ABSTRACT
Background: Diabetic nephropathy (DN) is an important and catastrophic complication of diabetes mellitus (DM). Kidney disease has heterogeneity in histology in diabetes patients and includes both diabetic kidney disease (DKD) (albuminuric or nonalbuminuric) and nondiabetic kidney disease (NDKD) either in isolation or in coexistence with DN. Diabetic nephropathy is hard to overturn. While NDKD is treatable and reversible. Materials and methods: We enrolled a total of 50 type 2 diabetes mellitus (T2DM) patients with clinical kidney disease, of both genders and age >18 years, who underwent kidney biopsy from October 2016 to October 2018. Patients with proteinuria <30 mg per day were excluded from the study. The indications of the renal biopsy were nephrotic syndrome (NS), active urinary sediment, rapid decline in renal function, asymptomatic proteinuria, and hematuria. Result: A total of 50 (males: 42 and females: eight) patients with T2DM who underwent kidney biopsy were enrolled. The clinical presentation was: NS 26 (52%), chronic kidney disease (CKD) 11 (22%), asymptomatic proteinuria and hematuria six (12%), acute kidney injury (AKI) four (8%), and acute nephritic syndrome (ANS) three (6%). Diabetic retinopathy (DR) was noted in 19 (38%) cases. Kidney biopsy revealed isolated DN, isolated NDKD, and NDKD superimposed on DN in 26 (52%), 14 (28%), and 10 (20%) cases, respectively. Idiopathic membranous nephropathy (MN) (4) and amyloidosis (2) were the most common forms of NDKD, whereas diffuse proliferative glomerulonephritis (DPGN) was the main form of NDKD superimposed on DN. Diabetic nephropathy was observed in 15 (79%) cases in presence of DR and also in 11 (35.5%) cases even in absence of DR. Of eight patients with microalbuminuria four (50%) cases have biopsy-proven DN. Conclusion: About 48% of patients had NDKD either in isolation or in coexistence with DN. Diabetic nephropathy was found in absence of DR and in patients with a low level of proteinuria. The level of proteinuria and presence of DR does not help to distinguish DN vs NDKD. Hence, renal biopsy may be useful in selected T2DM patients with clinical kidney disease to diagnose NDKD.
ABSTRACT
Background: Puerperium is of 6 weeks after delivery, when body reverts back to its original non pregnant state. This period holds its own set of medical issues with frequent occurrence of gynaecological complaints like hematoma, bleeding, painful discharge and many medical issues like pyrexia, mastalgia, coagulation disorders and depression. The management of all these problems is further complicated by consideration of lactation which prohibits use of many drugs. There are many studies available in international communities that analysed women in puerperium but the data from Indian subpopulation where most deliveries are conducted in government funded institutes is lacking. The current study was an observational single center study carried out at gynaecology department along with medicine and surgery department of a tertiary care hospital associated with a medical teaching institute for defining the epidemiological parameters of the puerperal maladies.Methods: 150 randomly selected pregnant subjects with otherwise uncomplicated pregnancies, both booked at our institute or referred at the time of delivery between January to July 2016 were included in the study. Both normal vaginal or assisted deliveries were considered irrespective of booking status. Patient not willing for consent, and patients reporting beyond 2 weeks of delivery were excluded. All patients were observed while in hospital and weekly thereafter till 6th week and detailed gynaecological, medical and psychiatric evaluation was carried out by a multidisciplinary team. Detailed evaluation of cause was carried out in all cases of pyrexia, pain or other objective symptoms and analysis of depression was done. All data were collected and analysed by spss 22.0 at the end of 6 weeks.Results: Of the 150 patients studied, 40% had caesarean delivery while 60% had normal vaginal delivery with or without episiotomy. The most common complications noted during puerperium were wound discharge (10.67%), perineal pain (10%), fever (15%) and Mastalgia & Mastitis (13%). Depression was diagnosed in 6% of the studied cases. Cause of fever was mastitis/breast abscess in 30%, Urinary tract infection in 24%, Malaria in 7% and puerperal sepsis in 12% cases, in rest of the cases the cause of fever could not be found. The puerperal complication rate was more in LSCS 22.95% as compared with vaginal deliveries 14.6%.Conclusions: Puerperium remains an important aspect of pregnancy where the nature of complications differs totally from those seen during antenatal period. Our study suggests that most important complications in puerperium are purulent discharge, perineal pain and pyrexia. Depression is a frequent occurrence in post-partum period and its early identification can benefit both maternal and child health. Fever in puerperium is fairly common Perineal infection, Breast infection, Urinary tract infection and Malaria being common causes. A vigilant multidisciplinary approach is required to optimally manage all these complications.