Health Related Quality of Life Among Chronic Kidney Disease Patients Undergoing Hemodialysis in Pakistan.

Background: Hemodialysis is a well-established replacement therapy for patient with end stage kidney disease havin a great impact on the patient’s quality of life. Therefore, the purpose of this study is to identify the health-related quality of life of patients undergoing maintenance hemodialysis. Methods: A cross sectional single centere survey was carried out from March 2018 to June 2018 at Department of Nephrology, Institute of Kidney diseases, Peshawar in Pakistan. A 36 item KDQOL validated Urdu version was used to identify the quality of life of patients. Results: A total of n=184 patients having chronic kidney disease undergoing hemodialysis participated,of whom 63.6% were males and 57.1% patients were Pashtun. A multiple linear regression showed that patients having kidney disease caused due to hypertension had 45% higher kidney disease component summary (KDCS) score while 16% higher physical component summary (PCS) score and 60% higher mental component summary (MCS) score and were statistically significant. Similarly; Peshawari patients had 22% lower PCS score as compared to other ethnic groups ; however, in MCS Peshawari patients had 16% higher score and were statistically significant. Conclusion: The patients have poor quality of life receiving hemodialysis therapy in all three domains like PCS, MCS and KDCS.

Clinical Characteristics and degree of severity of COVID-19 in Hemodialysis Patients in Armed Forces Institute of Urology.

Introduction This study was conducted to evaluate the clinical characteristics and severity of COVID -19 in hemodialysis patients at from 1st March 2020 to 15th August 2020. Methodology It was a prospective and Cross Sectional Observational Study. We collected data prospectively that includes all patients on maintenance hemodialysis and reviewed clinical characteristics of those with laboratory-confirmed COVID-19 between March 1and August 15, 2020. Results 39 out of 268 dialysis dependent patients had COVID-19. Mean age of patients was 55.9yrs. Only 35.8% patients were symptomatic. 15 out of 39 were having mild disease,12 had moderate and 12 had severe disease. Females (54.5%) were found to be more affected than males(45.5%). Dry cough was the commonest symptom (53.8%) followed by fever (46.1%) and abdominal pain(18.1%). Patients with multiple comorbidities were found to have severe disease. Conclusion We concluded that patients receiving maintenance hemodialysis are susceptible to COVID-19 and that hemodialysis centers are high risk for spread of infection. Isolating patients with COVID-19 can help in preventing the spread of COVID-19.

BURKITT’S LYMPHOMA IN KIDNEY: A RARE ENTITY.

Burkitt’s Lymphoma is an aggressive form of Non-Hodgkin’s Lymphoma, with higher incidence in children comprising 30% of pediatric lymphoma. The hallmark of which is a translocation involving c-MYC gene on chromosome 8. Burkitt’s Lymphoma comprises of 6.35% of all lymphoma cases in Pakistan, with male predominance. Lymphoma rarely presents as a primary pathology of acute kidney injury. Burkitt’s lymphoma in adult population is uncommon and few cases have been reported where Burkitt’s lymphoma presents as a cause of acute kidney injury. There are three epidemiological subtypes Endemic (African), sporadic (non-endemic) and immunodeficiency related. Sporadic cases dominate amongst others in Pakistan.

Renal Transplant Pathology Series-V

Not applicable

Chronic hepatitis B virus (HBV) infection presenting as crescentic membranoproliferative glomerulonephritis: A distinctly rare occurrence

Hepatitis B virus (HBV) is a highly prevalent infection worldwide. It primarily infects liver and presents with features of chronic liver disease. Rarely, it presents with extra-hepatic manifestations. Kidney involvement in HBV infection is not uncommon. However, presentation with rapidly progressive glomerulonephritis is distinctly rare. A 40-year-old man with undiscovered HBV infection presented with fever-triggered body swelling for one month. Serum creatinine was 2.3 mg/dl on admission, which increased during hospitalization to 4.5 mg/dl. Renal biopsy demonstrated crescentic membranoproliferative glomerulonephritis, immune complex-mediated. Clinical, laboratory and imaging studies revealed mild chronic liver damage. Complete renal, hepatic and virological remission was achieved with steroids, plasmapheresis and antiviral therapy. This case emphasizes on early diagnosis and institution of multimodal therapy for better outcomes.

Management of Hepatitis C in Dialysis Dependent Patients.

Prevalence of Hepatitis C (HCV) is quite high in Pakistan and in particular among maintenance hemodialysis (MHD) patients. HCV is associated with increasing morbidity and mortality among MHD patients. The current availability of direct acting antiviral therapy has changed the canvas for HCV prevalence in many countries. Aim of our study was to evaluate the status of HCV prevalence and its management at our center. Methods: This descriptive study was conducted at Nawaz Sharif Kidney Hospital Swat, Pakistan to evaluate the seroprevalence of HCV among MHD patients. Data regarding HCV status, PCR positivity and number of patietns on active treatment were evaluated. Results: A total of 109 patients were undergoing MHD in this study. The prevalence of patient who had HCV was 40 (36.6%). All patietns had PCR done and out of them PCR was positive in 28 Patients. All except 4 of the 28 patients had been started on HCV treatment with direct antiviral therapy for HCV. Conclusion: almost all of HCV PCR positive patients were being treated with DAA in our dialysis unit.

Uncontrolled Hypertension and its Contributing Factors in a Tertiary Care Hospital of Lahore, Pakistan.

Hypertension is a major cause of morbidity and mortality worldwide. In spite of the availability of adequate medical therapy, more than half of the patients have blood pressures persistently above the treatment threshold (140/90 mmHg). Objective: To investigate the factors responsible for uncontrolled hypertension. Materials and Methods: It was a descriptive cross-sectional study. The study population comprised of 152 consecutive hypertensive patients more than 18 years of age presenting to the Nephrology Clinic at Fatima Memorial Hospital during the period of one month (July 2020) were included in this study. The criteria for control was defined as an office BP of less than 140/90 mmHg. Results: 96 patients (63.2%) had controlled blood pressure and 56 patients (36.8%) had uncontrolled blood pressure. Males exhibited uncontrolled BP (59%) more than females. Out of all the factors studied, volume status had a significant effect on control of HTN (p=0.003). Conclusion Control of hypertension in our population is still far being perfect. There is a need to fortify our efforts to control hypertension so as to reduce associated morbidity and mortality. At the same time there is a need to conduct large studies to fully elucidate the factors contributing to uncontrolled hypertension in our population.