Urology, Nephrology and Andrology International

Context: Disturbances in mineral metabolism are commonly seen in patients with chronic renal failure.But there are very few studies on their prevalence in Indian dialysis population. Aim: To know the prevalence of secondary hyperparathyroidism in patients with stage 5 chronic kidney disease on maintenance hemodialysis. Settings and Design: Hospital based cross sectional study. Methods and Material: This study was done on 85 patients undergoing maintenance hemodialysis for ≥ six months and data was collected between January 2018 and December 2018, for a period of one year. Patients were examined for clinical features of secondary hyperparathyroidism and serum calcium, phosphorus, alkaline phosphatase, 25 hydroxy vitamin D and intact parathyroid hormone levels were measured. Statistical analysis used: The data was analysed with SPSS using Descriptive statistics, Chi-square testand significance by p value. Results: Various mineral, bone abnormalities in our study population were as follows-hypercalcemia (5.88%), hypocalcemia (36.47%), hyperphosphatemia (30.59%), hypophosphatemia (28.24%), hyperparathyroidism (36.48%), hypoparathyroidism (10.59%), deficiency of vitamin D(52.94%) and insufficiency of vitamin D (20%). Conclusions: Prevalence rate of secondary hyperparathyroidism was 36% in our study and 40% had oversuppresion of iPTH levels. One third of our patients had a risk of adynamic bone disease. Keywords: Chronic kidney disease; Secondary hyperparathyroidism; hemodialysis.

Urolithiasis is one of the oldest diseases and continues to be a major problem in India. PCNL continues to be the standard of care in selected cases according to the stone size, location, shape and composition of the stone. PCNL is recommended for cases with stones larger than 20mm, cases with struvite or cysteine stones, or in cases of anatomical variation. The outcomes of PCNL is interpreted in terms of success of the procedure and complication rates. Multiple factors have been investigated as predictors of success rates and complications. A quick, simple and reproducible method for the prediction of the outcomes of PCNL was proposed by Thomas et al called as the ‘Guy’s stone score’. The grading system mainly takes into consideration the number of stones, stone location and whether the renal anatomy is simple or abnormal. Currently there is no single agreement upon an ideal predictive model that characterizes the complexity of renal stones predicting surgical outcomes following PCNL. Hence the present study was conducted for evaluating the role of GUY’s score in the outcome of PCNL. Materials and methods: Patients scheduled to undergo PCNL at Ramaiah Hospitals were assessed for eligibility for the study and those satisfying the inclusion criteria were included in the study. The stone burden was determined by radiographic studies, and stones will be classified using the GSS as Guy's I, II, III and IV. Post-operative stone clearance rate was assessed by any residual shadow in x-ray KUB in the immediate post-operative period and NCCT after 3 months and patients were followed up to note any complications in the postoperative period. And stone free status was assessed Results and discussion: 200 patients scheduled to undergo PCNL were included. Incidence of complications was more in patients with GUY’S grade IV (P<0.01). Incidence of relook PCNL was more in patients with GUY’S grade IV. stone free clearance was more in patients with GUY’S grade I and II, stone size <200mm2, with essence HU <800 HU, with lower calyx puncture. We have also observed that incidence of complications pleural effusion, urine leak and bleeding was more with Guy’s IV and more with superior calyx puncture. Conclusion: We conclude that GUY’S score is a useful tool in the initial evaluation to predict surgical outcomes in PCNL and can help in better pre-operative planning of the surgery. Keywords: Guy's score; PCNL; Urolithiasis; Outcome; Prediction.

Emphysematous pyelonephritis (EPN) is a life threatening necrotizing infection of the kidney. It is commonly seen in diabetic patients and continuous to be a major cause for morbidity Treatment options were limited in the past and most patients were managed surgically. With newer antibiotic protocols medical management is effective in most of the cases. Aims and Objectives: To study about the mortality with conservative medical management of Emphysematous Pyelonephritis in type 2 Diabetes Mellitus patients. Methods: Study population included type 2 Diabetes Mellitus patients with urinary tract infection (UTI) (proven by culture) and radiological evidence of Gas in the collecting system, renal parenchyma or perirenal tissue. 50 patients with EPN who were admitted in our hospital from1 October, 2010 to March 31, 2021 were included in this prospective observational study. The clinical presentation, comorbidities, baseline laboratories data and abdominal CT scan were taken. Patients were classified into four stages based on CT imaging. All the patients were started on medical management with antibiotics. Those patients not responded to medical therapy were offered surgical treatment and the outcome of management was assessed. Results: Mean age of the study group was 59.24 years. Fever was the most common presenting symptom (100%). E.Coli was the most common organism isolated from urine (75%). Patients were divided into different classes based on CT imaging and most of them belonged to class II (50%). Most of the patients managed successfully with antibiotics. Multiple factors found to influence the mortality such as shock, altered sensorium and advanced classes in CT scan. Conclusions: Medical therapy is the corner stone of management of class I and class II EPN. Keywords: Emphysematous Pyelonephritis; Type 2 Diabetes Mellitus.

Aim: To study the spectrum of organisms and their antibiotic sensitivity studied from rectal swabs in the community. Methods: A 2 years prospective study in which rectal swabs were collected from patients who fulfilled the inclusion criteria. Baseline information with a detailed written informed consent was taken from each patient. Results were characterized for identification of the organisms and antimicrobial susceptibilities. The data was tabulated for evaluation on a predesigned proforma. Results: Of 373 patients, 290 patients were male and 83 female (Mean age - 62.7 +/- 18 years). The most common organism was Escherichia coli in 76.56% of cases, Klebsiella Sp in 12.5%, Proteus Sp in 1.56% and others including Enterococcus, Pseudomonas, Staphylococcus aureus contributed to 9.37%. In the antibiotic sensitivity pattern, the sensitivity of fluoroquinolones was as low as 48.43%. Nitrofurantoin showed a higher sensitivity of 83.59 % than fluoroquinolones but similar to carbapenems (88.2%) and third generation cephalosporins (78.12%). In our study, 23 patients were planned for a TRUS guided prostate biopsy. The culture positive rate in this group was 43.47 % of which 60% of the organisms grown was Esherichia coli (p = 0.01) on sub group analysis. They showed a quinolone sensitivity of only 40% . Conclusion: With increasing antibiotic resistance and multi drug resistant organisms, we suggest the use of a culture based antibiotic for infections and trans rectal biopsy procedures. There is a change in antibiotic resistance pattern of organisms of the gut flora with rising pattern of fluoroquinolone resistance. Keywords: Antibiotic sensitivity; Biopsy; E-Coli; Prostate biopsy; Rectal swab.