Background: Thyroid nodules are commonly encountered in clinical practice and require accurate diagnostic evaluation to differentiate benign lesions from malignancies. Ultrasonography using the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS), along with fine-needle aspiration cytology (FNAC) interpreted by the Bethesda system, plays an important role in preoperative risk stratification. Aim: This study aimed to evaluate the association between radiological findings and cytopathological diagnosis of thyroid nodules in patients attending a tertiary care center in Uttar Pradesh. Materials and Methods: A retrospective and prospective cross-sectional study was conducted in the Departments of Pathology and Radiology at VIMS, Gajraula, from January 2023 to September 2024. Patients presenting with palpable or incidental thyroid nodules underwent high-resolution ultrasonography followed by ultrasound-guided FNAC. Thyroid nodules were categorized according to ACR TI-RADS, and cytological findings were reported using the Bethesda system. The diagnostic accuracy, specificity, and positive predictive value of FNAC and TI-RADS were assessed and compared with histopathological findings wherever available. Results: A total of 127 patients were included, with a mean age of 43.2 ± 11.4 years and female predominance. The mean thyroid nodule size was 2.14 ± 1.2 cm. FNAC findings showed that 80.0% of lesions were non-cancerous, while 20.0% were cancerous. Papillary carcinoma was reported in 13.0% of cases, follicular neoplasm in 7.4%, AUS/FLUS in 5.6%, and suspicious follicular neoplasm in 3.7%. Most nodules belonged to benign or probably benign TI-RADS categories, while suspicious and moderately suspicious lesions constituted a smaller proportion. FNAC demonstrated an accuracy of 90.74% and a positive predictive value of 81.82%. Specificity for benign lesions was 95.24% for FNAC and 93.33% for TI-RADS, whereas specificity for malignant lesions was 93.02% and 95.45%, respectively. Conclusion: The combined use of ultrasonographic TI-RADS scoring and FNAC improves diagnostic precision in the evaluation of thyroid nodules. This dual-modality approach is useful for identifying malignant lesions, reducing unnecessary surgical interventions, and improving preoperative management in tertiary care settings. Further studies with larger cohorts and long-term follow-up are recommended to validate these findings.

Background: Acute respiratory infections are one of the most frequent causes of pediatric outpatient visits, and are a significant contributor to antibiotic consumption. There are many infections that are viral and self-limiting, and inappropriate antibiotic prescribing is a preventable contributor to antimicrobial resistance. Antibiotics are the most commonly used drugs in children with ARI, and their use is guided by evidence-based clinical guidelines. Objective: To evaluate antibiotic prescribing practices and adherence to clinical guidelines in pediatric outpatients with ARI. Methods: The study was a cross-sectional, observational study of 420 prescriptions for children aged 1 month to 12 years who were seen in a pediatric outpatient department. A structured proforma was used to record diagnosis, clinical features, investigations, antibiotic use, drug class, dose, duration and appropriateness. Results: In 238/420 encounters (56.7%) an antibiotic was prescribed. The most frequent diagnoses were acute upper respiratory tract infection/common cold (33.8%), acute pharyngitis/tonsillitis (21.4%), acute otitis media (13.6%), bronchitis/bronchiolitis (12.6%), pneumonia (10.7%) and acute sinusitis (7.9%). In total, 152 of the antibiotic prescriptions (63.9%) were guideline-concordant and 86 (36.1%) were inappropriate. The most common inappropriate prescriptions were for common cold/viral upper respiratory infection (72.7%) and bronchitis/bronchiolitis (66.7%). Amoxicillin-clavulanate was the most commonly used antibiotic (39.1%), followed by azithromycin (24.4%) and amoxicillin (18.5%). Documentation of diagnosis, fever, respiratory rate and danger signs was complete in 61.2% of encounters, and was associated with lower inappropriate prescribing (27.4% vs 49.2%, p=0.001). Conclusions: The use of antibiotics for pediatric acute respiratory infections was widespread and over one-third of the prescriptions were inappropriate. Diagnosis-based stewardship, documentation and following pediatric outpatient guidelines are required.

Background: Iron deficiency anemia is the most prevalent nutritional anemia in children and can affect growth, immunity, cognition and development. Where iron studies are not available, hematological indices may be useful in determining the severity and for early diagnosis. Methods: This cross sectional study involved 210 children aged 6 months to 12 years who were diagnosed with IDA by hemoglobin, red cell indices, peripheral smear, serum ferritin and transferrin saturation. Children who had hemoglobinopathies, chronic kidney disease, acute infection, recent transfusion, or hematinic therapy were excluded. The hematological parameters were compared between the mild, moderate and severe anemia groups. Results: Mean age was 4.8 +/- 3.1 years; 116 children (55.2%) were male. The most common anemia was moderate (46.7%), followed by mild (31.9%) and severe (21.4%). Mean hemoglobin was 10.4 +/- 0.5 g/dL in mild, 8.3 +/- 0.8 g/dL in moderate, and 6.4 +/- 0.7 g/dL in severe anemia (p<0.001). As the severity increased, MCV, MCH, ferritin and transferrin saturation decreased, whereas RDW and platelet count increased. Hemoglobin correlated positively with ferritin (r=0.52, p<0.001) and MCV (r=0.61, p<0.001), and negatively with RDW (r=-0.58, p<0.001). Conclusion: Routine haematological parameters are significantly related to the severity of paediatric IDA and can be used as an aid to early grading and treatment decisions.

Background: Exclusive breastfeeding is recommended for optimal growth, but information on longitudinal anthropometric changes throughout the first year of life is limited in the local context. Objective: To evaluate the relationship between exclusive breastfeeding for 6 months and growth parameters in the first year of life. Methods: 180 term singleton infants were recruited and followed from birth to 3, 6, 9 and 12 months. Infants who were only breastfed for six months were compared with infants who were mixed or formula fed prior to six months. Weight, length, head circumference and WHO z-scores were measured. Results: 180 infants, 112 (62.2%) were exclusively breastfed for six months and 68 (37.8%) were non-exclusively breastfed. Baseline birth weight was comparable between groups (2.94 ± 0.36 kg vs 2.91 ± 0.34 kg, p=0.59). At 12 months, mean weight was slightly lower in the exclusive breastfeeding group (9.28 ± 0.86 kg vs 9.61 ± 0.91 kg, p=0.018), while length (74.9 ± 2.7 cm vs 74.3 ± 2.8 cm, p=0.15) and head circumference (45.9 ± 1.3 cm vs 45.6 ± 1.4 cm, p=0.12) were similar. There was no increased risk of undernutrition, but at 12 months, weight-for-length z-score was lower among exclusively breastfed infants (0.18 ± 0.79 vs 0.49 ± 0.84, p=0.014). Fewer episodes of respiratory illness (0.72 ± 0.84 vs 1.18 ± 1.02, p=0.002) were associated with exclusive breastfeeding. Conclusion: Adequate linear and head growth was observed during exclusive breastfeeding, and the weight gain was relatively leaner with relatively lower morbidity.

Background: Nocturnal enuresis is a common paediatric condition that may persist beyond early childhood and affect emotional wellbeing, sleep, family functioning, and school participation. Rural school data are important for estimating community burden and identifying modifiable associated factors. Methods: A school-based cross-sectional study was conducted among 416 children aged 6–12 years attending five rural primary schools in Mathura district from March 2024 to September 2025. Data were collected using a pre-tested structured parent questionnaire. Nocturnal enuresis was defined as bedwetting during sleep occurring at least twice per week for at least three months. Variables included demographic characteristics, wet-night frequency, daytime urinary symptoms, bedtime, and evening fluid intake, ease of arousal, snoring, family history, and recent stress. Data were analysed using frequency distributions, percentages, mean ± standard deviation, median with interquartile range, and appropriate statistical tests. Results: The overall prevalence of nocturnal enuresis was 18.8% (78/416). Wet-night frequency among enuretic children ranged from 2 to 7 nights/week, with a mean of 3.56 ± 1.46 and median of 3.0 (IQR: 2–4). Primary enuresis was present in 64 children (82.1%), while secondary enuresis was present in 14 children (17.9%). Monosymptomatic nocturnal enuresis accounted for 48 cases (61.5%), and non-monosymptomatic nocturnal enuresis accounted for 30 cases (38.5%). Nocturnal enuresis was significantly associated with maternal education, daytime urgency, daytime frequency, daytime wetting, later bedtime, evening fluid intake after 6 pm, type of evening drink, and difficulty in arousal from sleep. Parental night waking was common among affected children and reflected a family management practice. Age group, sex, number of siblings, birth order, snoring, family history of bedwetting, and recent stress were not statistically significant. Conclusion: Nocturnal enuresis affected nearly one-fifth of rural school children aged 6–12 years. The condition was mainly primary and monosymptomatic, although a substantial subgroup had daytime urinary symptoms. Later bedtime, evening fluid intake, difficulty in arousal, and daytime urinary symptoms were important associated factors, supporting the need for early identification and structured, non-stigmatizing counselling.

Background: Laparoscopic cholecystectomy is now a procedure of choice for cholelithiasis and chronic cholecystitis. Laparoscopic procedures are being done under general anaesthesia with muscle relaxants and controlled ventilation. Postoperative nausea and vomiting (PONV) is a common and a distressing complication after surgery. PONV may be mild or transient, but its impact on patients can be much more severe, it can cause inability to mobilize after surgery, restricted oral intake, complications of protracted vomiting and delayed recovery and discharge after surgery. Methods: Sixty patients, of either sex, ASA physical status I or II, undergoing elective laparoscopic cholecystectomy, were randomly allocated into two groups containing thirty patients each. Group A received intravenous inj. Amisulpride 5 mg i.v. over 1-2 minutes before induction of anaesthesia. Group O received intravenous inj. Ondansetron 4 mg i.v. over 1-2 minutes before induction of anaesthesia. Results: In Group A, total 4 patients had nausea and/or vomiting, while other 26 patients were asymptomatic, while in Group O, total 13 patients had nausea and/or vomiting, while 17 other patients were asymptomatic. Conclusion: Amisulpride can be considered as a safe and a promising alternate option for PONV in place of Ondansetron.

Background: Neostigmine, the conventional agent for neuromuscular blockade reversal, acts indirectly by inhibiting acetylcholinesterase and is associated with unpredictable recovery times and muscarinic side effects. Sugammadex, a modified γ-cyclodextrin, reverses steroidal neuromuscular blocking agents by direct encapsulation, offering the potential for rapid and predictable reversal. While prior studies demonstrated its efficacy in deep blockade, evidence comparing both agents in moderate blockade under inhalational anaesthesia was limited.  Methods: One hundred twenty patients, of either sex, ASA physical status I or II, undergoing elective Laparoscopic cholecystectomy under general anaesthesia, were randomly allocated into two groups containing sixty patients each. Group A received Sugammadex for Reversal of muscle relaxant and Group B received Neostigmine/Glycopyrrolate for Reversal of Muscle Relaxant. Results: Sugammadex achieved TOF ≥ 0.9 significantly faster than Neostigmine (89 second versus 399 second, P < 0.0001). 98% of patients receiving Sugammadex recovered within 2 minutes showing greater predictability, while with neostigmine some patients required more than 7 minutes to recover. Conclusion: Sugammadex provides markedly faster, more predictable, and reliable reversal of moderate rocuronium-induced neuromuscular blockade compared with neostigmine during sevoflurane anaesthesia, with a comparable safety profile.

Background and Aims: Emergency laparotomy carries a significantly higher risk of morbidity and mortality compared to elective gastrointestinal surgery. Preoperative risk stratification is essential for identifying high-risk patients and guiding perioperative management. This study aimed to determine and compare the accuracy of the Portsmouth-POSSUM (P-POSSUM) score and the National Emergency Laparotomy Audit (NELA) score in predicting 30-day and 60-day postoperative mortality in patients undergoing emergency laparotomy at a tertiary care centre in Eastern India. Methods: This retrospective cohort study included 116 consecutive patients who underwent emergency laparotomy at KPC Medical College and Hospital, Kolkata, from January 2021 to March 2023. Demographic variables, laboratory parameters, and operative details were retrieved from medical records. P-POSSUM and NELA scores were calculated using electronic risk calculators. Mortality at postoperative day 30 and 60 was the primary outcome. Statistical analysis was performed using SPSS version 19.0; an independent samples t-test was used for group comparison. Discriminatory accuracy was assessed using receiver operating characteristic (ROC) curve analysis and comparison of area under the curve (AUC) values. Results: Among 116 patients, the 30-day mortality rate was 8.6% (n = 10) and the 60-day mortality rate was 13.8% (n = 16). ROC curve analysis revealed that the AUC for the NELA score was significantly superior to that of the P-POSSUM score for both 30-day mortality [AUC 0.873 (95% CI 0.799–0.948) vs. 0.533 (95% CI 0.361–0.726), p < 0.001] and 60-day mortality. Conclusion: The P-POSSUM score demonstrated significantly greater discriminatory accuracy in predicting both early and late postoperative mortality following emergency laparotomy compared to the NELA score in this Eastern Indian cohort. The authors recommend adoption of the P-POSSUM score as the preferred risk stratification tool for patients undergoing emergency laparotomy.

Background: Tuberculosis is a preventable and curable disease. In 2022, TB was the world’s second leading cause of death from a single infectious agent. Isoniazid is the first line medicine for the treatment of active tuberculosis and latent TB infection, with high bactericidal activity. Resistance to isoniazid reduces the effectiveness of TB treatment and increases the risk of acquiring resistance to other first line drugs. This leads to increase risk of multidrug resistant TB. Aim and objectives: The objective is to study clinical profile and treatment outcome in isoniazid mono resistant pulmonary TB under programmatic conditions. Materials and Methods: This study is a prospective, observational and longitudinal single center study performed at the tertiary health care center in South Gujarat (DRTB NODAL Center). Diagnosed isoniazid (mono- H) resistant pulmonary tuberculosis patients during study period were enrolled and followed up during study to record demographic data, clinical characteristics and treatment outcomes. Results: In our study, 30 patients of isoniazid mono resistance pulmonary TB were enrolled. The mean age of patients was 36.7 years. Two-third of the patients were male (70%). 63.3% of patients were underweight (BMI < 18.5 kg/m²). All patients presented with symptoms of cough, fever and anorexia. Primary H mono resistant was detected in 83.3% patients. Most common INH mutation detected on FL-LPA was in the Kat G gene in 60% patients followed by InhA gene in 36.7% patients and one patient had both gene mutation. The most common ADRs observed were gastritis and GIT symptoms (43.3%). In our study favorable outcomes with treatment regimen as per national program guidelines was observed in 28 (93.34%) patients. Unfavorable outcome was observed in form of treatment failure in 1 patient and death in 1 patient. Conclusion: Most of isoniazid mono resistant TB patients present with primary resistance to isoniazid. Patients who have microbiologically confirmed TB with rifampicin sensitive need to be checked for FL-LPA for isoniazid sensitivity. The availability of rapid diagnostic test and treatment regimen under national program is effective for diagnosis and management of H mono resistant TB.

Background: Pertrochanteric fractures in elderly patients are associated with significant morbidity, mortality, and functional impairment. Bipolar hemiarthroplasty has emerged as an effective treatment option for unstable fractures in osteoporotic patients. However, evidence comparing metaphyseal and diaphyseal fit stems remains limited. Aim: To compare the functional outcomes of metaphyseal and diaphyseal fit bipolar hemiarthroplasty in elderly patients with pertrochanteric fractures. Methods: This prospective observational cohort study included 54 elderly patients with unstable pertrochanteric fractures treated with bipolar hemiarthroplasty. Patients were divided equally into diaphyseal stem and metaphyseal stem groups. Functional outcomes were assessed using Harris Hip Score (HHS) and Visual Analogue Scale (VAS) at multiple postoperative intervals. Operative time, blood loss, mobilization, and full weight-bearing status were also evaluated. Results: The mean age of participants was 72.91 ± 9.35 years, with females constituting 61.1% of cases. Diaphyseal stem fixation demonstrated significantly higher HHS at 2 weeks, 6 weeks, 3 months, and 6 months compared to metaphyseal stems (p<0.001). Mean operative time and blood loss were significantly higher in the diaphyseal group (162.00 ± 51.59 minutes and 663.70 ± 280.40 mL respectively) compared to the metaphyseal group (114.67 ± 18.79 minutes and 411.48 ± 132.74 mL respectively). However, patients in the diaphyseal group achieved earlier full weight bearing. Conclusion: Diaphyseal fit bipolar hemiarthroplasty demonstrated superior functional outcomes and earlier mobilization compared to metaphyseal fit stems despite increased operative time and blood loss. Diaphyseal fixation may therefore be preferred in elderly patients with unstable pertrochanteric fractures.

Aim: The aim of this paper is to describe how nociceptive pathways in the peripheral nervous system, thalamus, and cortical areas respond to NSAIDs and opioids, with emphasis on the biological basis of analgesia and the clinical implications of central and peripheral modulation of pain transmission. Materials and Methods: This paper was prepared as a narrative review of published literature on nociception, pain transmission, thalamic relay function, cortical pain processing, and the pharmacology of NSAIDs and opioids. Sources describing peripheral transduction, ascending spinothalamic signaling, thalamocortical integration, and descending inhibitory pathways were synthesized to build a structured account of drug effects across the pain axis. Result: The literature shows that NSAIDs reduce pain mainly by blocking cyclooxygenase-mediated prostaglandin synthesis in inflamed tissue and also by lowering central prostaglandin signaling, thereby reducing peripheral sensitization and central amplification of nociceptive input. Opioids act through μ, δ, and κ receptors to inhibit neurotransmitter release, hyperpolarize nociceptive neurons, and strengthen descending inhibitory control at spinal and supraspinal levels, including thalamic and cortical circuits. Conclusion: Nociception is not a single linear pathway but a distributed network involving peripheral receptors, spinal relays, thalamic integration, and cortical perception, all of which can be modified by analgesic drugs. NSAIDs are most effective where inflammation drives prostaglandin-dependent sensitization, whereas opioids exert broader central inhibition but carry greater risks of tolerance, dependence, and adverse effects.

Aim: Dexmedetomidine and clonidine are alpha-2 adrenergic agonists frequently used as adjuvants to local anaesthetics in brachial plexus block because they may shorten onset time, improve block quality, and prolong postoperative analgesia. The clinical question addressed in this review is whether dexmedetomidine provides superior efficacy to clonidine when used in axillary brachial plexus block, while maintaining acceptable haemodynamic and safety outcomes. Materials and Methods: A structured clinical evidence synthesis was undertaken using indexed comparative literature on dexmedetomidine versus clonidine as perineural adjuvants in brachial plexus block. Core evidence was drawn from a 2022 meta-analysis of 24 randomized controlled trials 2017 systematic review and meta-analysis of 14 randomized controlled trials. Both reviews compared dexmedetomidine and clonidine as adjuvants to local anaesthetics for upper-limb surgery and analyzed sensory block duration, motor block duration, analgesia duration, onset characteristics, and adverse events. Result: Across comparative brachial plexus block evidence, dexmedetomidine consistently outperformed clonidine on efficacy endpoints. In the 2022 meta-analysis, dexmedetomidine significantly prolonged sensory block duration by a mean difference of 173.31 minutes, motor block duration by 158.35 minutes, and duration of analgesia by 203.92 minutes compared with clonidine. Dexmedetomidine also hastened onset of sensory block by 1.58 minutes and motor block by 1.46 minutes, and improved the likelihood of higher-grade block quality. The 2017 meta-analysis similarly found that dexmedetomidine increased sensory, motor, and analgesic duration by an estimated ratio of means of about 1.2 each, while also accelerating onset. The 2017 review signaled increased transient bradycardia and postoperative sedation with dexmedetomidine, whereas the 2022 review found no statistically significant difference in hypotension. Conclusion: The best available evidence suggests that dexmedetomidine is clinically more effective than clonidine as a perineural adjunct in brachial plexus block, with longer sensory and motor blockade, longer postoperative analgesia, and somewhat faster onset.

Aims: To compare the fetomaternal outcomes in gestational thrombocytopenia with thrombocytopenia due to hypertensive disorders of pregnancy. Objectives: The objectives of the study were to evaluate fetomaternal outcomes in gestational thrombocytopenia, to assess fetomaternal outcomes in thrombocytopenia associated with hypertensive disorders of pregnancy, and to compare the fetomaternal outcomes between gestational thrombocytopenia and thrombocytopenia secondary to hypertensive disorders of pregnancy. Materials and Methods: This observational study was conducted in the Department of Obstetrics and Gynaecology at Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, over a period of 18 months. A total of 304 antenatal women beyond 20 weeks of gestation with persistent thrombocytopenia (<1.5 lakh/mm³) were enrolled. Patients were divided into Group A comprising 152 women with thrombocytopenia associated with hypertensive disorders of pregnancy and Group B comprising 152 women with gestational thrombocytopenia. Detailed history, clinical examination, complete blood count, coagulation profile, liver and renal function tests, and obstetric ultrasonography were performed. Maternal and fetal outcomes were assessed until discharge. Statistical analysis was performed using SPSS version 17.0, and p value <0.05 was considered statistically significant. Results: Majority of patients in both groups belonged to the 21–30 years age group and presented at term gestation. Moderate thrombocytopenia was the most common presentation in both groups. Deranged liver enzymes, elevated bilirubin, renal dysfunction, coagulation abnormalities, postpartum hemorrhage, and platelet transfusion requirements were significantly more common in Group A compared to Group B. Vaginal delivery was the most common mode of delivery in both groups, although cesarean section rates were higher in hypertensive thrombocytopenia. Neonatal complications including NICU admission, neonatal demise, and neonatal thrombocytopenia were also more frequent in Group A. Conclusion: Gestational thrombocytopenia is generally a benign condition with favorable maternal and fetal outcomes and spontaneous postpartum recovery. In contrast, thrombocytopenia associated with hypertensive disorders of pregnancy is associated with increased maternal complications such as postpartum hemorrhage, coagulation abnormalities, liver and renal dysfunction, along with poorer neonatal outcomes. Early diagnosis, close monitoring, and multidisciplinary management are essential to improve fetomaternal outcomes in thrombocytopenic pregnancies.

Background: Anatomical Variations of Renal Arteries and Their Surgical Significance in Laparoscopic Procedures deals with a clinically relevant diagnostic and anatomical problem in the routine practice of tertiary care. The objective of this study was to document renal artery variations and explain their significance for laparoscopic donor nephrectomy, pyeloplasty and renal hilar surgery. Method: The study design was a cross sectional observational study using CT angiographic and cadaveric approach in the Department of Anatomy, Radiology and Surgery of a tertiary care centre. A total of 150 renal units of 75 adults were included in the study, which was performed using multidetector CT angiography and additional cadaveric observations. The participants/specimens were divided into single renal artery, accessory renal artery and early branching patterns. Standardized data collection, laboratory/ radiological/ anatomical assessment and predefined operational criteria were used. Results: A single renal artery was found in 72.0% of renal units, accessory renal arteries in 21.3% and early branching in 18.7%. The left side had more accessory arteries (25.3%) than the right side (17.3%), but this difference was not significant (p=0.228). Inferior polar arteries were found in 9.3% and were deemed to be surgically significant in the lower pole. Conclusion: Variations in the renal arteries were frequent and significant. Vascular mapping is crucial prior to laparoscopic renal surgery to minimize vascular injury and ischemic complications.

Background: End-stage kidney disease is increasing worldwide, primarily in the developing countries. It is affecting mainly the productive age group. We therefore sought to describe the clinical and epidemiological characteristics of hemodialysis patients. Aims and Objective: To identify the socio-demographic characteristics, comorbidities and clinical profile of patients treated with hemodialysis. Material and Methods: This was a descriptive, cross-sectional study conducted among 40CKD patients undergoing hemodialysis at I.Q City medical college and Hospital, Durgapur, West Bengal. The study was based on the patients’ attending Hemodialysis Unit in between April 2025 to March 2026. The ethical clearance for the research was taken. 40 patients were retrieved and data was collected according to Performa. Socio demographic profiles including age, sex and clinical data including etiology, duration of CKD, duration of hemodialysis and laboratory parameters including hemogram and renal function test were recorded. Patients more than 20 years and above and receiving hemodialysis more than six months included in the study. Results: Among all 40 patients, range age is 24 to 66 years with mean (SD) 45.46(±12.32) years. Almost half of the patients 20(50%) belongs to the middle age group (36-56) years followed by 10(25%) comprises as senior citizens (60 and above) years. Twenty-six (65%) are male and 14(35%) patients are female. Similarly, 27(67.5%) are married and majority 32(80%) belongs to Hindu community. 33(82.5%) were as nuclear family. Regarding education level, eighteen (45%) were illiterate and only 3(7.5%) had University level education and 36(90%) were dependent on their family after starting the treatment. Conclusion: Hypertension and diabetes were the leading cause of End stage renal disease in most of the patients. Early diagnosis, treatment and proper follow up of the risk factors will be the key to prevent progression of chronic kidney disease into the end stage requiring hemodialysis or Renal Transplant.