Posterior Reversible Encephalopathy Syndrome in a Patient With Microscopic Polyangiitis: A Case Report and Literature Review

Central nervous system (CNS) is rarely involved in microscopic polyangiitis (MPA). Here, we report a 14-year-old girl with MPA who developed new-onset seizures with deterioration of renal function. Her brain CT scan and MRI showed concurrent complications of intracerebral hemorrhage and posterior reversible encephalopathy syndrome (PRES). She got remission with combinations of methylprednisolone pulse, plasma exchange, regular hemodialysis, antiseizure and antihypertension medications. Furthermore, it is crucial to exclude the adverse effect of medications such as corticosteroid and biological therapy. We searched the literatures, retrieved 6 cases of MPA with PRES and summarized their clinical characteristics.

Role of Oxidative Stress as a Marker of Cardiovascular Risk in Children on Regular Hemodialysis

Introduction: Chronic kidney disease (CKD) is a major public health problem worldwide, and its main consequences include loss of renal function leading to end-stage renal disease (ESRD), increased risk of cardiovascular disease (CVD), significant increase in morbidity and mortality, and a decrease in health-related quality of life. Aims and Objectives: The basic aim of the study is to analyze the oxidative stress and total antioxidant capacity as a biomarker of cardiovascular risk in those children who are on regular hemodialysis. Materials and Methods: This cross sectional study was conducted at DHQ hospital, Faisalabad during July 2020 to January 2021. The data were collected from the age of less than 18 years children of both sexes. There were 50 children who was selected for this study. At the time of the study, all the patients were on regular three HD sessions per week. In HD patients, venous blood samples were drawn immediately before and after hemodialysis session. Baseline laboratory investigations were carried out for all patients and controls including complete blood count, serum urea and creatinine, arterial pH, arterial blood gases and infection screening, which included blood and urinary cultures by standard methods. Results: The data were collected from 50 dialysis patients. The mean age of this study is 15years. We collected all the demographic data of patients. The mean value of Urea is 64.34±2.44 mg/dl). At before-dialysis session, duration of disease positively correlated with TPX (r = 0.969, P <0.001), but, negatively correlated with TAC (r = −0.469, P <0.002). At after-dialysis session, HIF-1α negatively correlated with each of TPX (r = −0.529, P <0.001) and OSI (r = −0.459, P <0.003); while, OSI positively correlated with TPX (r = 0.944, P <0.001). Conclusion: It is concluded that HD patients, the clinical and prognostic significance of oxidative status associated with cardiovascular risk factors is very different from the general population. Although a direct causality cannot be inferred from such kind of correlative investigations.

Inferior vena cava diameter and collapsibility index as a marker of fluid status in regular hemodialysis patients

Background Patients with renal failure suffer from fluid overload which is a risk factor for mortality and morbidity. Therefore, fluid status assessment in patients on regular hemodialysis is very important. Dry weight assessment by clinical parameters is not always reliable. We evaluate the role of inferior vena cava ultrasound in estimating fluid overload in regular hemodialysis patients. Results A total of 45 persons, 30 end-stage renal disease patients on regular hemodialysis in group A (18 men and 12 women) and 15 healthy persons in group B (10 men and 5 women), were included in the study. The patients in group A ages ranged from 29 to 70 years with a mean of 48.38 ± 12.70 years and in group B ages ranged from 25 to 55 years with a mean of 34.93 ± 8.26. By clinical methods, the mean dry weight was 68.37 kg (68.37 ± 10.42). After HD mean, IVCe decreased from 2.01 ± 0.29 to 1.79 ± 0.22 cm (P < 0.001) similarly, mean IVCi decreased from 0.99 ± 0.48 to 0.64 ± 0.39 cm (P < 0.001). Changes in IVCD were significantly correlated with alterations in body weight following dialysis (P < 0.001). The IVC-CI increased significantly after dialysis (P < 0.001). IVCD and its IVC-CI reflected alterations in fluid status (P < 0.001). Considering the clinical parameters of fluid status, following HD mean, heart rate increased from 81.80 ± 5.15 beats per minute to 89.87 ± 6.42, (P < 0.001), systolic blood pressure decreased from 130 ± 18.43 mmHg to 113.33 ± 15.27 (P < 0.001), and diastolic blood pressure decreased from 80.17 ± 10.12 mmHg to 71.50 ± 9.29 (P < 0.001). Conclusion It was found a significant correlation between IVCD and IVC-CI with ultrafiltration of hemodialysis. Thus, IVC ultrasound can be used in dry weight assessment in ESRD patients on regular HD by measurement of IVCD and IVC-CI before and after hemodialysis.

Correlation of Reticulocyte Hemoglobin Equivalent (Ret-He) Levels and Iron Deficiency Anemia in CKD Patients Treating Regular Hemodialysis

Background: Anemia appears in the early stages of CKD and its prevalence increases as kidney function declines. Ret-HE can be used to diagnose iron-deficiency anemia. Indonesia does not yet have appropriate research data on RET-He levels in CKD patients undergoing hemodialysis as a parameter to assess iron. Therefore, this study aims to examine the ability of RET-He as an alternative parameter to assess iron deficiency in hemodialysis patients. Method: This research is a correlation analytic study with a cross-sectional design, carried out in February-May 2021 at the Hemodialysis Installation of H. Adam Malik Hospital. Blood sample collection and examination are carried out at the Clinical Pathology Laboratory. Primary and secondary data were collected from interviews, questionnaires, or patient medical records. The data will be analyzed by Pearson correlation test using SPSS software. Results: A total of 41 samples consisted of 31 anemic patients and 10 anemic patients with normal RET-He levels. Demographic characteristics based on age group with an average of 47±13.28 years. The correlation of Ret-HE and TSAT levels in CKD patients undergoing hemodialysis shows a significance value of 0.000, so it can be concluded that there is a correlation between RET-HE and TSAT levels with a significance value of <0.05. According to the Pearson correlation number of 0.618 which is in the range of 0.61 to 0.80. Conclusion: There is a positive correlation between Ret-HE levels and iron deficiency anemia in CKD patients undergoing regular hemodialysis. Keywords: CKD, RET-HE, Hemodialysis.

The Association between Parathyroid Hormone (PTH) Level and Hemoglobin and Hematocrit Level in Chronic Kidney Disease (CKD) Patients with Regular Hemodialysis

Introduction: Chronic Kidney Disease (CKD) is a pathophysiological process with various etiology that causes a progressive decline in kidney function and ends in kidney failure. [1] CKD is a health problem that occurs in the community and has covered globally. The 2010 Global Burden of Disease stated that CKD was the 27th leading cause of death in the world in 1990. This has increased to 18th in 2010. Parathyroid hormone is a potential factor in the incidence of anemia in CKD patients. In CKD patients, there is an increase in levels of parathyroid hormone which is a uremic toxin that inhibits erythropoietin by increasing fibrosis in the bone marrow (myelofibrosis). The role of PTH in cases of renal anemia has been extensively investigated by various clinical observational studies. This study aimed to determine the association between parathyroid hormone (PTH) levels and hemoglobin and hematocrit levels in chronic kidney disease (CKD) patients with regular hemodialysis in Haji Adam Malik Central General Hospital. Methods: This is an analytical study with a cross-sectional design. A total of 45 study subjects met the inclusion criteria and exclusion criteria, underwent history taking, physical examination, anthropometry, and laboratory examination to measure parathyroid hormone, hemoglobin, hematocrit, and albumin levels. Data analysis was performed using SPSS. Results: The measured PTH level had a minimum value of 113 pg/ml and a maximum of 595 pg/ml with an average of 431.4. The minimum hemoglobin value is 6.3 g/dl and a maximum of 11.5 g/dl with an average of 7.9, while for the hematocrit the minimum value is 19% and the maximum is 35% and the average is 24.7. The Mann-Whitney U test showed that there is a significant relationship between PTH levels and hemoglobin, indicated by a significant p value of 0.001 (p value < 0.05). A significant relationship was also found between PTH levels and hematocrit (p value = 0.039). Conclusion: Parathyroid hormone has a statistically significant relationship with haemoglobin and haematocrit levels in CKD patients with regular hemodialysis. Keywords: Chronic kidney disease; haemoglobin; haematocrit; parathyroid hormone; anemia; hemodialysis.

The Relationship between Haemodialysis Procedures and Interleukin-6 Levels in Regular Hemodialysis Patients in Haji Adam Malik Central General Hospital

Introduction: Chronic kidney disease (CKD) is kidney damage characterized by the presence of protein in the urine or a decrease in the glomerular filtration rate (GFR). CKD is a global problem throughout the world, including Indonesia, which requires special attention. IL-6 is known to play a role in regulating hemostatic functions, including glucose metabolism, the hypothalamus-pituitary-adrenal (HPA) axis, influencing mood, fatigue, depression, and hematopoiesis. As an inflammatory cytokine, IL-6 is an inflammatory mediator that most plays a role in various conditions, such as infection, autoimmune disease, and cancer. In CKD patients undergoing dialysis (HD), elevated serum IL-6 levels beginning from the start of the treatment is a strong predictor of mortality. The study aimed to determine the association between hemodialysis procedures and interleukin-6 levels in regular hemodialysis CKD patients in Haji Adam Malik Central General Hospital. Methods: This is an analytical study with a cross-sectional design. A total of 20 study subjects met the inclusion criteria and exclusion criteria, underwent history taking, physical examination, anthropometry, and laboratory examination to measure hemoglobin, creatinine, albumin, and IL-6 levels. Data analysis was performed using SPSS. Results: The median level of IL-6 before hemodialysis was 10.39 pg/mL with the lowest level and the highest level being 1.50 – 74.79 pg/mL, the median level of IL-6 after hemodialysis was 29.13 pg/mL with the lowest level and the lowest level. the highest is 2.11 – 316.20 pg/mL. Based on the results of the analysis, the levels of IL-6 after hemodialysis were higher than the levels of IL-6 before hemodialysis, there was a statistically significant relationship between regular hemodialysis and interleukin-6 levels before and after in patients with kidney disease. Conclusion: Regular hemodialysis and interleukin-6 levels have a statistically significant relationship before and after hemodialysis in CKD patients. Keywords: Chronic kidney disease; haemodialysis; interleukin-6.