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Background & Objective: Kidney Injury Molecule-1 (KIM-1) is a peptide whose release into circulation is specific to tubular injury. This study aimed to estimate levels of kidney injury molecule-1 in diabetic patients with and without kidney disease. And evaluate the role of KIM-1 as an early screening marker of progressive kidney injury. Methods: This follow-up study included n=85 subjects from the diabetic clinic of Jinnah Post Graduate Medical Center (JPMC) in collaboration with Aga Khan University from November 2016 till September 2017 They were divided as: i) Group A1 (n=30) participants with diabetes for <5 years without microalbuminuria ii) Group A2 (n= 30) subjects with diabetes for 6-10 years with microalbuminuria; iii) Group B (n=25) subjects as healthy control group. All study participants were followed for 6 months and their blood glucose, urea, creatinine, electrolytes, albuminuria and serum KIM-1 were assayed. Results: High KIM-1 at baseline was present in group A2 patients as compared to controls and group A1 (p<0.001). Higher levels were seen after six months in group A1 along with the presence of micro albuminuria (p<0.001) suggesting kidney damage. Moderate positive association were seen for KIM1 with creatinine levels (r=0.530; p<0.001), and HbA1c (r=0.576; p<0.001) in all patients. While a strong positive association was seen for blood urea nitrogen as a marker for kidney function both at baseline (r= 0.728; p=0.000) and follow up (r=0.747; p=0.001). Multiple logistic regression controlling for age showed that KIM1 was independently associated with BUN (r=0.727; p<0.001), creatinine (r=0.510; p<0.001) and HbA1c (r=0.401; p=0.008) in all groups. Conclusion: Rising KIM-1 levels with progressive kidney damage with or without derangement of kidney function is reported in this study. This finding may pave a way towards identifying KIM1 as a prognostic marker for kidney injury. doi: https://doi.org/10.12669/pjms.35.4.154 How to cite this:Khan FA, Fatima SS, Khan GM, Shahid S. Evaluation of kidney injury molecule-1 as a disease progression biomarker in diabetic nephropathy. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.154 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The incidence and pattern of thyroid diseases in Saudi Arabia are not well known due to the lack of a national registry. Few studies were reported describing the pattern from non-mountainous regions of Saudi Arabia. [1][2][3][4] Asir is a high altitude territory and the pattern of thyroid diseases might be different. Indeed, we were struck by the unexpectedly high prevalence of malignancy in patients who underwent thyroidectomy for presumably benign goiter. We therefore decided to conduct this review in order to evaluate the pattern of surgically treated thyroid disease in the Asir area and compare it with other studies. Patients and MethodsAsir Central Hospital (ACH) is a referral hospital for the Asir Region of Saudi Arabia. The Department of Pathology at ACH is the main central laboratory, which receives specimens from 17 peripheral hospitals in the area. Over a period of six-and-one-half years, from January 1987 through June 1993, 361 thyroid specimens were received. The histopathological reports together with the age, sex, and nationality of the patients were reviewed. Statistical analysis was conducted using the SPSS/PC+ software package. Chi-square and Student's t-test were used at the 5% level of significance. ResultsAmong the 361 cases studied, 255 (70.6%) were Saudi nationals. The causes of goiter in surgically treated patients is shown in Table 1. The ages ranged from seven to 120 years (mean = 35.9±.13.8 years). Female patients constituted 81.7% of this series and the female to male ratio was 4.5:1. Multinodular goiter and adenoma (solitary nodule) constituted 68.3% of the cases, the latter being more common in young females (P<0.05). Toxic goiter was seen in 7.7% of patients and all of them either failed to respond or had recurrence after cessation of medical treatment. Autoimmune thyroiditis was seen in 23 (6.4%) patients, 16 of whom had Hashimoto thyroiditis (all except one were females) and the remaining seven patients had lymphocytic thyroiditis (two were males). In this series, there were three male patients (two Saudis and one Sudanese) who were diagnosed as dyshormonogenesis on the basis of high serum thyroid stimulating hormone (TSH) and diffuse hyperplasia on histopathological examination.Thyroid malignancy was found in 47 (13%) patients and the papillary carcinoma was the most common (65.9%) followed by thyroid lymphoma (21.3%); these findings are compared with other studies in Table 2. Four patients (40%) with lymphoma had an associated Hashimoto thyroiditis. The female to male ratio in patients with lymphoma was 4:1, the age range was 45 to 120 years (mean = 68.3 ± 22.3 years) and all were non-Hodgkin lymphoma.

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In this study, GC-MS analysis has shown that whole plant hexane fraction of Achillea wilhelmsii (WHFAW) consists of 66 compounds which exhibited antileishmanial activity. Antileishmanial bioassay was the method used for determining antileishmanial activity. The inhibitory concentration (IC50) which was observed for whole plant hexane fraction of Achillea wilhelmsii (WHFAW) against parasitic and vector-borne disease, leishmaniasis, is 58.27 ± 0.52 μg/mL. For leishmanicidal assay, Leishmania major is the species used for analysis. Whole plant methanol extract of Achillea wilhelmsii (WMEAW) and whole plant aqueous fraction of Achillea wilhelmsii (WAFAW) exhibited no antileishmanial activity.