[1675] Obstetric Complications, Snake Bites and Indigenous Medicines Account for Nearly Half the Cases of Biopsied Acute Kidney Injury in Southern India

Anila Abraham Kurien, Milly Mathew, Georgi Abraham. Madras Medical Mission, Chennai, Tamil Nadu, India

Background: Acute kidney injury (AKI) in the tropics is strikingly different from that in the western world in terms of etiology and presentation. With increasing opportunities for travel and work to various parts of the world, a working knowledge of these tropical diseases is imperative for the western world.
Design: All native kidney biopsies reported in the past 5 months (May 2011 to September 2011) in the renal pathology division of a tertiary care referral centre in southern India were analysed. We receive biopsies from rural as well as urban regions. Patients who had a clinical presentation of acute kidney injury were included in this study. Clinical details as specified by the referring clinician, along with the histopathological (light and immunofluorescence microscopy in all cases and immunohistochemistry for myoglobin, when applicable) findings were evaluated.
Results: Of the 470 native kidney biopsies, acute kidney injury was the indication for biopsy in 50 (10.6%) patients. This included 27 men and 23 women. The mean age was 35.7 years (ranging 13 years to 70 years).

Results
Clinical historyNumberHistopathological findings
Obstetric complications9Cortical necrosis(5) TMA(2) ATN(2)
Snake bite7ATN (3) AIN(2) Cortical necrosis(1) Rhabdomyolysis(1)
Traditional/indigenous medicines7AIN(6) ATN(1)
Bacterial infections/sepsis6ATN(3) PIGN(2) AIN (1)
AKI of unknown etiology5PIGN (3) ATN(1) AIN (1)
Pyrexia of unknown origin4Rhabdomyolysis(1) PIGN(1) AIN(1) Acute pyelonephritis with microabscess(1)
Falciparum malaria3ATN(1) AIN (1) TMA (1)
Leptospirosis3Rhabdomyolysis (2) ATN(1)
Diarrhoea/vomiting3ATN(3)
Mismatched blood transfusion1ATN(1)
Poisoning1ATN(1)
Wasp sting1AIN(1)
ATN- Acute tubular necrosis, AIN- Acute interstitial nephritis, TMA- Thrombotic microangiopathy, PIGN- Post infectious glomerulonephritis

In the 470 native kidney biopsies evaluated, there were 32 cases of post infectious glomerulonephritis (PIGN). Among these, 6 adult patients presented as acute kidney injury and were included in this evaluation.
Conclusions: This study emphasises some causes of AKI which are unusual to the Western world.
1) Obstetric complications, snake bites and indigenous medicines account for nearly half the cases of biopsied AKI in Southern India
2) Unsupervised consumption of traditional /indigenous medicines causes acute interstitial nephritis.
3) PIGN is still an important cause of AKI in adults.
Category: Kidney (does not include tumors)

Wednesday, March 21, 2012 1:00 PM

Poster Session VI # 263, Wednesday Afternoon

 

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