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Online since Friday, January 22, 2010
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Approach to urinary tract infections p. 129
MS Najar, CL Saldanha, KA Banday
DOI:10.4103/0971-4065.59333 PMID:20535247
Urinary tract infection (UTI) is the most common infection experienced by humans after respiratory and gastro-intestinal infections, and also the most common cause of both community-acquired and nosocomial infections for patients admitted to hospitals. For better management and prognosis, it is mandatory to know the possible site of infection, whether the infection is uncomplicated or complicated, re-infection or relapse, or treatment failure and its pathogenesis and risk factors. Asymptomatic bacteriuria is common in certain age groups and has different connotations. It needs to be treated and completely cured in pregnant women and preschool children. Reflux nephropathy in children could result in chronic kidney disease; otherwise, urinary tract infections do not play a major role in the pathogenesis of end-stage renal disease. Symptomatic urinary tract infections occur most commonly in women of child-bearing age. Cystitis predominates, but needs to be distinguished from acute urethral syndrome that affects both sexes and has a different management plan than UTIs. The prostatitis symptoms are much more common than bacterial prostatic infections. The treatment needs to be prolonged in bacterial prostatitis and as cure rates are not very high and relapses are common, the classification of prostatitis needs to be understood. The consensus conference convened by National Institute of Health added two more groups of patients, namely, chronic prostatitis/chronic pelvic pain syndrome and asymptomatic inflammatory prostatitis, in addition to acute and chronic bacterial prostatitis. Although white blood cells in urine signify inflammation, they do not always signify UTI. Quantitative cultures of urine provide definitive evidence of UTI. Imaging studies should be done 3-6 weeks after cure of acute infection to identify abnormalities predisposing to infection or renal damage or which may affect management. Treatment of cystitis in women should be a three-day course and if symptoms are prolonged, then a seven day course of antibiotics should be given. Selected group of patients benefits from low-dose prophylactic therapy. Upper urinary tract infection may need in-patient treatment. Treatment of acute prostatitis is 30-day therapy of appropriate antibiotics and for chronic bacterial prostatitis a low dose therapy for 6-12 months may be required. It should be noted that no attempt should be made to eradicate infection unless foreign bodies such as stones and catheters are removed and correctable urological abnormalities are taken care of. Treatment under such circumstances can result only in the emergence of resistant organisms and complicate therapy further.
Onion (Allium cepa) extract prevents cadmium induced renal dysfunction p. 140
SF Ige, EO Salawu, SB Olaleye, OA Adeeyo, J Badmus, AA Adeleke
Cadmium (Cd), a heavy metal, is known for its adverse effects on the body. In this study, the lowering effect of Cd on renal clearance (RC) was investigated, and Allium cepa extract (AcE) (an antioxidant) was pre-administered orally to prevent Cd's adverse effects. Seventy-two Wistar rats, grouped into three (n=24), were used for this study. While Group C was given 1.0 ml of AcE daily (orally), Group A and Group B were given distilled water. AcE administration was done for eight weeks. Afterwards B and C were then given 1.5 ml/kg BW of 0.3 mg/L 3CdSO 4 .8H 2 O intraperitoneally for three consecutive days. The results obtained showed that Cd causes significant reduction in the 24 hour urine volume (from 3.017±0.125 to 2.433±0.118 ml), RC (from 3.258 ±0.114 to 1.357±0.104 ml/h for creatinine; and from 0.350±0.057 to 0.185±0.055 ml/h for urea), plasma and tissue SOD and CAT activity (form 1.644±0.036 to 1.307±0.056 u/g protein for plasma SOD; 0.391±0.029 to 0.2692±0.031 u/protein for plasma CAT; 1.695±0.034 to 1.327±0.049 u/g protein for tissues SOD; and from 0.350±0.027 to 0.273±0.043 u for tissue CAT), and significant MDA increased in plasma (from 1496.79±1.321 to 1679.48±143.29 mg/g protein) and tissue (from 1265.22±2.285 to 1669.87±14.61 mg/dL). AcE, however, prevents these Cd's adverse effects. This findings lead to the conclusion Cd exposure causes renal dysfunction, but oral administration of onion could prevent it.
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Angiotensin converting enzyme gene polymorphism in type II diabetics with nephropathy p. 145
VVS Naresh, ALK Reddy, G Sivaramakrishna, PVGK Sharma, RV Vardhan, V Siva Kumar
Nephropathy is an important and a frequent complication of long-term type II diabetic nephropathy. Strong evidence exists that genetic predisposition plays a major role in the development of diabetic nephropathy. Recent studies have implicated association between angiotensin converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism and nephropathy. The deletion gene polymorphism of ACE gene has been shown to be associated with increased activity of this enzyme. This study examines the association of ACE I/D polymorphism with type II diabetes without nephropathy in 30 patients and type II diabetes with nephropathy in 30 patients. The results of the study suggest the association between the DD polymorphism and type II diabetes with nephropathy.
Outcomes of two different polytetrafluoroethylene graft sizes in patients undergoing maintenance hemodialysis p. 149
R Afshar, S Sanavi, S Afshin-Majd, A Davati
Arteriovenous access creation is mandatory for maintenance hemodialysis. If native fistula placement was not possible or failed, a prosthetic conduit would be the best substitute. The purpose of this prospective study was to compare outcomes of two different sizes of polytetrafluoroethylene (PTFE) grafts, in hemodialysis patients, at the Mustafa Khomeini Hospital in Iran. The study population consisted of 586 end-stage renal disease referrals for vascular access construction (January 2003 to January 2007) of which eventually 102 subjects were candidates for PTFE graft who were followed for one year. Data were collected by a questionnaire and analyzed using the SPSS, life table, Kaplan- Meier and Log-Rank tests. Out of 102 PTFE implantation candidates (mean value of age 51.7 ± 17.06 yrs), 56% were male and 44% female. PTFE grafts of 8 mm and 6 mm sizes were randomly placed in 57 and 45 subjects, with distribution of 83%, 12% and 5% in arm, forearm and thigh. The most underlying diseases were hypertension and diabetes. There was a significant difference in complication rates between patients with and without underlying diseases [42% vs. 10% ( P = 0.03)]. One-year patency rates were 42.2% and 36.5% for 6 mm and 8 mm grafts and 28.2% vs. 52% in patients with and without underlying diseases respectively. Despite more complication frequency in 8 mm grafts, the patency and complication rates of two graft groups did not significantly differ. Hypertension and diabetes could have contributory roles in graft complication rate, which may be preventable. Non-tapered grafts of 6 mm and 8 mm sizes have not significant different outcomes. Further research is recommended with larger sample size and longer duration.
Hypertension and hyperparathyroidism are associated with left ventricular hypertrophy in patients on hemodialysis p. 153
N Al-Hilali, N Hussain, AI Ataia, M Al-Azmi, B Al-Helal, KV Johny
Conflicting data for association between left ventricular hypertrophy (LVH) and secondary hyperparathyroidism has been reported previously among dialysis patients. The present study was conducted to evaluate the association of hyperparathyroidism and hypertension with LVH. Charts of 130 patients on hemodialysis for at least six months were reviewed. All were subjected to M-mode echocardiography. Left ventricular mass (LVM) was calculated by Devereux's formula. LVM Index (LVMI) was calculated by dividing LVM by body surface area. Sera were analyzed for intact parathyroid hormone (iPTH). iPTH of > 32 pmol/l and a mean blood pressure (MAP) of > 107 mmHg were considered high. Patients were stratified into groups according to their MAP and iPTH. A total of (47.7%) patients were males and 68 (52.3%) were females. Their median age was 57 years. The median duration on dialysis was 26 months. Forty eight (36.9%) patients had high BP and 54 (41.5%) had high iPTH. Both high BP and high iPTH were present in 38 (29.2%) patients. Analysis of the relationship between LVM, LVMI, MAP and iPTH showed that LVM and LVMI were significantly ( P< 0.001) higher in patients with concomitant high BP and high iPTH. LVMI was significantly higher in patients with high iPTH alone. Concomitant high iPTH and high MAP increase the risk of LVH in hemodialysis patients. High iPTH alone might contribute in escalating LVH. Adequate control of hypertension and hyperparathyroidism might reduce the risk of developing LVH.
Herbal vaginal pessary induced acute renal failure p. 158
UR Onyemekeihia, CO Esume, CO Oladele, E Oviasu
In Africa, the use of traditional herbal remedy is widespread. Acute renal failure (ARF) is one of the most serious complications. The use of herbal remedies (mostly orally) accounts for nearly 35% of all cases of acute renal failure in Africa. Development of renal failure following herbal vaginal pessary is rarely reported. In November 2003, a 35-year-old Nigerian female who is a petty trader and a primary school leaver with three children (all males) presented to us in the renal unit with oliguric ARF induced by herbal vaginal pessary. She had sought this alternative medicine in an attempt to have a female child as all her three children are males. Her condition was managed accordingly and required three sessions of hemodialysis. She started diuresing on the eighth day of admission. This case presentation highlights the potential tragedies of herbal preparation, of note, that herbal vaginal pessaries are as deleterious as the oral preparations, and that the dilemma of ignorance is still prevalent in our society.
Acute renal failure following consumption of fish gall bladder p. 161
PC Bhattacharyya, M Nayak, A Barkataky
A case of acute renal failure developing after consumption of fish gall bladder as a food item is reported. The patient recovered fully with conservative treatment and dialysis. The risk of acute kidney injury following ingestion of fish gall bladder, apparently for medical reasons is highlighted.
Hypophosphatemic rickets due to Dent's disease: A case report and review of literature p. 163
RA Annigeri, R Rajagopalan
We report a case of rickets due to Dent's disease in a two-year-old boy. He was treated with sodium phosphate, calcitriol and potassium citrate supplements, following which there was a remarkable improvement in mobility, growth and bony deformities. The hypercalciuria associated with Dent's disease was effectively corrected using hydrochlorothiazide.
Successful en bloc transplantation of pediatric deceased donor kidneys with grade 1 injury p. 167
P Modi, SJ Rizvi, HL Trivedi
Kidney transplantation from deceased donors is in its infancy in India. Marginal donors are now accepted by many centers for kidney transplantation. We report a case of procurement of en bloc kidneys from a pediatric deceased donor having grade 1 renal injury and transplanted to an adult recipient with a follow up of two years and five months.
Page kidney p. 170
A Mathew, B Brahmbhatt, R Rajesh, G Kurian, VN Unni
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Prevalence and association of hepatitis C viremia in hemodialysis patients at a tertiary care hospital p. 172
SK Agarwal
Authors' reply p. 173
S Jasuja, AK Gupta, R Choudhry, V Kher, DK Aggarwal, A Mishra, M Agarwal, A Sarin, MK Mishra, V Raina
Microalbuminuria and BMI p. 174
V Wiwanitkit
Reply to 'kidney transplantation in a patient with HIV disease' p. 175
SB Bansal, M Singhal, R Ahlawat, V Kher
Acute renal failure and neurological manifestations following ingestion of wild mushrooms p. 175
F Frantzeskaki, M Theodorakopoulou, I Mavrou, A Armaganidis