Clinicopathological spectrum of biopsy-proven renal diseases of patients at a single center in Sri Lanka: a cross sectional retrospective review.

BACKGROUND: The clinical presentation of renal diseases can vary widely. The lack of a comprehensive national registry for Sri Lanka makes it difficult to provide a detailed record of the various clinical presentations and histopathology of renal disorders in the nation. Therefore, this study aims to provide a record of the spectrum of renal diseases in Sri Lanka. METHODS: Renal biopsies performed at the nephrology unit in Colombo South Teaching Hospital (CSTH), Sri Lanka from March 2018 to October 2019 was retrospectively studied. Indications for renal biopsy were nephrotic range proteinuria, sub nephrotic range proteinuria, acute kidney injury without obvious etiology, chronic renal disease without obvious etiology and haematuria. RESULTS: A total of 140 native kidney biopsies were analyzed in which majority were females (55.7%). The mean age of the population was 46 ± 15.3 years. The most common indications for renal biopsy were nephrotic range proteinuria (54.3%), followed by sub-nephrotic range proteinuria (14.3%), nephrotic range proteinuria with haematuria (14.3%), sub-nephrotic range proteinuria with haematuria (9.3%), AKI without known cause (4.3%), and CKD without known cause (3.6%). The leading histopathological diagnoses were FSGS (22.1%), lupus nephritis (20%), PSGN (17.1%), DN (12.1%), HTN (9.3%), MCD (6.4%), IgA nephropathy (5.7%), IN (4.3%), vasculitis (2.1%), and MGN (0.7%). CONCLUSIONS: The most common indication for renal biopsy was nephrotic range proteinuria in our population. FSGS was the most prevalent histopathological diagnosis and the least frequent diagnosis reported was MGN. The spectrum of renal diseases could differ according to the study location and it changes over time. Therefore, a renal biopsy registry is needed for documenting the changing disease pattern in Sri Lanka.

Empagliflozin in South Asians with type 2 diabetes: Real world data on effects on cardiometabolic parameters, safety and determinants of response to therapy from a diabetes practice in Sri Lanka.

AIMS: SGLT2 inhibitors provide cardiovascular and renal protection in people with type 2 diabetes (T2DM). Real-world data on their effect on improving glucose and cardiovascular risk factors, and adverse effects in South Asians are limited. METHODS: We retrospectively analyzed clinical, demographic, anthropometric and biochemical data among adults with T2DM, commenced on empagliflozin and followed up for at least one month in a diabetes clinic in Colombo. RESULTS: Among 1523 participants (men 49.6 %, age 54.9 (± 10.8) years, diabetes duration 11.5 (± 7.6) years, body mass index 28.2 (± 4.5 kg/m2), over a median follow up of 12 months (range: 1-24 months), reduction in HbA1c, weight, systolic blood pressure (SBP) and urine albumin-creatinine ratio were evident within the first month. Benefits sustained up to two-years (mean changes from baseline: HbA1c - 0.31 (± 1.49), weight - 1.14 (± 4.17), SBP - 3.44 (± 21.75), UACR - 19.84 (± 108.22) follow up. eGFR declined by the third month, returned to baseline by 12th and remained stable over 24 months. Higher baseline HbA1c, weight and SBP predicted greater decline in HbA1c, weight and SBP respectively. Weight reduction independently predicted the SBP reduction. Eighteen participants per 100 patient-years discontinued therapy due to adverse effects: genital mycotic infections and features of hypovolaemia were the commonest. We observed only two events of diabetic ketoacidosis. CONCLUSIONS: Empagliflozin effectively improves glucose, weight and SBP and retards progression of renal impairment in South Asians with T2D. Genital mycotic infections and hypovolaemia were the commonest reasons for discontinuation. Careful patient selection and advice can avoid other sinister complications.

Impact of COVID-19 lockdown on people living with diabetes: Experience from a low-middle income country in South Asia.

AIMS: COVID-19 lockdown imposes many challenges to patients with diabetes. We aimed to assess the impact of COVID-19 lockdown on health-related behavior and disease control among patients with diabetes. MATERIALS AND METHODS: A cross-sectional study was conducted among adults with diabetes attending a diabetes clinic in Colombo, Sri Lanka in June-July 2020. Lifestyle and disease control changes before and during the lockdown, were determined using an interviewer-administered questionnaire and review of medical records. RESULTS: Among 1727 participants mean HbA1c decreased by 0.30% (95% CI 0.24-0.36, p < 0.001). HbA1c improved in 37.6% but deteriorated in 18.8%. Male sex (OR 1.36, 95% CI 1.10-1.67), better education (OR 1.10, 95% CI 1.01-1.20) and being employed (OR 1.08, 95% CI 1.00-1.16) were sociodemographic predictors of improved control. Better dietary adherence (OR 1.55, 95% CI 1.13-2.12), night-time sleep (OR 1.46, 95% CI 1.13-1.88) and indoor exercise (OR 1.62, 95% CI 1.23-2.07) were behavioural determinants of improved glycaemia. Decreases in self-monitoring of blood glucose (OR 1.45, 95% CI 1.09-1.93), exercise (OR 1.7, 95% CI 1.32-2.20), medication use (OR 1.95, 95% CI 1.37-2.78), dietary adherence (OR 1.72, 95% CI 1.32-2.26) and family income (OR 1.45, 95% CI 1.12-1.88) predicted worsening glycaemia. Only 4.1% used telehealth services; 83.1% of them reported good satisfaction. CONCLUSIONS: Mean HbA1c improved during the lockdown. Overall, 37.6% of participants improved their glycaemic control. Well-educated employed men were more likely to improve glycaemic status. Improving diabetes control through healthy lifestyle practices and self-monitoring are feasible even in resource limited settings.