Emphysematous pyelonephritis: experience at a tertiary care hospital in Bangladesh.

BACKGROUND: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma, collecting system and/or perinephric tissues, characterized by gas accumulation. We describe clinical, laboratory and imaging characteristics and in-hospital outcomes of patients with EPN. METHODS: This retrospective observational study was carried out at BIRDEM General Hospital, Dhaka, Bangladesh between 2014 and 2020. RESULTS: We followed 20 patients (mean age 49.4 years; females 70%). Risk factors for EPN were diabetes mellitus (in 100%) and renal stones (in 10%). Fever, loin pain, vomiting and dysuria were common. Complications included acute kidney injury (AKI, 70%; mostly stage 1, 78.6%), hyponatraemia (55%) and bacteraemia (15%). Escherichia coli was the most common (60%) urinary isolate. Most patients (80%) had class 2 EPN, with 15% class 3B and 5% class 3A. Besides medical management, four (20%) required surgery (nephrectomy in 3). Nephrectomised patients had a higher radiological class (p = 0.032) and incidence of AKI (p = 0.034). No deaths occurred. CONCLUSION: EPN occurred predominantly in female diabetic patients, who presented with fever, loin pain, vomiting and dysuria. Two-thirds of patients had AKI and one-fifth required surgery, and there were no deaths.

Class 4 emphysematous pyelonephritis with emphysematous cystitis: report of a rare case from Bangladesh.

Emphysematous pyelonephritis is a rare, severe form of necrotising infection of the kidneys and peri-nephric tissues with gas accumulation, occurring predominantly among patients with diabetes mellitus. Computed tomography scan can identify the distribution of gas in the affected reno-ureteral units and so establish and classify the diagnosis. We report a case of class 4 emphysematous pyelonephritis with emphysematous cystitis, occurring in a young Bangladeshi male, who presented with features of upper urinary tract infection. He had a background history of fibro-calculous pancreatic diabetes and chronic kidney disease. Imaging also revealed renal stones. He responded to conservative treatment.

Septicemic melioidosis complicating undiagnosed chronic kidney disease and beta-thalassemia minor in a Bangladeshi farmer.

Melioidosis is an emerging infectious disease in many countries including Bangladesh. Patients with diabetes mellitus are at increased risk for infection by Burkholderia pseudomallei, the causative agent for melioidosis. Here, we report an autochthonous case of septicemic melioidosis occurring in a middle-aged non-diabetic Bangladeshi farmer who presented with prolonged pyrexia and splenomegaly. Diagnostic workup revealed splenic micro-abscesses, previously undetected chronic kidney disease (CKD) and beta-thalassemia minor. This case stresses the importance of searching for less common risk factors for melioidosis such as CKD and hemolytic anemia.

Experience Managing Adult Patients on Continuous Ambulatory Peritoneal Dialysis in Bangladesh.

Continuous ambulatory peritoneal dialysis (CAPD) is becoming increasingly known to the patients of Bangladesh, and patient numbers are increasing. Here, we report our experience and clinical outcomes in this field.Our analysis included all CAPD patients managed in a tertiary care hospital in Bangladesh between 2003 and 2015. All patients received a Tenckhoff double-cuff catheter by mini-laparotomy, and twin bags were used in most patients. In acute cases, regular exchanges were started manually with small-volume dwells the same or the next day.During the study period, 500 patients (mean age: 62 ± 18 years; 62% men; 86% percent with diabetes) were managed. Selection of CAPD was made by choice (47%) or for hemodynamic instability (32%), remote residence (17%), or poor vascular access (4%). Total duration of follow-up was 9364 patient-months (range: 1 - 78 months). The peritonitis rate was 1 episode in 30 patient-months. Fewer than 5% of patients required catheter removal. Similarly, the percentages of catheter tip migration and fluid leak were at the lower end. Patient survival was 68%, 48%, 38%, 22%, and 8% at 1, 2, 3, 5, and 7 years. Deaths were mostly attributable to vascular events.In a population with predominantly diabetic patients, CAPD was shown to be a viable mode of renal replacement therapy. The rates of peritonitis and catheter-related complications were low. Survival in the initial years can be considered acceptable.

Genitourinary melioidosis in a Bangladeshi farmer with IgA nephropathy complicated by steroid-induced diabetes mellitus.

Melioidosis is an emerging infectious disease in many countries including Bangladesh. Genitourinary infection due to Burkholderia pseudomallei is a well-recognized manifestation although less commonly reported in Asia than Australia. Here, we report case history of a 38-year-old Bangladeshi farmer, diagnosed with IgA nephropathy and on oral prednisolone, who presented with features of urinary tract infection. Diagnostic workup confirmed genitourinary infection due to B. pseudomallei and diabetes mellitus. He was treated with ceftazidime followed by the combination of co-trimoxazole and doxycycline. After two-year follow-up, he was free of symptoms with no recurrence of melioidosis. In the context of growing evidence of melioidosis endemicity in Bangladesh, physicians should be aware and include melioidosis as differential in appropriate clinical scenario. Melioidosis may cause urinary tract infections and should be suspected in high-risk groups like farmers and in the presence of risk factors such as diabetes mellitus and other immunosuppressive conditions.

Purtscher's retinopathy and renal cortical necrosis: two rare vaso-occlusive complications in a patient with acute pancreatitis: a case report.

BACKGROUND: Purtscher's retinopathy and renal cortical necrosis are two rare vaso-occlusive complications of acute pancreatitis. Purtscher's retinopathy causes sudden impairment of vision, which was first reported in a patient with head trauma. Subsequently, it was also reported as a complication of acute pancreatitis and few other clinical conditions. Acute pancreatitis also rarely causes renal cortical necrosis leading to acute kidney injury. However, the simultaneous presence of both complications is rarely reported. CASE PRESENTATION: A 20-year-old Bengali man presented to our hospital with a history of acute upper abdominal pain, vomiting, anuria, and disorientation. He was ultimately found to have bilateral complete blindness due to Purtscher's retinopathy and acute kidney injury due to renal cortical necrosis, as sequelae of acute pancreatitis. He became dialysis-dependent, his vision did not recover, and he died 16 months after diagnosis. CONCLUSIONS: This case highlights Purtscher's retinopathy and renal cortical necrosis might be considered as a recognized pair complication of acute pancreatitis.