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   2008| October-December  | Volume 18 | Issue 4  
    Online since January 27, 2009

 
 
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ORIGINAL ARTICLES
An assessment of the quality of life in hemodialysis patients using the WHOQOL-BREF questionnaire
BS Sathvik, G Parthasarathi, MG Narahari, KC Gurudev
October-December 2008, 18(4):141-149
DOI:10.4103/0971-4065.45288  PMID:20142925
A cross-sectional study was conducted to evaluate the quality of life (QOL) of hemodialysis patients. An attempt was made to compare the QOL of hemodialysis patients with the QOL of the general population, renal transplant patients, and patients with a chronic disease, in this case, asthma. The WHOQOL-BREF questionnaire was used to assess the quality of life. Hemodialysis patients who had completed three months of maintenance hemodialysis ( n = 75) were enrolled into the study. The quality of life of hemodialysis patients was found to be significantly impaired ( P < 0.05) in comparison to healthy individuals of the general population, particularly with respect to the physical, psychological, and social relationship domains. In comparison to the quality of life of renal transplant patients, the quality of life of hemodialysis patients was significantly ( P < 0.05) lower in all the four WHOQOL-BREF domains. Only in the environmental dimension was the quality of life of hemodialysis patients found to be significantly lower than that of the asthma patients. Female hemodialysis patients showed significantly ( P < 0.05) lower quality of life than did male patients in the psychological and environmental dimensions of WHOQOL-BREF. A positive association was seen between higher education and the psychological functioning and the environmental dimensions of WHOQOL-BREF. Thus, the quality of life of hemodialysis patients was found to be considerably impaired when compared to that of healthy individuals of the general population as well as of renal transplant patients.
  14,015 1,370 9
Effect of cryotherapy on arteriovenous fistula puncture-related pain in hemodialysis patients
PB Sabitha, DC Khakha, S Mahajan, S Gupta, M Agarwal, SL Yadav
October-December 2008, 18(4):155-158
DOI:10.4103/0971-4065.45290  PMID:20142927
Pain during areteriovenous fistula (AVF) cannulation remains a common problem in hemodialysis (HD) patients. This study was undertaken to assess the effect of cryotherapy on pain due to arteriovenous fistula puncture in hemodialysis patients. A convenience sample of 60 patients (30 each in experimental and control groups) who were undergoing hemodialysis by using AVF, was assessed in a randomized control trial. Hemodialysis patients who met the inclusion criteria, were randomly assigned to experimental and control groups using a randomization table. Objective and subjective pain scoring was done on two consecutive days of HD treatment (with cryotherapy for the experimental and without cryotherapy for the control group). The tools used were a questionnaire examining demographic and clinical characteristics, an observation checklist for assessing objective pain behavior, and a numerical rating scale for subjective pain assessment. Descriptive statistics were used as deemed appropriate. Chi square, two-sample and paired t-tests, the Mann Whitney test, Wilcoxon's signed rank test, the Kruskal Wallis test, and Spearman's and Pearson's correlations were used for inferential statistics. We found that the objective and subjective pain scores were found to be significantly ( P = 0.001) reduced within the experimental group with the application of cryotherapy. This study highlights the need for adopting alternative therapies such as cryotherapy for effective pain management in hospital settings.
  6,496 391 2
CASE REPORTS
Blood urea nitrogen/creatinine ratio in rhabdomyolysis
MS Walid
October-December 2008, 18(4):173-174
DOI:10.4103/0971-4065.45295  PMID:20142932
Rhabdomyolysis, a potentially life-threatening syndrome, is not an uncommon condition with around 38,000 cases been reported in the USA in 2000. The risk of developing acute renal failure in the initial days of presentation can be as high as 40% and approximately 28-37% of patients require short-term hemodialysis. This report discusses a case of rhabdomyolysis after seizures in which blood urea nitrogen (BUN), creatinine, and BUN/creatinine levels were examined during the course of illness in the hospital. We found that the BUN/creatinine ratio is not a reliable indicator of renal function in rhabdomyolysis. Potassium levels can be a better marker for the early recognition of acute renal failure and an indication for prompt treatment with dialysis, which is crucial to prevent fatal complications.
  5,791 281 1
ORIGINAL ARTICLES
Pregnancy related acute kidney injury: A single center experience from the Kashmir Valley
M Saleem Najar, A Rashid Shah, IA Wani, A Rashid Reshi, KA Banday, M Ashraf Bhat, CL Saldanha
October-December 2008, 18(4):159-161
DOI:10.4103/0971-4065.45291  PMID:20142928
All patients admitted with pregnancy related acute renal failure (PRAKI) from June 2005 to May 2007 were studied with respect to etiology, clinical features, and outcome of PRAKI. Of 569 cases of acute kidney injury (AKI), 40 (7.02%) cases were related to gestational problems; the age of the patients ranged from 15 to 45 years. Septic abortion was the most common cause of PRAKI, accounting for 20 (50%) cases of which 15 (75%) cases occurred in the first and five (25%) in the second trimester. Other causes were antepartum hemorrhage: six cases (15%), toxemia of pregnancy: six cases (15%), acute gastroenteritis: three cases (7.5%), postpartum hemorrhage: two cases (5%), acute pyelonephritis: two cases (5%), and postpartum, acute kidney injury: one case (2.5%). Dialysis was needed in 60% of the cases and mortality was observed in 20% of the cases. PRAKI continues to be a major concern in our society, causing a high maternal mortality. Septic abortion which has virtually disappeared from developed countries, continues to be a major cause of PRAKI in our society. Hence, there is a need to halt the practice of illegal abortions and improve antenatal care.
  4,573 466 9
CASE REPORTS
Hemolytic uremic syndrome following Hemiscorpius lepturus (scorpion) sting
E Valavi, MJ Alemzadeh Ansari
October-December 2008, 18(4):166-168
DOI:10.4103/0971-4065.45293  PMID:20142930
Scorpion envenomations are a public health problem in many countries. Scorpions are second only to snakes in causing human fatalities from envenomation. Species of scorpions capable of inflicting fatal stings are living in North and South Africa, the Middle East, India, America, Trinidad, and Tobago. Hemiscorpius lepturus (from the Hemiscorpiidae family) is the most medically important scorpion in Iran which accounts for 92% of all hospitalized scorpion sting cases. The venom from H. lepturus is primarily a cytotoxic agent and has hemolytic, nephrotoxic, and to some extent, hepatotoxic activities. We found a combination of microangiopatic hemolytic anemia, thrombocytopenia, and acute renal failure in a seven year-old female child who was referred to us with a 12 h history of bloody urine following a H. lepturus sting. Her blood smear showed fragmented erythrocytes and burr cells, leading us to a diagnosis of hemolytic uremic syndrome (HUS). This report highlights the importance of acceptable prophylaxis and therapeutic protocols for HUS in these patients.
  4,644 304 9
ORIGINAL ARTICLES
Determination of urinary peptides in patients with proteinuria
M Prakash, JK Shetty, S Dash, BK Barik, A Sarkar, R Prabhu
October-December 2008, 18(4):150-154
DOI:10.4103/0971-4065.45289  PMID:20142926
Although considered useful in the diagnosis and prognosis of renal diseases, proteinuria can only be detected after significant renal paranchymal changes. There is considerable interest in the estimation of urinary peptides as an early marker of renal disease. In the current study, we have estimated urinary peptides in patients with different grades of proteinuria. Twenty-four hour urine samples were collected from 138 subjects and classified into three groups based on the urine protein excreted: group I (normoproteinuria, 0-150 mg/day, n = 37), group II (microproteinuria, 150-300 mg/day, n = 31), and group III (macroproteinuria, > 300 mg/day, n = 70). Urine proteins were determined using Bradford's method and urinary peptide levels were determined by subtracting Bradford's value from the Lowry value of the same sample. There was a significant decrease in the levels of urinary peptides in group III compared to group I ( P < 0.01), however, there was no difference in peptides between groups I and II. The percentage of urinary peptides was decreased in both groups II and III compared to group I ( P < 0.01), and there was a significant difference in % urinary peptide content in group II compared to group III ( P < 0.01). On correlation, % urinary peptides correlated negatively with urinary proteins/g creatinine (r = - 0.782, P < 0.01) and positively with urinary peptides/g creatinine (r = 0.238, P < 0.01). Our data suggest that there is a marked decrease in urinary peptide levels with an increase in proteinuria. This may suggest impaired tubular protein reabsorption and degradation capacity of renal tubules.
  3,617 350 -
CASE REPORTS
All that is swollen and red is not infection!
P George, MS Jhawar, B Pawar, A Joseph, U George
October-December 2008, 18(4):162-165
DOI:10.4103/0971-4065.45292  PMID:20142929
Unilateral upper limb extremity swelling and pain are common presentations in clinical practice whose differential diagnoses include cellulitis, abscess, lymphoedema, and venous thrombosis. We report here the case of a renal transplant recipient with an unusual cause of upper extremity swelling and pain. His condition of native radiocephalic, arteriovenous (AV), fistula-related, venous hypertension was misdiagnosed and managed as cellulitis. This case illustrates the importance of an index of suspicion and careful clinical examination for diagnosis and thus, avoid potentially dangerous and distressing symptoms. The patient improved with a surgical AV fistula ligation.
  3,681 247 -
CLINICOPATHOLOGICAL CONFERENCE
Nephrotic syndrome: A twist in the tail
Vinay Sakhuja, Vivekanand Jha, Amanjit Bal
October-December 2008, 18(4):175-182
DOI:10.4103/0971-4065.45296  PMID:20142933
  3,136 457 -
CASE REPORTS
Nephrotic range proteinuria in c-ANCA-positive crescentic glomerulonephritis with linear immune deposits
NP Singh, S Gulati, V Garg, P Beniwal, S Garg
October-December 2008, 18(4):169-172
DOI:10.4103/0971-4065.45294  PMID:20142931
The three broad groups of rapidly progressing glomerulonephritis are anti glomerular basement membrane (anti-GBM) disease, renal vasculitis characterized by antineutrophil cytoplasmic antibody positivity, and a heterogeneous group with granular immune deposits. Anti-GBM disease with cytoplasmic antineutrophilic antibodies (c-ANCA) positivity (type III disease) is not known to present with nephrotic syndrome. We report here a rare presentation of nephrotic syndrome in Type III disease. Larger studies are warranted to determine whether the amount and/or type of immune deposits decide the range of proteinuria. These studies are also required to elucidate the impact of immune complex deposition on renal disease in c-ANCA-positive glomerulonephritis and to outline its pathogenetic mechanism.
  3,147 267 -
Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07