an improvised pre-peritoneal tunneling technique under conscious sedation – 1 year outcome
Background: Peritoneal dialysis (PD) catheter dysfunction is one of the reasons for PD dropout. Tenckhoff Catheter (TC) functional longevity will improve PD outcomes. This series aims to study the safety and feasibility of laparoscopic TC insertion using an improvised pre-peritoneal tunneling technique under conscious sedation. Methods: Retrospective observational study of patients who underwent laparoscopic TC insertions using the proposed improvised preperitoneal tunneling technique under conscious sedation. Results: The mean age of the patients was 51.10 (SD=13.43) years old. Patients’ mean body mass index was 25.44 (SD=4.27) kg/m2. The procedure was performed on 115 patients, 78 (67.8%) had previous abdominal surgery. 15 (13.0%) required catheter reinsertion using this technique due to non-functioning existing TC inserted via a different method. 3 (2.6%) of the patients developed primary catheter dysfunction. At one-year post procedure the catheter survival rate was 97.3%, with a patient survival rate of 87.0%. At the time of writing, median catheter survival was 16.5 months. Conclusion: Laparoscopic TC insertion using this pre-peritoneal tunneling technique under conscious sedation is able to yield satisfactory catheter functionality, particularly for patients with a history of abdominal surgery, all while avoiding the risks associated with general anesthesia.
Anti-Glomerular Basement Membrane (Anti-GBM) Disease: The Challenges in Diagnosis and The Choice of Treatment
Anti–glomerular basement membrane (anti-GBM) antibody disease is an autoimmune disorder. The majority of patients develop widespread glomerular crescent formation, presenting with features of rapidly progressive glomerulonephritis (RPGN). The etiology is unclear. The treatment depends on the creatinine level at presentation, dialysis dependency, and pulmonary involvement to decide on plasmapheresis, glucocorticoid, and immunosuppressive therapy. We report a case of a 17-year-old lady who presented features of RPGN requiring intermittent dialysis, renal biopsy, and serology showing features of anti-GBM glomerulonephritis (GN).
High Glucose Content Genitourinary Fluid in Repeated Peritonitis (CAPD) Patient
We are describing a case of an adult patient with end-stage kidney failure (ESKF) who was on continuous ambulatory peritoneal dialysis (CAPD), presented with colourless fluid flow per vaginal due to peritoneal-fallopian tube fistula, a rare complication of recurrent peritonitis. We discuss on the approach taken for diagnosis and management in this case.
MYELOPROLIFERATIVE DISORDER ASSOCIATED WITH FOCAL SEGMENTAL GLOMERULOSCLEROSIS: A CASE REPORT
We report a rare case of focal segmental glomerulosclerosis (FSGS) with Myelofibrosis. A 57-year-old man with underlying Idiopathic Membranous Nephropathy (IMN) presented to us with chief complaints of frothy urine and leg swelling. Urine quantification showed nephrotic-range proteinuria. The patient underwent renal biopsy due to rapidly declining renal function and persistent proteinuria, in which the electron microscopy (EM) revealed the diagnosis of focal segmental glomerulosclerosis (FSGS) although initial light microscopy showed thickening of capillary loops which suggested MN. He was started on immunosuppressive therapy which consisted of calcineurin inhibitor and steroids, and his renal function and proteinuria improved. We wish to highlight the importance of incorporating EM as part of the routine histopathological assessment to yield a precise diagnosis. Keywords: Focal Segmental Glomerulosclerosis, Membranous Nephropathy, Myelofibrosis, Nephrotic syndrome, Electron Microscopy
Copyright (c) 2023 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
CONTINUOUS KIDNEY REPLACEMENT THERAPY IN CRITICALLY ILL INTENSIVE CARE UNIT PATIENTS WITH ACUTE KIDNEY INJURY IN A DISTRICT HOSPITAL WITHOUT NEPHROLOGIST
Introduction - Acute kidney injury in critically ill patient is associated with increased mortality. This paper describes characteristics of intensive care unit (ICU) patients who required continuous kidney replacement therapy (CKRT), property of CKRT, and clincal outcomes. Method - Retrospective descriptive review was conducted on 13 patients diagnosed with sepsis and underwent CKRT in an ICU of a district hospital without a in-house nephrologist between May 2022 to March 2023. Treatment indications were refractory fluid overload, severe metabolic acidosis, hyperkalaemia, and symptomatic uraemia. We describe patients’ characteristics, disease severity with Sequential Organ Failure Assessment (SOFA) score, nephrology referral and CKRT initiation, characteristics of CKRT, and outcomes i.e. length of ICU stay, mortality and renal recovery. Results - There were 13 critically ill patients diagnosed with sepsis and underwent CKRT in ICU since May 2022. There were five males and eight females, mean age 46 years (SD13.6). Pre-morbidly, eight had diabetes mellitus (61.5%), six had hypertension (46%), and three had heart failure (23%). Twelve patients (92%) had severe disease; mean SOFA score 16 (SD3.2). Time to nephrology referral were <1-2 days, with treatments initiation within 2 hours. Mean treatment duration is 38 hours (SD31.8). Incomplete treatment is due to seven circuit clotting and four deaths. Mean length of ICU stay was 10 days. Three patients survived with renal recovery. Mortality rate was 77%. Conclusion - CKRT provides hemodynamic stability for critically ill patients. We aim to improve outcomes by expanding treatment availability. This review provides improvement direction and encourages CKRT initiation.
Bedside Seldinger Tenckhoff Catheter Insertion Without Fluoroscopy by Nephrologist: A Safe And Effective Method For Timely Insertion and Initiation of Kidney Replacement Therapy
Introduction: Peritoneal dialysis (PD) is still underutilized despite being known as the most cost-effective dialysis modality. Until recently, our Tenckhoff catheter insertion requires the expertise of surgeon, anaesthetist, operating theater or fluoroscopic services in our center. This leads to long waiting time due to the scarcity of resources. To overcome this, we introduced bedside Seldinger Tenckhoff catheter (TC) insertion without fluroscopy. We aim to determine the safety, immediate and early complications following bedside TC insertion without fluroscopy Methods: This is a retrospective study conducted in Hospital Queen Elizabeth, Sabah whereby all patients aged more than 18 years old who underwent bedside Seldinger TC insertion from 1 January 2020 – 31 December 2020 will be included. Demographic data, immediate and early complications following TC insertion were collected and analysed. Results and Conclusion: There were 152 attempts of bedside Seldinger TC insertion with 149 TC inserted. Majority were female (65%) with mean age of 45.6 years old, body mass index of 24.6kg/m2 and mean TC insertion time was under 2 weeks. Main primary disease of end-stage kidney disease was diabetes (42%). Bleeding was the main immediate complication (n=6) where all were managed conservatively. The rates for PD catheter insertion-related peritonitis and primary catheter dysfunction following bedside TC insertion were 4.6% and 8%. To conclude, bedside TC insertion without fluroscopy allows timely insertion with low immediate and early complications. This allows patients with ESKD equitable access to kidney replacement therapy in a place with limited resources.
Bedside Seldinger Tenckhoff catheter insertion
PD catheter insertion-related peritonitis
Subumbilical Tenckhoff catheter insertion
Successful Treatment of Severe Covid-19 in A Kidney Transplant Recipient With Tocilizumab
We report a case of severe COVID?19 in a deceased donor kidney transplant recipient (KTR) who was successfully treated with Tocilizumab. She presented with COVID-19 symptoms and tested positive by reverse transcription real?time polymerase chain reaction (RT-PCR) of nasopharyngeal swab. The patient was admitted on day 5 of illness with chest radiography (CXR) suggestive of bronchopneumonia. Blood investigations showed leucocytosis with normal lymphocyte count and raised C-reactive protein (CRP). We closely monitored her condition as she was able to maintain saturation under room air. She deteriorated further on day 9 of illness, requiring withholding of immunosuppressive medications, increasing dose of oxygen therapy and dexamethasone. Tocilizumab was started for lymphopenia, raised lactate dehydrogenase (LDH) and persistence of alveolar opacities. Complications include acute kidney injury (AKI) and transaminitis. Her symptoms of pneumonia gradually improved, was able to be discharged on day 20 of illness, with complete resolution of AKI.
Estimates Of Glomerular Filtration Rate Based On Creatinine And Cystatin C Equations In Critically Ill Patients
Introduction: Accurate assessment of renal function in the critically ill is important for diagnostic and prognostic performance. It is usually estimated from various estimate glomerular filtration rate (eGFR) equations. We evaluated eGFR based on Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) from serum creatinine (SCr), serum cystatin C (SCysC), and its combination, against 24-hour creatinine clearance (CrCL) to find the most accurate, precise, and less biased equation for GFR estimation. Methods: Critically ill patients, older than 18 years who stayed longer than 24-hours were included. Urinary creatinine, SCr, and SCysC were measured at three-time intervals (8, 24, and 72-hour). After estimating GFR from SCr(eGFRCr), SCysC, (eGFRCysC) and combined CKD-EPI (eGFRCr-CysC), results were compared with CrCL. Results: A total of 43 patients were recruited. eGFRCr had the highest correlation to CrCL, with correlation of 0.81 and 0.73 at 24 hrs and 72 hrs, respectively, and was the most precise and accurate equation compared to eGFRCysC and eGFRCr-CysC at all-time intervals. The bias was lowest in eGFRCysC equation. The Area Under Curve of eGFRCr in diagnosing acute kidney injury (AKI) was 0.93 and 0.84 at 24 and 72 hours, respectively. Neither CKD-EPI equations nor CrCL played a role in the prediction of in-hospital mortality with p>0.05 at all-time points. Conclusion: eGFRCr had the highest correlation to CrCL and was the most accurate and precise equation, however, eGFRCysC had lowest bias at all-time intervals. Most of the equations contributed to the diagnosis of AKI. However, none on contributed to prediction of in-hospital mortality.
Copyright (c) 2022 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
Acute Kidney Injury in Covid-19 Infection: A Qualitative Review of Literature
COVID-19 is a coronavirus infection of the respiratory system, with multiorgan involvement. Acute kidney injury (AKI) is one of the complications of covid-19 infection. This review explored the epidemiology, pathophysiology, risk factors, and outcome of AKI in Covid-19 infection. There is huge variability in the incidence of AKI among COVID-19 patients from different regions of the world. Some modifiable and non-modifiable risk factors that can increase a patient’s risk of developing AKI have been identified. Mortality is significantly increased if a COVID-19 patient develops AKI. Avoidance of risk factors and improve survival and reduce morbidity among patients. Long term follow up is recommended for survivors with AKI to monitor for future kidney disease.
Challenges of Managing a Case of Worsening Acute Kidney Injury in Active Lupus Nephritis with Superimposed Covid-19 Infection: A Case Report
We present a case of a young man with known lupus nephritis who came to us with a flare of lupus nephritis and superimposed COVID-19 infection. He received intravenous immunoglobulin (IVIG) that resulted in clinically and biochemically improvement. He was discharged to home well. Future reports are needed to show the relations between COVID-19 infection and lupus nephritis.
Successful treatment of an end-stage kidney disease patient presenting with severe Covid-19 disease using enhanced cytokine removal with haemoadsorption therapy in addition to standard management
Endstage renal disease patients with severe COVID-19 disease has higher mortality rate as compared to those with no comorbidities. Here we report a case of endstage renal disease patient who was on regular haemodialysis presenting with severe COVID-19 disease and progressed to cytokine storm. In addition to standard management with steroids in view of the hypoxia, this patient received haemoadsorption therapy to aid cytokine removal hence potentially limiting the progression of the acute respiratory distress syndrome and preventing mortality. There are limited data on the use of haemoadsorption in endstage renal disease patients with COVID-19 disease. This patient survived to discharge without the need for supplemental oxygen. In conclusion, combined therapeutic modalities are possible promising treatment for severe COVID-19 infection in endstage renal disease patients.
Oxalate nephropathy secondary to oxalate-rich diet and excessive vitamin C Intake
Oxalate nephropathy is a rare condition but remains an important cause of end-stage kidney disease. A 42-year-old healthy man with no comorbid was sent to a nephrologist because of significantly increased creatinine (290-836 µmol/l) within 3 months. He was found to have renal impairment when he was treated for pneumonia a few months earlier. The initial workup was unrevealing. Within a couple of weeks after the first visit, he developed acute symptomatic worsening kidney injury with nausea, vomiting and creatinine up to 836 µmol/l. Further history revealed that he had sought alternative treatment with multiple supplements containing high doses of vitamin C and foods high in oxalate precursor. A kidney biopsy confirmed oxalate nephropathy. Despite restriction of oxalate consumption, his kidney function deteriorated and he commenced on permanent hemodialysis.
Pulmonary Embolism in ESKD and COVID-19 – A Known Common Problem Yet Too Much Unknown
Venous thromboembolism (VTE) is common in COVID-19 infection, particularly in those with severe disease. Here we report a case of pulmonary embolism (PE) in an end stage kidney disease (ESKD) patient on maintenance haemodialysis with COVID-19 infection. The clinical manifestations of PE in this case were non-specific, and were masked by the other concurrent illnesses. Patient was persistently hypoxic despite optimal management of the other concurrent illnesses, and PE was eventually diagnosed based on CT pulmonary angiogram. This case highlights a few important issues that, VTE incidence is unacceptably high despite pharmacological prophylaxis, and clinical manifestations of PE in CKD patients with COVID-19 are non-specific and are frequently thought to be due to other concurrent illnesses. Optimal treatment of PE in COVID-19 is unknown, and data is even more scarce in CKD population. Current treatment recommendations are largely extrapolated from data of non-COVID-19 population, though large prospective trials are underway.
Copyright (c) 2021 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
Use of Prophylactic Antibiotic In Micturating Cystourethrography: Intramuscular vs Oral and Impact on Patients’ Stress
Introduction: Our centre has been practicing pre-procedural single dose of intramuscular(IM) gentamicin as Urinary Tract Infection(UTI) prophylaxis for Micturating Cystourethrography(MCUG). Objectives: Primary: Quality assurance project to compare oral trimethoprim to IM gentamicin in reducing MCUG-related stress score Secondary: Evaluate the risk of post-procedural UTI(ppUTI) in each group, family preference of antibiotic administration and adherence to antibiotic prophylaxis. Method: This study conduct in two phases, each lasted 9 months. First phase patients received single dose IM gentamicin prior to MCUG except patients with eGFR< 60ml/min/1.73m2 to receive oral trimethoprim. Second phase patients received 3 days of oral trimethoprim started day before the procedure. Preferences type of antibiotic prophylaxis and stress scores of having respective antibiotic were recorded after the procedure. They were followed up with phone interview at one week and later in clinic. Result: 56 patients were recruited. (IM gentamicin, n=17, oral trimethoprim, n=39). The median age was 9 months (4 days–14 years). Mean stress score of IM gentamicin group was 3.9, oral trimethoprim group recorded 0. (p =0.000) Three oral trimethoprim users (7.89%) developed ppUTI, none from IM gentamicin group. (p =0.244). All 3 were younger than 3 months. Ninety percent of the patients preferred oral trimethoprim. The oral trimethoprim group reported a full adherence. The positive pick-up rate of urinary tract anomaly from MCUG was 34%. Conclusion: Oral trimethoprim significantly alleviates the stress of the procedure with excellent family adherence and family preference. Oral trimethoprim should be choice of antibiotic prophylaxis for children > 3 months old.
stress, post-procedural UTI, antibiotic prophylaxis, MCUG/ VCUG
Acute bilateral basal ganglia lesion: Lentiform fork sign in end stage renal disease with metabolic acidosis
Neurological complications are not uncommon in end stage renal disease population. Bilateral basal ganglia lesions have been widely reported to be associated with uraemic encephalopathy. Lentiform Fork sign is a unique, not uncommon MRI picture that is not only seen in patient with uraemic encephalopathy, but also in other condition that result in metabolic acidosis. It has been reported in the medical literature, but only infrequently. The present report details such a case which associated with metabolic acidosis. Keywords: bilateral basal ganglia lesion. Metabolic acidosis.
Copyright (c) 2021 Journal of Clinical and Translational Nephrology
The usage of guidewire or stylet in successful peritoneal dialysis catheter exchange without fluoroscopy or peritoneoscope use - The Serdang Method
Mechanical malfunction of peritoneal dialysis (PD) catheters remains the most common non-infective complication of peritoneal dialysis. Failure in conservative measures often results in surgical correction, which is often invasive, time-consuming and may require the patient to temporarily switch to haemodialysis while waiting for post-operative recovery and wound healing. This article describes two methods of PD catheter exchange that are minimally invasive, time- and cost-efficient; and most importantly, successful.
PD catheter; malfunction; guidewire; stylet
A Retrospective Study on the Incidence and Outcomes of Acute Kidney Injury among Patients Diagnosed with Malaria Infection in Sabah – a Tertiary Centre Experience
Introduction Acute kidney injury (AKI) is one of the most common complications of malaria infection. Plasmodium knowlesi is the most common malaria reported in Malaysia, this is not reported elsewhere. It has been suggested that severe malaria occurred more frequently in P. knowlesi infection compared to P. falciparum. Methods We conducted a retrospective cohort study to measure the incidence and outcomes of AKI among patients admitted to a state tertiary hospital for malaria infection for the year 2018. Results There were 173 cases of malaria infection reported in Queen Elizabeth Hospital, Sabah in 2018. Fifty-three cases were excluded as case notes were unavailable. Among the 120 cases included in analysis, 97.5% (117/120) were Plasmodium knowlesi infection. 19.2% (23/120) were classified as severe malaria. 31.7% (38/120) developed AKI as per KDIGO criteria. Among those with AKI, 50% (19/38) were Stage 1, 29% (11/38) were Stage 2, 21% (8/38) were stage 3. 7.8% (3/38) patients with AKI required temporary haemodialysis. Upon discharge, 81.6% (31/38) of AKI patients had recovered their renal function. At 3 months, 13% (5/38) of AKI patients had persistent renal impairment, with eGFR ranging from 44.2 – 51.9ml/min/1.73m2. Multivariate analysis showed that age 50 years old and older (OR 3.25; CI 1.37, 7.73; p=0.008), and high total bilirubin count (OR 5.6; CI 1.73, 18.12, p=0.004) were associated with the development of acute kidney injury. Conclusion AKI is common in malaria infection. Up to 13% of patients with AKI progress to chronic kidney disease at 3 months followup.
Isolated renal sarcoidosis with acute kidney injury - A rare entity
Sarcoidosis is a multisystem inflammatory disorder that commonly affecting the lungs. However, isolated renal sarcoidosis without lung involvement is a rare condition. Sarcoidosis is known to cause kidney involvement via different mechanisms. Hypercalcemia and hypercalciuria may trigger renal stones formation and result in obstructive uropathy. Sarcoidosis can also cause interstitial nephritis with or without granuloma formation in the kidneys. The true incidence of renal involvement in sarcoidosis is unknown as renal biopsy is not routinely performed unless there is presence of renal impairment. Renal sarcoidosis is a diagnosis of exclusion supported by the typical histopathological findings. Due to the scarcity of this disease, there is no universal guideline or recommendation regarding the diagnosis and treatment for renal sarcoidosis. Here we present a case that initially presented to us with rapid deterioration of kidney function, which was later proven to be renal sarcoidosis, followed by a literature review.
Copyright (c) 2020 Journal of Clinical and Translational Nephrology
Kidney with lower pole simple cysts - is it an absolute contraindication for renal biopsy?
A percutaneous renal biopsy is an essential tool for diagnosis, prognosis, and choice of treatment for primary and secondary renal disease, as well as transplant kidney. It is a core procedure of nephrologists done under ultrasound-guided. The lower pole of the left kidney is our usual approach as the risk of injury to the major vessels will be very minimal. However, the presence of renal cyst at the lower pole of the kidney may increase the difficulty of renal biopsy as there is the possibility of puncturing the renal cyst during the procedure causing unstoppable bleeding. Here we present two case reports in which we were able to do percutaneous renal biopsy under ultrasound-guided for patients with simple renal cysts at the lower pole of the kidney without causing any significant complication. In the hand of expert personnel, a lower pole cyst can be avoided under ultrasound-guided biopsy.
Sertraline for the treatment of Depressive Symptoms in Chronic Kidney Disease compared to placebo: A Limited Systematic Review
Background: Depressive symptoms have been associated with chronic kidney disease and has been linked with morbidity, treatment adherence, hospitalizations and mortality. Sertraline, a type of Selective Serotonin Reuptake Inhibitor has been used widely in the general population as treatment of depression. However, evidence of its effectiveness in chronic kidney disease patients with depressive symptoms is still lacking. Aim: To examine the effectiveness of Sertraline compared to placebo in treating depressive symptoms in adult patients with chronic kidney disease. Methods: A limited systematic review was performed using five databases; PsychoINFO, Medline, Embase, SCOPUS, PUBMED, until September 2019. Citation tracking and hand searching were also performed. Results: The literature search yielded 687 publications; of which 3 randomized controlled trials were included in the analysis. A total of 142 (n=15 to 102) patients were randomized to receive treatment with Sertraline. Trial durations were 8, 12 weeks and 6 months. There were no differences for non-dialysis population; score changed by -4.1 in the sertraline group and -4.2 in the placebo group (p=0.82). Two studies involving hemodialysis patients showed improvement in scores; from 24.5+4.1 to 10.3+5.8 (p<0.001) and 23+11 to 22.5+9; a reduction of 0.5+5 (p<0.001). However, both were of low quality as one had inadequate sample size and the other had less than half of the participants recorded reduction in scores despite overall improvement. Non-uniformity of validated assessment tools used for measurements precluded metanalysis. Conclusion: Available evidence do not demonstrate the effectiveness of sertraline as treatment for depressive symptoms in chronic kidney disease patients.
Double positive Anti-GBM and ANCA-associated glomerulonephritis – A case report
Double-Positive Anti-Glomerular Basement Membrane (Anti-GBM) and Anti-Neutrophil Cytoplasm Antibody (ANCA)- Associated Glomerulonephritis is a rare disease. The disease is characterized by concurrent presence of Anti-GBM antibodies and ANCA in a patient. The patient usually presents with rapidly progressive glomerulonephritis with or without pulmonary haemorrhage. We report a case of a middle-aged gentleman who presented acute kidney injury with a serum creatinine level of 459umol/L. He was tested positive for both Anti-GBM and ANCA with high titers. He underwent 6 cycles of plasma exchange, pulse IV cyclophosphamide and high dose steroid. During his 6 months outpatient review, a total of 6 doses IV cyclophosphamide has been given and his serum creatinine reduced to 146 umol/L. In conclusion, the use of pulse IV cyclophosphamide over oral form in this subject is empirical and showed marked improvement of renal function.
anti–neutrophil cytoplasm antibody, anti-GBM disease, Goodpasture syndrome, glomerulonephritis, vasculitis, iv cyclophosphamide
Shin Kuan Tee, Hon Shen P'ng, Fariz Bin Nordin, Wen Jiun Liu, Nik Hasimah Binti Nik Yahya, Wai Seng Cheong
Actinomyces odontolyticus catheter related bloodstream infection in a hemodialysis patient - First reported case
Actinomyces odontolyticus is a gram-positive bacillus, usually found in oropharynx, gastrointestinal tract and urogenital tract as human commensal flora. Infection caused by this organism is rare but may occur in an immunocompromised patient. This organism has been known difficult to be cultured. We reported a case of 60 years old woman, on regular hemodialysis for the past 3 years, who had Actinomyces odontolyticus bacteremia due to catheter-related bloodstream infection. She was treated with antibiotics for 3 weeks and was referred to dentist for dental clearance. We believe this is the first case report of Actinomyces odontolyticus bacteremia in a hemodialysis patient. This case report highlighted the importance of looking for the primary source (in this case oral cavity) as this is usually an endogenous infection arising most frequently from mucosal membrane. Early eradication of the primary source may help to fasten the recovery and prevent it re-occurs in the future.
Why clinicians should be involved in research?
Research is about discovering new knowledge that could lead to changes in treatment, policies or care. Hence, participating in research allows clinicians to evaluate their practice more objectively and to be involved in advancing their discipline. Moreover, by appraising the evidence and thinking critically about a situation makes one a better clinician. In this article, we have a rare opportunity to interview our Editor-In-Chief of our journal at to what actually sparkled his initial interest in research and how his passion in research blossom over the years. Prof. Dr. Goh is the Head and Senior Consultant Nephrologist in Serdang Hospital. He became a member of the Royal College of Physicians in United Kingdom MRCP(UK) in 1996 and obtained his further training as Renal Fellow at Monash Medical School, Melbourne, Australia. He was awarded the Fellowship of Royal College of Physicians and Surgeons in 2002 and Fellowship of Academy of Medicine of Malaysia in 2012. Prof. Dr. Goh has published numerous original articles in international peer-reviewed journals in the field of general nephrology, dialysis and transplantation. He has special interests in peritoneal dialysis (PD) and CKD-MBD and has numerous publications in PD-related articles in Seminars in Dialysis and Peritoneal Dialysis International. Being an ardent speaker in his expertise, he is a frequently sought-after invited speaker and has presented numerous scientific papers in international meetings and congresses. He is also involved in many Registries and Clinical Practice Guidelines and sits in many panels / committees / advisory boards as well as professional societies at both national and international levels. Currently, he is the Past President of the Malaysian Society of Nephrology (MSN), a member of International Society for Peritoneal Dialysis (ISPD) Working Party on PD Access Guidelines and Asia Pacific Renal Advisory Board member. He is also the Editor of National Renal Registry and was appointed as an Adjunct Professor. He is a member of Asia Pacific Congress of Nephrology 2018 & 2020, 23rd International Conference on AKI CRRT 2018, and International Society of Nephrology Global Health Summit.
Copyright (c) 2019 Journal of Clinical and Translational Nephrology (JCTN)
Journal article submission workflow at a glance
Journal of clinical and translational nephrology (JCTN) is the official online journal of Malaysian Society of Nephrology. It is a free and fully open access, online only journal publishing biannually. The journal will serve as an essential nephrology educational and training resource and it publishes original peer-reviewed research articles in all aspects of the basic clinical science research, prevention, diagnosis and management of kidney and associated disorders, translational research as well as related molecular genetics, pathophysiology, and epidemiology study in the field of renal disease.