Pregnancy related acute renal failure; an experience at nephro-urology department Chandka medical college teaching hospital Larkana

Acute renal failure [ARF] during pregnancy is rare event and continues to be common in developing countries. 1998-2005. Nephro-urology unit at Chandka Medical College, Larkana. Retrospective study. 294 cases of Acute Renal Failure were treated. Among these cases, 72 [24.5%] were pregnancy related in origin. All of these patients were known to be previously healthy. Pregnancy related Acute Renal Failure was associated with, post partum hemorrhage was in 20 [27.7%], intra intiauterine death in 20 [27.7%] antipartum hemorrhage was 18 [25%], preeclampsia-eclampsia in 8 [11.11%] and septic abortion and puerperal sepsis in6 [8.3%]. Among these patients 65 [90.3%] required dialysis therapy because of moderate to severe azotemia. 35 [48.61%] patients recovered normal function. 30 [46.15%] developed irreversible renal function. Early reorganization of this disorder, improvement of health infra structure, antenatal health care and intensive supportive therapy, can reduce maternal and fetal mortality and morbidity

Extracorporeal shock wave lithotripsy; Efficacy of in situ echoguidance in upper and lower ureteral calculi

amanullah7860@yahoo.com. To assess efficacy of ESWL as a single modality in upper and lower ureteric calculi. department of Nephro-Urology Chandka Medical College Hospital, Larkana. January 2003 to April 2006. 62 patients underwent ESWL. Upper and lower ureteral calculi were treated by using Dornier MPL-9000 Lithotripter with ultrasound localization. Among 62 cases 56[90.3%] patients had upper ureteric calculi, whereas 06[9.7%] patients had lower ureteric calculi. Size of stones ranged from 0.5 mm to 18mm having mean size of 10mm. All patients were followed for period of 6 weeks. Of these 62 patients 58 patients were stone free at the end of 2 weeks follow up. In 2 cases stones failed to fragment, where as 2 cases failed to attend out patient department for follow up. This study concluded that in situ echoguided ESWL was effective modality of treatment for upper and lower ureteric stones. Localization of ureteric stones with ultrasound has the advantage of elimination of radiation exposure to the patient and lithotripsy team

Acute renal failure: An experience at nephro-urology department Chandka Medical College Hospital Larkana

To find out the various causes of acute renal failure [ARF] and its out come in our setting of tertiary Care Hospital in rural areas. A retrospective Study. Nephro-urology department Chandka Medical College teaching hospital Larkana. From March 1998 to March 2005. Review of 294 patients of acute renal failure admitted in Nephro-urology department Chandka Medical College teaching hospital Larkana. Detailed history, physical examination and laboratory data of 294 consecutive patients of acute renal failure were analyzed. 294 patients were included in this study. Among them 149 [51.7%] were in the younger age group [less than 40 years] with dominance of males [1.61 to 1.00 male to female ratio]. Major cause of ARF was pre renal, seen in 172 [66.6%] patients, 70 [23.8%] of all cases of acute renal failure had gynecological and obstetrical back ground. Other causes C.V.A in 24 [9.3%], HHD in 14[4.5%]. Glomerulonephritis in 22[8.5%],and obstructive uropathy in 16[6.2%]. 92 Patients [31.3%] improved on conservative treatment,166[56.5%] needed dialysis and 36[12.2%] left against medical advice. This data reveals that pre renal element is the single most important cause of acute renal failure, in which commonest cause was pregnancy related ARF followed by C.V.A,HHD, glomerulonephrits and obstructive urophathy. Early indentification, referral treatment of pre renal factors, good peri natal care and good therapeutic measures substantially bring down the incidence of acute renal failure. 12.2% patients left against medical advice due to heavy expenses on the treatment and needs NGOs and Government support for treatment of poor patients

Serum lipids and lipoproteins in chronic primary glomerular diseases

Chronic Primary Glomerular Diseases [CPGD] that are common in our country, are often neglected and not given due attention, leading rise in number of patients with renal failure. Hyperlipidemia and lipoprotein abnormalities may play role in development of glomerular atherosclerosis in renal disease. Study was designed to characterize the status of lipids and lipoproteins in patients with CPGD and to find their correlation with serum albumin and that correction of the hyperlipidemia would be favorable in solving the progress of the renal failure. Study was conducted at Biochemistry Department, Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Centre [JPMC] Karachi. Seventy uncomplicated nephrotic patients [44 males, 26 females; age range 18 - 51 rears] with biopsy-proven CPGD were collected from Nephrology Department, JPMC, Karachi and twenty age- matched control subjects were investigated for serum total protein, albumin, triacylglycerols, total cholesterol, high-density lipoprotein cholesterol [HDL- cholesterol] and low-density lipoprotein cholesterol [LDL- cholesterol]. A highly significant [P<0.001] increase levels of triacylglycerols, total cholesterol, LDL- cholesterol, and the ratio of LDL-cholesterol to HDL- cholesterol, whereas a highly significant [P<0.001] decrease levels of serum HDL-cholesterol, total protein and albumin were observed in all patients when compared to matched control subjects. The correlation coefficient between serum albumin vs. triacylglycerols and total cholesterol were negative but highly significant [r = -0.68 and r = -0.64] were observed in such patients. It was concluded that CPGD are accompanied invariably by alteration in lipids and lipoproteins, which have potential for accelerating the atherosclerosis and increasing the risk of renal failure