Study of renal complications of malaria

Background: Plasmodium falciparum malaria is one of the major health problems in many tropical countries including India and due to increase in the drug resistance in India the incidence of complicated malaria has increased. Objectives: To study the renal complications of malaria. Materials and methods: 50 malaria positive cases with clinical renal disease were prospectively observed clinically and by laboratory investigations till the discharge. Results: Among the 50 malaria positive cases 41 (82 %) patients had p. falciparum infection, 4 (8%) had p. vivax and 5 (10%) had mixed infections. P. falciparum and mixed infection found to be responsible for ARF in 25 (89.28%), 3 (10.70%) respectively. Volume depletion was found to be the prominent cause (75%) of ARF, hyperbilirubinemia was noted in 64.28% of patients. Urinary abnormalities were noted in 24 (48%) cases, proteinuria in 20(40%), microscopic haematuria in 20 (40%), granular casts in 7 (14%). In the present study electrolyte abnormalities were noted in 46 (92%) of the patients. The overall mortality in the present study was 5 (10%). The cause of death was multi-factorial. MODS were the commonest cause of death. Conclusion: Renal complications were seen as the commonest complication of malaria. Early diagnosis, treatment specially the fluid management reduces the overall mortality

Urinary Abnormalities in Asymptomatic Children of Ho Chi Minh City: A Population-Based Study.

Aims: To estimate the prevalence of urinary abnormalities in asymptomatic children aged 3 to 5 and to estimate the prevalence of urological anomalies detected by renal ultrasound among children with abnormal urine findings in an urban district of Ho Chi Minh City. Study Design: cross-sectional population-based study. Place and Duration of Study: Twelve kindergartens in Binh Thanh district, Ho Chi Minh City, Vietnam from March to June 2012. Methodology: There were 11,093 children aged 3 to 5 attending 25 public and 17 private kindergartens including 2,657 in wealthy wards and 8,436 in non-wealthy wards. A total sample size of 2,402 children was required. Using a probability proportional-tosize method, 8 kindergartens in public area and 4 kindergartens in private area were randomly selected. Overall, 2,433 children were enrolled including 1,244 boys. The children were screened by dipstick. Those with abnormal results were confirmed by a second dipstick. Children with two positive dipsticks were retested 3 months later and underwent renal ultrasound for urological anomalies. Results: Abnormalities were detected in 7.8% of the subjects. Prevalence of proteinuria, hematuria, nitrituria, leucocyturia, and combined nitrituria and leucocyturia were 0%, 0.3%, 0%, 5.6%, and 0.2%, respectively. Girls had more abnormal results than boys (14.1% vs 1.8%, p<0.001). After a three-month period, the number of children with persistent abnormalities was 37. The renal ultrasound detected 5 (13.5%) hydronephrosis cases. No significant difference was found when comparing public to private kindergartens and wealthy to non-wealthy region. Conclusion: In such a region with high population density, the high prevalence of nitrituria and/or leucocyturia in girls calls for a good education for parents and caregivers in order to prevent urinary tract infection, and the low prevalence of proteinuria and hematuria suggests that the appropriate age for urinary screening in Vietnam might be over 6 years.

Investigation of urinary abnormalities and risk factors for kidney disease in the World Kidney Day campaigns in Northeast Brazil / Investigação de alterações urinárias e fatores de risco para doença renal nas campanhas do Dia Mundial do Rim no Nordeste do Brasil

Objective: chronic kidney disease (CKD) is an increasing common problem in the world due to the exponential growth of diabetes mellitus, hypertension and other risk factors. The aim of this study is to investigate urinary abnormalities and risk factors for kidney disease in the general population. Methods: this study was performed from data collected during the annual World Kidney Day (WKD) campaigns, in Fortaleza, Ceará, Brazil, between 2009 and 2012. The population sought assistance spontaneously in stands placed in high people-traffic areas. Results: among 2,637 individuals interviewed, the mean age was 50.7±15.7 years and 53% were male. The main risk factors found were sedentarism (60.7%), obesity (22.7%) and smoking (19.8%). Blood pressure (BP) > 140x90 mmHg was found in 877 (33%). Increased BP was found for the first time in 527 cases (19.9%). Cardiovascular diseases were reported in 228 (8.6%). Diabetes was related by 343 (13%). Capillary blood glucose > 200 mg/dL was found in 127 (4.8%) and it was > 200 mg/dL for the first time in 30 (1.13%). Urinalysis was performed in 1,151 people and found proteinuria in 269 (23.3%). Proteinuria was most frequent in hypertension people (77.3% vs. 55.8%, p=0.0001), diabetes mellitus (22.7% vs. 15.2%, p=0.005) and elderly (42.1% vs. 30.7%, p=0.0007). Conclusion: risk factors for CKD are frequent in the general population. Many individuals had hypertension and diabetes and did not know this. It is important to regularly perform actions like WKD in order to early detect potential candidates for CKD. .

Objetivo: a doença renal crônica (DRC) é um problema crescente no mundo em razão do crescimento exponencial do diabetes mellitus, da hipertensão e de outros fatores de risco. O objetivo deste estudo é investigar alterações urinárias e fatores de risco para doença renal na população geral. Métodos: este estudo foi realizado a partir de dados coletados durante as campanhas anuais do Dia Mundial do Rim, em Fortaleza, Ceará, Brasil, entre 2009 e 2012. A população buscou atendimento espontaneamente nos stands montados em locais de alto tráfego de pessoas. Resultados: entre 2.637 indivíduos entrevistados, a média de idade foi de 50,7±15,7 anos, sendo 53% do gênero masculino. Os principais fatores de risco encontrados foram sedentarismo (60,7%), obesidade (22,7%) e tabagismo (19,8%). Pressão arterial (PA) > 140x90 mmHg foi encontrada em 877 casos (33%). Aumento da PA foi encontrado pela primeira vez em 527 casos (19,9%). Doenças cardiovasculares foram relatadas por 228 indivíduos (8,6%). Diabetes foi relatado por 343 indivíduos (13%). Glicemia capilar > 200 mg/dL foi encontrada em 127 casos (4,8%) e > 200 mg/dL pela primeira vez em 30 (1,13%). O exame de urina foi realizado por 1.151 pessoas, sendo encontrada proteinúria em 269 casos (23,3%). Proteinúria foi mais frequente em pessoas com hipertensão (77,3% vs. 55,8%, p = 0,0001), diabetes mellitus (22,7% vs. 15,2%, p = 0,005) e em idosos (42,1% vs. 30,7%, p = 0,0007). Conclusão: fatores de risco para DRC são frequentes na população geral. Muitos indivíduos tinham hipertensão e diabetes e não sabiam disso. É importante a realização de ações como o Dia Mundial do Rim com o objetivo de detectar precocemente potenciais candidatos à DRC. .

Síndrome de Casamassima / Casamassima syndrome

El síndrome de Cassamasima se caracteriza por una triada que consiste en alteraciones costo vertebrales, atresia anal y alteraciones genitourinarias, siendo un síndrome de presentación rara y cuya supervivencia estará determinada por la gravedad de las alteraciones. Presentamos el caso de un niño con características típicas de este síndrome.

Cassamasima syndrome is characterized by a triad consisting costo vertebral alterations, anal atresia, and genito urinary disorders, being rare and whose survival is determined by the severity of the disturbances. We report the case of a child with typical features of this syndrome.

Rim em ferradura com cistos e ureter único: relato de caso / Horseshoe kidney with cysts and a single ureter: a case report

O rim em ferradura é a mais comum de todas as anomalias de fusão, ocorrendo em aproximadamente 0,25 por cento da população geral. O rim em ferradura com ureter único é uma rara anomalia. Um paciente do sexo masculino de 60 anos foi admitido para investigação rotineira de triagem. Sua história familiar era negativa para doenças renais e o exame físico foi considerado normal. A tomografia computadorizada revelou um rim em ferradura atípico com cistos e a reconstrução tridimensional na tomografia computadorizada mostrou a presença de um único ureter. O paciente encontra-se assintomático após dois anos de seguimento. Apresentamos um raro caso de paciente portador de rim em ferradura com cistos e ureter único diagnosticado incidentalmente.

Horseshoe kidney is the most common of all renal fusion anomalies, occurring in approximately 0.25 percent of the general population. Horseshoe kidney with only a single ureter is a rare anomaly. A 60-year-old man was admitted to hospital for routine health screening. His family history was negative for kidney diseases, and there was no abnormality in his physical examination. A computed tomography (CT) scan revealed an atypical horseshoe kidney with cysts and three-dimensional spiral CT reconstruction showed the presence of a single ureter. The patient has since been followed up for two years without any signs of clinical disease. We report a rare case of a patient with a horseshoe kidney with cysts and a single ureter that was diagnosed incidentally.

Long-Term Follow-up of Asymptomatic Hematuria and/or Proteinuria in Adults / 대한신장학회잡지

To determine the clinical outcome of patients with asymptomatic hematuria and/or proteinuria, the biochemical parameters and renal biopsies were reviewed. The patients with asymptomatic urinary abnormalities(n=193) were followed up in Kangnam St. Mary's hospital between 1981 and 1996 and their mean age was 38.8+/-14.0 years old, sex ratio of M:F 54:139, mean follow-up period 6.2+/-4.4 years. They were divided into three groups according to the first dipstick urinalysis findings:82 patients with isolated hematuria(H), 28 patients with isolated proteinuria(P), and 83 patients with concomitant hematuria and proteinuria(H+P). During the follow-up period, in the 82 patiets with H, 68.3% had persistent hematuria without proteinuria, hematuria disappeared in 23.2%, and 8.5% manifested proteinuria, none of the patients showed renal insufficiency. Of the 28 patients with P, 42.9% had persistent proteinuria, proteinuria disappeared in 39.3%, 10.7% manifested hematuria, and 7.1% showed renal insufficiency. Of the 83 patients with H+P, 51.8% had persistent hematuria and proteinuria, hematuria and proteinuria disappeared in 13.3%, 16.9% had persistent hematuria without proteinuria, 9.6% had persistent proteinuria without hematuria, and 8.4% showed renal insufficiency. Renal biopsy was performed in 79 patients. 75.9% of these patients had Ig A nephropathy, 11.4% had mesangial proliferative glomerulonephritis or mesangiopathy, and 8.9% had membranous proliferative glomerulonephritis. In conclusion, the most common cause of asymptomatic urinary abnormalities was Ig A nephropathy(75.9%) and all patients with isolated hematuria kept normal renal function, while some patients with proteinuria(7.1%) or concomitant hematuria and proteinuria(8.4%) progressed to chronic renal failure. Therefore, to monitor progressing to chronic renal failure, the patients with proteinuria(whether or not they showed concomitant hematuria) should be closely followed up.