Prevalence and factors associated with microalbuminuria and abnormal renal function in Thai obese adults.

OBJECTIVE: To determine the prevalence and factors associated with microalbuminuria and abnormal renal function in Thai obese adults. MATERIAL AND METHOD: A cross-sectional study data was collected from 86 patients during October 2010 to February 2011 at the obesity clinic and outpatient department of Siriraj Hospital. Obese patients with body mass index > or = 25 kg/m2 participated in the present study. Exclusion criteria were the patients who refused participation or patients with end stage renal disease who were under treatment with hemodialysis or continuous ambulatory peritoneal dialysis. A questionnaire was used for collecting information on demographic data, e.g., age, sex, residence, educational level, underlying diseases and drugs use, family history of obesity, family history of renal disease, smoking, or alcohol drinking; height, weight, body mass index, waist circumference, blood pressure, blood chemistry test and urine analysis were collected. The abnormal function of the kidney was assessed by presence of microalbuminuria or estimated glomerular filtration rate below 90 mL/min/1.73 m2. RESULTS: The prevalence of microalbuminuria in obese patients was 28% and prevalence of chronic kidney disease stage 2 or more was 22%. Factors associated with microalbuminuria were FBS > or = 126 mg/dL (OR = 6.2, 95% CI: 1.7-22.1), hyperuricemia (serum uric acid > or = > 7 mg/dL) (OR = 3.2, 95% CI: 1.0-9.8). Factors associated with chronic kidney disease stage 2 or more were age > or = 55 years (OR = 7.8, 95% CI: 2.5-24.1), Angiotensin II receptor blocker (ARB) use (OR = 4.1, 95% CI: 1.3-12.3) and hyperuricemia (serum uric acid > or = 7 mg/dL)(OR = 4.5, 95% CI: 1.5-13.5). CONCLUSION: Early identification of obesity and metabolic syndrome and modifying pattern of life style behavior in obese adults carrying risk factors might be beneficial in preventing and delaying the progression of chronic kidney disease in Thailand.

Late onset lupus nephritis: analysis of clinical manifestations and renal pathological features in Siriraj Hospital.

BACKGROUND: Lupus nephritis (LN) is uncommon after the age of 50 years and studies of elderly patients with LN are rare. The authors conducted the current study to determine the clinical manifestations, pathological features and prognosis of 30 Thai patients with late onset LN in Siriraj hospital in Bangkok from 1989 to 2006. MATERIAL AND METHOD: Thirty LN patients with a disease onset beyond the age of 50 years from 1989 to 2006 were enrolled in this retrospective study. All of them received renal biopsy. The histological classifications were categorized according to 2003 International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification. RESULTS: Clinical and pathologic records were collected from 30 patients (23 female and 7 men) who were followed-up for a mean period of 25.8 months (range, 6 to 96 months). The mean age was 56.6 +/- 4 years. Hypertension was diagnosed in 66.7% of patients and 41.3% had serum creatinine greater than 1.5 mg/dL. Nephrotic-range proteinuria was found in 63.3% of patients and creatinine clearance less than 50 ml/min was found in 70%. Of the 30 patients, the most common renal histologic finding was diffuse proliferative glomerulonephritis (63.30%). The overall probability of patient survival was 94.1% at 12 months, 68.6% at 36 months and 34.3% at 60 months. During the follow-up period (25.8 months; range, 6 to 96 months), 4 patients died. Infection was the leading cause of death (75%). CONCLUSION: Lupus nephritis in the elderly patients is not uncommon. Prompt diagnosis should be made for appropriate management and optimal outcome.

Efficacy and hemodynamic outcome of prolonged intermittent renal replacement therapy (PIRRT) in critically ill patients: a preliminary report.

BACKGROUND: Acute kidney injury (AKI) is frequently part of a multiple-organ dysfunction syndrome presenting in critically ill patients. Prolonged intermittent renal replacement therapy (PIRRT) provides the advantages of both continuous renal replacement therapy (CRRT) in term of hemodynamic stability and the cost-effectiveness of intermittent hemodialysis (IHD). This study aims to study PIRRT in the aspects of efficacy and hemodynamic outcomes. MATERIAL AND METHOD: The authors present a single-center experience accumulated over 20 months from February 2009 to September 2010 with two PIRRT techniques, called SLEDD and SLEDD-f. Eight-hour treatments were performed daily for three consecutive days. Hemodynamic parameters were recorded at different time points and blood samples were taken for urea and solute clearance before and after treatment. RESULTS: Sixty critically ill patients with AKI were randomly assigned to undergo PIRRT 33 patients received SLEDD and 27 patients received SLEDD-f. Our results demonstrate significant decrease in BUN, creatinine, serum potassium and phosphate in both PIRRT techniques. Moreover with the use of similar filters and blood flow rates, SLEDD-f was comparable with SLEDD in terms of small solute clearance and detoxification. For hemodynamic outcomes, the authors found that MAP increased after completion of the first session of PIRRT and along the three consecutive days of daily PIRRT, together with the gradual improvement of vasopressor scores. CONCLUSION: The prolonged intermittent renal replacement therapy (PIRRT) appears to be an outstanding technique for treatment of critically ill patients with AKI and it also seems to have cost effectiveness. Moreover it is suitable to a limited resource region such as Thailand.