Introduction: Acute kidney injury (AKI) is a rare complication of pregnancy, but may be associated with significant morbidity and mortality in young and often otherwise healthy women. In a developing countries like Bangladesh due to low resource settings intermittent hemodialysis is the usual mode of renal replacement therapy. It opens up a field of investigation to assess the maternal and renal outcome of pregnancy associated acute kidney injury after getting dialysis. Materials and method: This analytic, descriptive, prospective study was performed over 46 patients with pregnancy associated AKI requiring dialysis during July 2015 to June 2016. Etiology and spectrum of pregnancy related acute kidney injury (PR - AKI) requiring dialysis were assessed and maternal and renal outcome were analyzed. Result : Puerperal sepsis(25, 54.3%) was the most prevalent cause, followed by preeclampsia/ eclampsia, (7,15.2%), septic abortion ( 5 ,10.9%), PPH/APH (5 ,10.9%), sepsis with PPH (2 ,4.3%), HELLP syndrome (1 ,2.2%) and sepsis with HELLP (1 ,2.2%)36 (73.3%) patients remained alive and 10 (22.8%) patients expired. HELLP syndrome and maternal mortality was more commonly observed in dialysis requiring group. Delivery at term was more commonly observed in dialysis requiring group and preterm delidery was more common in dialysis not requiring group. 26(56.5%) patients had delivery at term , 15(32.6%) had preterm delivery and abortion was found in 5(10.9%). Renal out come was better in dialysis not requiring group when compared with dialysis requiring group.Complete recovery was found in 19(52.8%) patient at 3 months follow up, 10(27.8%) had partial recovery seven patients remained dialysis dependent. According to the RIFLE criteria,19 patients were in the Injury category and 27 patients were in the Failure category.Relative risk of mortality in Injury is 0.94 and in Failure is 1.05. Multivariate logistic regression analysis showed that RIFLE classification did not discriminate the prognosis ( p value 0.788) in pregnancy associated AKI requiring dialysis. Conclusion : PR- AKI requiring dialysis is associated with high maternal mortality and poor renal outcome. J Dhaka Med Coll. 2021; 30(2) : 202-207

Background : Chronic renal disease changes both quality and quantity of bone through multifactorial influences on bone metabolism, leading to osteopenia, osteoporosis and increased risk of fracture. The objectives of this cross sectional study are to determine the mean bone mineral density (BMD) and to identify osteopenia and osteoporosis in patients of CKD on maintenance hemodialysis. Methods: Twenty three male and 18 female patients with age between 18 and 50 years were enrolled in this study. The BMD of the lumbar vertebral spine (LV) and the neck of femur (FN) were measured in all patients. Data were analyzed using SPSS version 20.0 software and the level of significance was considered as P <0.05. Results: The mean BMD in the LV (L2-L4) was 1.18 ± 0.19 gm/cm2 in male and 1.04 ± 0.13 gm/cm2 in female patients (P =0.011). The mean BMD in the FN was 0.90 ± 0.19 gm/cm2 in male and 0.77 ± 0.15 g/cm2 in female patients (P = 0.022). Based on the World Health Organization criteria, 26.0% of the male and 22.2% of the female patients in our study had normal BMD; 39.2% male and 38.9%female patients had osteopenia, while 34.8% male and 38.9% female patients had osteoporosis .This study showed a marked decrease in mean BMD in the cortical bone (FN) compared with trabecular bone (LV) (P = 0.001) as well as in female patients on maintenance hemodialysis compared with male patients . Significant negative correlation (r= -0.480; p=0.001) was found between duration of hemodialysis and bone mineral density (BMD) in lumbar spine and femoral neck. Conclusion: The measurement of BMD is a good non-invasive screening test for renal bone disease and that a high number of patients with CKD stage 5 on maintenance hemodialysis have markedly decreased BMD. J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 3-11