Topical Henna Application Causing Acute Kidney Injury and Acute Hemolytic Anemia.

Body art by henna staining is a practice that is widely prevalent in the Middle East and Africa, and has been known to be in vogue for hundreds of years. The practice is also significant as a ceremonial custom for weddings and social gatherings. However, due to its natural components (Lawsone) and additives, including para-phenylene-diamine (PPD), henna has also been associated with a number of health hazards, including acute hemolysis and acute kidney injury (AKI). We report in this case, a female patient who presented with AKI and acute hemolytic anemia following excessive pre-wedding henna staining of her arms and legs.

Monkeypox in a Kidney Transplant Recipient: Case Report and Literature Review.

Monkeypox (mpox) infection is usually a self-limiting disease; however, kidney transplant recipients may be at a higher risk of serious complications, due to their immunosuppressed status. Nevertheless, the reported mpox cases in transplant recipients are very few, thus data on the clinical course and prognosis details of mpox in transplant recipients are scarce. Indeed, only 2 cases of mpox in kidney transplant recipients have been reported: one patient achieved good clinical recovery, and the other patient experienced a disseminated form of the disease with urinary and gastrointestinal complications. Yet, both patients recovered fully with no allograft involvement. Here, we report a case and images of a 46-year-old male patient, with a history of posttraumatic splenectomy in 1999 and a living related kidney transplant in 2010, who presented to us with fever, sore throat, and skin rash. After thorough examination, a throat swab sent for mpox DNA polymerase chain reaction was positive; similarly, a cutaneous swab taken from a skin lesion was positive for mpox by DNA polymerase chain reaction, although he had no history of recent travel or contact with mpox cases. Our patient received supportive care and made a good clinical recovery with no disease sequelae. In this report, we describe the patient's clinical course and outcome, as well as photographic illustrations of skin lesion progression. With the present outbreak of mpox cases, clinicians should consider mpox in differential diagnoses of skin rash in immunosuppressed patients. Early identification of the infection, through viral detection by DNA polymerase chain reaction from samples taken from the skin rash, is necessary to facilitate a prompt diagnosis.

An Interesting Case of Hypothyroidism Associated Acute Kidney Injury.

Muscle involvement is common in hypothyroidism. However, hypothyroidism as a causal factor for severe rhabdomyolysis and acute kidney injury (AKI) is rarely reported. We report a case of a 56-year-old Arab male who presented with unexplained acute worsening of chronic kidney disease. The patient was detected to have hypothyroidism and rhabdomyolysis on laboratory investigations. However, thyroxine replacement led to partial recovery of renal function. CPK also improved with vigorous hydration and thyroxine replacement. Although this is a rare association, in the absence of other causes of rhabdomyolysis, hypothyroidism should be suspected in patients presenting with AKI and high creatinine phospho-kinase.

Five-Year Mortality Analysis in Hemodialysis Patients in a Single-Center in Dubai.

The purpose of this study is to determine the mortality among patients on hemodialysis (HD). This observational cohort study was conducted at Dubai Hospital during the period between January 2012 and December 2016. All adults' patients with end-stage renal disease (ESRD) on HD irrespective of their age, gender, and duration of dialysis were enrolled. Mortality among these patients along with certain information like age at the time of death, gender, cause of ESRD, comorbidities, and serology report, were collected. Out of a total of 411 patients, 112 (27.3%) patients died during the study period, 56% were male and their median age at the time of initiation of dialysis and at the time of death was 59.38 ± 13.5 and 63.8 ± 13.6, respectively. Thirteen patients suffered early mortality; i.e., died within 365 days of initiation of dialysis. Diabetes mellitus (DM) was the most common cause of ESRD (73%) among the deceased populations, whereas hypertension was the most prevalent comorbidity in our study group. Anemia (46%), hypoalbuminemia (54%), and hypoparathyroidism (72%), whereas high ferritin (63%) and abnormal phosphorus (61.6%) were predominant biochemical parameters in the deceased patients. The leading cause of death was cardiovascular in 48 patients (42.85%) followed by infection/sepsis (21 patients, 18.75%), unknown causes/sudden death (including sudden death at home) in 18 patients (16.07%) and cerebrovascular events in seven patients (6.2%). Other causes include gastrointestinal hemorrhage, liver disease, and pulmonary embolism. In general, older age group, DM, prolonged duration on dialysis and cardiac diseases were the common causes of mortality in our study population. We found that the conventional risk factors such as old age, diabetes, cardiovascular disease, duration on dialysis, dialysis adequacy, low hemoglobin and low albumin, abnormal phosphorus, and high ferritin are comparatively prevalent in our study patients. Monitoring and timely intervention of these risk factors can help in reducing mortality in future.

Challenges in management of diabetic ketoacidosis in hemodialysis patients, case presentation and review of literature.

Chronic kidney disease is associated with accumulation of uremic toxins that increases insulin resistance which will lead to blunted ability to suppress hepatic gluconeogenesis and reduce peripheral utilization of insulin. CKD patients fail to increase insulin secretion in response to insulin resistance because of acidosis, 1,25 vitamin D deficiency, and secondary hyperparathyroidism. Hemodialysis causes further fluctuations in glycemic control due to alterations in insulin secretion, clearance and resistance. DKA is uncommon in hemodialysis patients because of the absence of glycosuria and osmotic diuresis which accounts for most of the fluid and electrolyte losses seen in DKA, anuric patients may be somewhat protected from dehydration and shock, although still subject to hyperkalemia and metabolic acidosis. However, substantial volume loss can still occur due to a prolonged decrease in oral intake or increased insensible water losses related to tachypnoea and fever. There is no current guidelines for the management of diabetic ketoacidosis in anuric hemodialysis patients considering their differences than general population. In this review article we reviewed the literature and came with specific recommendations for management of Ketoacidosis in patients with CKD treated by hemodialysis.

Epidemiology of end-stage renal disease in Dubai: Single-center data.

Hemodialysis (HD) was first established in Dubai in the year 1980 and was in its full capacity by the year 1983. Since then, the HD population has been growing rapidly. This report represents the demographic data and clinical characteristics of our HD patients during the period between January 2012 and October 2016. Diabetic nephropathy (57%) and hypertension (12.4%) are emerging as the most common causes of end-stage renal disease (ESRD) in our data, followed by undetermined causes in those who presented as ESRD (10.9%), and then by rejected transplant in 4.6%. Obstructive uropathy in our data was 4.37% among all causes. The causes were primary glomerulonephritis (only proven cases in kidney biopsy were counted) in 3.6%, adult polycystic kidney disease in 2.43%, and lupus nephritis in 1.45% of cases. The prevalence of ESRD in the current study was 152 patients per million population per year.

Pattern of acute glomerulonephritis in adult population in Dubai: A single-center experience.

Epidemiological data of renal diseases have great geographic variability throughout the world. Due to the lack of a national renal data registry system, there is no information on the prevalence rate, clinical and pathological features of various glomerulonephritis (GN) in the United Arab Emirates (UAE). In a retrospective cross-sectional study, we analyzed 158 renal biopsies done in Dubai Hospital, UAE, between the years of 2005 and September 2014, with an aim to determine the prevalence rate and frequency of different pathological patterns of GN in adult patients who presented with proteinuria ± hematuria. In our study, primary GN still remains more common than secondary GN (66.4% vs. 33.5%). Among the primary GN in our analysis, minimal change disease was the most common primary GN affecting 20% of the study population (13.2% of the total GN causes) followed with membranous GN (18.2%), then membrano- proliferative GN (15.3%) and focal segmental glomerulosclerosis (13.46%), while among the secondary causes lupus nephritis (LN) is the most prevalent GN in UAE, predominantly in the Emirati national population whom constituted 48% of total biopsies. Indeed, LN had the highest incidence among all types of GN even the primary ones, constituting 23.4% of total GN in Dubai (74% of the total secondary causes). Furthermore, systemic lupus erythematosus was the most common GN in women while the minimal change was widely affecting male patients. Among elderly, the most common pathology was diabetic glomerulosclerosis followed by amyloidosis.

Tuberculosis of the arterio-venous graft in a renal transplant recipient.

A 44-year-old Pakistani lady with end-stage renal disease secondary to rapidly proliferative glomerulonephritis underwent successful renal transplantation. Three years later, she was referred to the surgeon with an abscess in the axillary region at the site of a previous arterio-venous (AV) graft. She underwent repeated incision and drainage of the abscess, which was constantly recurring. Nine months later, she presented with a tender swelling at the site of the AV graft with purulent discharge. The graft was removed; culture and histology confirmed the presence of tuberculosis (TB). This patient presents a rare case of TB infection in the AV graft.