We describe a patient who presented with acute onset of abdominal pain, oliguria, gross hematuria and uremia. Further examination revealed spontaneous intraperitoneal rupture of the urinary bladder. Upon repair of the rupture, his biochemistry normalized within 24 h. Acute renal failure is characterized by an abrupt decline in glomerular filtration rate (GFR), biochemically reflected by elevation in serum creatinine level. It usually displays multifactorial etiology and can be classified as prerenal, renal and postrenal. In this case report, we describe a situation in which the increase in serum creatinine level was not related to any of these factors and was associated with normal GFR and absorption of urine across the peritoneal membrane following spontaneous rupture of bladder.

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Acute Renal Failure (ARF) in the immediate post transplant period is most commonly due to acute tubular necrosis, acute cellular rejection and calcineurin inhibitor toxicity apart from usual prerenal and post renal causes. In this report, we discuss an interesting and unusual cause of ARF due to thrombotic micro angiopathy in the immediate post transplant setting.

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Background and Aim: To assess the autonomic nerve functions in latent and manifest patients of acute intermittent porphyria. The aim of the present study was to study cardiovascular responses to autonomic nerve functions in patients of acute intermittent porphyria, we also tried to find out the relative sensitivity of the various tests employed to study cardiac dysautonomia in these cases. Methods: The study was carried out on thirty cases of acute intermittent porphyria to assess the cardiovascular reflexes. Twenty five healthy subjects closely matched for age and sex served as control. The cases were diagnosed by modified Watson Schwartz test, the cases of acute intermittent porphyria were divided into three groups. Results: The values of different autonomic nerve function tests were compared with control group and among the different groups of patients. The results were complied, compared and a conclusion was drawn. Immediate heart rate response to standing is more sensitive test than the Valsalva maneuver. Immediate heart rate response to standing is more sensitive and quite reliable which can easily be performed at bed side or even in outpatient departments, the test is simple and non-invasive. In our opinion, the test, beat to beat variation of heart rate to single deep breath is though easy to perform and more understandable, but lacks the sensitivity of other two tests. Conclusion: Significant cardiac dysautonomia is present in asymptomatic group, it is more marked in acute attack group. Immediate heart rate response to standing could be a more sensitive and reliable test in this dysfunction.