Granulomatosis with polyangiitis (GPA) previously known as Wegner’s granulomatosis, is a small vessel vasculitis that preferentially involves capillaries, arterioles and venules, presenting as multisystemic disease classically with alveolar haemorrhage and renal insufficiency. We report a case of GPA diagnosed on history, clinical findings and supported by imaging and very high levels of C-ANCA. Renal biopsy confirmed the typical histopathological findings. We discuss herein the management of the case and review of literature.

Abstract:We report 2 cases of primary hyperoxalurea who presented with refractory anaemia, nephrolithiasis, renal failure warranting repeated renal transplantation in one of the cases. Renal biopsy of the patients revealed crystals of calcium oxalate in the tubules. The same crystals were also visualized in bone marrow biopsy which confirmed the diagnosis of systemic oxalosis. We conclude that Primary hyperoxalurea may rarely cause anemia secondary to calcium oxalate crystal deposition in the bone marrow. DOI

Burkitt’s Lymphoma is an aggressive form of Non-Hodgkin’s Lymphoma, with higher incidence in children comprising 30% of pediatric lymphoma. The hallmark of which is a translocation involving c-MYC gene on chromosome 8. Burkitt’s Lymphoma comprises of 6.35% of all lymphoma cases in Pakistan, with male predominance. Lymphoma rarely presents as a primary pathology of acute kidney injury. Burkitt’s lymphoma in adult population is uncommon and few cases have been reported where Burkitt’s lymphoma presents as a cause of acute kidney injury. There are three epidemiological subtypes Endemic (African), sporadic (non-endemic) and immunodeficiency related. Sporadic cases dominate amongst others in Pakistan.

Liver disorders during pregnancy may have a strong bearing on both mother andthe foetus. Acute Hepatitis E is rightly considered to be an emerging infection. Loco-regionalstudies have shown it to be the most common cause of Acute Hepatitis in pregnant females. Wecarried out our study to elaborate the demographic profile of pregnant females presenting withAcute Hepatitis E along with the fetomaternal outcomes. Study Design: It was a prospective,observational study. Intervention: None. Settings and Participants: Over a period of two years,73 pregnant patients were evaluated by our team in the Department of Gastroenterology forsuspicion of liver disease. Outcomes and Measurement: Data was evaluated for quantitativeand qualitative variables. Outcome of mother, pregnancy and neonates was also recordedwhere available. Results: During the study period 73 pregnant patients presented with liverdisease giving an incidence of 3.6%. Serological evidence of Acute Hepatitis E was found in 50(68.5%) of the patients. Fulminant hepatic Failure developed in 5 (10%) patients. All five patientswith FHF could not survive. There were 4 (8%) intra-uterine deaths, 1 (2%) abortion and 5 (10%)neonatal deaths. Shortcomings: Relatively small sample size. Conclusions: Acute hepatitis Eduring pregnancy predicts poor outcomes for the mothers, foetus and neonates

Catheter related blood stream infections (CRBSI) in patients undergoinghemodialysis frequently results in significant morbidity and mortality. Attempts at prevention ofCRBSI by catheter lock antibiotics, antibiotic combinations or solutions including Taurolidinehave emerged over years. Objectives: To determine the role of taurolidine lock in presentationof Catheter related infection in hemodialysis. Design: Multicentre un-builded, randomizedcontrolled, non-inferiority trail. Period: Jul 2012 to Dec 2013. Setting: Department of Nephrology,Fatima Memorial Hospital UHS Lahore. Methods: It was a multicentre, un-blinded, randomizedcontrolled, non-inferiority trial. Results: Out of 95 patients, total of 38 patients were randomizedinto two groups. In group A catheters were locked with Taurolidine 2% and Heparin (5000IU/ml) equal to the catheter volume according to the protocol. In group B (control) catheters werelocked with Heparin alone. 36 patients completed the study protocol. For primary end pointanalysis (30 days) the mean duration of catheter days was 27.25 + 5.5 days (median 30 days).During this period of follow up only one patient from Group B had CRBSI resulting in a pointincidence of CRBSI of 2.7%. Conclusions: Catheter lock with Taurolidine 2% in combinationwith heparin compared to heparin alone had no additional benefit in prevention of CRBSI. Thishowever needs to be evaluated in a larger study using non cuffed temporary vascular access(TVA).