Background: Acute kidney injury is a decrease in kidney functions that results in reduced glomerular filtration rate, retention of nitrogenous waste products, and disturbances of extracellular volume and electrolytes. The incidence of acute kidney injury is about 20-200 per million, about 7-18% of patients in a hospital.² Acute diarrheal diseases are one of the important causes of preventable acute kidney injury. Improper fluid deficit restoration in diarrheal diseases results in acute kidney injury, manifested as decreased renal function and a rise in serum creatinine level with or without reducing urine output. The injury may range from mild to severe renal dysfunction; sometimes requiring renal replacement therapy.⁴The rapid and effective restoration of extracellular fluid can prevent acute kidney injury. Materials and Methods: An observational cross-sectional Study, among patients with acute diarrheal illnesses presented to all medical units (A, B, C &D) and the emergency department of Ayub Teaching Hospital, Abbottabad. A total of 140 patients presented in 3 months duration from 1^st July – 30^th Sep 2022. Data were analyzed by using SPSS 16 Results: In the sample size of 140 patients, the minimum age was 14 years and the maximum age was 70 with a mean of 38 years with a standard deviation of +/- 14 y. Among 140, 80 patients were male and 60 patients were female. Out of 140 patients, 47 were having hypertension, 19 were diabetic and 16 were known, cardiac patients. Urine output of 13 (9.3%) patients was less than 100ml/day, while 46 (32.9%) patients were having 100-400ml/day, 37 (26.4%) patients was having 400-1200ml/day and 44 (31.4%) patients had greater than 1200ml/day. The serum creatinine level was greater than 2.8mg/dl (more than 2 times normal) in 35 patients (25%), and 18 patients were having creatinine levels in the range of 1.5-2.8mg/dl (up to 2 times greater than normal) and 87 patients had creatinine levels in the normal range (0.7-1.4mg/dl). Out of 140 patients, 41 (29.3%) presented to the tertiary care hospital in shock (systolic blood pressure less than 90mmhg), 96 (68.6%) were normotensive and 3 (2.1%) patients were hypertensive. Conclusion: The incidence of acute kidney injury in patients presenting with acute gastroenteritis to a tertiary care hospital is 25%, due to hypovolemia caused by fluid losses in acute diarrheal illnesses. It can be prevented by prompt diagnosis and treatment by fluid administration. Keywords: Acute kidney injury (AKI), Acute renal failure(ARF), Eschericia coli (E.Coli) RIFLE (Risk, Injury, Failure, Loss, End Stage kidney disease)

Background and Aim: The occurrence of urinary tract infection (UTI) in type 2 diabetes (T2DM) administered with sodium-glucose co-transporter-2 (SGLT2) inhibitors are still debatable. The present study aimed to assess the occurrence of UTI in T2DM patients taking SGLT-2 inhibitors to regulate their blood sugar levels. Patients and Methods: This cross-sectional study was carried out on 369 T2DM patients investigated in the Nephrology division of Khyber Teaching Hospital, Peshawar from January 2022 to December 2022. Dapagliflozin and empagliflozin were SGLT-2 inhibitors drugs given to each individual. Patient’s detailed history and genitourinary infections were noted from medical records. Pain during micturition, micturition urgency, redness, abdominal pain, vomiting, and frequency of micturition, fever, soreness, and diarrhea were recorded using questionnaire based proforma. Results: Of the total 369 patients, the frequency of patients administered with dapagliflozin and empagliflozin was 178 (48.2%) and 191 (51.8%) respectively. Among 178 patients, there were 112 (62.9%) male and 66 (37.1%) females. Among 191 patients, there were 136 (71.2%) male and 55 (28.8%) females. The occurrence of UTIs in patients using dapagliflozin and empagliflozin was 18 (10.1%) and 28 (14.7%) respectively. Likewise, the genital tract infections were found in 20 (11.2%) dapagliflozin users and 26 (13.6%) empagliflozin users.

Background and Aim: Chronic kidney disease-associated pruritus (CKD-aP), commonly known as uremic pruritus is a frequent and inconvenient disease for patients undergoing hemodialysis. The purpose of the present investigation was to determine the association of CKD-associated pruritus with quality of life in patients undergoing hemodialysis presented to the nephrology division of Khyber Teaching Hospital Peshawar. Patients and Methods: This cross-sectional study was conducted on 227 CKD-associated pruritus patients investigated in the Nephrology Division of Khyber Teaching Hospital Peshawar from March 2022 to February 2023. Patients of either gender (>18 years) undergoing hemodialysis were enrolled. Demographic details, dialysis duration, duration of disease, and various comorbidities conditions were recorded based on a pre-designed questionnaire. Results: Out of 227 patients, there were 142 (62.6%) male and 85 (37.4%) female. The overall mean age was 40.82±6.82 years. The incidence of CKD-associated pruritus was 68.7% (n=156). The presence of various comorbidities such as diabetes mellitus, hypertension, hyperlipidemia, and cardiovascular disease was found in 30 (13.2%), 124 (54.6%), 16 (7.0%), and 6 (2.6%) respectively. The overall mean duration of CKD and duration on hemodialysis was 34.4 [12.0–48.0] months and 22.8 [12.0–36.0] months respectively.

Background and Aim: Renal failure, especially in its acute phase, is common in patients with liver cirrhosis and ascites. The incidence of hepatorenal syndrome varies from 18% to 39% in a span of 1 to 5 years. The present study aimed to determine the prevalence, predictive factors, and prognosis of hepatorenal syndrome (HRS) in cirrhosis with ascites. Patients and Methods: This prospective study was carried out on 68 cirrhotic patients admitted for the treatment of ascites in the Departments of Nephrology and Gastroenterology, Khyber Teaching Hospital, Peshawar from January 2022 to December 2022. The median GFR, median values of serum sodium, and urine sodium concentrations were measured for each individual. All the patients underwent physical examination and detailed history. The abdominal tapped fluid was used to measure the concentration of protein ascetic fluid. Descriptive statistics were done in SPSS version 27. Results: Of the total patients, there were 46 male and 22 females. The overall mean age was 48.64±4.8 years. Out of 68 patients, the incidence of cryptogenic cirrhosis and hepatitis B surface antigen (HBsAg)-positive cirrhosis was 76.5% (n=52) and 23.5% (n=16) respectively. Based on physical examination, the incidence of hepatomegaly, splenomegaly, and hepatic stigmata was 57.4% (n=39), 38.2% (n=26), and 79.4% (n=54) respectively. About 58.8% (n=40) patients had previous episodes of ascites. Gastrointestinal hemorrhage and hepatic encephalopathy was found in 26.5% (n=18) and 19.1% (n=13) respectively. Serum bilirubin levels increased in majority of patients 76.5% whereas serum albumin concentration decreased in 85.3% cases. Conclusion: The present study found that HRS is a comparatively common complication in cirrhosis patients with ascites that is significantly associated with higher mortality rate and short survival rate. Hepatorenal syndrome could be easily predicted by plasma renin activity, liver size, and concentration of serum sodium.

Aim: Polycystic liver infections are the most prevalent extra renal manifestation of autosomal-dominant polycystic kidney disease (PKD). People are living longer and there are more chances of spread on infections and these infections may cause different diseases but these can be improved by providing the proper knowledge among the lay men and control over these diseases can be made like better kidney survival, less death from heart disease, new treatments for kidney transplants, and more people with polycystic liver failure. There is a lack of research that completely characterizes PKD in big cohorts. Many other researchers has also been made to observe the size of the liver and the number of cysts which are linked to the size of the hepatic parenchyma, but this study is the specific to the polycystic kidney disease and its effect over the liver with the volume of cyst. This is the only studyin the region. . Methods: cross-sectional studies has been conducted to investigate the relationship between the initial volumes of the liver which was determined by MRI, and the patient’s demographics, the outcomes of these results also depends upon the quality of life of the patients. This research was conducted from January 2021 to June 2021 at Mayo Hospital, Lahore Pakistan. The information is gathered from the randomized, placebo-controlled trial that is currently being conducted at five tertiary-care medical facilities. In this the comparison was made between the groups of angiotensin I–converting enzyme inhibitor and an angiotensin II–receptor blocker. These findings were based on the normal situation o fthe blood [ressure. Because normal blood pressure related with the proper renal functioning. These tests were performed for 558 patients with ADPK (age, 16–50 y). Practical implication: We can easily implement these findings to PKD in hospitals and find the best treatment method according to this. Results: The significant level of hepatomegaly was seen in number of individuals diagnosed with ADPKD. Hepatomegaly was also existed in cysts as well as parenchyma. Cysts were found more often in women, and both the liver and cyst sizes were observed to be larger in women with the increase in age. Patients whose illness had progressed significantly demonstrated a significant reduction in the situation of liver parenchyma. In this study some minor irregularities were noticed in the results of laboratory testing on the liver, and splenomegaly and hypersplenism remained related to the severity of PLD. Inferior quality of life was connected with having a larger amount of damage in the liver tissue. Conclusion: Even in the earliest stages of ADPKD, hepatomegaly is rather prevalent, and it cannot be diagnosed properly just by the presence of cysts. Even for those who didn't have cysts, parenchymal volumes have been discovered to be substantially bigger than liver volumes in people without ADPKD or these predicted by basic tests performed in the specific laboratories. The harshness of PLD remained linked to changed biochemical also hematologic characteristics, in addition to a worse quality of life in patients. Keywords: Hepatomegaly, Polycystic liver infections, extra-renal manifestation, autosomal-dominant polycystic kidney diseases.