It gives me immense pleasure to be the editor of this special issue of Chettinad medical journal released on the occasion of General Medicine department’s annual Medical conference ‘CHETMEDICON 2018’. Renal involvement can be a cause or an effect of systemic disorders. The need for early detection and intervention is required to reduce the systemic co-morbidities of CKD (Chronic Kidney Disease). The theme of the conference ‘Renal Involvement In Systemic Disorders-An Update’ will help the physicians to address the challenges of renal disorders.

Human kidneys play a pivotal role in excretion of noxious substances from our body. The diseases affecting the kidney are many but early intervention can prevent permanent damage to them. One of the most common structures that get involved in the kidney is the glomerulus. These glomerular diseases have a varied clinical presentation . Ig A nephropathy is a disease process commonly involving the glomerulus.

Pancytopenia is an important clinico-hematological entity encountered in day-to-day practice. It is not a disease by itself; rather it describes simultaneous presence of anemia, leucopenia and thrombocytopenia resulting from a number of disease processes.

A 32 year old female presented with complaints of blurring of vision in both eyes for 2 weeks duration. She was diagnosed with stage V CKD following focal segmental glomerulosclerosis and was on hemodialysis since two months. There was no history of metamorphopsia, micropsia or dyschromatopsia. On examination her BCVA was 6/9 NIP OU. The anterior segment and IOP were normal in both eyes. A dilated fundus examination revealed normal disc and vessels, with ring reflex in the macula in both eyes. Right eye also revealed a small haemorrhage temporal to macula. OCT macula revealed detachment of sensory retina from RPE with subretinal fluid, suggestive of CSCR.

A 32 year old female presented with complaints of blurring of vision in both eyes for 2 weeks duration. She was diagnosed with stage V CKD following focal segmental glomerulosclerosis and was on hemodialysis since two months. There was no history of metamorphopsia, micropsia or dyschromatopsia. On examination her BCVA was 6/9 NIP OU. The anterior segment and IOP were normal in both eyes. A dilated fundus examination revealed normal disc and vessels, with ring reflex in the macula in both eyes. Right eye also revealed a small haemorrhage temporal to macula. OCT macula revealed detachment of sensory retina from RPE with subretinal fluid, suggestive of CSCR.

CKD is a global health issue associated with increased financial burden and affects the quality of life to a vast extent. The symptoms confronted by patients in various stages of chronic kidney disease are very debilitating. The most common symptoms of CKD are itching, sleep disturbance, anorexia, fatigue, muscle wasting, nausea, vomiting, chronic pain, shortness of breath, bleeding and sexual dysfunction. Most of the symptoms are due to increased proinflammatory mediators like IL-6 and TNF α. Recent research studies have discovered new biochemical substances like orexin, ghrelin, melatonin and adiponectin as mediators of some of the symptoms like fatigue and muscle wasting. This review focuses on the possible pathophysiological mechanisms and management of the above mentioned symptoms.

Urine is a window to understand diseases of the kidney. The product of kidney the urine is freely available and can be easily collected non-invasively. Urine microscopy dates back its origin in 1830 and still remains an important tool to physician. Urinalysis is much more than urine microscopy and it includes measurement of urine specific gravity, pH, estimation of solutes like protein,glucose etc.In the era of modern medicine, urinalysis is a powerful tool in diagnosing the etiology and prognosticating diseases of kidney and urinary tract.This article discusses the parameters in urinalysis and its usefulness in diagnosing diseases of kidney and urinary tract.

Acute kidney injury(AKI) is triggered by number of factors like ischaemia, nephrotoxins etc and is associated with increased morbidity and mortality. AKI diagnosis is usually based on the rise in serum creatinine or reduction in urine output. Though creatinine is used as an indicator of kidney function ,it is a suboptimal marker of injury as it rises only after around 50% of function loss. The delay in diagnosis of kidney injury prevent timely management decisions raising the demand for sensitive, specific and reliable biomarkers that can stratify correctly the extend of renal damage. A number of novel biomarkers are currently available to represent kidney injury and kidney function. Here we make an effort to present the main features of emerging biomarkers. An analytical approach attempted to know whether the new biomarkers diagnose acute kidney injury earlier than traditional tests, whether they can identify patients who need renal replacement therapy, does it improve patient outcome and when it should be measured.

Nutritional disturbances in Chronic Kidney Disease are quite common but often both under nutrition as well as over nutrition goes unnoticed and undiagnosed. In Chronic Kidney Disease (CKD). Medical Nutrition Therapy(MNT) has certain advantages in terms of improvement in the level of biomarkers and a reduction in the rapid progression of the disease in patients who are on conservative therapy as well as on dialysis .This positively helps in reducing complications so that the need for long term dialysis can be modified .Initially nutritional variations are screened and accordingly guidelines are formulated regarding daily recommended dietary intake of macronutrients and micronutrients. Apart from other therapies Medical Nutrition Therapy remains an efficient tool in the overall management of Chronic Kidney Disease.