Raised Serum Creatinine Levels Research Articles

Acute ST elevation myocardial infarction (STEMI) in a patient with leptospirosis; a therapeutical dilemma – A case report

A 45-year-old previously healthy farmer was seen at the Emergency Department with ischemic type chest pain. He had a history of an acute febrile illness for four days. The ECG showed an acute anterior myocardial infarction. His laboratory investigations revealed thrombocytopenia, a raised serum creatinine level and significantly raised high-sensitive cardiac Troponin I. A provisional diagnosis of acute STEMI with co-existing leptospirosis was made. The patient was managed conservatively with antibiotics, statins, and aspirin. Neither thrombolysis nor primary coronary intervention was attempted due to high risk of bleeding. Diagnosis of leptospirosis was confirmed later by markedly elevated leptospira antibodies. After recovery, he underwent coronary angiogram which revealed a totally occluded left anterior descending artery and is awaiting myocardial viability assessment with dobutamine stress echocardiography before PCI. We report this uncommon presentation of acute myocardial infarction in a patient with leptospirosis, as it causes a considerable therapeutic dilemma especially in a resource-poor setting.

Myoglobin Cast Nephropathy, A Series of Five Cases

Acute kidney injury is a potential complication of severe rhabdomyolysis, which occur mostly due to excessive release of myoglobin from necrosed muscle cells. The major causes of rhabdomyolysis in Indian subcontinent include wasp sting, snake envenomation, strenuous exercise and seizures, etc. The main pathophysiology of AKI due to tubular obstruction, renal vasoconstriction and tubular damage due to myoglobin casts in the tubular lumen. With raised serum creatinine level these patients also show remarkably high serum creatine phosphokinase (CPK). On light microscopy myoglobin casts present as granular eosinophilic pigment casts, sometimes may mimic haemoglobin casts or bile casts. To differentiate the myoglobin casts from other, immunohistochemistry for myoglobin is used in most of the centers worldwide now days. A good number of patients need haemodialysis and most of them recover well, however early diagnosis and timely intervention is warranted. Here we report five cases of myoglobin cast nephropathy in a year at department of histopathology, Armed Forces Institute of Pathology (AFIP), Dhaka, following different non traumatic causes, diagnosed by immunohistochemistry for myoglobin.

Emphysematous pyelonephritis: An assessment of prognostic factors and the role of early pigtail drainage

Abstract Introduction: The management of emphysematous pyelonephritis (EPN), a necrotizing renal infection, has shifted from more invasive to less invasive approach in due course of time with decrease or reduction in mortality rate. Aim: To analyze the clinical spectrum, prognostic factors, different management strategies, and the outcome of the patients of EPN with the role of early pigtail drainage. Materials and Methods: The study was carried out at a tertiary care hospital from January 2016 to December 2021 and included patients who were diagnosed with EPN. The data on the demographic profile, clinical features, biochemical parameters, imaging studies, management, and outcome of patients of EPN were recorded. Results: A total of 51 patients of EPN were studied and were divided into two groups, responders (40 patients) and nonresponders (11 patients), based on their clinical progression and outcome. Among responders and nonresponders, a significant difference was seen in terms of age, presentation of altered consciousness and shock, average hemoglobin, average serum creatinine, and presence of thrombocytopenia. Out of total 51 patients, 13 (25.49%) showed a response with antibiotics only, DJ stenting was done in five (9.8%) patients, and pigtail catheterization in 33(64.7%) patients. There was a significant difference seen in the response with early pigtail drainage. Nephrectomy was needed in eight (15.68%) patients, and the mortality rate was 9.8%, with the death of five patients. Conclusion: Advanced age, lower hemoglobin levels, thrombocytopenia, raised serum creatinine levels, altered mental status, and presence of shock can be used as a score for poor prognosis. With the use of broad-spectrum antibiotics and early pigtail drainage, a large number of patients with EPN can be managed effectively. Nephrectomy should be reserved for patients who fail to respond to conservative management or those with advanced disease with the presence of multiple risk factors.

Serum Creatinine Levels Have Been Shown to Accurately Predict in-Hospital Mortality in Individuals who have Been Effectively Treated with PPCI

Objective: The purpose of this study was to assess the predictive value of serum creatinine for in-hospital mortality among patients who had acute coronary syndromes. Study Design: An observational study Place and Duration: This observational study was conducted at Department of Cardiology, Rashid Latif Medical College, Lahore and Nowshera Medical College, Nowshera, KPK in the duration from 1st May, 2022 to 31 October, 2022. Methods: Total 198 patients had acute coronary syndromes who underwent successful primary percutaneous coronary intervention (PCI) were included. Patients were aged between 25-80 years. After receiving written consent, we recorded the subjects' ages, sexes, BMIs, and diagnoses in detail. Within 12 hours of an AMI diagnosis, serum creatinine levels were taken. Patients were split into two groups based on their serum creatinine levels upon admission. There are two categories, those with high levels of serum creatinine (over 1.3 mg/dL) and those with normal levels (below 1.3 mg/dL). Life expectancy at death was measured at one year. All of the information was analyzed with SPSS 22.0. Results: There were majority 140 (70.7%) males and 58 (29.3%) females in this study. Mean age of the patients was 55.18±11.24 years and had mean BMI was 24.6±14.52 kg/m2. Mean serum urea level was 37.3±0.22 mg/dL. Diabetes found in 40 (20.2%) cases and frequency of hypertension was 82 (41.4%). Anterior myocardial infarction was found in 79 (39.9%) cases followed by Inferior MI in 73 (36.9%) cases and non-ST MI in 46 (23.2%) cases. Mean left ventricular ejection fraction (LVEF) was 45±7.17 %. We found elevated serum creatinine in 37 (18.7%) cases and normal creatinine in 161 (81.3%) cases. Mortality in elevated group was higher found in 10 (27.02%) cases and as compared to normal group 8 (4.96%). Conclusion: The results of this study indicate that patients with AMI who had even slightly raised serum creatinine levels at admission have a significantly higher risk of dying within a year. Keywords: Myocardial Infarction, Comorbidities, Primary percutaneous coronary intervention, Mortality, Serum Creatinine

ASSOCIATION OF ALBUMINURIAAND URIC ACID IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Introduction: There are two possibilities of increase serum uric acid level it could be increase production or decrease excretion higher serum uric acid level in diabetic nephropathy is mostly due to abnormality in uric acid excretion or hyperuricemia may result from increased net tubular reabsorption. On the other hand, higher levels of serum insulin may decrease uric acid clearance by the kidneys. Today there is great interest in the potential that uric acid may represent a remediable risk factor for CKD. So we studied the relation between hyperuricemia and albuminuria in type 2 diabetes mellitus patients in asansol district hospital west Bengal.Aims: The aim of this study is to evaluate the association between serum uric acid & urinary Albumin to Creatinine Ratio (ACR) among patients with type 2 diabetes mellitus. Materials And Methods: This study was hospital based observational and prospective study to nd out relationship between serum uric acid level & albuminuria in type 2 Diabetes Mellitus patients. 83 patients aged between 40 to 80 years was selected from Medicine OPD and indoor wards, Department of General Medicine, KPC Hospital, West Bengal from 1august 2020 to 1august 2021. Type 2 Diabetics Melitus (T2DM) patients and Age: between 40 to 80 years were included in this study. Result: 41(49.4%) patients had Normoalbuminuria, 26(31.3%) patients had Microalbuminuria and 16(19.3%) patients had Macroalbuminuria.37(44.6%) patients had Hyperuricemia and 46(55.4%) patients had Normouricemia.25(30.1%) patients had ALT. Association of hypertensive / normotensive vs. Albuminuria was not statistically signicant (p=0.3579).Association of hyperuricemia / normouricemia vs. Albuminuria was statistically signicant (p<0.0001)..Poor control of HBA1C was signicantly associated with albumin excretion in urine (p<0.0001).Distribution of mean GFR vs. albuminuria was statistically signicant (p<0.0001). Distribution of mean urinary ACR vs. albuminuria was statistically signicant (p<0.0001). Distribution of mean serum uric acid vs. albuminuria was statistically signicant (p<0.0001). Conclusion : Hypertension, raised HbA1C levels, high blood sugar levels and raised serum creatinine levels are the major risk factors. Hence early detection of high risk patients and the early initiation of renal and cardiovascular protective agents helps in reducing morbidity and mortality due to type 2 diabetes mellites. There was negative correlation between serum uric acid with GFR and HDL, which were statistically signicant.

Intravascular ultrasound-supported percutaneous angioplasty of post-kidney transplant renal artery bifurcation stenosis.

Transplant renal artery stenosis (TRAS) is an uncommon complication following renal transplantation. Its usual clinical presentation includes worsening hypertension and/or renal function, without any evidence of graft rejection. Bifurcation renal artery stenosis of the transplanted renal artery is rarely encountered. Percutaneous transluminal renal angioplasty (PTRA) with or without stenting is the procedure of choice to treat TRAS. We hereby describe a patient, who presented with impaired renal functions, four months following the renal transplantation. He underwent intravascular ultrasound-guided PTRA of the bifurcation lesion of TRAS.Results and conclusion: Superior renal artery had coronary drug-eluting stent implantation, while inferior renal artery and side branch of the superior renal artery had balloon angioplasty, alone. Post-intervention, the raised serum creatinine level decreased from 2.9 mg% to 1.7 mg%. The index case described the successful PTRA and stenting of the bifurcation lesion of TRAS, the technical results of which was optimized with the use of intravascular ultrasound.

Etiological Spectrum and Clinical Features in 215 Patients of Crescentic Glomerulonephritis: Is it Different in India?

Introduction:Crescentic glomerulonephritis (CrGN) characterized by the presence of crescents in most (≥50%) glomeruli on renal histology clinically presents as rapidly progressive renal failure. It can occur due to diverse etiologies with varying course and renal outcomes. We studied the prognostic significance of its classification as pauci-immune, anti-GBM, and immune-complex mediated CrGN.Materials and Methods:Renal biopsies diagnosed as CrGN over 9 years were included. Clinical, biochemical, serological, and histological features of various classes of CrGN were correlated with renal outcome.Results:215 biopsies were diagnosed as CrGN during this period. A majority (63%) were immune-complex mediated while 32% were pauci-immune, followed by anti-GBM disease (5%). 85.5% of pauci-immune CrGN were ANCA associated. The levels of proteinuria and serum creatinine were significantly higher in anti-GBM CrGN as compared to the other two classes. The various histological features including Bowman's capsule rupture, peri-glomerular granulomatous reaction, fibrinoid necrosis, and vasculitis were more common in anti-GBM disease and pauci-immune CrGN. The median renal survival was 6.3, 5.3, 2.1 months in immune-complex mediated, pauci-immune, and anti-GBM CrGN, respectively.Conclusion:Immune-complex mediated is the commonest etiology of CrGN in India. Anti-GBM disease has the worst prognosis followed by pauci-immune and immune-complex mediated CrGN. Raised serum creatinine levels (>5mg%) and the degree of glomerulosclerosis at diagnosis were predictors of poor renal survival. High index of suspicion and prompt diagnosis can improve the outcome in these patients.

PCN site myiasis: a rarity

A 38-year-old woman was referred to us as a case of uterovaginal prolapse with bilateral obstructive uropathy. On local examination, she was found to have fullness and tenderness in her...

Clinico-histomorphologic Characteristics of Lupus Nephritis, Experience at a Center at Dhaka.

Lupus nephritis (LN) is one of the most serious systemic lupus erythematosus complications since it is the major predictor of poor prognosis. We present the clinico-histomorphologic characteristics of LN at a center in Dhaka. The study group comprised diagnosed cases of LN on core-needle renal biopsy specimens received in the Department of Histopathology, Armed Forces Institute of Pathology, Dhaka, from January 2018 to June 2019. Histological evaluation and direct immunofluorescence (DIF) study was carried out on each specimen. Each case was classified according to the International Society for Nephrology/Renal Pathology Society (ISN/RPS) Classification 2003 of LN. A total of 104 (9.20%) LN cases were included of total 1130 nonneoplastic renal biopsy specimens. The mean age was 28.29 ± 12.24 years, with a male:female ratio of 1:4.47. According to the ISN/RPS 2003 classification, most of the LN belong to class IV (42, 40.38%), followed by class III (27, 25.96%), class II (22, 21.15%), and so on. The mean age of class IV LN was 25.95 ± 10.15 years, with M:F = 1:4.25. The mean urinary total protein (UTP) was 4.62 ± 4.47 g/24 h and the mean serum creatinine was 1.87 ± 1.12 mg/dL. On histopathology, 22 (52.38%) had crescent formation, 27 (64.28%) had wire loop formation with subendothelial thrombi, and 30 (71.42%) had necrotizing lesion. Interstitial fibrosis and tubular atrophy (IFTA) was ≥25% in eight (19.04%) class IV LN. Among the subclasses, most common was IV-G (A/C) - 16 (38.09%), followed by IV-S (A/C) - nine (21.42%) and IV-S (A) and IV-G (A) each eight (19.04%). In four (9.52%) cases, class IV + V lesion was found. The mean age of class III LN was 26 ± 11.02 years, with a male:female of 1:26. The mean UTP was 3.45 ± 2.4 and serum creatinine was 1.71 ± 1.51. Among these, crescent was found in eight (29.63%) cases, wire loop and subendothelial thrombi in 11 (37.04%) cases, and necrotizing lesions in eight (29.63%) cases. IFTA was >25% in 14.81% of cases of class III LN. Among 27 class III LN, 17 (62.96%) were classified as III (A) and 10 (37.04%) as III (A/C). Two class III LN had an association with class V and two have presented with TMA. The mean age of class II LN was 29.95+ 12.26 years, with M:F = 1:2.66. UTP was 3.53 ± 2.43 g/24 h and serum creatinine was 1.52 ± 1.5 mg/dL for class II LN. Histologically, these cases had focal/diffuse mesangial proliferation with 25% IFTA in 9.09% of cases. One of the class II LN had associated amyloidosis. Among class V LN, the mean age was 45.12 + 13.64 years, with M:F = 1:3. The mean UTP was 4.06 ± 1.71 g/24 h and serum creatinine was 1.64 ± 0.94 mg/dL. Histologically, 37.5% had >25% IFTA. The mean age of class I lesion was 27.25 ± 17.42 years with equal number of males and females. The mean serum creatinine level was 0.65 ± 0.18 mg/dL and UTP was 2.71 ± 2.3 g/24 h for class I lesion. Only one class VI LN case was found which had IFTA 40% and presented with generalized edema. On DIF, among 100 cases, 86 were found with full-house immune deposits of different intensity; IgM was lacking in 10 cases and IgA was lacking in seven cases, while three cases lacked C3 deposits. The mean activity index was 7.10 and the mean chronicity index was 3.23 among 69 cases of proliferative LN. Among different histological classes of LN, the prevalence of class IV was more in this study which had the most severe form of clinical presentation, biochemical parameters (raised serum creatinine level), and histological findings (crescent formation and IFTA).

Systematic review on the definition and predictors of severe Clostridiodes difficile infection.

Clostridiodes difficile infection (CDI) is one of the most common hospital-acquired infections with high mortality rates. Optimal management of CDI depends on early recognition of severity. However, currently, there is no acceptable standard of prediction. We reviewed severe CDI predictors in published literature and its definition according to clinical guidelines. We systematically reviewed studies describing clinical predictors for severe CDI in medical databases (Cochrane, EMBASE, Global Health Library, and MEDLINE/PubMed). They were independently evaluated by two reviewers. Six hundred thirty-three titles and abstracts were screened, and 31 studies were included. We excluded studies that were restricted to a specific patient population. There were 16 articles that examined mortality in CDI, as compared with 15 articles investigating non-mortality outcomes of CDI. The commonest risk factors identified were comorbidities, white blood cell count, serum albumin level, age, serum creatinine level and intensive care unit admission. Generally, the studies had small patient populations, were retrospective in nature, and mostly from Western centers. The commonest severe CDI criteria in clinical guidelines were raised white blood cell count, followed by low serum albumin and raised serum creatinine levels. There was no commonly agreed upon definition of severe CDI severity in the literature. Current clinical guidelines' definitions for severe CDI are heterogeneous. Hence, there is a need for prospective multi-center studies using standardized protocol for biospecimen investigation collection and shared data on outcomes of patients in order to devise a universally accepted definition for severe CDI.

Evaluation of carbon dioxide angiography in lower limb angioplasties of peripheral arterial disease patients with borderline chronic kidney disease compared to the standard contrast agent

Introduction: Assessment of carbon dioxide (CO2) angiography for its efficacy and limitations in lower limb angioplasties for chronic limb-threatening limb ischemia needs to be evaluated in detail, as the use of CO2 as a contrast agent has a distinct advantage over conventional iodinated contrast medium (ICM) in patients with borderline chronic kidney disease (CKD), with respect to nephrotoxicity caused by the later. Aims and Objectives: To study the quality of angiography images obtained with CO2 as a contrast agent and the efficacy of CO2 angiography in guiding lower limb angioplasties for critical limb ischemia. Design: This was a prospective, observational, comparative, cohort study. Study Period: September 2017–December 2018. Materials and Methods: Patients of critical limb ischemia with raised serum creatinine level (>1.49 mg/dL) who were not on the dialysis and undergoing endovascular revascularization were enrolled in the study. Hand injections were made using CO2 Angioset. Intraoperative evaluation of image quality obtained using CO2 was done by two vascular surgeons and compared with conventional contrast medium. Necessary therapeutic intervention was performed using CO2 angiography image if reliable image was acquired using the same. Results: A total of 100 patients were evaluated consisting of 176 arterial segments, out of which 145 segments required use of ICM and 31 segments were intervened using CO2 only as a contrast agent (19 superficial femoral artery, 6 common iliac artery, 2 pop artery, 3 external iliac artery, and 1 anterior tibial artery). Assessment of scores given by the observer 1 and observer 2 was performed by their comparison for the statistical significance using McNemar–Bowker test and was found to be statistically significant with P = 0.02. Kendall's Tau b coefficient is 0.74 (significant) and Cohen's kappa is 0.63 (significant). Good-quality images were seen in above the knee (ATK) segment in 39.3% and moderate in 57.8%. However, below the knee (BTK) segments received poor image quality score in majority, i.e., 82.6%. There was significant reduction observed in the total volume of ICM. No major adverse reaction/complication encountered during the procedures was observed, except pain being the most common and distressing complication. Conclusions: CO2 angiography is a very useful tool in the armamentarium of vascular surgeon, especially while performing angioplasties for peripheral arterial disease in borderline CKD patients, not on dialysis, because it not only reduces the amount of iodinated contrast used but also has good imaging ability in ATK vessels. It was fought with multiple issues while imaging BTK vessels, leading to reduction in its reliability and feasibility in that segment.

Validation of prognostic scoring systems for predicting 30-day mortality in perforated peptic ulcer disease.

Perforations in Peptic Ulcer Disease are known to cause considerable morbidity and mortality. The objective of this study was to compare efficacy of known clinical parameters and three existing scoring systems in predicting 30-day mortality and determining mortality risk stratification based on risk factors. This was a prospective observational study of 190 patients operated for perforated peptic ulcer over a period of 14 months at a 1500 bed tertiary care university hospital in Western India. The mortality rate observed was 18.95%. Elderly population, raised serum creatinine, time delay to surgery > 24 hours, preoperative shock and pre-existing medical illness were identified as risk factors for poor postoperative prognosis. The Area under curve for mortality prediction was 0.590 for ASA, 0.745 for Boey and 0.804 for PULP score. Mortality was best anticipated by a combination of raised serum creatinine levels, preoperative shock and delayed surgery by multivariate logistic regression analysis. Poor outcome was significantly higher in the elderly, patients with raised serum creatinine, preoperative shock, pre-existing medical illness and when the time delay to surgery was > 24 hours. In spite of the Boey score being more practical in application, PULP score proved to be a more precise indicator of mortality. A larger study inclusive of other Mortality Risk Prediction Models would help formulate a more accurate and population specific scoring system.

Eosinophilic Ureteritis: Report of A Rare Case

During evaluation for left loin to groin pain, a 14- year-old boy was found to have left mid ureteric stricture with proximal hydro-ureteronephrosis on imaging. Pus cells were present in his urine with a raised serum creatinine level. There was peripheral eosinophilia and biopsy near the stricture revealed eosinophilic ureteritis. The patient was evaluated to find out the possible causes of eosinophilia. Here we report a case of eosinophilic ureteritis for its rarity.
 Journal of Surgical Sciences (2015) Vol. 19 (2) : 80-81

Clinical Presentations and Outcome of Acute Glomerulonephritis in Children

Acute post streptococcal glomerulonephritis (APSGN) is the most common type of acute glomerulonephritis (AGN) in childhood. It has not been studied well in Bangladesh. To evaluate the clinical characteristics, complications and outcome of Acute post streptococcal glomerulonephritis (AGN). the department of Pediatric Nephrology at Sir Salimullah Medical College and Mitford Hospital, Dhaka. A prospective study from April 2011 to March 2012 were conducted among the patients diagnosed as AGN in outdoor and indoor department. Hospital records of all 34 children who had been admitted to Sir Salimullah Medical College and Mitford Hospital were reviewed. All demographic, clinical, paraclinical data and consumed medications were obtained. Among 34 cases female and male ratio were 2.4:1; mean age of was 8.76 yrs. ± 2.5 SD and peak age 7.6. Etiology of AGN was post infectious glomerulonephritis (PIGN) 85.3%, ASO titer was raised in 88.2%, 41.2% had raised blood urea, and 32.4%raised serum creatinine level. All children presented with microscopic hematuria (100%), hypertension (100%), and edema (100%), other findings are fever (55.9%), oliguria (94.1%), abdominal pain (52.9%). History of sore throat and pyoderma was present in 41.2% and 44.1% cases respectively. Complications like hypertensive encephalopathy three (8.8%), urinary tract infection (UTI) one (2.9%) total seven (20%) were heart failure two (5.9%) and Acute kidney injury (AKI) one (2.9%), total seven (20%) were expired. Majority of cases manifest typically with edema, oliguria and hematuria. It usually has an uneventful course.
 Bangladesh Med J. 2019 Jan; 48 (1): 13-17

Concurrent Carotid Endarterectomy and Off-Pump Coronary Artery Bypass Graft Surgery in Bangladesh: A Prospective Cohort Study

A patient of ischemic heart disease (IHD) with additional carotid artery stenosis (CAS) has been distinguished as a high risk group for both heart and cerebral inconveniences following surgical intervention. We aimed to review the outcome of concurrent carotid endarterectomy (CEA) and off-pump coronary bypass graft (OPCABG)in a patient undergoing surgical revascularization for IHD and CAS at our institute.In the vicinity of 2014 and 2016, fifteen patients experienced OPCABG and CEA associatively in a single Surgeon's Practice. Six (40%) patients had a history of myocardial infarction (MI), four (26.66%) had unstable angina (USAP), and three (20%) had USAP together with MI, though two (13.33%) were asymptomatic. Nine (60%) patients demonstrated no neurological manifestations, three (20%) had transient ischemic assaults (TIAs), two (13.33%) experienced stroke, and 1 (6.66%) experienced both. Majority 7 (46.66%) patients had 75-90% carotid artery stenosis and 6(40%) patients experienced right though 8 (53.33%) experienced left CEA and only 1 (6.66%) had bilateral CEA. Five (33.33%) patients were found left main disease (>50% lesion) and 100% patients have had significant Left Anterior Descending (LAD) lesion in this study. Twelve (80%) patients show significant lesion in Right Coronary Artery (RCA) and ten (66.66%) patients had Obtuse marginal (OM) branch disease. CEA was performed before OPCABG in all cases. There were 15 patients (mean age 62.5±2.8 years; 80% were male), two (13.33%) had a perioperative stroke while one of them had TIAs (6.6%). Mean ICU stay was 36.6±4.5 h and patients were released in 10 days. There was no mortality in the early postoperative period and co-morbidity was less significant (6.6% myocardial ischemia, 13.33% atrial fibrillation, 6.66% TIA, 13.33% Stroke). There was 1 (6.66%) postoperative acute renal failure evidenced by raised serum creatinine level. Two (13.33%) patients showed respiratory complications; only 6.6% of them suffered from wound infection. A combined strategy by means of CEA with OPCABG is safe and savvy in view of the satisfactory consequences of morbidity and mortality rates and also short ICU and hospital stay status.Faridpur Med. Coll. J. Jan 2018;13(1): 2-7

A surprising case of bilateral ureteric stones causing acute renal failure and anuria

Introduction: We present a case of bilateral ureteric colic that causes anuric acute renal failure. Bilateral ureteric colic causing acute renal failure is not a new presentation. However, the patient had only 3 mm calculi, making our case unique. Background: Bilateral renal calculi are an uncommon cause of acute kidney injury (AKI). Obstructing ureteroliths rarely lead to AKI without any underlying renal disease or anatomic abnormalities, such as a solitary kidney or horseshoe kidney. The literature has reported the incidence of a unilateral ureterovesicular junction obstruction secondary to a stone as 20%. However, there are a very few case reports in the literature of urology, nephrology or emergency medicine regarding the incidence of bilateral ureteric calculi. Cases of bilateral ureteric calculi are rare, and cases with AKI and anuria are very rare. Case presentation: A 30-year-old male presented with bilateral colicky flank pain for 4 days and started to develop macroscopic haematuria. After proper pain management in the Emergency Department, the patient was found to have a raised serum creatinine level (152 μmol/L). A CT scan was performed showing two 3 mm calculi in the left and right proximal ureters. Ultrasound showed moderate left and mild right hydroureteronephrosis. Due to the relatively small size of the stones, and the clinical image of the patient, he was planned for medical expulsive therapy. Surprisingly, the patient developed complete anuria for 2 days and presented to the ED with a serum creatinine level of 843 μmol/L. Bilateral double J stents were placed and urgent ureteroscopy was done. Following treatment, the patient's condition significantly improved and his renal function returned to normal within 4 days. Conclusion: Even small bilateral stones can result in acute kidney injury.

Study of patients with nephrotic syndrome in Sohag University Hospital

Background Nephrotic syndrome is not a disease; it is the manifestation of a wide variety of underlying disease processes. Objectives The aim of the present study was to investigate different clinic-laboratory and histological patterns of nephrotic syndrome and the relationship between its clinical character and prognosis. Methods From January 2010 to December 2011 the authors of the present study retrospectively and prospectively studied 139 patients with nephrotic syndrome, diagnosed on the basis of heavy proteinuria greater than 3 g/day, hypoalbuminemia, evidence of fluid retention or edema, and hyperlipidemia. Results A total of 139 patients (M : F = 79 : 60) were included in the present study; their mean age was 33.9 ± 13.47 years (primary : secondary nephrotic syndrome = 80 : 59). Systemic lupus erythematosus was the most common underlying cause of secondary nephrotic syndrome [24 cases (40.7%)], followed by DM [13 cases (23.7%)]. Renal biopsy revealed 18 patients (30.5%) with membranoproliferative glomerulonephritis, 15 (25.43%) with membranous nephropathy, seven (11.86%) with mesangial proliferative glomerulonephritis, six (10.16%) with amyloidosis, five (8.47%) with focal segmental glomerulosclerosis, three (5.08%) with diffuse proliferative glomerulonephritis, one (1.69%) with focal proliferative, minimal mesangial, sclerosing glomerulonephritides, one patient (1.69%) with crescent glomerulonephritis, and another one (1.69%) with IgA nephropathy. A raised serum creatinine level was found in 49 (35%) patients, and 35 (74.4%) of them had normal renal function at the last follow-up. Complete remission of proteinuria occurred in 69 (49.6%) patients, partial remission in 53 (38.1%), and resistant proteinuria in 17 (12.2%). Conclusion Clinical features and biochemical values do not give many clues about the underlying histological types of glomerulonephritis. Therefore, renal biopsy should be carried out in all patients with adult nephrotic syndrome, as results permit us to establish a specific diagnosis, which helps in counseling the patients about the likely prognosis of their disease and to select a specific therapeutic regimen.

Targeted spontaneous reporting of suspected renal toxicity in patients undergoing highly active anti-retroviral therapy in two public health facilities in Uganda.

BackgroundAlthough the national HIV control programme in Uganda has a well-established system for monitoring disease progression and treatment outcomes, monitoring of adverse drug reactions (ADRs) is inadequate. In order to address under-reporting of ADRs, the National Pharmacovigilance Centre, in collaboration with the HIV control programme, piloted a targeted spontaneous reporting (TSR) system as a complementary method to traditional spontaneous reporting.MethodsFrom April 2012 to March 2014, all cases of suspected renal toxicity in 10,225 patients on tenofovir-based regimens were monitored in the regional pharmacovigilance centres of Masaka and Mbale. The identification of renal toxicity was performed using serum creatinine, urinalysis, and other signs and symptoms of kidney injury.ResultsThere was one suspected renal toxicity reported for every 200 patients on a tenofovir-based regimen. Some of the serious reactions reported were death in two cases and bone demineralisation in five patients. Most of patients had been on treatment for 2 years. Those that had been on tenofovir for more than 4 years had raised serum creatinine levels, emphasising the importance of monitoring for the risk of renal damage for longer. We also found that the reporting rate of suspected ADRs for all medicines in the two sites increased almost fivefold during the implementation period.ConclusionAlthough the occurrence of suspected tenofovir renal toxicity of HIV patients is low, there is need to monitor those at risk so as to prevent irreversible kidney injury. TSR can complement spontaneous reporting for collecting safety data on particular drugs and increase ADR reporting rates.Electronic supplementary materialThe online version of this article (doi:10.1007/s40264-015-0277-9) contains supplementary material, which is available to authorized users.

The utilization of diagnostic ultrasound in the evaluation of the kidneys in HIV-associated nephropathy

Aim: To evaluate the renal sizes and echogenicity pattern in patients with human immunodeficiency virus (HIV)-associated nephropathy and to correlate renal echogenicity with serum creatinine levels and proteinuria. Materials and Methods: A cross-sectional study of 100 consecutively confirmed HIV- seropositive patients aged between 19 and 65 years (Mean ± SD: 35 ± 10.79) comprising 32 males and 68 females with clinical and laboratory features of HIV-associated nephropathy (HIVAN) was conducted at the Infectious Diseases Clinic of the University of Maiduguri Teaching Hospital, between April 2011 and September 2012. The subjects were evaluated with renal ultrasound scan and the observed abnormalities were recorded. Serum creatinine levels and CD4 + lymphocyte counts were also obtained for all the patients. Proteinuria was established by dipstick method. Results: Of the 100 cases studied, ultrasound showed enlarged kidneys in 28 patients (28%) and abnormal echogenicity was present in 192 kidneys (96%). 100 kidneys (50%) were globular, 160 kidneys (80%) had decreased corticomedullary definition, 90 kidneys (45%) had decreased renal sinus fat and 80 kidneys (40%) had heterogenous renal parenchymal patterns. A high serum creatinine level, increased degree of proteinuria, lower CD4 counts, reproductive age group and black race were associated with HIVAN. Conclusion: The severity of HIVAN as indicated by raised serum creatinine level and proteinuria correlated positively with the degree of renal echogenicity.

Nephroprotective effects of Feijoa Sellowiana leaves extract on renal injury induced by acute dose of ecstasy (MDMA) in mice.

Because of the high total phenolic contents of Feijoa sellowiana, its nephroprotective effect was determined in 3,4-methylene dioxymethamphetamine (MDMA) treated mice. Animals received 10, 20 and 40 mg/kg doses of aqueous or methanol extract of F. sellowiana leaves, intra-peritoneally. After one hour, an acute administration of MDMA (20 mg/kg, IP) was injected. Nephroprotective effect was assayed by determination of serum creatinine, serum urea and kidney glutathione level. Histopathological study was also used. Results : Both extracts at 40 mg/kg resulted in a significant reversal in the raised serum creatinine levels (P <0.05). Not statistically significant was observed in effect of two extracts (P>0.05). A decrease in urea/ creatinine ratio was observed following aqueous extract treatment. Methanolic extract showed higher activity in increasing kidney glutathione (P<0.001 compared to MDMA group). Methanol extract showed higher protective activity in histopathology study. F. sellowiana extract resulted in a markedly decrease in the nephrotoxicity of MDMA in mice.