Peritoneal Dialysis-Related Peritonitis Caused by Lysinibacillus sphaericus.

Peritonitis is the major complication of peritoneal dialysis (PD) patients. Staphylococcus is the leading causative organism of PD-related peritonitis. However, there were more reports of unusual organisms causing peritonitis. Clinical features, management, and outcome of peritonitis from unusual organisms are important information. We reported herein a 72-year-old female patient who presented with fever, abdominal pain, and cloudy dialysate for 3 days. Upon admission, ceftazidime and vancomycin were given intraperitoneally. A preliminary report of blood and PD fluid culture showed the presence of Gram-positive bacilli. Her clinical status improved 48 hours after the commencement of the antibiotics. Subsequently, culture reports of blood and PD fluid showed Lysinibacillus sphaericus which was susceptible to vancomycin at a minimal inhibitory concentration of less than 0.25 µg/mL. The patient was given intraperitoneal vancomycin for a total of 14 days. Then, the PD effluent was clear, and its cell count was below 100 cells/mm3 in 3 days. The patient did not have a recurrence of peritonitis after antibiotic discontinuation. The possibility of this organism infection is environmental contamination related to the patient's gardening activities.

Effectiveness of integrated care on delaying chronic kidney disease progression in rural communities of Thailand (ESCORT study): rationale and design of the study [NCT01978951].

BACKGROUND: In developing countries, accessibility to specialists, and physician to patient contact time is limited. In Thailand, A unique community health service is provided by subdistrict health care officers and Village Health Volunteers (VHVs). If the personnel were trained on proper chronic kidney disease (CKD) care, CKD progression would be delayed. METHODS/DESIGN: We conducted a community-based, cluster randomized controlled trial at Kamphaeng Phet Province, located about 400 kilometers north of Bangkok. Two out of eleven districts of the province were randomly selected. Approximatly 500 stage 3-4 CKD patients from 2 districts were enrolled. Patients in both groups will be treated with standard guidelines. The patients in intervention group were provided the additional treatments by multidisciplinary team in conjunction with community CKD care network (subdistrict health care officers and VHVs) which will provide group counseling during each hospital visit and quarterly home visits to monitor dietary protein and sodium intake, blood pressure measurement and drug compliance. Duration of the study is 2 years. The primary outcome is the difference of rate of eGFR decline. The secondary outcomes are laboratory parameters and incidence of clinical endpoints such as mortality rate and cardiovascular events, end-stage renal disease (ESRD), etc. DISCUSSION: Insights of this study may set forth a new standard of community-based CKD care. TRIAL REGISTRATION: NCT01978951.

Role of meditation in reducing sympathetic hyperactivity and improving quality of life in lupus nephritis patients with chronic kidney disease.

BACKGROUND: Lupus nephritis is an important leading cause of chronic kidney disease (CKD) among the young population in Thailand. Systemic lupus erythematosus (SLE) is often characterized by the presence of sympathetic hyperactivity, which results in a perishing outcome. Some physiological studies reveal that meditation may reduce this autonomic dysfunction. The authors hypothesized that meditation could be beneficial in alleviating the sympathetic hyperactivity and improving quality of life in lupus nephritis patients with CKD. MATERIAL AND METHOD: The authors performed a prospective pilot study, which enrolled lupus nephritis patients and categorized enrollees into meditation group and control group. Method of meditation was instructed by an expert in Buddhist studies for a duration of 60 minutes every month. Participants in the intervention group were advised to meditate every day for 24 weeks. To evaluate change in sympathetic activity, normetanephrine level was measured at beginning and the end of study and compared between both groups. Quality of life was determined by SF-36. Heart rate variability was also assessed in meditation group. RESULTS: Thirty eligible patients were recruited into the study. Fifteen patients were stratified in the meditation group and 15 patients in the control group. After meditation for 6 months, serum normetanephrine level decreased, but without statistical significance (0.105 vs. 0.059, p = 0.28). The reduction in normetanephrine level was also observed in the control group (p = 0.11). In the aspect of quality of life, scores of physical and mental components improved significantly. In meditation group, physical component score increased from 21.4 (5.0-50.2) to 62.2 (51.8-88.4) points (p < 0.01) and mental score increased from 16.9 (4.4-46.0) to 72.4 (45.1-81.6) points (p < 0.01). Quality of life score in the meditation group significantly increased more than in control group (p < 0.01). The parameter of heart rate variability in time and frequency domain also improved in the meditation group. CONCLUSION: In lupus nephritis patients with CKD, meditation shows a trend of benefits in reducing sympathetic overactivity and improving quality of life. Our results support the important role of meditation as a valuable adjunctive treatment of lupus nephritis with CKD.

Prevalence and factors associated with microalbuminuria and abnormal renal function in Thai obese adults.

OBJECTIVE: To determine the prevalence and factors associated with microalbuminuria and abnormal renal function in Thai obese adults. MATERIAL AND METHOD: A cross-sectional study data was collected from 86 patients during October 2010 to February 2011 at the obesity clinic and outpatient department of Siriraj Hospital. Obese patients with body mass index > or = 25 kg/m2 participated in the present study. Exclusion criteria were the patients who refused participation or patients with end stage renal disease who were under treatment with hemodialysis or continuous ambulatory peritoneal dialysis. A questionnaire was used for collecting information on demographic data, e.g., age, sex, residence, educational level, underlying diseases and drugs use, family history of obesity, family history of renal disease, smoking, or alcohol drinking; height, weight, body mass index, waist circumference, blood pressure, blood chemistry test and urine analysis were collected. The abnormal function of the kidney was assessed by presence of microalbuminuria or estimated glomerular filtration rate below 90 mL/min/1.73 m2. RESULTS: The prevalence of microalbuminuria in obese patients was 28% and prevalence of chronic kidney disease stage 2 or more was 22%. Factors associated with microalbuminuria were FBS > or = 126 mg/dL (OR = 6.2, 95% CI: 1.7-22.1), hyperuricemia (serum uric acid > or = > 7 mg/dL) (OR = 3.2, 95% CI: 1.0-9.8). Factors associated with chronic kidney disease stage 2 or more were age > or = 55 years (OR = 7.8, 95% CI: 2.5-24.1), Angiotensin II receptor blocker (ARB) use (OR = 4.1, 95% CI: 1.3-12.3) and hyperuricemia (serum uric acid > or = 7 mg/dL)(OR = 4.5, 95% CI: 1.5-13.5). CONCLUSION: Early identification of obesity and metabolic syndrome and modifying pattern of life style behavior in obese adults carrying risk factors might be beneficial in preventing and delaying the progression of chronic kidney disease in Thailand.

Late onset lupus nephritis: analysis of clinical manifestations and renal pathological features in Siriraj Hospital.

BACKGROUND: Lupus nephritis (LN) is uncommon after the age of 50 years and studies of elderly patients with LN are rare. The authors conducted the current study to determine the clinical manifestations, pathological features and prognosis of 30 Thai patients with late onset LN in Siriraj hospital in Bangkok from 1989 to 2006. MATERIAL AND METHOD: Thirty LN patients with a disease onset beyond the age of 50 years from 1989 to 2006 were enrolled in this retrospective study. All of them received renal biopsy. The histological classifications were categorized according to 2003 International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification. RESULTS: Clinical and pathologic records were collected from 30 patients (23 female and 7 men) who were followed-up for a mean period of 25.8 months (range, 6 to 96 months). The mean age was 56.6 +/- 4 years. Hypertension was diagnosed in 66.7% of patients and 41.3% had serum creatinine greater than 1.5 mg/dL. Nephrotic-range proteinuria was found in 63.3% of patients and creatinine clearance less than 50 ml/min was found in 70%. Of the 30 patients, the most common renal histologic finding was diffuse proliferative glomerulonephritis (63.30%). The overall probability of patient survival was 94.1% at 12 months, 68.6% at 36 months and 34.3% at 60 months. During the follow-up period (25.8 months; range, 6 to 96 months), 4 patients died. Infection was the leading cause of death (75%). CONCLUSION: Lupus nephritis in the elderly patients is not uncommon. Prompt diagnosis should be made for appropriate management and optimal outcome.

Nephrotic syndrome in elderly patients: three years experience at Siriraj Hospital.

BACKGROUND: The population age is being high and nephotic syndrome is a common renal disease. OBJECTIVE: To find the etiology and clinical manifestations of nephrotic syndrome in the elderly patients who underwent renal biopsy at Siriraj hospital including management and outcome. MATERIAL AND METHOD: Retrospective study in 76 nephrotic patients whose age > or =50 years and underwent renal biopsy between 2005-2007. RESULTS: Seventy six nephrotic patients with age ranged from 50-84 years were analysed. Primary glomerulonephritis diseases were found more than secondary causes (5:2). The two most common glomerulonephritis were membranous GN and focal/segmental glomerulosclerosis. The etiology of common secondary GN was lupus nephtitis 11.84% following by diabetic nephropathy and amyloidosis. The patients received immunosuppressive drugs and complete response was found in 51%, partial response 10.2%, no response was 2% and no immunosuppressive therapy 36.7%. There was 1 patient died of septicaemia. CONCLUSION: Nephrotic syndrome in the elderly patients were not uncommon. The causes should be identified for prompt management and excellent outcome.

Acute kidney injury in primary nephrotic syndrome: report of nine cases in Siriraj Hospital.

Acute kidney injury is a rare but important complication of nephrotic syndrome. We demonstrated here nine patients with nephrotic syndrome and oliguric renal failure in Siriraj Hospital during 2007-2009. Renal biopsy was done in every patient. The results were focal and segmental glomerulosclerosis (FSGS) in three patients, minimal change disease in four patients and collapsing focal segmental glomerulosclerosis in two patients. Seven patients had dramatic response to corticosteroid treatment within a few weeks and had rapid recovery of renal function. The exact mechanism of idiopathic renal failure is not well understood but it might be related to reduction in ultrafiltration coefficient of the glomeruli.

Biosimilar recombinant human erythropoietin induces the production of neutralizing antibodies.

Recombinant human erythropoietin (r-HuEpo) has been used for the treatment of renal anemia. With the loss of its patent protection, there has been an upsurge of more affordable biosimilar agents, increasing patient access to treatment for these conditions. The complexity of the manufacturing process for these recombinant proteins, however, can result in altered properties that may significantly affect patient safety. As it is not known whether various r-HuEpo products can be safely interchanged, we studied 30 patients with chronic kidney disease treated by subcutaneous injection with biosimilar r-HuEpo and who developed a sudden loss of efficacy. Sera from 23 of these patients were positive for r-HuEpo-neutralizing antibodies, and their bone marrow biopsies indicated pure red-cell aplasia, indicating the loss of erythroblasts. Sera and bone marrow biopsies from the remaining seven patients were negative for anti-r-HuEpo antibodies and red-cell aplasia, respectively. The cause for r-HuEpo hyporesponsiveness was occult gastrointestinal bleeding. Thus, subcutaneous injection of biosimilar r-HuEpo can cause adverse immunological effects. A large, long-term, pharmacovigilance study is necessary to monitor and ensure patient safety for these agents.