Effect rHuEpo on predialysis CRF patients: study of 45 cases.

Forty five (24 male & 21 female) moderate to severe degree of predialysis CRF patients were prospectively studied over a period of 6 months (July- December, 2004) to see the effect of Recombinant Human Erythropoietin (rHuEpo/EPO) therapy on renal anaemia, progression of renal excretory function & quality of life at 3 and 6 months intervals from the starting of EPO therapy. Mean +/- SD age of the patients was 56 +/- 12 (30-77 yrs) and causes of CRF were Diabetic Nephropathy (DN)=15 (33%), Chronic Glomerulonephritis (CGN) =14(31%), Hypertension (HTN)=11(21%), Chronic Pyelonephritis (CPN)=03 (6.5%) and Obstructive Uropathy (OU)=02 (4.5%). Doses of rHuEpo was 80-100 IU/k week subcutaneously (SC) until the target Hb 11gm% & Hct 30% were achieved; there after the dose was titrated as appropriate. Serum Iron & Ferritin levels were also kept within normal reference level by iron therapy during the study period. Mean +/- SD base line (before starting EPO therapy) level of haemoblobin were 8.4 +/- 0.81(gm%), Hct 27.86 +/- 1.6 (%), blood urea 21.72 +/- 10.5 (mmol/L), S. creatinine 431.93 +/- 228.79 (mmol/L) & Ccr. 21.25 +/- 10 mum respectively. The results showed that significant improvement of haemoglobin level occurred (gm%) from 8.4 +/- 0.81 (gm%) to 9.51 +/- 1.02 (p<0.001) at 3 months and 8.4 +/- 0.81 to 11.10 +/- 1.4, (p<0.001) at 6 months interval. Haematocrit (Hct%) value also significantly increased from 27.86 +/- 1.5 to 30.57 +/- 3.62, (p<0.001) at 3 months and 27.86 +/- 1.5 to 32.81 +/- 3.92 (p<0.001) at 6 months of EPO therapy. Mean blood urea and S. creatinine levels decreased from base line level during the study period but did not show any statistical significance. There was no significant side-effects like uncontrolled hypertension, seizure or hyperviscosity syndrome in any of the study population. The quality of life in terms of improvement of physical ability and sense of well being were also improved in all the study patients. In conclusion, this study showed that the effect of rHuEpo therapy is beneficial for the correction of renal anaemia, can delay the progression of renal failure and improvement of overall quality of life in predialysis CRF patients.

Assessment of renal insufficiency in gestational proteinuric hypertension in third trimester pregnancy.

This prospective study on assessment of renal insufficiency in pregnancy induced proteinuric hypertension was carried out on 104 cases, in Bangabandhu Sheikh Mujib Medical University (former IPGM&R), Dhaka during period of August 1997 to September 1998. The objective of this study, to find out the impairment of renal function in mild (<110 mmHg) and severe (>110 mmHg) hypertension. The frequency of mild hypertension was 96.29% and severe hypertension was 3.71% in third trimester of pregnancy. In this study mean age of the patient was 26.53+/-3.9 years, mean gestional age was 36.46+/-1.93 weeks and mean diastolic BP was 99.07 mmHg. The prevalence of hypertension was more in primigravida which was (72.23%) than multigravida (27.77%). Proteinuria was diagnosed as quantitative measurement of 24 hour urinary protein in photometric colorometer. The mean value of total urinary protein was 335+/-74.14 mg/24 hour (range 280-800 mg/24) hour). 1+Oedema was present in 48.14%, 2+ was 12.96% and 3+ was 14.81% of cases. There is a correlation of proteinuric hypertension with renal function which was done on the basis of laboratory investigations. Findings of parameters of renal function found to declined: Serum creatinine mean value 1.0+/-0.14 (P<0.001) (normal range 0.6-0.8 mg/dl.), Urinary creatinine mean 57.69+/-12 mg/dl., Creatinine clearance mean 53.72+/-11.63 ml/min, Total urinary protein mean 335.52+/-74.14 mg/24 hour. Total urinary volume mean 2985+/-49 ml/24 hr. All the patients and their babies were followed up till discharge from hospital. Cesarean section was done in 76% of cases and vaginal delivery was done in 24% cases. Mean hospital stay was prolonged in proteinuric hypertension 7+/-1 days than non proteinuric normotensive goup 3+/-1 days. All of those were average socio-economic status. Extreme low birth weight was 14.81% in 50% of IUGR cases.

IgA nephropathy in teaching hospitals of Dhaka.

A light and immunofluorescence microscopic study on renal biopsies were performed on 42 patients. Nephrotic syndrome with accompanying microhematuria and recurrent hematuria (Macroscopic/microscopic) with or without renal failure were the commonest indications for renal biopsy. Primary IgA nephropathy was diagnosed in five cases. Among the IgA nephropathy patients, the commonest light microscopic finding was mesangial proliferative glomerulonephritis. Macroscopic hematuria with proteinuria was the commonest feature. Three of the patients had hypertension at the time of renal biopsy. The age of the patients ranged from 19-38 years with a mean of 26 years. The high frequency of hypertension, degree of proteinuria and associated renal failure in one patient that it is a progressive disease. This preliminary study revealed that IgA nephropathy exists in Bangladesh. Larger samples need to be studied with a view to find out its prevalence and its peculiarities in this part of the world.

Study of proteinuria in a community.

Proteinuria of more than 500 mg/dl were present in 3% of all age groups in the village Pandhua. It is directly correlated with hypertension, scabies and recurrent history of tonsillitis. If any body suffers from hypertension, pyoderma and scabatic lesion the chances to have proteinuria is 86%.

Intermittent peritoneal dialysis--21/2 years experience in IPGMR.

Intermittent peritoneal dialysis (IPD) has been used extensively over the years for temporary management of end stage renal failure. There is no long-term report of IPD in the management of these patients. We, however, managed successfully patients with Chronic renal failure (CRF) with IPD for over 6 months to 2 1/2 years. One hundred and ninety-six patients with CRF were admitted in one of the Nephrology Unit of the Institute of Postgraduate Medicine Research over a period of 2 1/2 years; 61 of these patients were end stage renal failure and were managed successfully with IPD. The mean age of these patients was 35 (range 20-70 years; male 48; female 13). Forty-five of the patients were below 50 and 16 were above 51 years. Seventeen patients has been on dialysis for 6 months to 2 1/2 years, another 17 of 3-6 months and 27 has 1 to 3 months of dialysis. Control of urea, creatinine and electrolytes were good among the dialysed patient. Haemoglobin level and serum calcium, however, did not rise after dialysis. Blood pressure control, was easier among the dialysis patients and peritonitis was infrequent during dialysis. 23 of the patients died. Ten of these patients were on dialysis for more than 6 months. The causes of death were acute left ventricular failure, myocardial infarction congestive cardiac failure and carcinoma of cervix.