Renal Parenchymal Disease Research Articles

Quantitative magnetic resonance imaging of chronic kidney disease: an experimental in vivo study using rat chronic kidney disease models.

Recent advances in magnetic resonance imaging (MRI) may allow it to be an alternative emerging tool for the non-invasive evaluation of renal parenchymal disease. To validate the usefulness of quantitative multiparametric MRI protocols and suggest the suitable quantitative MR sequence protocol to evaluate parenchymal fibrosis using an animal model of chronic kidney disease (CKD) by long-term adenine intake. In this prospective animal study, 16 male Wistar rats were analyzed and categorized into three groups. Rats in the CKD groups underwent 0.25% adenine administration for three or six weeks. Quantitative MRI protocols, including diffusion-weighted imaging (DWI), T1ρ (T1 rho), and T2* mapping were performed using a 9.4-T animal MR scanner. A semi-quantitative histopathologic analysis for renal fibrosis was conducted. Quantitative MR values measured from anatomic regions of kidneys underwent intergroup comparative analyses. The apparent diffusion coefficient (ADC) and T1 (T1 rho) values were significantly increased in all CKD groups. Values measured from the cortex and outer medulla showed significant intergroup differences. Total ADC values tended to increase according to periods, and T1ρ values increased in three weeks and decreased in six weeks. Quantitative MRI protocols could be a non-invasive assessment modality in the diagnosis and evaluation of CKD. Particularly, T1ρ may be a suitable MR sequence to quantitatively assess renal parenchymal fibrosis.

Pediatric hypertension based on Japanese Society of Hypertension Guidelines (JSH 2019) with actual school blood pressure screening data in Japan.

Blood pressure (BP) in children and adolescents is associated with their growth. BP is most strongly associated with height during height gain and with degree of obesity after reaching final height. BP in childhood and adolescence is correlated with BP in adulthood. The pathophysiology of pediatric essential hypertension is associated with obesity, excess salt intake, and a low birth weight. The common causes of pediatric secondary hypertension are renal parenchymal and renovascular diseases. The significance of diagnosing pediatric hypertension involves detecting secondary hypertension and preventing organ damage due to hypertension as well as tracking essential hypertension in adulthood. Appropriate BP measurement procedures are required for diagnosing pediatric hypertension. The inflatable bladder of an appropriately sized cuff should exceed 40% of the arm circumference. BP measurements should be performed consecutively at least 3 times using an appropriately sized cuff. The diagnosis of hypertension requires that all BP values measured on 3 or more occasions be above the reference value. The criteria for pediatric hypertension are determined based on the distribution of BP in healthy children and adolescents, with values above the 95th percentile of normal representing hypertension. Japanese criteria define pediatric hypertension as ≥120/70 mmHg for preschool children, ≥130/80 mmHg for 1st–3rd graders, ≥135/80 mmHg for 4th–6th graders, ≥140/85 mmHg for 7th–9th grade boys, ≥135/80 mmHg for 7th–9th grade girls, and ≥140/85 mmHg for senior high school boys and girls. The prevalence of Japanese pediatric hypertension was 0.9% based on proper measurement protocols. The basis of managing pediatric essential hypertension is healthy lifestyle modifications. Pharmacotherapy is indicated for persistent hypertension, symptomatic hypertension, secondary hypertension, the development of target organ damage, the presence of chronic kidney disease, and diabetes mellitus. Screening for pediatric hypertension is important; therefore, BP should be routinely measured in children and adolescents.

Comparison of Renal Segmental Artery Blood Flow on Doppler in Young Obese & Non Obese Individuals

Aim: To compare renal segmental artery blood flow on Doppler in young obese & non-obese individuals. Methodology: In University Ultrasound Clinic Green Town, Lahore, Pakistan, a comparative study was conducted. 180 patients of age group 16 to 25 were enrolled in this study with convenient sampling technique. All the obese & non-obese patients having no history of renal disease were included in this study. Hypertensive and diabetic patients were also included. Pregnant females having any renal parenchymal disease were excluded. Results: In 90 non-obese individuals the average mean of PI was .989±.249 while in 90 obese individuals the average mean of PI was .985±.338. No statistical difference between the two averages as p-value 0.928> α=0.05. Conclusion: Study concluded that no statistically significant difference between the average PI in non-obese individuals compared to the average of PI in obese individuals. Keywords: Obese, Renal segmental artery, Pulsatility Index (PI), Ultrasonography

P14 A case of myositis in patient with atypical bacterial pneumonia

Case report - IntroductionBacterial community-acquired atypical pneumonia is sometimes complicated by myositis or by renal parenchymal disease. They can present with myositis and present with muscle weakness, pain or swelling, and elevated muscle enzymes. We present the case of a patient with lower limb weakness and raised creatinine kinase with atypical pneumonia caused by Legionella pneumophila.Case report - Case descriptionA 76-year-old Caucasian man, who was previously fit and independent and walked 3 miles every day presented with a 1-week history of progressive leg weakness, and inability to mobilize. He had a fall and was on the floor for 2 hours. He had a background history of hypercholesterolemia and was on atorvastatin for 15 years. On his vital observation, he was found tachypnoeic, tachycardic, and hypoxic. He had a right upper lobe crackle but he didn’t have respiratory symptoms. His muscle power in his leg was 3/5 with carpet burns on knees and elbow. Initial investigation showed raised inflammatory marker CRP 412mg/L, AKI stage 1, and CK 43400 IU/L. His CXR showed dense right upper lobe consolidation. Legionella urinary antigen was positive. Myositis myoblot, ANA, ANCA negative. COVID-19 swab negative.Treated with IV antibiotic, supplemental oxygen, and IV fluid. Transferred to ITU due to worsening of hypoxia and kidney function. Interestingly, the CK level had improved significantly within 48 hours along with clinical improvement in his symptoms. There was no role of steroid or immunosuppressant due to his significant clinical improvement. On day 7 he was off oxygen, kidney function improved, had physiotherapy, and transferred to ward and on day 10 he was ambulant and discharged home.Case report - DiscussionTo date, very few case reports of myositis in a patient with atypical pneumonia have been reported. The mechanism underlying acute myositis in atypical pneumonia is still unknown. The present analysis points out that the organism underlying atypical bacterial pneumonia may occasionally invade the muscle tissue thereby inducing both myositis and secondary kidney damage.Case report - Key learning pointsWe should be aware of this rare complication of atypical pneumonia and the resolution of symptoms that occur with the treatment of pneumonia. This would avoid unnecessary investigation and use of steroid.

A clinico-pathological study of percutaneous renal biopsies in South-western region of Maharashtra

Introduction: Renal biopsy is the corner stone of diagnostics modalities in renal parenchymal disease and offers vital prognostic information for nephrologists. The present study was undertaken with a view to become familiar with the histological patterns of different renal lesions and their correlation with clinical manifestations, hematological and biochemical changes. Methods: This study includes 129 renal biopsies received in the Department of Pathology, Prakash institute of medical sciences and research over a period 3 years January 2017 to December 2019. In all the cases, percutaneous renal biopsy was done under local anesthesia. The technique used was that of Kark and Muehrcke via Wilms Silverman needle with Franklin's modification. Results: The commonest lesion observed was minimal change disease (31.87%). This was followed by acute glomerulonephritis (26.36%). Maximum number of cases were observed in second and third decade of life, together comprising about 70% of cases. Overall male preponderance was observed. The commonest cause of nephrotic syndrome was observed to be minimal change disease. Conclusion: Nephrotic syndrome is common in adults also as against the general belief. Minimal change disease and acute glomerulonephritis are the commonly observed lesions causing nephrotic syndrome in most of the cases.

Recent management of surgically correctable hypertension

Abstract Background Surgical hypertension is elevated blood pressure that results from an underlying, identifiable, often correctable cause. Obstructive sleep Apnea, Aldosteronism, presence of renal artery Bruits (suggesting renal artery stenosis), renal parenchymal disease (Bad kidneys), excess Catecholamines, Coarctation of the aorta, Cushing's syndrome, Drugs, Diet, polycythemia, and some neuroendocrine tumors. Objective To assess, through the available literature. The role of surgery in the management of endocrine, renal and vascular causes of hypertension and outcome benefits of surgery. Data Sources Medline databases (PubMed, Medscape, Science Direct. EMF-Portal) and all materials available in the Internet till 2018. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion Secondary hypertension may be due to underlying correctable cause. Diagnosis and surgical correction of the underlying cause may improve hypertension and improve life quality of the patient especially in young patients resistant to medical therapy for hypertension.

Renovascular Hypertension in Chronic Hemodialytic Patient

Background: Hypertension is a major contributor to the development of chronic kidney disease. Data in Indonesia, hypertension is still the most comorbid disease in CKD patients on dialysis (51%). Hypertension in CKD on dialysis patients is common and often uncontrolled. Renovascular hypertension is the most common cause of secondary hypertension. Diagnosis and treatment of RAS is very important, because it can accelerate the achievement of blood pressure targets, reduce the risk and complications due to hypertension.
 Case Report: A 52-year-old woman with CKD has been undergoing hemodialysis for 2 years. Hypertension that was previously well controlled for 2 years required an increase in antihypertensive therapy from 2 to 4 drugs in recent months. On physical examination the blood pressure 180/90 mmHg, pulse 79 bpm, respiration 20/min, temperature 36.7oC. Conjunctiva looks anemic, cardiomegaly, lungs within normal limits, no ascites and edema in the extremities. On renal artery duplex ultrasound examination, right main renal artery acceleration time 147.65 ms, Peak Systolic Velocity (PSV) 31.9 cm/s. RI 0.69 and left main renal artery acceleration time 120.81 ms, PSV 16.9 cm/s, RI 0.61. There was 20-30% left renal artery stenosis, 80% right renal artery stenosis. A stent was placed on the right renal artery. The patient's condition after PTRA improved, but at the next follow-up, mean systole and diastole 170 mmHg and 80 mmHg, respectively. Patient received 4 antihypertensive therapy.
 Conclusion: Renal artery stenosis is a disease that consists of a broad spectrum of different entities with different pathophysiologies that require varied approaches to diagnose and treat. Current diagnostic tools include MRA, CTA and renal artery duplex ultrasonography. Patients with renal parenchymal disease are poorer candidates for revascularization.

Relationship between renal ultrasonographic, CD4 cell count and proteinuria findings in HIV infected adult patients in Jos, Nigeria

This study intends to describe renal sonographic outcomes in matured patients with HIV/AIDS in Plateau State capital Jos and relate the outcome with proteinuria and the subjects’ CD4 cell count. The 504 subjects were evaluated for renal ultrasound scan, CD4 cell counts and dipstick proteinuria (using Combi 10 Urinalysis strips) were obtained, and their findings recorded. Twenty-four (4.8%) of the patients had abnormal renal sonographic findings while 480 (95.2%) had normal findings. Sixteen (3.2%) out of the 24 patients with abnormal renal ultrasound had enlarged kidneys, 24 (4.8%) patients had increased renal echogenicity while 19 (3.8%) had loss of corticomedullary differentiation. One (0.2%) patient was observed to have a globular kidney. Significant proteinuria was observed in all the 24 (4.8%) patients with abnormal renal sonographic findings to suggest HIV-associated nephropathy (HIVAN) while the remaining 480 (95.2%) patients had no significant proteinuria. Hence, the prevalence of HIVAN in this study was 4.8%. Kidney size, renal echogenicity and corticomedullary differentiation correlated significantly with proteinuria count with P-values of 0.05, r = 0.084) and between corticomedullary differentiation and CD4 cell amount (p >0.05, r = 0.049). Sonographically based determination of renal size and echogenicity/echopattern combined with proteinuria are good determinants of renal parenchymal disease and may have diagnostic usefulness as a non-invasive procedure in the identification of HIVAN in HIV-positive subjects with renal disease. Key words: HIV, AIDS, HIV-associated nephropathy, kidneys, ultrasonography, proteinuria.

Analysis of profibrogenic microRNAs (miRNAs) expression in urine and serum of chronic kidney disease (CKD) stage 1\u20134 patients and their relationship with proteinuria and kidney function

PurposeBesides conventional kidney diseases diagnostics, micro RNAs (miRNAs) assessment in urine and serum is considered to be a promising non-invasive method of diagnostics of renal parenchymal diseases and valuable therapeutic target also. The purpose of the study was to investigate the role of several miRNAs as a markers of kidney damage.MethodsAssessment of 45 chronic kidney disease (CKD) patients stage 1–4 and 17 healthy control. Sample of urine and blood was taken from each participant for molecular analysis using Real Time PCR method to identify such micro-RNAs as: hsa-miR-155-5p, hsa-miR-214-3p, hsa-miR-200a-5p, hsa-miR-29a-5p, hsa-miR-21-5p, hsa-miR-93-5p, and hsa-miR-196a-5p. Basic biochemical test was done. Analysis was performed in CKD patients group and subgroup with chronic glomerulonephritis (CGN) confirmed by kidney biopsy. Moreover, analysis was performed in subgroup with different estimated glomerular filtration rate (eGFR) (according to CKD–EPI equation: eGFR < 60 ml/min, eGFR > 60 ml/min) and different daily protein excretion (DPE): (DPE < 3.5 g; DPE > 3.5 g).ResultsIncreased relative expression of hsa-miR-29-5p, hsa-miR-21-5p, and hsa-miR-196a-5p and decreased expression of hsa-miR-155-5p, hsa-miR-214-5p, hsa-miR-200a-5p, and hsa-miR-93-5p was demonstrated in urine of analyzed CKD patients. In subpopulation of chronic glomerulonephritis (CGN) patients, there was higher level of expression in urine of hsa-miR-155-5p, hsa-miR 214-3p, hsa-miR-93-5p, and hsa-miR-196a-5p in CGN with DPE < 3.5 g. CGN patients with eGFR < 60 ml/min showed higher expression level of miRNAs such as hsa-miR-214-3p, hsa-miR-29-5p, hsa-miR-93-5p, and hsa-miR-196-5p in urine. There was increase in hsa-miR 155-5p, hsa-miR-214-3p, and hsa-miR-200a-5p serum expression level in CKD population and reduction of hsa-miR-29a-5p, hsa-miR-21-5p, and hsa-miR-93-5p expression. Increased level of expression of hsa-miR-155-5p; hsa-miR-214-3p, hsa-miR-200a-5p, and hsa-miR-29-5p was found in CGN patients with eGFR > 60 ml/min.ConclusionIncreased relative expression of profibrogenic miRNAs in urine or serum of CKD patients with eGFR > 60 ml/min and DPE < 3.5 g may indicate higher degree of fibrosis at early CKD stages.

Trends in cause-related comorbidities in hospitalized patients with secondary hypertension in China from 2013 to 2016: a retrospective analysis of hospital quality monitoring system data.

Background:Secondary hypertension has emerged as a major public health problem in China. Early diagnosis and treatment can significantly improve the clinical outcomes. However, data on the current cause composition in China are seldom reported.Objective:To describe the trends in cause-related comorbidities in hospitalized patients with secondary hypertension in China from 2013 to 2016.Methods:This was a retrospective analysis based on the national Hospital Quality Monitoring System (HQMS) database, which collects information from the front pages of in-hospital medical records. Hospitalized patients with secondary hypertension from 746 tertiary hospitals that consistently uploaded data to the HQMS from 2013 to 2016 were enrolled. All diagnoses were identified using International Classification of Diseases version 10 (ICD-10) diagnostic codes. Descriptive analyses were used to determine the proportions of secondary hypertension causes and changing trends over 4 years.Result:The study collected data on 402 371 hospitalized patients with secondary hypertension from the HQMS during 2013–2016. Secondary hypertension caused by renal parenchymal disease ranked first and accounted for more than 50%. Obstructive sleep apnea syndrome (OSAS) followed closely with a rate of approximately 25%. Primary aldosteronism presented the highest proportion among all causes of endocrine hypertension. Regarding longitudinal changes over time, the rates of renal hypertension showed a significant downward trend from 2013 to 2016 (P < 0.001). In contrast, OSAS, endocrine hypertension, renal vascular disease, and aorta diseases maintained a significant upward trend from 2013 to 2016 (P < 0.001). The rates of these diseases in women with common secondary hypertension was higher than that of men, except in patients with OSAS (P < 0.001). In addition, renal parenchymal diseases and renal vascular diseases gradually decreased with age, whereas OSAS and aortic diseases gradually increased with age. The proportion of endocrine hypertension in the middle-aged group was higher than the other two age groups.Conclusion:The study provides important information on the changing trends of cause rate of secondary hypertension modified by age and sex in China during 2013–2016. Renal parenchymal disease is still the most common cause of secondary hypertension with a decreasing trend, followed by OSAS with an increasing trend.

PREVALENCE AND PREDICTION OF SECONDARY HYPERTENSION IN YOUNG MALE MILITARY PERSONNEL

Abstract Objective: Current guidelines suggest screening for secondary causes in the early onset of hypertension (HTN) before 30 years. However, there have been few studies on secondary HTN in young adults. We aimed to investigate the prevalence and predictors of secondary HTN in young male military personnel. Design and method: This study used data from the Defense Medical Information System (DEMIS) database between January 2011 and June 2017. Of 6373 hypertensive males (19–29 years) from 19 military hospitals in South Korea, we comprehensively reviewed the medical records of 638 cases with any diagnosis associated with secondary HTN. Results: Secondary HTN was confirmed only in 140 subjects (2.2%) as a final diagnosis through detailed chart review. The most common causes were polycystic kidney disease (0.74%) and renal parenchymal diseases (0.38%). Other endocrinologic causes were very rare. The independent predictors for secondary HTN were abnormal thyroid function test (odds ratio [OR], 9.50; 95% confidence interval [CI], 4.84 to 19.45; P &lt; 0.001), proteinuria (&gt; trace) (OR, 6.13; 95% CI, 2.97 to 12.99, P &lt; 0.001), hematuria (&gt; trace) (OR, 4.37; 95% CI, 2.15 to 9.01; P &lt; 0.001), severe HTN (&gt;180/110 mmHg) (OR, 3.07; 95% CI, 1.42 to 6.65; P = 0.004), and overweight (body mass index &gt; 23 kg/m2) (OR, 0.33; 95% CI, 0.19 to 0.59; P &lt; 0.001). However, there were no significant differences in the family history of HTN, headache, total cholesterol level and diabetic state between primary and secondary HTN. Conclusions: Secondary HTN is very rare in young male military personnel. To ensure cost-effectiveness, screening for secondary HTN should be performed selectively considering various predictive factors.

BILATERAL RENAL ARTERY EMBOLIZATION IN END-STAGE RENAL DISEASE AND RESISTANT HYPERTENSION

Objective: Some patients with end-stage renal disease present with resistant or refractory arterial hypertension despite dialysis and use of multiple antihypertensive drugs. Renal artery embolization is a rarely used minimally invasive interventional procedure which may provide improved blood pressure (BP) control in chronic renal parenchymal disease by eliminating renal function while avoiding the morbidity and mortality of a nephrectomy. Design and method: A 44-year old white male with chronic glomerulonephritis and stage 5 chronic kidney disease undergoing regular dialysis treatment was referred for refractory arterial hypertension. Despite treatment by 7 antihypertensive drugs and good therapeutic adherence his office and ambulatory BP remained very high. Plasma renin was markedly elevated and CT angiography found diffuse atherosclerotic changes of renal arteries. Sequential catheter-based renal artery embolization with application of a tissue glue was indicated. Results: In September 2019, catheter based embolization of right renal artery was performed in analgosedation, followed by the embolization of the left renal artery two weeks later. Because of the rapid antihypertensive effect of the procedure, antihypertensive medications were reduced at the time of the left-sided procedure (from 9 to 6 defined daily doses). One month after the renal artery embolization, despite reduced medication, office BP decreased from baseline 170/106 mmHg by 57/22 mmHg. Mean 24-hour, day-time and night-time ambulatory BP was reduced by 15/11 mmHg, 14/11 and 34/15 mmHg, respectively. The patient reported prolonged flank pain lasting approximately one week after the embolization, which responded well to conventional analgesics. Conclusions: Renal artery embolization lead to a marked improvement of BP control in a patient with end-stage renal disease, refractory arterial hypertension and high plasma renin. Further studies are warranted to assess the efficacy and safety of renal artery embolization in such patients.

Non-invasive Assessment of Subclinical Renal Parenchymal Changes in Chronic Hepatitis B Virus By T1 Mapping Magnetic Resonance Imaging.

Background:Renal parenchymal changes are seen in chronic hepatitis B virus (HBV) infection, and its disease diagnosis should be confirmed by renal biopsy, which is an invasive technique. Apparent-T1 mapping magnetic resonance imaging (MRI) is an established imaging technique that assesses subclinical tissue injury without using a contrast agent.Aims:To investigate the early stage subclinical renal changes without apparent renal dysfunction in patients with chronic HBV infection by renal apparent-T1 mapping MRI.Study Design:A cross-sectional study.Methods:This study included 45 participants with normal kidney function, wherein 25 have biopsy-proven chronic HBV hepatitis and 20 are healthy individuals. Liver and kidney biochemical tests were performed within 1 month before the MRI scan, and the estimated glomerular filtration rate was calculated by diet modification in renal disease formula. Breath-hold, electrocardiogram-gated Modified Look-Locker Imaging sequence was acquired in the coronal plane without contrast agent administration. Apparent-T1 mapping value was measured by manually drawing a region of interest in six points for both kidneys by two observers. Apparent-T1 mapping values were compared between the two groups.Results:The mean apparent-T1 mapping values of the kidneys were significantly higher in patients with chronic HBV infection compared to the control group (1445 ± 129 ms vs. 1306 ± 115 ms, P = 0.003). Inter-class correlation coefficient measurement analysis showed excellent agreement.Conclusion:Renal apparent-T1 mapping MRI may help show the early stage of renal parenchymal disease without apparent renal dysfunction in chronic HBV infection.

Radionuclide Renogram Findings in Different Kidney Diseases Referred to Institute of Nuclear Medicine and Allied Science (INMAS)

Renal function evaluation with the use of radio nuclide scanning is a very helpful technique. Renogram is a routine procedure in the Institute of Nuclear Medicine and Allied Sciences (INMAS), Sylhet. This is a tertiary referral hospital to north east part of the country. The aim of this study was to analyze the renal disease pattern and outcome of diuretic renogram of different types of renal diseases. This retrospective study was conducted among 223 patients who underwent 99mTc-DTPA renogram from February to October 2018 in INMAS, Sylhet. Mean age of the patients was 30.04 ± 18.52 year with age range 1 to 80 years, male to female ratio 1.5:1. USG. Clinical information and other adjuvant findings along with the ultrasound findings were collected to categorize the study subject. Most common indication for the renogram was hydronephrosis (HDN) 80.27%, followed by smaller kidney 7.17%, renal parenchymal disease 3.14%, nephrolithiasis 3.14% and others (renal cysts and renal artery stenosis). The mean and standard deviation of serum creatinine was 0.9 ± 0.51, range from 0.30 to 4.50. Among the 179 HDN patients, mild, moderate and severe cases were 37 (20.7%), 44 (24.6%) and 81 (45.3%) respectively. Most common site of involvement was left kidney (n=90, 41.3%), followed by both kidneys (n=67, 30.7%). Overall renographic findings showed obstructive disease in 144 (66.05%) patients and non- obstructive disease in 74 (33.94%) patients. It concluded that isotope renogram is very important in the evaluation of renal function especially differentiate between obstructive from non-obstructive pathology.&#x0D; Bangladesh Med J. 2021 January; 50(1) : 10-14

Hypertension in children

Hypertension in children and adolescents is a major health condition that clinicians frequently overlook. Children should have their blood pressure checked annually beginning at the age of 3, or at each visit if risk factors are present. Secondary etiologies of hypertension are more common in children than adults, with renal parenchymal and renovascular disease being the most common. In youngsters, overweight and obesity are highly associated with primary hypertension. All children newly diagnosed with hypertension should have a history and physical examination to rule out any underlying medical conditions. Other risk factors for cardiovascular disease, such as diabetes mellitus and hyperlipidemia, should be examined in children with hypertension, and a retinal examination and echocardiography should be performed to assess for target organ damage. In children with hypertension, lifestyle adjustments such as weight loss if they are overweight or obese, a nutritious diet, and regular exercise are initially used to address the condition. Children with stage 2 hypertension without a modifiable factor such as obesity, evidence of left ventricular hypertrophy on echocardiography, any stage of hypertension associated with chronic kidney disease, or persistent hypertension despite a trial of lifestyle modifications are more likely to require antihypertensive medications. Angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and thiazide diuretics (thiazide diuretics) are all efficacious, safe, and well tolerated in children.

Does diffusion-weighted magnetic resonance imaging help in the detection of renal parenchymal disease and staging/prognostication in chronic kidney disease?

PurposeDiffusion-weighted imaging (DWI) in renal diseases is an upcoming modality, and its utility as an additional marker is yet to be proven. This study was intended to find the relationship between apparent diffusion coefficient (ADC) values with renal function tests and stages of chronic kidney disease (CKD) to assess renal dysfunction, and to label a cut-off for normal renal function and dysfunction.Material and methodsA prospective diagnostic study was conducted on 120 patients: 60 with deranged renal function tests (RFT) and 60 with normal RFT. DWI using a 1.5-Tesla MRI (at b-values of 0 and 500 s/mm2) was done. A region of interest of size 1-2 cm2 was placed on renal parenchyma in the region of medulla, one each, over the superior, mid, and lower regions of each kidney separately. ADC values were recorded for renal parenchyma and compared.ResultsIn patients with renal dysfunction ADC values were significantly lower than in patients with normal function (1.75 ± 0.25 vs. 2.28 ± 0.21 of right kidney and 1.79 ± 0.17 vs. 2.29 ± 0.21 of left kidney [×10−3 mm2/s]; p = 0.001). ADC values of different stages of CKD showed a decreasing trend with increasing stage.ConclusionsADC values taken at all poles to get focal involvement of the kidney can be used to measure each kidney separately, and values can be individually correlated with the elevated renal parameters. The cut-off value of the mean ADC for individual kidneys was > 2.28 (×10−3 mm2/s) in normal renal function and < 2.00 (×10−3 mm2/s) in renal dysfunction.

Myositis and acute kidney injury in bacterial atypical pneumonia: Systematic literature review

BackgroundBacterial community-acquired atypical pneumonia is sometimes complicated by a myositis or by a renal parenchymal disease. Available reviews do not mention the concurrent occurrence of both myositis and acute kidney injury. MethodsIn order to characterize the link between bacterial community-acquired atypical pneumonia and both myositis and a renal parenchymal disease, we reviewed the literature (United States National Library of Medicine and Excerpta Medica databases). ResultsWe identified 42 previously healthy subjects (35 males and 7 females aged from 2 to 76, median 42 years) with a bacterial atypical pneumonia associated both with myositis (muscle pain and creatine kinase ≥5 times the upper limit of normal) and acute kidney injury (increase in creatinine to ≥1.5 times baseline or increase by ≥27 μmol/L above the upper limit of normal). Thirty-six cases were caused by Legionella species (N = 27) and by Mycoplasma pneumoniae (N = 9). Further germs accounted for the remaining 6 cases. The vast majority of cases (N = 36) presented a diffuse myalgia. Only a minority of cases (N = 3) were affected by a calf myositis. The diagnosis of rhabdomyolysis-associated kidney injury was retained in 37 and that of acute interstitial nephritis in the remaining 5 cases. ConclusionBacterial atypical pneumonia may occasionally induce myositis and secondary kidney damage.

Metoprolol-induced hyperkalemia – A case report

Hyperkalemia is a condition that increased serum potassium levels, which can lead to life-threatening cardiac conditions. A 59-year-old female patient admitted to an emergency medicine ward with complaints of gradually progressive retrosternal chest pain. She was a known case of diabetes mellitus (DM), hypertension, and ischemic heart disease with a positive family history of DM and hypertension. She has treated with tablet metoprolol 12.5 mg twice daily from 20 days. On examination, the patient was restless due to unstable angina BP in the range of 110/70–180/90 mm of Hg, PR range 84–86 bpm, and SPO2 – 98%. Laboratory investigation revealed that the HbA1c was 7.19, and mean blood glucose of the past 90 days was in average control. Ultrasonography shows the Grade I renal parenchymal disease. The serum blood sugar level was elevated. Serum troponin I was 0.91 ng/ml. Ultrasonography abdomen was normal. Electro cardiogram: Sinus tachycardia suspected left inferior hemiblock, poor R-wave progression, inverted T- wave, and slide ST segments elevation and 2D-echocardiogram: IHD and RWMA at rest (basal inferior moderate left ventricle dysfunction). On hospital admission, the patient was treated with antiplatelet agents, anticoagulant, insulin, anti-ischemic agents, hypolipidemic agents, and potassium binder resins and diuretics. Patients with diabetes and kidney dysfunction have a higher risk of hyperkalemia in concomitants therapy with beta-blockers, so the health care workers should be aware of life-threatening events due to hyperkalemia secondary to beta-blockers. This case-report adds the evidence on the electrolyte related adverse drug reactions due to the beta-blockers.

Screening of Secondary Hypertension in Private Clinic in Karachi, Pakistan: A Randomised Study

Hypertension hasbeen recognized as aglobalhealth concern fordeveloping countries.Secondary hypertension(SH)including endocrine hypertension has been reported to be uncommon and is scarcely described in many of these countries. There is no current nationally representative study. Therefore, we estimated the prevalence of SH among hypertensive patients in private clinic by screening. The goal of the cross-sectional study conducted from May 2017to June2018 was to estimate the prevalence of hypertension inPakistani population based on data collected fromthe screening held at private clinic inKarachi. From the initial screening of 566 patients, we suspected 437 (M:187), (F:250) patients to have secondary hypertension and conducted tests for the cause of hypertension, measured plasma aldosterone concentration, plasma renin activity, serum cortisolconcentrationandplasmacatecholamine concentration.Asasecondary screening,wereferredpatientsforfurosemide plus upright test, captopril renography, dexamethasone suppression test, abdominal ultrasonography (US), abdominal CT. and arteriography investigations. These tests clearly demonstrated that the prevalence of Secondary Hypertension was 8.1% among 437 patients investigated. 42 were found to have Renal parenchymal disease; 25 were having Acute Renal Failure; 15 patients had Calculi; 29 patients had chronic glomerulonephritis leading to CRF and 3 had reno vascular hypertension. Further, 2 cases with aortic coarctation were found on arteriography; 1 patient had primary aldosteronism; 5 had primary hyperparathyroidism; 6 patients had hyperthyroidism and 11 had Hypothyroidism. In seven cases of hydronephrosis (two known and five newly detected) we could not determine whether the hypertension was caused by the hydronephrosis. The prevalence of curable SH among hypertensive subjects was higher in this screening study, conducted in majority of cases with simple tests. The rates of blood pressure screening in Pakistan are worryingly low; the underlying disease in hypertensive patientsshould be treated appropriately to avoid long-term use of antihypertensive drugs and risks of atherosclerotic complication. This calls for the establishment of a nationwide program on screening to improve detection, awareness and treatment of hypertension.

An Evaluation of Abdominal Manifestations by Ultrasonography in Immunodeficiency Patients

Introduction: The major target of HIV is the immune system and the abdominal pathologies are second most commonly found in patients of AIDS after pulmonary manifestations. These abdominal manifestations are on increase may be due to immunocompromised status of these patients and due to antiretroviral therapy which has increased life expectancy in these patients. Purpose of this study is to describe abdominal findings and to evaluate clinical utility of USG in HIV patients with the use of abdominal probe, high frequency probe and Color Doppler USG. Methods: This Retrospective Analytical study involved 60 randomly selected HIV patients attending to Local ART Units . Prior Consent was obtained from Local ART Centre to see the records of the patients from there MRD .Patients of all age groups and both sex having cataract were included in the study Results: This study includes 60 HIV patients, 37 patients were male and 23 patients were female. Age group studied was 20 yrs to 65 yrs referred from ART Department . Most prevalent age group was from 40 - 49 yrs that was 23 patients, next was 30 - 39 yrs i.e. 20 patients, third in declining order was 20 - 29 yrs i.e. 12 patients and less prevalent age groups were from 50 - 59 yrs and above 60 - 70 yrs. These patients had diverse abdominal findings. Out of 60 patients 3 had no abdominal findings. Hepatomegaly was found in 33 patients, fatty hepatic changes in 14 patients and in one case there was Hepatic abscess. Lymphadenopathy was found in 28 cases. Splenomegaly was found in 20 cases and in 6 cases there were also having splenic abscesses. Ascites was found in 12 cases it was septated and non septated ascites. Cholecystitis in 4 cases. Bowel wall thickening in 5 cases in most of cases it was thickening of ileum and Ileocaecal junction thickening. Other findings were renal parenchymal disease in 2 cases, Bulky pancreas in 2 cases, cervicitis in 2 cases, one case each of cystitis and pyocele. Testicular abscess in 2 cases and gluteal abscess in one case along with other abdominal findings. Many patients had two or more pathologies. Conclusion: AIDS is multisystem disease but its demographic and clinical pattern remains same globally. USG is optimally suited for its clinical management especially in developing countries like India. Results of sonographically evaluated cases of abdominal findings are comparable to other diagnostic modalities like CT scan. The ease of availability, diagnostic accuracy of USG and its affordable cost and interventional and follow up advantages makes USG first choice of investigation for evaluation of abdominal findings. Clinico-pathological correlations can further increase its diagnostic accuracy.