Ocular Fundus Abnormalities in Pre-Dialytic Chronic Kidney Disease Patients

Background: Chronic kidney disease (CKD) affects 10% - 16% of the adult population. Although ocular findings related to renal insufficiency include cataract, conjunctival calcification, lid edema, conjunctival pallor and xanthalesma, by far the most important is retinopathy. Objective: To evaluate the ocular fundus abnormalities in pre-dialytic chronic kidney disease patients of the adult population. Methodology: This cross-sectional observational study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from April 2012 to March 2014. A total of 100 hospital admitted CKD patients were purposively selected for this study. Age, gender, blood pressure, Body Mass Index (BMI), 24 hours Urinary Total Protein (UTP), haemoglobin level, serum creatinine, serum cholesterol, serum triglyceride and color fundus photography findings of both eyes were recorded for each patient. Inter-group comparisons were made between patients with retinopathy and those without retinopathy. Results: Out of 100 adult non-dialytic CKD patients, 43 (43%) had ocular fundus abnormalities, among them 27 (62.8%) were male and 16 (37.2%) were female. The risk of development of retinopathy was significantly higher among older patients (p = 0.006), those with low haemoglobin level (p = 0.0001) and high blood pressure. Retinopathy was significantly (p = 0.0001) increased with reduction of e-GFR. There was no relationship between BMI and high serum triglyceride level with retinal abnormality. Among 43 (43%) patients with retinal abnormality, 30 (69.76%) patients showed only hypertensive retinopathy and 5 (11.6%) patients showed only diabetic retinopathy. Mixed hypertensive and diabetic retinopathy was found in 8 (18.6%) patients. Maculopathy was seen in 11 (25.58%) patients, of whom 3 (6.98%) had hypertensive retinopathy and 8 (18.87%) had diabetic retinopathy. Optic atrophy was seen in 2 (4.6%) patients and drusen like retinal deposits were seen in 2 (4.6%) patients. Conclusion: Ocular fundus abnormalities are common among adult pre-dialytic CKD patients. Retinopathy is significantly higher in advanced stages of CKD.

Awareness of Chronic Kidney Disease among Patients Attending Tertiary Care Hospital in Bangladesh

Background: Patients with chronic kidney disease (CKD) are at increased risk of morbidity & mortality. Educational interventions aimed at empowering patients are successful in chronic disease management including CKD. Objective: To explore the awareness regarding CKD among patients attending in a tertiary care hospital in Bangladesh. Methodology: This was a descriptive observational study, which includes 100 adult patients attending the department of Medicine in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2013 to June 2013. Data were collected on a pre-tested questionnaire by face-to-face interview to investigate awareness toward: 1) basic knowledge of personal health;2) perceptions of factors increasing the risk of CKD;3) knowledge of therapies to slow CKD progression;4) perceptions of CKD increasing the risk of other medical conditions and 5) demographic information. Main outcome variables were demographic parameters, socio-economic status and awareness about chronic kidney disease. Data were analyzed and compared by statistical tests. Results: Almost one third (32.0%) respondents were in 3rd decade and male to female ratio was 1:1.5. Majority (43.0%) patients came from lower-middle income family. In all age groups, the majority (60%) respondents had low knowledge of CKD. Among the study population, 44.0% believe that smoking increases risk of CKD;42.0% believe that restricting salt intake reduces the progression of CKD;34.0% mention that CKD increases the risk for hypertension and 82.0% mention that renal transplantation is the treatment of choice in CKD. Among the participants, 32.8% had knowledge of increasing risk factor of CKD, 30.8% had knowledge of the method of slow progression of CKD, 30.3% had knowledge of conditions for increase risk of CKD and 41.7% respondent had knowledge of treatment of CKD. Conclusion: Most of the study participants had inadequate knowledge of CKD. Lack of CKD screening and educational programs have contributed to the inadequate patient knowledge about the condition.

Non-Diabetic Renal Disease in Patients with Type 2 Diabetes Mellitus with Proteinuria

Background: Diabetes mellitus (DM) is the leading cause of end stage renal disease (ESRD) worldwide. Although DM with proteinuria is the ultimate result of diabetic nephropathy (DN), a wide spectrum of non-diabetic renal diseases (NDRD) can occur in such patients. Objective: To observe the frequency and histological pattern of NDRD in diabetic patients with proteinuria and to explore their association with clinical and laboratory parameters. Methods: This cross-sectional study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from April 2016 to September 2017. In this study a total of 38 cases of DM with proteinuria (>1 gm/24-hour) were selected purposively. Renal biopsy was done in all patients. Based on histological findings they were categorized into two groups;Group 1 with NDRD and Group II with DN. Their clinical and laboratory parameters were analyzed and compared. Results: Among the total study subjects, 21 (55.3%) were male and 17 (44.7%) were female, mean (±SD) age 43.45 ± 9.99 years in the NDRD group and 41.57 ± 9.50 years in the DN group. Thirty one cases (81.6%) out of thirty eight had NDRD and seven (18.4%) cases had isolated DN;therefore more than two third cases had NDRD. Duration of DM was found to be significantly shorter (p = 0.004) in the NDRD group. Diabetic retinopathy was present in 12.9% cases in NDRD group vs. 57.1% cases in DN group (p = 0.025). Frequency of microscopic hematuria was significantly higher (90.3%) in NDRD patients (p = 0.002). Conclusion: The frequency of NDRD in type 2 diabetic patients other than diabetic nephropathy is relatively high. Membrano proliferative glomeru-lonephritis and membranous nephropathy are more common in NDRD. Absence of diabetic retinopathy, presence of hematuria and shorter duration of DM are markers associated with NDRD in type 2 DM, which are important indicators for renal biopsy in diabetic patients with proteinuria.