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Background Acute kidney injury (AKI) is a serious problem during pregnancy. Once occurred, it causes devastating maternal and fetal outcomes. In developed nations, the trend of pregnancy-related AKI (PRAKI) is on a decline due to the advances in obstetrics care and the legality of abortion. On the contrary, this situation remains a major health problem in the developing countries. Aim of the work in the present study, we determine the incidence, etiology and outcome of PRAKI in a sample of Egyptian patients. Methods Prospective observational study to determine the incidence, etiology and outcome of PRAKI was conducted over a period of one year from January to December 2017 at Ain Shams university obstetrics & gynecology hospital. Patients were enrolled in this study once PRAKI at antepartum as well as postpartum period was diagnosed according to the definition of KDIGO AKI guidelines diagnostic criteria Results During the period of the study a total of 13050 obstetric patients were admitted in Ain Shams university obstetrics & gynecology hospital. In total, 78 patients met the diagnostic criteria of PRAKI representing an incidence of 0.59% (78/13050). Pre-eclampsia & sepsis were the two most common causes of PRAKI, others were dehydration, postpartum hge, antepartum hge, UTI, proteinuria for investigation, SLE activity, DIC, TTP, Acute fatty liver of pregnancy, eclampsia, eclampsia complicated with HELLP syndrome, eclampsia with acute fatty liver of pregnancy, HUS, hyperemesis gravidarum, hypertensive emergency. Fifty five patients (70.5%) received conservative management. Hemodialysis was initiated in twelve patients (15.3%) based on standard indication (azotemia, oliguria volume overload, hyperkalemia and/or metabolic acidosis). Hemodialysis and plasma exchange was used for four patients (5.1%). Plasma exchange was indicated for seven patients. None of the patients received peritoneal dialysis or continuous renal replacement therapy. The ultimate evolution was good in 47 (60%) patients with complete recovery of the kidney function.14 women (17.9%) had an increased serum creatinine level at discharge for follow up at outpatient clinic. 6 patients (7.6%) had kept with advanced renal failure requiring hemodialysis. There were 11 cases of death, mortality rate was 14%. Conclusion AKI during pregnancy poses a challenge for physicians. In view of the multifaceted problems that potentially complicate pregnancy in women with AKI. Fortunately, with ongoing improvements in obstetrical care, multidisciplinary approaches comprising nephrologists, obstetricians and neonatologists maternal and perinatal mortality in this setting are largely avoidable. Therefore early recognition of signs and symptoms, close monitoring in high risk cases, early referral and a multidisciplinary team management could potentially prevent progression to higher stages of PRAKI and reduce morbidity and mortality.

Background:: Sodium glucose co transporter 2 inhibitor (SGLT2i) is a new arment in the prevention and treatment of diabetic kidney disease with a potential effect on reducing and preventing chronic kidney disease (CKD) progression. Objective:: To evaluate the effect of SGLT2 inhibitor in comparison to traditional medication in diabetic patients with microalbuminuria. Patients and Methods:: 60 diabetic patients with microalbuminuria were divided into group I: 30 patients were treated by traditional medications (RAAS blockers) and group II: 30 patients for whom Dapagliflozin was added to the traditional medications. All patients were followed up for 6 months with measuring of urine albumin/creatinine ratio (UACR) and eGFR changes. Results:: UACR significantly declined after 6 months of treatment in group II with (p-value &0.001). There was no significant eGFR changes between both groups. Systolic blood pressure decreases in both groups but the decrease was highly significant in group II (pvalue<0.001). Diastolic blood pressure decreases significantly in both groups (p-value<0.001). Also, body weight reduced significantly in group II with (p-value<0.001). Conclusion:: Dapagliflozin when added to traditional medications (RAAS Blockers) has resulted in significant reduction in microalbuminuria with no significant eGFR changes.

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Fibroblast growth factor 23 (FGF-23) is a recently discovered regulator of phosphate and mineral metabolism and has been associated with both progression of CKD and mortality in dialysis patients. To evaluate the association between serum FGF-23 levels and echocardiographic measurements in long-term HD (HD) patients without cardiac symptoms, we studied 90 consecutive patients treated in a single HD center (51 males, 39 females; mean age 41.5 ± 14.2 years, mean HD duration 71.2 ± 14.2 months). Comprehensive echocardiography was performed after HD and blood samples were obtained before HD. The serum FGF-23 level in dialysis patients was 95.7 ± 88.4 pg/mL. In univariate analysis, serum calcium levels (r = 0.33, P <0.05), serum creatinine (r = 0.34, P <0.05), serum albumin (r = 0.35, P <0.05) and left ventricular mass index (LVMI) (r = 0.33, P <0.001) were correlated weakly with the FGF-23 levels. Neither s. phosphorus nor calcium x phosphorus product correlated with FGF-23. In univariate regression analysis, only LVMI [β = 0.42, P <0.05, confidence interval (CI) 0.3-4.3], serum calcium (β= 0.87, P <0.001, CI 0.8-7.3), serum albumin (β= 0.87, P < 0.001, CI 0.8-7.3) and serum creatinine (β= 0.67, P <0.05, CI 0.5-6.5) significantly correlated with FGF-23. FGF-23 was identified as a factor that is weakly associated with LVMI. Thus, FGF-23 alone may not be a parameter that can be used for evaluation of the cardiac status in HD patients.