Anticoagulant-related nephropathy (ARN) is a recently described disease entity which is an underdiagnosed complication of anticoagulation. Despite widespread usage of anticoagulants, ARN is not commonly reported. We report a case of a 64-year old man with biopsy-proven ARN who presented with over anticoagulation and acute chronic kidney injury while on warfarin therapy for his left lower limb deep-vein thrombosis. Various investigations were performed and renal biopsy confirmed the diagnosis of anticoagulant-related nephropathy.
The role of end-of-life care is fundamental for end-stage renal disease (ESRD) patients, who are known to have a high morbidity and mortality rate despite being on dialysis. This requires effective communication and shared decision-making. Thus, exploring patients' knowledge and perceptions is essential to improve the gaps in delivering end-of-life care. This study aimed to describe the knowledge and perceptions of end-of-life care among ESRD patients on hemodialysis (HD). This was a cross-sectional study involving 14 outpatient HD centers in Kuantan, Malaysia. Patients were recruited from March to June 2019. A validated questionnaire was delivered via interview-based surveys by the researcher or trained interviewers. The majority of the respondents had poor knowledge of the disease and end-of-life care. However, more than 70% of the respondents felt that it was important for them to be actively involved in medical decision-making, as well as being prepared and planning for death. End-of-life needs, which included management of symptoms and psychological, social, and spiritual support, were important to most respondents. Additionally, patients with higher educational backgrounds were observed to have higher scores for both knowledge and perceptions (P <0.05). The study found poor knowledge but acceptable perceptions among patients. This highlights the gaps in the current local approach in clinical practice to end-of-life care in ESRD.
The prevalence of glomerulonephritis (GN), especially membranous GN (MGN), changes from time to time. This change may be due to genetic predisposition, environmental factors race, age, and indications for a renal biopsy. This study was conducted to evaluate the distribution and changing patterns of GN by further assessing the prevalence of MGN. A 1000, 123 biopsies were performed from January 2012 to October 2019 in Hospital Serdang and Hospital Kuala Lumpur. Electron microscopy, immunohistochemistry, and clinical presentations were used to differentiate primary and secondary MGN, from which 611 and 457 primary and secondary subjects were diagnosed with primary and secondary GN, respectively. Primary MGN accounts for 13% of all the primary GN, while lupus nephritis (LN) accounts for 44.2% of all secondary GN followed by diabetes mellitus (25.6%). The proportions of primary and secondary MGN were 64.8% and 35.2%, respectively, with a male-to-female ratio of 1:1.1 in favor of females. The renal biopsy obtained from the registry of two prominent hospitals in Malaysia provided valuable prevalence and demonstrated changes in the prevalence of GN in Malaysia. Notwithstanding, immunoglobulin A nephropathy and LN remain the most common causes of primary and secondary GN in Malaysia.
Chronic kidney disease (CKD) represents a major public health issue, which then progresses to end-stage renal disease (ESRD) sooner or later. This retrospective cohort study aimed to determine the renal survival time of CKD patients. In total, 247 CKD patients in one of the tertiary referral hospitals in Malaysia between January 2005 and December 2015 were enrolled. All CKD patients were included if they were dependent on dialysis. Patients who were transferred out and those with incomplete records were excluded from the study. The renal survival time was calculated from the time of the first diagnosis of CKD to a confirmed ESRD diagnosis or the use of dialysis. In total, 193 (78.1%) CKD patients progressed to ESRD. The mean age of the ESRD patients was 53 years old. The majority of ESRD patients were male (57.0%) and of Malay ethnicity (89.6%). The most common comorbidities among ESRD patients were hypertension (92.2%) and diabetes mellitus (85.5%). The majority of patients were in Stage IV and V (97.9%). The overall renal survival time of CKD patients who develop ESRD was 26 months (95% confidence interval: 20.41, 31.59). Patients who smoked (P = 0.001), had hyperlipidemia (P <0.001) and consumed lipid-lowering agents (P = 0.004) had a significant P-value in the log-rank test. The progression of CKD from diagnosis to ESRD was within 2 years. Therefore, early recognition of CKD is important to improve patients' outcomes and prolong their renal survival time.