Frequency of Renal Diseases in Diabetic Patients Renal diseases in diabetic patients

Diabetic nephropathy, also known as diabetic kidney disease is the chronic loss of kidney function occurring in those with diabetes mellitus. Diabetic nephropathy is one of the leading causes of chronic kidney disease (CKD) and end-stage renal disease (ESRD) globally. Protein loss in the urine due to damage to the glomeruli may become massive, and cause a low serum albumin with resulting generalized body swelling (edema) and result in the nephrotic syndrome. Objective: The aim of this study was to determine the frequency of renal disease in diabetic patients and its complications in Pakistan. Methods: A cross sectional study was conducted at Renal and Diabetic Departments of the Sir Ganga Ram Hospital, Lahore, over a period of 3 months, after obtaining the ethical approval from the The University of Lahore. A total number of 100 Diabetic patients were selected through non probability convenient sampling technique. Patients of both sexes and all age groups were included. Results: In this study 60% were male and 40% were female. About 41% diabetic patients were 1-6 month of age, 42% were 1-5 years old and 1% of 18-23 years old who had renal diseases while 9% patients were without any renal disease. Whereas the prevalence of diabetes is more in infants than others which is 35%. But there was not significant association between onset of renal diseases with the onset of diabetes mellitus with p-value 0.24. Conclusions: Results of current study showed that diabetes mellitus effecting individuals of all ages equally but there was not significant association between diabetes and renal diseases. 

Utility of Free to Total Psa Ratio in the Prediction of Prostate Cancer in Patients With Intermediate Total Psa Levels and Negative Digital Rectal Examination

Background: Prostate carcinoma is among the top 5 cancers occurring in Kenyan men. Prostate-specific antigen (PSA) is currently the most important biochemical marker for the diagnosis of prostate cancer and its widespread use as a serum tumor marker has revolutionized the management of patients with prostate cancer. The identification of early prostate cancer is vital in the management of especially men who have mild or vague prostatic symptoms. The most basic and important proxy for determining the need for a biopsy in both symptomatic and asymptomatic(screened) patients is the serum prostatic specific antigen (PSA).If a patients PSA level is above 11 ng/ml then there is a high probability of prostate cancer and a biopsy would be recommended. By contrast, of those patients whose PSA level is between 4 and 11 ng/ml (intermediate range) only25-30% are diagnosed with prostate cancer. As such in these instances the specificity of PSA is reduced, resulting in taking many unnecessary biopsies. Consequently several different methods to enhance the sensitivity and specificity of PSA have been proposed. one of these is the determination of Free PSA levels and use of this as a percentage or ratio of Total PSA. Objective: To determine utility of Free to Total PSA ratio in enhancing differentiation of prostate cancer from benign prostate disease in male patients with intermediate Total PSA levels (4-11ng/ml) and negative digital rectal examination (DRE) in three hospitals in Nairobi,Kenya. Design: Cross sectional study Setting:Aga KhanUniversityHospital,NazarethHospital and St.Marys hospital Subjects: 180 male patients aged 40 years and above attending urology/surgical clinics at three hospitals, found to have age adjusted total PSA values between 4-11ng/ml with negative digital rectal examination (non suspicious for cancer) and in whom either an ultrasound guided biopsy, transurethral resection of the prostate or prostatectomy was performed and histopathology examination carried out. Results: On histology, 138(77%) of the 180 patients were diagnosed with benign prostate hyperplasia, 18(10%) with High grade intraepithelial neoplasia(HGPIN )and 24(13%) with carcinoma. Analysis of variance (one way) was performed to compare the mean of age, Total PSA, Free PSA and Free to Total PSA ratio in patients with BPH, HGPIN and Carcinoma. No significant statistical difference in mean age and Total PSA (6.614, 6.781, and 7.6) was found between patients with BPH, HGPIN and Carcinoma respectively. Mean Free PSA was significantly higher in patients with BPH (1.637) than those with HGPIN (1.012) and prostate carcinoma (0.743). No significant statistical difference