Association of visfatin with chronic kidney disease in a cohort of patients with and without diabetes

To evaluate association of serum visfatin with CKD secondary to diabetic nephropathy and to compare it with patients of CKD secondary to other risk factors. Seventy eight individuals including 28 healthy controls and 50 patients of CKD were included in this study. Patients with CKD were further grouped based on etiology of CKD into diabetics and non-diabetics. Patients with type 1 diabetes mellitus, urinary tract infection, urolithiasis, liver cirrhosis, stroke, ischaemic heart disease, and rheumatoid arthritis were excluded. Measurement of Serum visfatin was done through EIA Kit [Phoenix pharmaceuticals Burlingame CA]. Visfatin concentration was significantly high in patients with CKD compared to controls [8.7 +/- 4.7 vs. 5.2 +/- 3.3 p = 0 .001]. No significant difference in Visfatin concentrations between patients of CKD with and without diabetes was detected [9.2 +/- 5.5 vs. 8.3 +/- 3.2 p = 0.694]. A significant negative correlation of visfatin with estimated GFR [r[2]= -0.383, p=0.01] and a positive correlation with degree of proteinuria [p=0.01] was observed. The present study confirms the association of visfatin with CKD, however further studies at molecular level to check its expression within renal tissue may clarify its definitive role in CKD

relationship of visfatin with measures of obesity in patients of diabetic nephropathy

Visfatin is proposed as an adipocytokine secreted from visceral fat and its blood level correlate with obesity, diabetes mellitus and inflammation. Aim of this study was to examine association of serum visfatin with measures of obesity in a group of patients with diabetic nephropathy and normal controls. This was a cross sectional study analyzing 60 subjects including 30 patients of diabetic nephropathy and 30 controls. Anthropometric measurements were done using standard methods and visfatin was measured through EIA Kit. Serum visfatin in obese subjects among both groups was not different from non obese subjects [7.9 +/- 6.1 vs. 6.4 +/- 3.2 p=0.238]. We found a positive correlation of visfatin with BMI [r=0.313, p<0.05] but no correlation with waist circumference [r=0.148 p=0.695] and waist to hip ratio [0.198, p=0.136]. Serum visfatin in subjects of diabetic nephropathy and non diabetics was [9.2 +/- 5.4 vs. 5.2 +/- 3.4 p<0.05. Serum visfatin does not correlate with markers of visceral obesity including waist circumference and waist to hip ratio. However, a positive correlation is observed with BMI. Future studies involving larger sample size and quantifying visceral tissue expression of visfatin may explain its potential role in visceral obesity

Etiology and outcome of acute renal failure in pregnancy

To determine the etiology and outcome of Acute Renal Failure [ARF] in pregnancy. A case series. Nephrology Department of the Jinnah Postgraduate Medical Centre, Karachi, from August 2007 to July 2008. Pregnant women who were healthy previously and had developed ARF, diagnosed on oliguria [urine output <400 ml/day] and mounting azotemia [serum creatinine > 2 mg%] were included in the study. Percutaneous renal biopsy was performed for delayed recovery, i.e. after three weeks. Patients were followed up for a period of 6 months. Percentages were calculated for qualitative variables i.e. causes of ARF, mortality, morbidity and outcome in form of complete recovery, partial recovery, demise and non-recovery. A total of 43 patients with pregnancy-related ARF were included in the study. The puerperal group comprised 36 patients [83.7%]. Haemorrhage was the etiology for ARF in 25 [58.1%], antepartum haemorrhage APH in 8 [18.6%] and postpartum haemorrhage PPH in 16 [37.2%] of patients. In 12 [27.9%], puerperal sepsis was the etiological factor, while 4 [9.3%] patients had DIC on presentation. Pre-eclampsia, eclampsia and HELLP syndrome accounted for 5 [11.6%]. While 1 [2.3%] was diagnosed with hemolytic uremic syndrome and another one was diagnosed as ARF secondary to hypotension produced by hyperemesis gravidarum. Renal biopsy was performed in 31 patients showing that 10 had acute cortical necrosis and 21 had acute tubular necrosis. Maternal mortality was 16.2% [n=7]. Of the 36 [83.7%] surviving patients, 18 [41.4%] had complete recovery of renal function; 12 [27.9%] had partial recovery; and 6 [13.9%] required chronic dialysis. Pregnancy-related ARF was associated with poor outcome. Antepartum and postpartum haemorrhage were the most common cause of ARF in pregnancy

Lupus nephritis: clinicopathological correlation

To analyze clinicopathological correlation in lupus nephritis [LN]. Analytical study. Two years [January 2002 to December, 2004] study conducted at the Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi. Thirty patients of both sexes between ages of 15 - 70 years, fulfilling criteria of primary SLE and with renal impairment were included in the study. Various investigations like complete blood picture, blood urea nitrogen [BUN], serum creatinine, 24 hours urinary protein, creatinine clearance, ANA, double stranded DNA [Anti Ds DNA], ultrasound of kidneys were carried out. Ultrasound guided renal biopsy was done in all cases. Proteinuria was found in all 30 cases, nephrotic syndrome in 18 [60%] patients, oliguria in 17 [56.60%], microscopic hematuria in 20 [66.60%] and hypertension in 21 [70%] cases. Various clinical features of SLE including arthritis in 20 [66%], arthralgia 26 [86.60%], serositis 7 [23%] and anemia in 20 [66.6%] cases. Renal biopsy results were classified according to WHO criteria and it revealed that 16.70% has mesangial proliferation, 20% had focal proliferation, 40% showed diffuse proliferation, 16.70% membranous type and 6.70% had advanced sclerosis. Whenever a patient, especially young female, presents with proteinuria and haematuria with RBCs cast, lupus nephritis should be suspected. If it is proved then renal biopsy should be done to classify into either mild lesion [class-11 or V] or severe lesions [class-III or IV]. The findings of renal biopsy can help in planning appropriate management of the patients

study of 30 cases of renal amyloidosis

To determine the clinicopathological features of renal amyloidosis. Patients And A total number of thirty cases were included in two year study. Diagnosis was based on renal biopsy and Congo red staining. There was 18 [60%] male and 12 [40%] female patients. Age range was 20 - 70 years and maximum number was found between 40 - 50 years. Out of 30 cases tuberculosis was present in 10 [33.3%], leprosy in 6 [20%], bronchiectasis and rheumatoid arthritis in 4 [13.3%], chronic osteomyelitis in 3 [10%], ankylosing spondylitis in 2 [6.7%] and multiple myeloma in 1 [3.3%] case. Proteinuria was present in all cases. Generalised edems found in 26 [86.6%], hypertension in 17 [56.6%], hematuria in 10 [33.3%], hepatosplemngely in 5 [16.6%] patients. Tuberculosis was the commonest cause of secondary renal amyloidosis