Objective: The incidence of stroke is greater in patients with end-stage renal disease (ESRD) as compared to the general population. It is thought that there may be a few extra risk factors in ESRD patients suffering from stroke as compared to ESRD patients without stroke. This study aims to better understand the risk factors for stroke that are unique to patients with ESRD. Methods: In order to find out the different causative factors influencing the production of ischemic stroke (IS) in patients with ESRD, we carried out this retrospective study at the DHQ hospital in Faisalabad. In this study total of sixty patients were recruited and further divided into two groups. The first group consisted of 30 patients with ESRD with a history of ischemic stroke, while 30 patients with stroke-free dialysis were selected as the age and gender control group. Patients with and without ischemic stroke were compared in terms of demographic characteristics, stroke risk factors, and lab results. Results: Patients with acute ischemic stroke had an average age of 56.70 ± 8.87 years with 52% male whereas the non-ischemic stroke group had an average age of 58.9 ± 9.20 years. Small vascular obstruction was found to be the most common subtype of IS (42%), followed by atherosclerosis of large vessels (28%). Compared with patients who did not have a stroke, patients who had a stroke had significantly higher rates of hypertension (HTN), higher systolic (SBP) and diastolic blood pressure (DBP) at admission. The group with a stroke had significantly lower total cholesterol and LDL cholesterol. Lower levels of low-density lipoprotein (LDL) and higher systolic blood pressure were found to be the independent risk factor for an ischemic stroke in a multivariate analysis (OR=1.025, 95% CI p=0.045 and OR=1.458, 95% CI, P=0.03 respectively). Conclusion: According to the findings of our study, ESRD patients with hypertension and diabetes have a higher chance of ischemic stroke and the lower LDL levels and higher systolic blood pressure were the independent predictors of ischemic stroke. Keywords: Hemodialysis, Ischemic stroke, risk factors, Hypertension, end stage renal disease,
Background: To find out the causes of Acute Kidney Injury (AKI) in population.Methods: A total of 150 patients were enrolled from medical, surgical, gynecology and obstetrics units of Allied Hospital and Madinah Teaching Hospital, Faisalabad, Pakistan. History, physical examination and investigations were recorded on specially designed proforma. Patients were evaluated to find out the etiologies of AKI. All patients were subjected to urine analysis, complete blood count, blood biochemistry (urea, creatinine, electrolytes, uric acid, calcium and phosphorus) and ultrasound scan of the abdomen and pelvis. Renal biopsy, immunological assays, such as hepatitis B surface antigen, anti-hepatitis C virus antibody, complements level, antinuclear antibody, anti-double-stranded DNA, anti-neutrophil cytoplasmic antibody and anti-glomerular basement membrane antibody were performed in selected cases.Results: Male (36%) and female (64%). Pre-renal AKI was most common and was reported in 80 patients (53.33%). Intrinsic Renal azotemia in 56 patients (37.33%). Post renal azotemia in 14 patients (9.33%). Among 80 patients of prerenal AKI, hemorrhage in 45(56.25%), gastroenteritis in 16(20%), sepsis in 8(10%), cardiac diseases in 4(5%), hepatorenal syndrome in 3 (3.75%), peritonitis in 2 (2.50%) and burns in 2(2.50%) were the main causes of Pre-renal AKI. Among 56 patients of intrinsic renal AKI, 40(71.4%) had acute tubular necrosis (ATN), 12(21.4%) with multifactorial causes and 4(7.14%) were found to have glomerulonephritis. Among 14 patients of post renal AKI, 6(42.9%) were having calculi, 6(42.9%) were to have enlarged prostate and 2(4.3%) were having stricture urethra. In this study, contribution of obstetrical, medical and surgical etiologies were recorded as 40%, 36% and 20% respectively.Conclusions: In contrast to study reported from neighbouring country, this study shows rather increase in pregnancy related AKI.
Background: Screening studies for hepatitis C have proved that it is more prevalent in patients with renal diseases. Chronic hepatitis C infection in patients with kidney disease not only accelerates renal deterioration but also adversely effects morbidity and mortality. Availability of direct acting antiviral drugs has revolutionized treatment of hepatitis C even in difficult patients. In advanced kidney diseases, selection of treatment is difficult. Aim of this study was to evaluate the efficacy and safety of Sofosbuvir based DAAs in patients with advanced CKD.Methods: In this Quasi experimental study, CHC patients with or without cirrhosis having advance CKD (eGFR <30 ml/min per 1.73 m2) and/or on dialysis were enrolled. End points of the study were documentation of SVR 12 or discontinuation of therapy. Different regimens of oral DAAs with or without Ribavirin were used.Results: 86 patients with a median age of 53 years were enrolled. 37 patients were on maintenance dialysis and 49 were not on dialysis with eGFR <30 ml/min per 1.73 m2. Virological response was 92.68% at the end of treatment and SVR was achieved by 90.2% twelve weeks after therapy. Insomnia 14%, headache 11% and anemia 7% were main dverse effects. Mean eGFR and creatinine before and after treatment remained the same. Only 2 patients relapsed, both were on dialysis thrice weekly.Conclusions: All Sofosbuvir based regimens used for the treatment of CHC in patients with end stage renal disease are effective and well tolerated. Close follow up is advised to monitor side effects.
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