While pregnancy among end-stage kidney disease patients is rare, the number of females becoming pregnant has been increasing worldwide during the last decade. The frequency of conception in this patient group has been reported to be between 0.3% and 7% per year. The aim of this review is to summarize the latest guidelines and practice points for ensuring the best outcome for both the fetus and the mother.

Background and Aims Diabetes mellitus was prevalent in nearly 0.8 % of the adult population and assent in our modest hemodialytic population in 1990. Changing of lifestyle and nutrition, increase in longevity, aging population, and stress have brought to increase of this morbid condition. Nowadays, with a galloping rise, we have a prevalence of 11,1 % of DM in the adult population and nearly 22% of hemodialysis patients whose primary diagnosis is diabetes. Despite this, data of EUROSTAT put us in the first place for mortality due to diabetes. It's time to act! Method We analyzed the number of diabetic patients in Albania second the IDF data and the number of diabetic nephropathy patients hospitalized during this decade in our Departement of Nephrology according the Statistical Department of UHC "Mother Theresa". Results In 2010 there were 4.5% diabetics in the adult population in Albania and in 2019 there were 9%, so doubling of numbers. Diabetic nephropathy is increasing too and now is our everyday clinical practice challenge, in 2010 there were 54 patients hospitalized for DN and its complications and in 2019 this number increased to 164 patients. Diabetics on hemodialysis are now more and more present with their problems and difficulties that need not only nephrologists but a multidisciplinary approach. Diabetic nephropathy in 2011 had only 11,3% of the hemodialytic pie and now is reaching 17,2% of the primary cause of ESRD in our hemodialytic population, regarding ERA EDTA registry, but our 2020 numbers rise to 22%. We are below the European and North American data but in incident patients it is becoming the second predominant cause of renal failure, after the hypertensive nephrosclerosis, reaching 25%-27%. Mortality in this population is a crucial point, we stand first in Europe with 110 deaths/ million inhabitants despite the reimbursement range is three-fold compared to 10 years ago An increasing number is translated into increased problems especially in vascular access, cardiovascular problems, diabetic foot problems, glycemic control, etc. Conclusion Nephrology Units and Hemodialysis Units too are being invaded by diabetics Caring about the glycemic levels, type of hypoglycemia drugs, time and dosage, eating or not during the hemodialysis session, are every session challenges. Cardiovascular problems with frequent hypotensions, coronary heart disease, and cardiac heart failure are other difficult to manage fields. But the most important and continuous care is that of vascular access, the "Achille's Heel" of our patients. Results from our studies reveal diabetes like the second cause of arteriovenous fistulas failure, after the age of patients so we are reinforcing the whole medical chain for referring patients in the fourth stage of CKD for the creation of permanent vascular access, especially diabetics.

Background and Aims Cognitive impairment is an increasingly identified major cause of chronic disability and is commonly found in patients with chronic kidney disease (CKD). Knowledge of the link between kidney dysfunction and impaired cognition may enhance our understanding of risk factors impacting cognitive dysfunction. Our study aimed to evaluate the relation between serum inflammatory markers and the risk of cognitive decline among adults with CKD. Method Forty-six patients predialysis patients CKD stage 5 (mean age 55.6±11.5 years old) accepted to participate in the study. The Montreal Cognitive Assessment (MoCA) scale was administered to patients. Patients with a MoCA global score of 24/30 were considered cognitively impaired. Descriptive analysis was done for the socio-demographic and clinical variables. We measured high-sensitivity C-reactive protein (hs-CRP), ferritin level, albuminemia, and fibrinogen in baseline plasma samples. Results The mean total MoCA score for all the patients was 22.9 ±3.8 points. Thirty-seven patients, 57.7%, were evaluated with CI, where 74.6 % with Mild CI (MCI) and 25.4% with severe CI (SCI) under 20 points). MoCA subscale analysis revealed that the mean score for visuospatial/executive domain and attention were the lowest with 5.41±1.1 /8max and 2.93±1.75/6 max, and scores for orientation were the highest 5.92±0.57/6 max. At baseline, higher levels of each inflammatory marker were associated with poorer age-adjusted performance. In analyses adjusted for baseline cognition, demographics, comorbid conditions, and kidney function, participants in the highest tertile of hs-CRP, the highest tertile of fibrinogen, and the highest tertile of ferritin had an increased risk of impairment in attention compared to participants in the lowest tertile of each marker (p=0.043, p=0.047, p=0.029, respectively. The high level of ferritin was evaluated as a risk of impairment visuospatial/executive ability, and no relationship of inflammatory markers was observed with impairment of orientation p=0.01. hs-CRP and ferritin and low albumin level were independently associated with longitudinal global cognitive function (p=0.04, p=0.02, p=0.49 respectively). Conclusion In CKD patients, we have a relatively high risk for cognitive impairment. Our results extend the findings from prior studies by showing that inflammatory markers used in routine practice contribute and are independently associated with longitudinal changes in some domains of cognitive function in patients with CKD going in parallel with the inflammatory mechanisms that have been implicated in the pathogenesis of vascular and Alzheimer’s dementia.

Background and Aims We present the case of a 16 years old girl who was admitted to our Emergency Unit in May 2019 for diarrhea, nausea, dysuria, foamy urine, urinary incontinence, malnutrition, polyserositis, and hypertension. Her medical history started 8 months ago with diarrhea and urinary incontinence for which first was hospitalized in the Gastroenterology unit and then in the Infectious Disease Unit. There she was completed with colonoscopy, contrast CT scan and then was discharged with the diagnosis of Gastrocolitis. In January 2019 due to the persistence of symptoms they did a specialized consultation in Athens, Greece. After a series of examinations the patient was diagnosed with Anorexia Nervosa and antidepressant therapy was started. In February 2019, the patient was rehospitalized with nephritic grade proteinuria and the kidney ultrasound showed stage four bilateral hydronephrosis and urinary bladder with thick and trabecular walls. To exclude urological problems, an MRI was performed which results in no obstructive problems. Arterial hypertension and lower extremities edema were present. She was then transferred to our University Hospital “Mother Teresa”, Nephrology Department for further examinations. During hospitalization her blood investigation showed severe anemia (HGB = 6.7gr / dl), kidney failure (creatinine = 1.5mg / dl, urea = 83mg / dl), elevated liver enzymes (Alt:162u/ml, Ast:101u/ml), albuminemia: 2.9 g / dl, total proteinemia: 5.9g / dl. The lipid profile showed cholesterolemia: 300mg / dl, triglyceridemia: 170mg / dl. Electrolytes were within normal limits. Coombs test resulted positive. Urinalysis showed microscopic hematuria with leukocyturia and grave albuminuria around16gr/ 24 hours. Immunologic workup showed: AntiDna = 383.5U / ml, Ena profile SSA poz, ANA ++++, C3 101, C4 18. Tumoral markers and hepatitis resulted in negativ. Method Renal biopsy was performed which resulted: Lupus Podocytopathy Results The patient was diagnosed with a case of lupus cystitis with lupus podocytopathy. She was treated with methylprednisolone, immunosuppressive therapy, and Plaquenil. It was started with intravenous methylprednisolone 0.5 g / day for 3 days and then switched to oral methylprednisolone 0.5 mg /kg /day. Mycophenolate mofetil was started with 1 gr increased to 2 grams. After 6 months of therapy Hydroureteronephrosis completely disappeared and 24 h urinary protein became normal. The dose of therapy was tapered and switch to maintenance doses, methylprednisolone 8 mg, MMF 500gr, and Plaquenil. Laboratory examinations Hgb: 12gr / dl, Urea: 36mg / dl, Creatine: 0.6mg / dl, Alt: 23u / l, Ast: 26u / l. Urinalysis: albumin trace, RBC: 0, Wbc 8 / field. The autoimmune workup was normalized, AntiDna; C3, C4, Ana. In a realized ultrasound hydronephrosis was gone, kidney structure was in normal parameters and bladder wall was in a normal structure. Conclusion Disseminated Eritematous Lupus and its rare forms like Lupus Cystitis and Lupus Podocytopathies can be diagnosed, cured successfully, and followed up in the best way despite you are a simple teenager in a village of Albania or a noticed and famous actor or singer in the USA.

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