Introduction: Kidney Biopsy is an important diagnostic tool in Nephrology. It is useful in Nephrology in terms of diagnosis, prognosis and management. There is little information on renal biopsy data from central Nepal. We describe our center`s experience in kidney biopsy in term of histological patterns, complications and outcomes.Methods: We prospectively analyzed the biopsies data of patients over a period of one and half year. All kinds of kidney disease patients were included for kidney biopsy, irrespective of their clinical syndromes and underlying diagnosis.Results: A total of 75 biopsies were analyzed. Majority of them were females; 56% (n=42). Most of the biopsies; 84% (n=63) were from younger subjects ≤ 45 years and majority of them fell in the age group 11-20 years. Most common clinical renal syndrome to undergo biopsy was Sub Nephrotic range Proteinuria in 53.3% (n=40). Among comorbid conditions, 53.3% (n=40) had Hypertension. The most common histological pattern seen was Mesangial proliferative Glomerulonephritis (MesPGN) seen in 24% (n=18). Among complications associated with the procedure, macroscopic hematuria was seen in 6.7% (n=5) cases and clinically significant perinephric hematoma causing pain was seen in 5.3% (n=4). There was no mortality associated with biopsy procedure.Conclusions: Sub Nephrotic range Proteinuria was the commonest clinical renal Syndrome observed. In terms of renal histology, Mesangial Proliferative Glomerulonephritis (MesPGN) was the commonest histological pattern observed. Kidney biopsy is a safe procedure without any significant adverse events.Keywords: Kidney biopsy, sub nephrotic range proteinuria, mesangial proliferative glomerulonephritis

Acute kidney injury (AKI) is a common and major complication of sepsis. Sepsis-induced AKI is associated with higher morbidity and mortality. A prospective study was designed to include all the patients with a provisional diagnosis of sepsis with AKI admitted in our intensive care unit from August 2009 to September 2010. Detailed demographic data including various clinical parameters, co-morbidities, investigations, complications and outcome were entered in a designated proforman and were analyzed. A total of 53 subjects with the provisional diagnosis of sepsis with AKI were included in the study. The majority of patients (60.37%) were female. The mean age of the study population was 45.84 ± 20.5 years. Forty-nine percent of the subjects were <45 years old and 26.4% patients were >65 years. Among the co-morbid conditions, 9.4% subjects had diabetes mellitus type 2. Among the primary causes of AKI, 72% of the cases were due to medical causes, in which pneumonia was the major cause, and 28% were due to surgical causes, in which cholecystitis was the major cause. 47.1% cases expired, 11.3% subjects left against medical advice and 41.5% cases had favorable outcome. Among the expired cases, 20.7% subjects expired within 24 h; for others, the median hospital stay was four days. This prospective study showed that the major causes of AKI were medical illness and pneumonia. Mortality in sepsis-induced AKI is significantly high. This highlights the importance of prevention of AKI in sepsis by early and renal-friendly aggressive treatment of sepsis and the need for improvement in the management of such AKI cases.

Background Peripheral arterial disease is a common condition in the hemodialysis population with an estimated prevalence ranging from 17-48%. Many studies have been conducted to know the prevalence of peripheral vascular disease in hemodialysis population. However no such study has been conducted so far in Nepal.Objective This study was carried out with an objective to assess the prevalence of Peripheral Arterial Disease in End Stage Renal Disease Patients on Hemodialysis.Method Fifty patients with a diagnosis of End Stage Renal Disease (irrespective of the underlying cause), and those who were on hemodialytic support for more than 3 months were studied over a period of one year. Peripheral arterial disease was diagnosed on the basis of the ankle –brachial index, which was the ratio of the resting systolic blood pressure in the arteries of the ankle to that of the brachial artery, measured by using a standard mercury manometer with a cuff of appropriate size and the Doppler ultrasound. Patients with ankle –brachial index ?0.9 were considered positive for peripheral arterial disease.Result A total of 50 End Stage Renal Disease patients were analyzed. The mean age of the patient was 49.81±12.63 years. The age range was from 18- 79 years. Majority of them were males 64% (n=32). Peripheral arterial disease defined by ankle –brachial index ?0.9 was present in 30% (n=15) of patients. The three major cause of End Stage Renal Disease in the study population was Chronic Glomerulonephritis 40 % (n=20), Type 2 Diabetes Mellitus 28 % (n=14) and Hypertension 24 % (n=12). Type 2 Diabetes Mellitus was the commonest cause 53% (n=8) of End Stage Renal Disease in patients with peripheral arterial disease followed by hypertension 33% (n=5). On univariate analysis, peripheral arterial disease was found to be significantly associated with age >40 years (p value= 0.003; OR=14.8; CI=1.75-125.27), Type 2 Diabetes Mellitus (p value= 0.009; OR=5.4; CI=1.44-21.14), parasthesia of lower limbs (p value= 0.001; OR=10; CI-2.31-43.16), and intact PTH >300 ng/ml (p value =0.006; OR=5.7; CI=1.55-21.50). However on multivariate analysis only parasthesia of lower limbs and intact PTH >300 ng/ml were significantly and independently associated with peripheral arterial disease, while other variables were not significant.Conclusion Peripheral arterial disease was common occurrence in End Stage Renal Disease patients on hemodialysis. Ankle –brachial index needs to be included as a routine assessment in End Stage Renal Disease patients to detect peripheral arterial disease at its earliest.Kathmandu University Medical Journal Vol.12(3) 2014; 181-184

Food ingestion is heavily implicated in inducing symptoms of irritable bowel syndrome (IBS) and functional dyspepsia (FD), which affect over one-third of adults in developed countries. The primary aim of this paper was to assess the alignment of dietary assessment and symptom-reporting capture periods in diet-related studies on IBS or FD in adults. Secondary aims were to compare the degree of alignment, validity of symptom-reporting tools and reported significant associations between food ingestion and symptoms. A five-database systematic literature search resulted in 40 included studies, from which data were extracted and collated. The food/diet and symptom capture periods matched exactly in 60% (n = 24/40) of studies, overlapped in 30% (n = 12/40) of studies and were not aligned in 10% (n = 4/40) of studies. Only 30% (n = 12/40) of studies that reported a significant association between food and global gastrointestinal symptoms used a validated symptom-reporting tool. Of the thirty (75%) studies that reported at least one significant association between individual gastrointestinal symptoms and dietary intake, only four (13%) used a validated symptom tool. Guidelines to ensure that validated symptom-reporting tools are matched with fit-for-purpose dietary assessment methods are needed to minimise discrepancies in the alignment of food and symptom tools, in order to progress functional gastrointestinal disorder research.