Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
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Saudi J Kidney Dis Transpl · Jan 2011
High mortality in critically ill patients infected with 2009 pandemic influenza A (H1N1) with pneumonia and acute kidney injury.
Patients infected with H1N1 virus may develop pneumonia and acute kidney injury (AKI). To determine the epidemiological characteristics, clinical features, management and out-comes of patients with confirmed H1N1 complicated by pneumonia and AKI and treatment with oseltamivir and to identify the prognostic indicators, we studied all the patients with a confirmed diagnosis of H1N1 infection with pneumonia and AKI, using real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay, between October 2009 and March 2010. H1N1 infection was confirmed in 20 patients with pneumonia and AKI; the mean age was 42.8 ± 18.2 years and 12 (60%) of the patients were males. ⋯ Fifteen (75%) patients required mechanical ventilation and 14 (70%) died. None of the health care workers developed influenza-like illness, when they received oseltamivir prophylaxis. Mortality was associated with higher Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment score (SOFA), Multiple Organ Dysfunction Score (MODS), XRChest score, in addition to requirement of inotrope, ventilator support, renal replacement therapy (RRT), and presence of underlying risk factor for severe disease.
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Saudi J Kidney Dis Transpl · Jan 2011
Outcome of patients treated with automated peritoneal dialysis: effects of selection of patients.
To determine the effect of selection of peritoneal dialysis patients who used auto-mated PD (APD) as a first renal replacement therapy (RRT) option, we studied two groups of adult chronic kidney disease (CKD) patients treated with APD over a period of 4 years: group 1 included 30 patients in whom APD was the first choice for RRT and group 2 included 40 patients transferred from failed hemodialysis (HD) treatment. Both groups were matched for the original causes of CKD and comorbid conditions. However, group 1 had significantly higher residual renal function (RRF) than group 2 [glomerular filtration rate (GFR) 11.85 ± 4 mL/min and urine output 995 ± 465 mL/day vs. 3.69 ± 3.7 mL/min and 340 ± 447 mL/day, respectively, P = 0.0001] and Kt/v (2.7 ± 0.7 vs. 1.9 ± 0.4, respectively, P = 0.006). ⋯ However, group 1 achieved better clinical outcome than group 2, including relatively higher survival rate and kidney transplantation, significantly fewer episodes of peritonitis per year (0.09 vs. 0.14, respectively, P = 0.0001), higher serum albumin (2.95 ± 0.3 vs. 2.7 ± 0.27 g/dL, respectively, P = 0.035), hemoglobin (11.5 ± 0.9 vs. 10.6 ± 0.7 g/dL, respectively, P = 0.022) and lower parathormone levels (283 ± 117 vs. 389 ± 269 pg/mL, respectively, P = 0.02). They also maintained significantly higher total fluid removal compared to group 2 (1120 ± 330 vs. 560 ± 300 mL/day, respectively, P = 0.004), higher RRF (GFR 8 ± 2.6 mL/min vs. 1.8 ± 2.4 mL/min, respectively, P = 0.0001), and urine output (556 ± 447 mL/day vs. 240 ± 347 mL/day, respectively, P = 0.004), and significantly higher Kt/v (2.8 ± 0.7 vs. 1.9 ± 0.4, respectively, P = 0.2). In conclusion, in CKD patients, PD is a viable initial modality of RRT, and with better RRF may have a better outcome than as a secondary choice.
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Saudi J Kidney Dis Transpl · Nov 2010
Impact of mild renal impairment on early postoperative mortality after open cardiac surgery.
Preoperative severe renal impairment is included in the risk scores to predict outcome after open cardiac surgery. The purpose of this study was to assess the impact of preoperative mild renal impairment on the early postoperative mortality after open heart surgery. Data of all cases of open cardiac surgery performed from January 2005 to June 2006 were collected. ⋯ Binary logistic regression analysis showed that female gender (P = 0.01), preoperative mild renal impairment (P = 0.007) as well as occurrence of multi organ failure (P < 0.001) were the only independent variables determining the early postoperative mortality after cardiac surgeries. Among them, preoperative mild renal impairment was the most significant and the best predictor for early postoperative mortality after cardiac surgery. Our study suggests that renal impairment remains a strong predictor of early mortality even after adjustment for several confounders.
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Saudi J Kidney Dis Transpl · Nov 2010
Case ReportsPregnancy predisposes to rhabdomyolysis due to hypokalemia.
Increased predilection for hypokalemia-induced rhabdomyolysis has been noted in pregnant women. We managed a woman with distal renal tubular acidosis (RTA) with persistent hypokalemia who presented with recurrent rhabdomyolysis in her consecutive pregnancies despite adequate potassium citrate therapy.
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Saudi J Kidney Dis Transpl · Nov 2010
Case ReportsLocalized renal cystic disease: report of a rare case.
We report a case of a 32-year-old female who presented with right flank pain. Ultrasonography done for hematuria 10 years ago indicated the presence of renal cysts in the right kidney, but she had been asymptomatic since then. This history attracted our attention to the possibility of "localized renal cystic disease" (LRCD). ⋯ She is still being followed up for the last 3 years and is doing well. LRCD has been given various names since it was first recognized as a distinct clinical entity but the term LRCD appears to be the most accurate. Here, we present a brief discussion of clinical significance, diagnosis and differentials of this rare condition.