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

Glycemic status, income, self-monitoring, compliance, education and pattern of pharmacotherapy in 100 patients of type 2 diabetes mellitus

To assess the glycemic status, income, self-monitoring, compliance, education and pattern of pharmacotherapy in 100 type 2 diabetes mellitus patients. Material and This descriptive observational study was carried out at Medical A Unit, Khyber Teaching Hospital Peshawar. A total of 100 type 2 diabetic patients were included through non-probability sampling. Glycosylated hemoglobin of each patient was determined and questions were asked about income, self-monitoring of glycemic status, education and compliance of the patients. Majority of the patients [78%] had poorly controlled diabetic mellitus. Most of the patients [42%] were poor and their monthly income was less than 5000 rupees. Only 57% of the patients monitored their blood sugar once a month. No patient was using glycosylated hemoglobin for assessment of his or her glycemic status. Majority of the patients [82%] were illiterate. Oral hypoglycemic agents were used by 81% of the patients. Most of the patients had poorly controlled diabetes mellitus. Majority of the patients were poor and illiterate and there was poor self-monitoring. Most of the patients were using oral hypoglycemic drugs

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