BackgroundFor peritoneal dialysis patients, the likelihood of conception is low and the probability of getting through the pregnancy successfully is even lower. Almost 60 years after the first reported case of a successful pregnancy in a dialysis patient, many issues concerning pregnancy in dialysis patients remain unresolved. Our patient’s pregnancy is considered high risk as she has end stage renal failure and falls in the category of advance maternal age for pregnancy. We describe here the course of her uneventful pregnancy which we hope will contribute to the overall knowledge and management of pregnancy in elderly patients receiving peritoneal dialysis.Case presentationWe report a successful elderly multigravid pregnancy, in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD). Her pregnancy was detected early and she was closely managed by the nephrologist and obstetrician. She tolerated the same PD prescription throughout 36 weeks of pregnancy with daily ultrafiltration of 500-1500mls. Her blood pressure remained well controlled without the need of any antihypertensive medication. Her total Kt/V ranged from 1.93 to 2.73. Her blood parameters remained stable and she was electively admitted at 36 weeks for a trans-peritoneal lower segment caesarian section and bilateral tubal ligation.ConclusionsAt the age of 42, our case is the oldest reported successful pregnancy in a patient on peritoneal dialysis. With careful counselling and meticulous follow up, we have shown that woman in the early stage of end stage renal failure can successfully deliver a full term baby without any complications. Therefore, these women should not be discourage from conceiving even if they are in advanced maternal age for pregnancy.

Pleural effusion or hydrothorax is a relatively rare but well-recognized complication associated with peritoneal dialysis (PD). We describe the successful long term resolution of a patient who developed pleural effusions after starting continuous ambulatory peritoneal dialysis (CAPD), by altering the PD prescription to normal volume daytime ambulatory peritoneal dialysis (DAPD) transiently before resuming the usual CAPD exchanges four months later. After 8 years of follow up, there is no sign of recurrence of the effusion. Normal volume DAPD present as an attractive alternative and cheap method for resolution of pleura-peritoneal fistula.

There have been only 5 reported cases of Roseomonas peritonitis in peritoneal dialysis (PD) patients (1-4). Our 61-year-old patient on continuous ambulatory PD (CAPD) presented with asymptomatic, cloudy peritoneal dialysate. Intraperitoneal (IP) cloxacillin and ceftazidime was initiated. Blood test results were as follows: C-reactive protein 168 mg/L, white cells 15.4 × 10 9 /L. Dialysate cell count was 40 cells/ mm 3 , predominantly polymorphs. Dialysate fluid cleared up on day 3, with corresponding negative cell counts. Peritoneal dialysate culture grew Roseomonas gilardii on day 6, resistant to ceftazidime, cefeperazone and piperacillin, and sensitive to amikacin, gentamycin, imipenem, ciprofloxacin, cefepime, and meropenem. Clinical improvement led to continuation of IP ceftazidime and cloxacillin. Two days later, dialysate cell counts rebounded to 180 cells/mm 3. The patient was switched to 2 weeks of IP meropenem and was allowed to go home with improving parameters. She was readmitted on day 22 day for culture-negative PD peritonitis that we suspected was due to inadequately cleared Roseomonas gilardii. Despite treatment with multiple IP antibiotics, the catheter was not salvageable. Ours is the second case of Roseomonas gilardii peritonitis ever reported. Roseomonas is associated with contaminated water source and soil (1,2). Our patient was washing her hands under unhygienic circumstances. Roseomonas peritonitis presents with vague abdominal pain (1-3). Despite 2 weeks of antibiotic treatment, half of the patients in reported cases relapsed within 4 weeks and a third ended up with catheter removal (3,4). Patients with culture-negative peritonitis or with a recent history of Roseomonas infection may benefit from early addition of aminoglycosides, carbapenems, or fluoroquinolones. We therefore suggest IP antibiotic therapy for a minimum of 3 weeks for Roseomonas peritonitis. Relapses must be treated aggressively to avoid refractory peritonitis that will lead to catheter removal and septicemia.

Centre, NPRA from 2000 to 2016 were extracted. Reports of all druginduced AKI were analysed. Reports with missing data and with more than one suspected causative agent were excluded from analysis. Results: From 2000 to 2016, a total of 616 reports of drug-induced AKI were received. There was an increasing trend in the incidence of druginduced AKI cases from 2000 to 2014 before the incidence began to decline. Drug-induced AKI reports accounted for 0.51% of all reports for 2000-2001 and only began to decline to 0.03% in 2016. Males accounted for 60.2% of the reports and the mean age was 48.27AE23.11 years. Penang reported the highest number of druginduced AKI (13.5%) followed by Johor at 11.5%. The drug class having the highest number of reported AKI was renin-angiotensin system blockers (23.2%), followed by non-steroidal anti-inflammatory drugs (9.6%) and aminoglycosides (8.3%). Among the antimicrobial agents (n¼ 225), vancomycin was ranked the second highest drug reported to cause kidney injuries (n¼37, 16.4%) after aminoglycoside, followed by 30 cases caused by conventional amphotericin B (13.3%) while polymixin B/colistin contributed to 4% (n¼9). Methotrexate was responsible for 4.7% (n¼29) while radio contrast agents accounted for only 1.5% of the total cases reported. Hypertension was found to be the most common indication of drugs causing AKI at 128 (20.8%) cases. There were 35 (5.7%) deaths associated with drug-induced AKI. However, the rates of death declined from 2.76% during years 2000-2004 to zero cases during years 2015-2016. The majority of the druginduced AKI outcomes were unreported (n¼291, 47.2%). Conclusion: There was a declining trend in drug-induced AKI reporting in Malaysia in recent years. Aminoglycosides and renin-angiotensin system blockers appeared to be the main causative drug groups. Identifying high risk patients with prompt cessation of the offending drug are the key to managing AKI before the injury causes permanent damage to the kidneys.

EF < 35%) (10.99% vs. 4.31%; p<0.001) and with higher pre-operative creatinine (median 90.5mmol/L vs. median 79mmol/L; p<0.001). These observations probably explained the higher incidence of AKI among diabetic patients. Interestingly, mortality rate for diabetics and non-diabetics were comparable in our population (5.8% vs. 6.1%). There was also no significant difference in renal recovery and length of hospital stay. Conclusion: Patients with diabetes were found to be at higher risk of developing AKI after cardiac surgery. However, with appropriate management, the mortality rate, length of hospital stay, and renal recovery were comparable between diabetics and non-diabetics.