Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Causes, complications and short-term outcome of acute Kidney injury in a resource-limited setting(SAGE-Hindawi Access to Research, 2024-12) Herath, N.; De Silva, S.; Liyanage, P.; Kumara, S.; Devi, S.; Abeysekara, V.; Mallawarachi, R.; Perera, S.; Karunathilaka, I.; Samarasinghe, S.; Weerakoon, K.AIMS The outcome of acute kidney injury (AKI) depends on causes, patient factors and care received. We studied the causes, complications and 90-day outcomes of patients with AKI at a tertiary referral centre in Sri Lanka. METHODS Patients aged 18 years or older with AKI referred to nephrology services were analysed retrospectively. AKI severity was assessed using the KDIGO classification. Information was gathered from hospital and clinic records. RESULTS Of the 464 patients studied, 262 (56.5%) were males. The mean age of the study sample was 57.04 (SD 16.85) years. The majority (212-45.69%) were discharged with normal renal functions, 173 (37.28%) were discharged with impaired functions, and 79 (17.03%) died during hospital stay. There were 377 patients at 3 months follow-up; 331 (87.8%) had normalised renal function, 40 (10.6%) had not recovered fully and 6 (1.6%) had succumbed. Progression of AKI to chronic kidney disease or death was significantly high in patients aged > 60 years (p=0.017). More severe AKI was associated with type 2 diabetes (p=0.0042), hypertension (p < 0.0001) and multiple comorbidities (p=0.0014). Persons with no comorbidities had less severe AKI (p=0.0004). Even in the early stages of AKI, there was significantly high mortality (11% in AKI stages 1 and 2) which doubled in stage 3 (22%). Mortality was low in patients with prerenal causes of AKI (OR: 0.59, 95% CI: 0.35-0.99 and p=0.047). CONCLUSIONS AKI in elderly and comorbid patients has high morbidity and mortality. Identification of individuals who are at high risk of developing AKI is important for its prevention, early diagnosis and proper treatment. Limitations in infrastructure, manpower, local research, reporting and recording of AKI are key challenges in providing optimal care for AKI in Sri Lanka.Item Rhabdomyolysis associated acute kidney injury following a physical violence(Science Resource Online, 2021) Thivaharan, Y.; Kitulwatte, I.D.G.Introduction: Physical violence can lead to serious and, rarely, fatal injuries. In addition to head injury, which is the leading cause of death and long-term disability, injuries of the musculoskeletal system and internal organs are important cause of assault-related morbidity. This paper discusses such rare complication of an interpersonal violence - rhabdomyolyis associated with Acute Kidney Injury (AKI). Case: A 37-year-old man who claims to be assaulted by a group of people, presented with focal contusions and extensive grazed abrasions over the trunk and limbs. Injuries to brain and other visceral organs were excluded. Serum creatinine and urea were elevated significantly, along with increase in C-reactive protein and liver enzymes. Urinalysis contained red cells and leukocyte esterase, following which rhabdomyolysis was diagnosed. He developed oliguric AKI, and haemodialysis was initiated. He was discharged after eleven days of hospitalization, following improvement in renal functions. Discussion: Rhabdomyolysis is a common cause for oliguric renal failure, and can be traumatic or non-traumatic. Rhabdomyolysis has specific clinical and laboratory parameters, but still requires high level of suspicion, for timely diagnosis. Highly elevated levels creatinine phosphokinase (CPK) is the most specific parameter for the diagnosis of rhabdomyolysis. Myoglobinuria, elevated levels of lactase dehydrogenase and transaminases are also considered valuable markers of rhabdomyolysis. AKI is the commonest systemic complication of rhabdomyolysis and various causative mechanisms have been explained. Conclusion: Rhabdomyolysis requires high index of suspicion when acute kidney injury and altered metabolite levels are suspected in a patient with major or minor muscle injuries, in order to prevent complications or death.