Pregnancy-related Acute Kidney Injury in Public Hospital in South India: Changing Trends

Background: Pregnancy-related acute kidney injury (PRAKI) is a common problem in the developing world. Materials and methods: In this retrospective observational study at a tertiary care hospital in South India we evaluated records for the maternal, fetal, and renal outcomes in women with PRAKI. Results: Over a 10-year period, 395 patients of PRAKI were seen constituting 8.1% of all acute kidney injury (AKI). The mean age of patients was 27 ± 3 years. A total of 176 (44.5%) had pre-eclampsia, 132 (33.4%) had puerperal sepsis, 76 (19.2%) had antepartum hemorrhage or postpartum hemorrhage (APH 30/PPH 46), nine (2.2%) had hemolytic uremic syndrome (HUS). Obstruction was seen in two patients. Eleven had underlying glomerulonephritis out of three had lupus nephritis. Forty-five of 395 (11.39%) had hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, that is, 25.5% of those with pre-eclampsia. Sixteen (4.0%) had placental abruption. A total of 288 (72.9%) presented postpartum. Renal biopsy done in 103 (26%) showed patchy cortical necrosis (PCN) in 25 (22.3%), diffuse cortical necrosis (DCN) in 23 (20.3%), acute tubular necrosis (ATN) in 20 (19.4%), acute interstitial nephritis (AIN) in 10 (9.7%), while nine (8.7%) had thrombotic microangiopathy (TMA). Glomerular disease was seen in 11. Cortical necrosis (CN) was seen in 48 patients of which 10 (20.83%) had abruption placenta, 25 (52%) had puerperal sepsis, 11 (22.9%) had postpartum hemorrhage (PPH), and two (4.1%) had TMA. A total of 290 (73.4%) required dialysis. About 76% improved while 8.3% progressed to end-stage renal disease (ESRD). Maternal mortality (MM) was 5%. There were 42 intrauterine deaths and 30 deaths in the neonatal period. Discussion: Pregnancy-related acute kidney injury in developing countries is more common as compared to the West. Only 49% patients had booked pregnancy, that is, received regular antenatal care. Apart from pre-eclampsia which is also the major cause in the West and was the etiology in 44% of patients with PRAKI in our study, sepsis (33%) and maternal hemorrhage (19%) were also significant. Immediate recovery from PRAKI was 75% however about 8% develop end-stage kidney disease (ESKD) while in the west ESKD occurred in only about 2%. Conclusion: Pregnancy-related acute kidney injury is an important cause of maternal and fetal morbidity and mortality. Pre-eclampsia emerged as the most common cause of PRAKI and CN was the most common histological lesion. Proper antenatal care and management may improve pregnancy outcomes.

Mediastinal teratoma with spontaneous rupture into the lung

We report a 37-year-old woman presenting with recurrent respiratory infections since childhood. She was admitted due to persistent cough. The patient was evaluated by chest radiography and computed tomography scan which revealed multiple cystic cavities in the right upper lobe associated with a mass with air-fluid level. Complicated pulmonary bronchogenic cyst was suspected. After thoracic surgery, pathologic diagnosis was reported as mediastinal mature cystic teratoma with rupture into the lung

Pattern of dynamic intestinal obstruction in adults

To evaluate the causes of dynamic intestinal obstruction at PIMS Islamabad. Material and This was a prospective study of 75 consecutive cases of dynamic intestinal obstruction, conducted in department of surgery at Pakistan Institute of Medical Sciences, Islamabad from 1st August 1998 to 31st December 1999. Those patients who improved with conservative treatment and did not undergo laparatomy were excluded from the study. All patients who underwent laparatomy for management of their disease were included. Laparatomy findings were recorded and where necessary specimen was taken for histopathology for confirmation of final diagnosis. In this study of 75 cases, 100% patients presented with pain and distension of abdomen, other symptoms were less in frequency. Males were 38 and females were 37 with male to female ratio of 1.01:1. Tuberculosis was the leading cause of [36%] dynamic intestinal obstruction followed by carcinoma of the large gut and postoperative adhesions. Only two patients had small bowl malignancy and intessusception, and one patient was with meckle's diverticulum. Tuberculosis is emerging as a leading cause of dynamic intestinal obstruction. Therefore it is time to run more efficiently the tuberculosis control programme in Pakistan, before it is too late

study of the effect of immunological changes and diet elimination in autistic children with gastrointestinal tract [GIT] symptoms in an Arabic culture

Correlation of the severity of autistic criteria with specific immunoglobulins [IgG and IgA] for casein and gluten and the past history of prominent GIT symptoms, and to show the effect of casein and gluten diet elimination in the improvement of autistic criteria. 42 autistic children were subjected to C.A.R.S. initial assessment, laboratory investigations to detect immunological reactions toward casein and gluten, diet elimination for 6 months, re-assessment with The Childhood Autism Rating Scale [C.A.R.S.] after 3 and 6 months of diet elimination. 64.3% of the sample of autistic children had past history of GIT symptoms. 85.7% of autistic children had positive scores to IgG casein and 50% with positive scores of IgA gluten. 21.4% of autistic children had positive scores in IgA casein and 19% with positive scores of IgA gluten. Diet elimination was effective with significant difference in autistic children who were suffering from prominent past history of colic. Casein elimination alone or in combination with gluten was effective in improvement in autistic symptoms. Immunological changes, history of GIT symptoms may act as contributing factors to autistic spectrum disorder and diet elimination is effective in improvement of autistic symptoms

Prevalence of hepatitis C virus antibodies in hemodialysis patients

The prevalence of HBsAg and antibodes to hepatitis C virus [HCV Ab's], in 50 staff members [group I] and 64 patients, 25 patients on regular hemodialysis [HD] for less than one year [group II] and 39 patients on regular HD for more than one year [group III], was determined. Six patients were HBsAg positive, 2 [8%] of group II and 4 patients [10.3%] of group III, respectively. As regards HCV 18 patients [72%] of group II and 39 patients [100%] of group III were positive, there was a significant increased positivity when compared both groups with control [p <0.001 and 0.0001] and there was a significant increase positivity in group III when compared with group II [p <0.01]. It was concluded that the duration of dialysis is a more serious risk factor in HCV infection, and liver enzymes elevation in patients on dialysis was related to HCV infection