Role of antenatal care in reducing the risk of postpartum acute kidney injury.

Objective: Antenatal visits play a very important role to diagnose and manage pregnancy related health issues. This study was an attempt to identify the reasons that increase the risk of postpartum acute kidney Injury with special focus on antenatal care. Methods: We analyzed 110 patients in Nephrology and Gynaecology wards in Lahore General Hospital. Out of these 40 had Postpartum Acute Kidney Injury and 70 patients did not have it. Questionnaire regarding aspects of antenatal care (demographics, timing and number of antenatal visits) was filled by the patient or immediate family members. Results: Mean age of the 110 patients was 26.45 years. Mean Duration of pregnancy in the control group was 36.12 weeks and in cases it was 31.62 weeks. Out of 110 patients, 36(32.72%) patients did not have any antenatal visit while 62(56.3%) patients had more than five visits. Out of the 40 Postpartum Acute Kidney Injury patients, 23(57.5%) patients did not get any antenatal care. Out of 70 patients without Postpartum Acute Kidney Injury, 13 did not have any antenatal care. There were 19 patients who did not have booked visits because of financial Issues, followed by lack of awareness in 12 patients, distance issues for three patients and lack of family support for two patients. Conclusion: Patients who did not have antenatal care were at an increased risk of developing PPAKI. Financial issues and lack of awareness were the most common risk factors for compromised antenatal care.

Refusal of hemodialysis by hospitalized chronic kidney disease patients in Pakistan.

In Pakistan, patients with chronic kidney disease (CKD) are commonly diagnosed at a late stage. There is little information about the refusal of hemodialysis by hospitalized CKD patients who need hemodialysis (HD) and reasons for acceptance and refusal among these patients. All patients with Stage V CKD who had medical indications to undergo HD and were hospitalized at a tertiary care facility over a six-month period were invited to participate in this study. Patients were surveyed regarding acceptance or refusing of HD and reasons for their decisions. Demographic, socioeconomic, and clinical characteristics of patients were compared between patients who accepted or refused HD. A total of 125 patients were included in the study. The mean age of the patients was 47.9 ±12.1 years. The mean duration of diagnosis of CKD was 2.5 ± 0.6 months. Of all patients, 72 (57.6%) agreed to do HD and 53 (42.4%) refused HD. Patients with arteriovenous fistula in place (27.1 vs. 9.1%, P 0.02) and those in the middle- or higher-income group (64.4% vs. 38.6%, p = 0.03) were more willing to undergo HD. Trust in doctor's advice (86.1%) was the most common reason for acceptance of HD. Frequency of HD per week (52.8%), lifelong and permanent nature of HD (50.9%), advice by family members or friends (37.7%), perception of poor quality of life on HD (35.8%), and fear of HD needles and complications during HD (33.9%) were the most common reasons for refusal. Refusal of HD is common among hospitalized CKD patients with medical indications to undergo HD, especially in lower income group.

Clinical predictors of an abnormal ultrasound in patients presenting with suspected nephrolithiasis.

OBJECTIVE: To determine any clinical features associated with an abnormal ultrasound in patients with suspected nephrolithiasis in an out-patient setting. METHODS: The study design was cross-sectional in nature. The study was conducted at an out-patient nephrology department of a tertiary care facility over a 3 month period. Patients included in the study were 18-80 years old, who presented with unilateral flank or costovertebral angle pain with or without other clinical features suggestive of renal or ureteric calculus based on clinician's judgement. Every patient's history was reviewed to obtain information on age, gender, location and radiation of pain, onset, severity and nature of pain, associated urinary and systemic symptoms and past history of nephrolithiasis. An ultrasound was considered to be abnormal if there was documented presence of renal or ureteric stone and/or unilateral hydronephrosis. RESULTS: A total of 209 patients were included in the study. Of these patients, 126 (60.3%) were males and 83 (39.7%) were females, 60 (28.7%) had prior history of nephrolithiasis. Ultrasound was abnormal in 110 patients (52.9%). On a multivariate logistic regression analysis, only past history of nephrolithiasis (OR 3.3, 95% CI 1.65-6.7) was associated with an abnormal ultrasound. CONCLUSION: In the absence of any significant clinical predictors use of ultrasound is justified in patients with suspected nephrolithiasis especially in those with prior history of stones.

ECG Abnormalities In Patients With Chronic Kidney Disease.

BACKGROUND: Chronic kidney disease (CKD) is associated with increased risk of cardiovascular disease. Electrocardiographic (ECG) abnormalities are common in CKD patients. However, there is variation in literature regarding frequency of ECG abnormalities in CKD patients and limited information in local population. METHODS: The study design was cross-sectional in nature. All patients between ages of 20-80 years with CKD not previously on renal replacement therapy who were admitted to nephrology ward at a tertiary care facility over a 6-month period were included. All patients underwent 12 lead electrocardiograms (ECG). ECG abnormalities were defined based on accepted standard criteria. RESULTS: Total number of patients included in the study was 124. Mean age of all patients was 49.9±13.8 years, 106 (84.8%) had hypertension, 84 (70%) had diabetes mellitus, and 35 (29.9%) had known cardiovascular disease. Mean serum creatinine was 7.2±3.4 mg/dl, mean eGFR was 10.6±9.2 ml/min/1.73 m2. Overall 78.4% of all CKD patients have one or more ECG abnormality. Left ventricular hypertrophy (40%), Q waves (27.2%), ST segment elevation or depression (23.4%), prolonged QRS duration (19.2%), tachycardia (17.6%) and left and right atrial enlargement (17.6%) were the most common abnormalities. CONCLUSIONS: ECG abnormalities are common in hospitalized CKD patients in local population. All hospitalized CKD patients should undergo ECG to screen for cardiovascular disease.

Frequency of Hepatitis C in hospitalized patients with chronic kidney disease.

BACKGROUND AND OBJECTIVES: Hepatitis C and chronic kidney disease (CKD) are major global health problems and are highly prevalent in Pakistan. There is limited information on prevalence of hepatitis C in patients with CKD not yet on dialysis. The objective of this study was to determine the frequency of hepatitis C in hospitalized chronic kidney disease patients at a tertiary care center in Pakistan. METHODS: The study design was cross-sectional in nature. Patients between ages of 20-80 years with CKD not previously on renal replacement therapy and who were admitted to nephrology ward at a tertiary care facility were included. Hepatitis C was tested using 3rd generation enzyme linked immunosorbent assay (ELISA). Hepatitis C RNA was tested by polymerase chain reaction (PCR) in patients with positive ELISA. RESULTS: A total of 180 patients were included in the study. Mean age of patients was 48.7±14.9 years. Of all patients, 105 (58.3%) were males and 75 (41.7%) were females, 152 (84.4%) had hypertension, 113 (62.8%) had diabetes mellitus and 26 (14.9%) had known cardiovascular disease. Mean eGFR of patients was 11.4±9.4 ml/min/1.73 m2. Of all patients with CKD, 49 (27.2%) had hepatitis C test positive by ELISA. Hepatitis C PCR testing was done in 39 patients with hepatitis C ELISA positive status and 29 (74.4%) tested positive. Risk factors and clinical characteristics of patients with and without positive hepatitis C antibody by ELISA were similar. CONCLUSION: A significant proportion of hospitalized CKD patients have hepatitis C. Strict universal infection control measures should be implemented in nephrology wards to prevent transmission of hepatitis C infection.