Spectrum of pathological lesions in cystoscopic bladder biopsies: a clinicopathologic study

To determine the clinicopathologic characteristics and frequencies of different pathological lesions in cystoscopic bladder biopsies in patients with bladder diseases. Design: A single- institution based retrospective observational study. Place and Duration of Study: The study was conducted in the Department of Histopathology, Sindh Institute of Urology and Transplantation [SIUT], Karachi over a period of five years [December, 1996 to December, 2001]. Subjects and All patients, who presented to the urology clinic of SIUT between December 1996 and December 2001 with haematuria, dysuria, urgency and frequency and in whom a cystoscopy and bladder biopsy were performed to elucidate the nature of underlying pathology, were included in this study. A total of 784 patients were studied. Clinical and demographic data and pathological diagnoses were retrieved from the original surgical biopsy reports. Bladder biopsies were received in 10% buffered formalin, gross examination done and processed for paraffin embedding. Histologic sections were stained routinely with Hematoxylin and Eosin, PAS and PAS with diastase. Sections were examined under the light microscope to document the pathologic diagnosis. Of the total 784 patients, 577[73.6%] were males and 207 [26.4%] were females with an overall male to female ratio of 2.8:1. Age range was wide [4 to 86 years]. The spectrum of pathological lesions included tumours: 497 cases [63.7%], followed by acute and chronic non-specific inflammation: 86[11%], cystitis cystica and glandularis: 40 [5%], Tuberculosis: 17[2.16%], squamous metaplasia: 13[1.65%] and a number of other rare lesions. Among the tumours, transitional cell tumours [TCC] were most common [95.3%]. Tumours were more common in males than in females [male to female ratio: 5.3:1] and peaked in 4th through 7th decades. Pathologic staging was possible in 89.7% of the cases. A majority of these cases [62%] presented with superficial disease, while in 38% the disease was muscle-invasive when first diagnosed. Grading was possible in all except two cases, which contained only necrotic tissue. A vast preponderance of tumours [74.5%] were well-differentiated, while 25.5% belonged to poorly-differentiated category [Grade 3 and 4]. In a significant number of biopsies: 105 cases [13.4%], no significant pathology was noted. TCC is the most common lesion in cystoscopic bladder biopsies

Nutritional assessment of patients on maintenance haemodialysis

Nutritional assessment was carried out on fifty haemodialyzed patients by demographic, anthropometric, biochemical and dietary indices. The mean age of the patients was 49 years with a male to female ratio of 2.3:1. The duration of dialysis ranged from 6 to 40 months with a mean of 25 months. Fifty percent of the patients were moderately nourished based on their body weight 44%, body mass index 40% and mid-arm circumference 66%. Seventy percent patients had albumin and total proteins within the normal range. Blood urea nitrogen, creatinine, cholesterol, potassium and phosphorus did not significantly change from the previous reports. The caloric and protein intake in 60-70% cases was less than recommended. Overall there was a tendency to caloric and to a lesser degree protein malnutrition in our patients. It is suggested that preventing malnutrition by economical, aggressive and ongoing dietary intervention may minimize malnutrition in haemodialyzed patients

Lipid abnormalities in patients with chronic renal failure

This work was designed to determine the serum lipid pattern in end stage renal disease. Thirty six non - diabetic patients were selected for the study. The results were compared with normal control subjects. Three age groups and three disease groups were recognized. Serum total lipids levels were found to be normal in all age and disease groups except the patients of old age group [46 to 65 years]. In this group low lipid levels were observed as compared to the normal control subjects [p<0.001]. Serum total cholesterol levels were also found to be decreased in the old age group of patients [p<0.01]. Serum triglycerides levels were found to be significantly elevated in young [6 to 25 years] and old [46 to 65 years] age groups [p<0.05, p<0.01]. A significant decrease was observed between serum high - density lipoprotein cholesterol in patients of age group 26 to 45 years [p<0.001]. The levels of serum high - density lipoprotein cholesterol were also low in hypertensive patients with chronic renal failure [p<0.01]. The levels of low density lipoprotein cholesterol were normal in all age and disease groups except in the age group 46 to 65 years in which low levels were observed [p<0.01]. Serum very low - density lipoprotein cholesterol were found to be higher in patients of age group 6 to 25 years

relation between the serum lipids and hemoglobin A1 in patients with chronic renal failure

Studies were undertaken in order to find the correlation of serum lipids with haemoglobin A1 in nondiabetic patients with chronic renal failure. Thirty six patients were selected for the study. Three age groups and three disease groups of the patients were recognized. A slight but significant inverse relationship was found between the value of haemoglobin A1 and high - density lipoprotein cholesterol in patients of age groups 6 to 25 years [r = -0.422, p<0.05]. An inverse relationship was also observed between above mentioned biochemical parameters in patients with chronic renal failure due to chronic nephritis [r = -0.408, p<0.05]

Experience of hemodialysis at the kidney centre

Seventy-nine patients of end stage renal disease [ESRD] on maintenance haemodialysis were studied. Most of the cases were in their prime of life. The disease was equally common in both sexes and all ethnic groups. Chronic glomerulonephritis was the commonest cause followed by diabetes mellitus. Hypertension was the commonest associated illness. All patients were screened for hepatitis B surface antigen and antibody and those found negative were vaccinated. A-V fistula in the upper extremity was used as the vascular access in 93% cases. In 68% cases dialyzer was reused without any ill effect. Amongst the complications observed, hypotension was seen in 65%, psychological disorders in 52%, followed by nausea, vomiting, itching and cramps. Technical complications were related to A-V fistula in 45% cases. Forty three percent patients were maintained without blood transfusion and 88% showed improvement in their quality of life

Experience of erythropoietin in anemia of end stage renal disease

Recombinant human erythropoietin 50 units/kg intravenous twice a week was given to 9 anemic patients and end stage renal disease [ESRD] who were undergoing dialysis at the Kidney Centre. Of the total, 8 required no transfusion since the initiation of therapy and their haematocrit increased to approximately 29% or more with the improvement in general condition, sense of well being and exercise tolerance. One patient showed an increase in serum creatinine and two iron deficiency during therapy. In all cases blood pressure remained adequately controlled. No organ dysfunction or any other complication was observed

relation between the hemoglobin a1 and fasting serum glucose in non-diabetic patients with chronic renal failure

Nondiabetic patients were selected to investigate the relationship between haemoglobin A1 and fasting serum glucose in end stage renal disease. Thirty six patients were undertaken for the study. Four age and three disease groups of the patients were recognized. The results documented statistically significant positive correlation in age groups 6 to 25 years and 46 to 65 years [r= 0.512, p<0.05; r=0.693, p<0.01]. A weak significant direct relationship was also observed in patients with chronic renal failure due to chronic nephritis[r=0.43, p<0.05]. No significant interdependence was observed between haemoglobin A1. and fasting serum glucose in other age and disease groups

Urinary protein in healthy subjects

Urinary protein was determined in 200 healthy males and females of various age groups representing various socio-economic status. Urinary protein excretion was higher in males than females in all age groups and the concentration in children and adults was the same

Gravel passers

Eighty-two gravel passers were seen over a two-year period with normal IVPs having various complaints of haematuria, dysuria, lumbar pain and frequency. All had elevated serum uric acid and 24 hours urinary uric acid levels. Treatment with Allopurinol and high fluid intake relieved symptoms and lowering of serum and urinary uric acid in over 75% of patients

Role of infection in bladder stone disease in children

The urine from 180 children with bladder stone disease [BSD] was cultured for evidence of urinary tract infection. Fifty eight [22.2%] BSD children had positive urine culture. E. Coli was the commonest organism [52%] followed by B. Proteus [31%]. There was a significant relationship [P < 0.001] between high urinary pH and growth of B. Proteus whereas E. Coli was positively correlated with lower urinary pH. On correlating urinary tract infection with surface constituents of analysed stones, uric acid was more commonly seen in sterile urine [P < 0.05]. On infrared spectroscopic analysis of calculi calcium phosphate occurred significantly more frequently [P < 0.01] in the group with infected urine

Analysis of urinary calculi by chemical methods

Two hundred twelve samples from 90 stones obtained from one hundred consecutive children with bladder stone disease [BSD] were analysed by qualitative and quantitative chemical methods. Majority [72%] of the stones were spherical in shape while 51% had mammilated surface. Children in older age group had heavier stones [P < 0.05]. The calculi were predominantly of mixed type [88.9%]. Calcium oxalate was the commonest [97.7%] compound detected by qualitative chemical method. The central portion of calculi showed a significantly higher [P < 0.02] occurrence of ammonium urate compared to the surface. Uric acid was present in surface layer in significantly higher [P < 0.05] number in patients with uninfected urine. On quantitative analysis calcium and oxalate occurred in significantly higher [P < 0.01] percentage in surface layers, while urate occurred more frequently [P < 0.05] in the central portion of calculi. On comparing the two chemical methods of stone analysis, a good agreement was seen in the detection of calcium, oxalate and urate but phosphate was missed in 39% samples by the qualitative method and in 10% samples by quantitative method