Background: Adult onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown aetiology, frequently accompanying multiple lymphadenopathy. It often mimics malignant lymphoma, and immunohistochemical and molecular studies are needed for definite diagnosis. Aims: To aid in diagnosis and understand the pathogenesis of the disease by clarifying lymph node (LN) pathology in AOSD. Methods: Thirteen biopsies (one follow up biopsy) and medical records of 12 patients were reviewed. Immunohistochemistry, polymerase chain reaction for T cell receptor c chain (TCRc) and immunoglobulin heavy chain gene rearrangement, and Epstein-Barr virus in situ hybridisation were performed. Results: Histologically, LN lesions were classified into four patterns. The most common (six biopsies) showed paracortical hyperplasia, with prominent vascular proliferation, scattered large B/T immunoblasts, and infiltration by reactive lymphocytes and inflammatory cells. In the second pattern (two biopsies), paracortical hyperplasia was accompanied by massive sinus histiocytosis and S-100 positive histiocyte aggregates. The third pattern (three patients) showed an exuberant immunoblastic reaction, in the form of patchy/diffuse infiltration of large T immunoblasts with high mitotic activity, although clonal rearrangement of the TCRc gene was not detected. The fourth pattern showed distinct follicular hyperplasia (two cases). One patient with a follow up biopsy showed a pattern change from pronounced follicular hyperplasia to atypical paracortical hyperplasia. Conclusions: AOSD LN lesions show a dynamic histological spectrum, including atypical paracortical hyperplasia, burnt out histiocytic reaction, exuberant immunoblastic reaction, and follicular hyperplasia. During the course of disease, LN reactivity changes and mixed B and T cells are involved in the pathogenesis.

Aim Data published on COVID-19 in the Filipino population, particularly those with end stage kidney disease (ESKD) are still lacking. Methods We performed a retrospective, observational study of 68 ESKD patients admitted with COVID-19 infection at a tertiary hospital in Metro Manila, Philippines from April 1, 2020 to July 31, 2020. We compared the clinical features, baseline laboratory data, treatment strategies and short-term outcomes between those who survived and those who died. We also determined the risk factors associated with mortality from COVID-19. Results Mean age was 54.5 years old, 66% were male. All patients admitted were on maintenance hemodialysis (HD). The most common presenting symptoms were dyspnea (57%), fever (47%) and cough (38%). There was an equal number of patients on high flow nasal cannula (17.7%) and invasive mechanical ventilation (17.7%). ICU admission was required in 17.7% of the cohort. In-hospital death occurred in 25% of the patients. Admission PaO 2 /FiO 2 (PF) ratios (162 ± 134 versus 356 ± 181; p=0.0009) were lower, and procalcitonin (6.07 ± 10.5ng/mL versus 0.73 ± 3.61 ng/mL; p=0.02), lactate dehydrogenase (396 ± 274U/L versus 282 ± 148 U/L; p=0.03), and white blood cell counts (10 ± 7.3 x 10 9 /L versus 6.3 ± 4.2 x 10 9 /L; p= 0.0039) were significantly higher among those who died compared to those who survived. After adjusting for confounders, only low PF ratio (HR 1.01 for every unit decrease, 95% CI 1–1.01) and need for ventilation (HR 6.45, 95% CI 1.16–35.97) conferred a significant risk for in-hospital mortality. Conclusion Short-term, in-hospital mortality is high among patients on chronic hemodialysis admitted for COVID-19 infection. They present similarly with the general population. Low PF ratio on admission and need for ventilation are independent risk factors for in-hospital mortality.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have revolutionized our armamentarium for kidney and heart protection in patients with or without diabetes. Based on early reports of a limited number of cases, a concern for increased risk of urinary tract infections arose, which has become one of the main areas of concern for some clinicians. However, data from large randomized clinical trials and real-world population-based studies have not shown a significantly increased risk of UTI in patients on SGLT2 inhibitors. The goal of this brief review article is to review the literature and provide reassurance to the patients and prescribers for the broader use of these agents.

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Crescentic glomerulonephritis is usually associated with an acute nephritic syndrome with rapidly declining renal function. Postinfectious cases usually have a higher possibility of recovery. Juvenile nasopharyngeal angiofibroma (JNA) is a rare, locally aggressive tumour affecting mostly young men. A 28-year-old man presented with recurrent JNA initially excised 2 years prior. The patient was initially managed as a case of airway obstruction and pneumonia. He developed tea-coloured urine, oedema and acute kidney failure requiring dialysis while awaiting surgery. Urine and immunological studies (low C3, negative antineutrophil cytoplasmic antibody and antinucleosomal antibody and high antistreptolysin O) suggested a nephritic aetiology. Nasopharyngeal swab cultures of the mass revealed gram-negative organisms. Kidney biopsy showed diffuse proliferative glomerulonephritis compatible with a postinfectious glomerulonephritis with 77% cellular crescents. The mass was excised with histopathology consistent with JNA. The patient was eventually discharged off dialysis.