Background: Mineral homeostasis deteriorates when kidney function diminishes, manifesting as variations in blood and tissue levels of calcium and phosphate, followed by the change in circulating parathyroid hormone (PTH). Mineral bone disorders (MBD) are a clinical illness caused by chronic renal disease that expresses as a systemic impairment of mineral and bone metabolism. Aim: To find out prevalence of bone mineral disorders in hemodialysis patients presenting in Nephrology Ward, SIMS. Lahore Methodology: This observational analysis included a total of 88 patients, who were on dialysis at the nephrology department of SHL for the period of more than six months. The study was conducted from 17 September 2021 to 10 March 2022 after the approval of the ethical review board of the Department. According to their blood PTH levels, the patients were split into three groups: those with PTH levels less than 150 pg/ml (low bone turnover), those with PTH levels between 150 and 300 pg/ml (normal bone turnover), and those with PTH levels greater than 300 pg/ml (high bone turnover). Results: The prevalence of bone mineral disorder was 87.5% in hemodialysis patients presenting at the nephrology department, in which prevalence of high turnover bone disorder was 73.9% whereas the prevalence of low turnover bone disorder was 13.6%. In the early dialysis period (0.5-5 years) the prevalence of bone mineral disorders was more prominent as compared to the patients on dialysis for more than 5 years. Conclusion: There was a high prevalence of bone mineral disorders, in which patients with high turnover were found to be more prevalent. Similarly, patients in the early years of dialysis are more prone to develop bone mineral disorders. Thus, we should keep these findings in mind while doing the follow up and adjust the medication accordingly. Keywords: Bone Mineral Disorders, Low Turnover Bone Disorders, Hyper Para Thyroid Disorder, Prevalence of Disease

Background: All guidelines recommend pre-emptive arteriovenous fistula (AVF) formation in late-stage chronic kidney disease (CKD) patients. New evidence shows that pre-emptive AVF can improve estimated glomerular filtration rate (eGFR) as well. Aim: To evaluate the beneficial effect of AVF on improvement of eGFR in pre dialysis patients of CKD stage 5 disease. Methodology: A total of one hundred CKD stage five pre-dialysis patients were included in this prospective cohort research from the Nephrology unit of Services Hospital Lahore (SHL). After receiving approval from the ethical review committee SHL, the study was performed from September 2021 to March 2022. Patients were separated into two groups. Fifty patients with arteriovenous fistula (AVF) were in Group AVF, whereas those in Group Non-AVF were only on conservative therapy as they opted for conservative treatment despite counseling about need for AVF and Renal Replacement Therapy (RRT) in future. Over the course of six months, both groups were monitored. The initial eGFR was measured immediately after the formation of AV fistula and monthly for next six months (Final eGFR). Results: The median age of the study population was 37 years in which the sixty percent of the males. The most common comorbid condition was hypertension (96%) and the main reason for late-stage renal disfunction was diabetic nephropathy (45%). We found statistically significant improved eGFR in AVF group as compared to the non-AVF group (p < 0.01). Conclusion: From the results of our study, it can be concluded that the creation of AV fistula in the pre-dialysis patient has a beneficial effect on improvement of eGFR and delaying the progression CKD. Keywords: End Stage Renal Disease, AV fistula, Pre-Dialysis, e GFR, chronic kidney disease,

Background: Renal biopsy, an invasive and costly procedure, is required to diagnose lupus nephritis. In some studies, complement levels C3 and C4 are being utilized as a diagnostic tool to distinguish whether active urine sediment, rising proteinuria and loss of renal function are attributable to systemic lupus erythematosus (SLE) activity or other non-immunological causes. Aim: To find out the frequency of altered levels of complement factors C3 and C4 in lupus nephritis with nephric or proteinuric flare. Methods: The present observational study was conducted in the Department of Nephrology, Services Hospital, Lahore. A total of fifty patients of lupus nephritis showing proteinuric, nephritic or mixed flare were enrolled. Demographics and clinical parameters were noted and C3 and C4 levels were measured. Both males and females were included in the study. This study was approved by the Institutional Review Board of the Services Institute of Medical Sciences. Results: Out of a total of 50 patients, 19 were males while 31 were females. The mean age of the patients was 29.40 ± 6.66 years. Low levels of complement factor C3 were discovered in 12(24%) of the patients, whereas low levels of complement factor C4 were detected in 18(36%) of the patients. Proteinuric flare was found in 17 patients, nephritic flare in 25 patients whereas both types of flare were found in a total of 8 patients. Conclusion: One-third of the patients with nephritic type flare of lupus nephritis had low levels of C3 or C4 in our study. Further studies with larger sample size are needed to assess the potential of complement levels C3 and C4 as tools to diagnose lupus nephritis flare. Keywords: Complement, C3, C4, Systemic lupus erythematosus, Lupus nephritis flare