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Chronic kidney disease (CKD) is progressive loss of renal functions. The degree of renal functions impairment correlates with the severity of renal failure. Hence patient needs renal replacement therapy. Haemo dialysis is one of the renal replacement therapy where in body’s waste products including creatinine, urea and excess water are removed. To study impact of haemodialysis on CKD patients in pre and post heamodialysis periods. This prospective study was conducted on 91 CKD patients from Jan 2017 to June 2019 in the department of Pathology and Nephrology, District hospital Vijayapur. All 91 patients renal functions were studied in pre haemodialysis period (before the first cycle of haemodialysis) and post haemodialysis period (After the last haemodialysis cycle after two half year). Regular follow up of these patients done during study period (Two and half years). Renal functions tests of these patients were assessed by testing the blood urea and serum creatinine and measuring urine outflow levels of each individual by using standard techniques in pre haemodialysis period then comparing those parameters with post haemodialysis period. Improved CKD patients and deaths of CKD patients. Acute Kidney disease patients. All 91(100%) patients renal function tests in pre haemodialysis period were highly impaired. 57 (62.6%) patients were having and high blood urea (150 -20 0 mg/ dl), high serum creatinine (11.1 -14 mg/ dl) and low levels urinary flow (ranging 200 -400 ml / 24 hours). 21 (23.1%) patients were ha ving high blood urea (100 -150 mg/ dl), high serum creatinine (8.1 -11 mg/ dl) and low levels urinary flow (ranging 401 -800 ml / 24 hours). 13 (14.3%) patients were havin g high blood urea (50 -100 mg/ dl), high serum creatinine (5.1-8 mg/ dl) and low levels urinary flow (ranging 801 - 1200 ml / 24 hours).All 91(100%) patients in post haemodialysis period, renal function tests were done. It was found 55 (60.4 %) patients renal functions tests shows significant improvement with haemodialysis therapy. 32(41.7%) patients were showed improved blood urea (121-150 mg/dl), creatinine (7.1-9 mg/ dl) levels and urine outflow levels (400 -800 ml /24 hours). 11(12.1%) patients showed improved blood urea (91-120 mg/dl), creatinine (5.1 -7 mg/dl) and urine outflow levels (800 -1200 ml / 24 hours). 12(13.2%) patients showed improved blood urea(61 -90 mg/dl), creatinine (3.1-5 mg/dl) and increased urine outflow levels (1200 -1600 ml /24 hours).There was significant improvement in blood urea, serum creatinine and urine outflow levels in post haemodialysis period of 91 studied CKD patients when compared with pre haemodialysis period parameters.Major underlying cases for CKD were Chronic Glomerulonephritis in 62(68.1%) patients. There is improvement in renal functions after the haemodialysis therapy. Hence haemodialysis will play a significant role in improvement of renal functions in chronic kidney disease patients.

Metastasis of Gall Bladder Carcinoma (GBC) is very uncommon, aggressive and fatal cancer. World wide incidence rate reported as <2/100000 of all Gastrointestinal tumours. More frequent in women than men, older age more affected and coexisting Gall stonesare seen in majority cases. Because of vague symptoms at early stage tumour will not be encountered, most of the patients present in advanced stage, soprognosis is poor, hence Metastasis of GBC forms a diagnostic and therapeutic challenge. Case Report: A 53 years old male, known diabetic past 10 years presented with intermittent vague symptoms of vomiting, nausea, fever, fatigue, right upper quadrant pain since 3 months. Family history of Gallstones and cancer was present. On examination 2-3 bilateral cervical swellings present, abdominal examination reveals liver was palpable 4 cms below the right costal margin. Relevant investigations done.Complete blood count & Liver function tests were abnormal. Ultrasonography (USG) of abdomen and pelvis, USG guided FNAC of liver, CT of abdomen and pelvis, PET scan of abdomen, Histopathological and Immunohistochemistry report of left supraclavicularlymphnode biopsy were suggestive of metastatic adenocarcinoma of GB origin. After appropriate staging adjuvant chemotherapy started, after third chemotherapy cycle he died of due to metastasis of GBC, two months from his initial diagnosis. Conclusion:In the present study patient was diagnosed in advanced stage, early diagnosis could be missed due to vague symptoms and as GBC is uncommon entity, So proper evaluation of the patient in early stage may prolong the survival.