Osmolar gap in hyponatraemia: An exploratory study.

Hyponatraemia has indeed been extensively studied from multiple angles, including volume status, tonicity, and aetiology; however, the specific consideration of the osmolar gap (OG) within the context of hyponatraemia and its potential impact on their overall outcomes received limited attention in research. The current study represents an effort to address this gap in our understanding. This prospective exploratory study was conducted on adults aged 14 years and older at the Indus Hospital, Karachi, from 2017 to 2020. The study involved categorising severity of hyponatraemia and volume status. The osmolar gap (OG) was calculated and categorised as either increased (OG>10) or normal (OG<10). Among the 262 patients included in the study, there were 139 females and 123 males. Elevated OG was observed in 141(53.8%) patients. There were 28 (10.7%) recorded fatalities and majority of these individuals had an elevated OG. These findings underscore the importance for clinicians to consider the osmolar gap when managing patients with hyponatraemia.

Epidemiology And Risk Factors Of Chronic Kidney Disease In Rural Areas 4 (Badin) Of Sind, Pakistan.

Objective: To evaluate the epidemiology of chronic kidney disease in a rural setting. METHODS: The retrospective study was conducted at Indus Hospital, Badin, Sindh, Pakistan, and comprised data of patients of either gender regardless of age who visited the nephrology clinic between July 2019 and July 2020. Data was retrieved from the institutional health management information system. Data was analysed using SPSS 21. RESULTS: Of the 348 patients, 184(52.9%) were males and 164(47.1%) were females. The overall mean age was 40.4±19 years. Obstructive nephropathy was the most frequent cause of chronic kidney disease 108(31%), followed by chronic kidney disease of unknown aetiology 79(22.7%). The most prevalent comorbid was hypertension in 106(30.5%) patients, while 56(16.1%) were diabetic. The stone disease was found in 90(24.6%) patients. Age was strongly associated with chronic kidney disease (p<0.001). Among those with chronic kidney disease of unknown aetiology, 35(44.3%) patients were aged 31-50 years 35. The expected glomerular filtration rate in such patients was significantly associated with the cause of chronic kidney disease (p<0.001). Conclusion: Unknown aetiology and kidney stones were the leading causes of chronic kidney disease among the rural population studied.

Nutritional vitamin D is efficacious for reducing intact parathyroid hormone in chronic kidney disease, a prospective interventional study.

OBJECTIVE: To see the efficacy of oral cholecalciferol administered to chronic kidney disease patients with vitamin D deficiency. Methods: The prospective interventional study was conducted at the Indus Hospital, Karachi, from January 11, 2017, to January 10, 2018, and comprised diagnosed pre-dialysis chronic kidney disease patients of either gender aged >14 years having vitamin D deficiency. Oral vitamin D 50,000IU was given weekly to those who had severe deficiency <10ng/ml, and every other week to those with less severe 10-25ng/ml deficiency for 3 months. Improvement in vitamin D level was checked along with other chronic kidney disease markers every month over the 3-month period. Data was analysed using SPSS 24. RESULTS: Of the 186 patients enrolled, 129(%) completed the study; 76(58.5%) males and 53(40.8%) females. Overall, 105(81.4%) patients achieved normal vitamin D levels after 3 months of treatment. Significant negative but weak correlation of phosphate, creatinine and intact parathyroid hormone levels was found with vitamin D (p<0.05). Significant positive but weak correlation was found between albumin and vitamin D levels (p<0.05). Conclusion: Significant efficacy of oral vitamin D in chronic kidney disease patients was seen.

Epidemiology and complications of snakebite in rural area of Badin and Thar Sind, Pakistan.

OBJECTIVE: To identify the population at risk of snakebite, the peak season and the site of bite. METHODS: The retrospective study was conducted at the Indus Hospital, Badin, Pakistan, and comprised data of patients bitten by snake between January 2017 and December 2020 in the rural area of the Sindh province who presented to the emergency room and were treated according to the institutional protocol. Data was collected on a structured proforma. Data was analysed using SPSS 21. RESULTS: Of the 695 patients, 517(74.4%) were males and 178(25.6%) were females. The overall mean age was 29.9±15.7 years. Majority of the patients were farmers 294(42.3%), followed by labourers 195(28.1%). The most common site of snakebite was foot 556(80%). In 476(68.5%) cases, the snake type was not identified. Viper bite was noted in 193(28.2%) cases. Proteinuria, haematuria and renal dysfunction were observed in 302(43.5%), 302(43.5%) and 112(16.1%) patients, while leucocytosis, raised prothrombin time and low platelets were found in 305(43.5%), 268 (38.6%) and 100(14.4%) patients, respectively. Maximum number of cases took place in the peak summer month of July 112(16.1%). There were 8(1.2%) mortalities. CONCLUSIONS: Morbidity and mortality by snakebite was found to be prevalent in the study site, calling for preventing strategies.

Strategies for preventing end stage kidney disease: The impact of kidney stone disease on Chronic Kidney Disease in Pakistan.

Chronic Kidney Disease (CKD) is one of the major noncommunicable diseases that have social and economic impacts along with day-to-day health-related problems. Kidney stone disease is still one of the major causes of CKD in Pakistan. Kidney stone disease is a preventable cause of renal failure, if detected and treated early. Kidney stone is prevalent in the stone belt areas in our country which are located in rural areas. The treatment is very costly, and mostly available only in large cities. The treatment requires tertiary care setup and expertise. Therefore, there is a need to focus on the preventive strategies which are mainly dietary and lifestyle modifications, along with public awareness programmes. Nephrologists and urologists along with the government should take interest and give priority to CKD due to stone disease.

Status of chronic kidney disease of unknown aetiology in Pakistan.

The incidence of chronic kidney disease (CKD) is rising all over the world. Developing countries like Pakistan will be most affected due to the prevalence of risk factors associated with CKD, such as diabetes, hypertension, kidney stone, and infections. Chronic kidney disease of unknown aetiology (CKDu) is an emerging CKD recently recognised in agricultural communities all around the world. CKDu is recognised, mostly in men between 20 and 50 years of age, with no symptoms, having normal or borderline elevated blood pressure with normal blood glucose levels. Their ultrasonography manifests small kidneys. Urine examinations reveal no or minimal proteinuria, few red blood cells and leukocytes. The actual prevalence in Pakistan is unknown but it is not infrequent for nephrologists and physicians to see these patients in hospitals. There is a need to look into this entity at the community level.

Is haemodialysis the most feasible dialysis modality for Pakistan?

Chronic kidney disease (CKD) has shown a rising trend in the last two decades. It is one of the most devastating diseases which has an enormous psychosocial and economic burden. The treatment available includes haemodialysis, peritoneal dialysis and kidney transplantation. All treatment options have their pros and cons, needs and preferences, though haemodialysis is one of the most available entity in Pakistan. There are a few intrinsic problems associated with haemodialysis which has significant environmental as well as economic impact. One of the most important is the need of huge quantity of water to carry out the haemodialysis procedure along with production of solid waste in the form of disposables and electricity consumption. Peritoneal dialysis on the other hand is more environment-friendly and cost-effective and it should be one of the preferred options for our CKD patients.

The role of the poultry industry on kidney and genitourinary health in Pakistan.

Pakistan is experiencing a "double burden'' of disease. Under-development is associated with illnesses like infections and nutritional deficiency, and is accompanied with diseases linked with development, such as diabetes, hypertension, cancer and chronic kidney disease. In Pakistan, renal and genitourinary diseases are an important, unaddressed health issues. Chronic kidney disease of unknown etiology (CKDu) is a recognized form of renal failure in Pakistan. A possible cause of CKDu is toxins such as arsenic, cadmium, lead and other heavy metals associated with renal and genitourinary diseases. The poultry industry is an important source of both heavy metal toxins and also mycotoxins spread in the process of farming. Of the numerous mycotoxins, zearalenone and ochratoxin are well-known for their hazardous effects on genitourinary and renal parenchyma respectively. We reviewed the literature using PubMed and Google Scholar databases for levels of these toxins in various constituents of chicken farming like chicken feed, meat, litter and human drinking water contamination in various parts of the country. We found that these toxins are in higher levels than recommended.

Reusing dialyzer in low income countries: A good cost saving tactic with complex ethics.

Despite almost universal practice of dialyzer reuse from the earliest days of haemodialysis, reusing dialyzer always remains a controversial issue and several ethical concerns have been raised. Some of the important are safety of reuse over single use, informed consent of the patient, conflict of interest on the part of physician or manufacturer, fiscal responsibility and environmental stewardship. Indeed, at the beginning of this century, there was a drastic shift of practice in favour of single use in developed countries due to availability of biocompatible haemodialyzers, at favourable price. Despite this mega shift, dialyzer reuse is still widely practised in low-income countries. Considering cost inflation and limited medical resources in such countries, dialyzer reuse may be justified as a cost-saving strategy for this part of world. However, it poses the same ethical questions to us which were a matter of debate for the western world in the 1980s and 1990s. This review of literature was planned to revisit and highlight these concerns.

More hostile dyslipidaemia in chronic kidney disease patients on maintenance haemodialysis than on conservative management.

OBJECTIVE: To study the pattern of dyslipidaemia in patients with stage-V chronic kidney disease on conservative management and those on maintenance haemodialysis. METHODS: This comparative observational study was conducted at the Jinnah Postgraduate Medical Centre, Karachi, from February to July, 2008, and comprised stage-V chronic kidney disease patients. The patients were divided in two groups. Those who were on conservative management were placed in Group A, and those who were on maintenance haemodialysis were in Group B. Serum total lipid, cholesterol, triglycerides and high-density lipoprotein for both groups were assayed on chemical analyser and low-density lipoprotein was calculated by Friedwald equation. SPSS 17 was used for data analysis. RESULTS: Of the 120 patients, there were 60(50%) in each group. The mean age of patients in Group A was 46.33±14.56 years and in Group B was 43.4±14.1years. Of all, 64(53.3%) were men and 56(46.7%) were women. Mean systolic and diastolic blood pressure was 134±19.58mmHg and 83.6±14.14mmHg in Group A and 129±19.7mmHg and 79.7±12.1mmHg in Group B. Mean serum total lipid was significantly higher (p<0.01) whereas mean serum cholesterol was significantly lower (p<0.01) in Group B. Comparison of mean serum triglycerides between the groups was also statistically significant (p<0.01) and was high in Group B. Mean serum high-density lipoprotein was lower in Group B (p<0.01). The difference between serum low-density lipoprotein levels was statistically insignificant between the groups (p=0.11). CONCLUSIONS: Pattern of dyslipidaemia in patients on maintenance haemodialysis was more hostile than those on conservative management, and posed increased risk of coronary heart disease.