Desmopressin Acetate Before Percutaneous Ultrasound-Guided Kidney Biopsy in Patients with Renal Failure - Is it Really Beneficial?

Introduction: The most common complication of percutaneous renal biopsy is bleeding, which can be seen in up to one-third of cases. The aim of this study was to evaluate the effect of prebiopsy administration of intranasal desmopressin acetate in reducing the incidence of biopsy-related bleeding complications in patients with significant renal dysfunction who underwent renal biopsy. Methods: This was a retrospective, observational study of percutaneous native renal biopsies performed at our center from July 2014 to June 2018. Bleeding complication rates of patients with renal failure (estimated glomerular filtration rate [eGFR] <30 mL/minute/1.73 m2) who received desmopressin and those who did not receive desmopressin were compared. Results: Desmopressin administration before renal biopsy in patients with eGFR <30 mL/minute/1.73 m2 was associated with a significant reduction of bleeding complications (major and minor together; P = 0.025) and no significant reduction in major complications (P = 0.616) or intervention rates (P = 0.251) when compared with a group that did not receive desmopressin. Conclusions: While prebiopsy intranasal desmopressin use was associated with a significant reduction of overall bleeding complications including major and minor complications, there was no reduction in the rate of other major complications and interventions.

Delayed onset bleed after percutaneous kidney biopsy: is it the same as early bleed?

BACKGROUND: While the majority of bleeding complications after a percutaneous kidney biopsy (PKB) occur early (≤24 h), delayed onset bleeding complications (>24 h) have been rarely reported and can be catastrophic for the patient. PURPOSE: To describe the incidence, risk factors, and outcomes of delayed bleeding complications after PKB. MATERIAL AND METHODS: We retrospectively studied native and graft kidney biopsies in patients who developed delayed bleeding complications (>24 h) after the biopsy performed in the Department of Nephrology and Renal Transplantation of a tertiary care medical institution in north India between January 2014 to December 2018. RESULTS: Of the 4912 renal biopsies reviewed, 20 patients (16 men, 4 women; 0.40%) had a delayed biopsy bleeding complication. Of these patients, 95% had major bleeding complications requiring blood transfusions and 85% needed intervention like gelfoam/coil embolization. Despite intervention, one patient (5%) had mortality due to complications of bleeding and sepsis. When compared to a control group of patients with early biopsy bleed, patients with the delayed biopsy bleed had similar demographic and clinical profiles except for higher pre-biopsy hemoglobin and lower systolic and diastolic blood pressure. CONCLUSION: A post-PKB delayed onset bleed is not uncommon, and the vast majority of these patients had major bleeding complications requiring blood transfusions and/or intervention like embolization. They had a similar demographic and clinical profile presentation as early bleed patients. Meticulous outpatient monitoring and patient education after discharge may be useful to detect this complication promptly and to intervene early to have good patient outcome.

Comparative Effects of Pegylated Erythropoietin and Darbepoetin Alfa on Erythropoietin Hyporesponsive Anemia of Patients with Chronic Kidney Disease on Maintenance Hemodialysis.

OBJECTIVES: This study was carried out to evaluate the effect of pegylated erythropoietin and to compare its effects with the effects of darbepoetin alfa on anemia of chronic kidney patients on maintenance hemodialysis having erythropoietin hyporesponsiveness. METHODS: Forty adult patients of chronic kidney disease(CKD) with erythropoietin hyporesponsiveness undergoing maintenance hemodialysis were included in the study. These patients were randomly divided into two groups, Group A consisting of 20 patients who received Subcutaneous Pegylated erythropoietin at a dose of 0.6 mcg/kg body weight, once in every two weeks along with intravenous iron 100 mg/week for 3 months. Group B patients received subcutaneous darbepoietin alfa at a dose of 0.45 mcg/kg body weight once weekly along with iv iron 100mg /week for 3 months. Hematological, renal and inflammatory parameters such as erythrocyte sedimentation rate, C reactive protein, serum ferritin and transferrin saturation were measured at monthly intervals for three months, compiled and analyzed statistically. RESULTS: At the end of the study, in group A there was a significant rise in the hemoglobin, haematocrit and transferrin saturation (p < 0.001 for each of them) while there was a significant decrease in serum ferritin levels (p<0.001). In group &B the increase in hemoglobin, haematocrit and transferrin saturation were not statistically significant (p>0.05), and also there was a significant rise in the serum ferritin levels at the end of the study (p< 0.05). The mean rise in hemoglobin between subsequent months was higher in group A as compared to group B which was statistically significant. CONCLUSION: Pegylated erythropoietin is better than darbepoetin alfa in overcoming erythropoietin hyporesponsiveness and maintaining stable hemoglobin levels in CKD patients on maintenance hemodialysis.

Confrontation with a live subretinal parasite.

BACKGROUND: Parasitic infestation of the eyes are a major cause of ocular diseases across the globe. Filarial and filarial-like nematodes top the list of the nematodes that affect the eye. CASE: A rare case of live sub retinal worm is reported in a 25 years old apparently healthy young male. The case presented with unilateral loss of vision and floaters in the affected eye. Upon examination a live subfoveal worm was identified with continuous wriggling movements and diffuse retinal edema. The worm was removed surgically and sent for parasitological examination. OBSERVATION: The worm was identified microscopically as Loa Loa. However detailed histopathological examination could not be incorporated. The patient's vision improved to 6/12 (0.30 Log MAR) from the initial presentation of 3/60 (1.30 Log MAR) after three months follow-up. CONCLUSION: The rare sub retinal live worm presents a challenge in management. The management depends upon the location and viability of the parasite. Surgical management is aimed at worm removal and vision preservation.