Arteriovenous Fistula Creation by Nephrologist: A Single Centre Experience

Introduction: Arteriovenous Fistula (AVF) is the preferredvascular access with the least rate of complications andmorbidities. Across the globe except European countriesAVF is created predominantly by surgeons. There are veryfew experiences shared by Nephrologists from Indiansubcontinent in creating AV fistulas and their follow up. Theaim of this study was to assess preoperative factors affectingthe outcome of AVF creation and the follow up of successfullycreated fistulas.Material and Methods: A prospective observational studywas carried at our hospital over a period of six months from01 October 2018 to 31 March 2019. All patients undergoingAVF creation by nephrologist from 01 October 2018 to 15Feb 2019 were included in the study and each patient wasfollowed for six weeks. Besides baseline parameter, historyof Diabetes, hypertension and coronary and peripheralvascular disease were noted. All the perioperative findingslike vascular calcification and Blood pressure were noted. Allsuccessful AVF were followed for six weeks with serial USGand Doppler at postoperative day 1, 2 week and 6 weeks.Results: A total of 20 (77%) out of 26 AVF were successfullycreated, The average age was 54.6±15.4 years, Among baselineparameters gender had statistical significance (p=0.03).During surgery more arterial diameter and hypertension wereassociated with successful outcome. During follow-up, botharterial and venous diameter as well as blood flow in arteryand AVF had significant correlation between postoperative 1st,2nd and 6th week (p<0.01). More than 35% and 80% of patientsat 2 and 6 weeks respectively achieved criteria for successfulmaturation as per NKF- KDOQI criteria and it was > 90% and100% as per UAB criteria.Conclusion: Our experience suggest good outcome of AVFcreation by nephrologist, even with those with risk factors forfailure and non maturation. Also we suggest early cannulationof AVF at four weeks or earlier.

Azathioprine Causing Cholestatic Jaundice In A Lupus Nephritis Patient: A Case Report And Review Of Literature

The systemic lupus erythematosus (SLE) is an autoimmune disease affecting predominantly females of reproductive age group. Pregnancy is advised only after a period of disease quiescence for at least six months. Azathioprine (AZA) and prednisolone are the immunosuppressants commonly used during pregnancy in lupus nephritis. Azathioprine causing cholestatic jaundice has been reported only a few times but none in a patient with lupus nephritis, pregnant or otherwise to the best of our knowledge. We present an interesting case of a young pregnant patient of lupus nephritis (LN) developing cholestatic jaundice in the third trimester, causing diagnostic dilemma between drug-induced jaundice and Intrahepatic cholestasis of pregnancy which resolved after withholding azathioprine. We should be aware of this uncommon adverse effect of this very commonly used drug in SLE patients.

Sjogren’s Syndrome Presenting With Recurrent Hypokalemic Paralysis

Sjogren’s syndrome is an autoimmune disorder commonly affecting females and presents with the dryness of the mouth and eyes. Here, we present an interesting case of Sjogren’s syndrome, initial presentation with distal renal tubular acidosis (RTA) causing recurrent hypokalemic paralysis, and dyspnea requiring ventilator support. The patient improved dramatically with potassium and alkali supplementation. She has been on follow-up for the past 3 months and remains asymptomatic. Only a few case reports and series have been reported on such initial presentation of Sjogren’s syndrome. To conclude, one must be aware of distal RTAs associated with autoimmune disorder presenting with hypokalemic paralysis.