Background Few data are available about the rate of short-term remission and its impact on the long-term outcomes of proliferative lupus nephritis in the Middle East. Methods An observational study was carried out involving 96 adult patients with biopsy-proven focal or diffuse proliferative lupus nephritis (PLN) from four different hospitals. Data on induction, remission and long-term outcomes were collected and analyzed. Results Among the 96 patients with biopsy-proven PLN (median age 27 (IQR: 21,34) years, 85% women and median duration of systemic lupus erythematosus (SLE) prior to diagnosis 27 (IQR: 11, 55) months), 67% developed remission at 6 months (proportion 0.67; 95% CI 0.57, 0.76). Mycophenolate mofetil (MMF) was used in 45/96 (47%), CYC in 41/95 (43%) and other agents in 10/96 (10%). The choice of MMF as induction agent has increased in recent years. Among baseline characteristics, only histologic activity was found to have a significant association with remission, with active lesions more likely to remit than active/chronic and chronic lesions (AOR 6.5, 95% CI 1.44–29.39, p = 0.015). Based on Kaplan–Meier analysis, the 5-year renal survival rate without doubling serum creatinine was 73.8%. Compared to patients with complete remission, lower long-term renal survival rates were observed in patients with no remission (89.7 versus 43%, p = 0.001) and partial remission (89.7 versus 77.6%, p = 0.256). The cumulative rate of doubling serum creatinine, dialysis, relapse and death was 23%, 11%, 10% and 5%, respectively, at 48-month median follow up. Conclusion Approximately two-thirds of patients with PLN develop remission in response to standard induction therapy. Remission was negatively associated with the presence of chronic changes in renal biopsy. Overall, MMF is the most commonly used agent to induce remission; however, with more severe disease CYC, is used more frequently. PLN is associated with significant long-term renal outcomes including a 26% cumulative rate of doubling of serum creatinine at 5 years. Initial remission predicts this long-term renal survival.

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Hypertension is a common early finding in autosomal dominant polycystic kidney disease (ADPKD). Improvements in screening and diagnosis of ADPKD have allowed earlier diagnosis, later onset of end-stage renal disease, and better survival. However, the main and most effective therapy remains control of hypertension. Hypertension is the most important modifiable risk factor in ADPKD. Therefore, early management of hypertension reduces the incidence of cardiovascular events in ADPKD patients. Stimulation of the renin-angiotensin-aldosterone system (RAAS) plays a central role in the pathogenesis of hypertension in ADPKD. Therapies that block the RAAS have improved patient management, blood pressure control, and ADPKD patient survival. This review highlights the current understanding of the epidemiology, potential pathogenetic mechanisms and proposes a strategy for the treatment and management of hypertension in ADPKD.

Objectives: To detect the incidence of and risk factors for infections among patients with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD). Methods: A retrospective cohort study was conducted at the PD unit of King Fahad Medical City. End-stage renal disease patients above the age of 12 years who were undergoing PD management between January 2006 and March 2016 were included. Results: One hundred PD patients were enrolled in the study and examined over a total observation period of 2,553 patient-months. The leading ESRD etiology was hypertension (26.3%). The mean duration of PD was 28.05 months. A total of 45 patients developed 101 episodes of technique-related infections (TRIs). Peritonitis represented the majority of these episodes (90 episodes), with an overall rate of one episode per 28.3 patient-months. TRIs were mostly caused by coagulase-negative staphylococci. A total of 12 patients developed non-technique related infections (NTRIs). There was a statistically significant difference between patients with TRI and non-infected patients regarding the presence of diabetes and duration of dialysis. No peritonitis-related deaths were noted. In total, 21 patients continued on PD and 18 patients were shifted to hemodialysis (HD). Conclusion: In our setting, ESRD patients undergoing PD are more susceptible to TRIs than NTRIs. Diabetes increases the risk of developing TRIs. The high incidence of coagulase-negative staphylococcal TRI suggests touch contamination.

Our observations suggest that the mere replacement of glucose by amino acids in PD solutions does not necessarily imply "glucose sparing" from the perspective of induction of a glucoregulatory hormonal response because of the aminogenic stimulation of secretion of multiple hormones.