Dermatoglyphics in kidney diseases: a review.

Kidney diseases are becoming a major cause of global burden with high mortality and morbidity. The origins of most kidney diseases are known, but for some the exact aetiology is not yet understood. Dermatoglyphics is the scientific study of epidermal ridge patterns and it has been used as a non-invasive diagnostic tool to detect or predict different medical conditions that have foetal origin. However, there have been a limited number of studies that have evaluated a dermatoglyphic relationship in different kidney diseases. The aim of this review was to systematically identify, review and appraise available literature that evaluated an association of different dermatoglyphic variables with kidney diseases. This review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The PubMed(®) (Medline), POPLINE, Cochrane Library and Trip Database and grey literature sources such as OpenGrey, Google Scholar, and Google were searched to earliest date to 17 April 2014. Of the 36 relevant publications, 15 were included in the review. Of these studies, there are five case reports, seven case series and three comparative studies. Possible association of dermatoglyphics with Wilms tumor (WT) had been evaluated in two comparative studies and one case series that found fewer whorls and a lower mean total ridge count (TRC). Another study evaluated adult polycystic kidney disease (APCD) type III that revealed lower TRC means in all cases. All other case series and case reports describe dermatoglyphics in various kidney disease such as acro-renal-ocular syndrome, potter syndrome, kabuki makeup syndrome, neurofaciodigitorenal syndrome, syndactyly type V, ring chromosome 13 syndrome, trisomy 13 syndrome and sirenomelia. It is evident that whorl pattern frequency and TRC have been used widely to investigate the uncertainty related to the origin of several kidney diseases such as WT and APCD type III. However, small sample sizes, possibly methodological issues, and discrepancy in the make up between cases and control groups limits interpretation of any significant findings. Future studies with proper protocol, adequate cases, and control groups may provide stronger evidence to resolve uncertainty related to the aetiology of kidney diseases.

Structural changes in pre-eclamptic and eclamptic placentas--an ultrastructural study.

OBJECTIVE: To determine the ultrastructural changes of the placenta in women with pre-eclampsia and eclampsia compared to the placenta of normotensive patients. STUDY DESIGN: Comparative descriptive study. PLACE AND DURATION OF STUDY: Obstetrics Unit of North Colombo Teaching Hospital, Ragama, Sri Lanka in 2004. METHODOLOGY: Placentae of 10 normotensive women and 10 hypertensive women with pre-eclampsia and eclampsia were studied. Morphological abnormalities in chorionic villi, cytotrophoblastic cells and basement membrane under electronmicroscope were detected. Findings were recorded and compared. RESULTS: Microvillous surface of many chorionic villi of hypertensive placentae showed a complex appearance with many distorted microvilli and frequent cytotrophoblast cells compared to normotensive placentae. The basement membrane of chorionic villi was more thickened in hypertensive placentae. Patchy necrosis with loss of microvilli and gross thinning of the syncytium with distorted microvilli were seen in terminal villi of placentae of women with eclampsia. In areas where the syncytium was absent, the cytotrophoblast cells showed numerous vacuolated mitochondria with loss of cristae, and few rough endoplasmic reticulum, lysosomes and glycogen deposits. An accumulation of electron dense amorphous substance and number of vacuolated mitochondria were concentrated in the cytoplasm of endothelial cells of fetal capillaries. CONCLUSION: Ultrastructural villous changes were found in the placentae of women with pre-eclampsia and eclampsia which are likely to influence adversely on placental function.

Effects of placental infarctions on the fetal outcome in pregnancies complicated by hypertension.

OBJECTIVE: To determine the frequency of placental infarcts and its effects on the fetal outcome in pregnancies complicated by hypertension. STUDY DESIGN: Case control. PLACE AND DURATION OF STUDY: Obstetrics Unit of North Colombo Teaching Hospital, Ragama, Sri Lanka, from January 2003 to January 2004. PATIENTS AND METHODS: Placentae of 150 normotensive women and 200 hypertensive women were studied to detect the number of placentae with infarctions. Apgar score, birth weight and the head circumference of the newborns were measured and analyzed. RESULTS: The frequency of placental infarcts was significantly higher in hypertensive group (30%) compared to normotensive group (18.7%). An association between placental infarction and low Apgar score of the newborn was seen in the hypertensive group (p<0.001). The difference in the birth weight of the newborns in hypertensive and normotensive groups in relation to placental infarction was statistically significant (2.2 vs. 3.1 kg, p<0.001). A highly significant difference was observed in the head circumference of the newborns of hypertensive group compared to normotensive group in relation to placental infarctions (30.7 cm vs. 32.3 cm, p<0.001). CONCLUSION: The frequency of placental infarcts was higher in hypertensive women when compared to normotensives. Placental infarctions had an adverse effect on growth and development of the newborns. This information can be useful in planning and management of future pregnancies.