Journal of Clinical and Translational Nephrology
type: channel
description: 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.
publisher: Malaysian Society Of Nephrology (ROS: 82/84)
language: en
publication name: Journal of Clinical and Translational Nephrology
issn: 2710-5903
items: Necrotising Lymphadenitis with Bicytopenia as Prelude to Systemic Lupus Erythematosus
items: A Headache Beyond the Brain: Cerebral Venous Sinus Thrombosis Revealing IgA Nephropathy
items: THE IMPACT OF HYPERUREMIA TO THE RENAL SURVIVAL IN MALAYSIAN CKD POPULATION
items: A Journey from Thrombocytosis to Nephrology: Unmasking Amyloidosis
items: LUPUS NEPHRITIS, A GREAT MIMICKER
items: Nephrotic Syndrome In Young Adolescent
items: Rare Renal Manifestation of Plasma Cell Disorder
items: Pneumonia – The Silent Renal Killer
items: Laparoscopic Tenckhoff catheter insertion using an improvised pre-peritoneal tunneling technique under conscious sedation – 1 year outcome
items: Anti-Glomerular Basement Membrane (Anti-GBM) Disease: The Challenges in Diagnosis and The Choice of Treatment
items: High Glucose Content Genitourinary Fluid in Repeated Peritonitis (CAPD) Patient
items: MYELOPROLIFERATIVE DISORDER ASSOCIATED WITH FOCAL SEGMENTAL GLOMERULOSCLEROSIS: A CASE REPORT
items: CONTINUOUS KIDNEY REPLACEMENT THERAPY IN CRITICALLY ILL INTENSIVE CARE UNIT PATIENTS WITH ACUTE KIDNEY INJURY IN A DISTRICT HOSPITAL WITHOUT NEPHROLOGIST
items: Bedside Seldinger Tenckhoff Catheter Insertion Without Fluoroscopy by Nephrologist: A Safe And Effective Method For Timely Insertion and Initiation of Kidney Replacement Therapy
items: Successful Treatment of Severe Covid-19 in A Kidney Transplant Recipient With Tocilizumab
items: Estimates Of Glomerular Filtration Rate Based On Creatinine And Cystatin C Equations In Critically Ill Patients
items: Acute Kidney Injury in Covid-19 Infection: A Qualitative Review of Literature
items: Challenges of Managing a Case of Worsening Acute Kidney Injury in Active Lupus Nephritis with Superimposed Covid-19 Infection: A Case Report
items: 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
items: Oxalate nephropathy secondary to oxalate-rich diet and excessive vitamin C Intake
items: Pulmonary Embolism in ESKD and COVID-19 – A Known Common Problem Yet Too Much Unknown
items: Use of Prophylactic Antibiotic In Micturating Cystourethrography: Intramuscular vs Oral and Impact on Patients’ Stress
items: Acute bilateral basal ganglia lesion: Lentiform fork sign in end stage renal disease with metabolic acidosis
items: The usage of guidewire or stylet in successful peritoneal dialysis catheter exchange without fluoroscopy or peritoneoscope use - The Serdang Method
items: A Retrospective Study on the Incidence and Outcomes of Acute Kidney Injury among Patients Diagnosed with Malaria Infection in Sabah – a Tertiary Centre Experience
items: Isolated renal sarcoidosis with acute kidney injury - A rare entity
items: Kidney with lower pole simple cysts - is it an absolute contraindication for renal biopsy?
items: Sertraline for the treatment of Depressive Symptoms in Chronic Kidney Disease compared to placebo: A Limited Systematic Review
items: Double positive Anti-GBM and ANCA-associated glomerulonephritis – A case report
items: Actinomyces odontolyticus catheter related bloodstream infection in a hemodialysis patient - First reported case

Necrotising Lymphadenitis with Bicytopenia as Prelude to Systemic Lupus Erythematosus
type: item
description: A 32-year-old woman presented with a three-month history of intermittent fever, profound weight loss, anorexia, and inflammatory polyarthralgia, followed by acute painful cervical lymphadenopathy. She had a prior history of immune thrombocytopenia. Examination revealed pallor, malar rash, and tender cervical lymphadenopathy. Laboratory evaluation demonstrated normocytic anaemia, leukopenia, elevated inflammatory markers, hypoalbuminaemia, low complement C3, positive direct Coombs test, and subnephrotic proteinuria with preserved renal function. Immunological studies showed high-titre antinuclear antibodies with strongly positive anti-Sm, U1-RNP/Sm, and ribosomal P antibodies, while anti-double-stranded DNA was negative. Ferritin was markedly elevated. Fine-needle aspiration cytology of the lymph node revealed necrotising lymphadenitis without malignancy. Renal biopsy confirmed ISN/RPS class II lupus nephritis with membranous features. This case highlights necrotising lymphadenitis and bicytopenia as early manifestations of systemic lupus erythematosus and underscores the importance of renal biopsy despite minimal urinary abnormalities.
subject: Clinical image
  topic: section
subject: Open Access
  topic: category
subject: necrotizing lymphadenitis
  topic: keywords
subject: bicytopenia
  topic: keywords
subject: lupus nephritis
  topic: keywords
subject: Nephrology
  topic: disciplines
subject: lupus nephritis
  topic: disciplines
creator: Nor Izzati Mohd Zuki
creator: Christopher Thiam Seong Lim
creator: Fauzah Abdul Ghani
rights: Copyright (c) 2026 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2026-03-02
publication date: 2026-03-02

A Headache Beyond the Brain: Cerebral Venous Sinus Thrombosis Revealing IgA Nephropathy
type: item
description: IgA nephropathy commonly presents with haematuria and subnephrotic proteinuria, while nephrotic syndrome and extra-renal thrombotic complications are rare. We report a 49-year-old man with no prior medical illness who presented with a two-week history of thunderclap headache, frothy urine, and peripheral oedema. Investigations revealed severe hypoalbuminaemia, nephrotic-range proteinuria, hypercholesterolaemia, and preserved renal function. Neuroimaging demonstrated cerebral venous sinus thrombosis. Renal biopsy confirmed IgA nephropathy (Oxford classification M0 E0 S1 T0 C0). This case highlights an atypical presentation of IgA nephropathy complicated by cerebral venous sinus thrombosis secondary to nephrotic syndrome–associated hypercoagulability. It underscores the importance of recognising thunderclap headache as a red flag for cerebral venous sinus thrombosis in nephrotic patients and the role of early renal biopsy in establishing diagnosis despite negative serological workup.
subject: Clinical image
  topic: section
subject: Open Access
  topic: category
subject: headache
  topic: keywords
subject: nephrotic range proteinuria
  topic: keywords
subject: thrombosis
  topic: keywords
subject: nephrology
  topic: disciplines
creator: JZE WEI WONG
creator: Christopher Thiam Seong Lim
rights: Copyright (c) 2026 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2026-03-02
publication date: 2026-03-02

THE IMPACT OF HYPERUREMIA TO THE RENAL SURVIVAL IN MALAYSIAN CKD POPULATION
type: item
description: 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.
subject: Original Article
  topic: section
subject: Original Articles
  topic: category
subject: Causative roles
  topic: keywords
subject: hyperuricemia
  topic: keywords
subject: mortality
  topic: keywords
subject: kidney replacement therapy
  topic: keywords
subject: renal deterioration
  topic: keywords
subject: Chronic kidney disease
  topic: disciplines
subject: Hyperuricemia
  topic: disciplines
subject: Nephrology
  topic: disciplines
creator: MOHAMMAD ZULKARNAIN BIDIN
creator: Anim Md Shah
creator: Johnson Stanslas
creator: Bak Leong Goh
creator: Christopher Lim Thiam Seong Lim
rights: Copyright (c) 2025 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2025-09-01
publication date: 2025-09-01

A Journey from Thrombocytosis to Nephrology: Unmasking Amyloidosis
type: item
description: 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.
subject: Clinical image
  topic: section
subject: Open Access
  topic: category
subject: Original Articles
  topic: category
subject: Editorial
  topic: category
subject: Abstract
  topic: category
creator: Zhun Han Wong
creator: Elmina Mohamad Mokhtar
creator: Norlisa Khalid
creator: Kar Wah Fuah
creator: Bak Leong Goh
creator: Fairol Huda Ibrahim
creator: Christopher Lim Thiam Seong
rights: Copyright (c) 2025 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2025-03-02
publication date: 2025-03-02

LUPUS NEPHRITIS, A GREAT MIMICKER
type: item
description: 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.
subject: Clinical image
  topic: section
subject: Open Access
  topic: category
creator: Shamira Shahar
creator: Bak Leong Goh
creator: Elmina Mohamad Mokhtar
creator: Kiew Fong Juen
creator: Anusha Kalyanasundaram
creator: Christopher Lim Thiam Seong
rights: Copyright (c) 2025 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2025-03-02
publication date: 2025-03-02

Nephrotic Syndrome In Young Adolescent
type: item
subject: Clinical image
  topic: section
subject: Open Access
  topic: category
creator: Tee Tat khoo
creator: Christopher Thiam Seong Lim
creator: Haidi Mohamad
creator: Elmina Mohamad Mokhtar
creator: Bak Leong Goh
rights: Copyright (c) 2024 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2024-09-01
publication date: 2024-09-01

Rare Renal Manifestation of Plasma Cell Disorder
type: item
subject: Clinical image
  topic: section
subject: Open Access
  topic: category
subject: myeloma
  topic: keywords
subject: acute kidney injury
  topic: keywords
subject: plasma cell disorder
  topic: keywords
creator: Shamira Shahar
creator: Christopher Thiam Seong Lim
creator: Haidi Mohamad
creator: Fauzah Abd Ghani
creator: Bak Leong Goh
rights: Copyright (c) 2024 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2024-09-01
publication date: 2024-09-01

Pneumonia – The Silent Renal Killer
type: item
description: 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.
subject: Case Report
  topic: section
subject: Open Access
  topic: category
creator: Logaruban Aravan
creator: Christopher Thiam Seong Lim
creator: Haidi Mohamad
creator: Fauzah Abd Ghani
creator: Bak Leong Goh
rights: Copyright (c) 2024 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2024-09-01
publication date: 2024-09-01

Laparoscopic Tenckhoff catheter insertion using an improvised pre-peritoneal tunneling technique under conscious sedation – 1 year outcome
type: item
description: 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.
subject: Original Article
  topic: section
subject: Original Articles
  topic: category
creator: Vinoth Kasi Rajan Athmalingam
creator: Sentilnathan Subramaniam
creator: Kheng Wee Goh
creator: Jin Jiun Mah
creator: Koh wei Wong
creator: Fei Sia Chan
creator: Shankaran Thevarajah
rights: Copyright (c) 2024 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2024-09-01
publication date: 2024-09-01

Anti-Glomerular Basement Membrane (Anti-GBM) Disease: The Challenges in Diagnosis and The Choice of Treatment
type: item
description: 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).
subject: Case Report
  topic: section
subject: Open Access
  topic: category
subject: Anti-GBM disease
  topic: keywords
subject: Glomerulonephritis
  topic: keywords
subject: Rapid progressive glomerulonephritis
  topic: keywords
subject: End stage kidney disease
  topic: keywords
creator: Li Li Kwan
creator: Christopher Thiam Seong Lim
creator: Yong Fatt Cheng
creator: Fauzah Abdul Ghani
creator: Raihan Ramli
rights: Copyright (c) 2024 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2024-03-01
publication date: 2024-03-01

High Glucose Content Genitourinary Fluid in Repeated Peritonitis (CAPD) Patient
type: item
description: 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.
subject: Case Report
  topic: section
subject: Open Access
  topic: category
creator: Kok Zhang Tee
creator: Sin Yee Tan
creator: Siew Ping Lau
rights: Copyright (c) 2024 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2024-03-01
publication date: 2024-03-01

MYELOPROLIFERATIVE DISORDER ASSOCIATED WITH FOCAL SEGMENTAL GLOMERULOSCLEROSIS: A CASE REPORT
type: item
description: 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
subject: Case Report
  topic: section
subject: Open Access
  topic: category
creator: Nurnadiah Kamarudin
creator: Christopher Thiam Seong Lim
rights: Copyright (c) 2023 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2023-09-01
publication date: 2023-09-01

CONTINUOUS KIDNEY REPLACEMENT THERAPY IN CRITICALLY ILL INTENSIVE CARE UNIT PATIENTS WITH ACUTE KIDNEY INJURY IN A DISTRICT HOSPITAL WITHOUT NEPHROLOGIST
type: item
description: 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.
subject: Original Article
  topic: section
subject: Open Access
  topic: category
subject: CKRT
  topic: keywords
subject: CVVHDF
  topic: keywords
subject: AKI
  topic: keywords
subject: ICU
  topic: keywords
subject: Haemodialysis
  topic: keywords
creator: Xue Meng Lim
creator: Mohd Kamil bin Ahmad
creator: Nor Haslina binti Abdul Rahman
rights: Copyright (c) 2023 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2023-09-01
publication date: 2023-09-01

Bedside Seldinger Tenckhoff Catheter Insertion Without Fluoroscopy by Nephrologist: A Safe And Effective Method For Timely Insertion and Initiation of Kidney Replacement Therapy
type: item
description: 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.
subject: Original Article
  topic: section
subject: Open Access
  topic: category
subject: Original Articles
  topic: category
subject: Bedside Seldinger Tenckhoff catheter insertion
  topic: keywords
subject: Peritoneal dialysis
  topic: keywords
subject: PD catheter insertion-related peritonitis
  topic: keywords
subject: Primary catheter dysfunction
  topic: keywords
subject: Subumbilical Tenckhoff catheter insertion
  topic: keywords
subject: Nephrology
  topic: disciplines
subject: Interventional nephrology
  topic: disciplines
creator: Jer Ming Low
creator: Koh Wei Wong
rights: Copyright (c) 2023 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2023-03-01
publication date: 2023-03-01

Successful Treatment of Severe Covid-19 in A Kidney Transplant Recipient With Tocilizumab
type: item
description: 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.
subject: Case Report
  topic: section
subject: Open Access
  topic: category
subject: COVID-19
  topic: keywords
subject: Kidney Transplant
  topic: keywords
subject: Tocilizumab
  topic: keywords
creator: Jing Ling Choe
creator: Xue QI Tan
creator: Soon Leng Lee
creator: Lik Wee Ee
creator: Wen Jiun Liu
rights: Copyright (c) 2023 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2023-03-01
publication date: 2023-03-01

Estimates Of Glomerular Filtration Rate Based On Creatinine And Cystatin C Equations In Critically Ill Patients
type: item
description: 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.
subject: Original Article
  topic: section
subject: Original Articles
  topic: category
subject: Estimated Glomerular Filtration Rate
  topic: keywords
subject: Serum Creatinine
  topic: keywords
subject: Serum Cystatin C
  topic: keywords
subject: Intensive Care Unit
  topic: keywords
creator: Azrina Md Ralib
creator: Sohaila Kakar
creator: Edre Mohammad Aidid
creator: Shahir Asraf Abdul Rahim
creator: Mohd Basri Mat Nor
rights: Copyright (c) 2022 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2022-08-31
publication date: 2022-08-31

Acute Kidney Injury in Covid-19 Infection: A Qualitative Review of Literature
type: item
description: 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.
subject: Editorial
  topic: section
subject: Open Access
  topic: category
subject: Acute Kidney Injury
  topic: keywords
subject: COVID-19
  topic: keywords
creator: Xue Meng Lim
creator: Christopher Thiam Seong Lim
rights: Copyright (c) 2022 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2022-02-28
publication date: 2022-02-28

Challenges of Managing a Case of Worsening Acute Kidney Injury in Active Lupus Nephritis with Superimposed Covid-19 Infection: A Case Report
type: item
description: 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.
subject: Case Report
  topic: section
subject: Open Access
  topic: category
creator: Faiz Mashood
creator: Gan Chye Chung
rights: Copyright (c) 2022 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2022-08-31
publication date: 2022-08-31

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
type: item
description: 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.
subject: Case Report
  topic: section
subject: Open Access
  topic: category
subject: COVID-19
  topic: keywords
subject: Endstage renal disease
  topic: keywords
subject: Haemodialysis
  topic: keywords
subject: Cytokine storm
  topic: keywords
subject: Haemoadsorption therapy
  topic: keywords
subject: Nephrology
  topic: disciplines
subject: Infectious Disease
  topic: disciplines
creator: Esther Zhao Zhi Tan
creator: Hin Seng Wong
rights: Copyright (c) 2022 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2022-02-28
publication date: 2022-02-28

Oxalate nephropathy secondary to oxalate-rich diet and excessive vitamin C Intake
type: item
description: 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.
subject: Case Report
  topic: section
subject: Open Access
  topic: category
subject: Oxalate
  topic: keywords
subject: oxalate crystals
  topic: keywords
subject: AKI
  topic: keywords
subject: oxalate nephropathy
  topic: keywords
subject: vitamin c
  topic: keywords
subject: megadose
  topic: keywords
subject: case report
  topic: disciplines
subject: nephrology
  topic: disciplines
creator: Siti Hafizah Mohammad Ismail
creator: Roslina Suboh
creator: Lily Mushahar
rights: Copyright (c) 2022 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2022-02-28
publication date: 2022-02-28

Pulmonary Embolism in ESKD and COVID-19 – A Known Common Problem Yet Too Much Unknown
type: item
description: 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.
subject: Case Report
  topic: section
subject: Open Access
  topic: category
subject: Original Articles
  topic: category
subject: Editorial
  topic: category
creator: Go Zher Lin
creator: Irene Wong
creator: Khairul Anuar Abd Manaf
creator: Norleen Zulkarnain Sim
creator: Shahnaz Shah Firdaus Khan
rights: Copyright (c) 2021 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2021-09-01
publication date: 2021-09-01

Use of Prophylactic Antibiotic In Micturating Cystourethrography: Intramuscular vs Oral and Impact on Patients’ Stress
type: item
description: 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.
subject: Original Article
  topic: section
subject: Open Access
  topic: category
subject: Original Articles
  topic: category
subject: Editorial
  topic: category
subject: stress, post-procedural UTI, antibiotic prophylaxis, MCUG/ VCUG
  topic: keywords
creator: Suet Li Yap
creator: Yok Chin Yap
rights: Copyright (c) 2021 Journal of Clinical and Translational Nephrology https://creativecommons.org/licenses/by/4.0
date: 2021-09-01
publication date: 2021-09-01

Acute bilateral basal ganglia lesion: Lentiform fork sign in end stage renal disease with metabolic acidosis
type: item
description: 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.
subject: Case Report
  topic: section
subject: bilateral basal ganglia lesion
  topic: keywords
subject: nephrology
  topic: disciplines
creator: Lau Siew Ping
rights: Copyright (c) 2021 Journal of Clinical and Translational Nephrology
date: 2021-03-01
publication date: 2021-03-01

The usage of guidewire or stylet in successful peritoneal dialysis catheter exchange without fluoroscopy or peritoneoscope use - The Serdang Method
type: item
description: 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.
subject: Case Report
  topic: section
subject: PD catheter; malfunction; guidewire; stylet
  topic: keywords
creator: Azhani Akmar Azhar
creator: Christopher Thiam Seong Lim
creator: Bak Leong Goh
rights: Copyright (c) 2021 Journal of Clinical and Translational Nephrology
date: 2021-03-01
publication date: 2021-03-01

A Retrospective Study on the Incidence and Outcomes of Acute Kidney Injury among Patients Diagnosed with Malaria Infection in Sabah – a Tertiary Centre Experience
type: item
description: 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.
subject: Original Article
  topic: section
subject: Malaria
  topic: keywords
subject: Acute Kidney Injury
  topic: keywords
subject: Plasmmodium knowlesi
  topic: keywords
subject: Acute Kidney Injury
  topic: disciplines
creator: Alexander Kok Yip Chow
creator: Nadirah Sulaiman
creator: Khai Lip Ng
creator: Sooth Jiun Lu
creator: Valerie Scarlett Seibing
creator: Koh Wei Wong
rights: Copyright (c) 2021 Journal of Clinical and Translational Nephrology
date: 2021-03-01
publication date: 2021-03-01

Isolated renal sarcoidosis with acute kidney injury - A rare entity
type: item
description: 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.
subject: Review Articles
  topic: section
subject: Original Articles
  topic: category
subject: renal, sarcoidosis, literature review
  topic: keywords
creator: Tze Jian Ng
creator: Christopher Thiam Seong Lim
creator: Noorjehan Omar
creator: Fauzah Abd Ghani
creator: Bak Leong Goh
rights: Copyright (c) 2020 Journal of Clinical and Translational Nephrology
date: 2020-09-04
publication date: 2020-09-04

Kidney with lower pole simple cysts - is it an absolute contraindication for renal biopsy?
type: item
description: 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.
subject: Case Report
  topic: section
subject: Original Articles
  topic: category
subject: renal cyst
  topic: keywords
subject: lower pole of the kidney
  topic: keywords
creator: Tze Jian Ng
creator: Christopher Thiam Seong Lim
creator: Bak Leong Goh
rights: Copyright (c) 2020 Journal of Clinical and Translational Nephrology
date: 2020-09-04
publication date: 2020-09-04

Sertraline for the treatment of Depressive Symptoms in Chronic Kidney Disease compared to placebo: A Limited Systematic Review
type: item
description: 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.
subject: Review Articles
  topic: section
subject: Original Articles
  topic: category
creator: Rafidah Abdullah
rights: Copyright (c) 2020 Journal of Clinical and Translational Nephrology
date: 2020-09-04
publication date: 2020-09-04

Double positive Anti-GBM and ANCA-associated glomerulonephritis – A case report
type: item
description: 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.
subject: Case Report
  topic: section
subject: Open Access
  topic: category
subject: anti–neutrophil cytoplasm antibody, anti-GBM disease, Goodpasture syndrome, glomerulonephritis, vasculitis, iv cyclophosphamide
  topic: keywords
creator: Sunn-Ren Tee
creator: Shin Kuan Tee, Hon Shen P'ng, Fariz Bin Nordin, Wen Jiun Liu, Nik Hasimah Binti Nik Yahya, Wai Seng Cheong
rights: Copyright (c) 2020 Journal of Clinical and Translational Nephrology
date: 2020-03-05
publication date: 2020-03-05

Actinomyces odontolyticus catheter related bloodstream infection in a hemodialysis patient - First reported case
type: item
description: 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.
subject: Case Report
  topic: section
subject: Open Access
  topic: category
subject: Actinomyces odontolyticus, bacteremia
  topic: keywords
creator: Tze Jian Ng
creator: Christopher Thiam Seong Lim
creator: Bak Leong Goh
rights: Copyright (c) 2020 Journal of Clinical and Translational Nephrology
date: 2020-03-05
publication date: 2020-03-05