Effectiveness of Immunosuppressants along with ACEI/ARBS in treating Proteinuria in patients with Solitary Kidney Post Nephrectomy

Objective: To ascertain the effectiveness of immunosuppressants along with ACEI and /or ARBS in proteinuria in patients with solitary kidney post nephrectomy

Study Design: Prospective quasi-experimental study

Place and Duration of Study: Combined Military Hospital Peshawar and Multan, from 2010 to 2016

Subjects and Methods: The sample population comprised of 07 cases of post nephrectomy solitary kidney developing proteinuria from 2010-2016 reporting to hospitals. Patients were given initially ACEI and/or ARBS to lower proteinuria for three months. They were followed up to see for complete or partial remission. Deltacortil 1mg/kg max 60mg/day along with ACEI and /or ARBS was added to patients who didn't go into remission

Results: Out of 7 patients, 3 [42.9 percent] were males and 4 [57.1 percent] were female patients. Addition of deltacortil 1mg/kg max 60mg/day along with ACEI and /or ARBS reduced proteinuria to less than 1 gram in 3 patients [2 males and 1 female] and less than 300mg in 4 patients [1 male and 3 females].There was a reduction in the mean 24hrs urinary protein excretion as a whole from the baseline 2.33 +/- 0.84 g/24 hrs to 0.48 +/- 0.33 g/24 hrs. Remission was achieved on the average in three months and maintenance on tapering doses for 12 months. Cyclosporine was used in three cases who relapsed on tapering steroids and remission was achieved with 5-10mg steroids and 100-200mg of cyclosporine

Conclusion: Non respondent patients with solitary kidney developing proteinuria being treated with ACEI and/or ARBS had good chance to lower their proteinuria with steroids. Relapses even with steroids responded to cyclosporine

Hyperkalemia - frequency in a group of hypertensive diabetics

To evaluate the frequency of hyperkalemia in a cohort of hypertensive diabetic patients. A prospective analytical cohort study. The study was carried out in department of medicine [nephrology] Military Hospital [MH] and Armed Forces Institute of Urology [AFIU] Rawalpindi from Jun 2007 - Jun 2009. A total of 110 hypertensive, middle aged diabetic patients attending medical OPD in MH and AFIU. Rawalpindi were followed over two years from Jun 2007 - Jun 2009 for development of hyperkalemia and monitored for changes in eGFR, Serum Urea, creatinine and blood glucose random besides changes in blood pressure and ECG findings. SPSS version 13 was employed for statistical analysis. During the course of study 9 patients were lost to follow up. There were 7 deaths among study subjects before the end of study after about ten to twelve months. Out of the 94 patients followed up mean Serum Urea at the end of study was 13.50 mmol/l against a serum creatinine level of 2.26mmol/l and an estimated GFR of 21.08 ml/ min. The frequency of raised serum Potassium of 5.1-6.0 mmol/l was 46.08% and 26.59% of the patients had serum Potassium of 6.1-7.2 mmol/l at the end of study. This was against an initial level of 4.5-5.0 mmol/l in 100% of the study subjects. Paired sample t-test revealed significant changes in each variable studied but a borderline positive correlation of 0.619 was observed only between serum potassium and change in eGFR at the end of study. The mean blood glucose random dropped from 16.14 mmol/l to 10.41 mmol/l. at the end of study mean systolic BP was 122mm Hg and diastolic BP 80.2mm Hg. The ECG revealed tall T waves in 64.9% of cases while at the start of study all subjects had their electrocardiograms within normal limits. There was a trend of increase in frequency of tall T waves with the rise of serum potassium levels. Raised serum potassium is a significant potential complication among long standing diabetics with covert nephropathy treated with ACE inhibotrs, ARBs, potassium sparing diuretics or a combination of these drugs. Co morbidities and development of this complication must therefore be considered by physicians when dealing with such patients

Correlation of doppler waveform abnormalities of hepatic veins with histological findings in chronic liver disease [HCV infection]

To study the relationship of the abnormalities in Doppler waveform of hepatic veins with histologic findings in chronic liver disease [HCV infection]. cross- sectional study. Radiology Department Military Hospital Rawalpindi. The duration of study was one year from February 2004 to February 2005. 50 patients with non de-compensated HCV infection were studied, who were subjected to biopsy by medical specialists. Their Doppler waveforms of hepatic veins were noted. On histopathology, 4 cases [8%] had no evidence of fibrosis, 27 cases [54%] had mild, 15 cases [30%] had moderate and 4 cases [8%] had severe fibrosis. Three patterns of waveform were observed. These waveforms include normal triphasic waveform [type O], decreased amplitude of phasic oscillations without the reversed flow phase [type 1] and completely flat waveform [type 2]. Among 33 cases of type 0 flow, majority [85%] had either mild fibrosis. Twelve cases that had type 1 flow, majority [92%] had mild to moderate fibrosis. Out of 5 cases that were observed ultrasound type 2 flow, all had either moderate or severe fibrosis. The degree of fibrosis was related directly to the hepatic vein waveforms abnormalities [p<0.001]. Ultrasonographic abnormalities of Doppler waveforms of hepatic veins are equivalent to histology in predicting the progression of CLD