Frequency of IgA Nephropathy Presenting at a Tertiary Care Hospital in Pakistan.

OBJECTIVE: To determine the frequency of IgAnephropathy presenting at a tertiary care hospital. STUDY DESIGN: Across sectional, observational study. PLACE AND DURATION OF STUDY: Pakistan Institute of Medical Sciences, Islamabad and Shifa International Hospital, Islamabad, Pakistan, from November 2008 to November 2014. METHODOLOGY: This was a retrospective analysis of renal biopsies for the diagnosis of nephropathy during the study period. Biopsies were stained with fluorescence isothyocyanate (FITC) labelled antibodies against IgG, IgA, IgM, C3, C4 and C1q for fluorescent microscopy. For histopathological examination, the specimens were stained with hematoxylin and eosin, Periodic acid Schiff and methanamine silver stains for light microscopy. RESULTS: Out of total 1,658 renal biopsy cases, 142 (8.6%) were diagnosed as IgA nephropathy on light and immunofluorescence microscopy. Majority of IgAnephropathy patients were young (mean age = 33.2) and presented with proteinuria. The frequency rose from 2% in 2008 to 9.4% in 2014. CONCLUSION: IgAnephropathy was present in younger population and has a rising trend in our population.

Antiphospholipid Antibody Syndrome Presenting with Unilateral Adrenal Hemmorhage.

The antiphospholipid antibody syndrome presents with vascular thrombosis which involve both arterial and venous systems. The clinical presentation of antiphospholipid antibody syndrome includes obstetric complications leading to recurrent abortions, presence of circulating antibodies against phospholipids, and multi-organ thromboembolisms. We report a case of a patient who presented with unilateral adrenal hemorrhage and subsequently found to have antiphospholipid antibody syndrome and lupus nephritis.

Predictive factors for increased aortic pulse wave velocity in renal transplant recipients and its relation to graft outcome.

To evaluate aortic stiffness in renal transplant patients and to determine the correlation of renal insufficiency and estimated glomerular filtration rate (eGFR) with aortic pulse wave velocity (APWV), we studied 96 renal transplant patients followed-up at our center. We measured the APWV using transcutaneous Doppler flow recordings and the foot-to-foot method, and calculated the eGFR using the Modification of Diet in Renal Disease equation. The study included 81 (84.4%) males and 15 (15.6%) females. The mean age of the patients was 37.84 ± 10.10 years. The mean duration of transplant was 47.90 ± 34.40 months. The eGFR of the patients ranged from 1 to 120 mL/min, with a mean GFR of 72.6 ± 23.2 mL/min. Sixty-seven (69.8%) patients had eGFR > 60 mL/min and hence had stages 1 and 2 chronic kidney disease (CKD), 27 (28.1%) patients had eGFR 30-60 mL/min and hence had stage 3 CKD and two (2.1%) patients had eGFR <30 mL/min and hence had stages 4 and 5 CKD. The APWV of the patients ranged from 4 to 14.2 m/s, with a mean of 7.49 ± 2.47 m/s. A significant inverse correlation was found between the APWV and eGFR (Pearson correlation coefficient, -0.427, P = 0.00). The mean APWV was significantly higher among patients with higher CKD stage, P = 0.004. We conclude that the APWV is related to the renal graft dysfunction as measured by eGFR. The poorer the renal function, the higher was the APWV. Determination of the APWV may be helpful in predicting the outcome in renal transplant recipients.

Prevalence of peripheral arterial disease diagnosed by ankle brachial index among chronic kidney disease patients in a tertiary care unit.

The objective of this study is to determine the prevalence of peripheral vascular disease (PVD) in patients with chronic kidney disease (CKD). Seventy-two patients with CKD stage 3 or above were included in this study. Blood samples were taken from each patient to determine complete blood counts, serum albumin, electrolytes, lipid profile and blood sugar random/fasting. The glomerular filtration rate (GFR) was estimated with the Cockcroft-Gault formula. The ankle-brachial index (ABI) was determined to identify the presence of PVD. A standardized Doppler ultrasound device was used. ABI of <0.90 was considered diagnostic of PVD. The mean age of the patients was 53.22 ± 12.8 years. Forty-six patients (63.9%) were male. Twenty-five patients (34.7%) were in stage 3 CKD, 20 patients (27.8%) were in stage 4 CKD and 27 patients (37.5%) were in stage 5 CKD. Twenty patients (27.8%) had an ABI <0.9 and hence had PVD. Of these patients, 13 (18.1%) had mild to moderate PVD with ABI of 0.41-0.90 and seven (9.7%) had severe PVD with ABI of 0.00-0.40. All the baseline parameters including systolic blood pressure (BP), diastolic BP, height, weight, body mass index, GFR, hemoglobin, total blood count, platelets, triglycerides, high-density lipoprotein, low-density lipoprotein and uric acid were not significantly different between patients with and without PVD (P >0.05). However, the mean total cholesterol was significantly higher among patients with PVD. The prevalence of PVD was significantly high in patients with stage 5 CKD (P <0.05). PVD is frequent among patients with CKD based on the ABI as measured by Doppler ultrasound.

Acute renal failure following multiple wasp stings.

Wasp bite induced ATN from direct venom toxicity is very rare. We report two such cases. The first case was a 14 years old boy admitted with oliguria following multiple wasp stings. He had grossly deranged renal function requiring hemodialysis support. The other patient was a 24 years old man admitted with similar history and also required hemodialysis support. Renal biopsy in both cases was consistent with acute tubular necrosis without any casts or other changes, suggesting direct venom toxicity. Both the patients recovered completely after a period of few weeks, highlighting the importance of early detection and treatment of renal failure from wasp venom.

Nephritis and Charcot-Marie-Tooth disease: an unusual association.

A 24 years old male, who presented to us with uraemic symptoms secondary to chronic glomerulonephritis. On examination, he was found to have features of peripheral neuropathy which was confirmed as Charcot-Marie-Tooth type 1 on nerve conduction studies. Very few cases of glomerular disease, mainly focal segmental glomerulosclerosis have been associated with the Charcot-Marie-Tooth worldwide.