الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
CKDu is a form of CKD that appears unrelated to traditional risk factors such as diabetes and hypertension. It is responsible for widespread morbidity and mortality in specific geographic locations across three continents.
Renal biopsy procedure in patients with CKD is a valid and irreplaceable tool that help clinicians not only to achieve a correct diagnosis, but also to predict prognosis and to decide better treatment options (141).
We aimed at this study to detect possible unpredictable causes in patients with unexplained elevated serum creatinine and their clinicopathological characteristics and specify the clinicopathological characteristics of CKDu in our agricultural community.
Our study is a single center prospective cross sectional observational study. It was conducted in Assiut University Hospitals, Department of Internal Medicine, Nephrology units, in the period from June 2018 to May 2022. It included 210 patients presented by unexplained elevated serum creatinine with negative serological and immunological marker.
Our study included 210 patients, (107, 51%) males and (103, 41.9%) women. Their ages ranged between (18-80 years) with a mean age of 43.70 (±14.88) years. The median of their serum creatinine was 724 umol/l (136.0-2300). Most of the patients (180, 85.7%) had an eGFR category V when estimated by CKD-EPI equations.
According to the histological diagnosis, we had five main groups.
• Glomerular diseases group: included 88 (41.9 %) patients, as follows 30 patients with FSGS, 13 patients with membranous nephropathy, 11 patients with membranoproliferative pattern, 2 patients with necrotizing glomerulonephritis, and 32 patients with amyloidosis.
• Tubulointerstitial diseases group included 28 patients with ATN, 8 patients with chronic specific tubulointerstitial nephritis, 2 patients with acute interstitial nephritis and 5 patients with finding suggestive of genetic origin.
• Paraprotein-related kidney diseases group were 27 patients, 22 patients with cast nephropathy, 3 patients with monoclonal deposition disease, and 2 patients with AL amyloidosis.
• Vascular diseases group were 35 patients included 26 patients with small vessel vasculitis, 8 patients with TMA and 1 patient with cryoglobulinemic vasculitis.
• CKDu group were 17 patients (11 patients with advanced glomerulosclerosis and 6 patients with chronic non- specific tubulointerstitial nephritis).
• As regard our cohort outcome after 3 month follow up, 43 patients (20.5%) had their eGFR improved compared to their values at time of biopsy, 75 patients (35.7%) had stable impaired eGFR but without maintenance hemodialysis (CKD-non-HD), 89 patients (42.2%) were maintained on dialysis (CKD-HD) and three patients (1.4%) died with causes not related to the biopsy procedure.
• Post biopsy complications occurred in 19 patients (9%), six patients (2.9%) had major complications and 13 had minor ones. Histological parameters associated with the occurrence of complications were glomerulosclerosis, interstitial fibrosis > 50%, and marked tubular atrophy. Neither age, hypertension, blood pressure level, hemoglobin level, nor platelet count had significant association with the occurrence of post biopsy complications
• Of our cohort had a chronicity score ≥8/10. Hemoglobin level, serum calcium, albumin and kidney size showed statistically significant negative correlation with chronicity score while high systolic and mean pressure, serum iPTH, and proteinuria had statistically significant positive correlation with chronicity score.