Medical Complications Of Renal Transplant - 2 Years' Experience At Armed Forces Institute Of Urology.

BACKGROUND: Renal transplant is the renal replacement therapy of choice for all patients of chronic kidney disease. The aim of this study was to analyse the trends of medical complications in renal transplant recipients at our centre. METHODS: it is a prospective cross sectional descriptive study. All the patients undergoing renal transplant at Armed Forces Institute of Urology from September 2013 to September 2015 were included in the study. The patients were followed prospectively till March 2016 and a complete data about their complications and lab investigations was maintained.. RESULTS: This study included a total of 63 patients with a mean duration of follow-up of 14.05 months (SD±4.45). Infective complications as a group are the commonest complication occurring in over 50% of cases followed by haematological complications (17.5%), new onset diabetes after transplant (15.9%) and transplant dysfunction (14.3%) Cardiovascular complications were seen in only 4.8% cases but with high mortality. Gingival hypertrophy was seen in 4.8% cases. CONCLUSIONS: Medical complications are common after renal transplant especially in the early post-operative period. The only way forward is early recognition and aggressive treatment, as delays can cost losses in the form of kidney function, life and higher health care cost.

Two-photon LIF on the HIT-SI3 experiment: Absolute density and temperature measurements of deuterium neutrals.

Two-photon laser-induced fluorescence measurements were performed on the helicity injected torus (HIT-SI3) device to determine the density and temperature of the background neutral deuterium population. Measurements were taken in 2 ms long pulsed plasmas after the inductive helicity injectors were turned off. Attempts to measure neutrals during the main phase of the plasma were unsuccessful, likely due to the density of neutrals being below the detection threshold of the diagnostic. An unexpectedly low density of atomic deuterium was measured in the afterglow; roughly 100 times lower than the theoretical prediction of 1017 m-3. The neutral temperatures measured were on the order of 1 eV. Temporally and spatially resolved neutral density and temperature data are presented.

Severe post-dialysis hypokalaemia leading to quadriparesis.

A 36-year-old male developed acute renal failure and severe metabolic acidosis following acute severe gastroenteritis. Two hours following haemodialysis he developed generalized muscle weakness, which progressed to quadriplegia over the next 4 hours. Electrocardiography (ECG) revealed classic signs of hypokalaemia. Serum potassium (K+) levels were 0.98 mmol/L. He was immediately started on intravenous (i/v) and oral potassium supplementation. He gradually improved and his ECG changes also reverted as potassium levels normalized. Postdialysis hypokalaemia can be a serious complication in patients who are already in total body potassium deficit. Dialysis fluid potassium levels should be kept higher in such patients.

Nutritional profile and inflammatory status of stable chronic hemodialysis patients at Nephrology Department, Military Hospital Rawalpindi.

BACKGROUND: Protein-energy malnutrition (PEM) is common in the haemodialysis population. Identification and management of these patients can result in significant reduction in morbidity and mortality. Aim of the study was to find the prevalence of PEM in otherwise stable haemodialysis patients at Military Hospital Rawalpindi at a single point in time with the help of established biochemical and physical markers. MATERIAL AND METHODS: Height, dry weight and body mass index (BMI) were recorded for 64, stable, 14-75 year-old patients who were on haemodialysis for > or = 3 months. Blood samples were drawn (pre-dialysis) for complete blood count, serum C-reactive protein, serum total protein, serum albumin and serum Creatinine. Ideal body weights and BMI were obtained from Pakistan Army Selection and Recruitment standards. RESULTS: Out of 64 patients 43 (67%) were males. Mean age was 44.5 +/- 14.3 yr. Mean haemoglobin was 8.84 +/- 2 g/dl. Fifty-seven patients (89%) had haemoglobin < or = 11 g/dl. Pearson correlation coefficient (r) with albumin was significant (p = 0.01). The mean serum albumin was 34.2 +/- 4.25 g/l. Serum albumin of less than 40 g/l in 58 patients (90.6%). C-Reactive protein was available for 58 (90.6%) of patients. It was positive in 23 (35.9%) and was associated with a lower mean serum albumin (32.7 g/l vs 35.4 g/l) which was statistically significant (p = 0.017). There was no significant relationship between the lymphocyte count and albumin levels. However, the Pearson correlation of albumin with the total WBC count gave ap value of 0.05. Mean BMI was 19.8 +/- 2.9 kg/m2. Thirty-seven (57.8%) patients had BMI in the normal range (18.5-24.6 kg/m2) and 24 (37.5%) were below normal (14.6-18.3 kg/m2). Correlation of albumin with BMI and serum creatinine was not significant (p = 0.46 and 0.53 respectively). CONCLUSION: Serum albumin is a strong marker of malnutrition but needs to be associated with other physical and inflammatory parameters to correctly identify malnourished haemodialysis patients.