Contrast media administration can lead to acute deterioration in renal function particularly in patients with pre-existing chronic kidney disease. This prospective, randomized controlled open-label parallel group study was undertaken at Nizam's Institute of Medical Sciences, Hyderabad, from June to December 2015. A total of 95 patients were included, of which 35 received n-acetylcysteine (NAC) + normal saline (NS), 30 patients received allopurinol (ALL) + NS, and 30 patients received placebo. In our study, the overall incidence of CIN was 24%. Incidence of CIN in NAC + NS, ALL + NS, and placebo group were 20%, 16%, and 36%, respectively. The major finding of this study was there was no significant difference between NAC and allopurinol in the prevention of contrast nephropathy. However, only allopurinol was superior to placebo. In our study, hyperuricemia and baseline serum creatinine were the only risk factors associated with CIN.
To study the effect of individualized dialysate sodium on interdialytic weight gain and blood pressure. Methodology: It was a Prospective study. Duration: 2 years from January 2019 to December 2020. In this study, about 50 patients on maintenance hemodialysis for at least six weeks and IDWG more than 3kg were enrolled. Patients receiving maintenance hemodialysis in Narayana Medical College and Hospital Nellore were enrolled in the present study. Results: Fifty patients who met the inclusion criteria were enrolled in our study. These include 33(66%) males and 17(34%) females with a mean age of 51.58 years. The mean duration of HD in our study was 16.92 months. The most common cause of ESRD in our study was Diabetic Nephropathy (54%); other causes include Chronic Glomerular Nephritis (18%), Chronic Interstitial Nephritis (8%), and CKD of unknown cause in 20% of patients. Dialysate sodium in standard phase (Phase I) was kept constant at 138meq/L, whereas mean dialysate sodium in individualized sodium Phase (Phase II), calculated by multiplying mean pre-HD sodium by 0.95 (Donnan coefficient), was 128meq/L. The Mean pre-HD sodium level was almost similar in both phases, but there was a 3meq/L difference in the mean post-HD sodium level in standard and individualized phases. There was a significant reduction in mean IDWG by 0.63 kg in Phase II, and there was also a significant reduction in mean UF requirement by 0.55 kg in the individualized sodium phase (Phase II) when compared with the standard phase (Phase I). There was a significant reduction in post-HD diastolic blood pressure by 3mmHg in the individualized sodium phase (Phase II) compared with the standard phase (Phase II). There was a reduction in intradialytic complications in Phase II when compared with Phase I. Despite the low dialysate sodium concentrations, there was no increase in hypotension episodes in the individualized sodium phase (Phase II).
Conclusion:We conclude that individualizing dialysate sodium in hemodialysis patients significantly reduced interdialytic weight gain, ultrafiltration requirement, and blood pressure.
Aim and Objective:To assess the correlations between clinical and biochemical parameters with radiological severity of acute pyelonephritis. Methodology: It was a descriptive analytical study. All patients admitted to Narayana Medical College and Hospital, Nellore, from March 2019 to December 2020 with a CT proven diagnosis of acute pyelonephritis. All the patients diagnosed to have APN based on clinical and/or radiological findings were included in this study. Diagnosis of APN was based on both clinical and radiological criteria. Clinical criteria include the presence of "classical" symptoms of APN. Results: A sample size of 100 patients was considered for the study. But, in view of COVID pandemic, sample collection as limited to 62mong 62 patients with pyelonephritis, 30(48.4%) were males, and 32(51.6%) were females. Males were older when compared to females. The mean age of 62 patients with acute pyelonephritis was 55.47 ± 12.82 years. The total number of patients with diabetes mellitus were 19(30.65%). Patients with hypertension were 18(29.03%). 4(26.67%) patients in group 1, 9(28.13%) patients in group 2, and 5(33.33%) patients in group 3 were found to have hypertension. Classical triad of pyelonephritis was seen in 51 (82.3%) patients and was absent in 11 (17.7%) of patients. There was an association between inotrope use and severe CT grading by using the likelihood ratio test, which was statistically significant with a p-value of 0.015. Ultrasound was found to detect pyelonephritis in 18(29.03%) patients. In 44(70.97%) patients, ultrasound was found to be normal despite the presence of clinical features. HbA1C levels were similar among the three groups with a mean value of 6.48±0.65, 6.53±0.62, and 6.59±0.77 in group 1, group 2, and group 3 patients, respectively. Conclusion: This study showed a good correlation between clinical and radiological severity in adult patients with APN. Duration of hospital stay, presence of hypotension, and leukocytosis were associated with severe pyelonephritis.
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