Bardet-Biedl syndrome (BBS) is a rare cause of renal failure requiring renal replacement therapy. It is an autosomal recessive condition characterized by retinitis pigmentosa, postaxial polydactyly, central obesity, mental retardation, hypogonadism, and renal involvement. We report the first successful renal transplant in a case of BBS from India.
Surgical minilaparotomy technique of Tenckhoff catheter placement is rarely practiced by nephrologists. There is a scarcity of data comparing technique and outcomes of surgically inserted peritoneal dialysis catheters by surgeon and nephrologist. We retrospectively analyzed 105 Tenckhoff catheters inserted by surgical minilaparotomy (”S” [surgeon], n = 43 and “N” [nephrologist], n = 62) in end-stage renal disease. Comparative analysis of surgical technique, survivals, and complications between both groups was done. “N” group observed two major advantages; shorter break-in (P < 001) and early continuous ambulatory peritoneal dialysis rehabilitation. Cumulative catheter experience was 1749 catheter-months: 745 and 1004 catheter-months in “S” and “N” groups, respectively. “N” group had a better overall catheter and patient survival, and a statistically insignificant mechanical complications, seen mostly in obese and post-abdominal surgery patients, without fatality or catheter loss. Peritonitis rates (P = 0.21) and catheter removal due to refractory peritonitis (P = 0.81) were comparable. The technique used is practical and aids early break-in, yields better results, and later on, helps in easy and uncomplicated PDC removal as and when indicated. Mechanical complications, mostly bleeding, were managed conservatively without any catheter or patient loss. This method should be encouraged among nephrologists and nephrology residents.
Continuous ambulatory peritoneal dialysis (CAPD) is a standard renal replacement therapy, but there is a lack of consensus for catheter insertion method and type of catheter used. We retrospectively analyzed 140 peritoneal dialysis catheters (PDC) inserted in 139 CAPD patients by two methods; percutaneous (Group “P,” n = 47) and surgical mini laparotomy (Group “S,” n = 93) technique over a 39-month period, with cumulative experience of 2415 catheter-months: 745 catheter-months for Group “P” and 1670 catheter-months for Group “S.” Break-in period was shorter in Group “P” (P = 0.002) whereas primary nonfunction rate was comparable (P = 0.9). The mean catheter survival was better in Group “S” (17.95 ± 10.96 months vs. 15.85 ± 9.41 months in “P” group, P = 0.05) whereas the death-censored and overall catheter survival was comparable in both groups. PDC removal due to refractory peritonitis was also comparable. Mechanical complications were more in “P” group (P = 0.049), leading to higher catheter removal (P = 0.033). The peritonitis rates were higher in “P” group (1 episode per 24.8 catheter-months vs. 1 episode per 34.8 catheter-months in “S” group, P = 0.026) and related to a higher number of rural patients in the group (P = 0.04). Patient survival was comparable. There was no effect on episodes of peritonitis in those CAPD patients who had diabetic etiology or prior hemodialysis catheter-related sepsis, age, and PDC insertion method.
A 38-year-old male presented after a binge of alcohol with acute onset, rapidly progressive distension of abdomen, hematuria, oligoanuria and dialysis dependent renal failure. Evaluation revealed ascitic fluid with high creatinine and computed tomography cystogram showed contrast leak into the peritoneum. Retrograde cystoscopy confirmed rupture of the bladder. He had prompt diuresis after indwelling Foley's catheter was placed. By 2 weeks, he had recovered renal function completely. A high index of suspicion can make an early diagnosis and avoid unnecessary investigations. The mechanism of spontaneous rupture of bladder after an alcohol binge is discussed.
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