Objectives: To determine knowledge, attitude and practice regarding AV fistulacare in patients of end stage renal disease on hemodialysis. Study Design: Cross sectionalstudy. Setting: ESRD patients in Nephrology Department of Lahore General Hospital by usingself-designed questionnaire. Period: Six months from Jan 2017 to June 2017. Method: Thestudy included about 141(consecutive sampling) patients of chronic kidney disease using AVfistula for hemodialysis. Data was collected using self designed questionnaire. Data analysiswas done using SPSS version 22. Result: The most well- known precautionary measures to betaken for arteriovenous fistula care are to avoid taking blood pressure and intravenous line on thearm bearing AV fistula and to avoid trauma and weight lifting with that limb. The knowledge wasseen to be particularly deficient about the measures to be taken in case of swelling. The attitudetowards AV fistula care was observed to be positive, majority of our study population claimed tofollow maximum precautionary measures most of the time, but percentage of practicing doesnot coincide with that (85.1% vs.74.7% respectively). The least practiced measure is elevationof limb in case of swelling, observed by only 36.9% of our study population. Conclusion:Knowledge regarding fistula care was adequate about most of the precautionary measures,most of the participants showed positive attitude towards practicing precautionary measures forfistula care, but number of patients actually practicing these precautions is less than the numberof patients that have knowledge about them.

A considerable number of patients on hemodialysis have pulmonary hypertension which is associated with the longer duration of maintenance hemodialysis.

ABSTRACT… Background: Internal jugular vein is considered the preferred site of insertion. Prevalence of central vein stenosis following temporary double lumen catheterization at different sites seems to be different in Asian countries. Objectives: To evaluate the number of cases having catheterization and stenosis after being subjected to central vein catheterization (CVC) among Pakistani population. Study Design: Cross sectional study. Period: 6 months period. Setting: Admitted in the Department of Nephrology or already undergoing maintenance hemodialysis fulfilling the inclusion criteria were included in the study. Material and Method: The sample which was considered suitable for this study was 150 cases after checking the inclusion criteria carefully. The patients were advised to undergo color Doppler ultrasonography of IJV and SCV of both sides. Demographics and outcome variables were noted and recorded for the analysis purposes. Data was analyzed used SPSS 20.inc Results: The frequency of catheterization of catherization at IJV was found to be 128(85.3%) and frequency of catheterization at SCV was 22(14.7%). The frequency of CVS at IJV was found to be 43(29.68%) and the frequency of CVS at SCV was 81(54.54%). The frequency of stenosis at SCV was found to be significantly higher with a p value of 0.029 (<0.05). Conclusion: Internal jugular vein is the most frequent and preferred site of temporary double lumen catheterization for haemodialysis as it is associated with significantly lower rate of stenosis as compared to subclavian vein.

Background Post-infectious glomerulonephritis (PIGN) (immune complex-mediated glomerulonephritis) and C3 glomerulopathy are sub-types of glomerulonephritis (GN) with hypercellularity. Both have overlapping clinical and morphologic features on a kidney biopsy, however, the treatment and prognosis of these diseases are quite different making their distinction of utmost importance. Immune complex-mediated glomerulonephritis arises from glomerular deposition of immune-complexes (Igs) and C3 as a result of activation of classical (CP) and lectin pathways (LP). C4d is produced as a result of activation of the CP/LP. On the other hand, C3 glomerulopathy results from activation of alternative pathway of complement. Aim To distinguish between PIGN and C3 glomerulopathy with the help of C4d IHC stain. Materials and Methods We studied 28 biopsies reported as GN with hypercellularity from January 2015 to January 2020. Clinical information, histological features and immunofluorescence patterns were analyzed. C4d IHC was performed on all the biopsies. Six known cases of immune complex-mediated GN were selected to act as a positive control for C4d staining. Results Amongst 28 cases originally reported as GN with hypercellularity, 18 were labeled as post-infectious GN and 10 as C3 glomerulopathy based on clinical information and serological findings. 13 of 18 (72.2%) cases of PIGN had mild to moderate (1–2+) C4d staining, 2 (11.1%) had strong (3+) staining and 3 (16.7%) cases were negative for C4d staining. In the 10 biopsies of C3 glomerulopathy, mild (1+) C4d staining was noted only in 3 (30%) biopsies. C4d had moderate to strong (2–3+) staining in the control group. Conclusion C4d IHC stain can be helpful in distinguishing PIGN from C3 glomerulopathy.

Introduction: Hemodialysis is a process of removal of waste products andtoxic substances from the body using an extracorporeal system. During the procedure, lotsof hemodynamic and metabolic changes occur in the body as a result of which patientsundergoing hemodialysis may suffer from complications both acutely during or just after dialysisas well as in long term. Objective: To determine the frequencies of various acute intradialyticcomplications in our hemodialysis patients. Study Design: Cross sectional survey. Setting:Lahore General Hospital, Lahore. Period: 3 months from May 2017 to July 2017. Method:End stage renal disease patients on regular hemodialysis in the dialysis unit of a tertiary carehospital. A total of 81 patients were included in the study. Patients with acute renal failure andacute on chronic renal failure were excluded from the survey. Results: Common complicationsobserved in our studied population included muscle cramps (70.7%), post dialysis fatigue(57.3%), back ache (56.1%), intradialytic shivering (57.3%), hypoglycemia (21.4%), hypotension(37.8%), hypertension (8.5%), headache (13.4%), vomiting (13.4%) and anaphylaxis in 2.4%.Conclusion: Hemodialysis is a complex procedure and can cause many complications mostof which are not life threatening. With proper monitoring and immediate treatment thesecomplications can be overcome without causing interruption in hemodialysis.

Background. The updated version of predictive classification for immunoglobulin A nephropathy (IgAN) prognosis “The Oxford Classification” identifies five histopathological features including mesangial hypercellularity (M), endocapillary proliferation (E), segmental glomerulosclerosis (S), tubular atrophy/interstitial fibrosis (T) and crescents (C), the MEST-C. However, few studies suggest that tubulointerstitial inflammation, which is not included in the MEST-C, is also linked to disease progression and is, consequently, a neglected determinant of prognosis among others. Therefore, there is a need to evaluate this histopathological parameter in patients with IgA nephropathy. Materials and Methods. This cross-sectional descriptive study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan. Data of histopathological and immunofluorescence proven renal biopsies (300) of IgA nephropathy patients from January 2016 through May 2022 were extracted using a convenient sampling technique. Biopsies were histologically reviewed for type and severity of tubulointerstitial inflammation, in addition to the MEST-C score. Renal biopsies of patients who had a history of transplant, autolyzed tissue, no glomeruli on histological examination, and/or a tubular atrophy/interstitial fibrosis score of 2 (T2) in MEST-C scoring were excluded. Data were analyzed using SPSS 20. An association between the variables was analyzed using the chi-square and Fischer exact tests. A p value less than 0.05 was considered statistically significant. Results. A total of 247/300 biopsies were eligible for inclusion. The mean age at the time of biopsy was 31.90 ± 12.48 with 63.6% in the age group between 21 and 40 years, and 69.6% were male. Tubulointerstitial inflammation was observed in 90.2% cases with 49.4% showing moderate while 4.5% showing severe degree of inflammation. A strong association of both the type and severity of tubulointerstitial inflammation was found with M, E, T, and C scores ( p value < 0.05). Conclusion. The high-frequency and strong statistical association of tubulointerstitial inflammation with the M, E, T, and C scores in our study elucidate its prognostic role in the progression and management of IgA nephropathy.

Background: Internal jugular vein is considered the preferred site of insertion.Prevalence of central vein stenosis following temporary double lumen catheterization at differentsites seems to be different in Asian countries. Objectives: To evaluate the number of cases havingcatheterization and stenosis after being subjected to central vein catheterization (CVC) amongPakistani population. Study Design: Cross sectional study. Period: 6 months period. Setting:Admitted in the Department of Nephrology or already undergoing maintenance hemodialysisfulfilling the inclusion criteria were included in the study. Material and Method: The samplewhich was considered suitable for this study was 150 cases after checking the inclusion criteriacarefully. The patients were advised to undergo color Doppler ultrasonography of IJV and SCVof both sides. Demographics and outcome variables were noted and recorded for the analysispurposes. Data was analyzed used SPSS 20.inc Results: The frequency of catheterization ofcatherization at IJV was found to be 128(85.3%) and frequency of catheterization at SCV was22(14.7%). The frequency of CVS at IJV was found to be 43(29.68%) and the frequency of CVSat SCV was 81(54.54%). The frequency of stenosis at SCV was found to be significantly higherwith a p value of 0.029 (<0.05). Conclusion: Internal jugular vein is the most frequent andpreferred site of temporary double lumen catheterization for haemodialysis as it is associatedwith significantly lower rate of stenosis as compared to subclavian vein.

Background: Although AV fistula is considered as a gold standard for initiatinghemodialysis in patients with ESRD, the incidence is quite low in our population. Aim: Theaim of this study is to find out the incidence of permanent AV access i.e. AV fistula at the timeof first dialysis and causes leading to failure of this protocol. Study Design: Cross-sectionalstudy. Setting: Hemodialysis unit of Lahore General Hospital. Period: August-September,2017. Method: Patients undergoing hemodialysis in dialysis center of Lahore GeneralHospital. Results: Out of 82 patients recruited, only 4 patients were found to have their firsthemodialysis with AV fistula, remaining 78 patients had temporary double lumen catheter foremergency hemodialysis who were later on counselled to have AV fistula. Reasons include lackof counselling/awareness/education of disease in patients 71.79%, emergency HD in patientswith hypertensive emergencies 14.1%, and delay in maturation (7.6%) and failure (6.4%) ofAV fistula. Conclusion: To increase the incidence of fistula first initiative integration of differentprofessional teams are required as well as education and awareness should be instilled inpatients to help them in taking decisions.