BACKGROUND AND OBJECTIVES:The prevalence of non diabetic renal disease (NDRD) among patients with type 2 diabetes mellitus varies widely depending on the selection criteria and the populations being studied. The aim of this study was to evaluate the renal biopsies performed on type 2 diabetic patients for suspicion of NDRD and to correlate the pathological with the clinical and laboratory findings.SUBJECTS AND METHODS:We selected and reviewed biopsies performed on type 2 diabetics for clinically suspected NDRD from January 2006 to December 2008 at a single hospital. Clinical and laboratory data were analyzed in relation to the histopathology findings. Patients were grouped into either group I with isolated DGS or group II with NDRD on top of DGS.RESULTS:Thirty-one biopsies were performed on type 2 diabetic patients; Seventeen patients (54.8%) were males. Mean age was 50.68 (11.29) years. The mean duration of diabetes was 9.33 (3.6) years. Renal biopsy showed that among the studied group 14 patients (45.2%) showed NDRD on top of DGS. Crescentic glomerulonephritis was the commonest finding seen in 3 cases (21.4% of group II cases) followed by acute tubulointerstitial nephritis and hypertensive changes each was seen in 2 cases (14.4%). Other findings included IgA nephropathy, primary focal segmental glomerulosclerosis, rhabdomyolysis, membranoproliferative glomerulonephritis each of them was seen in one case (7.1%). Group I had a significantly higher level of proteinuria 4.97 (2.08) gm/24 hrs urine than group II 2.72 (1.09) gm/24 hrs urine (P=.003). There was no significant difference between the two groups in age, duration of diabetes, gender, presence of hypertension, hematuria, serum creatinine or glomerular filtration rate.CONCLUSION:The present study showed that crescentic glomerulonephritis is the commonest NDRD among diabetic patients. A higher level of proteinuria was reported among those with NDRD superimposed on DGS. So, Renal biopsy should be performed in diabetics when the clinical scenario is atypical.
A case of Acremonium kiliense peritonitis is described. Diagnosis was established by repeated isolation of the fungus from peritoneal dialysate and by its identification on the basis of morphological characteristics and sequencing of internal transcribed spacer (ITS) regions of ribosomal DNA (rDNA). This report and available literature suggest that A. kiliense may have a greater clinical significance than hitherto recognized. CASE REPORTA 75-year-old Jordanian man with a long history of diabetes mellitus and hypertension developed end-stage kidney disease requiring continuous ambulatory peritoneal dialysis (CAPD). His course of CAPD was largely uneventful except for a single episode of bacterial peritonitis, for which he was hospitalized and treated with parenteral antibiotics, with an excellent response. In January 2010, he became febrile, with clinical evidence of peritonitis, and was admitted to the hospital. The peritoneal fluid was turbid, with a white blood cell (WBC) count of 2.1 ϫ 10 9 /liter. On initial microscopic examination, the presence of fungal elements in the peritoneal dialysate was missed. The peritoneal fluid sample was inoculated into aerobic Bactec blood culture bottles, which yielded a growth after 59 h of incubation. The Gram-stained smear from blood culture bottles showed branched hyphal elements. On Sabouraud dextrose agar (SDA; Oxoid Ltd., Basingstoke, England), the specimen yielded slimy colonies with a pinkish appearance ( Fig. 1). Microscopic examination of the primary culture (isolate Kw441-2010) showed hyaline hyphae, with scanty sporulation. A provisional identification of Acremonium/Fusarium species was made, and the growth was subcultured on Sabouraud dextrose agar and oatmeal agar (OMA; oatmeal [30 g], agar [20 g], distilled water [1 liter]) for further identification and antifungal susceptibility testing. Subsequent cultures of the peritoneal fluid yielded the same fungus on three occasions. A serum sample was obtained for the detection of galactomannan (Platelia Aspergillus enzyme immunoassay [EIA] kit; BioRad, Marnes-la-Coquette, France) and (1-3)--D-glucan (Fungitell; Associates of Cape Cod); the latter test was positive (253 pg/ml). An Etest performed on RPMI 1640 medium supplemented with 2% glucose revealed that the isolate was resistant to amphotericin B and caspofungin but susceptible to voriconazole and posaconazole, with MIC values of Ͼ32 g/ml, Ͼ32 g/ml, 0.064 g/ml, and 0.75 g/ml, respectively. The patient was started on voriconazole, with a loading dose of 400 mg, followed by a maintenance dose of 200 mg, given every 12 h via the oral route. Although the patient showed clinical improvement after 2 weeks of voriconazole therapy, the peritoneal dialysate remained turbid (WBC counts, 2.0 ϫ 10 9 / liter). Abdominal ultrasound examination did not reveal any evidence of intraperitoneal adhesions or organ invasion. Since the response to treatment was not adequate, the Tenckhoff catheter was removed and the patient was temporarily switched to hemodialysis. After 1 week of a...
BACKGROUND:Little is known about the nature and the course of IgA nephropathy (IgAN) in Arab countries. The aim of this work was to study the spectrum of clinical presentation and histopathological findings at our institution.DESIGN AND SETTING:Retrospective review, all renal biopsies at the Mubarak Al Kabeer Hospital between January 2000 and December 2004.METHODS:Cases of IgA nephropathy were selected, and their medical records and biopsy findings were reviewed.RESULTS:Eighty patients (9.2% of all native kidney biopsies) were diagnosed to have IgAN nephropathy. Sixty-nine biopsies were included in the study;11 were excluded. Forty-three (62.3%) patients were male and 26 (37.7) patients were female. Fifty (72.5%) patients were below the age of 40 years. Mean (SD) duration of follow-up was 3.6 (1.3) years. The first presentation included nephritic-range proteinuria (49.3%) and renal impairment (50.7%). During the follow-up period, 56 (81.2%) patients were stable or improved. Hass classification of biopsies showed 36.2% had class I, 27.5% had class II, 13.0% had class III, 5.8% had class IV, and 17.4% had class V IgAN. Females had milder forms of the disease than males. Macroscopic hematuria and renal impairment at presentation were seen more in patients with class IV and V IgAN. The presenting serum creatinine and uric acid values were higher in those with Hass classes III to V. Deterioration of renal function during the follow-up period was more significant in the presence of hypertension, renal impairment, or macroscopic hematuria at the time of biopsy .CONCLUSION:The prevalence of IgAN in Kuwait is about 9.2%. Renal impairment or macroscopic hematuria at presentation was seen in patients with more aggressive renal lesions and contributed to poor outcome.
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Introduction: Severe preoperative renal impairment (RI) is often included in score systems used to predict outcome after open cardiac surgery. The purpose of this study was to investigate the impact of mild preoperative RI on the early postoperative mortality after open heart surgery. Methods: We retrospectively collected data of all patients who underwent open cardiac surgery in Kuwait Chest Disease Hospital from January 2005 to June 2006. Multiple baseline and perioperative variables, including the presence of mild preoperative RI, were scrutinized for potential association with early post operative mortality. Results: The study included 500 subjects, 47 of whom had mild preoperative RI, defined by an estimated glomerular filtration rate (eGFR) between 89-60 ml/ min. The overall 30 days mortality was 6.8%. Mortality was 40.8% in patients who had mild preoperative RI, 28.7% in patients who developed acute postoperative deterioration in renal function and 33.3% in patients who required dialysis postoperatively. Binary logistic regression analysis showed that the development of postoperative multi-organ failure (MOF), female gender and mild preoperative RI were the only independent variables predicting early post operative mortality after cardiac surgeries. Conclusion: A number of studies have identified moderate to severe RI as a predictor of mortality and morbidity after open heart surgery. RI is often associated with other comorbidities which are likely to have a negative impact on morbidity and mortality after open heart surgery. However, in this study mild preoperative RI remained a strong predictor of early mortality even after adjustment for several confounders.
patient can be given a 89 per cent chance of ultimately achieving satisfactory function.What then is the current place of the pull-through operation? We believe that it is an acceptable alternative to abdominoperineal excision of the rectum for carcinomas sited 7-10 cm. from the anal verge. I t is also an occasional alternative to anterior resection for turnours at a higher level. On the criteria used in this review, the operation cannot be recommended when excision is palliative and the anticipated survival time is short. SUMMARYA localized type of colitis cystica profunda is described. Its clinical presentation, pathology, and treatment together with a short review of the literature are considered.
Introduction: Granulomatous interstitial nephritis (GIN) is a rare histological diagnosis that can be the first manifestation of systemic disease. It has been associated with medications, infections, sarcoidosis, crystal deposits, paraproteinemia and Wegnere's granulomatosis. It can also be seen in an idiopathic form. Case report: A 37 year-old female patient presented to our nephrology service with lethargy and weight loss of three months duration. Her past medical history and clinical examination were not remarkable. She had impaired renal function tests and hypercalcemia associated with elevated angiotensin converting enzyme levels and sonographically normal kidneys. Extensive investigations revealed no other organ involvement and no evidence of infection or malignancy. Renal biopsy showed extensive interstitial non-necrotizing granulomata. Accordingly, she was diagnosed as a case of isolated renal sarcoidosis and started on steroid therapy. Within one month of treatment, she recovered normal renal function. Steroids were successfully tapered after another six months, and she shows no evidence of recurrence 24 months after steroid withdrawal. Conclusion: The possibility of isolated renal sarcoidosis should be considered in any case of impaired kidney function and hypercalcemia even in the absence of systemic manifestation. The finding of non-caseating interstitial granulomata in renal biopsy supports this diagnosis.
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