Iron Profile and Status of Anemia with the Associated Factors in Chronic Kidney Disease Patients.

BACKGROUND: One of the main complications of chronic kidney disease is anemia. Disorders of iron homeostasis seen in such patients make the management of anemia more challenging and risky. To obtain the desired result, erythropoietin and iron dose must be carefully regulated. The aim of the study is to find out the prevalence of anemia and level iron indices in patients of chronic kidney disease at a tertiary care hospital. METHODS: A cross-sectional descriptive study was conducted on chronic kidney disease patients at a tertiary care center. Demographic data like age, sex, height and weight were collected with the help of using Performa. The hematological and biochemical study variables were assayed by blood sample of the patients in the clinical laboratory services. Data were analyzed by statistical package for the social sciences Version 20.0 Results: Out of 171 patients with chronic kidney disease, 162 (94.7%) were anemic, with the highest percentage 54 (31.5%) having hypertension. The median value with inter-quartile range of hemoglobin, serum iron, serum ferritin, TIBC and transferring saturation were 8.9 gm/dl (6.7-10.0), 115.0 (µg/dl) (60.0-140.0), 599.0 ng/ml (142.6-973.0), 279.0 µg/dl (250.0-342.0) and 41.0 % (22.0-53.0) respectively. Serum creatinine and eGFR were significantly correlated with hemoglobin and iron indices. CONCLUSIONS: The current study showed that anemia was more prevalent in patients of chronic kidney disease in our setting as compared to similar studies. Hypertension was the most common disease among them. The median value of parameters of iron profile except ferritin among them was within the reference limit.

Subclinical Hypothyroidism among Chronic Kidney Disease Patients Admitted to Nephrology Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Chronic kidney disease is a condition, which worsens the quality of life in many ways including thyroid disorder in many cases. The aim of the study was to find out the prevalence of subclinical hypothyroidism among chronic kidney disease patients admitted to the Nephrology Department of a tertiary care centre. Methods: A descriptive cross-sectional study was carried out on the patients diagnosed with chronic kidney disease at a tertiary care hospital from 15 May 2022 to 10 October 2022 after getting ethical approval from the Institutional Review Committee (Reference number: 621/2022). Pre-designed proforma was used to collect demographic data like age, sex, height and weight. Blood samples of the patients were analysed for thyroid function tests (triiodothyronine, thyroxine and thyroid stimulating hormone levels) by chemiluminescence immunoassay. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 156 study participants with chronic kidney disease, subclinical hypothyroidism was present in 34 (21.79%) (15.31-28.27, 95% Confidence Interval) patients. Conclusions: The prevalence of subclinical hypothyroidism amongst chronic kidney disease patients was found to be lower than in other similar studies conducted in similar settings. Keywords: chronic kidney disease; thyroid stimulating hormone; thyroxine; triiodothyronine.

Remission after Six Months of Induction Immunosuppressive Treatment with Mycofenolate Mofetil and Prednisolone in Patients with Lupus Nephritis: A Descriptive Cross-sectional Study.

INTRODUCTION: Treatment of lupus nephritis consists of six months of induction immunosuppression followed by years of maintenance immunosuppression. The aim of present study was to find the prevalence of remission after six months of induction immunosuppressive treatment with induction therapy in patients with lupus nephritis. METHODS: A descriptive cross-sectional study was conducted in the nephrology unit of department of internal medicine of a tertiary care hospital from September 2018 to September 2020. The study was approved by institutional review committee of same institution (reference number 184/2018). Convenience sampling method was used and Statistical Package for Social Sciences version 26 was used for statistical analysis. Point estimate at 90% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 24 patients, overall remission was seen in 21 patients (87.4%) (90% Confidence Interval= 76.26-98.54). Complete remission and partial remission were seen in 16 (66.6%) and 5 (20.8%) patients respectively resulting in an at the end of six months of induction immunosuppressive treatment. The most common class of lupus nephritis was class IV, 7 patients, followed by class IV+V, and class V, 6 patients in each respectively. The mean 24-hour urinary total protein, serum albumin and serum creatinine were 2492±1051 mg, 2.1±0.4 g/dl, and 0.9±0.1 mg/dl respectively. Adverse events were observed in 6 (25%) patients. CONCLUSIONS: Our study shows that good proportions of patients with lupus nephritis achieve clinical remission at the end of six months of induction immunosuppressive treatment with induction therapy, however, at the cost of some tolerable side effects.

Occult Hepatitis B Infection in End-Stage Renal Disease Patients Starting Maintenance Hemodialysis at a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Occult hepatitis B infection is defined as the presence of the hepatitis B virus deoxyribonucleic acid in liver tissues and/or serum in the absence of serum hepatitis B Virus surface antigen. The prevalence of occult hepatitis B infection in end-stage renal disease patients is largely unknown. The aim of the study is to determine the prevalence of occult hepatitis B infection in the hemodialysis population starting maintenance hemodialysis. METHODS: A descriptive cross-sectional study was conducted in the department of Internal Medicine of a tertiary care hospital. Convenience sampling method was used; 50 consecutive end-stage renal disease patients, who started maintenance hemodialysis from March 2019 to March 2020, were enrolled in the study. The study was approved by the Institutional Review Committee of the hospital (reference number: 351/2019). Statistical Package for Social Sciences version 26.0 was used for statistical analysis. RESULTS: The mean age of the patients was 50.34±12.65 years, and 42 (84%) were male. About 4 (8%) patients were diagnosed having occult hepatitis B infection, 3 (6%) of them were seropositive and 1 (2%) seronegative. About 41 (82%) patients had no history of hepatitis B vaccination series before starting hemodialysis; 36 (72%) had anti-hepatitis B surface antibody titre <10 mIU/ml. About 44 (88%) patients received a blood transfusion during their hemodialysis sessions and 14 (28%) patients had a history of receiving hemodialysis at other centres. CONCLUSIONS: Our study demonstrated a high prevalence of occult hepatitis B infection among end-stage renal disease patients starting hemodialysis.

Initial Experience of Renal Biopsy at a New Nephrology Center in Eastern Nepal.

We report the initial experience of renal biopsy at a new nephrology center in eastern Nepal. A prospective analysis of patients who underwent renal biopsy from January 2016 to December 2018 at the department of nephrology, Nobel Medical College Teaching Hospital, Biratnagar, Nepal was done. One hundred and fifty-six patients underwent renal biopsy, mean age of the patients was 32.8 ± 14.6 years, and 88 (56.4%) were female. The most common indication of renal biopsy was nephrotic syndrome (NS) (71 patients, 45.5%), followed by nephritic syndrome (63 patients, 40.3%). Renal biopsy was done in 15 patients (9.6%) who had hypertension (HTN) with renal impairment and normal size kidneys, in five diabetic patients (3.2%) when there was suspicion of nondiabetic kidney disease and in one patient (0.6%) with unexplained acute renal failure. The most common histological finding in NS was primary membranous nephropathy (MN), 23 (32.3%) followed by primary focal segmental glomerulosclerosis, 17 (23.9%). Lupus nephritis (LN) contributed to 50.7% (32 patients) of total nephritic syndrome and Class IV LN was the most common (34.3%) pathological class. Immunoglobulin A nephropathy (10 patients, 66.6%) was the most common cause of HTN with renal impairment with normal size kidneys. Among five diabetic patients, one case each of kappa chain restricted cast nephropathy and primary MN was identified. A heterogeneous pattern of renal diseases identified in our study should provide an impetus to the nephrology community of Nepal to start a national renal biopsy registry.

Complete Recovery of Renal Function among Obstetric Patients with Acute Kidney Injury at a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Acute kidney injury  is a rare complication of pregnancy and is associated with high maternal morbidity and mortality. Obstetric factors associated with it are preeclampsia/eclampsia, sepsis, hemorrhage and dehydration. Here, we aim to find out the prevalence of complete recovery of renal function among obstetric patients with acute kidney injury. METHODS: This is a descriptive cross-sectional study conducted in a tertiary care hospital from 1st July 2020 to 30th June 2021 where obstetric patients who had developed acute kidney injury were included and followed till 6 weeks of diagnosis. Ethical approval was obtained from Institutional Review Committee of Nobel Medical College and Teaching Hospital (IRC- NMCTH 437/2020). The convenience sampling method was used. Data entry and analysis were done using Statistical Package for Social Sciences version 21. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of total 66 obstetric patients with acute kidney injury, 45 (68.2%) (57-79.3 at 95% Confidence Interval) had complete recovery of renal function. Rate of renal function recovery in Stage 1, Stage 2 and Stage 3 acute kidney injury were 19 (90%), 19 (86%) and 7 (58%) respectively. The most common causes of acute kidney injury were Preeclampsia/eclampsia 18 (40%), sepsis 23 (28.8%) and hemorrhage 10 (22.2%). CONCLUSIONS:  The prevalence of complete recovery in obstetric patients with acute kidney injury was similar to findings from other studies done in similar settings.

Solitary Plasmacytoma of the Calcaneum: A Case Report.

Solitary Plasmacytoma is characterized by a mass of neoplastic monoclonal plasma cells in either bone or soft tissue without evidence of systemic disease attributing to myeloma. Solitary bony plasmacytoma commonly presents in the axial skeleton. The occurrence of solitary bony plasmacytoma in young individuals is exceedingly rare but has been reported sporadically. We report a case of Solitary bony plasmacytoma involving the calcaneum (appendicular skeleton) in a 26-year-old male with a prior history of trauma at the same site. To our knowledge, this is one of the few cases of solitary bony plasmacytoma in the calcaneum being reported. Our patient presents with some unusual features like the unusual site of the lesion (calcaneum), presentation at a young age and the disease being symptomatic following trauma. Keywords: age groups; calcaneus; plasmacytoma; trauma.

Different faces of Nocardia infection in renal transplant recipients.

AIM: Nocardia infections are an uncommon but important cause of morbidity and mortality in renal transplant recipients. The present study was carried out to determine the spectrum of Nocardia infections in a renal transplant centre in Australia. METHODS: A retrospective chart analysis of all renal transplants performed from 2008 to 2014 was conducted to identify cases of culture proven Nocardia infection. The clinical course for each patient with nocardiosis was examined. RESULTS: Four of the 543 renal transplants patients developed Nocardia infection within 2 to 13 months post-transplant. All patients were judged at high immunological risk of rejection pre-transplant and had received multiple sessions of plasmaphoeresis and intravenous immunoglobulin before the onset of the infection. Two patients presented with pulmonary nocardiosis and two with cerebral abscesses. One case of pulmonary nocardiosis was complicated by pulmonary aspergillosis and the other by cytomegalovirus pneumonia. All four patients improved with combination antibiotic therapy guided by drug susceptibility testing. At the time of Nocardia infection all four patients were receiving primary prophylaxis with trimethoprim/sulphamethoxazole (TMP/SMX) 160/800 mg, twice weekly. CONCLUSION: Plasmaphoeresis may be risk factor for Nocardia infection and need further study. Nocardia infection may coexist with other opportunistic infections. Identification of the Nocardia species and drug susceptibility testing is essential in guiding the effective management of patients with Nocardia. Intermittent TMP-SMX (one double strength tablet, twice a week) appears insufficient to prevent Nocardia infection in renal transplant recipients.

Renal transplantation in Nepal: beginning of a new era!

AIM: To assess the first year outcomes in terms of patient survival rate, graft survival rate and secondary outcomes after starting the first live related renal transplant in Tribhuvan University Teaching Hospital, Nepal. METHODS: A retrospective analysis was done of the first 70 renal transplants, who have completed a minimum of 1 year of follow up. All recipients were on Tacrolimus, Mycophenolate Mofetil, and corticosteroids. RESULTS: Patient and graft survival rate at the end of one year was 94.3% (95% confidence interval (CI) 86.2-97.8). Mean serum creatinine and estimated glomerular filtration rate at 1 year was 115 ± 25 µmol/L (range 63-192) and 66 ± 15 mL/min per 1.73 m2 (range 37-102) respectively. Twenty-two episodes of biopsy proven acute rejection occurred in 18 recipients (25.7%). Three patients (4.2%) had acute tubular necrosis; however, only one (1.4%) had delayed graft function. One patient, with focal segmental glomerulosclerosis had recurrence of native kidney disease. Thirty-two episodes of urinary tract infection were observed in 22 recipients (31.4%), and Escherichia coli was the most commonly isolated organism, 17 (53.1%) out of 32 episodes. New onset diabetes mellitus after transplant occurred in 16 recipients (22.8%). CONCLUSION: One-year patient survival, graft survival and secondary outcomes of our kidney transplant recipients, with our limited facilities, were within acceptable limits.

Assessing climate change and heat stress responses in the Tarai region of Nepal.

This paper intends to analyse responses of the working people to heat stress in Nepal's Tarai region. Here, the heat stress responses refer to the working environments- indoor and outdoor settings, prevailing diseases, and adaptive measures by the workers. Data were gathered from the sample households by using household survey, observation, and informal discussions. Environmental conditions in terms of heat exposure in the working areas have been measured with heat index, humidity index, and WBGT, based on the HOTHAPS approach. The findings are that: the average temperature during the peak hot months reached to over 39°C and the environmental conditions in the selected factories during the hot summer months were too hot to the workers to work continuously during the day, where there was inadequacy of facilities to combat against the hot. Males were more exposed than females to the heat due to heavy type of works in outdoor settings. Few workers found to have adapted coping measures such as shift in working time, wearing thin cotton clothes, etc but they were inadequate against the heat stress. More quantitative measurements of workers' health effects and productivity loss will be of interest for future works.

Clinical features and histological patterns of lupus nephritis in Eastern Nepal.

To determine the clinical profile and patterns of lupus nephritis patients in Eastern Nepal, we studied 38 patients fulfilling the 1982 revised criteria of American College of Rheumatology for systemic lupus erythematous (SLE), followed up from January 2004 to January 2008. Arthritis was a common initial feature in addition to variable cutaneous, cardiac, pulmonary and neuropsychiatric manifestations. Renal biopsy showed grade 1 changes in 5 (13.5%) patients, grade 2 changes in 13 (35.1%) patients, grade 3 changes in 9 (24.3%) patients, grade 4 changes in 7 (18.9%) patients, grade 5 changes in 2 (5.4%) patients, and grade 6 changes in 2.7% patients. Antinuclear antibody (ANA) assay and anti-ds DNA were positive in 78.4 and 81.1%, respectively. We conclude that mesangial proliferative glomerulonephritis (grade 2) was the most common pattern of lupus nephritis encountered in our study. Timely diagnosis and treatment may improve the overall patients' survival.