Acute hydrothorax from peritoneal dialysis successfully treated with new dialysis regime

Hydrothorax is a rare and often unrecognized complication associated with peritoneal dialysis (PD). This is usually due to the presence of pleuroperitoneal fistula. Most nephrologist will choose to cease the peritoneal dialysis and rest the peritoneum. More than often surgical interventions include pleurodesis or thoracotomy will be required. In this report, we reported a patient who developed pleural effusion after starting continuous ambulatory peritoneal dialysis. She was successfully managed by the use of low volume exchange during daytime with avoidance of conversion to haemodialysis or any surgical intervention

A rare case of streptococcus gordonii peritonitis in a patient on peritoneal dialysis

Peritonitis is a known complication among end stage renal disease patients undergoing peritoneal dialysis (PD). Gram positive species such as staphylococcus are commonly grown. However, cultures may yield rare organisms such as streptococcus gordonii; a subgroup of viridians streptococcous. Most causes of PD peritonitis come from touch contamination but streptococcus gordonii causing PD peritonitis is postulated to originate from the oral cavity. We report a rare case of streptococcus gordonii PD peritonitis in our tertiary renal hospital, in a patient with poor dental hygiene. This is the third reported case of streptococcus gordonii PD peritonitis in the literature. We have demonstrated that early identification of the organism and source can lead to successful treatment

Ochrobactrum anthropi bacteremia with variable clinical course: report of two cases

Ochrobactrum anthropi is a rare nosocomial pathogen that is manifesting itself mostly in immunocompromised patients and those with indwelling catheters. Identification of the microorganism is challenging and the ability to survive in aquatic surroundings have made it a clinically significant pathogen. Furthermore, the clinical picture of O. anthropi infection, is not well described. It may manifest in any form of clinical infections though bacteremia is the most common mode of presentation reported in the limited literature. We report here two cases of O. anthropi bacteremia presenting in an immunocompetent and an immunocompromised host respectively with different clinical manifestation and response. In view of the highly variable presentation of O.anthropi, a high index of suspicion must be given to at risks patients to ensure the timely diagnosis and optimal clinical outcome

Dengue fever in end-stage renal failure patient case report and updated literature review in the diagnostic and management challenges

Dengue viral infection is common in tropical and subtropical parts of the world and may lead to death. There are an estimated 390 million cases of dengue viral infections reported worldwide each year, putting 2.5 billion individuals at risk of this arthropod-borne viruses. The cornerstone of its management is prompt diagnosis, appropriate monitoring, and careful fluid replacement. This is particularly difficult in end-stage renal failure (ESRF) patients on maintenance dialysis, as there is a complex issue of the ability of making a prompt diagnosis, the presence of coagulopathy, and the risk of fluid overload due to constant evolving fluid dynamic as part of the dengue fever disease process. There is a serious lack of literature report in the area of dengue infection in ESRF patient. We report a case of a man with ESRF with a delayed diagnosis of dengue viral infection, who admitted at the critical phase of the illness. Despite that, he managed to recover uneventfully with tailored management in his fluid replacement, medication adjustment, and dialysis prescription. Hence, a high index of suspicion is needed when an ESRF patient presents with fever in a dengue-endemic area. A multidisciplinary approach with good collaboration between physician and nephrologist is needed to ensure the best outcome. Renal replacement therapy and medications should be individually tailored according to the patient's clinical condition. We hope that our reported clinical case will contribute to the understanding of the complex issue of management of dengue fever in ESRF patients

Correlates of physical activity level among hemodialysis patients in Selangor, Malaysia.

INTRODUCTION: There is mounting evidence demonstrating the importance of adequate physical activity to promote better well-being among hemodialysis patients. Available data pertaining to the levels of physical activity and its determinants among hemodialysis patients is, however, scarce in Malaysia. The objectives of this study are hence to determine the levels of physical activity and it associated factors among hemodialysis patients. METHODOLOGY: A total of 70 subjects were recruited from three dialysis centres in Selangor. A face-to-face interview was conducted to obtain socio-demographic data and subjects' knowledge on dietary sources. Medical history, biochemical parameters and weight status were obtained from medical records. Physical activity level (PAL) was assessed using the Global Physical Activity Questionnaire (GPAQ). RESULTS: A total of 81.4% and 18.6% of the respondents had low and moderate PALs, respectively. Thus, none of the respondents had high PAL. Serum creatinine, education level, personal income and knowledge score on potassium-related medical complications were factors found to correlate significantly with PAL. Multiple linear regression analysis showed that higher PAL was predicted by a lower knowledge score on dietary sodium source, higher education and higher serum creatinine. CONCLUSION: Despite consistent documentation of the potential positive impact of physical exercise on hemodialysis outcomes, the level of physical activity remains low among these patients. It is hoped that these findings can add to the existing body of knowledge and serve as a supporting document for the formulation of appropriate interventions to improve the status of physical activity among hemodialysis patients in Malaysia

Partially reversible acute renal cortical necrosis secondary to hyperhomocysteinemia - a case report and literature review

Acute renal cortical necrosis (ACN) is a potentially fatal renal condition. Our objective is to report a case of ACN in a young man who had developed premature atherosclerotic vascular disease and required intermittent hemodialysis support. His renal biopsy showed diffuse cortical necrosis. Subsequently, 2 weeks after the renal insult, he developed a cardioembolic stroke and was anticoagulated with low-molecular-weight heparin. Thrombophilia screen revealed elevated serum homocystein and he was treated with folate supplement and vitamin B12 injection. With these treatments, he had partial renal recovery and became dialysis independent. In conclusion, this is a rare case of ACN, which may have occurred as a complication of hyperhomocysteinemia

Pulmonary hemorrhage associated with severe leptospirosis – the role of low dose intravenous methylprednisolone

Leptospirosis has a wide range of presentation which ranges from mild flu-like symptoms, to severe form including renal failure, liver failure, and hemorrhage. Pulmonary involvement can progress from subtle clinical features to life threatening pulmonary hemorrhage and acute respiratory distress syndrome. Although benefits of corticosteroids in adult respiratory distress syndrome have been proven and accepted, evidence for use of corticosteroids in pulmonary leptospirosis is still limited. Given the vasculitic nature of severe leptospirosis, it has been proposed that addition of intravenous corticosteroid therapy, particularly in cases of pulmonary involvement is beneficial. We report a case of leptospirosis with suspected pulmonary hemorrhage which deteriorates after a few days of admission in our tertiary hospital. We have demonstrated that the prescription of a lower dose of corticosteroid than what was widely reported in the literature can equally led to a satisfactory recovery of the pulmonary hemorrhage

Pregnancy and peritoneal dialysis: an updated review

Women who conceive while receiving peritoneal dialysis (PD) are at a high risk of encountering maternal and fetal complications. Although the occurrence of successful pregnancies in women with end-stage renal disease undergoing PD is becoming more common with advancing dialysis technology, women in this population must be monitored by a team of dedicated renal physicians and obstetric teams to ensure the best maternal and fetal outcomes are achieved. Given the haemodynamic advantages of PD over haemodialysis in pregnancy, PD therapy is the favoured renal replacement option in pregnant women with end-stage renal disease. This is particularly true when PD is initiated after conception or if pregnancy occurs within 1 year of starting PD. The management of anaemia, hypertension, dry weight adjustment, and dialysis regimen in a pregnant PD patient will undergo continuous adjustment to maintain haemodynamic and physiologic stability to meet the demands of the pregnancy-associated changes. In this article, the incidence and management of fetal and maternal complications and pregnancy outcomes in women receiving PD are reviewed based on the latest literature available

Cryptococcal meningitis in an immunocompetent swiftlet rancher – first reported case

Cryptococcal meningitis is a central nervous system infection cause by Cryptococcus neoformans. Although Cryptococcus is found in bird droppings, it has never been reported for those ranchers involved in the niche swiftlet ranching industry despite having close proximity with the bird droppings. We present here a case of a 41-year-old healthy swiftlet rancher who presents with a history of prolonged fever, headache and altered behaviour of a month duration. Cerebral spinal fluid analysis revealed the presence of Cryptococcus. He was treated with intravenous am-photericin B and flucytosine and discharged well with fluconazole consolidation therapy for 8 weeks, followed by maintenance therapy for 1 year. We believe this is the first reported case of Cryptococcal meningitis (CM) occurring in an immunocompetent swiftlet rancher. This case should highlight the needs to wear a proper personal protective equipment inside a swiftlet ranch due to the constant exposure to the potential cryptococcal-rich environment. A high index of suspicion, careful history taking and physical examination focusing on neurologic assessment is key to early diagnosis and timely management of CM

Pregnancy and Peritoneal Dialysis: An Updated Review

Women who conceive while receiving peritoneal dialysis (PD) are at a high risk of encountering maternal and fetal complications. Although the occurrence of successful pregnancies in women with end-stage renal disease undergoing PD is becoming more common with advancing dialysis technology, women in this population must be monitored by a team of dedicated renal physicians and obstetric teams to ensure the best maternal and fetal outcomes are achieved. Given the haemodynamic advantages of PD over haemodialysis in pregnancy, PD therapy is the favoured renal replacement option in pregnant women with end-stage renal disease. This is particularly true when PD is initiated after conception or if pregnancy occurs within 1 year of starting PD. The management of anaemia, hypertension, dry weight adjustment, and dialysis regimen in a pregnant PD patient will undergo continuous adjustment to maintain haemodynamic and physiologic stability to meet the demands of the pregnancy-associated changes. In this article, the incidence and management of fetal and maternal complications and pregnancy outcomes in women receiving PD are reviewed based on the latest literature available