Comparison of Renal Segmental Artery Blood Flow on Doppler in Young Obese & Non Obese Individuals

Aim: To compare renal segmental artery blood flow on Doppler in young obese & non-obese individuals. Methodology: In University Ultrasound Clinic Green Town, Lahore, Pakistan, a comparative study was conducted. 180 patients of age group 16 to 25 were enrolled in this study with convenient sampling technique. All the obese & non-obese patients having no history of renal disease were included in this study. Hypertensive and diabetic patients were also included. Pregnant females having any renal parenchymal disease were excluded. Results: In 90 non-obese individuals the average mean of PI was .989±.249 while in 90 obese individuals the average mean of PI was .985±.338. No statistical difference between the two averages as p-value 0.928> α=0.05. Conclusion: Study concluded that no statistically significant difference between the average PI in non-obese individuals compared to the average of PI in obese individuals. Keywords: Obese, Renal segmental artery, Pulsatility Index (PI), Ultrasonography

Risk Factors for Major Hemorrhage Following Percutaneous Image-Guided Renal Biopsy: What is the “core” of the Problem? A Retrospective Case–control Study

Objectives: Percutaneous renal biopsy (PRB) plays a critical role in the work-up of renal parenchymal disease. Although it is considered a low-risk procedure, additional interventions may be required in about 7% of the cases following biopsy. The purpose of this study was to identify risk factors for major hemorrhage by microscopic analysis of the cores obtained following PRB, with an intent to enhance the sensitivity and specificity of the risk stratification process, especially in patients undergoing this procedure in an outpatient setting. Material and Methods: A retrospective review identified 17 of 179 patients (9.50%) with major hemorrhage following PRB between July 2014 and June 2019. Using propensity score matching, 26 controls (without major hemorrhage) were matched to 17 cases (with major hemorrhage). The biopsy cores obtained from the cases and controls were analyzed by a single pathologist for medullary, cortical, total (medullary + cortical) lengths, and the number of arcuate arteries (AAs). Medullary:cortical (M:C), cortical:total (C:T), and medullary:total (M:T) length ratios were then calculated. Results: A stratified version of logistic regression was used to test for an association between each of the variables identified on the cores and the probability of a major hemorrhage. The analysis revealed that there was a statistically significant association between the number of AAs per specimen with the risk of major hemorrhage (P = 0.0006). When 0, 1, or >2 AAs were identified, the frequency of major hemorrhage was 13.04%, 66.67%, and 75.00%, respectively. The odds of major hemorrhage were 6 times higher with one AA and (95% CI, 1.28–32.30) and 15 times higher with >2 AAs (95% CI, 1.41–169.57). No significant association was found between medullary length (P = 0.228), medulla:cortex (M:C) (P = 0.089), medulla:total (M:T) (P = 0.108), or cortex:total (C:T) (P = 0.112) length ratios and major hemorrhage. Conclusion: There was a strong and incremental correlation between major renal hemorrhage following PRB and the number of AAs per core specimen. Identification of AAs by the pathologist, while assessing for sample adequacy, in the US suite can help predict major hemorrhage in patients undergoing PRBs.

Disseminated cryptococcosis and hepatitis C virus infection: A fatal co-infection

Background and Purpose: We report a case of disseminated cryptococcosis in a treatment-naïve patient, incidentally diagnosed with hepatitis C virus (HCV) infection and renal parenchymal disease. The patient succumbed to death given the very late diagnosis of the disease.Case report: A 54-year-old male presented with the chief complaints of abdominal pain, chest pain, and phlegmy cough for a month. There was a past history of decreased urine output, lower limb swelling, and fever lasting for 15-20 days. After a general physical examination, the differential diagnosis of hepatitis C-related liver disease with hepatic encephalopathy, disseminated tuberculosis, and septic shock was made. Radiological examination revealed renal parenchymal disease on ultrasound abdomen and opacity with reticulonodular opacity in the bilateral lung zones. In laboratory investigations, serum reactive sample was tested for anti-HCV antibodies. In addition, Cryptococcus var grubii was identified in blood culture using the matrix-assisted laser desorption ionization-time of flight mass spectrometry (Bruker Daltonics, Germany). The patient succumbed to death before the initiation of any specific antifungal therapy.Conclusion: Cryptococcosis-HCV co-infection is a fatal condition with a fulminant course that might be difficult to treat.

Role of duplex ultrasonography in patients with renal parenchymal disease: renal resistive index vs serum creatinine level

Background: In view of the fact that Brightness (B)-mode ultrasound findings in patients with renal parenchymal disease are profoundly non-specific, this study was carried out to determine the efficiency of color Doppler sonography for assessing renal function. In this series, the relationship between the resistive index (RI) of renal interlobar artery and serum creatinine level was analyzed for any relevant association of this color Doppler index with the serum creatinine level.Methods: In this prospective cross-sectional study, 40 patients with renal parenchymal disease having serum creatinine level >1.4 mg/dL were chosen midst routine revisits. The control group comprised of 40 normal subjects with serum creatinine levels <1.4 mg/dL. After assessing the kidneys of these subjects with gray-scale ultrasound for presence of any stones, hydronephrosis, and/or space occupying lesions instead of, they were subsequently interrogated with color Doppler sonography and RI calculated.Results: The mean serum creatinine levels±SD in the case and control groups were 6.7±0.7 mg/dL and 1.0±0.4 mg/dL, respectively. The mean±SD resistive index (RI) was 79.0%±1.8% in the diseased group and 60.3%±0.7% in the healthy subjects (p<0.001). The correlation between the RI and the serum creatinine level was statistically significant (p<0.001).Conclusions: Resistive index (RI) measurement by color doppler ultrasonography is a reasonable prognosticator of functional outcome in patients with renal parenchymal disease.

ADVERSE DRUG INTERACTION BETWEEN ASPIRIN AND FUROSEMIDE: A CASE REPORT

Drug–drug interaction between two drugs leads to a serious adverse drug reaction which is an adverse drug interaction. A 60-year-old female patient came with complaints of chest pain since 6 pm on the day of admission which is a burning type of pain and also a history of breathlessness. She was a known case of hypertension and diabetes mellitus since 5 years on medications, i.e. tablet atenolol-5 mg - 1-0-0, tablet amlodipine - 5 mg - 1-0-0, and tablet metformin - 500 mg - 1-0-1; the patient’s appetite was reduced and sleep was disturbed. On examination, blood pressure was 120/100 mmHg, pulse rate: 80 bpm, SpO2: 94% with room air, respiratory system: B/L coarse crept (+), and pallor (+) remaining systemic examination showing no any deformities. Laboratory reports show microcytic hypochromic with neutrophilia and thrombocytosis and ultrasonography (USG): B/L Grade I renal parenchymal disease. The patient ongoing treatment was tablet aspirin - 325 mg stat and 150 mg 0-1-0, tablet clopidogrel 300 mg stat and 75 mg 0-1-0, tablet atorvastatin 80 mg stat and 40 mg 0-0- 1, injection furosemide 40 mg IV 1-1-0, and injection nitroglycerin 2 amp in 1 pint NS at 12 drops/min and stopped on the 2nd day; injection pantoprazole 40 mg IV 1-0-1, injection heparin 5000 IU IV 1-1-1, and injection insulin R 8-8-6 S/C 1-0-1 started from the 2nd day; tablet enalapril 2.5 mg PO 1-0-1 given on the 2nd and 3rd days; tablet amlodipine 5 mg PO 1-0-1 given on the 2nd day and stopped; and injection insulin 1 pint in 25% dextrose, injection calcium gluconate, and nebulizer asthalin given only on the 3rd day. Here come 6 major interactions between amlodipine and clopidogrel, aspirin and furosemide (causes possible nephrotoxicity), clopidogrel with aspirin and heparin (increased risk of bleeding) and also heparin with nitroglycerin. The patient diagnosed as chronic kidney disease in the middle of the treatment which was adverse reaction interaction between aspirin and furosemide.

Renal Parenchymal Disease Mimicking Preeclampsia

A 28-year-old primigravida woman, who was diagnosed with preeclampsia and managed with calcium channel blockers during the pregnancy for control of hypertension, was referred to the cardiologist 2 weeks after the pregnancy for management of accelerated hypertension. Preeclampsia diagnosis is substantiated by detecting hypertension in the 20th week of pregnancy, pedal edema, proteinuria, and liver enzyme abnormalities. A subsequent evaluation found that the patient had shrunken kidney, perhaps due to chronic pyelonephritis. Physicians always have to keep in mind to detect the secondary cause of hypertension in a pregnant woman.