Cases Of Chronic Renal Disease Research Articles

Frequency of New Onset Atrial Fibrillation in Patients Presenting with ST-Segment Elevation Myocardial Infarction

Aim: To study the magnitude of atrial fibrillation in patients with ST segment elevation myocardial infarction. Study Design: Prospective analytic cross-sectional study. Place and duration of study: Department of Cardiology of a Tertiary Cardiac Care Center of Pakistan from 1st June 2022 to 30th November 2022. Methodology: Two hundred and thirty-six patients were selected through non-probability, consecutive sampling technique. Patients were divided into Group 1 who did not develop AF while group 2 included the new cases of AF during in-hospital stay for STEMI. All patients underwent clinical examinations, echocardiography, angiography and percutaneous coronary intervention. Results: Forty five cases with an average age of 71±14 years developed atrial fibrillation. Female population 25(60%) was at higher risk than male 17(40%). In AF group, 22(53.3%) cases of dyslipidemia, 11(26.1%) cases of chronic renal disease, 4(8.8%) cases of prior myocardial infarction, 14(33.3%) cases of diabetes and a single case (2.2%) of implantable cardiac-defibrillator were observed when compared with the non-AF group. Practical Implication: In-hospital complications are also highly associated with AF which may result in high Incidents of mortality. Conclusion: Aging, comorbidities and inferior wall MI are the independent predictors of AF. In-hospital complications are associated with AF which may result in high incidents of mortality. Early diagnosis of STEMI patients with a high risk of developing AF is necessary to reduce the morbidity and mortality. Keywords: Atrial fibrillation, ST-segment elevation, Myocardial infarction

JIM Reading List.

JIM Reading List.

Estimating the obstetric co-morbidity burden using administrative data: The impact of the pregnancy-related assessment window.

Despite increased research using large administrative databases to identify determinants of maternal morbidity and mortality, the extent to which these databases capture obstetric co-morbidities is unknown. To evaluate the impact that the time window used to assess obstetric co-morbidities has on the completeness of ascertainment of those co-morbidities. We conducted a five-year analysis of inpatient hospitalisations of pregnant women from 2010-2014 using the Nationwide Readmissions Database. For each woman, using discharge diagnoses, we identified 24 conditions used to create the Obstetric Comorbidity Index. Using various assessment windows for capturing obstetric co-morbidities, including the delivery hospitalisation only and all weekly windows from 7 to 280days, we calculated the frequency and rate of each co-morbidity and the degree of underascertainment of the co-morbidity. Under each scenario, and for each co-morbidity, we also calculated the all-cause, 30-day readmission rate. There were over 3 million delivery hospitalisations from 2010 to 2014 included in this analysis. Compared with a full 280-day window, assessment of obstetric co-morbidities using only diagnoses made during the delivery hospitalisation would result in failing to identify over 35% of cases of chronic renal disease, 28.5% cases in which alcohol abuse was documented during pregnancy, and 23.1% of women with pulmonary hypertension. For seven other co-morbidities, at least 1 in 20 women with that condition would have been missed with exclusive reliance on the delivery hospitalisation for co-morbidity diagnoses. Not only would reliance on delivery hospitalisations have resulted in missed cases of co-morbidities, but for many conditions, estimates of readmission rates for women with obstetric co-morbidities would have been underestimated. An increasing proportion of maternal and child health research is based on large administrative databases. This study provides data that facilitate the assessment of the degree to which important obstetric co-morbidities may be underascertained when using these databases.

TREATMENT OF HYPERTENSIVE PATIENTS WITH HIGH OR VERY HIGH CARDIOVASCULAR RISK. PHARMACOECONOMIC EFFICIENCY OF A TRIPLE COMBINATION THERAPY CONTAINING ANGIOTENSIN CONVERTING ENZYME INHIBITOR, CALCIUM CHANNEL BLOCKER AND STATIN

Arterial hypertension (AH) is one of the most common cardiovascular diseases and a frequent cause of cardiovascular complications and early disability. In Russia, AH of varying severity may affect about 30% of the population. [1] Hypertension is the causal factor for 27% of cardiovascular events in women and 37% in men. [2] AH accounts for about 14% of myocardial infarctions in men and 30% in women [3], 35% of ischemic strokes, 39% of chronic heart failures in men and 59% in women, and 56% of cases of chronic renal disease. [4–6]

Hypoglycemic therapy in patients on hemodialysis and peritoneal dialysis

Diabetes mellitus (DM) is a leading cause of renal insufficiency in developed countries. Most cases of chronic renal disease in DM patients are dueto diabetic nephropathy. The impairment of renal function at later stages of diabetic nephropathy is accompanied by complicated changes in the regulationof carbohydrate metabolism most of which require hypoglycemic therapy to be corrected

Chronic Renal Disease in Kuwaiti Nationals: A Prospective Study During the Past 4 Years

Our study is a prospective one conducted at Al-Amiri Hospital and including all new cases of chronic renal disease (CRD) seen at the capital area of Kuwait between 1 January 1999 and 30 December 2003. Diagnosis of CRD was based on clinical, laboratory, and radiological features. Kidney biopsies were done when indicated. A total of 271 cases of chronic renal failure (CRF) were diagnosed, of whom 143 were women. The median age was 40 years (range, 5 to 80 years; mean ± SD: 40 ± 14). The most common cause of CRF was glomerulonephritis (32%), of which systemic lupus erythematosis and vasculitis constituted 5% and 4%, respectively. Diabetic glomerulosclerosis was the second leading cause of CRD (24%), followed by tubulointerstitial disease (11%) and nephroangiosclerosis (10%). Less frequent causes included renovascular/ischemic disease (6%), obstructive nephropathy (3%), and adult polycystic kidney disease (3%). One hundred and seven patients had 121 incidents of acute deterioration of underlying renal disease. This was mostly due to drugs (22%), infection (21%), and volume depletion (13%). Antiinflammatory drugs were the most common drugs (63%) responsible for the acute decline in renal function. By the end of the study, 18 (7%) patients died, 55 (20%) required maintenance dialysis, and 40 (15%) had received a kidney allograft. Diabetic patients did not differ from nondiabetic with regard mortality, although had more renal replacement therapy (p = .002). Using the Cox regression model, analysis of the relative risk factors likely to contribute to mortality, viz. age, gender, original kidney disease, fitness for transplantation, and mode of presentation, did not show significant factors except for less hazard to death in those diagnosed early with CRD (i.e., on routine testing; relative risk 0.06, p = .01). In conclusion, our study indicates that early diagnosis and management of CRD can improve the patient's quality of life and decrease the cost of frequent hospitalization, morbidity, and even mortality associated with end-stage renal disease.

Factors associated with chronic renal failure in HIV-infected ambulatory patients

Renal disease is an increasingly common manifestation among HIV-positive persons, particularly during late stages of HIV disease. We performed a cohort-based, nested case-control study to examine the role of several factors in developing HIV-related chronic renal disease, including HIV viral load and CD4+ cell count. Incident cases of chronic renal disease were identified from a cohort of 6361 prospectively followed HIV-1 positive persons. Controls were selected using incidence density sampling and matched 4:1 on age, race/ethnicity, and gender. Odds ratios (OR) and 95% confidence intervals (CI) were obtained using conditional logistic regression. One hundred and eight cases of chronic renal disease were identified; 80 (74.1%) were eligible for the current analysis. Nadir CD4+ cell count < 200 x 10(6) cells/l (OR = 4.3; 95% CI, 2.1-8.7), highly active antiretroviral therapy (HAART) use for 56 days or more (OR = 0.5; 95% CI, 0.3-1.0), and hypertension [treated with angiotensin-converting enzyme (ACE) inhibitors: OR = 4.6; 95% CI, 1.8-11.6; treated with non-ACE inhibitors: OR = 2.5; 95% CI, 1.0-6.2; not treated: OR = 4.2; 95% CI, 0.8-21.6] were associated with disease. HAART use for 56 days or more modified the associations for nadir CD4+ cell count and hypertension. Our findings suggest that advanced HIV-disease, as indicated by low CD4+ cell count, is associated with subsequently developing chronic renal disease and treatment with HAART may reduce the risk of developing chronic renal disease.

Progression of chronic renal disease in the dog.

Progressive loss of nephron function may be caused by persistence of factors that initiated renal disease. However, newer studies suggest that nephron damage is self-perpetuating once renal mass is reduced to some critical level. Original theories on mechanisms of self-perpetuated nephron injury focused on intraglomerular hypertension and glomerular hypertrophy, but several other factors have now been incriminated, including tubulointerstitial responses, proteinuria, and oxidative stress. Studies of dogs with surgically reduced renal mass (remnant kidney model of chronic renal disease) have allowed investigation of the self-progression theory in this species. Use of this model eliminates pre-existing renal disease as a confounding factor. Data from these studies indicate that self-perpetuated renal injury is initiated when mild azotemia is induced (plasma creatinine concentration = 2 to 4 mg/dL). Thus, with naturally occurring renal disease(s), it is likely that self-perpetuated nephron damage is occurring before or at the time when most cases of chronic renal disease are diagnosed. In dogs with remnant kidneys, loss of renal function often occurs at a linear rate over time, but non-linear patterns are common as well. The reciprocal of plasma creatinine concentration, which has been used to monitor rate of progression, is only a fair marker of renal function when compared to GFR. Thus, clinical results from creatinine measurements on cases of naturally occurring disease should not be interpreted too stringently. In remnant kidney dogs, the magnitude of proteinuria (UPC ratio) was not predictive of the rate in decline of GFR, casting doubt on importance of proteinuria in causing progression of renal disease. However, progressive increases in UPC may be a marker of an accelerated rate of renal injury. Self-perpetuation of renal injury in dogs could be the sole mechanism by which naturally occurring renal diseases progress. When more information is available on the rate of progression of naturally occurring diseases, it may become apparent whether factors initially inciting renal damage have an additive effect on rate of progression.

Prevalence of antibodies specific to Puumala virus among farmers in Sweden.

The Puumala virus is the causative agent of nephropathia epidemica, a European form of hemorrhagic fever with a renal syndrome. From its reservoir in bank voles, the virus is spread by airborne transmission to humans. Occupational risks for the acquisition of nephropathia epidemica are not well defined. The prevalence of serum antibodies to Puumala virus was determined for Swedish farmers. From a comparison of the prevalence among farmers from various parts of the country, the assumption that Puumala virus occurs endemically only in the northern and central parts of Sweden was also tested. Serum samples from 910 farmers and 663 referents living in various rural parts of Sweden were tested with an enzyme-linked immunosorbent assay, using a recombinant nucleocapsid protein of Puumala virus as the antigen. North of a latitude of 59 degrees N, the prevalence of Puumala virus antibodies was significantly higher among farmers (12.9%) than among referents (6.8%). In the southern areas, antibodies to Puumala virus were rare, and altogether only 2 of 459 persons had antibodies. Seropositive persons did not differ from seronegative ones with regard to blood pressure, and they did not comprise cases of chronic renal disease. Serological evidence confirmed that the exposure of humans to Puumala virus is firmly restricted to the northern and central parts of Sweden. In addition the evidence indicated that, in this region, farming is associated with an increased risk of contracting hantavirus infection.

Roentgenographic manifestations of pulmonary calcifications. A rare cause of respiratory failure in chronic renal disease.

Two cases of chronic renal disease with massive pulmonary calcification leading to respiratory failure and death are presented. In both cases, chest roentgenograms showed relatively stable pulmonary infiltrates in the clinical presence of fever, dyspnea, and arterial hypoxemia. Primary clinical and radiographic considerations in these patients were pulmonary infection and pulmonary edema. In one patient, in retrospect, the infiltrates were definitely calcified on the chest roentgenograms. Since pulmonary calcification is potentially reversible by parathyroidectomy or proper dialysis, it is imperative that radiologists recognize or suggest this diagnosis when confronted with unchanging pulmonary infiltrates in a patient with chronic renal disease.

THE CONGENITAL FACTOR IN CHRONIC RENAL DISEASE

The purpose of this report is to record briefly the clinical notes and pathologic findings in three uncommon cases of chronic renal disease occurring in comparatively young persons, associated with a marked degree of nitrogen retention and running a rapidly fatal course. In addition, because of the absence of a definite etiologic factor, together with an unusual appearance of the kidneys at necropsy, the importance of a congenital basis is emphasized, as an etiologic factor in these and similar cases. REPORT OF CASES Case 1.1 —J. M., a white man, aged 37, a policeman for the last fifteen years, who was admitted to the Jefferson Hospital in the service of Dr. H. A. Hare, April 12, 1921, complained of shortness of breath. His family history was negative. He had had typhoid fever at 13, gonorrhea at 22 and influenza at 33, from all of which he had apparently made

A Clinical Lecture ON TWO CASES OF CHRONIC RENAL DISEASE: A Contrast in Treatment and Prognosis

A Clinical Lecture ON TWO CASES OF CHRONIC RENAL DISEASE: A Contrast in Treatment and Prognosis