Muhammad Taher Ahmad

Objectives: Chronic kidney disease (CKD) is characterized by a prolonged decline in kidney function, defined by an estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m² for over 3 months. Persistent, low-grade systemic inflammation is critical to CKD progression and associated with higher mortality. This study aims to evaluate the role of Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte ratio (PLR) as hematological inflammatory biomarkers across different stages of CKD to observe their trends in relation to proteinuria and assess CKD severity. Materials and Methods: This cross-sectional study was conducted at a Tertiary Care Hospital, with 188 patients who presented with CKD, between May 2024 and September 2024. Laboratory data included absolute neutrophil count, absolute lymphocyte count, absolute platelet count, urinary protein, urinary creatinine, urinary protein-creatinine ratio (PCR), serum creatinine and eGFR. Results: Among the studied patients, male were 60%, and female were 40%, mean age of 40.1 and a range of 14-30 years. The distribution of CKD stages among the patients was as follows: 36.7% in stage 1, 16% in stage 2, 14.9% in stage 3A, 9% in stage 3B, 10.1% in stage 4 and 13.3% in stage 5. Both PLR and NLR correlated positively with proteinuria, with NLR emerging as a stronger predictor of inflammation than PLR, with data showing a stage-wise increase in NLR values, particularly higher in patients in advanced CKD stages. Conclusion: NLR and PLR can be used as biomarkers for assessing inflammation and monitoring CKD severity. These biomarkers demonstrate a stage-wise increase across different CKD stages in various patients, with higher values observed in advanced stages, thus helping identify those at risk.

In this essay, the authors analyze the COVID-19 pandemic from the perspective of inequalities and socio-economic vulnerabilities. We argue that the current pandemic has been looked at mainly through the lens of biology, leaving sociological blind spots in the response to this pandemic that have had adverse effects. We conclude with the suggestion that apart from recommendations from health sciences, policy makers must also take into account local societal structures in order to design effective policies to control the contagion.