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).
|Clinical history||Number||Histopathological findings|
|Obstetric complications||9||Cortical necrosis(5) TMA(2) ATN(2)|
|Snake bite||7||ATN (3) AIN(2) Cortical necrosis(1) Rhabdomyolysis(1)|
|Traditional/indigenous medicines||7||AIN(6) ATN(1)|
|Bacterial infections/sepsis||6||ATN(3) PIGN(2) AIN (1)|
|AKI of unknown etiology||5||PIGN (3) ATN(1) AIN (1)|
|Pyrexia of unknown origin||4||Rhabdomyolysis(1) PIGN(1) AIN(1) Acute pyelonephritis with microabscess(1)|
|Falciparum malaria||3||ATN(1) AIN (1) TMA (1)|
|Leptospirosis||3||Rhabdomyolysis (2) ATN(1)|
|Mismatched blood transfusion||1||ATN(1)|