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A 63-year-old woman undergoing peritoneal dialysis (PD) presented to our hospital with abdominal pain, diarrhea, and cloudy PD effluent. An elevated white blood cell count in the PD effluent led to a diagnosis of PD-associated peritonitis. She was subsequently started on intraperitoneal cefazolin and ceftazidime, after which her condition improved rapidly. The peritonitis resolved after 21 days of therapy, with no subsequent relapse. Centrifuged PD effluent samples identified as the causative organism. Reports of PD-associated peritonitis caused by are rare, with reported adult cases requiring PD catheter removal due to relapse. In contrast, this case was successfully resolved without catheter removal. The increasing use of advanced technologies, such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, is expected to lead to more reports of -associated PD peritonitis in the future. Although biofilm formation by is known to increase the risk of recurrent peritonitis, this case suggests that catheter removal may not always be necessary.

A 46-year-old woman on peritoneal dialysis (PD) had cloudy peritoneal dialysis effluent that had persisted for 10 days by the time she visited our hospital. The white blood cell count in the effluent was elevated to 1500/μL, leading to a diagnosis of peritoneal dialysis-associated peritonitis. The effluent cleared within two days with treatment using cefazolin and ceftazidime, and the white blood cell count dropped to 0/μL by day 6. Culture of the effluent revealed the presence of . The patient's treatment was switched to ceftazidime monotherapy, and antibiotic therapy for 21 days resulted in the resolution of the peritonitis. Reports of peritonitis caused by are rare; however, with the spread of diagnostic methods, such as matrix-assisted laser desorption ionization-time of flight mass spectrometry, an increase in reported cases is expected. Unlike previous cases, in this case, the interval from onset to treatment initiation was longer. However, similar to reported cases, in this case, the infection was cured with antibiotic treatment without the need for PD catheter removal.

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a frequent cause of hyponatremia that presents substantial management challenges in clinical settings. Despite a range of treatment options, including fluid restriction, demeclocycline, and vasopressin antagonists, urea remains underutilized, particularly in North America, despite its well-documented efficacy, safety, and cost-effectiveness. Urea corrects hyponatremia by promoting osmotic diuresis without causing significant fluid shifts, making it an ideal treatment for both acute and chronic SIADH. Comparative studies have demonstrated urea's effectiveness, particularly in contrast to vasopressin antagonists, which are costly and pose risks such as hepatotoxicity and rapid sodium overcorrection. However, barriers to urea's utilization include limited clinician familiarity, lack of advocacy in guidelines, and patient adherence issues due to its unpalatable taste, although flavored formulations now address this issue. Increased awareness, training, and guideline inclusion could promote urea as a viable, primary treatment for SIADH. This editorial advocates for the expanded adoption of urea in clinical practice to enhance patient outcomes, especially in resource-limited settings where high-cost treatments may not be feasible.

Background Calcific uremic arteriolopathy (CUA) is a rare but debilitating disease affecting patients with kidney disease. Reported risk factors of CUA in the literature include female sex, obesity, diabetes mellitus, and vitamin K antagonists' (VKAs) usage. CUA prevalence in Malaysia is unknown and has not been reported before. Methods A multicenter observational study was conducted in 13 centers all over Malaysia to study the clinical characteristics, treatment, and outcomes of CUA. The data of patients confirmed with CUA between January 1, 2016, and December 31, 2021, was collected from medical records by each center's nephrologists. Results Out of 33 confirmed CUA cases, 69.7% were females, and 66.7% were Malay with a mean age of 47.33 ± 13.80 years old. The mean BMI was 25.66 ± 9.77 kg/m , and 18.2% were classified as obese (BMI > 30). Two-thirds of the patients were on hemodialysis (HD), and the mean dialysis vintage was 6.2 ± 4.11 years. A majority (87.9%) have hypertension, 33.3% are diabetic, and 27.3% have coronary artery disease. Only 15.2% of the patients were on warfarin at the time of diagnosis. A total of 78.8% of patients were taking calcium-based phosphate binders during diagnosis. Investigation results showed calcium, 2.44 ± 0.29 mmol/L; phosphate, 2.18 ± 0.67 mmol/L; CaXPO4 = 5.41 ± 1.90; and parathyroid hormone, 181.14 ± 153.23 pmol/L. About half (54.5%) had skin biopsy confirmation done. Distribution of lesions was 57.6% peripheral and 30.3% central. For treatment of CUA, there were 57.6% usage of non-calcium-based phosphate binders, 48.5% cinacalcet, 30.3% sodium thiosulphate, and 33.3% had parathyroidectomy. Half (54.5%) of our CUA patients died within three months from diagnosis. The mean time from diagnosis to mortality was 4.12 ± 5.59 months. A majority (45.5%) died from septicemia caused by infections. Interestingly, there were a few rare presentations of CUA such as pulmonary calciphylaxis, heart and lung calcifications, liver and spleen calcifications, and genital lesions. One patient had resistant CUA and was given a trial of lipid apheresis for 10 sessions. Conclusion This is the first and largest multicenter study looking into the characteristics, treatment, and outcome of CUA in Malaysia. Majority of patients in Malaysia undergo HD as kidney replacement therapy; hence, our results correlate with this. The incidence of CUA was estimated to be 6.6 per 10,000 dialysis patients in this study and the mortality rate is very high. This is consistent with worldwide data which reported mortality as high as 60%.