BackgroundAlthough there is a large volume of literature regarding the definition and epidemiology of.Type 2 diabetes nephropathy (T2DN). There has been a paucity of data focused on the rate of transition of T2 DN. Based on our personal observation a certain percentage of our incident end stage renal disease (ESRD) patients from T2DN experienced a rapid decline of renal function. Their rapid decline nature of glomerular filtration rate (GFR) of 46 to 60 mL/min per 1.73m2 per year have far exceeded the KDIGO definitions of acute kidney injury (abrupt decrease in kidney function occurring over 7 days or less), acute kidney disease (acute or subacute damage and/or loss of kidney function for a duration of between 7 and 90 days after exposure to an acute kidney injury initiating event (Chawla et al Nat Rev Nephrol 241–57 2017) or even rapid decliner (eGFR declines > 5 mL/min per 1.73m2 per year) (Chawla et al Nat Rev Nephrol 241–57 2017; Andrassy Kidney Int 622–623 2013).Case presentationWe describe here three cases of type 2 diabetic patients that have rapid renal deterioration with rate of decline 46 - 60 mL/min per 1.73m2 per year. All the patients are heavily nephrotic. All of the renal biopsies done showed the classical diabetic changes, hypertensive changes, diffuse tubulointerstitial damage, and interstitial nephritis. All of the patients admitted to taking various form of traditional medications in hope of curing their renal disease.ConclusionWe wish to highlight that type 2 diabetics with massive nephrotic range proteinuria have enhanced risk of rapid renal function deterioration. The patients should be educated about the risks of rapid renal function deterioration when there is presence of heavy proteinuria. High grade proteinuria is likely to inflict the diffuse tubulointerstitial inflammation. The interstitial nephritis could be further worsened by traditional supplements consumption. Timely health education and advice must be undertaken to retard this unwanted rapid renal disease progression.
Introduction: Leptospirosis, a zoonosis cause by Leptospira, is endemic in the tropics and is a relatively important cause of acute kidney injury (AKI) in this region. Mortality has been reported to be as high as 15-18% in those with AKI in the 1990's but there is lack of data on renal and patient outcome in this current age with the improvement of diagnostic techniques [microscopic agglutination test (MAT) is currently the gold standard], renal support and medical care. Objective: To study the incidence and outcome of acute kidney injury in patients with leptospirosis Methodology: This retrospective study was performed on all patients admitted from 1 st January 2015 to 31 st December 2016. Patients with confirmed leptospirosis (ie positive for both IgM antibodies and MAT) were identified from the Hospital Laboratory Information System (LIS). Patients' demography, relevant clinical data, laboratory results, renal outcome and patient outcome were retrieved from hospital's electronic medical record. Subjects with incomplete data were excluded. Results were analysed using SPSS version 23. Results: Of a total of 125,243 admissions, 35 patients were admitted with confirmed leptospirosis. Twenty-three patients (65.7%) developed AKI. The mean age of those with AKI was 35.7 AE 19.2 years and 21 (92.3%) were male. Thirteen (56.5%) were Malay while Chinese, Indians and others accounted 5 (21.7%), 4 (17.4%) and 1 (4.3%) respectively. Only 14 (60.9%) received renal consults and 4 (17.4%) required dialysis support. One patient who required dialysis, died during the admission giving a mortality rate of 4.3%. At time of discharge, 18 (78.3%) had complete renal recovery, 4 (17.4%) developed chronic kidney disease and 1 (4.3%) died before discharge. None of the patients required dialysis support at discharge. Compared to the 12 patients who did not develop AKI, male gender was found to be a risk factor of developing AKI (p¼0.023). There was a suggestion that older patients have a higher preponderance of developing AKI but this did not reach statistical significance. Conclusion: AKI is common in leptospirosis with an incidence of 65.7% but with a favorable outcome where 78.3% have a complete AKI recovery. Male gender appeared to be a risk factor of developing leptospirosis associated AKI.
morbidity and mortality especially in developing countries. Those patients suffering the most severe form of AKI requiring acute dialysis have particularly high rates of adverse outcomes during hospitalization and after discharge. Despite the importance of AKI, there have been relatively few studies about its population epidemiology. Objectives: To estimate the prevalence of dialysis-requiring AKI and identify specific demographic subgroups with increased propensity for dialysis requiring AKI in H. Adam Malik Hospital, Medan in 2016. Methods: We analyzed data from medical record in H. Adam Mali-kHospital Medan between January 1 st and December 31 st 2016, to identify cases of dialysis-requiring AKI using validated International Classification of Diseases, Ten Revision (ICD-10) codes. Dialysisrequiring AKI was defined as acute dialysis in patients without previously registered end-stage renal disease. Comorbidity was identified by relevant ICD-10 codes and classified according to the Charlson Comorbidity Index. Admission and discharge dates were identified in medical record and the duration of dialysis requirement and hospitalization was calculated. Statistical significance was defined as a two sided p-value <0.05 Results: Out of 151 hospitalizations with AKI (both adult and pediatric), there were 40 cases (26.5%) with dialysis-requiring AKI. Hospitalized patients with dialysis-requiring AKI were older than their counterparts without dialysis-requiring AKI (59.6 versus 42.8 years), were more likely to be male (51.7% versus 45.4%). The total number of deaths associated with dialysis-requiring AKI was 21 cases (52.5 %) Conclusion: The prevalence of dialysis-requiring AKI was high and the number of deaths associated with dialysis-requiring AKI more than doubled.
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