Abdul Manan Junejo

Jinnah Sindh Medical University

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Hina Iram

Rawalpindi Medical University

Ayesha Ejaz

Shaikh Zayed Medical College and Hospital

Bhagwan Das

Liaquat University of Medical & Health Sciences

Sagheer Ahmed Solangi

Jinnah Postgraduate Medical Center

Shafique A Solangi

Jinnah Postgraduate Medical Center

Sadia Rehman

Bahria University

Muhammad Ali

Shifa International Hospital

Om Lal

Jinnah Postgraduate Medical Center

Shafique Ahmed

Agricultural Research Center

Irfana Hassan

University of Baghdad

Cooperative Institutions

Jinnah Postgraduate Medical Center

Liaquat National Hospital

Jinnah Sindh Medical University

Sindh Institute of Urology and Transplantation

Liaquat University of Medical & Health Sciences

Bahria University

Dow University of Health Sciences

Nishtar Medical College and Hospital

Indira Gandhi Institute of Medical Sciences

Ziauddin University

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CHRONIC KIDNEY DISEASE

The Professional Medical Journal (2018)

Pooran Mal Muhammad Ahsan Mehwish Bukhari Abdul Manan Junejo

INTRODUCTION:Chronic kidney disease (CKD) is a progressive health care issue that is increasing cost burden on patients and health care system. In different researches it was concluded that relatives of patients suffering from CKD are at more risk of development of kidney problems and diagnosed with CKD. OBJECTIVE: To evaluate the early diagnosis of CKD in at risk population by screening the close family relatives of CKD patients. PATIENTS AND METHODS: A cross-sectional screening study of family members of CKD patients performed in Nephrology department of Jinnah Postgraduate Medical Centre (JPMC), Karachi from September 2015 to January 2017. Total 200 relatives (58% male and 42% female) of CKD patients close relatives were enrolled and screened for medical history, physical examination (weight, height and BMI) and clinical investigations such as urine analysis, serum Creatinine and Glomerular filtration rate (GFR) calculated by Cock GraftGault equation for assessment of renal functions.RESULTS: we observed53 abnormalities in relatives of CKD patients. Family history for Diabetes was present in 58(29%) relatives, Hypertension in 42(21%) relatives, 26 (13%) relatives with Glomerulonephritis (GN), and 74 patients (37%) with Tuberculosis (TB), Kidney damage and Stone diseases. Albuminuria was high in 33% relatives of CKD patients, mostly affecting first degree relatives 20.5% as compared to second degree relatives 2.5%. Relatives of CKD patients were diagnosed with high albuminuria in DM (36.2%) as compare to HTN (35.8%) and GN (27.0%). For final diagnosis, albuminuria and CrCl were monitored, that were found abnormalin 26.5% relatives of CKD patients.CONCLUSION:The screened relatives of CKD patients are at higher risk of kidney problems in the future, especially patients suffering from DM, HTN and GN.

Albuminuria

Nephrology

Medical History

10.29309/tpmj/2018.25.09.129

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Citations (2)

Association of visfatin with chronic kidney disease in a cohort of patients with and without diabetes.

PubMed (2010)

Nosheen Mahmood Abdul Manan Junejo Qamar Jamal Rashid Awan

To evaluate association of serum visfatin with CKD secondary to diabetic nephropathy and to compare it with patients of CKD secondary to other risk factors.Seventy eight individuals including 28 healthy controls and 50 patients of CKD were included in this study. Patients with CKD were further grouped based on etiology of CKD into diabetics and non-diabetics. Patients with type 1 diabetes mellitus, urinary tract infection, urolithiasis, liver cirrhosis, stroke, ischaemic heart disease, and rheumatoid arthritis were excluded. Measurement of Serum visfatin was done through EIA Kit (Phoenix pharmaceuticals Burlingame CA).Visfatin concentration was significantly high in patients with CKD compared to controls (8.7 +/- 4.7 vs. 5.2 +/- 3.3 p = 0.001). No significant difference in Visfatin concentrations between patients of CKD with and without diabetes was detected (9.2 +/- 5.5 vs. 8.3 +/- 3.2 p = 0.694). A significant negative correlation of visfatin with estimated GFR (r2= -0.383, p = 0.01) and a positive correlation with degree of proteinuria (p = 0.01) was observed.The present study confirms the association of visfatin with CKD, however further studies at molecular level to check its expression within renal tissue may clarify its definitive role in CKD

Etiology

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Etiology and outcome of acute renal failure in pregnancy.

PubMed (2009)

Irfana Hassan Abdul Manan Junejo Manohar Lal Dawani

To determine the etiology and outcome of Acute Renal Failure (ARF) in pregnancy.A case series.Nephrology Department of the Jinnah Postgraduate Medical Centre, Karachi, from August 2007 to July 2008.Pregnant women who were healthy previously and had developed ARF, diagnosed on oliguria (urine output <400 ml/day) and mounting azotemia (serum creatinine > 2 mg%) were included in the study. Percutaneous renal biopsy was performed for delayed recovery, i.e. after three weeks. Patients were followed up for a period of 6 months. Percentages were calculated for qualitative variables i.e. causes of ARF, mortality, morbidity and outcome in form of complete recovery, partial recovery, demise and non-recovery.A total of 43 patients with pregnancy-related ARF were included in the study. The puerperal group comprised 36 patients (83.7%). Haemorrhage was the etiology for ARF in 25 (58.1%), antepartum haemorrhage APH in 8 (18.6%) and postpartum haemorrhage PPH in 16 (37.2%) of patients. In 12 (27.9%), puerperal sepsis was the etiological factor, while 4 (9.3%) patients had DIC on presentation. Pre-eclampsia, eclampsia and HELLP syndrome accounted for 5 (11.6%). While 1 (2.3%) was diagnosed with hemolytic uremic syndrome and another one was diagnosed as ARF secondary to hypotension produced by hyperemesis gravidarum. Renal biopsy was performed in 31 patients showing that 10 had acute cortical necrosis and 21 had acute tubular necrosis. Maternal mortality was 16.2% (n=7). Of the 36 (83.7%) surviving patients, 18 (41.4%) had complete recovery of renal function; 12 (27.9%) had partial recovery; and 6 (13.9%) required chronic dialysis.Pregnancy-related ARF was associated with poor outcome. Antepartum and postpartum haemorrhage were the most common cause of ARF in pregnancy.

Oliguria

Etiology

Acute tubular necrosis

HELLP syndrome

Hyperemesis gravidarum

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Frequency of electrolyte imbalance associated with cisplatin in oral cancer patients; a tertiary care experience from Pakistan

Journal of Nephropharmacology (2018)

Kashif Gulzar Maseer Ahmed Abdul Manan Junejo

Introduction: Electrolyte imbalance associated with cisplatin is quite prevalent, and increase morbidity in cancer patients. Objectives: To determine the frequency of electrolyte imbalance associated with cisplatin in oral cancer patients. Patients and Methods: Oral cancer patients of more than 16 years of age, who received cisplatin-based cancer chemotherapy, were monitored for electrolyte imbalance (Na, K, Ca and Mg). Patients who were as the known cases of kidney disease (acute or chronic) or those having electrolyte imbalance prior to start of chemotherapy were excluded. Primary outcome was to determine electrolyte imbalance. Results: Among 98 patients, 90 patients developed electrolyte imbalance to cisplatin chemotherapy. The observed electrolyte imbalance included hyponatremia, hypokalemia, hypomagnesemia and hypocalcaemia. Hypokalemia is found to be the most common electrolyte to be affected in the patients (91.8%), whereas hypocalcemia in 88.7%, hypomagnesemia in 67.34% is also observed. Mild hyponatremia is also observed less frequently in 67% of patients. Conclusion: Cisplatin-based chemotherapy has a high potential to cause electrolyte imbalance. Most of the abnormalities were of milder nature and not associated with symptoms. The common electrolyte abnormalities such as hypokalemia, hypocalcemia and hypomagnesemia were statistically significant, but hyponatremia was not statistically significant.

Electrolyte Disorder

Hypocalcaemia

10.15171/npj.2018.26

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THE RELATIONSHIP OF VISFATIN WITH MEASURES OF OBESITY IN PATIENTS OF DIABETIC NEPHROPATHY

Pakistan Journal of Medical Sciences (2010)

Nosheen Mahmood Qamar Jamal Abdul Manan Junejo

Objective: Visfatin is proposed as an adipocytokine secreted from visceral fat and its blood level correlate with obesity, diabetes mellitus and inflammation. Aim of this study was to examine association of serum visfatin with measures of obesity in a group of patients with diabetic nephropathy and normal controls. Methodology: This was a cross sectional study analyzing 60 subjects including 30 patients of diabetic nephropathy and 30 controls. Anthropometric measurements were done using standard methods and visfatin was measured through EIA Kit. Results: Serum visfatin in obese subjects among both groups was not different from non obese subjects (7.9 ±6.1 vs. 6.4 ± 3.2 p=0.238). We found a positive correlation of visfatin with BMI (r=0.313, p<0.05) but no correlation with waist circumference (r=0.148 p=0.695) and waist to hip ratio (0.198, p=0.136). Serum visfatin in subjects of diabetic nephropathy and non diabetics was (9.2 ±5.4 vs. 5.2 ±3.4 p<0.05. Conclusion: Serum visfatin does not correlate with markers of visceral obesity including waist circumference and waist to hip ratio. However, a positive correlation is observed with BMI. Future studies involving larger sample size and quantifying visceral tissue expression of visfatin may explain its potential role in visceral obesity.

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Frequency of Intradialytic Complications in Patients of End-Stage Renal Disease on Maintenance Hemodialysis

Cureus (2021)

Muhammad Ali Ayesha Ejaz Hina Iram Shafique A Solangi Abdul Manan Junejo

Introduction Hemodialysis is a vital management option for end-stage renal disease (ESRD) patients. With adequate hemodialysis, patients can have a good quality of life but complications do occur during the session, which can be minor to life-threatening. The objective of this study was to assess the frequency of acute complications during this procedure. Material and methods An observational, cross-sectional study was conducted at Jinnah Postgraduate Medical Centre, Karachi, Pakistan. Patient data were collected about access, comorbid conditions, frequency and duration of hemodialysis, and intradialytic complications. Those with acute kidney injury were excluded. Results There was a total of 94 patients, with a mean age of 45.51±13.29 years, of which 62 (66%) were males and 32 (34%) were females. Diabetes mellitus was the most common cause of ESRD (47.9%, n=45). Patients on twice and thrice-weekly sessions were 51 (54.3%) and 43 (45.7%), respectively. The most common complication was hypotension (28.7%), followed by hypertension (17%), and nausea/vomiting (11.7%). The arteriovenous fistula was the most common access used (75.5%, n=71). Most patients were found to be on hemodialysis for more than five years (51.1%, n=48). Conclusion Blood pressure changes are critical while performing hemodialysis, just like we found hypotension as the most common intradialytic complication in our results, followed by hypertension. Others were fever, muscle cramps, and nausea/vomiting. a prospective follow-up study shall be done to have comparative and long-term results related to the acute and chronic complications of dialysis.

10.7759/cureus.12641

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Comparison of the Efficacy of Gabapentin Versus Levodopa-C for the Treatment of Restless Legs Syndrome in End-Stage Renal Disease on Hemodialysis Patients

Cureus (2020)

Muhammad Ali Hina Iram Fahad Nasim Shafique A Solangi Abdul Manan Junejo

Objective: We aimed to compare the efficacy of gabapentin and levodopa-c for the symptoms of restless leg syndrome in patients of end-stage renal disease (ESRD) undergoing maintenance hemodialysis therapy. Methods: In this observational, cross-sectional study, patients of ESRD on hemodialysis with restless leg syndrome were included after assessment of symptoms and quality of sleep before the treatment by completing two questionnaires: the International Restless Leg Syndrome Study Group (IRLSSG) questionnaire and the Pittsburgh Sleep Quality Index (PSQI) scale. They were randomly divided into two groups. One group was prescribed levodopa-c (110 mg) as a single dose two hours before bedtime for four weeks. The other group was given gabapentin (200 mg) after each hemodialysis session for four weeks. After the treatment, the patients completed the two questionnaires again: the IRLSSG questionnaire and the Pittsburgh Sleep Quality Index. Results: In our study, men were 14 (53.8%), and women were 12 (46.2%). Gabapentin was given to 14 (53.8%) patients, and 12 (46.2%) patients were prescribed levodopa-c. In the levodopa group, the average baseline IRLSS was 24.333 ± 7.936), and the mean baseline PSQI score was 13.583 ± 3.396. After treatment with levodopa for four weeks, the mean IRLSS was 8.666 ± 3.312, and the mean PSQI score was 4.666 ± 2.839; a P-value of 0.00001 was noted. While in the gabapentin group, the mean baseline IRLSS was 26.071 ± 7.936, and the mean baseline PSQI score was 14.857 ± 3.254. After treatment for four weeks with gabapentin, the mean IRLSS was 5.3571 ± 1.392, and the post-treatment average PSQI was 2.992 (SD: 0.916); a P-value of 0.00001 was noted. Conclusion: Both levodopa and gabapentin effectively relieve symptoms of restless leg syndrome and improve the quality of sleep and life in ESRD patients undergoing hemodialysis.

Restless Legs Syndrome

Bedtime

10.7759/cureus.12034

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Rosuvastatin Therapy in Prevention of Contrast-Induced Acute Kidney Injury in Patients with Chronic Kidney Disease

Asadullah Bhagwan Das Santosh Kumar Abdul Manan Junejo Rafia Memon

Objective: To determine the efficacy of rosuvastatin therapy in prevention of contrast-induced acute kidney injury in patients with chronic kidney disease. Study design: Descriptive cross-sectional study. Place and Duration of Study: Department of Nephrology, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan from 21st January 2020 to 20th July 2019. Methodology: One hundred and twenty-five patients were enrolled. Blood samples and creatinine levels were taken to measure CIN at 48 h and 72 h after PCI to assess the efficacy of therapy. Results: The mean age was 51.1±10.6 years and mean duration of chronic kidney disease was 6.7±3.6 months. Seventy-eight (62.4%) were males while 47 (37.6%) were females. Efficacy of rosuvastatin therapy was found in 97 (77.6%) patients. Conclusion: The efficacy of rosuvastatin therapy is an effective and safe treatment option in prevention of contrast induced acute kidney injury in patients with chronic renal failure. Keywords: Efficacy, Rosuvastatin, Contrast induced nephropathy (CIN), Acute kidney injury, Chronic kidney disease

Nephrology

10.53350/pjmhs2023175216

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Vitamin D Deficiency in End Stage Renal Disease Patients with Diabetes Mellitus Undergoing Hemodialysis

Cureus (2020)

Muhammad Hassaan Ali Ayesha Ejaz Shafique A Solangi Abdul Manan Junejo Mahjabeen Yaseen

Objectives: To assess the association of hypovitaminosis D with diabetes mellitus (DM) in patients with end stage renal disease (ESRD) undergoing hemodialysis. Methodology: This cross-sectional study was conducted at the Jinnah Postgraduate Medical Centre between July 2019 and February 2020. Patients with diagnosed ESRD who were on hemodialysis, with or without concomitant DM were registered. Vitamin D levels were categorized according to the severity of the deficiency or excess as 0-10 ng/mL, severely deficient; 11-20 ng/mL, deficient; 21-32 ng/mL; insufficient, 33-49 ng/mL, adequate; 50-65 ng/mL, optimum; and above that as high. Patients were stratified according to the status of DM. Results: In a total of 80, the mean age was 45.21±12.67 years with 51 (63.75%) males and 29 (36.25%) females. A total of 36 (45%) CKD patients had concomitant diabetes. The median vitamin D levels were 20.25ng/mL. It was found that chronic kidney disease (CKD) patients with concomitant DM had significantly lower levels of vitamin D [15.19±6.83 vs. 30.28±14.22 (p<0.001)]. Out of the 12 patients with a severe deficiency, three-fourths of the population had DM as comorbidity, while in those with ‘deficiency’, 19 (67.9%) had DM. The majority of the patients without DM had adequate or optimum levels of serum 25-hydroxyvitamin D levels. Conclusion: Current study indicated that deficiency of serum vitamin D is associated with concomitant DM in patients with CKD as the majority had a severe deficiency of serum 25(OH)D. Supplemental vitamin D may help correct the deficiency and prevent the associated complications in patients.

Concomitant

10.7759/cureus.11668

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Frequency of Risk Factors and Outcome of Hospital-Acquired Acute Kidney Injury

Cureus (2020)

Hina Iram Muhammad Sajawal Ali Vinod Kumar Ayesha Ejaz Shafique A Solangi

Objective: To determine the frequencies of risk factors and the ultimate outcomes of ccute kidney injury (AKI) among hospitalized patients. Materials and methodology: This prospective, observational study was carried out from September 15, 2018, to March 14, 2019. All admitted patients, both male and female, with AKI, were included. Those with chronic kidney disease (CKD), small size echogenic kidneys (on ultrasonography, performed on admission), and recent history of urological intervention were excluded from the study. All patients were assessed for etiological factors (sepsis, gastroenteritis, surgical, and obstetrical) and outcome (improved, progression to CKD, or expired). Results: Out of a total of 230, most patients were aged between 20-50 years with a mean age of 38.99 ± 7.61 years. Males were 144 (62.61%) and females were 86 (37.39%). About 78 (33.91%) patients were hypertensive while 65 (28.26%) were diabetic. The cause of hospital-acquired AKI was found to be sepsis in most (71.73%, n=165) of the cases, followed by gastroenteritis (10.00%, n=23), surgical (9.56%, n=22), and obstetric (8.69%, n=20) causes. When the outcome was assessed, 10 (4.35%) patients expired, 154 (66.96%) improved completely, while 66 (28.69%) progressed to CKD. Conclusion: This study has shown that sepsis is the most common cause of AKI in patients admitted to the hospital. So we recommend that proper steps should be taken to ensure adequate hospital care for avoiding such outcomes in hospitalized patients, and further decrease mortality.

10.7759/cureus.12001

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Citations (4)