Acute kidney injury (AKI) is one of the most dreaded complications of severe malaria. We carried out prospective study in 2010, to describe clinical characteristics, laboratory parameters, prognostic factors, and outcome in 59 (44 males, 15 females) smear-positive malaria patients with AKI. The severity of illness was assessed using Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) score, Multiple Organ Dysfunction Score (MODS), and Glasgow Coma Scale (GCS) scores. All patients received artesunate and hemodialysis (HD). Mean age of patients was 33.63 ± 14 years. Plasmodium falciparum malaria was seen in 76.3% (n = 45), Plasmodium vivax in 16.9% (n = 10), and mixed infection in 6.8% (n = 4) patients. Presenting clinical features were fever (100%), nausea-vomiting (85%), oliguria (61%), abdominal pain/tenderness (50.8%), and jaundice (74.5%). Mean APACHE II, SOFA, MODS, and GCS scores were 18.1 ± 3, 10.16 ± 3.09, 9.71 ± 2.69, and 14.15 ± 1.67, respectively, all were higher among patients who died than among those who survived. APACHE II ≥20, SOFA and MODS scores ≥12 were associated with higher mortality (P < 0.05). 34% patients received blood component transfusion and exchange transfusion was done in 15%. Mean number of HD sessions required was 4.59 ± 3.03. Renal biopsies were performed in five patients (three with patchy cortical necrosis and two with acute tubular necrosis). 81.3% of patients had complete renal recovery and 11.8% succumbed to malaria. Prompt diagnosis, timely HD, and supportive therapy were associated with improved survival and recovery of kidney functions in malarial with AKI. Mortality was associated with higher APACHE II, SOFA, MODS, GCS scores, requirement of inotrope, and ventilator support.

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We report a case of diabetic end-stage renal disease patient who presented with a right common carotid artery jugular arteriovenous fistula as a complication of the insertion of a polyurethane double-lumen hemodialysis catheter into the right internal jugular vein .On physical examination of the neck, a pulsating mass with a palpable thrill and a bruit was noted in the right subclavicular region. The diagnosis was confirmed by color doppler ultrasonography of the neck and carotid angiography. The review of the literature suggests the occurrence of this complication as rather rare. The fistula was successfully repaired surgically. It is emphasized that while securing the access, a thorough physical examination with a special emphasis on seeking any neck swellings, thrill, and bruit along with routine use of vascular doppler for securing dialysis access is recommended.

DDRTx in patients with DN has acceptable graft function and patient/graft survival over 10-year follow-up in our center and, therefore, we believe it should be encouraged.

RTx is best treatment for children with ESRD. Data scarcity on DDRTx outcome in children prompted us to review our experience. This study was undertaken to evaluate patient/graft survival, function vis-a-vis SCr, rejection episodes, and mortality in DDRTx performed in 37 children between 1998 and 2011. The most common recipient diseases leading to ESRD were congenital anomalies of kidney and urinary tract (48.6%) and chronic glomerulonephritis (18.9%). Mean recipient age was 13.8 ± 3.1 yr; 67.5% (n = 25) were men. Mean donor age was 38.8 ± 18.6 yr; 48.5% (n = 18) were men. Mean dialysis duration pre-transplantation was 15.5 ± 3.5 months. All recipients received r-ATG, and triple immunosuppression. Over a mean follow-up of 3.93 ± 3.5 yr, patient and graft survival rates were 72.9% (n = 27) and 83.7% (n = 31), respectively, with a mean SCr of 1.1 mg/dL; 21.6% (n = 8) of patients had acute rejection episodes; 24.3% (n = 9) of patients had DGF. A total of 27% (n = 10) patients died, mainly owing to infections (n = 6) and cardiovascular disease (n = 3). DDRTx is a viable option for children and achieves acceptable graft function with patient/graft survival over long-term follow-up, encouraging use of this approach.

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Introduction: Patients on Maintenance Hemodialysis (HD) are at high risk of viral hepatitis due to blood transfusion, prolonged vascular access, exposure to infected patients and contaminated equipments etc. Knowledge of the prevalence of such infections is very important to access magnitude of the problem because these infections play important role in the morbidity and mortality of hemodialysis (HD) patients. Aim and Objectives: This study was done to determine the prevalence of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections in patients on hemodialysis at our tertiary care hospital of Western Maharashtra. Materials and Methods: Settings and Design: Hospital based cross sectional study was conducted for six months in HD unit at our tertiary care hospital. All patients (n=135) were screened for Hepatitis B surface antigen and antibodies to HCV (anti-HCV). Prevalence, age and sex wise distribution as well as risk factors for transmission of these infections were observed. Results: Total 135 HD patients were screened for presence of HBV and HCV infections. Of these, 39 (28.9%), 20 (14.8%), 6 (4.4%) were found to be having HCV, HBV and Dual HBV and HCV infection respectively. Conclusions: HCV was the most prevalent among HD patients than HBV. History of multiple blood transfusions, HD outside center or longer duration of HD were all important risk factor noted for high prevalence of sero-positivity for HBV and/or HCV. Strict adherence to universal precautions careful attention to hygiene and strict sterilization of dialysis machines are important to prevent further transmission of these viruses.

The assessment of renal vascular pathology requires invasive procedures. The retinal vasculature, conversely, can be observed noninvasively and therefore offers a unique opportunity to explore the association between systemic microvascular diseases and renal function.Aims: The study aims to highlight the importance of ocular screening in patients with chronic renal failure (CRF) on haemodialysis by analysing the fundus changes in these patients. Settings and design: This was a prospective observational study. Materials and Methods: 94 patients with CRF on haemodialysis were evaluated over a period of 6 months. Ocular examination included visual acuity, intraocular pressure measurement, slit lamp examination and fundus examination with indirect ophthalmoscope. Results: 60.64% of 188 eyes had visual acuity < 6/18. The most common causes of visual impairment were maculopathy in 68 eyes. The fundus findings included Hypertensive Retinopathy (HR) which was seen in 32 patients, followed by Diabetic Retinopathy (DR) in 22 patients, mixed retinopathy in 12 patients, Age-related macular degeneration (ARMD) in 9 patients, Retinal Detachment in 2 patients, glaucomatous optic atrophy in 1 patient and Vein Occlusion in 2 patient. Conclusion:The study highlights the importance of detailed ophthalmic examination in patients with CRF on haemodialysis. These patients should be followed up regularly in order to prevent further deterioration of retinal changes and visual loss. Since retinopathy is asymptomatic in its early stages, patients must be made aware of the ocular morbidity associated with CRF.