Background: Adriamycin (ADR) nephrosis in mice has been extensively studied and has enabled a greater understanding of the processes underlying the progression of renal injury. Dendrin is a novel component of the slit diaphragm with proapoptotic signaling properties, and it accumulates in the podocyte nucleus in response to glomerular injury in mice. The present study re-evaluated chronic progressive nephropathy in ADR mice and the localization of dendrin in mice and in human glomerulopathy. Methods: To investigate the localization of dendrin, a mouse model of nephrosis and glomerulosclerosis was used, in which ADR was injected once. WT-1-positive cells and apoptotic cells were counted in vivo and in vitro. To check the expression of dendrin in ADR mice, immunostaining and Western blot were performed. A survey of dendrin staining was performed on human kidney biopsy specimens. Results: The injection of ADR induced proteinuria, podocyte loss and glomerulosclerosis. It also caused the relocation of dendrin from the slit diaphragm to the podocyte nucleus. We demonstrated the location of dendrin to podocyte nuclei in several cases of human glomerulopathy. The mean occurrence of dendrin-positive nucleus per glomerulus increased in several cases of human glomerulopathy. Conclusions: These findings suggest that the relocation of dendrin to the podocyte nuclei is useful as a novel marker of podocyte injury in human glomerulopathy.

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Background. A catheter-associated urinary tract infection (CA-UTI) is preceded by biofilm formation, which is related to several risk factors such as gender, age, diabetic status, duration of catheterization, bacteriuria before catheterization, virulence gene factor, and antibiotic usage. Aims. This study aims to identify the microbial composition of catheter samples, including its corresponding comparison with urine samples, to determine the most important risk factors of biofilm formation and characterize the virulence gene factors that correlate with biofilm formation. Methods. A longitudinal cross-sectional study was conducted on 109 catheterized patients from September 2017 to January 2018. The risk factors were obtained from the patients’ medical records. All catheter and urine samples were cultured after removal, followed by biomass quantification. Isolate identification and antimicrobial susceptibility testing were performed using the Vitex2 system. Biofilm-producing bacteria were identified by the Congo Red Agar (CRA) method. A PCR test characterized the virulence genes of dominant bacteria (E. coli). All data were collected and processed for statistical analysis. Results. Out of 109 catheterized patients, 78% of the catheters were culture positive, which was higher than those of the urine samples (37.62%). The most common species isolated from the catheter cultures were Escherichia coli (28.1%), Candida sp. (17.8%), Klebsiella pneumoniae (15.9%), and Enterococcus faecalis (13.1%). E. coli (83.3%) and E. faecalis (78.6%) were the main isolates with a positive CRA. A statistical analysis showed that gender and duration prior to catheterization were associated with an increased risk of biofilm formation p < 0.05 . Conclusion. E. coli and E. faecalis were the most common biofilm-producing bacteria isolated from the urinary catheter. Gender and duration are two risk factors associated with biofilm formation, therefore determining the risk of CAUTI. The presence of PapC as a virulence gene encoding pili correlates with the biofilm formation. Biofilm-producing bacteria, female gender, duration of catheterization (more than five days), and PapC gene presence have strong correlation with the biofilm formation. To prevent CAUTI, patients with risk factors should be monitored by urinalysis tests to detect earlier the risk of biofilm formation.

The International Diabetes Federation (IDF) estimated that 425 million people were living with diabetes mellitus (DM) in 2017 (1), which had far exceeded what was originally predicted in 2003 (333 million people by 2025). Consequently, the IDF provided a new projection of a near doubling of 629 million people with DM in 2045, with 4 out of 5 people with DM living in low-and middle-income countries (LMICs), majority from South East Asia (82 million) and the Western Pacific (159 million) regions. The increasing prevalence of DM has contributed to the growing burden of ESKD, and it is estimated that DKD is responsible for about 50% of ESKD in the developed world (2). The global burden of DKD and ESKD has a major impact on healthcare costs and resources; making screening, early detection and preventive treatment important strategies to mitigate this worldwide pandemic.

Background: In various animal studies, vitamin D has been shown to have a significant effect on reduction of proteinuria and the progression of kidney disease. However, little is known on its renoprotective effect in adriamycin (ADR)-induced nephrosis mice. The present study was intended to determine the therapeutic benefit of 22-oxa-calcitriol (OCT), a vitamin D analog, in reducing proteinuria and its renoprotective effect, i.e. preventing podocyte injury on ADR-induced nephrosis mice. Methods: Three experimental groups were used as follows: (1) nephrosis mice, established by a single intravenous injection of ADR; (2) ADR+OCT mice, nephrosis mice treated with OCT, and (3) mice treated only with OCT as the control group. Podocyte injury was assessed by podocyte apoptosis using the TUNEL assay, podocyte counting, podocyte-specific expressed protein by immunofluorescence and Western blot analysis, and foot process effacement using electron microscopy. Results: Lower proteinuria was observed in ADR+OCT mice. Improvement in glomerulosclerosis and interstitial fibrosis, and prevention of glomerular hyperfiltration were observed in ADR+OCT mice. Immunofluorescence and Western blot analyses showed restoration of downregulated expression of nephrin, CD2AP and podocin. Nevertheless, dendrin expression was not restored. An insignificant reduction in podocyte numbers was found in ADR+OCT mice. Complete foot process effacement was partially prevented in ADR+OCT mice. Conclusions: The results indicate that OCT reduces podocyte injury and has renoprotective effects in ADR nephrosis mice.

In the 2018 iteration of the United States Renal Data System (USRDS) report, 6 out of the top 10 countries in the world with diabetic kidney disease (DKD) as the cause of end-stage kidney disease (ESKD) were from the Asia-Pacific region, with Malaysia and Singapore topping the charts consistently over the previous years (1). It is, therefore, unsurprising that DKD is a significant healthcare burden for the Asia-Pacific countries, with a considerable amount of the countries' medical expenditure being spent on kidney replacement therapy (KRT) (2). Specifically, the differences in healthcare infrastructure, resources and cultural beliefs among the Asia-Pacific countries have resulted in the heterogeneity of care and outcomes This article was originally published in Nephrology Vol. 25 Issue S2. Republished with permission.

ABSTRAKPendahuluan. Mortalitas pasien yang menjalani hemodialisis (HD) paling tinggi pada tiga bulan pertama. Data mengenai insidens dan prediktor mortalitas dini pada pasien HD sangat terbatas. Suatu model prediksi dapat menjadi alat bantu yang sederhana untuk mengetahui pasien yang berisiko tinggi sehingga pada akhirnya upaya pencegahan dapat dilakukan. Penelitian ini bertujuan untuk mengetahui insidens dan prediktor mortalitas 3 bulan pada pasien hemodialisis baru dan membuat suatu model prediksi.Metode. Penelitian dengan disain kohort retrospektif terhadap 246 pasien PGTA yang baru menjalani HD di Unit HD RSCM antara Januari 2011-Januari 2012. Dilakukan analisis chi-square untuk mendapatkan nilai OR (Odds Ratio) terhadap variabel usia, pembiayaan, jenis HD, akses pembuluh darah, anemia, hipoalbuminemia, kelainan EKG, kardiomegali, komorbid, waktu rujukan ke nefrologis, dan kepatuhan. Prediktor yang bermakna kemudian dimasukkan pada model regresi logistik untuk mendapatkan sistem skor.Hasil. Sebanyak 78 (31,7%) dari 246 pasien meninggal dalam 3 bulan pertama. Terdapat 5 variabel yang berhubungan dengan terjadinya mortalitas 3 bulan yaitu usia > 60 tahun, hemoglobin <8 g/dl, albumin serum <3,5 g/dl, kelainan EKG, dan akses femoral. Skor prediksi untuk prediktor usia, hemoglobin, albumin serum, kelainan EKG, dan akses pembuluh darah berturut-turut sebesar 1, 3, 1, 3, 1. Jumlah skor kemudian dikategorikan menjadi risiko rendah (skor 0-3), sedang (skor 4-6), dan tinggi (skor 7-9). Tiap kelompok memiliki prediksi mortalitas 3 bulan berturut-turut sebesar 1,23%, 26,69%, dan 86,04%.Simpulan. Insidens mortalitas 3 bulan pada pasien HD baru sebesar 31,7%. Usia > 60 tahun, hemoglobin <8 g/dl, albumin serum <3,5 g/dl, kelainan EKG, dan akses femoral merupakan prediktor yang bermakna terhadap terjadinya mortalitas dalam 3 bulan pertama HD. Kata kunci. Hemodialisis, insidens, mortalitas 3 bulan, sistem skor.

Background: Peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) is largely underutilized globally. We analyzed PD utilization, impact of economic status, projected growth and impact of state policy(s) on PD growth in South Asia and Southeast Asia (SA&SEA) region. Methods: The National Nephrology Societies of the region responded to a questionnaire on KRT practices. The responses were based on the latest registry data, acceptable community-based studies and societal perceptions. The representative countries were divided into high income and higher-middle income (HI & HMI) and low income and lower-middle income (LI & LMI) groups. Results: Data provided by 15 countries showed almost similar percentage of GDP as health expenditure (4%-7%). But there was a significant difference in per capita income (HI & HMI -US$ 28 129 vs. LI & LMI -US$ 1710.2) between the groups. Even after having no significant difference in monthly cost of haemodialysis (HD) and PD in LI & LMI countries, they have poorer PD utilization as compared to HI & HMI countries (3.4% vs. 10.1%); the reason being lack of formal training/incentives and time constraints for the nephrologist while lack of reimbursement and poor general awareness of modalities has been a snag for the patients. The region expects ≥10% PD growth in the near future. Hong Kong and Thailand with 'PD first' policy have the highest PD utilization. Conclusion: Important deterrents to PD underutilization were lack of PD centric policies, lackadaisical patient/physician's attitude, lack of structured patient awareness programs, formal training programs and affordability.