Clinical Characteristics of Patients on Long-term Hemodialysis.

OBJECTIVE: To study the clinical characteristics of patients on hemodialysis for more than ten years in order to highlight the modifiable factors that may improve survival in low socioeconomic status. STUDY DESIGN: Observational cross-sectional study. PLACE AND DURATION OF STUDY: Department of Nephrology, The Kidney Centre Postgraduate Training Institute (TKCPGTI), Karachi, from November 2017 to January 2018. METHODOLOGY: Clinical records of 38 patients, who have been on thrice weekly hemodialysis for more than ten years at the study centre with registration period from 1989 to 2018, were reviewed. The participants were placed in three groups according to duration of hemodialysis: 10 to 15 years; 15 to 20 years, and >20 years. Background information (age, gender, age at initiation of hemodialysis, cause of renal failure), dialysis dose (urea reduction ratio), anemia (hemoglobin), bone-mineral metabolism (calcium, phosphate and iPTH), and nutrition (albumin) were evaluated. The parameters were compared among the groups and with respect to K/DOQI and EBPG guidelines. RESULTS: Mean age at institution of hemodialysis was 33.5 years. The most common cause of End Stage Renal Disease (ESRD) was of unknown etiology (bilateral small shrunken kidneys). Chronic sclerosing glomerulonephritis was the second most common cause. The mean hemoglobin level was 10.98 +1.4 g/dL. Mean phosphate, calcium and iPTH were 4.75 ±1.34 mg/dL, 9.62 ±0.64 mg/dL and 281.5 pg/ml, respectively. Serum albumin was 3.66 ±0.39 mg/dL. These indexes were comparable to recommended guidelines. CONCLUSION: Clinical characteristics and other profiles of patients on hemodialysis for more than 10 years are comparable to the standard K/DOQI and EPBG guidelines. We believe that complying the standard guidelines for management of patients on chronic hemodialysis can result in better long-term outcome and survival in our population.

Distribution of Biopsy-Proven Presumed Primary Glomerulonephropathies in 2000-2011 Among a Racially and Ethnically Diverse US Population.

BACKGROUND: The incidence and distribution of primary glomerulonephropathies vary throughout the world and by race and ethnicity. We sought to evaluate the distribution of primary glomerulonephropathies among a large racially and ethnically diverse population of the United States. STUDY DESIGN: Case series from January 1, 2000, through December 31, 2011. SETTING & PARTICIPANTS: Adults (aged ≥ 18 years) of an integrated health system who underwent native kidney biopsy and had kidney biopsy findings demonstrating focal segmental glomerulosclerosis (FSGS), membranous glomerulonephritis (MGN), minimal change disease (MCD), immunoglobulin A nephropathy (IgAN), and other. OUTCOMES: Rates and characteristics of the most common primary glomerulonephropathies overall and by race and ethnicity. RESULTS: 2,501 patients with primary glomerulonephropathy were identified, with a mean age 50.6 years, 45.7% women, 36.1% Hispanics, 31.2% non-Hispanic whites, 17.4% blacks, and 12.4% Asians. FSGS was the most common glomerulonephropathy (38.9%) across all race and ethnic groups, followed by MGN (12.7%), MCD (11.0%), IgAN (10.2%), and other (27.3%). The FSGS category had the greatest proportion of blacks, and patients with FSGS had the highest rate of poverty. IgAN was the second most common glomerulonephropathy among Asians (28.6%), whereas it was 1.2% among blacks. Patients with MGN presented with the highest proteinuria (protein excretion, 8.3g) whereas patients with FSGS had the highest creatinine levels (2.6mg/dL). Overall glomerulonephropathy rates increased annually in our 12-year observation period, driven by FSGS (2.7 cases/100,000) and IgAN (0.7 cases/100,000). MGN and MCD rates remained flat. LIMITATIONS: Missing data for urine albumin and sediment, indication bias in performing kidney biopsies, and inexact classification of primary versus secondary disease. CONCLUSIONS: Among a racially and ethnically diverse cohort from a single geographical area and similar environment, FSGS was the most common glomerulonephropathy, but there was variability of other glomerulonephropathies based on race and ethnicity.

[Prophylaxis and prognosis of preeclampsia in patients with chronic pyelonephritis and chronic glomerulonephritis].

The investigations performed showed that pregnant women with chronic pyelonephritis (CP) and chronic glomerulonephritis (CG) have certain response to therapy done in accordance with level of kidney function activity. In the pregnant women with CP and CG and kidney functional reserve KFR > 10% and from 5 to 10% the treatment efficacy was higher and practically absent in pregnant women with KFR < 5%.

Prevalence and factors associated with CKD: a population study from Beijing.

BACKGROUND: Chronic kidney disease (CKD) is considered a serious worldwide public health problem, but data from developing countries are extremely limited. STUDY DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: A representative sample of 13,925 adults in Beijing, China. PREDICTORS: Age (18 to 39, 40 to 59, 60 to 69, and >70 years), sex, urban or rural area, history of chronic respiratory infection and cardiovascular disease, hepatitis B virus infection, smoking, family history (diabetes, hypertension, and CKD), nephrotoxic medications, central obesity, diabetic and hypertension status, and dyslipidemia. OUTCOMES AND MEASUREMENTS: CKD was defined as estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) or markers of kidney damage. Glomerular filtration rate was estimated by using calibrated serum creatinine level and a formula specific for China. Persistent albuminuria and hematuria were considered markers of kidney damage. RESULTS: The prevalence of CKD in adults in Beijing was 13.0% (95% confidence interval [CI], 11.9 to 14.2). It therefore was estimated that the number of adults in Beijing with CKD was 1.43 million. In subjects aged 18 to 39, 40 to 59, 60 to 69, and older than 70 years, prevalences of CKD were 10.0% (95% CI, 8.9 to 11.3), 14.2% (95% CI, 13.0 to 15.4), 20.8% (95% CI, 18.1 to 23.9), and 30.5% (95% CI, 26.6 to 34.7), respectively. Factors independently associated with decreased kidney function included older age (odds ratio [OR], 1.83; 95% CI, 1.51 to 2.22 per 10-year increase), nephrotoxic medications (OR, 2.19; 95% CI, 1.21 to 3.97), rural area (versus urban area; OR, 0.47; 95% CI, 0.28 to 0.78), history of cardiovascular disease (OR, 2.04; 95% CI, 1.24 to 3.38), high-density lipoprotein cholesterol level less than 40 mg/dL (OR, 3.00; 95% CI, 1.39 to 6.51), and hypertension status (with duration > 10 years; OR, 1.85; 95% CI, 1.19 to 2.88). LIMITATIONS: Kidney function and indicators of kidney damage were based on single measurements. CONCLUSIONS: CKD is a public health burden in Beijing.

High-efficiency short daily haemodialysis--morbidity and mortality rate in a long-term study.

BACKGROUND: In conventional haemodialysis (CHD), the morbidity and mortality rate is unacceptably high; consequently, variations in the length and frequency of the haemodialysis sessions have been studied to reduce the complications of dialysis treatment. In this sense, high-efficiency short daily haemodialysis (SDHD) has been proposed as an alternative for patients on renal replacement therapy. In this study, we have related our experience with this dialysis modality. METHODS: Twenty-six patients (16 males, mean age 35.6 +/- 14.7 years) were treated by SDHD for 33.6 +/- 18.5 months (range 6-57 months). The mean time on CHD before the switch to SDHD was 25.5 +/- 31.9 months (range 1-159 months). In 23 (88.5%) patients, native arteriovenous fistulae were used for vascular access. SDHD was performed six times a week, 1.5-2 h per session, and high flux polysulfone dialysers (surface area: 1.8 m(2)) were employed. The blood flow and dialysate flow rate were 350 and 800 ml/min, respectively. RESULTS: In this trial, the patient survival was 100%. The vascular access survival after 12, 24, 36 and 48 months on SDHD was 100, 89, 89 and 80%, respectively. There were three failures of vascular access in 72.7 patient-years (0.04 failures/patient-year). In 15 patients on SDHD during 36 consecutive months, the vascular access survival after 12, 24, 36 and 48 months was 100, 93, 93 and 84%, respectively. Also, in this group of patients, there were 0.27 hospitalizations/patient-year and 1.24 days of hospitalizations/patient-year. CONCLUSIONS: We concluded that in a long-time study of patients on SDHD the morbidity and mortality rate is very low. Furthermore, we observed that failures of vascular access are not a significant problem. Consequently, we believe that SDHD is a powerful renal replacement therapy for treatment of patients on maintenance haemodialysis.

Comparison of dialysis and clinical characteristics of patients with frequent and occasional hemodialysis-associated hypotension.

BACKGROUND: Symptomatic dialysis hypotension (DH) continues to be a common problem. By comparing patients prone and resistant to DH, several dialysis session and patient related characteristics have been identified that confer susceptibility to DH. Less is known, however, about the comparison of patients with frequent and only occasional DH. The aim of the study was to compare clinical and dialysis-session- (complicated by hypotension) related data between those with frequent (fDH) and those with occasional dialysis hypotension (oDH). METHODS: Nine hundred and fifty-eight patients at 11 dialysis units were followed for 10 months and characteristics of patients with fDH (> or = 10 hypotensive events necessitating medical intervention) (n = 96) were compared to that of patients with oDH (1 or 2 events/10 months) (n = 130). Significant and independent predictors of fDH were obtained by multivariate logistic regression. RESULTS: Significant differences between fDH vs. oDH patients were older age (64.4 vs. 56.9 years, p < 0.001), more females (66 vs. 46%, p < 0.005) in fDH. More fDH patients had diabetes (27 vs. 15%, p < 0.05) and less had glomerulonephritis (15 vs. 35%, p < 0.001) as the cause for ESRD. Coronary artery disease (68 vs. 50%, p < 0.01) and long-acting nitrate treatment (51 vs. 30%, p < 0.001) was more frequent while treatment with ACEI (33 vs. 48%, p < 0.05) or Ca-channel blockers (40 vs. 53%, p < 0.05) were less frequent in patients with fDH. Patients with fDH had higher serum phosphorus levels (1.99 vs. 1.79 mmol, p < 0.005). Dialysis session related data were similar but the hypotensive episode occurred earlier during dialysis in fDH (136 vs. 156 min, p < 0.01). In multivariate analysis, significant independent predictors of fDH were older age (OR = 1.04 [1.02-1.07]), lack of glomerulonephritis as renal diagnosis (2.63 [1.18-5.87]), high phosphorus levels (5.0 [2.45-10.0]), lack of use of Ca-channel blockers (2.09 [1.12-3.91]), and the use of nitrates (2.38 [1.24-4.55]). CONCLUSION: Features of the dialysis sessions complicated by DH seem to be similar between patients with fDH and oDH, while patient characteristics such as older age, renal diagnosis other than glomerulonephritis, higher serum phosphorus levels, use of nitrates, and lack of use of calcium channel blockers are significantly and independently associated with fDH.

Estudio clínico patológico de las glomerulopatías primarias

Se revisaron las historias clínicas y los diagnósticos anatomopatológicos de 382 biopsias renales realizadas en nuestro centro durante el período de 1995-1998. De ellas se seleccionaron para esta investigación 241 con diagnóstico de glomerulopatías primarias, las cuales se estudiaron por Microscopía óptica, inmunohistoquímica y algunos casos por Microscopía electrónica. Se observó mayor incidencia entre los 21-30 años representado por un 29,87 porciento y la raza blanca fue más afectada con un 53,11 porciento. La variedad de Glomerulopatía más frecuente resultó la glomerulosclerosis segmentaria Focal con 22,82 porciento siguiéndole en orden de frecuencia la glomerulosclerosis proliferativa mesangial con 17,82 porciento y la glomerulonefritis proliferativa endocapilar con 16,18 porciento.la menos frecuente fue la glomerulonefritis esclerosante. (1,65%). Se analizaron aspectos clínicos y de laboratorio constatándose que la proteinuria e Hipertensión arterial se presentaron en el 87,27 porciento y 41,81 porciento respectivamente en la Glomerulosclerosis segmentaria Focal y el Síndrome nefrótico se constató en el 38,18 porciento en esta variedad. En la Glomerulonefritis proliferativa mesangial el aspecto más relevante lo constituyó la proteinuria con 93,02 porciento y en la glomerulonefritis Proliferativa endocapilar proteinuria, hematuria y hipertensión arterial. La proteinuria fue la manifestación más frecuente en todas las variedades de glomerulopatías. Se realizaron estudios de inmunofluorescencia para valorar la positividad de inmunoglobulinas así como complementos que ayudan a corroborar el diagnóstico. Todos los resultados fueron reflejados en tablas y figuras(AU)

The clinical histories and the diagnoses anatomopatológicos of 382 renal biopsies were revised carried out in our center during the period of 1995-1998. Of them they were selected pear this investigation 241 with diagnosis of Primary glomerulopatías, which were studied by optic Microscopy, inmunohistoquímica and some cases by electronic Microscopy. Bigger incidence was observed among the 21-30 years represented by 29,87 percent and the white race was more affected with 53,11 percent. The variety of more frequent Glomerulipatía was the Focal segmental glomerulosclerosis with 22,82 percent following him in order of frequency the glomerulosclerosis proliferativa mesangial with 17,82 percent and the glomerulonefritis proliferativa endocapilar with 16,18 percent less frequent .la it was the glomerulonefritis esclerosante. ( 1,65 percent ). Clinical aspects were analyzed and of laboratory constatándoce that the proteinuria and arterial Hypertension were presented respectively in 87,27 percent and 41,81 percent in the Focal segmental Glomerulosclerosis and the Syndrome nefrótico was verified in 38,18 percent in this variety. In the Glomerulonefritis proliferativa mesangial the most excellent aspect constituted it the proteinuria with 93,02 percent and in the glomerulonefritis Proliferativa endocapilar proteinuria, hematuria and arterial hypertension. The proteinuria was the most frequent manifestation in all the glomerulopatías varieties. They were carried out inmunofluorescencia studies to value the inmunoglobulinas positividad as well as complements that you/they help to corroborate the diagnosis. All the results were reflected in charts and figures(AU)

Endemic occurrence of glomerulonephritis associated with streptococcal impetigo.

We report here a case of type 1 mesangiocapillary glomerulonephritis as well as a case of mesangial proliferative glomerulonephritis associated with streptococcal skin infection superimposed on atopic dermatitis. Both were endemic occurrences of postinfectious glomerulonephritis developed after repeated dirty-skin treatments for atopic dermatitis performed by unauthorized individuals under unsanitary conditions. Of 20 patients who were similarly treated and subsequently admitted to our hospital because of skin infection and fever, 8 (40%) showed urinary abnormalities. Four patients had renal dysfunction with acute nephritic onset. Almost all showed a decrease in CH50 values and an increase in levels of antistreptolysin O and IgE. In the 2 cases presented here, the disease eventually regressed in association with improvement of the skin infection. Although the occurrence of postinfectious glomerulonephritis has recently become uncommon, we must take care to note urinary abnormalities as early as possible in order to prevent the progression of glomerulonephritis.

Some non-infective diseases endemic in the West Indies.

The West Indies, and associated parts of the Caribbean area, are extremely diverse and afford interesting examples for the study of geographical medicine. Short accounts are given of some conditions whose aetiologies have been relatively recently clarified, including vomiting sickness of Jamaica, veno-occlusive disease of Jamaica, blackfat pulmonary fibrosis of Guyana, and epidemic acute glomerulonephritis of Trinidad. The aetiology of tropical sprue, which is common in Puerto Rico and absent from Jamaica remains to be explained although a hypothesis has been put forward. Further work is needed to establish the geographical distribution of idiopathic cardiomegaly and the spinal neuropathies and associated syndromes of retrobulbar neuritis and sensorineural deafness before their aetiologies can be understood.