Browsing by Author "Shah, DS"
Now showing 1 - 7 of 7
Results Per Page
Sort Options
Publication Dialysis adequacy in ESRD patients on maintenance hemodialysis in a tertiary care center(Institute of Medicine, 2017) Baral, S; Pant, V; Shah, DSAbstract Introduction: Assessment of the hemodialysis adequacy is one of the key factors for measurement of quality of life in end stage renal disease since it can predict the outcome of this disease. In this study, we aimed to evaluate hemodialysis adequacy in Institute of Medicine, Kathmandu. This would provide a good background for effective future planning by healthcare authorities. Methods: This is a cross-section observational study done in Hemodialysis Unit, Tribhuvan university teaching hospital, Kathmandu, a tertiary level referral hospital in Nepal. Hemodialysis sessions of 50 patients on maintenance hemodialysis were evaluated after written consent Demographic data along with length of hemodialysis, reuse of hemodialyzer, hemodialysis sessions per week and hemodialyzer membrane type were recorded for each patient. Urea reduction ratio (URR) and single pool kT/v (spKt/v) were calculated to determine hemodialysis adequacy. Results: Bicarbonate-based solutions and low-flux membranes was used in all patients. Length of each hemodialysis sessions was 240 minutes. Thirty-nine (78%) patients were male and eleven (22%) patients were female. The mean spKt/V and URR were found to be (1.15 ±40.3) and (60.35 ±9.26%) respectively. A spKt/V more than 12 and urea reduction rate more than 65% were found in 42% and 34% of the end stage renal disease patients respectively. Conclusions: This study showed hemodialysis inadequacy in more than half of the patients. Adequacy of hemodialysis can be obtained by increasing its frequency, avoiding multiple use of dialyzer and increasing blood flow rate. Keywords: End stage renal disease, Urea Reduction Ratio, Single-pool Ki/VPublication Hepatitis E induced severe myositis(Institute of Medicine, 2016) Nepali, R; Shah, DS; Sigdel, MRAbstract Hepatitis E is one of a rare cause of viral myositis in immunocompromised patients. Presentation in immunocompetent patient is even rarer. We present a case of 26-year-old female patient who presented with viral myositis secondary to hepatitis E with rhabdomyolysis with acute kidney injury with right leg foot drop due to compartment syndrome in an immunocompetent patient. Keywords: Hepatitis E, viral myositis, RhabdomyolysisPublication Kidney Diseases Screening for Asymptomatic School Children by Urine Dipstick Method(Institute of Medicine, 2018) Khatri, B; Shah, DSAbstract Background: Screening of urine is a useful tool to identify school children with renal diseases who are asymptomatic. A dipstick urinalysis screening was conducted on World Kidney Day to determine the kidney disease from asymptomatic school going children. Methods: A cross sectional study was carried out in a secondary school in Kathmandu, Nepal. 579 asymptomatic children were enrolled. Morning mid-stream urine samples were obtained from students and tested by dipstick method. Results: Seventy(12.08%) children had urinary abnormalities at the screening in the form of proteinuria, none had glycosuria. Urinary abnormalities were more common in females than in males. Children with hypertension were more likely to have proteinuria than normotensive children. Most positive results were detected in the age group 9-12 years. Body mass index had no correlation with proteinuria. Conclusion: The study found that there is high burden of proteinuria (>12%) indicated asymptomatic urine abnormalities.Hence only early detection of renal disorders in childhood will lead to effective interventions and reduction in the number of individuals with renal disease. Key words: Proteinuria, Dipstick method, Body mass index, glomerulonephritisPublication New onset diabetes after transplant in renal transplant recipients(Institute of Medicine, 2017) Nepali, R; Shah, DSAbstract Introduction: New onset diabetes after transplantation (NODAT) is a common complication of renal transplantation. Despite its prevalence and importance, the data on NODAT and its risk factors in Nepalese population are lacking and the incidence and risk factors for NODAT in Nepalese population who underwent renal transplantation at Tribhuvan University Teaching Hospital. Methods: All the patients who underwent living donor kidney transplantation at Tribhuvan University Teaching Hospital between August, 2008 and February, 2016 were included in this study. Patients who were diagnosed with diabetes mellitus before transplantation were excluded from the study. Patients were divided into NODAT and Non-NODAT groups. Then, risk factors were compared between the two groups. Results: A total of 350 patients who underwent living donor renal transplantation at our hospital during the study period were included. 23 patients who were diagnosed cases of Diabetes Mellitus before transplantation were excluded. In the remaining 327 cases, the incidence of NODAT was 19.57% (64 patients). Most of them (95.31%) occurred within the first 12 months’ post transplantation. The mean duration of onset of NODAT was 121.46 ± 275.58 days post transplantation. Age of the recipient greater than 45 was significantly associated with NODAT than non-NODAT patients. However, there was no statistical difference in sex between NODAT and non-NODAT patients. Conclusion: NODAT is common complication after renal transplantation. Age of recipient > 45 years is a significant risk factor for the development of NODAT. So, we have to be more vigilant in these patients Keywords: Renal transplantation, NODAT, AgePublication Pulmonary aspergillosis in a renal transplant recipient(Institute of Medicine, 2018) Nepali, R; Shah, DSAbstract Aspergilloma, one of the spectrum of pulmonary aspergillosis, is the most common and best-recognised form of pulmonary involvement by Aspergillus species. It usually develops in a pre-existing cavity in the lung secondary to tuberculosis. Here, we present a case of live non related renal transplant recipient with aspergilloma with bronchiectasis with tuberculosis who underwent left upper lobectomy with antitubercular treatment and voriconazole with complete resolution. Keywords: Renal transplant, aspergilloma, tuberculosisPublication Renal transplant in Nepal: medical complications in first three months(Institute of Medicine, 2013) Shrestha, S; Sigdel, MR; Raut, KB; Kafle, MP; Shah, DSAbstract Introduction: A successful renal transplant program was started in Nepal on August 8, 2008 in Tribhuvan University Teaching Hospital; and since then more than 200 live renal transplants have been done in our center. Methods: A prospective analysis was done of 50 consecutive renal transplant recipients (performed from June 29, 2011 to May 16, 2012), with a minimum of 3 months of follow up. All recipients were on tacrolimus, mycophenolate mofetil, and steroids. The outcomes of the study were medical complications that occurred within the study period. Results: The mean age of the recipients and donors were 36.0 ± 1.1 (range 15-59) and 48.3 ± 1.1 (range 22-65) years respectively. The fatal complications were one case each of hospital acquired pneumonia leading to sepsis, delayed graft function secondary to acute tubular necrosis, and community acquired pneumonia. The most common non-fatal infection in first month post-transplant was urinary tract infection, 24 episodes were identified in 20 recipients (40%). In 1 to 3 month post-transplant also, urinary tract infection was the most common non-fatal infection, 6 episodes occurred in 5 recipients (10%). 6 episodes of biopsy proven acute rejection occurred in 6 recipients (12%). Delayed graft function was observed in 2 patients (4%). New onset diabetes after transplant occurred in 6 patients (12%). Conclusion: The most common medical complication in first three months post-transplant was urinary tract infection, followed by acute rejection, new onset diabetes mellitus after transplant and delayed graft function. Keywords: receipient, renal, transplantPublication Urological complications after Kidney transplantation(Kathmandu University, 2010) Chalise, PR; Sharma, UT; Gyawali, PR; Shrestha, GN; Joshi, BR; Gurung, GS; Ghimire, RK; Kafle, MP; Sigdel, MR; Shah, DS; Raut, KB; SidharthABSTRACT Background Renal transplantation is a regular service at Tribhuvan University Teaching Hospital and complications have been known to occur after it. This study was conducted to assess complications after transplantation. Objectives To determine the incidence of urological complications after living related renal transplantation at Tribhuvan University Teaching Hospital. Methods A clinical study was performed (from August 2008 to July 2010) which included 50 living-related renal transplantations at Tribhuvan University Teaching Hospital. All the donors and recipients were evaluated preoperatively with necessary investigations and followed up postoperatively with standard hospital transplant protocol. The incidence of urological complications were documented and analyzed. Results Fifty living-related, renal transplantations were carried out during the study period. Seven doors had minor post operative complications; three had post operative fever, two had chest infections and each one had superficial surgical site infections and severe pain at incision site. Ureteroneocystostomy was performed with double J stent in all recipients. Urological complications were noted in 12 (24%) recipients. Clinical significant hematuria occurred in four cases. One patient had ureteric necrosis and urinary leak which required re-exploration post operatively. Two patients developed delayed ureteric stricture which were managed by antegrade Double J stenting and ureteric reimplantation. Peri-graft abscess occurred in two cases, which were drained percutaneously. surgical site infections was seen in one case. Conclusions Urological complications are inevitable in renal transplantation and our complications rate appears similar to that reported in literature. Key words double J stent, renal transplantation, urological complications