Background and Aims Kidneys are target organs in hypertension. Hypertensive damage results in glomerular as well as tubular dysfunction. Albuminuria is a known marker of glomerular damage. Whereas, urinary uromodulin is increasingly considered as potential biomarker of early tubular dysfunction. The aim of this study was to identify the pattern of early renal involvement based on glomerular and tubular function assessment by measuring urinary albumin and uromodulin in hypertensive patients Method In this cross-sectional study 122 hypertensive subjects with age>30 years, duration of hypertension <5years, without accelerated or malignant BP, absence of dipstick proteinuria and eGFR>60ml/min. Subjects with possibility of secondary hypertension were excluded. There were also 33 normotensive volunteers included as healthy referents. Morning spot urine for albumin-creatinine ratio (ACR mg/g), urine uromodulin-creatinine ratio (urUMODµg/g), urinary sodium-creatinine ratio (mEq/g) and potassium-creatinine ratio (mEq/g) were measured in single urine sample. Urine uromodulin was measured by ELISA method. Results The hypertensive and healthy subjects were matched for age 48±11 vs. 47±11, years (P=NS). The systolic BP was 145±15 vs. 112±12 mmHg and diastolic BP 86±9 vs. 70±8 mmHg; (p<0.001) and the mean ACR was 29±65 vs. 5.6±2.7 mg/g, (p<0.001) respectively. Around 20% hypertensives had albuminuria. Urinary potassium excretion was lower in hypertensives (51±31 vs. 69±31, mEq/g; p<0.02). The median urUMOD in hypertensive subjects was 3.38 (1.73-9.06) and in normotensives 3.85(2.28-5.69) µg/g (P=NS).Multivariate analysis showed significant inverse association between diastolic blood pressure and urinary uromodulin excretion. An urURMOD cut-off of 2.9 (25th percentile in normotensives) showed eGFR, urinary sodium & potassium excretions were significantly lower at low uromodulin cut-off and this was seen in38%subjects. Conclusion The glomerular involvement was found in 20% hypertensives as evidenced by albuminuria. In general urinary uromodulin level was not different between hypertensive and normotensive subjects. Association of low uromodulin cut-off with lower eGFR, Na+ and K+ excretion indicates simultaneous tubule glomerular involvement in 38%.

Background and Aims Maintenance hemodialysis (MHD) patients have been identified as a high-risk group for COVID-19 infection. Serological testing can be used to monitor disease prevalence & evaluate screening measures & protocols aiming at limiting transmission within dialysis units. This study was conducted to observe the sero prevalence of COVID-19 infection among maintenance hemodialysis patients. Method The study was conducted during the 3rd wave of covid-19 infection. Total 194 in-center MHD patients were included from three dialysis centers. Relevant history regarding covid-19 symptom, testing, managements and vaccination were collected. During our study a serum sample was collected to test IgG antibody against nucleocapsid protein (NP) (cut-off positive when >1.5) and spike protein (S) (cut-off positive when >50 AIU/L) of COVID-19 infection and tested by Chemiluminescent microparticle immunoassay (CMIA) method developed by Abbott (FDA-EUA approved). Results Mean age of the MHD subjects was 48±12 years where male was 60%. Duration of MHD was 31±22 (6-120) months. Renal pathology was DN in 31%, possible GN 31%,HTN 19% and rest from others .From records past covid infection was clinically diagnosed in 39% of which 10% based on RT-PCR and another 29% fell into suspected category (i.e. symptom with/or suggestive serology). Presentation pattern was mild in 75%, moderate 15% (requiring oxygen), severe in 5% (requiring hospitalization) and asymptomatic rest 5%. Vaccine against covid-19 was availed by 38%. In vaccinated vs. non-vaccinated patients the IgG for NP was positive in 63% vs. 561%(P = 0.65) and IgG for S in 99% vs. 98%(P = 0.56). These indicate naturally acquired immunity in most before any vaccination. The IgG titer against spike (S) protein between vaccinated and non-vaccinated groups was 7743±8920 and 5386± 6839 AIU/L (p = 0.06). The correlation study showed that IgG titer against S has no correlation with dialysis duration, age, BMI, Hb%, serum albumin or Kt/V. Similarly IgG titer against NP shows mostly no significant correlation with laboratory parameters. Conclusion These data demonstrate that seroprevalence in hemodialysis population based on antibody against nucleocapsid protein shows only half infected by SARS-CoV-2 where as antibody against spike protein indicates larger number of patients are naturally infected even before vaccinated. Therefore for seroprevalence studies both antibody testing should be used to identify greater population infected until more sensitive tools are established.