Introduction: Acute kidney injury (AKI) is a common condition and its incidence is increasing . No study has been done so far on this subject in the Armed Forces. This retrospective study is therefore, to find out the incidence, etiology , predisposing factors, diagnostic approach, clinical course and finally outcome of the patients with AKI in this country, in a selected group of patients. Methods: This retrospective cross sectional study was conducted in Combined Military Hospital, Dhaka, from July 2007 to July 2011. Total 105 cases were included in this study. All were adult and their age of distribution was 18-80 years. Cases were studied in terms of etiology, mode of presentation, laboratory findings, management and response to treatment or outcome. Results: Mean age was 47.24+ 18.35 years. Male, female ratio was 3:2. Hypovolemia was the major (23.8%) etiological factor of AKI in this study due to acute gastroenteritis, 14.28% cases were due to different non-steroidal anti inflammatory drugs (NSAIDs), 9.52% cases due to rhabdomyolysis following physical assault and vigorous exercise, 7.61% cases were due to septicaemia, 8.57% cases were due to glomerulonephritis and 6.66% cases due to acute pyelonephritis.6.66% cases developed AKI due to falciparum malaria and 5.71% due to obstructive uropathy. Other causes of AKI in this study are –contrast induced nephropathy 3.8%,postoperative AKI 4.76%,AKI due to vasculitis 3.8%,2.85% cases due to HELLP syndrome,0.95% case due to snake bite and 0.95% case due to thrombotic thrombocytopenic purpura(TTP). Oliguria (66.66%) and oedema (64.76%) were the commonest presentation in this study. Mean blood urea and serum creatinine level on admission being 9134 mg/dl and 4.292.55 mg/dl respectively. Haemodialysis was done in 44 cases, continuous renal replacement therapy (CRRT- continuous venovenous haemodialysis) was given in 6 patients, peritoneal dialysis in 5 patients and 49 cases were managed with conservative therapy alone. Complete recovery occurred in 88 patients, 8 had recovery with residual renal impairment, 6 patients developed end stage renal disease (ESRD) and 3 patients died due to septicaemia and multi-organ failure (MOF). Conclusion: Most of the cases of AKI are preventable if we can take due care of some common health problems like gastroenteritis and at the same time outcome can be rewarding if we can ensure early reporting, quick diagnosis and appropriate management DOI: http://dx.doi.org/10.3329/bjmed.v22i2.13587 Bangladesh J Medicine 2011; 22: 35-40

Introduction: In military environment where musculoskeletal injury is more common, NSAIDs abuse and subsequent AKI carries a special risk. This study of NSAIDs induced AKI was carried out to highlight this issue.Objective: To find out the incidence, risk factors, diagnostic approach, clinical course, management and outcome of patients of Bangladesh Armed Forces.Methods: This longitudinal study was carried out in nephrology centre, combined military hospital (CMH) Dhaka from July 2010 to Jun 2013. Total 59 patients of NSAIDs induced AKI were included in this study. Any patient having pre existing renal pathology or chronic kidney disease was excluded from the study.Results: Total 59 patients were included in this study. Mean age of the patient was 36±7.12 yrs. Forty five patients (76.27%) took NSAIDs at their own and 14 patients (23.73%) were prescribed by physician. Fifty one patients (86.44%) took NSAIDs because of musculoskeletal pain. Dehydration due to physical exertion (30.50%), gastroenteritis (15.25%) and nil per os (NPO) (5.08%) were the common predisposing factors. Common symptoms were swelling of the body (40.67%), headache (32.20%), fatigue (27.11%) and vomiting (13.55%). Oedema was the most common sign (40.67%). Blood urea and serum creatinine were raised in all patients. Treatment includes drug withdrawl (100%), fluid resuscitation (86.44%), fluid restriction (61.01%), short course of steroid (13.55%) and haemodialysis (10.16%). Forty seven patients (79.66%) had complete recovery within two weeks of therapy whereas nine patients (15.25%) required more than two weeks to one month for complete recovery. Three patients (5.09%) developed chronic kidney disease (CKD).Conclusion: NSAIDs induced AKI carries a good prognosis with early diagnosis and proper management and it can be prevented by limiting the availability of over the counter drugs and creating awareness both in physicians and patients.Journal of Armed Forces Medical College Bangladesh Vol.10(2) 2014

In military profession, acute kidney injury (AKI) due to rhabdomyolysis is not uncommon because of its nature of job. This life threatening condition needs early aggressive management in a specialized centre to restore normal renal function. Here we report a case of rhabdomyolysis due to physical exertion who developed acute kidney injury and required haemodialysis. Patient developed hypercalcaemia in his recovery phase which was successfully managed.

Acute kidney injury (AKI) usually detected by s. creatinine, which rises after 48 hrs of insult causes delay in diagnosis and to take preventive or therapeutic measures. Hence amongst many neutrophil gelatinase associated lipocalin (NGAL) is emerging as early, sensitive, and most promising biomarker of AKI both in urine and plasma.This prospective cross sectional observational study was carried out in Combined Military Hospital (CMH) Dhaka from October 2011 to March 2012. A total of willing 100 adult patients undergoing elective coronary angiogram (CAG) with normal kidney function were included in this study. Our study defined contrast induced AKI (CI-AKI) as rise of serum creatinine by >25% or e"0.5 mg/dl from baseline after exposure to contrast media and urine NGAL e"100 ng/ml was taken as cut off value to predict AKI as calculated by ROC curve. The main outcome measures were urine NGAL at 4 hrs and serum creatinine at 48 hrs after CAG. Significant elevation of urine NGAL was noted in 9 patients after 4 hrs of CAG, of them 8 (8%) patients developed raised s. creatinine (AKI) after 48 hrs. Patient demographics and procedural factors were although statistically significant in few instances but none was predictive of AKI. Introduction:The incidence of acute kidney injury (AKI) has reached epidemic proportions worldwide, affecting about 7% of hospitalized patients. In the critical care settings, the prevalence of AKI requiring dialysis is about 6% with a mortality rate exceeding 60%. 1,2 A significant increase in morbidity and mortality associated with AKI has been demonstrated in a wide variety of clinical situations including exposure to radio contrast dye, cardiopulmonary bypass, mechanical ventilation, sepsis etc. The early diagnosis of AKI currently depends on detection of reduced kidney function by the rise in serum creatinine concentration which is a delayed and unreliable measure in acute setting.