Chulananda D. A. Goonasekera

Vesicoureteric reflux and reflux nephropathy

Reflux nephropathy i.e. renal scarring associated with vesico-ureteric reflux (VUR) and urinary tract infection (UTI) was originally considered an acquired disease. The renal scarring seems to get worse with recurrent urine infections especially in the young. Therefore, in the past much effort was undertaken to correct the VUR surgically and minimize the number of recurrent urinary tract infections by antibiotic prophylaxis with the hope of reducing if not arresting the onset of complications that follow i.e. hypertension and renal failure. However, it is now becoming clear that reflux nephropathy encompass at least two major categories of disease; “acquired” renal scarring secondary to UTI and VUR predominantly affecting females and “congenital” scarring with dysplastic features associated with prenatal VUR but with no infection and predominantly affecting boys. The latter is much less common but is disproportionately represented in the group of patients with reflux nephropathy that go on to develop renal failure. Unfortunately, the susceptibility to renal scarring, the onset of hypertension and progression to renal failure seems to be significantly influenced by genetic factors and hence measures undertaken to prevent recurrence of UTI may not change the ultimate outcome although it will certainly improve the comfort of the individual. Therefore, the extensive investigation and management routines adopted today in these children may not be cost-effective in preventing end stage renal disease in VUR. The progression to renal failure, however, can be delayed but not halted with adequate control of high blood pressure and hence the need for life long follow-up.

Spot Urine Osmolality/Creatinine Ratio in Healthy Humans

Background: Spot urine albumin/creatinine ratio is a reliable estimate of 24-hour urine albumin excretion. In a pilot study, we observed that the spot urine osmolality/creatinine ratio (Uosm/Ucr) in healthy adults is reproducible. Therefore, we postulated that Uosm/Ucr of a spot urine sample may give an overall estimate of urinary excretion of solutes, renal concentrating ability and body hydration status. Method: Early morning spot urine samples were collected from healthy humans, frozen and analyzed in batches to establish spot Uosm/Ucr and its variation in relation to sex, age, body weight and height. Results: Two hundred and twenty-nine healthy volunteers participated. They were stratified into seven age groups: (a) 1.5–5, (b) >5–10, (c) >10–20, (d) >20–30, (e) >30–45, (f) >45–60, and (g) >60 years. Fifteen males and 15 females were allocated to each age category. A spot urine sample was collected from all subjects in the morning after the first void and was analyzed for osmolality and creatinine. The influence of age, sex, body weight and height on spot Uosm/Ucr was investigated using multiple linear regression. Only height showed a significant correlation (R2 = 0.02). Further analysis after excluding the 1.5–5 years age group revealed no significant correlation between age, sex, body weight and height and the Uosm/Ucr ratio. Conclusion: Spot Uosm/ Ucr of healthy humans is a consistent index in steady state and needs no correction for sex, age and body weight above the age of 5 years.

Peritoneal Dialysis in Dengue Shock Syndrome May Be Detrimental

Dengue shock syndrome is the most severe form of Dengue that can be fatal. Nonresponders to standard therapy need intensive care. This paper outlines the clinical features, complications, and outcomes of Dengue Shock Syndrome not responding to standard therapies and needing supportive care in a tertiary referral intensive care unit of a developing country. Nearly one-third die within 3 days of admission to ICU. Peritoneal dialysis predicts the worst outcomes.

Carbapenem induced convulsions in the critically ill – A case series.

Carbapenem induced convulsions are said to be commoner amongst critically ill patients. During a 1½ year study period we observed 4 of 15 patients receiving meropenem and 3 of 7 patients receiving imipenenm develop convulsions in an intensive care unit. The withdrawal of the offending drug rapidly resolved the problem in all but one. DOI: http://dx.doi.org/10.4038/sljcc.v2i1.2265 Sri Lanka Journal of Critical Care Vol.2(1) 2011 13-15