Aetiology, maternal and foetal outcome in 60 cases of obstetrical acute renal failure

Acute renal failure is a serious complication in pregnancy. Not only does it result in significant maternal morbidity and mortality but also results in significant number of foetal loss. Although incidence of obstetrical acute renal failure has decreased in developed countries but still it is one of the major health problem of developing nations. The objective of this study was to study aetiology, maternal and foetal outcome in obstetrical acute renal failure. This study was conducted at Department of Nephrology, Khyber Teaching Hospital, Peshawar from August 2006 to December 2007. It was a descriptive, case series study. Female patients with pregnancy and acute renal failure, irrespective of age, were included in the study. Patients were thoroughly examined and baseline urea, creatinine, serum electrolytes, peripheral smear, prothrombin time, partial thromboplastin time, fibrinogen degradation products, renal and obstetrical ultrasound were performed on each patient and 24-hr urinary protein and bacterial culture sensitivity on blood, urine or vaginal swabs were done in selected patients. Foetal and maternal outcome were recorded. Data were analysed using SPSS. A total of 60 patients were included in the study. Mean age of the patients was 29 +/- 5.4 years and duration of gestation was 33 +/- 4.9 weeks. Mean gravidity was 4 +/- 2.2. Sixteen patients [26.66%] were treated conservatively while 44 [73.33%] required dialysis. Postpartum haemorrhage was present in 14 [23.33%], postpartum haemorrhage and disseminated intravascular coagulation [DIC] in 11 [18.33%], eclampsia-preeclampsia in 8 [13.33%], antepartum haemorrhage in 8 [13.33%], antepartum haemorrhage with DIC in 6 [10%], DIC alone in 4 [6.66%], obstructed labour in 3 [5%], septic abortion in 3 [3.33%], HELLP [haemolysis elevated liver enzyme and low platelet] in 2 [3.33%], urinary tract infection with sepsis in 1 [1.66%] and puerperal sepsis in 1 [1.66%]. Foetal loss was 40 [66.66%]. Maternal mortality was 9 [15%] while 28 [46.66%] fully recovered. Among the rest 6 [30%] had partial recovery and 5 [8.33%] had dialysis dependent chronic kidney disease. Obstetrical acute renal failure not only results in foetal loss but also causes significant maternal morbidity and mortality

Doppler detected opening size and flow chart as predictors of early failure of arteriovenous fistula in hemodialysis patients

To determine whether Flow rate and the Size of the opening can predict early failure of arteriovenous fistulae in haemodialysis patients on Doppler ultrasonography. Prospective, quasi experimental study from March 2004 to January 2006. This study was conducted in Surgical "c" ward of the Khyber Teaching Hospital, Preshawar. A total of 92 patients with ESRD [End Stage Renal Disease] who were selected for haemodialysis. All the patients were subjected to Doppler study during the first week of AVF [arteriovenous fistula] construction, and the stomal size and blood flow rate detected. Both these parameters were used as predictors of AVF failure on follow-up visits during the next six months. Out of 92 patients, 13 [14.1%] had an initial stomal opening ranging from 2.3-3.5 mm and 44 [47.8%] from 3.5-5mm, while in 35 [385] patients the opening was > 5 mm. Twenty two [23.9%] patients had an initial flow rate of <400ml/min, 52 [56.5%] 400-700 ml/min and in 18 [19.5%] patients the flow rate was >700 ml/min. During the six months follow-up visits there were 14 [15.3%] AVF failures; all these patients had an initial flow rate of less than 400 ml/min, with a stomal opening of <3 mm in size. Initial stomal opening size and flow rate can be used as good predictors of early Arterio-venous failure in haemodialysis patients on Doppler ultrasonography

Renal biopsy: an effective and safe diagnostic procedure

This study was conducted to know the frequency of various complications of percutaneous renal biopsy [PRB] and to find out its diagnostic yield in terms of enough material for diagnosis. We conducted this study at the department of Nephrology; Khyber Teaching Hospital Peshawar, from 1st January 2003 to 31st December 2004. PRB were performed on native kidneys with ultrasound guidance. All the patients were observed for 24 hours after the biopsy for any complications. Once the report of the biopsy was available, we recorded further information regarding diagnosis and adequacy of biopsy. We analyzed 200 percutaneous renal biopsy procedures. There were no complications in 90% of biopsies [n=180]. Only 8% [n=16/200] of the cases had minor complications and 2% [n=4/200] had major complications including gross haematuria requiring blood transfusion and catheterization for clot retention. Definitive diagnosis was made in 96% [n=192] of biopsies. Two percent [n=4] had inadequate biopsy or medullary sample. No patient sustained major complications like infections, nephrectomy and death. We conclude that PRB with automatic biopsy needle and ultrasound guidance is a very effective and safe procedure for the definitive diagnosis of renal diseases

Arteriovenous fistula construction in chronic haemodialysis patients: comparison of end-to-side and side-to-side techniques

To compare the techniques of end-to-side and side-to-side anastomosis in arteriovenous fistulae construction in terms of success rate and immediate postoperative complications. Design: Comparative study. Place and Duration of Study: Ayub Hospital Complex, Abbottabad, from October 1999 to December 2002 and Khyber Teaching Hospital, Peshawar, from January 2003 to December 2003. Patients and One hundred and ninety patients with end stage renal disease [ESRD] were included in the study. Arteriovenous fistula was constructed in these patients by two techniques i.e. end-to-side and side-to-side anastomosis. The two methods were compared in terms of duration of surgery, immediate success rate and short-term complications. Among 190 patients, 118 [62%] were males and 72 [38%] females. The age ranged between 24 to 66 years with average age of 54 years. Side-to-side anastomosis was done in 120 [63%] patients while end-to-side in 70 [37%] patients. The average duration of surgery in side-to-side group was 50 minutes and in end-to-side group it was 75 minutes. Bleeding occurred in 4[5.7%] cases in end-to-side group and 2[1.7%] patients in side-to-side group requiring reexploration. The immediate failure rate of the procedure was 2.5% in side-to-side group and 7.5% in end-to-side group. Wound infection occurred in 1[1.4%] case in end-to-side group and 2[1.7%] cases in side-to-side group. In patients with end stage renal disease [ESRD] arteriovenous fistula construction by side-to-side anastomosis is less time-consuming and has less complications as compared to end-to-side technique

Misoprostol in renal transplant recipients on cyclosporin monotherapy

Misoprostol, a PGE1 analogue was evaluated in a prospective, randomized, double-blind single centre trial in renal transplant recipients for 12 weeks along side cyclosporin only immunosuppression.Misprostol use was not associated with a reduction in the incidence of acute rejection or cyclosporin nephrotoxicity