A review of the epidemiology of chronic kidney disease in Pakistan: A global and regional perspective.

Both the incidence and prevalence of chronic kidney disease (CKD) are rising with immense pace worldwide. People living in developing countries are speculated to suffer the consequences due to economic deprivation and high cost of treatment. The prevalence of CKD is highly variable in different parts of the world, due to various environmental, ethnic, socioeconomical, and rural-urban differences. It has become very important for the developing countries to understand the true nature of the disease and its prevalence, rather than to hypothesize or make supposition on the bases of Western data. It is imperative to understand the risk factors in our region or country. Few studies have reported that the prevalence of CKD in Pakistan and its risk factors. Through the internet, we searched the terms prevalence of CKD, and included articles that discussed the CKD prevalence in different regions. We reviewed all studies along with the global as well as regional data to have better insight into the problem.

Reasons for Removal of Non-Tunneled Double Lumen Catheters in Incident Dialysis Patients.

OBJECTIVE: To evaluate the reasons of removal of non-tunneled double lumen catheters (NTDLC) in incident hemodialysis (HD) patients in a tertiary renal care hospital. STUDY DESIGN: Observational retrospective study. PLACE AND DURATION OF STUDY: Department of Nephrology, The Kidney Centre Postgraduate Training Institute (TKC PGTI), Karachi, from June 2015 to May 2016. METHODOLOGY: All patients were selected who had naive NTDLC placement at TKC PGTI either in Emergency Room (ER) or Intensive Care Unit (ICU) during the study period. The reason for removal were observed. Data was analysed by SPSS 21 and mean, percentages and frequencies were calculated. Cross tabulation between variables was done to find significance. RESULTS: A total of 429 NTDLCs were inserted in the study period, out of which 296 catheters were inserted for incident HD. One hundred and twenty-seven (42.9%) catheters were removed prematurely due to malfunction, and 50 (17%) due to catheter-related blood stream infection (CRBSI). Methicillin resistant Staphylococcus aureus was the commonest organism responsible for CRBSI. One hundred and five (35.47%) catheters were removed because the permanent vascular access (PVA) became usable. CONCLUSION: Catheter malfunctions and infections frequently occurred in NTDLC used for HD, which culminated early removal of catheter. Early creation of PVA should be encouraged to reduce the complications in already immunocompromised patients.

Clinical variables differentiating diabetic from nondiabetic kidney disease in patients with diabetes: A single-center study.

Patients with diabetes may have kidney diseases other than the diabetic kidney disease. Kidney biopsy is the investigation of choice when this is suspected. This retrospective analysis included all patients known to have diabetes mellitus (DM) and who had a kidney biopsy at our center between 1998 and 2014. The aim of this study was to assess if an association exists between the clinical factors on the presence or absence of diabetic nephropathy (DNP). A total number of 206 patients were included in our study. The association between the diabetic retinopathy (DRP) and DNP was high (P = 0.001). We found that the DRP is highly specific for the presence of DNP [89.7% (78 out of 87)] whereas sensitivity of DRP for DNP was 56.3% (67 out of 119). Among other factors, only duration of DM showed a significant association (P = 0.005) (odds ratio: 1.1085 and confidence interval: 1.025-1.149) with the development of DNP. We conclude that the absence of DRP is strongly associated with the presence of nondiabetic renal disease while the presence of DRP has a low sensitivity for the presence of DNP.

Analysis of renal diseases detected in renal biopsies of adult patients: A single-center experience.

Renal biopsy is crucial while evaluating for the diagnosis of glomerular, vascular, tubulointerstitial, and genetic diseases. It gives vital information which helps in estimating the disease prognosis, progression, and management. This is the retrospective analysis of all adult patients aged above 18 years, who underwent percutaneous renal biopsy at The Kidney Center Post Graduate Training Institute, Karachi, over a duration of 18 years, i.e., January 1, 1996, to December 2013. Renal graft biopsies and those which were inadequate were excluded from analysis. Of the1962 biopsies performed, we included 1521 biopsies in our assessment. The mean age of the population was 38 ± 15.26 years (range 18-88 years). There were 920 (60.5%) males and 601 (39.5%) females. The most common clinical indication of kidney biopsy was nephrotic syndrome, i.e., 741 (45.7%), followed by chronic kidney disease, 253 (16.6%); acute renal failure, 184; (12.1%) and rapidly progressive glomerulonephritis (GN), 124 (8.2%). Primary GN was found in the majority of the patients, 984 (64.7%), followed by secondary GN in 249 (16.4%), tubulointerstitial disease in 224 (14.7%), and vascular disease in 64 (4.2%). In primary GN, focal segmental glomerulosclerosis was the most common histopathological diagnosis in 297 (19.5%) patients, followed by MGN in 224 (14.7%), chronic GN in 98 (6.4%), crescentic GN in 93 (6.1%), minimal change disease in 87 (5.7%), membranoproliferative glomerulonephritis in 58 (3.8%), and postinfection glomerulonephritis in 53 (3.5%) patients. This study shows that focal segmental glomerulosclerosis is the most common lesion in renal biopsy in the young age group followed by membranous nephropathy. Diabetic nephropathy and chronic interstitial nephritis were dominant secondary pathological lesions in older age group, whereas lupus nephritis was the most common secondary disease in young age females.

Morbidity and mortality associated with Plasmodium vivax and Plasmodium falciparum infection in a tertiary care kidney hospital.

Malaria is a disease of tropical regions and both types of plasmodia, i.e. Plasmodium falciparum and Plasmodium vivax, cause significant morbidity and mortality. P. vivax was thought to be benign and cause less morbidity and mortality. Many reports showed the devastating effect of vivax malaria too. We compared the clinical symptoms, laboratory markers, treatment and outcome of both the plasmodia. This is a retrospective analysis of 95 patients admitted to The Kidney Center, Karachi in a duration of 15 years (1997-2012); 45 patients with falciparum malaria and 50 patients with vivax malaria, and compared the clinical presentation, laboratory workup, treatment and outcome in both groups. The two groups constitute a mixed population of diabetes, chronic kidney disease (CKD) and hemodialysis patients. Both plasmodia have an equal clinical impact in terms of fever and rigors, anorexia, nausea, feeling of dyspnea, change in the mental status, changes in the urine color, diarrhea, volume depletion and pedal edema. However, patients with falciparum had significantly more vomiting (P = 0.02), oliguria (P = 0.003) and jaundice (P = 0.003). Laboratory parameters also showed a severe impact of falciparum, as there was more severe anemia and kidney and liver dysfunction. More patients were treated with dialysis and blood transfusion in the falciparum group. The outcome in the two groups was not significantly different in terms of death and days of hospitalization. Falciparum malaria has a higher clinical impact than the vivax malaria, but vivax is not as benign as it was once thought to be. It also has devastating effects on vulnerable populations like patients with CKD and diabetes.