Background Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma, collecting system and/or perinephric tissues, characterized by gas accumulation. We describe clinical, laboratory and imaging characteristics and in-hospital outcomes of patients with EPN. Methods This retrospective observational study was carried out at BIRDEM General Hospital, Dhaka, Bangladesh between 2014 and 2020. Results We followed 20 patients (mean age 49.4 years; females 70%). Risk factors for EPN were diabetes mellitus (in 100%) and renal stones (in 10%). Fever, loin pain, vomiting and dysuria were common. Complications included acute kidney injury (AKI, 70%; mostly stage 1, 78.6%), hyponatraemia (55%) and bacteraemia (15%). Escherichia coli was the most common (60%) urinary isolate. Most patients (80%) had class 2 EPN, with 15% class 3B and 5% class 3A. Besides medical management, four (20%) required surgery (nephrectomy in 3). Nephrectomised patients had a higher radiological class (p = 0.032) and incidence of AKI (p = 0.034). No deaths occurred. Conclusion EPN occurred predominantly in female diabetic patients, who presented with fever, loin pain, vomiting and dysuria. Two-thirds of patients had AKI and one-fifth required surgery, and there were no deaths.

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Escherichia coli and Klebsiella pneumoniae are responsible for UTI in 80-90% cases [2][3][4] . Extended-spectrum beta-lactamase (ESBL) producing E. coli and K. pneumoniae are increasingly being isolated in cultures from urine samples in Bangladesh 5-8 . Advanced age, diabetes mellitus (DM), use of urinary catheters, previous hospital admission and antibiotic intake are reported as risk factors for ESBL positivity 9,10 . Data regarding ESBL positive organisms are limited in our country. This study was designed to describe the frequency of ESBL positive E. coli and K. pneumoniae causing UTI, their associated risk factors and antibiotic sensitivity pattern in a tertiary care setting of Bangladesh. Methods :This prospective cross-sectional study was done in the Department of Nephrology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, Bangladesh from January 2014 to March 2014. Adult patients who got admitted with a clinical diagnosis of UTI were initially enrolled for the study. Those with a growth of micro-organism from their urine samples were then selected for the study and finally one hundred consecutive culture positive UTI cases due to E. coli or K. pneumoniae infection, irrespective of their ESBL positivity were purposively included in this study. Original

Abstract:Toxin is a common cause of community acquired acute kidney injury (AKI) which includes environmental toxins like plant toxins as well as various drugs and chemicals which are usually ingested for medicinal as well as recreational purposes.Averrhoa carambola (Star fruit/ Kamranga) and Avorrhoa bilimbi are two such commonly used traditional remedies. They belong to family Oxalidaecae and contain high-levels of oxalic acid. AKI may occur after consuming concentrated juice due to deposition of oxalate crystals in the renal tubules.Here we present two patients who developed AKI after ingestion of freshly made juice from A. bilimbi and star fruit. Both patients were diabetic and the juice was ingested on empty stomach with the belief of improving glycemic status. Initial presentation was GI upset in both scenarios. Patient with A. bilimbi toxicity had diabetic nephropathy and required hemodialysis. Renal biopsy revealed deposition of polarizable oxalate crystals in the patient who consumed A. bilimbi and acute tubular necrosis in the patient with star fruit toxicity. All cases regained normal renal function within three months.We also present a patient who ingested raw fish gallbladder as a remedy for asthma. The patient presented with AKI within five days of ingestion and required hemodialysis. His highest serum creatinine was 10.4mg/dl and fell to 1.7 mg/dl after four weeks. Cyprinol and related compounds in fish gallbladder are thought to be the cause of acute tubular necrosis in such cases.The fourth patient developed AKI with rhabdomyolysis after consuming a locally made energy drink. He also required dialysis and serum creatinine gradually improved from 7.2mg/dl to 1.4mg/dl at discharge. The possibility of toxicity of caffeine, adulteration with other chemicals or ascorbic acid toxicity causing oxalate nephropathy could not be excluded.All four patients developed AKI caused after ingesting easily available products and are presented here for public awareness. We believe proper knowledge and education can reduce toxin induced AKI in our society.

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Background: Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. CTS and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy.Methods: This study was a hospital based descriptive cross sectional study done in a tertiary care hospital, Dhaka between July, 2015 and June, 2016. The initial clinical diagnosis of diabetic peripheral neuropathy was made from history and examination. It was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Collected data were checked, verified for consistency and edited for final results. Data cleaning, validation and analysis were performed using Statistical Package for the Social Sciences (Version 20.0).Results: A total of 354 cases were finally analyzed with 153 (43.2) patients being symptomatic for CTS and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Majority (38.4%) of patients belonged to the age group of 51-60 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). One hundred and ninety two (54.2%) patients were housewives, 57 (16.1%) were garment workers, 45 (12.7%) patients were businessmen and 60 (16.9%) patients were service holders. Study subjects with CTS had significantly higher body mass index, higher fasting blood glucose and higher HemoglobinA1c in comparison to patients without CTS. Examination of upper limb sensory nerves showed that nerve conduction velocity was significantly decreased and distal latency was found to be significantly increased in patients with CTS on median nerve examination. The mean compound motor action potential was not significantly different between patients with and without CTS.Conclusion: Symptoms and signs of CTS are mostly masked by the symptoms of DPN and patients presenting with such symptoms in the upper limbs should be evaluated for CTS as a separate entity to DPN. The finding of a frequency of CTS of 26% in subjects with diabetes with varying degrees of DPN is remarkably high. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions be made carefully after nerve conduction study and proper diagnosis.Birdem Med J 2018; 8(3): 246-250

Bilimbi/belembu fruit belongs to the family of Oxalidacae, species Averrhoa bilimbi. Freshly prepared concentrated juice of bilimbi has very high oxalic acid content and consumption carries a high risk of developing acute kidney injury (AKI) by deposition of calcium oxalate crystals in renal tubules. AKI due to Averrhoa bilimbi juice injestion is very rare. We report the case history of a 60-year-old hypertensive, dyslipidemic patient, with normal renal function, who ingested around 600ml of juice in fasting state for treating dyslipidemia. The patient developed AKI and required three sessions of hemodialysis. Her renal function returned to normal after five weeks.Bangladesh Crit Care J September 2015; 3 (2): 71-73

Background: Urinary tract infection (UTI) is common and diabetic patients are at increased risk for UTI. UTI may be complicated by acute kidney injury (AKI).the world. 3-6 Extended-spectrum beta-lactamase (ESBL) producing strains are an ever increasing problem 7-9 and diabetic patients with long duration and poor glycaemic control are at increased risk for UTI due to ESBL-positive organisms. 5,10 UTI may be complicated by acute kidney injury (AKI) and sepsis. 3 This study was designed to evaluate whether UTI due to ESBL-positive organisms should be considered as a risk factor for AKI in type 2 diabetic subjects. Methods:This case-control study was done in the Department of Internal Medicine and Department of Nephrology of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, Bangladesh from April to June 2016. Hospitalized patients with a clinical diagnosis of UTI were initially enrolled for the study purpose. A clean catch technique was applied for urine (preferably early morning midstream specimen) collection.