Background Glomerulonephritides (GN) are relatively rare kidney diseases with substantial morbidity and mortality. They are often difficult to treat, sometimes with no cure, and can lead to chronic kidney disease (CKD) and end stage kidney disease (ESKD). Kidney biopsy is the diagnostic procedure of choice with variable indications from center to center. It helps in identifying the exact specific diagnosis, assessing the level of disease activity and severity, and hence aids in proper therapy and helps predicting prognosis. There is a global change of pattern of glomerular disease over the last five decades. Methods Retrospective analysis of all kidney biopsies (545 cases) that were done in patients over 12 year-old over last six years in four major hospitals in Kuwait. The indications for kidney biopsy were categorized into six clinical syndromes: nephrotic syndrome, sub-nephrotic proteinuria, nephrotic syndrome plus acute kidney injury (AKI), sub-nephrotic proteinuria plus AKI, isolated hematuria, and Unexplained renal impairment. We calculated the incidence of each type of kidney disease and indication of biopsy. Results most common indication of kidney biopsy was sub-nephrotic proteinuria associated with AKI in 179 cases (32.8%). Primary Glomerulonephritis was the main diagnosis that was reported in 356 cases (65.3%). Immunoglobulin A Nephropathy (IgAN) was the commonest lesion in primary glomerulonephritis in 85 (23.9%) cases. Secondary Glomerulonephritis was diagnosed in 134 cases (24.6%), 56 (41.8%) of them were reported as lupus nephritis cases. In young adults (below 18 years of age) there were 31 cases reviews, 35.5% were found to have minimal change disease (MCD). Conclusion IgAN is the commonest glomerulonephritis in primary nephrotic syndromes in Kuwait over the past six years. Lupus nephritis is the leading secondary glomerulonephritis diagnosis.

Acute stroke could be the presentation of unrecognised cardiomyopathy postanabolic androgenic steroid (AAS) abuse. A 39-year-old male patient displayed signs of acute stroke, which were associated with AAS abuse over the last 3 years. Despite the absence of symptoms and signs of congestive heart failure at presentation, AAS-induced cardiomyopathy with a thrombus in the left ventricle was discovered to be the aetiology of his stroke and peripheral vascular disease. Awareness of the complications of AAS led to the prompt treatment of the initially unrecognised dilated cardiomyopathy, and stroke.

Ga-prostate-specific membrane antigen (PSMA) ligands are novel PET radiotracers for prostate cancer. These radiotracers also localize in the normal renal cortex to a high degree and can demonstrate parenchymal defects. We recently started a prospective research study to compare 68 Ga-PSMA-11 PET/CT with 99m Tc-dimercaptosuccinic acid (DMSA) scan in adults with pyelonephritis. Here, we present a side-by-side comparison of renal cortical PSMA PET/CT and DMSA images of an adult patient with chronic recurring pyelonephritis. Methods: Our prospective study was approved by the Ethical Committees. DMSA images (multiple planar and SPECT) were obtained 3 h after intravenous injection of 111 MBq (3 mCi) of 99m Tc-DMSA. On a separate day, we obtained PET/CT images of the kidneys 60 min after intravenous injection of 74 MBq (2 mCi) of 68 Ga-PSMA-11 after the patient provided written informed consent. Results: The patient was a 46-y-old woman with history of chronic recurring pyelonephritis. Both DMSA scan and PSMA PET/CT demonstrated slight cortical thinning with mildly reduced uptake in the upper pole of the right kidney, with no significant cortical defects. There was an excellent distribution of activity in the renal cortex and better image resolution with PSMA PET than with DMSA scan. Non-attenuation-corrected PSMA PET images also showed the same findings, with reasonable image quality. Conclusion: In our first case, 68 Ga-PSMA-11 PET imaging provided promising results in an adult patient with pyelonephritis. The results of our prospective study on a larger number of adult patients will provide a more accurate comparison of 68 Ga-PSMA-11 PET to 99m Tc-DMSA scanning in pyelonephritis.

To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

Introduction COVID‐19 is an ongoing pandemic with high morbidity and mortality and with a reported high risk of severe disease in kidney transplant recipients (KTR). Aim We aimed to report the largest number of COVID‐19‐positive cases in KTR in a single center and to discuss their demographics, management, and evolution. Methods We enrolled all the two thousand KTR followed up in our center in Kuwait and collected the data of all COVID‐19‐positive KTR (104) from the start of the outbreak till the end of July 2020 and have reported the clinical features, management details, and both patient and graft outcomes. Results Out of the one hundred and four cases reported, most of them were males aged 49.3 ± 14.7 years. Eighty‐two of them needed hospitalization, of which thirty‐one were managed in the intensive care unit (ICU). Main comorbidities among these patients were hypertension in 64.4%, diabetes in 51%, and ischemic heart disease in 20.2%. Management strategies included anticoagulation in 56.7%, withdrawal of antimetabolites in 54.8%, calcineurin inhibitor (CNI) withdrawal in 33.7%, the addition of antibiotics in 57.7%, Tocilizumab in 8.7%, and antivirals in 16.3%. During a follow‐up of 30 days, the reported number of acute kidney injury (AKI) was 28.7%, respiratory failure requiring oxygen therapy 46.2%, and overall mortality rate was 10.6% with hospital mortality of 13.4% including an ICU mortality rate of 35.5%. Conclusion Better outcome of COVID‐19‐positive KTR in our cohort during this unremitting stage could be due to the younger age of patients and early optimized management of anticoagulation, modification of immunosuppression, and prompt treatment of secondary bacterial infections. Mild cases can successfully be managed at home without any change in immunosuppression.

We previously reported the 68 Ga-labeled prostate-specific membrane antigen (PSMA)-11 and 99m Tc-dimercaptosuccinic acid (DMSA) images of the first patient in our prospective research comparing renal 68 Ga-PSMA-11 PET with 99m Tc-DMSA scanning in adults with pyelonephritis. Here, we present the renal cortical 68 Ga-PSMA-11 PET and 99m Tc-DMSA images of our second patient, who had chronic recurring pyelonephritis and demonstrated renal parenchymal defects secondary to scarring in the kidney.

Patient: Male, 43-year-old Final Diagnosis: Q-fever endocarditis Symptoms: Lower limb edema • shortness of breath Medication: — Clinical Procedure: — Specialty: General and Internal Medicine Objective: Rare co-existance of disease or pathology Background: There is a close association between Q fever and autoimmune disease, with some case reports in the literature of Q fever presenting as systemic lupus erythematosus (SLE) and others documenting their coexistence. However, making the correct diagnosis remains challenging and Q fever often is overlooked. Therefore, it is essential to review such a rare presentation to help in accurate diagnosis in future cases. This report is of a case of endocarditis due to Coxiella burnetii in a patient with Q fever and a history of SLE. Case Report: We report the case of a 43-year-old man with a history of SLE and rheumatic heart disease, status post-valve replacement. The patient initially presented with an acute kidney injury in the setting of a history of full-house lupus membranous nephropathy, which was diagnosed on kidney biopsy. The patient had been on immunosuppressive therapy for 2 years. Shortly after he was admitted, echocardiography was ordered because the patient had progressive dyspnea, revealing infective endocarditis involving multiple valves. He underwent valve repair surgery and was placed on an extended course of antibiotic therapy. His symptoms gradually resolved, with normalization of his immunological markers. The patient’s immunosuppressive regimen was eventually discontinued. He remains on lifelong antibiotic suppression therapy. Conclusions: This case highlights the importance of awareness of infectious causes of endocarditis in patients with underlying autoimmune diseases such as SLE. This rare case of C burnetii endocarditis may have been associated with underlying valvular SLE.

in five patients (62.5%). The most common de novo GN in those with a known NKD was calcineurin (CNI) induced thrombotic microangiopathy (TMA) in five patients (62.5%) while the most common de novo GN in those with unknown NKD were IgA nephropathy (4, 26.7%) and FSGS (4, 26.7%). Renal allograft biopsy was done mostly for proteinuria (18, 56.3%) followed by deterioration in renal function (9, 28.1%). Biopsy was done 17.5 (AE15) months post-transplant with the minimum duration being as low as six days. The mean period of follow up of patients with denovo/recurrent GN (from the time of diagnosis) was 25.8(AE22.3) months. In patients with denovo CNI induced TMA, graft function improved after the withdrawal of CNI. Excluding the above subgroup of patients, the rate of decline in GFR in patients with recurrent/denovo GN over the mean follow up period was 0.39ml/min/month. Graft loss was observed in 8 patients with recurrent/denovo GN. Conclusions: Glomerulonephritis (GN) in the renal allograft recipient is not uncommon. Of the 548 patients, 6.4 % developed GN of which the most common was IgA nephropathy. The most common recurrent GN was IgA nephropathy while the most common de novo GN in those with a known NKD was calcineurin induced thrombotic microangiopathy while the most common de novo GN in those with unknown NKD were IgA nephropathy and FSGS.