Search

This cross sectional comparative study was conducted in the Nephrology and Medicine outdoor and in-patients department of Mymensingh Medical College Hospital, Bangladesh from April 2014 to March 2015. A total of 100 patients with CKD and 100 healthy subjects were included in the study. Data were collected by interview of the patients, clinical examination and laboratory investigations using a semi-structured case record form. Among all subjects, 50.0% had no CKD and 50.0% patients had CKD: Stage 3 CKD were 8.5%, CKD Stage 4 CKD were 21.0%, CKD Stage 5 CKD were 20.5%. Serum creatinine was 4.32±3.08mg/dl in patients with CKD and 1.00±0.22mg/dl was in healthy subjects. Mean±SD of CCR/ml/min was found 17.67±11.63ml/min in patients with CKD and 79.31±13.31ml/min was found in healthy subjects. On the other hand, Mean±SD CCCR/ml/m/1.73m² was found 19.79±12.85 ml/m/1.73m² in patient with CKD and healthy subjects had 83.83±13.33 ml/m/1.73m². Urinary creatinine was 45.59±15.63 & 57.66±11.45mg/dl respectively. CKD-EPI eGFR was 22.10±15.02 & 90.61±23.27ml/m/1.73m²; MDRD eGFR was 22.15±14.18 & 89.35±26.19 ml/m/1.73m² respectively. Difference between all the variables between CKD group and healthy group was found statistically significant (p<0.001). CKD-EPIeGFR and MDRDeGFR were increased both in CKD patients and healthy subjects in respect to CCR and CCCR. There was a strong positive correlation between CCCR (ml/m/1.73m2) and CKD-EPI (ml/m/1.73m²) among all patients (r=0.934 and p<0.001) and also a positive correlation of CCCR with MDRD among all patients (r=0.913 and p<0.001). A positive correlation of CCCR was found with CKD-EPIeGFR among CKD patients (r=0.848 and p<0.001). A positive correlation of CCCR was also found with MDRDeGFR among CKD patients (r=0.841, p<0.001). There are positive correlations between CCCR and CKD/EPI among healthy subjects (r=0.616 and p<0.05) and between CCCR with MDRD among healthy subjects (r=0.568 and p<0.05). Various formulae were used to calculate GFR on the basis of serum creatinine levels. The Overall correlation of population (healthy and CKD patients) between CCCR and CKD EPI and MDRD formula was (r=0.93 and 0.91) respectively, among CKD patients it was (r=0.848 and r=0.841) in healthy subjects it was (r=0.616 and r=0.568) respectively. CKD EPI eGFR and MDRD eGFR formula had fairly good correlation with conventional 24 hours creatinine clearance in both CKD patient and healthy subjects, there was even more strong correlation especially in CKD patients. The performance of CKD-EPI equation is better than MDRD equation to estimate the eGFR in both CKD patients and healthy subjects.

Eventration of diaphragm is an abnormal elevation of diaphragmatic musculature while retaining normal attachments to the sternum, ribs and dorsolumber spine. It is a rare anomaly where the continuity of diaphragm remains intact. Pathological process can affect either all or only a portion of hemidiaphragm. Symptoms vary according to size of the defect. Large defect may mimic diaphragmatic hernia. The present case represents a full term female newborn that developed respiratory distress, cyanosis and feeding difficulties since 1st day of life. Clinical features and chest imaging of this case was assumed to be left sided diaphragmatic hernia which was found wrong in the operation theater. She was found to have left sided eventration of diaphragm to create symptom. Successful plication of ipsilateral diaphragm was done on 13th day of life. Supervised post operative ventilatory support along with other postoperative care improved the condition of this neonate. A large defect with eventration of diaphragm may be life threatening but a timely good management can save neonate from such condition.

Cardiac valve surgery is considered one of the most frequent surgical procedures in which AKI is a common & serious complication. Although serum creatinine is routinely used as a marker of renal function, it poorly reflects the immediate post operative period renal function. Within minutes to few hours after a renal insult, plasma neutrophil gelatinase associated lipocalin (pNGAL) is released. The aim of this study was to assess the superiority of pNGAL over serum creatinine in detecting AKI in early post operative period. This prospective observational study was carried out in the Department of Nephrology of National Institute of Kidney Diseases & Urology in collaboration with National Institute of Cardiovascular Diseases (NICVD) & Dhaka Shisu Hospital (DSH) from January 2015 to December 2016. Total 120 patients were selected from inpatient ward of cardiovascular surgery department. According to inclusion & exclusion criteria total 80 patients were included who was undergone cardiac valve surgery. Serum samples for pNGAL were collected from study population 6 hours after completion of surgery & stored at -80°C, serum samples were also collected for serum creatinine day before surgery, in 1st post operative day (POD1) & 2nd post operative day (POD2). Total 79 patients undergoing cardiac surgery, who met the inclusion & exclusion criteria, were consecutively included. There were 44 male (55.69%) and 35 female (40.31%) ranged from 15-60 years, with mean age of 36 years. pNGAL level in the blood of AKI patients (244.19±59.61ng/ml) 6 hours after completion of surgery was significantly higher from the non AKI patients (171.73±68.63ng/ml). A positive significant correlation was found between pNGAL 6 hours after completion of surgery & serum creatinine at POD1, POD2. This study demonstrated that level of pNGAL concentration 6 hours after completion of cardiac valve surgery increased before the rise of serum creatinine level & can thus AKI can be detected earlier by pNGAL.

This cross sectional observational study was done in the Department of Medicine, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from May 2013 to April 2014 to find out the proportion of acute kidney injury among patients with acute viral hepatitis and to identify risk factors associated with development of acute kidney injury (AKI). A total of 100 patients with acute viral hepatitis were included purposively as study subjects. Among them 61 were male and 39 were female. They were divided into AKI group (n=6) and non-AKI group (n=94) on the basis of development of AKI. There was no significant difference in mean age (39.0±13.1 years vs. 32.2±10.8 years, p=0.335) and sex (67% vs. 61% & 33.0% vs. 39.0%) p=0.769) between AKI group and non-AKI group. There were 27% acute viral hepatitis A, 21% acute viral hepatitis B and 52% acute viral hepatitis E but no case of acute viral hepatitis C was found in this study. Acute kidney injury (AKI) developed in 6 of 27 patients with acute viral hepatitis A. This study showed that 22.2% patients with acute viral hepatitis A developed acute kidney injury but patients with acute viral hepatitis B (HBV) and hepatitis E (HEV) did not develop acute kidney injury. Majority of the patients with acute kidney injury were smokers and hypertensive with elevated mean arterial pressure (p=0.0001) at presentation and had higher total bilirubin (p=0.0001), alanine aminotranseferase values (p=0.040), prolonged prothrombin time (INR) {p=0.0001}, lower albumin (p=0.0001), lower haematocrit level (p=0.0001), high CRP concentration (p=0.0001), leucocytosis (p=0.0001) and thrombocytopenia (p=0.0001) at presentation than patients without acute kidney injury. It is evident from the study that acute kidney injury is not a rare complication in patients with acute viral hepatitis.

Low serum level of IgG, complement C3 and C4 in nephrotic syndrome children may cause increased susceptibility to infection. Serum level of IgG and complements in nephrotic children (NS) with UTI has been analyzed in this cross sectional study. It was carried out in the department of Pediatric nephrology, National Institute of Kidney Diseases & Urology (NIKDU), Dhaka, Bangladesh. The study subjects were followed up prospectively for one year to see and compare the frequency of relapse of NS and UTI. Patients were selected in a nonrandom purposive technique. Nephrotic syndrome children with initial attack between 1-12 year of age were included over a period of one year. The patients were grouped into Group I - UTI positive and Group II - UTI negative depending on urine culture positivity and colony count >10⁵ CFU/ml. Serum IgG and complements C3, C4 levels were done in both groups during nephrosis and were compared. A total of 101 children M: F 1.7:1, mean age 5.96±3.2 years were included in this study. Group I, n=45 vs. Group II, n=56. The mean serum level of IgG was low in Group I (549.91±210.71 vs. 728.64±235.81mg/dl, p<0.001). Serum IgG level less than 700mg/dl was found in 37 vs. 23 children {x² (¹) 17.52 p<0.001, OR=6.63}. Mean serum complement C3 level was also low in Group I (123.09±40.52 vs. 143.38±37.06mg/dl, p<0.05). But complement C3 and C4 level do not carry any risk of developing UTI in nephrotic children. Higher number of children in Group II were at remission (n=24) during follow up, while frequent relapsers were high in Group I (n=22). Increased frequency of UTI attack (88 episodes) was found in Group I children compared to none in Group II during follow up. So low serum level of IgG in children with NS during nephrosis can predict UTI with an odds ratio of 6.63 as well as relapse. Serum level of C3, C4 do not associated with any risk of development of UTI in NS children.

This study was done to find out the thyroid function of nephrotic children during nephrosis and to compare any significant changes of thyroid function status during nephrosis and remission. This is an observational study with prospective follow up of study subjects. It was carried out over a period of one year from July'2006 to June'2007 in the department of Paediatric Nephrology, National Institute of Kidney Diseases & Urology (NIKDU), Dhaka, Bangladesh. A total of 85 nephrotic children with initial attack and relapse cases were studied. Age ranged from 2-12 years, M: F=1.7:1. All patients were clinically euthyroid. The mean value of serum T3 (0.65±0.31 ng/ml) and T4 (5.04±4.18 μg/ml) in 85 nephrotic children during nephrosis were within normal limit. But the mean value of thyroid stimulating hormone (TSH) was higher than normal level (7.1±5.8 MIU). In 21 nephrotic children thyroid function status was compared during nephrosis and 4 weeks later after achieving remission. A significant increase in TSH level during nephrosis (9.11±6.36 vs. 4.2±3.6 MIU/L, p = 0.005) was found, which normalized during remission. No significant difference between T3 and T4 level was observed. There was a negative correlation of serum albumin with serum TSH level (r = -0.216, p = 0.047). This result suggests that children with nephrotic syndrome commonly have a state of mild or subclinical hypothyroidism during proteinuria although they are clinically euthyroid. This temporary hypothyroid state improves with remission and needs no treatment.