Chronic kidney disease (CKD) is associated with a higher risk for stroke in studies from developed countries. This prospective study was conducted to study the clinical profile, management, and outcome of stroke in patients of chronic kidney disease who had been admitted in our institute during the period from December 2004 to December 2006. A higher incidence of stroke was found in men and in the fifth decade of life. Hypertension and diabetes were found in 88.8 and 48.1% of the patients respectively. CKD was detected for the first time during stroke evaluation in 55.5% of the patients. Stroke was due to cerebral infarction in 48.14% and due to cerebral hemorrhage in 40.7% of the patients. Surgical intervention was needed in 14.8% of all patients while stroke was managed medically in the rest. Over 70% of the patients were discharged after they showed improvement in the symptoms.

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We report the case of a 26-year-old female who underwent emergency caesarean section at a private hospital and was referred to the Government Maternity Hospital (GMH), Tiruapti for bleeding per vaginum 4 hours after delivery. She had received one unit of whole blood transfusion outside. Later, whole blood, platelets (n= 1 unit) and fresh frozen plasma (n= 2 units) were transfused over a period of 6 hours at GMH, Tirupati. Two hours there after, she complained of sudden breathlessness with cough. On examination, bilateral basal crepitations and wheezing were noted. Fall in oxygen saturation by pulse oximetry, hypotension, tachypnoea and mild fever were also noted. Chest radiograph showed bilateral frontal opacities. Possibility of transfusion-related acute lung injury (TRALI) was considered. Supportive treatment included supplemental oxygen through oxygen mask followed by assisted mechanical ventilation and the patient improved. The present case highlights the importance of transfusion related adverse events so as to facilitate prompt recognition and appropriate treatment at the right time.

Perinephric abscess is accumulation of pus in the space between the renal capsule and the Geroto's fascia. The pus that accumulates in the perinephric space, may extend in several directions. Extension into the the mediastinum and spinal epidural space is unusual. Such situation is presented in this report.