Assessment of hypertension control in chronic kidney disease patients by ambulatory blood pressure monitoring.

BACKGROUND: Inadequate control of blood pressure (BP) increases cardiovascular mortality and morbidity in chronic kidney disease (CKD) and renal transplant patients. 24 hour ambulatory BP was recorded to evaluate the adequacy of BP control in these patients. METHODS: 60 CKD patients (25 conservative therapy, 16 maintenance hemodialysis, 19 renal transplant patients) were studied prospectively. After achieving clinic BP control, 24 hour ambulatory BP was recorded at 1 and 6 months. The patients were followed up for one year. RESULTS: Mean daytime and nighttime systolic blood pressure (SBP) both at 1 month and at 6 month was higher in non-survivors than in survivors. The survivors had better control of their daytime (p=0.018) as well as nighttime SBP levels (p=0.018) at 6 months compared to those at 1 month. Survivors achieved nocturnal dipping of SBP at 1 and 6 months (p=0.047, p=0.025, respectively). Non-survivors failed to achieve lower daytime (p=0.375) or nighttime SBP (p=0.254) at 6 months as compared to SBP at 1 month in spite of optimizing antihypertensive therapy. Daytime (p=0.022) and nighttime (p=0.029) diastolic BP (DBP) in the non-survivors was higher than in survivors. Nocturnal dip in DBP was not seen in either survivors at 1 (p=0.177) and 6 months (p=0.434) or non-survivors at 1 (p=0.408) and at 6 months (p=0.081). Renal transplant patients did not exhibit nocturnal dipping of BP. CONCLUSION: We conclude that, unlike survivors, there was worsening of 24 hour BP control in non-survivors. ABPM has a role in better management of total BP burden in CKD patients.

Impact of mass bathing on the water quality of the Ganga River at Haudeshwarnath (Pratapgarh), India--a case study.

This paper reports on the impact of mass bathing on Ganga River water quality on the occasion of the Maha-Shivaratri festival at Haudeshwarnath Ghat situated on the left bank of the River Ganga in the district of Pratapgarh, India. Water samples collected from three sampling points before and after mass bathing were analysed for a total of 17 physico-chemical and seven biological parameters. It was concluded from the results that mass bathing causes a significant change in water quality of the river, which may represent a health hazard to users of the river water.

Carcinosarcoma of renal pelvis with immunohistochemical correlation.

Carcinosarcoma, a malignant tumor with biphasic morphology is uncommon in the renal pelvis. Immunohistochemistry (IHC) plays an important role in establishing the diagnosis and differentiating it from other biphasic malignant tumors. We present a rare case of immunohistologically confirmed carcinosarcoma of renal pelvis in a 42-year old female, which possibly developed on a background of multicentric squamous cell carcinoma arising as a consequence of chronic irritation caused by calculi.