A case of acute renal failure developing after consumption of fish gall bladder as a food item is reported. The patient recovered fully with conservative treatment and dialysis. The risk of acute kidney injury following ingestion of fish gall bladder, apparently for medical reasons is highlighted.

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BACKGROUND Urinary tract infection is the most common bacterial infection in post-menopausal women. Urine is a good culture medium for the growth of bacteria. This infection can lead to urinary sepsis if not diagnosed with proper clinical and bacteriological evolution. There is a need to study the various typical and atypical presentations of urinary tract infection and probe various microbiological agents causing urinary tract infection. METHODS This is a time bound observational hospital based prospective analytical study conducted in the Dept. of General Medicine, Down Town Hospital, Guwahati, Assam, between Jan 2017 to Dec 2017. 100 patients who showed growth on urine culture were included in the study. RESULTS 100 urine culture positive cases of postmenopausal females aged 45 years and above were included in the study. 76 patients were found to be having complicated UTI whereas 24 patients were having uncomplicated UTI. Fever (37%) is the most common presentation of the patients in UTI, overall as well as individually in uncomplicated UTI while burning urination (30%) is the most common clinical presentation among complicated UTIs followed by pain abdomen (23%). For complicated UTI, diabetes mellitus (46.2%) is most common risk factor. Gram negative organisms are the most common uropathogens as recorded in the study. CONCLUSIONS Present study revealed that clinical presentation is not conclusive but plays a minor role in establishing diagnosis in UTI. Uncomplicated UTI is high among younger females in postmenopausal age group. Complicated UTI is more common among older age group. Fever and burning of micturition are the most common symptoms; combination of symptoms is more predictive of UTI. Diabetes and urogenital instrumentation are the major risk factors for complicated UTI. E. coli is still the most widely prevalent organism causing UTI in the community, and increasing rates of resistant ESBL species are found.

BACKGROUND Chronic renal failure is a progressive decline in renal function with loss of nephrons leading to signs and symptoms of uraemia. CRF affects endocrine systems in multiple ways including abnormal hormone production, metabolism, feedback regulation and altered tissue sensitivity. Thyroid hormones are essential for an adequate growth and development of kidneys; conversely, kidney is not only an organ of metabolism and elimination of thyroid hormones, but also a target of iodothyronine actions. Renal disease leads to significant changes in thyroid function. In CRF, iodide uptake is low due to decreased iodide clearance. Protein loss may alter the binding capacity of hormones and abnormal constituents like urea may blunt the tissue responsiveness to thyroid hormones. The association of different glomerulopathies less frequently tubulointerstitial diseases have been reported with hypo or hyper function of the thyroid. METHODS Patients with chronic kidney disease in Department of Medicine and Nephrology, Down Town Hospital, Guwahati, Assam, were included in the study. Both male and female patients with varying grades of CRF, more than 18 years of age were included in the study. It was cross sectional study. RESULTS Age range in the study varies from 27-87 years. Male patients were 30 accounting for 60% and female patients were 20 accounting for 40%. Creatinine clearance ranges from 3.4 mL/min-32.3 mL/min. Blood urea values varied from 55-257 mg/dL, the mean being 121.04. Serum creatinine levels varied from 1.8-21.16 mg/dL, the mean value being 7.58 mg/dL. The study range of serum T3 was 0.643-2.3 nmol/L, (normal range 1.49-2.60 nmol/L), serum T4 was 37.7-140 nmol/L (normal range 71.2-142 nmol/L) and serum TSH was <0.015->100 micro IU/mL (normal range 0.465-4.68 mIU/mL). In our study 10 patients had low T3 syndrome, 2 patients had low T4 Syndrome, 9 patients had hypothyroidism, 8 patients had subclinical hypothyroidism and 1 patient had hyperthyroidism. CONCLUSIONS In the current study 50 cases with varying grades of chronic renal failure with age >18 years are selected according to inclusion and exclusion criteria as mentioned. The present study is limited in the sense that data comes from a population served in a tertiary healthcare hospital. Therefore, it's not a population-based study. However, the findings of this study will serve to analyse the association between thyroid dysfunction, if any, in chronic renal failure patients.

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