Combined fluoroscopic- and sonographic-assisted Tenckhoff catheter insertion for patients with previous intraperitoneal surgery.

BACKGROUND: Tenckhoff catheter (TC) insertion for patients with previous intraperitoneal surgery (IPS) is challenging. METHODS: This is a case series of 11 patients with history of previous IPS who underwent TC insertion under combined fluoroscopic and sonographic (CFS) guidance with preperitoneal tunneling at our center. RESULTS: This is an interim result of our study. The mean age of the patients was 49.1 (±12.7). Seven were females, and four were males. Only two patients underwent more than one IPS prior to this procedure. The mean body mass index (BMI) of patients was 29.2 kg/m2 (±6.2). All patients underwent the procedure successfully. One patient developed post-procedure exit site bleeding which resolved spontaneously. One patient had urgent-start peritoneal dialysis (PD) (less than 72 h), and two patients had early-start PD (less than 2 weeks). Median catheter survival is 8 months at the time of writing. CONCLUSION: CFS-assisted TC insertion with preperitoneal tunneling for patients with previous IPS is a safe and effective technique.

A practical approach to chronic kidney disease in primary care.

Chronic kidney disease (CKD), a common clinical problem in primary care, can be defined as any abnormality of the kidney structure and/or function that has been present for at least 3 months. Over the past 20 years, the incidence and prevalence of CKD have been increasing in Malaysia in line with the rising number of non-communicable diseases. At present, CKD has no cure. The treatment of CKD is very much dependent on early diagnosis and prevention of CKD progression. In this article, we aim to illustrate a practical approach to CKD in primary care, including diagnosis, evaluation, and management of CKD.

Case of acute kidney injury due to bilimbi fruit ingestion.

Bilimbi fruit is widely eaten in Malaysia. Rarely reported is its potential to cause acute kidney injury (AKI) in patients with prior normal renal function. The possible dangers of its consumption are still relatively unknown among many. This case highlights the importance of taking a thorough dietary history in patients with AKI. We also hope to increase awareness among healthcare professionals on the nephrotoxic and neurotoxic effects of bilimbi fruits.

Renal cell carcinoma with proliferative lupus nephritis.

We report a case of renal cell carcinoma diagnosed after a patient was treated successfully with intravenous cyclophosphamide for her active proliferative lupus nephritis (classes III and V). After the intravenous cyclophosphamide regimen, the patient was asymptomatic with persistent microscopic haematuria, and no proteinuria. The renal cell carcinoma was located on the left kidney; incidentally, this was where the initial renal biopsy was done to diagnose lupus nephritis.

Rhodococcal lung abscess in a renal transplant recipient.

BACKGROUND: Rhodococcus species are relatively rare human pathogens, but are being increasingly recognized as causes of infection especially in immunosuppressed patients. CASE REPORT: We present a case of Rhodococcus lung abscess in a patient 10 months post-cadaveric renal transplant, successfully treated with a combination of antibiotics. She required a prolonged course of oral antibiotics for 6 months. She did not require surgical intervention. Chest X-rays and CT thorax showed complete resolution of the initial lesion. We also review the medical literature related to Rhodococcus infection in patients with renal transplantation. Rhodococcus infection should be considered as in the differential diagnosis of immunosuppressed patients who present with lung abscess/mass. CONCLUSIONS: A literature review indicates this is a potentially fatal condition with disseminated sepsis/abscesses.