Risk factors associated with the development of diabetic kidney disease in Sudanese patients with type 2 diabetes mellitus: A case-control study.

BACKGROUND AND AIMS: Limited data are available regarding the risk factors associated with the development of diabetic kidney disease (DKD) among Sudanese adults with type 2 diabetes mellitus (T2DM). METHODS: A case-control study was conducted at Dr. Salma Center for Kidney Diseases between April and September 2019. Patients with T2DM and DKD were compared to age and sex-matched T2DM patients with no kidney disease (NKD). Socio-demographic features, clinical findings, and laboratory investigations of the study subjects and controls were analyzed using SPSS. RESULTS: A total of 372 patients with DKD were compared to 364 T2DM patients with NKD. The mean age of the DKD patients was 58 ± 13.4 years, their median eGFR was 37.3 ± 4.9 ml/min/1.73 m2; they had their T2DM at a significantly younger age compared to controls (P = 0.014). Logistic regression analysis revealed that a family history of diabetes mellitus, a family history of chronic kidney disease, the presence of hypertension, obesity, hypercholesterolemia, hyperuricemia, smoking, recurrent urinary tract infection, and the regular use of non-steroidal anti-inflammatory drugs were significantly associated with the development of DKD (P values < 0.05). CONCLUSION: A series of modifiable risk factors were found to be significant determinants for developing DKD. Primary care physicians are expected to pay considerable attention to their control.

Ciclosporin-induced accessory breast tissue: Dramatic improvement after dose adjustment.

Accessory breast tissue is a relatively common congenital condition in which abnormal accessory breast tissue is seen as a mass anywhere along the course of embryologic mammary streak in addition to the presence of normal breast tissue. Ciclosporin therapy has been associated with benign breast disease in women. However, to the best of our knowledge, there are no reported cases of accessory breast tissue growth associated with ciclosporin therapy and regression after adjusting the dose. A 48-year-old woman had renal transplantation in 2009 with her brother as the donor. Her transplant follow-up over eight years had been unremarkable. She presented to our transplant follow-up clinic with bilateral painful axillary masses approximately 3 cm × 3 cm in diameter, not attached to the skin or underlying structures with no skin changes and no lymphadenopathy. Breast examination did not reveal any abnormalities. Her ciclosporin levels over the previous three years ranged between 130 and 150 ng/mL. These levels were within the acceptable recommended level of 100-150 ng/mL at that time (currently reduced to 80-120 ng/ml). Ultrasound of both axilla showed well-defined hypoechoic smooth outline masses in both axillary regions 3 cm × 4 cm. Fine-needle aspiration showed lesions consisting of cohesive ductal cells. The findings were consistent with accessory breast tissue with no evidence of inflammatory infiltrate or malignant changes. Her ciclosporin dose was reduced with the subsequent follow-up visits levels ranging between 90 and 110 ng/mL. Clinical examination four months later showed dramatic reduction in the axillary masses on both sides. Ultrasound confirmed the regression in the size of both masses. We conclude that ciclosporin was probably responsible for the formation of accessory breast tissue and reduction in the dose of ciclosporin resulted in substantial reduction in the tissue size.

Pattern and outcome of acute kidney injury among Sudanese adults admitted to a tertiary level hospital: a retrospective cohort study.

INTRODUCTION: Little is known about the pattern and outcome of Acute Kidney injury (AKI) in Sudan. This study aimed to determine the etiology and outcome of AKI among Sudanese adults. METHODS: A retrospective cohort study was conducted in a tertiary level hospital, Soba University Hospital, Sudan. The medical records of all adults admitted to hospital from the 1st of January to 31st of December 2014 were reviewed. The diagnosis and severity of AKI was defined as per the Kidney Disease Improving Global Outcomes (KDIGO) recommendations. RESULTS: The medical records of 6769 patients were reviewed. AKI was diagnosed in 384 patients (5.7%); being community acquired in 82.6% of cases. Sepsis, volume depletion, obstructive uropathy, heart failure, acute glomerulonephritis and severe malaria were the commonest causes of AKI diagnosed in 44%, 38.5%, 8.9%, 5.7%, 4.7% and 3.1% of patients, respectively. Following treatment complete renal recovery was seen in 35.7% of patients; whereas 31.2% of patients died. Predictors of increased risk of death were old age [OR 1.03, 95% CI (1.01-1.057); P=0.003], presence of chronic liver disease [OR 2.877, 95% CI (1.5-5.5); P=0.001], sepsis [OR 2.51, 95% CI (1.912-4.493);P=0.002] and the severity of AKI [OR 3.873, 95% CI(1.498-10.013);P=0.005]. CONCLUSION: AKI was diagnosed in 5.7% of adults admitted to hospital. Most patients were having community acquired AKI. Old age, the presence of chronic liver disease, sepsis, and the severity of AKI as per KDIQO staging were significant predictors of mortality.