Nature Of Renal Disease Research Articles

MO1041AWARENESS, KNOWLEDGE AND PERCEPTION OF CHRONIC KIDNEY DISEASE PATIENTS AT RENAL MEDICINE OUTPATIENTS' CLINIC, SINGLE CENTRE EXPERIENCE

Abstract Background and Aims Chronic kidney disease (CKD) is a major cause of morbidity and mortality in the Sultanate. Many preventive measures have focused on early detection and education. Hence, awareness and education of kidney disease influence positively its medical management and diminish significantly the economic burden on public health. Knowledge of CKD and risk factors increases the perception of being at high risk and increasing health seeking behaviour. We conducted a longitudinal survey at Renal Medicine Department among our patients to assess the level of awareness, knowledge of CKD and the treatment options. Method We used a pretested structured questionnaire to collect information on socio-demographic and knowledge of patients attending Renal Medicine Department. The questionnaire was distributed to all CKD patients of at least one-year duration after their diagnosis. Results A total of 200 patients completed this study, mainly from the capital region. The mean age was 50 (SD 17.1) years for male participants and 42.3 (SD 16) years for female participants. The majority (74.3%) knew the reason for their referral to nephrologist. 31% of the patients with CKD reported their shock when informed about their kidney status by the nephrologist at the first time. Two third (64%) of patients reported having no knowledge of their kidney function and 50% of them were not aware about renal replacement therapy options. 52.1% of participants refused for early access creation. 22% of them expressed their refusal for the early access creation as they have no uremic signs. Finally, 60% of the study participants had no family member attending with them during their clinic visit. Conclusion Patients and their family should receive enough information and education regarding the nature of renal disease and the options for the treatment to allow them to make an informed decision about the management of their CKD. Awareness of the factors associated with a well-informed-decision making in the treatment of CKD can provide health professionals with evidence on how best to deliver education programs for patients and their families. It may also enhance communication and improve the capacity for patient and family involvement in shared decision making.

Evolving Challenges in Diagnosis of Renal Vasculitis

Renal-limited vasculitis is a rare anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis that presents only with a renal manifestation in the absence of other organs involvement. In this report, a 50-year-old female presented with nonspecific symptoms and anemia, who was subsequently discovered to have renal-limited vasculitis. After receiving a combination of steroid and immunosuppressive therapy, she recovered uneventfully without further relapse. A wide range of nonspecific presenting symptoms and the insidious nature of renal disease often delay in early recognition of renal-limited vasculitis. Keeping a lower threshold of initiating vasculitis workup helps detect the earlier diagnosis which is crucial in management with improved renal outcome. J Med Cases. 2021;12(4):157-159 doi: https://doi.org/10.14740/jmc3648

Coronary Artery Bypass Grafting for Hemodialysis‐ Dependent Patients

Patients with end-stage renal disease carry a risk of coronary atherosclerosis. This study was performed to evaluate the perioperative and remote data of coronary artery bypass grafting (CABG) in hemodialysis dependent patients. We retrospectively analyzed the results of isolated CABG performed at Shin-Tokyo Hospital between June 1, 1993 and May 31, 2000. Preoperative, perioperative, and follow-up data of the patients on hemodialysis (Group HD, n = 37) were collected and compared with those of control patients (Group C, n = 1,639). Group HD consisted of 26 males and 11 females with a mean age of 59.9 +/- 8.1 years, and the mean number of bypasses was 2.5 +/- 1.1. Group HD had a longer postoperative intubation time, ICU stay, and hospital stay than Group C. The postoperative major complication rate in Group HD (18.9%) was not significantly different from that in Group C (11.3%). However, the inhospital mortality rate in Group HD (5.4%) was higher than Group C (0.6%). At the mean follow-up of 2.4 years, the actuarial 3-year survival of Groups HD and C were 90.6% and 97.6%, respectively (p < 0.001), excluding hospital mortality. The actuarial 3-year cardiac event-free rates were 84.3% in Group HD and 88.8% in Group C, showing no difference. Patients on chronic hemodialysis carry a significant risk of prolonged inhospital care and hospital death. Once successful surgical revascularization was completed, their long-term cardiac events could be controlled as effectively. The increased distant death rates was probably associated with the nature of renal disease.

Anti-HIV indeterminate western blot in dialysis patients: a long-term follow-up.

In a group of 520 patients undergoing chronic hemodialysis, 23 (4. 4%) were enzyme immunoassay (EIA) positive for human immunodeficiency virus (HIV) and indeterminate by Western blot (IWB) analysis. The antibodies were mostly directed against p24 and p55 antigens. A comparison between hemodialysis patients with and without IWB showed significant differences between the two groups with respect to number of units of blood transfused, history of renal transplant rejection, and Rh status. No significant differences were observed with respect to ethnic group, nature of renal disease, duration of hemodialysis, associated diseases, and ABO blood group. The HIV IWB phenomenon may represent abnormal immune reactivity as a result of transplantation antigens and/or autoantibody formation. Five-year follow-up of the HIV EIA-positive IWB patients showed that none had seroconverted to HIV-positive status.

Treatment of Renal Failure

<i>To the Editor</i>.—In the May 1978 issue of theArchives(113:581-858), LeVeen and co-workers reported their work on the treatment of renal failure in ascites secondary to hepatic, renal, and pancreatic disease. The diagnosis of hepatorenal syndrome in patients with liver disease with azotemia and oliguria is difficult to make. Prerenal oliguria should be ruled out by a judicious trial of volume expanders to determine whether the decreased effective intravascular volume is the cause of oliguria. The reported cases of LeVeen secondary to liver disease or encephalopathy do not provide enough data regarding the nature of renal disease. It is of critical importance in making a diagnosis to obtain urine osmolality, urine-to-plasma osmolality ratio, and urine-to-plasma creatinine ratio. In Table 2, patient 1, after many days of high urine output, the serum creatinine level did not change substantially and there was no improvement of the glomerular filtration rate. This

Etiology of hyperparathyroidism and bone disease during chronic hemodialysis. I. Association of bone disease with potentially etiologic factors.

The present study was prompted by the observation that, in patients with chronic renal failure being followed at this center, renal osteodystrophy developed almost exclusively in those who were treated by chronic hemodialysis at home rather than in our center. A systematic comparison was made between the 10 patients with roentgenographic evidence of the bone disease and 18 patients without demonstrable bone disease. The two groups were similar in age, sex, nature of renal disease, and duration of dialysis. The mean duration of kidney disease was almost 2 yr longer in the patients without bone disease than in those with bone disease. Other significant differences related to where the hemodialysis was performed and to the calcium concentration in the dialysate (6.0-7.4 mg/100 ml in the hospital and 4.9-5.6 mg/100 ml at home). If the unknown factors related to where the dialysis was performed were of no consequence, the major factor contributing to the production of bone disease observed in these patients was the use of a dialysate with a calcium concentration less than 5.7 mg/100 ml.

The identification and clinical significance of casts.

In many cases of congestion, and in inflammation of the kidney, a spontaneously coagulable material is effused into the tubes and coagulates there forming a cast or mould of the tube... entangles in its meshes any structures which may be there at the time. The characters of the cast will vary... according to the state of the tubes. By observing... we are often able to form a correct notion concerning the nature of morbid changes going on in tubes at the time the cast was formed. It has been stated that the different morbid states of the kidney are but different stages of one and the same disease... a few months' careful study in the wards of a hospital and in the dead-house, will serve to convince any unprejudiced person that the nature of renal disease may be diagnosed in many cases by the microscopical characters of the urinary deposit,