Acute kidney injury in association with acute pancreatitis

Objective: To report case series of patients with acute kidney injury [AKI] developing in association with acute pancreatitis [AP]

Methods: All patients coming to Sindh Institute of Urology and Transplantation [SIUT], who developed AKI in association with acute pancreatitis, were included in the study. AKI was defined with sudden rise in creatinine and decline in urine output with normal size kidneys and no previous co morbid. AP defined as patients with abdominal pain and > 3 times rise in serum amylase and /or lipase and radiology suggestive of AP

Results: Between 2000- 2017, 24 patients were found to have AKI in association with AP. Among these 13 were female, mean age was 36.875±10.152 years. Oligoanuria was present in 83%, 46% were icteric on presentation, 42% had circulatory failure, 33% had respiratory failure, 17% had abnormal Glasgow Coma Scale. Renal replacement was required in 79% patients. Complete renal recovery was observed in 54% patients, while 37% died during acute phase of illness. Multi-organ failure showed high prediction of mortality

Conclusion: Being a tertiary renal care unit only patients with renal failure were referred to our hospital, thus exact prevalence of AKI in AP is not known. Multi organ failure [MOF] has shown high mortality in this case series

Snake-bite-induced acute kidney injury

Objective: To describe the clinical spectrum and outcome of patients presenting to a tertiary care kidney center, developing acute kidney injury [AKI] after snake-bite

Study Design: An observational study

Place and Duration of Study: Nephrology Department, Sindh Institute of Urology and Transplantation [SIUT], Karachi, from January 1990 to December 2014

Methodology: All patients coming to SIUT identified as having AKI after snake-bite during the study period were included. AKI was defined according to RIFLE criteria with sudden rise in creatinine or decline in urine output or both. Demographics, clinical presentation, laboratory profile, and final outcome was noted

Results: During the studied period, 115 cases of AKI, secondary to snake-bite, were registered at this institution. Median age of patients was 35.92 +/- 15.04 [range: 6 - 70] years and male to female ratio was 1.6:1. Time from bite and referral to this hospital ranged from 2 to 28 days [mean: 8.77 +/- 5.58 days]. Oligo-anuria was the most common presentation, being found in 98 [93.90%] patients. Bleeding diathesis was reported in 75 [65.21%] patients on presentation. All patients had normal sized, non-obstructed kidneys on ultrasonography, with no previous comorbids. Renal replacement therapy [RRT] was required in 106 [92.17%] patients. Complete recovery was seen in 59 [51.30%], while 15 [13.04%] patients expired during acute phase of illness, 4 [3.47%] developed CKD, 11 [9.56%] required dialysis beyond 90 days, and 26 [22.60%] were lost to long-term follow-up

Conclusion: Snake-bite, leading to multiple complications including renal failure and death, is a major health issue in tropical countries. Late referral of these patients to specialized centres results in undesirable outcome

Plasmodium Vivax causing acute kidney injury: a foe less addressed

objective: To report patients developing acute kidney injury [AKI] after Vivax malaria

Methods: An observational cohort of patients identified as having acute kidney injury [AKI] after Plasmodium vivax infection. AKI was defined according to RIFLE criteria with sudden rise in creatinine or decline in urine output or both. All patients had normal size non obstructed kidneys on ultrasonography, with no previous co morbids. Malarial parasite Vivax was seen on blood peripheral film in all patients

Results: From January 1990 - December 2014, total 5623 patients with AKI were registered in our institute, of these 671 [11.93%] developed AKI in association with malarial infection, furthermore, Vivax was species in 109 patients. Average age of patients was 33.49 +/- 14.67 [range 8-78 years] with 66 male and 43 female. Oligo-anuria and vomiting were most common associated symptoms with fever. Renal replacement therapy required in 82 [75.22%] patients. Complete recovery was seen in 69 [63.30%], while 14 [12.84%] expired during acute phase of illness. Jaundice, thrombocytopenia, central nervous system involvement, mechanical ventilation requirement and hematuria were the factors significantly associated with high mortality

Conclusion: Malaria still causing significant morbidity and mortality in our part of world. Vivax malaria can present with hemolysis, thrombocytopenia and kidney failure in remarkable number of patients

Analysis of factors causing acute renal failure

Factors leading to acute renal failure [ARF] were analysed in 376 consecutive patients between January 1993 and December, 1994 in a Karachi centre. Two hundred and sixteen [57%] had medical conditions, 86 [24%] obstetrical, 28 [7%] obstructive, 18 [5%] surgical and in 28 [7%] the causes were uncertain. Within the medical group, the causes were diarrhoea 30%, drugs 23%, malaria 15% and liver disease 5%. In the obstetrical group majority of the patients had multiple etiologies. Sixty percent of patients had ante-partum haemorrhage, 33% post-partum haemorrhage, intrauterine deaths were seen in 31%, septic abortions in 20% and pre-eclamptic toxemia in 22% cases. In the obstructive group, most of the patients had stone disease, where bilateral ureteric calculi constituted 57% of the cases. In surgical group, 11 [61%] had ARF due to post-operative complications. This data confirms the pattern of ARF from other third world countries where obstetrical and obstructive causes are high as compared to western countries

Acute renal failure due to traumatic rhabdomyolysis

Trauma and non-traumatic insults can cause muscle damage to such an extent that serious sequelae to other organs may result. Myoglobinuria and subsequent acute renal failure [ARF] is a well known and widely studied fact of such sequelae. Twelve cases of ARF [between 1990-1993] who have developed renal dysfunction after prolonged muscular exercise e.g., squat jumping, sit-ups and blunt trauma from sticks or leather belts mainly given by law enforcing personnel for certain issues were studied. None of them had previous history of myopathy, neuropathy or renal disease. All were critically ill on presentation and required renal support in the form of dialysis. Although morbidity was high in all, eleven of them recovered and one expired due to sepsis