| Nephrology |
1. To Study The Effect of N-Acetyl Cysteine on Radio Contrast Induced Reduction in Renal Functions on Patients Undergoing Intravenous Pyelography HK Aggarwal, D Jain, M Lather, SK Singh, N Nand The present study was conducted on forty adult patients with pre-renal insufficiency requiring intravenous pyelography. Patients were randomized into two groups (A and B) of 20 patients each. All patients received non ionic low osmolar contrast ‘iopromide’. Group A patients were given n-acetyl cysteine 600 mg every 12 hourly, a day before and on the day of radiocontrast administration plus hydration with normal saline at a rate of 1 mg/kg/hr for 12 hour before and 6 hour after exposure and group B patients were given only hydration with normal saline. Serum creatinine and creatinine clearance were studied at 24 hour, 48 hour and 5th day after contrast administration. Seven out of forty patients (17.5%) had more than 0.5 mg% or 25% increase of serum creatinine from basal value within or at 48 hour after radiocontrast administration (2 out of 20 patients in nacetyl cysteine group and 5 out of 20 patients in control group). None of the patients required dialytic therapy. There was a statistically significant rise of Serum creatinine (2.31 ± 0.68 to 2.40 ± 0.84 and 2.31 ± 0.68 to 2.40 ± 0.85) and decrease in creatinine clearance (36.32 ± 18.45 to 36.14 ± 19.16 and 36.32 ± 18.45 to 35.64 ± 18.85) at 24 hour and 48 hour respectively after contrast administration in group B (p < 0.01), while in group A the rise of Serum creatinine and fall in GFR were statistically insignificant (p > 0.05). On 5th day both these value were comparable with basal values in group A and group B (p > 0.05). None of the patient developed any side effects due to nacetyl cysteine. It can be concluded that prophylactic oral administration of antioxidant n-acetyl cysteine along with hydration prevents the reduction in renal function induced by contrast administration in patients with pre-renal insufficiency. 2. Inflammatory Markers in End Stage Renal Disease N Kumar, T Wadhwa, W Baig, R Prabhu Introduction : Circulating levels of cytokines and other inflammatory markers are markedly elevated in patients with chronic renal failure. This could be caused by increased generation, decreased removal or both. However it is not well established to what extent renal function per se contributes to uraemic proinflammatory milieu. The aim of the present study is to analyse the relationship between inflammation and glomerular filtration rate. Methods : circulating levels of hs-c reactive protein, albumin and erythrocyte sedimentation rate were measured in 50 patients. Patients were divided into two groups subsequently according to Glomerular filtration rate (>/< 10 ml/min.) Results : It has been found that hs-c reactive protein (Rho: - 0.16; p < 0.05) and erythrocyte sedimentation rate (rho: -0.18; p< 0.05) were significantly greater in subgroup with low Glomerular filtration rate and significant negative correlation was noted. Conclusion : These results show that a low Glomerular filtration rate per se is associated with an inflammatory state, suggesting impaired renal elimination of proinflammatory cytokines, increased generation of cytokines in uraemia or an adverse effect of inflammation on renal function. 3. Clinical Profile of Acute Renal Failure in Intensive Care Unit Kori S Prakash, R Prabhu, Waqas Baig, S Shetty Aims and Objectives : To analyse the clinical spectrum of acute renal failure in various intensive cars units in terms of etiology, risks and prognosis and final outcome. Methods : This prospective study is being conducted from Jan 2007 to Jan 2008 in Kasturba Hospital, Manipal involving patients admitted under various intensive care units having acute renal failure. Those patients having chronic renal failure will be excluded. Clinic features and lab data will be collected and analysed from the day of admission till the time of discharge from ICUs. Results : Till now 50 patients have been studied and analysed Mean age of the patients is 45 yrs. Comorbidity is seen in 56% of the patients. Etiology of acute renal failure is multifactorial and sepsis (58%) is most common and hypotension (42%) volume depletion (45%) multiple organ involvement present in 65% of the patients. Mortality was present in 60% of the patients and study is being conducted further and final results will be presented at the time of conference. Conclusion : Acute renal failure is seen in 30% of the patient in ICUs. Presence of sepsis and other organ involvement is associated with high mortality. 4. Immunosuppression – Gains and Pains SJ Adkar, VA Borse, MM John 58 year old renal allograft recipient male patient, who also had chronic Hepatitis B virus infection and was on triple immunosuppression (steroid, mycophenolate mofetil and everolimus) and antiviral therapy, was admitted with right lower limb cellulites and fever of one day duration. He had mild allograft dysfunction at admission. The cellulitis subsided with treatment within few days, but fever continued for 15 days. The initial etiological work-up did not yield anything. Hence a system specific evaluation was done which revealed positivity for HBeAg and quantitative and HBV DNA. Antiviral therapy was continued. An OGD scopy done as a part of the evaluation showed a large ulcer in the antrum of the stomach. Biopsy from the ulcer base confirmed tuberculous granuloma. ATT with 4 drugs (INH, Pyrazinamide, Ethambutol and Ofloxacin) was gradually introduced. The patient responded immediately and became afebrile. The allograft dysfunction also partially improved. Gastric tuberculosis is a rare condition. The reported incidence is 0.02-0.5% of cases of pulmonary tuberculosis. The rarity of gastric involvement is due to the bactericidal property of gastric acid and paucity of lymphoid follicles in the stomach. The lesion is located in the pyloric antrum in 80% of cases. 5. Bartter’s Syndrome RH Mayle, YA Gokhale, V Patil, V Billa Bartter’s is a rare inherited defect in the renal tubules, which causes low potassium levels and metabolic alkalosis. We here present one such case of hypokalemia which tuned out to be bartter’s syndrome. 15 yr old female presented with myalgia and weakness in both upper and lower limbs since 2 days. 3 hours prior to admission she developed severe breathlessness. On admission she was afebrile. HR-104/min, BP-110/70 mmHg, RR-28/min. Patient was conscious, had hypotonia in all 4 limbs. Power was bilaterally 3/5 at should joint and 4/5 at elbow and wrist joints. Lower limbs had power of 3/5 at hip and knee joints and 4/5 at ankle joint bilaterally. All deep tendon reflexes were depressed. Her serum potassium was 1.9 meq/lit and ABG showed metabolic alkalosi. She was treated with IV potassium as well as oral supplements. Patient improved clinically but serum potassium was persistently low. Urinary electrolytes were asked for and TTKG was calculated. TTKG was 12 (N 2-6). Her 24 hrs urinary calcium was 106.6 mg/day. This when compared to her low serum calcium of 8.0 mg/dl and low calcium diet was significantly high. Her 24 hrs urinary magnesium (7.4 mg/day) was within normal limits. High 24 hrs urinary calcium with metabolic acidosis in a case of hypokalemia helped up cinch the diagnosis of bartter’s syndrome. Patient was treated with NSAIDS (C. indocid) and she responded very well. Timely correction of electrolyte imbalance can save valuable lives in such cases. |