Hyponatremia

The prevalence of chronic kidney disease (CKD), especially the early stages, is still not exactly known. This is also true for CKD stage 3, when cardiovascular and other major complications generally appear. The NANHES data have shown a steady increase in the prevalence of CKD 3 up to 7.7% in 2004. Chronic kidney disease and renal failure are underdiagnosed all over the world. In Italy, prevalence estimates for stage 3 to 5 CKD are around 4 million yet, less than 30% of these subjects are believed to be followed at nephrology clinics. This means that in Italy for every dialyzed patient there are about 85 individuals with possibly progressive kidney disease, while fewer than five (mainly stage 4 and 5 patients) are actually followed by a nephrologist.

Prevalence of chronic kidney disease

Recommendations concerning fluid management have been modified to reflect recent findings from a randomized controlled clinical trial showing no difference in cerebral injury in patients rehydrated at different rates with either 0.45% or 0.9% saline. This article is protected by copyright. All rights reserved.

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state.

Durante la ultima decada el campo del aprendizaje multimediado ha emergido como una disciplina coherente basada en la investigacion. El Manual presenta un panorama actualizado y comprensivo de ambos. Este tipo de aprendizaje tiene lugar a traves de palabras (textos orales e impresos) e imagenes (ilustraciones, fotografias, mapas, animaciones, video). El Manual se centra en el modo en que se aprende con estos recursos en contextos mediados por la computadora.

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The Cambridge Handbook of Multimedia Learning

aDivision of Endocrinology, Boston Children’s Hospital, Boston, MA, USA; bBarts Health NHS Trust, Royal London Hospital, London, UK; cInstitute of Endocrinology and Diabetes, The Children’s Hospital at Westmead; School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia; dOxfordshire Children’s Diabetes Service, Oxford Children’s Hospital, Oxford, UK; eSection of Endocrinology, University of California, Davis School of Medicine, Sacramento, CA, USA; fPediatric Endocrinology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India; gEndocrinology Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore; hDepartment of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya ; iDepartment of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA; jDivision of Endocrinology, Diabetes and Metabolism, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA and kDepartment of Pediatrics, NU Hospital Group, Uddevalla and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden

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Diabetic ketoacidosis and hyperglycemic hyperosmolar state

The sixth annual report of the South African Renal Registry summarises the 2017 data on renal replacement therapy (RRT) for patients with end-stage renal disease (ESRD) in South Africa. In December 2017, the number of patients with ESRD who were treated with chronic dialysis or transplantation stood at 10 744, a prevalence of 190 per million population (pmp). The growing prevalence observed since the registry was established is due mainly to the increasing numbers of patients accessing haemodialysis in the private sector, where the prevalence was 855 pmp. In the public sector, which serves 84% of the South African population, the prevalence of RRT (66 pmp) remained below the level reported for 1994, so that the disparity in access continued to increase. The disparities between provinces remained, with Limpopo and Mpumalanga the most under-served, as did the disparities between ethnic groups, with Blacks being the most under-served group. The Western Cape was the province with the highest public sector treatment rates and was also where most of the country’s public sector kidney transplants were performed.

South African renal registry annual report 2012

There are four themes in this teaching exercise for Professor McCance. The first challenge was to explain how a premature infant with Bartter's syndrome could survive despite having such a severe degree of renal salt wasting. Second, the medical team wanted to know why there was such a dramatic decrease in the natriuresis in response to therapy, despite the presence of a permanent molecular defect that affected the loop of Henle. Third, Professor McCance was asked why this patient seemed to have a second rare disease, AQP2 deficiency type of nephrogenic diabetes insipidus. The fourth challenge was to develop a diagnostic test to help the parents of this baby titrate the dose of indomethacin to ensure an effective dose while minimizing the likelihood of developing nephrotoxicity. The missing links in this interesting story emerge during a discussion between the medical team and its mentor.

Antenatal Bartter's syndrome: why is this not a lethal condition?

A 22-year-old male developed a severe degree of metabolic acidosis (plasma pH 7.20, bicarbonate 8 mmol/l), with a large increase in the plasma anion gap (26 mEq/l). Ketoacidosis was suspected because of the odour of acetone on his breath and a positive qualitative test for acetone in plasma (to a 1:4 dilution). Later, his plasma beta-hydroxybutyrate concentration was found to be 4.5 mmol/l. After receiving an infusion of 1 l of half-isotonic saline and 1 l of 5% dextrose in water over 24 h, as well as curtailing his large oral intake of sweetened beverages, all blood tests became normal. Diabetic ketoacidosis, alcoholic ketoacidosis, starvation ketosis and hypoglycaemic ketoacidosis were all ruled out, and his toxin screen was negative for salicylates. Finding another possible cause for ketoacidosis became the focus of this case.

An unusual cause for ketoacidosis.

The prevalence of chronic kidney disease (CKD) is increasing worldwide and in Africa. Health related quality of life (QOL) has become an essential outcome measure for patients with CKD and end stage renal disease (ESRD). There is growing interest worldwide in QOL of CKD patients but paucity of data in Ghana. This study sought to assess QOL in patients with moderate to advanced CKD (not on dialysis) and establish its determinants. We conducted a cross sectional observational study at the renal outpatient clinic at Komfo Anokye Teaching Hospital (KATH). We collected demographic, clinical and laboratory data. A pretested self-administered Research and Development corporation (RAND®) 36-Item Health Survey questionnaire was administered and QOL scores in physical component summary (PCS) and mental component summary (MCS) were computed. Determinants of QOL were established by simple and multiple linear regression. P value of < 0.05 was considered statistically significant. The study included 202 patients with CKD not on dialysis. There were 118(58.5%) males. Mean age was 46.7 ± 16.2 years. The majority, 165(81.7%) of patients were on monthly salaries of less than GHS 500 (~USD 125). Chronic glomerulonephritis was the most common cause of CKD in 118 (58.5%) patients followed by diabetes mellitus in 40 (19.8%) patients and hypertension in 19 (9.4%) patients. The median serum creatinine was 634.2 μmol/L (IQR 333–1248) and the median eGFR was 7 ml/min/1.73m2 (IQR 3–16). The most common stage was CKD stage 5 accounting for 143 (71.1%), followed by CKD stage 4 with 45 (22.4%) of cases and 13 (6.5%) of CKD stage 3. The overall mean QOL score was 40.3 ± 15.4. MCS score was significantly lower than PCS score (37.3 ± 10.8 versus 43.3 ± 21.6, P < 0.001). Multiple linear regression showed that low monthly income (p = 0.002) and low haemoglobin levels (p = 0.003) were predictive of overall mean QOL. Patients with moderate to advanced CKD had low-income status, presented with advanced disease and had poor QOL. Anaemia and low-income status were significantly associated with poor QOL.

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Quality of life among patients with moderate to advanced chronic kidney disease in Ghana - a single centre study

A 7-year-old, 20 kg female had a 2 week history of polydipsia, polyuria and a weight loss of 2.5 kg. She was drowsy, but easily roused and answered questions appropriately. Blood pressure was 100/60mmHg, heart rate 148/min, respiratory rate 12/min, capillary refill >3 s and tissue turgor was poor. There was no urine output in the first 2 h (a Foley catheter was inserted). Laboratory data are summarized in Table 1. Based on this information, 98 adult and paediatric medical specialists were asked to assess her degree of extracellular fluid (ECF) volume contraction (Table 2).

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Mogamat Razeen Davids

Papers

South African renal registry annual report 2012

Antenatal Bartter's syndrome: why is this not a lethal condition?

An unusual cause for ketoacidosis.

Quality of life among patients with moderate to advanced chronic kidney disease in Ghana - a single centre study

Assessing the degree of extracellular fluid volume contraction in a patient with a severe degree of hyperglycaemia