Pakistan Journal of Kidney Diseases

Pinch Off effect: A lethal Unusual complication of Subclavian Hemodialysis Catheter in a Child

Mohammed AlbLooshi — 2025-09-30

Pinch-off effect is reported as potential complications of subclavian venous access in 14 years old male child with hemodialysis catheter. Patient presented with features of luminal obstruction 8 months after insertion of hemodialysis catheter. X ray chest confirmed diagnosis of Pinch off syndrome. Replacement of Hemodialysis catheter through supraclavicular subclavian approach resulted in achieving safe and functional venous access for last 12 months.

From The Desk of Editor in Chief

Rubina Naqvi — 2025-09-30

Nephro-Pathology Quiz

Muhammed Mubarak — 2025-09-30

Laparoscopic Peritoneal dialysis catheter insertion and its outcome in a cohort of automated peritoneal dialysis patients.

Shahzad Ashraf — 2025-09-30

Background: Reliable peritoneal dialysis (PD) access is critical to technique survival. We describe early outcomes from a single-center series of PD catheter insertions and summarize durations and reinsertion events.

Methods: Consecutive patients undergoing PD catheter placement were analysed. The primary outcome was any catheter reinsertion or documented malfunction. Durations from index insertion to 1 September 2025 were computed. Descriptive statistics were generated.

Results: Among 21 patients (mean age 54.9±18.9 years), laparoscopic placement was used in 21 cases. Reinsertion/malfunction occurred in 4 (19.0%). Mean duration was 260.2±169.6 days; median 235 (range 10-601). Duration categories: ≤30 days: 2 (9.5%), 31–90 days: 2 (9.5%), 91–180 days: 2 (9.5%), >180 days: 15 (71.4%).

Conclusions: Laparoscopically placed PD catheter resulted in an overall successful maintenance of PD catheter short term and long term. Further long term studies are needed for a local experience in PD catheter placement laparoscopically and a comparative analysis with other techniques.

An Effectiveness of RNA interference therapies in reducing urine and plasma oxalate levels among patients with primary hyperoxaluria- A systematic review

Sabeeta Khatri — 2025-09-30

Background:

Primary hyperoxaluria is a rare genetic disorder of hepatic oxalate over production. Standard of care was largely supportive with hyperhydration, urinary alkalinization and pyridoxine. RNA interference therapies have recently shown promising results.

Material and Methods:

The systematic review was prospectively registered with PROSPERO and followed PRISMA guidelines. Pubmed, EMBASE and CENTRAL were searched from January 1974 to July 2024 for randomized controlled trials and single arm intervention studies on use of RNAi therapies in primary hyperoxaluria.

Results:

We found 127 records across the databases, with 12 of them included in the final analysis. A total of 140 patients were enrolled in Lumasiran (9 trials) and Nedosiran (3 trials). Most studies demonstrated a significant reduction in the oxalate burden. Injection site reaction was the most common adverse event with a largely acceptable safety profile. Quality of studies assessed through ROB-2 and ROBINS-I showed a low risk of bias.

Conclusion:

This systematic review emphasizes the effectiveness and safety of RNA interference therapies, Lumasiran and Nedosiran, in treating primary hyperoxaluria by lowering urinary and plasma oxalate levels.

Frequency and Resistance pattern of clinical isolates of Enterococcus Species in a Tertiary Care Hospital.

Muhammad Bilal Basit — 2025-09-30

Introduction: Hospital acquired infections are becoming a major concern for health care providers and especially nephrology patients where a lots of interventions and frequent admissions are observed. Objective of this study was to evaluate one of the emerging multidrug resistant enterococcus organisms with significant healthcare implications.

Methods: This was a retrospective study evaluating the isolates from different samples from May 2018 to Sep 2019. All isolates growing enterococci were identified and evaluated for sensitivity pattern.

Results: Out of 1500 samples 86 cases of Enterococci were isolated and 8 samples had resistance to Vancomycin. 2 isolates were also resistant to linezolid.

Conclusion: Vancomycin resistance among Enterococci isolates is a major concern for health care providers dealing with complex and prolonged hospital stay patients. Furthermore, the emergence of Linezolid resistance is a cause of concern highlighting the judicious use of antibiotics.

Contribution of Acute Renal Cortical Necrosis to Acute Kidney Injury: A 25-year experience from a tertiary care renal unit in Pakistan

Rubina Naqvi — 2025-09-30

Background: Acute cortical necrosis (ACN) is a rare contributing factor to acute kidney injury (AKI). The present study aims to report clinico-pathological profile and outcome of ACN in the setting of AKI.

Patients and Methods: This study was carried out at XXXXXXXXX. Subjects for the study comprised a cohort of 349 patients, (6.2% of total AKI) seen over a period of 25 years. AKI was defined according to KDIGO guidelines and diagnosis of ACN was based on radiological or histological findings.

Results: From January 1990 to December 2014, 5,623 adult patients presented with AKI. Among these, 349 (6.2%) were found to have ACN. The mean age of ACN cohort was 29.33 ± 7.85 years. The major contributing cause was obstetrical AKI 286 (82%). On presentation 342 (98 %) were oligo-anuric. Histological diagnosis was available in 89 (25.50 %) cases, in 47 (53%) the pattern was diffuse and in 42 (47%) it was patchy. In rest, diagnosis was based on radiological findings. Hemodialysis was done in 346 (99.4 %). Complete recovery was seen in 9 (2.6 %), partial recovery in 76 (22%), chronic kidney disease (CKD) developed in 57 (16 %), end stage renal failure (ESRF) in 202 (58 %) while 5 (1.4 %) died during acute phase of illness.

Conclusion: ACN is still encountered as a cause of AKI. Some patients may remain dialysis free even with diffuse pattern on histological examination and this population should be closely monitored to avoid nephrotoxic exposure.

Incidence of Catheter-Related Infections in Maintenance Hemodialysis Patients: A Critical Challenge in Balochistan, Pakistan

Abdul Wali — 2025-09-30

Background: Catheter-related infections (CRIs) represent a critical complication in haemodialysis patients, particularly in resource-limited settings. This study investigated the incidence, risk factors, and predictors of CRIs among haemodialysis patients at Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.

Methods: A cross-sectional observational study was conducted from January 2023 to December 2024, enrolling 357 adult patients with end-stage renal disease undergoing maintenance haemodialysis via central venous catheters. Data were collected using structured questionnaires covering demographics, clinical parameters, catheter characteristics, and institutional factors. Statistical analyses included descriptive statistics, chi-square tests, Mann-Whitney U tests, logistic regression, and Kaplan-Meier survival analysis.

Results: The CRI incidence was exceptionally high at 82.1% (293/357 patients), with exit-site infections predominating (96.2%) and catheter-associated bloodstream infections accounting for 22.9%. Diabetes mellitus emerged as the strongest predictor (adjusted OR = 6.3, P < 0.001), followed by non-sterile gauze use (OR = 4.2) and hypertension (OR = 3.1). Femoral catheters were associated with higher bloodstream infection rates compared to subclavian access (P = 0.023). Critical institutional gaps included suboptimal hand hygiene compliance (73%), minimal staff training rates (2.2-10.9%), and zero utilization of antibiotic lock therapy.

Conclusions: CRI rates at this facility far exceed international benchmarks, driven by modifiable patient-specific, procedural, and institutional factors. Urgent implementation of evidence-based interventions including improved infection control protocols, staff training, and catheter care bundles is essential to reduce this preventable burden in Balochistan's vulnerable haemodialysis population.