Form Of Hemodialysis Research Articles

Korelasi Efikasi Diri dengan Tingkat Intradialitic Weight Gain (IDWG) Pada Pasien Gagal Ginjal Kronik

Background: Kidney failure in carrying out its functions at the terminal stage requires treatment in the form of hemodialysis. In hemodialysis patients, adhering to fluid intake restrictions has a very vital role to prevent further complications. The success of fluid and diet management in therapy is measured by the level of Interdialytic Weight Gain (IDWG). One of the things that affects IDWG during the hemodialysis therapy period is self-efficacy. Purpose: To determine the relationship of self-efficacy with the level of Interdialytic Weight Gain (IDWG) of chronic kidney disease patients in the hemodialysis unit of RAA Soewondo Pati Hospital. Methods: This study is a correlational analytical study, with a cross-sectional research design, a sampling method using consecutive sampling, with a total sample of 68 respondents and data collection using questionnaires. Results: The results of this study found that respondents with high category self-efficacy and IDWG levels in the mild category were 38 respondents (50.5%), the results of the analysis with the spearman rank correlation test obtained p value = 0.000< α (0.05) which can be concluded to be a relationship between self- efficacy and the interdialytic weight gain (IDWG) level of chronic kidney disease patients in the hemodialysis unit of RAA Soewondo Pati Hospital. Conclusion: There was a significant relationship between self-efficacy and interdialytic weight gain (IDWG) levels of chronic kidney disease patients in the hemodialysis unit of RAA Soewondo Pati Hospital.

Case Report: 18 Year Old Male Patient with Lupus Nephritis

Systemic lupus erythematosus is a chronic autoimmune disease that can affect various organs of the body, one of the most commonly affected complications is the kidneys and results in lupus nephritis, the percentage of disease occurrence is more than 50% of patients in the first 5 years. Male patients tend to have more aggressive disease with renal, vascular, and cardiac involvement. Based on the criteria of Systemic Lupus International Collaborating Clinics in 2012 defines lupus nephritis if there is proteinuria in 24 hours ≥ 0.5 g / day, there is urine sediment, and there is a decrease in renal filtration function. Although the disease can be diagnosed based on these three things kidney biopsy remains the gold standard of diagnosis. In this case report, an 18-year-old male with lupus history came to the emergency room with the main complaint of fever accompanied by shortness of breath, from the results of supporting examinations obtained anemia, thrombocytopenia, high creatinine, and eGFR of 4 mL/minute, complete urine showed proteinuria, cylinders, and erythrocytes, AP thorax photos showed cardiomegaly, bronchopneumonia, and bilateral pleural effusions. Based on history, physical examination, lab, and imaging, the patient was diagnosed with systemic lupus erythematosus, lupus nephritis, chronic kidney disease, normocytic normochromic anemia, and community acquired pneumonia. The patient received glucocorticoids, immunosuppressants, diuretic, antihypertensives, antibiotics, and other supportive therapy, The patient also received renal replacement therapy in the form of hemodialysis and a kidney biopsy will be done after the condition improves

INCIDENCE OF ACUTE KIDNEY INJURY IN PATIENTS OF ACUTE GASTROENTERITIS ADMITTED AT LADY READING HOSPITAL, PESHAWAR

Acute gastroenteritis affects all age groups alike, is a common cause of hospitalization worldwide, and is the most common known cause of preventable acute kidney injury. AKI may be defined as a sudden decrease in kidney function, which results in reduced filtration capability of the kidneys, accumulation of waste products, and their resultant clinical manifestations. The level of insult may range from mild to severe, requiring simple oral rehydration most times, while in a few cases needing intervention in the form of hemodialysis. The elderly population is more prone to develop AKI due to age-related deterioration in renal function. An overall positive outcome has been associated with early hemodialysis in progressively deteriorating AKI and critically ill patients. A prospective observational study was conducted on 40 patients with AKI secondary to acute gastroenteritis admitted to MTI, Lady Reading Hospital, Peshawar, KP, Pakistan, from February 2023 to June 2023. These patients were selected from 142 patients with acute gastroenteritis admitted to MTI, Lady Reading Hospital, Peshawar. Data collected was analyzed using SPSS 20. This study was conducted on 40 patients with a mean age of 39.82±16.54 years. Gender: Our study included 22 (55%) male and 18 (45%) female patients. We observed that 11 (27.5%) patients on dialysis had developed AKI secondary to AGE. We observed that older patients above 40 years of age who developed AKI secondary to AGE had a significantly higher frequency of hemodialysis (47.1%) as compared to patients less than 40 years of age (13%) (P = 0.01). According to the comparison of mortality with age groups, no mortality was seen in the age group of < = 40 years; however, there were 2 mortalities in the age group of > 40 years. One patient expired after 2 sessions, and one expired after 5 sessions and a prolonged stay. Our results showed a significant association between favorable outcomes and dialysis sessions for the less than 40 age group (P = 0.0001) and the more than 40 age group (P = 0.004). Although the overall outcome with dialysis was favorable, with good recovery, the age group of 40 years and above showed significantly higher rates of hemodialysis requirement and more morbidity and mortality compared to the age group of 40 years and less. 40(28.2%) patients with Acute gastroenteritis developed Acute kidney injury. Among these patients, 11 (27.5%) required hemodialysis. This concluded that 29 patients (72.5%) were treated conservatively and discharged with full recovery of renal function. 72.7% requiring hemodialysis were above 40 years of age, proving that the incidence of AKI and its severity increased.

Biochemical and Sociodemographic Correlates of Major Depressive Disorder in Patients With Chronic Kidney Disease Receiving Hemodialysis.

Introduction Chronic kidney disease (CKD) is a chronic disabling illness with multiple physical and psychosocial consequences. A major treatment modality for CKD is renal replacement therapy in the form of hemodialysis. A bidirectional relationship between depression and CKD is proposed, as depressive symptoms lead to poorer outcomes in CKD and vice versa. This study aimed to determine the prevalence of major depressive disorder (MDD) in CKD patients on maintenance hemodialysis and find any sociodemographic, clinical, or biochemical correlates. Material and methods This was a cross-sectional study conducted at a tertiary care teaching hospital in north India. We used clinical interviews for diagnosing MDD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The severity was quantified using Hamilton Depression Rating Scale (HAM-D) in those diagnosed with MDD. Results A total of 77 patients were included in the study. The prevalence of MDD in patients with CKD undergoing hemodialysis was 31.17%, much higher than in the general population. Most of those who were depressed had moderate to severe depression. Male gender and lower socioeconomic status were significantly associated with the diagnosis of MDD. Those undergoing dialysis less frequently or having more work days lost due to CKD were more likely to be depressed. Additionally, patients with MDD were found to have significantly lower blood hemoglobin levels, lower serum ionized calcium levels, and a lower urea reduction ratio compared to those who did not have MDD. Conclusion The high prevalence of MDD in patients with CKD undergoing hemodialysis suggests that clinicians should actively evaluate for depressive symptoms in this patient population and refer them to mental health services when required, especially those with the above-identified sociodemographic and biochemical risk factors.

СЕРИЯ КЛИНИЧЕСКИХ СЛУЧАЕВ ТЯЖЕЛОГО ТЕЧЕНИЯ ИНФЕКЦИИ COVID-19 У РЕЦИПИЕНТОВ ПОЧЕЧНЫХ ТРАНСПЛАНТАТОВ

Coronavirus infection has had a significant impact on people around the world, however, there is a category of patients who are at high risk of severe disease - kidney transplant recipients. The high risk is due to the presence of a pronounced comorbid background, long-term background immunosuppression, a high risk of secondary infection, and graft dysfunction as a result of a severe infection. This paper presents a series of clinical cases of severe COVID-19 infection in kidney transplant recipients. We have demonstrated that timely diagnosis and intensive therapy, including both adequate drug therapy and the use of renal replacement therapy in the form of hemodialysis and extracorporeal detoxification methods, can not only save the lives of such patients, but also preserve a functioning kidney transplant.

ANALISIS SURVIVAL PENDERITA GAGAL GINJAL DENGAN PENDEKATAN MULTIVARIATE ADAPTIVE REGRESSION SPLINE

Survival analysis is a statistical method where the outcome variable that is considered is the time until the occurrence of an event or called an event. Survival analysis in the medical world can be used to test the survival of patients suffering from a disease, one of which is kidney failure. Based on the results of the 2013 Basic Health Research, 0.2% of the total population of Indonesia, namely 499,800 people, experienced kidney failure. Kidney failure is a process of decreasing kidney function that requires renal replacement therapy, in the form of hemodialysis or kidney transplantation. If the survival data involve independent variables that are thought to affect the survival time, then the Cox Proportional Hazard (PH) regression approach can be developed which can be developed for the Multivariate Adaptive Regression Spline (MARS) approach. The MARS approach is a nonparametric regression approach with high-dimensional data, namely data with an independent variable of 3≤𝑝≤20 and a data sample of 50≤N≤1000. This study aims to describe the characteristics of patients with kidney failure, identify the factors that affect the survival time of patients with kidney failure and determine the MARS model. The MARS approach is obtained from a combination of functional basis, maximum interaction, and minimum observation by trial and error. Based on the model that has been formed using the MARS approach, it is found that the most influential variables on the survival time of patients with kidney failure are age, urea levels, and creatine levels.
 Key words: Renal failure, hemodialysis, survival analysis, nonparametric, MARS

CORRELATION BETWEEN THE PERCENTAGE OF HYPOCHROMIC ERYTHROCYTES AND FERRITINE LEVELS IN CHRONIC KIDNEY DISEASE PATIENTS UNDERGOING HEMODIALYSIS IN PKU BANTUL HOSPITAL

Abstrak: The incidence of CKD in the world is more than 500 million patients and up to 1.5 million patients need to undergo renal replacement therapy in the form of hemodialysis. Chronic kidney disease is inseparable from several complications, one of which is anemia. Confirmation of the diagnosis of anemia in CKD patients can be confirmed through various examinations such as the classic examination of serum ferritine levels, but ferritine is known to be involved in the inflammatory process that occurs in CKD. The aims of this study were to determine the relationship between the percentage of hypochromic erythrocytes and ferritine levels, to determine the average percentage of hypochromic erythrocytes and to determine the average ferritin level in CKD patients undergoing hemodiliasis at PKU Bantul Hospital. This study was conducted using a cross-sectional method involving 50 CKD patients at PKU Bantul Hospital. Blood samples were taken to check ferritine levels and hypochromic erythrocyte percentage. Data analysis was carried out with two types, univariate analysis and bivariate analysis which were carried out with the Spearman correlation test. Based on the results of univariate analysis, the median percentage of hypochromic erythrocytes of the research subjects was 0.95%. The median ferritine in research subjects was 105.5 ng/mL. based on the results of bivariate analysis, there was no significant relationship between the percentage of hypochromic erythrocytes and ferritine levels (p=0.130, r=-0.217). There was no significant relationship between the percentage of hypochromic erythrocytes and ferritine levels. Keywords: anemia; ferritine serum, chronic kidney disease, reticulocytes hemoglobin

Status gizi berdasarkan dialysis malnutrition score (DMS) dengan kualitas hidup pasien hemodialisis

Nutritional status based on the dialysis malnutrition score (DMS) with hemodialysis patients' quality of lifeBackground: Chronic kidney disease (CKD) is a disorder of the kidney organs characterized by abnormalities in the structure or function of the kidneys. Patients suffering from end-stage CKD require renal replacement therapy in the form of hemodialysis. However, hemodialysis on a routine basis can decrease nutritional status, which will result in malnutrition patients. Malnutrition is associated with morbidity and mortality rates, such as prolonged weakness, susceptibility to infectious diseases, and impaired wound healing that can affect the quality of life. Objective: This study aims to determine the correlation between nutritional status based on the Dialysis Malnutrition Score (DMS) with the quality of life of hemodialysis patients. Methods: The research design was cross-sectional with an observational research design. This research was conducted from 02 September 2019 until 11 September 2019 in the hemodialysis unit at RSUD Panembahan Senopati Bantul with 182 subjects of all chronic kidney disease patients undergoing hemodialysis from 2009 until April 2019. The researcher assessed nutritional status data based on the DMS. In addition, the quality of life was based on Kidney Disease Quality of Life (KDQoL) which researchers for elderly subjects assisted, and some parts filled directly by the subject. The statistical analysis used for this study was the Chi-square test. Results: Based on the Chi-square test, there is a correlation between nutritional status based on the DMS and the quality of life of hemodialysis patients (p-value=0.009). Most subjects had good nutritional status based on the DMS and had good quality on the KDQoL. Conclusions: There is a correlation between the risk of malnutrition based on the Dialysis Malnutrition Score (DMS) and hemodialysis patients' quality of life (KDQoL).

Pre Eclampsia: Its contribution to Pregnancy Related Acute Kidney Injury. A tertiary care nephrology unit experience

Preeclampsia, eclampsia and hemolysis, elevated liver enzymes and thrombocytopenia (HELLP) are among many other conditions of pregnancy related AKI (PR-AKI). Present study aims to report case series of patients with PR-AKI developing in association with preeclampsia, their course of illness and outcome.
 Patients and Methods: Subjects for the study reported here comprise a cohort of 227 women coming to this institution with diagnosis of preeclampsia and AKI. Results: From January 1990 to December 2014, there were 1,441 women with PR-AKI brought to this institution among these 227 (15.75%) fulfilled the criteria of preeclampsia. On presentation 93.4% were oligo-anuric, thrombocytopenia was found in 48%, deranged INR in 18.9% and raised liver enzymes in 33.5%. On arrival 22% were in sepsis, mechanical ventilator support required in 11%. Impaired Glasgow coma scale noticed in 22%. Intra uterine death of fetus was reported in 75%. Antepartum hemorrhage in 38% and post partum hemorrhage in 32%. Renal replacement therapy in form of hemodialysis was conducted in 94.7%. Complete recovery seen in 25%, partial recovery in 31%, CKD developed in 4.4%, ESRF in 27.3% and 12 % died during acute phase of illness. Sepsis, multi-organ failure and requirement of mechanical ventilatory support on arrival were significant predictors of mortality with p value <0.001.
 Conclusion: Preeclampsia and its progress to eclampsia can be a severe life-threatening condition especially when patients present with sepsis and multi organ failure. A significant number of women developed irreversible AKI and progessed to CKD.

Acute kidney injury with cardiorenal syndrome; experience from a tertiary care renal unit in Pakistan

Introduction: Acute kidney injury (AKI) is a commonly recognized clinical problem after many morbid conditions related to heart like congenital heart disease surgery, acute or chronic congestive heart failure, acute myocardial infarction, infective endocarditis or cardiomyopathies. Cardio-renal syndrome (CRS) includes a spectrum of disorders involving both the heart and kidneys simultaneously; here acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other. Objectives: To report here, case series of patients with AKI developing in association with CRS. We aim to report different causes of CRS and outcome of patients in this group of patients. Patients and Methods: Subjects for the study reported here comprised a cohort of 34 patients coming to this institution with AKI in association of CRS. AKI was defined according to KDIGO guidelines and CRS based on consensus conference of ADQI in 2012. Type 1or type2 CRS are included in the study. All patients had normal size kidneys on ultrasonography. Results: Thirty-four patients with AKI and CRS were brought to this institute from January 1990 to December 2014; this was contributing 1% to medical causes of total AKI. Among these 25 were males and 9 females; mean age of these patients was 54.06±14.106 years. Causes of CRS were acute myocardial infarction (ST elevated), congestive cardiac failure, infective endocarditis and dilated cardiomyopathy. More than two third of patients were either oliguric or anuric on presentation. Fluid replacement and/or inotropic support required in 79%. Renal replacement therapy in form of hemodialysis was conducted in 64.7% and intermittent peritoneal dialysis in one patient. Complete renal recovery was observed in 19 (56%) patients, while 12 (35%) died during acute phase of illness. CKD-V developed in one patient, 2 patients lost long term follow up, but became dialysis free and renal functions were in improving trends, they were labeled as partial recovery. Secondary insults like hypotension, aggressive diuresis, and volume loss from gastro-intestinal tract or infection were evaluated for any co-relation with outcome but statistically no significant difference was found. Conclusion: CRS can be severe life-threatening condition especially when patients present with circulatory collapse. Diuretics must be used cautiously in patients with congestive cardiac failure. Infective endocarditis with acute right heart failure can lead to CRS.

Atypical hemolytic uremic syndrome: a case report

BackgroundThrombotic microangiopathy is a pathological condition comprised of microvascular thrombosis involving any organ of the body leading to thrombocytopenia, Coombs-negative hemolytic anemia, and end-organ damage. The most common forms of thrombotic microangiopathies are Shiga toxin-producing Escherichia coli-mediated hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and atypical hemolytic uremic syndrome. The atypical hemolytic uremic syndrome occurs due to genetic and acquired mutations in complement regulatory factors and to complement activation factors in the immune system, mainly the alternative pathway. Clinical manifestations and outcomes differ with the prevalent mutations of the patient. Currently, available treatment modalities are therapeutic plasma exchange and a monoclonal antibody against C5, eculizumab. We report a case of a Sri Lankan girl diagnosed with atypical hemolytic uremic syndrome complicated with septicemia, hemolytic anemia, acute kidney injury, pulmonary hemorrhage with respiratory failure, and hypertension who had a complete remission following long-term (30 months) therapeutic plasma exchange.Case presentationA 15-year-old Sri Lankan girl was transferred from a local hospital with the features of septicemia and acute kidney injury for specialized management. She had high blood pressure (180/100 mmHg) on admission. She underwent appendicectomy based on suspicion of acute appendicitis as the cause of sepsis. Following surgery, her condition deteriorated, and intensive care unit management was warranted because she developed pulmonary hemorrhages and respiratory failure requiring mechanical ventilation and renal replacement therapy in the form of hemodialysis. Her blood investigations showed microangiopathic hemolytic anemia, thrombocytopenia, elevated lactate dehydrogenase, and reduced human complement C3 levels, together with a normal coagulation profile. She was diagnosed with atypical hemolytic uremic syndrome and was initiated on therapeutic plasma exchange and other supportive therapy, including corticosteroids. Following a lengthy course of plasma exchange, complete recovery was achieved.ConclusionThe atypical hemolytic uremic syndrome is a rare disease entity requiring a high index of suspicion to diagnose. It is a diagnosis of exclusion. Early diagnosis with prompt treatment will render a better outcome. The atypical hemolytic uremic syndrome needs to be considered in all patients with thrombotic microangiopathy.

THE EFFECTIVENESS OF INTRADIALYSIS STATIC BIKE EXERCISE TOWARD FUNCTIONAL CAPACITY IN HEMODIALYSIS PATIENTS

Background: Patients with terminal renal failure require renal replacement therapy in the form of hemodialysis. Although already have hemodialysis therapy, there is still buildup of metabolic waste in patients’ body that results in a decrease in functional capacity. Decreased functional capacity in hemodialysis patients causes limitations in carrying out physical activities that reduces their quality of life. However, intradialysis physical exercise by using static bike can be a therapy to increase patients’ functional capacity.Objective: This study was aimed to determine the effectiveness of static bike exercise toward functional capacity in hemodialysis patients.Method: This research is a quantitative study with a quasi-experimental method using pre and post approach with control group design. Intervention and control groups were included in this study. There were 20 people in each group that were selected through consecutive sampling technique as samples of this study. The study was carried out in the hemodialysis room of RSUP Dr. M. Djamil, Padang.Result: The analysis was done using Paired T-Test with a degree of confidence of 95% and showed that intradialysis static bike exercise effectively increased the functional capacity in hemodialysis patients (p = 0.001).Conclusion: Intradialysis static bike exercise can be used as a nursing intervention to increase the functional capacity in hemodialysis patients. Key words: Hemodialysis, exercise, functional capacity.

MON-104 tRial Evaluating Mid cut-Off Value membrane clearance of Albumin and Light chains in HaemoDialysis patients (REMOVAL-HD): A single-arm device safety study

Mid cut-off (MCO) membrane dialysis is a novel form of haemodialysis (HD) therapy designed to increase clearances of larger middle molecules and uraemic toxins but may result in short-term loss of albumin. REMOVAL-HD study aimed to determine if regular HD using MCO dialyser is safe and specifically will not result in a significant loss of albumin.This study also assessed the efficacy of larger middle molecules clearance and patient-centred outcomes in chronic HD patients.

SAT-017 End Stage Renal Disease in Ghana

Chronic kidney disease (CKD) is an important global health problem with increasing incidence and prevalence. Currently, the worldwide prevalence is 10-13% and similar estimates of 13.9% have been reported in sub-Sahara Africa in a recent meta-analysis. The prevalence of CKD in Ghana is 13.3%. Chronic kidney disease inevitably progresses to end-stage renal disease (ESRD) which requires renal replacement therapy (RRT) in the form of haemodialysis, peritoneal dialysis or renal transplantation as the main modalities of treatment. It has been shown consistently that renal transplantation is cost effective, improves patient survival and quality of life as compared to peritoneal dialysis and haemodialysis. Unfortunately, Ghana has no national renal transplantation programme but has had limited renal transplantation services in Korle-Bu Teaching Hospital. As result the predominant mode of treating ESRD in Ghana is haemodialysis In order to assess the burden and causes of ESRD in Ghana, the Ghana Kidney Association with the help of the African Association of Nephrology established a renal registry in 2017. This project is an analysis of the data in the registry at the end of 2017 At the end of 2017 there were 686 patients with end stage renal disease on renal replacement treatment (RRT) in Ghana giving an RRT rate of 23.56/per million population (pmp). Of these patients, 661 were on haemodialysis, 24 had a kidney transplant and two were on peritoneal dialysis. The median age of patients on RRT was 45.5 (range 6.2-84.3 years) and this is 20 years younger than in the UK. The majority of patients 65.6% were male. The major causes of ESRD were hypertensive renal disease (39%), diabetic nephropathy (9.1%) and glomerulonephritis (6.6%) ESRD is more common in Africans than in Europeans. The prevalence of RRT in Ghana of 23.56 pmp contrasts with that of 738 pmp in Europe. In Ghana as in sub-Saharan Africa the overwhelming majority of patients with ESRD die undiagnosed and untreated. This gap in our health policy needs to be addressed.

Pituitary dysfunction in survivors of Russell's viper snake bite envenomation: A prospective study.

Endocrinal insufficiency caused by vasculotoxic snake envenomation is under-recognized and is mostly confined to a specific geographic area. We conducted a prospective study to determine the prevalence and pattern of pituitary-target gland insufficiencies caused by snake envenomation. The hormonal evaluation of patients who had suffered from vasculotoxic snake envenomation was done at baseline and at 6 months of follow-up. Those patients with a documented hormonal insufficiency underwent magnetic resonance imaging (MRI) of the hypothalamo-pituitary area. The severity of envenomation was assessed by the acute physiology and chronic health evaluation II (APACHE-II) score, the sepsis-related organ failure assessment (SOFA) score, and the snake bite severity score (SBSS) for all patients. Seventy-six patients were seen during the study period, of which 60 were available for a repeat hormonal evaluation at 6 months, with the majority of patients belonging to the middle age group (mean age, 37.6 ± 14.9 years). The mean lag period at presentation was 32 ± 20 h. Thirty-five patients (46.1%) had coagulopathy, 20 patients (26.3%) had acute kidney injury (AKI), and 8 of 76 patients (10.5%) needed renal replacement therapy (RRT) in the form of hemodialysis. Six patients (out of 41 with vasculotoxic bites) developed chronic hypopituitarism, which was in continuation with the acute hypopituitarism that they developed. Growth hormone and glucocorticoid deficiencies were the most common endocrinopathies observed. The occurrence of hypopituitarism was observed only in patients with a vasculotoxic snake bite (due to Russell's viper); coagulopathy, renal insufficiency, or any of the scoring tools did not predict the occurrence of hypopituitarism. Acute asymptomatic and chronic symptomatic or asymptomatic hypopituitarism are important sequelae of viper bite in a small proportion of patients and can occur in the presence of normal pituitary imaging. Routine prospective pituitary hormone screening should be done in all patients within the first 6 months of envenomation by the vasculotoxic snakebite as chronic pituitary dysfunction can often occur in these patients.

Immunological pecularities of recipients of renal transplant

Objective. To study immunopathological disorders in renal allograft recipients with terminal stage of chronic kidney disease. Material and Methods. There were studied 119 medical cases of patients with terminal renal insufficiency (tCKD). The amount of leucocyte subpopulation CD19+, CD3+, CD3-CD16+CD56+, CD3+CD16+CD56+, CD3+CD4+, CD3+CD8+, and as well as of lymphocytes expressing activation receptors of CD3+HLA-DR+, CD3+CD38+, CD3+CD8+HLA-DR+, immunoglobulins G, A, С3- and С4-components of the complement were assessed within the patients. Results. There was detected a decrease of the main subpopulations of T lymphocytes CD3+ lymphocytes (рabs=0,033), T helper CD3+CD4+ (рrel=0,002 and pabs=0,001) and T-cytotoxic lymphocytes CD3+CD8+ (рrel=0,006 and рabs=0,001), CD3-CD16+CD56+ lymphocytes (рabs=0,045) within the patients with terminal stage of chronic kidney disease who were on renal replacement therapy; an increase of the subpopulation of TNK-lymphocytes (CD3+CD16+CD56+) (рrel=0,015) was also detected; an increase in the concentration of C4 component of the complement was detected (p=0,014). There was detected positive level correlation of C3-component of the complement (rs=+0,49; р=0,007), C4-component of the complement (rs=+0,37; р=0,049) and CIC (rs=+0,4; р=0,029) with the duration of the hemodialysis, and C3-component of the complement (rs=+0,79; р=0,034), CIC (rs=+0,39; р=0,0334), IgG (rs=+0,845; р=0,008) and IgA (rs=+0,732; р=0,039) with the duration of peritoneal dialysis. Conclusion. Thus, the immune system dysfunction within the patients with terminal kidney disease on renal replacement therapy in the form of hemodialysis or peritoneal dialysis is associated with a change in the quantitative composition, functional activity and cooperation between immunocompetent cells.

Rhabdomyolysis in Dak-Bum devotees: A case series.

Introduction:India is a land of culture and heritage always known for its rituals. The devotees offer their prayers in the form of fasting, sacrifices and many other difficult ways to please Almighty! While doing so they often endanger their lives. Rhabdomyolysis, in a particular group of devotees of Bihar/Jharkhand known as Dak-Bum, is a life-threatening clinical entity which occurs in these devotees who travel a long distance in a short period in a fasting state. Rhabdomyolysis detected by myoglobinuria can lead to acute kidney injury and mortality.Aim:To study and identify cases of rhabdomyolysis in devotees (Dak-Bum) and the role of early diagnosis and management.Materials and Methods:The study was conducted at Ruban Emergency Hospital Patna from August 2010 to August 2013 over 27 patients - 26 males and 1 female of age group 22–34 years. They presented with major symptoms such as dehydration, tender swollen calf muscles and myoglobinuria. The patients were admitted over a period of 2–3 weeks time in a single year (nine patients in 2010, five patients in 2011 and seven patients in 2012 and six patients in 2013). The study was restricted to the month of August every year, as this ritual occurs in a particular season. Inclusion criteria were all previously healthy devotees. The study period was from admission till discharge with daily follow-up of each patient.Results:Rhabdomyolysis developed in 27 Dak-Bum devotees and all had acute renal failure at the time of admission. RIFLE criteria-Stage F (failure) and acute kidney injury network criteria (3rd stage). However, recovery was good due to early intervention in the form of haemodialysis and forced alkaline diuresis by soda bicarbonate infusion.Conclusion:Rhabdomyolysis developing in Dak-Bum devotees because of travelling a long distance in a short period, could be managed well due of early diagnosis, timely referral, haemodialysis and forced alkaline diuresis.

Organization of care for patients with diabetic retinopathy in Uzbekistan

Abstract : The organization of medical care to patients with diabetes who have complications — diabetic reti-nopathy, in the Republic of Uzbekistan was studied. Keywords: diabetic retinopathy, organization of specialized ophthalmologic help. Relevance and purpose of the work.- Diabetic retinopathy (DR) is a leading cause of blindness in people of working age in developed countries. It accounts 80–90% of all disability due to diabetes mellitus (DM) [1, 10–14; 5, 35–37; 7, 13–15; 10, 354–356; 14, 1195–1200]. WHO experts predict that by 2025 the number of diabetics will ex-ceed 300 million people. However, this forecast may be too “optimistic”. The number of registered patients with diabetes mellitus (DM) in 2000 was 11 % higher than the estimates of WHO experts [13, 1414–1431]. Rising incidence of diabetes has an impact on the level of disability, in patients with dia-betes type 1, in 5 years after the onset of disease symptoms DR detected in 25 % of cases, in 10 years — nearly 60 %, and in 15 years — 80 % [10, 354–356]. According to the Wiscon-sin Epidemiologic Study of Diabetic Retinopathy (WESDR), proliferative retinopathy — the greatest threat to vision, was noted in approximately 50 % of patients with duration of dia -betes type 1–20 years and more [4, 20–27]. In DM type 2, which is 90–95% of all cases of the disease, due to the late diagnosis, signs of DR are revealed at the time of diagnosis of diabetes in 15–30% of cases, in 10 years — 50–60 %, and in 30 years — in more than 90% of patients. Proliferative processes observed in 2% of patients with diabetes for less than 5 years, and 25% of those with diabetes for 25 years or more [11, 1235–1241; 14, 1195–1200].According to WESDR 60% of adult diabetic patients (over 30 years) not treated with insulin, had retinopa-thy in 25 years, while 10% — proliferative form. Among older patients receiving insulin diabetes due to severity of DM, over 80% have retinopathy after 15 years of the dis -ease and 10% had a proliferative retinopathy. Over 20 % of patients were suffering from retinopathy at the moment of diagnosis of type 2 diabetes. Almost 100% of patients with type 1 diabetes had retinopathy developed after 15 years from the onset of the disease, and about 25% of patients had proliferative DR.Since type 2 diabetes is much more common than type 1 diabetes, this form of the disease may be considered as the main cause of vision loss in patients aged 20 to 74 years [3, 4–5; 6, 80–81; 12, 642–652].In Uzbekistan, according to ShagazatovaB.H. (2004), one of the leading reasons that led to disability (after diabetes that caused more than 50 % disability), was diabetic retinopa -thy — 7.0% [8, 41–50; 9, 3–5]. However, according to the data of the Executive Committee of the CIS, in our country, the number of diabetic patients in the last 10 years is increas -ing annually by 8 %. Currently there are more than 90,000 pa -tients registered, however, considering the fact that at least 2 % of the population of Central Asia have diabetes, and the popu-lation of Uzbekistan is 27 million, the real number of patients with diabetes is at least 6 bigger times and according to fore-casts is more than 500,000, and the number of persons with disabilities due to diabetic retinopathy — over 20,000.It should be understood that if in other complications of diabetes there are at least some, even palliative therapies (such as neuropathic with CRF — replacement therapy in the form of hemodialysis, in diabetic foot — surgical aids et al.), in the loss of vision due to DR, there are no even symptomatic treatments. This makes prevention the only affordable and effective method of care for patients with dia -betes. Considering the scale of the problem and the huge moral and economic damage to the person, family, society, the need becomes clear to study the situation and assess the adequacy of care provided to patients and ongoing preven-tion of DR, to develop and propose ways to prevent this terrible complication.

Challenges in renal transplantation in Yemen.

Background Renal replacement therapy was first introduced in Yemen in 1978 in the form of hemodialysis. Twenty years later, the first renal transplantation was performed. Kidney transplantations were started in socially and financially challenging circumstances in Yemen in 1998. A structured program was established and has been functioning regularly since 2005. A pediatric transplantation program was started in 2011. Material and Methods This was a prospective study of 181 transplants performed at the Urology and Nephrology Center between May 1998 and 2012. All transplants were from living related donors. The immunosuppressive protocol consisted initially of double therapy with steroid and mycophenolate mofetil (MMF). Subsequently, triple therapy with addition of a calcineurin inhibitor was introduced. Primary graft function was achieved in 176 (97.2%) recipients. Results Cold ischemia time was 48-68 min. Episodes of acute rejection in 12 patients were treated with high-dose steroids. Anti-thymocyte globulin (ATG) was used in cases of vascular or steroid-resistant rejection in 2 patients. The post-transplant complications, either surgical or medical, were comparable to those recorded in the literature. Conclusions Renal transplantation is a good achievement in our country. The patients and graft survival rates are comparable to other reports.

Acute kidney injury associated with rhabdomyolysis after coronary artery bypass graft: a case report and review of the literatures

BackgroundPost-operative rhabdomyolysis is a well-known complication, especially after bariatric and orthopaedic surgeries. There are few published reports of rhabdomyolysis following cardiac surgery. Acute kidney injury had been distinguished as a serious complication of cardiac surgery. We report a case of 55-years-old male patient who developed rhabdomyolysis precipitated acute kidney injury after coronary artery bypass graft.Case presentationThe patient underwent urgent coronary artery bypass graft surgery, with a long duration of surgery due to technical difficulty during grafting. He developed rhabdomyolysis induced acute kidney injury necessitating hemodialysis. The patient in turn developed heart failure, which along with acute kidney injury lead to prolonged ventilation. There was supervening sepsis with prolonged intensive care unity stay and eventually prolonged hospitalization. The peak creatine kinase level was 39000 IU/mL and peak myoglobin was 40000 ng/ml. Reviewing the patient, surgery was prolonged due to technical difficulties encountered during grafting, leading to rhabdomyolysis induced acute kidney injury. The pre-operative use of statins by the patient could also have contributed to the development of rhabdomyolysis. He developed post-operative right heart failure and sepsis. The patient’s renal function gradually improved over 4 week’s duration. Favorable outcome could be achieved but after prolonged course of renal replacement therapy in the form of hemodialysis.ConclusionProlonged duration of surgery is a well-recognized risk factor in the development of rhabdomyolysis. Early recognition of rhabdomyolysis induced acute kidney injury is important in reducing the post-operative morbidity and mortality in patients. A protocol based approach could be applied for early recognition and management.