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.

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.

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.

Sphingomonas paucimobilis peritonitis: A case report and review of the literature.

Sphingomonas paucimobilis, a yellow-pigmented, aerobic, glucose non-fermenting, Gram-negative bacillus, is a rare cause of human infection normally associated with immunocompromised hosts. It has been associated with a few cases of continuous ambulatory peritoneal dialysis (PD) and is notorious for its resistance to the commonly used antibiotics. In half of the cases reported so far, the peritonitis was refractory to treatment, necessitating PD catheter removal. We report a case of Sphingomonas paucimobilis peritonitis in a 50-year-old patient who had been on PD for two years. The patient was successfully treated with intraperitoneal and intravenous antibiotics and the PD catheter was salvaged.

Renal failure in Hay-Wells syndrome.

Ectodermal dysplasia (ED) is a group of disorders involving developmental defects of the ectodermal structures, with abnormalities in the skin, hair, nails and sweat glands. Ankyloblepharon - ectodermal defects-cleft lip/palate (AEC) syndrome, also known as Hay-Wells syndrome, is characterized by eyelid fusion, ED and cleft lip/palate. We report a 15-year-old Omani boy with AEC syndrome who presented with end-stage renal disease (ESRD) requiring renal replacement therapy. Genitourinary anomalies including hypospadiasis, posterior urethral stricture and bilateral vesicoureteric reflux were noted. These led to secondary focal segmental glomerulosclerosis and ESRD. Screening for genitourinary anomalies and renal function tests must be performed in all patients with ED to facilitate early detection of renal disease and appropriate management.

Vaccination and transient hepatitis B surface antigenemia.

Hepatitis B vaccination is mandatory for all hepatitis B surface antigen (HBsAg)-negative hemodialysis (HD) patients with low hepatitis B surface antibody titers. We report a case of transient hepatitis B surface antigenemia, detected incidentally, in an HD patient after the second dose of Hepatitis B vaccine. The patient had to be isolated on a separate HD machine, in a separate room, until further investigations ruled out a true hepatitis B virus infection. This led to further unnecessary testing and generated great concern and anxiety for the patient. We present this case to emphasize that HD units should be aware of this phenomenon and that HBsAg testing be deferred until 4 weeks after vaccination to avoid HBsAg false positivity.