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Introduction: Chronic kidney disease (CKD) remains a major treatment challenge in low- and middle-income countries due to limited resources, delayed diagnosis, poor access to essential medicines, and inadequate renal replacement services. Given the limited evidence on CKD management and outcomes in these settings, this study aimed to evaluate the clinical outcomes and associated factors among patients with CKD at Zewditu Memorial Hospital and Tikur Anbessa Specialized Hospital, Ethiopia. Methods: A retrospective cross-sectional study design was employed. All adult patients with CKD attending the renal clinics at both hospitals between March and July 2019 were enrolled. Sociodemographic and clinical characteristics were collected through structured patient interviews and review of medical records. Data were analyzed using Statistical Package for Social Science (SPSS) version 23. Results: Of 300 CKD patients included in the study, nearly half of them had CKD-related complications, and 11% were in end-stage renal disease (ESRD). Among those with complications, 29% had hospitalization prior to data extraction. Most participants (83.7%) adhered to clinician-recommended non-pharmacological interventions. Enalapril and amlodipine were prescribed for 39.0% and 37.3% of patients, respectively, and polypharmacy was observed in 53.3% of patients with stage five CKD. Conclusion: A substantial proportion of patients  with CKD had complications, including hospitalization and ESRD. Polypharmacy was prevalent among patients with advanced CKD, underscoring the need for comprehensive management and close monitoring to improve treatment outcomes.

Introduction: Anti-glomerular basement membrane (anti-GBM) disease is classically diagnosed based on presence of rapidly progressive glomerulonephritis, circulating anti-GBM antibodies, and the hallmark finding of linear IgG deposition along the glomerular basement membrane on kidney biopsy. These deposits are considered a defining feature of the disease, aiding in its differentiation from other pauci-immune glomerulonephritis. However, rare cases lacking IgG deposits on kidney biopsies challenge this paradigm, complicating both diagnosis and management. Case Presentation: We report the case of an 80-year-old male with metastatic rectal cancer, who presented with acute kidney injury, hematuria, and proteinuria. Serological testing confirmed elevated anti-GBM antibody levels. Surprisingly, renal biopsy revealed crescentic glomerulonephritis without characteristic linear IgG deposition, which raised diagnostic uncertainty. Despite the absence of this classic finding, the patient’s clinical course was consistent with anti-GBM disease. Given his malignancy, treatment was tailored to balance immunosuppression with oncologic and infectious considerations. The patient received a modified immunosuppressive regimen, including plasma exchange and corticosteroids, but IV cyclophosphamide was withheld due to recurrent infections. Initially, from a nephrology standpoint, his clinical course was notable for partial renal recovery, resolution of hematuria, and improvement in both creatinine and proteinuria levels. However, he ultimately passed away due to severe infectious complications. Conclusion: This case underscores the diagnostic challenges and therapeutic decision-making in patients who present with features suggestive of anti-GBM disease, characterized by positive anti-GBM antibodies but absent immune deposits, especially when accompanied by malignancy, prior exposure to immunosuppressive therapy, and concurrent infections.

The diagnosis of tuberculosis (TB) in dialysis patients may be difficult because of the increased frequency of extra-pulmonary presentations, atypical clinical manifestations, and nonspecific symptoms. This study aimed to investigate the spectrum of clinical presentations and outcomes of TB in dialysis patients in a retrospective case series and data analysis over a 14-year period between 2011 and 2024. A total of 6 (3%) patients undergoing hemodialysis were diagnosed with TB from 200 being cared for in Madinat Zayed Hospital Al Dhafra, Abu Dhabi, UAE. Most had extrapulmonary involvement and a delayed diagnosis, and all patients came from countries where TB is endemic. The first-line antituberculous medication proved safe and effective in all cases. Additionally, we report these cases as an important reminder to clinicians to be aware that body fluids may not initially provide positive results for acid-fast bacilli smear, culture or polymerase chain reaction test polymerase chain reaction, additionally, the tuberculin PPD skin test (TST), the classic diagnostic tool for latent TB infection, has several major drawbacks, including poor sensitivity (because of a high prevalence of energy in dialysis patients). Although all patients' microbiology were negative, the diagnostic criteria included lymphocytic exudative fluid upon aspiration, response to empirical antituberculous treatment and in selected patients, tissue diagnosis was obtained. TB should be strongly considered in dialysis patients from endemic regions presenting with unexplained inflammatory syndromes or serosal effusions, even when microbiological tests are negative. Early empirical treatment can be both diagnostic and life-saving.

Light chain-only variant of proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID-LC) and light chain deposition disease (LCDD) are both renal disorders caused by the overproduction of monoclonal immunoglobulin light chains and their deposition in renal tissues. However, the renal pathological features of these two entities are characteristically distinct. We report a rare case of multiple myeloma presenting with renal pathology exhibiting overlapping features of both PGNMID-LC and LCDD. A 54-year-old woman presented with nephrotic syndrome. Renal biopsy revealed glomerular lesions resembling type III membranoproliferative glomerulonephritis on light microscopy. Immunofluorescence microscopy demonstrated κ light chain deposition along the glomerular capillary walls as well as in the mesangial areas, Bowman's capsule, and tubular basement membranes. C3 was also deposited in the glomeruli, while IgG and λ light chain staining were negative. Electron microscopy revealed dense deposits in the mesangial, subepithelial, and subendothelial areas, along with powdery deposits within the glomerular basement membrane, tubular basement membranes, and Bowman's capsule. Monoclonal κ light chains were detected in both serum and urine, and bone marrow examination showed 30.6% monoclonal plasma cells. The patient was diagnosed with multiple myeloma-associated kidney disease due to monoclonal light chain deposition and was treated with bortezomib and dexamethasone, resulting in improved renal function and a marked reduction in proteinuria. This case highlights a rare pathological overlap between PGNMID-LC and LCDD, underscoring the importance of comprehensive renal pathological evaluation in patients with monoclonal gammopathies.

Chronic kidney disease (CKD) poses a significant global health burden, with hyperuricemia emerging as a potential modifiable risk factor for disease progression. Urate-lowering agents (ULAs) have been hypothesized to preserve renal function by reducing serum uric acid (SUA) levels and mitigating associated pathogenic mechanisms. However, clinical evidence regarding their efficacy remains inconsistent. This systematic review aimed to evaluate the effects of ULAs on renal outcomes in CKD patients by synthesizing evidence from recent placebo-controlled randomized trials. A comprehensive search of PubMed, Scopus, Web of Science, Embase, and ClinicalTrials.gov was conducted to identify randomized controlled trials (RCTs) published between 2020 and 2025. Ten studies met the inclusion criteria, assessing allopurinol, febuxostat, verinurad, and topiroxostat. The risk of bias was evaluated using the Cochrane Risk of Bias 2 (ROB 2) tool (London, United Kingdom). Data were synthesized narratively due to clinical and methodological heterogeneity. Febuxostat demonstrated potential renal benefits, with significant estimated glomerular filtration rate (eGFR) preservation in three studies. Allopurinol showed neutral effects on eGFR decline in large trials. Albuminuria reduction was observed with verinurad plus febuxostat but not with other ULAs. Safety profiles were favorable across studies, with no significant differences in adverse events versus placebo. While febuxostat may slow CKD progression in select populations, evidence for allopurinol and combination therapies remains inconclusive. Heterogeneity in outcomes underscores the need for personalized treatment and further research to identify optimal candidates for ULA therapy.

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%.