Frequency, Co-morbidities and outcome of acute kidney injury in elderly admitted patients.

OBJECTIVES: To analyse the frequency, co morbidities and outcome ofAcute Kidney Injury (AKI) in elderly patients. METHODS: This is an observational retrospective study performed in a secondary care Hospital located in Abu Dhabi. Study include adult patients admitted during 01st January 2018 till 31st December 2018. We uses KDIGO criteria of more than 26.5 micromol/L increase in serum creatinine within 48 hours or 1.5 times increase from baseline within seven days to define AKI. Patients were followed from admission till discharge from hospital either to Home, to other facility or death. Analysis was done on SPSS version 20. RESULTS: Total admissions for age 60 and above were 880. AKI was observed in 71 patients (8.0%). Most common co-morbidity found was hypertension being observed in 85.9%. Renal recovery was observed in 70.4% out of whom complete recovery was seen in only 32.4% and rest shows partial recovery. Hemodialysis was required in 16.90% and death results in 22.5% of our study patients. CONCLUSION: AKI is frequent among elderly admitted patients, commonest co- morbidity in these patients is hypertension. Outcome of AKI in elderly patients is poor with death in 22% of our patients.

Acute kidney injury in Ureteric Stones:Single centre short term analysis.

OBJECTIVE: To analyze acute kidney injury (AKI) frequency, risk factors and outcome in ureteric stone patients. METHODS: This is an observational retrospective study performed in a single tertiary care centre in Abu Dhabi from October 2014 till August 2015. Convenient sampling was done on 152 consecutive patients who underwent decompression surgery (Ureterorenoscopy LASER Lithotripsy and DJ Stenting) for ureteric stones. Serum Creatinine was used to calculate creatinine clearance by cock croft Gault formula in all patients before and after procedure. Analysis was done on SPSS version 17. RESULTS: Out of 152 patients who under went decompression surgical procedure for ureteric stones AKI was seen in 49(32.2%). Patients with AKI were found to be more higher age, increasedweight, bilateral stones, lower ureteric stones and with co morbidities in comparison to those who were without acute kidney injury. Patients developing AKI, 89.7% recovered either partially(20.4 %) or completely (69.3%). CONCLUSION: AKI is seen more in ureteric stone patients with older age, increased weight, bilateral stones, lower ureteric stones and with co morbidities. Recovery is good when obstruction is relieved.

Glomerular diseases outcome at one year in a tertiary care centre.

OBJECTIVES: To determine outcome in primary and secondary glomerular diseases at one year follow up. METHODS: Study design is observational cohort, done in out-patient department, Dow Iinternational Medical College, DUHS. All information gathered on a proforma. All patients with dipstick positive proteinuria and clinical glomerular disease were included in study. Patients with no proteinuria were excluded so were patients with stage 5 CKD. Patients were followed for proteinuria and renal insufficiency at completion of one year follow up. Statistical analysis was done on SPSS version 16. RESULT: Total number of patients who completed one year follow up was 173. Mean age of patients was 51.67+ 10.16 (range 15 to 75 years). Ninety two (53.2%), were males and 81(46.8%) were females, ratio being 1.1: 1.0. Mean weight of our patients was 67.43+ 14.13 Kg, (35 to 107 kg). Commonest cause of glomerular disease in our patient was diabetic nephropathy which was seen in 94.2% patients. Commonest associated problem with glomerular disease was hypertension seen in 66.5% of patients. Four out of 173 patients had stage 5 CKD at end of follow up at one year while quantitativ proteinuria remained same at one year follow up. CONCLUSION: One year follow up is critical for patients with glomerular disease associated with stage 4 CKD as progression to end stage renal failure may be seen within one year in these patients.

Are medical undergraduates more likely to indulge in substance abuse than non-medical undergraduates? A survey from Karachi.

OBJECTIVE: To determine frequency of substance abuse and the commonest substance of abuse among medical and non-medical undergraduates. STUDY DESIGN: Survey report. PLACE AND DURATION OF STUDY: Dow International Medical College, Karachi, from June 2012 to August 2012. METHODOLOGY: Semester VIII students from Dow International Medical College, Dow University of Health Sciences who visited the selected medical and non-medical universities, data collected through self responding questionnaire which was handed out to the participants. Data was collected from 4 medical and 4 non-medical universities. All responding undergraduate students in selected universities were included. Data was maintained and analyzed on SPSS version 16 for descriptive statistics. RESULTS: Total number of responders was 572 with male: female ratio of 1.23: 1.0 and mean age of 21.76 ± 2.168 years. Frequency of regular substance abuse was 20.1%. Males were abusing substance more than females, ratio being 4.7: 1.0 among abusers. The most common substance of abuse was tobacco. Frequency of regular substance abuse in nonmedical undergraduates was 29.4% which was higher than medical graduates (13.4%). CONCLUSION: Substance abuse among undergraduates in selected universities in Karachi was overall 20.1%. Male nonmedical undergraduates were more frequently using such substances; tobacco being the most common.

Fabry's disease--a comprehensive review on pathogenesis, diagnosis and treatment.

Fabry's is a progressive, destructive and life threatening disease which reduces significantly life expectancy of the affected individual. It is a genetic disorder of X-linked inheritance caused by deficiency of lysosomal enzyme alpha-galactosidase A resulting in progressive accumulation of glycosphingolipids within different body cells. Fabry's deposits are defined histopathologically as lamellate membrane like structure called myeloid or Zebra bodies. Clinical manifestations of disease are hypohidrosis, acroparesthesias, heat intolerance, angiokeratomas, corneal opacities, cardiac arrhythmias, left ventricular hypertrophy, proteinuria, renal insufficiency and cerebrovascular accidents. Diagnosis of Fabry's need a high clinical suspicion, good physical examination, organ specific tests and is confirmed by demonstrating low enzyme assays in homozygous males and gene typing in heterozygous females. Specific therapy for Fabry's disease is enzyme replacement with recombinant human alpha-galactosidase A. If started early it has a promising role in renal and cardiac disease however beneficial role is not yet defined in CNS involvement.

Hemodialysis patients profile at Dow University of Health Sciences, Karachi. Pakistan.

OBJECTIVES: To determine the frequency of diseases contributing to End Stage Renal Failure (ESRF) and to determine the frequency of seropositivity for hepatitis B and hepatitis C in our patients. METHODS: This is an observational study of two years duration from January 2012 till December 2013, done at Dow university of Health Sciences. Sample size is 189 by convenient method. Data collection is retrospective. Inclusion criteria includes all patients ever hemodialysed at DIMC with age 14 or above. Exclusion criteria is age below 14. Data maintained and analyzed on SPSS version 16. All categorical data in percentages and numeric data is given in frequencies and mean with Standard deviation. RESULT: Total number of patients included in study were 189, Males were 94/189 (49.7%), females were 95/189 (50.3%), Male to female ratio was 0.98: 1.0. Mean age was 51.88+15.2, range was14-86 years. Patients started on Hemodialysis were found to have hypertension in 40.2%, both diabetes and hypertension was present in 42.8%, diabetes alone in 3.1% of patients as likely etiology of renal failure. Seropositivity for HBV was found 4/189(2.1%) and HCV in 31/189(16.4%) at initiation of Hemodialysis. CONCLUSION: Hypertension alone is an important disease found in patients with renal failure as likely cause followed by diabetes. Hepatitis C positivity at start of hemodialysis is 16%.