Background. Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction leading to acute kidney injury (AKI). Methods. We report a case of 23-year-old army personnel who presented with persistent vomiting leading to severe hypokalaemia, metabolic alkalosis, and acute kidney injury resulting in cardiorespiratory arrest. Results. After successful resuscitation, he was supported with haemodialysis and aggressive electrolytes correction. He was repeatedly not able to tolerate nasogastric (NG) tube feeding and computerised tomography of abdomen was performed, and the diagnosis of SMA syndrome was made. Gastroscopy examination revealed duodenal ulcer at D1, pinhole D1-D2 junction, but there was no evidence of intraluminal mass or lesions leading to upper gastrointestinal obstruction. A nasojejunal tube was inserted to bypass the narrow segment of the duodenum, and he was put on nutritional support. He was subsequently weaned off dialysis support as his renal function gradually improved and later on normalised. He remains symptoms free, and he gained five kilograms in four months after discharge. Conclusions. SMA syndrome is a rare cause of upper gastrointestinal obstruction but should be considered as a differential diagnosis in a patient who presented with recurrent vomiting and AKI with metabolic alkalosis.

Background: Chronic kidney disease (CKD) is a major public health issue because of the rising number of patients with the risk of progression to end-stage renal disease. The retinal micro-vasculatures provide a unique window to assess systemic microcirculation. Optical Coherence Tomography Angiography (OCTA) parameters may provide a noninvasive method for systemic correlation. This research aims to compare the association of OCTA parameters in different causes of CKD. Methods: This is a single-center cross-sectional study on patients with CKD at the Universiti Kebangsaan Malaysia Medical Centre over 2 years. Patients with CKD were divided into three groups: DM group (diabetic CKD), HPT group (hypertensive CKD), and AG group (autoimmune-related glomerulonephritis CKD). The OCTA parameters, namely, the foveal avascular zone (FAZ), vascular density (VD), perfusion density (PD), and macular volume (MV), were measured and recorded using OCTA. Blood and urine analyses were taken as the patient’s CKD profile. The demographic data, the OCTA parameters and the CKD profiles, were analyzed using SPSS version 23. Results: The right eyes of 232 patients were included. The median age of the control and CKD subjects were 36 and 61 years old respectively. The proportion of the subjects under the control, diabetes mellitus (DM), HPT, and AG group were 30.6, 53.4, 5.6, and 10.4% respectively. There was no significant difference in FAZ, but there is a significant difference in the VD, PD, and MV between the control and CKD groups. There was a statistically significant difference between the three different causes of CKD in VD and PD (p < 0.001, p = 0.001, respectively). When compared with the control group for VD and PD, there were significant differences between the DM-control group (p < 0.001, p < 0.001) even when the age variable was considered, but no significant difference when comparing the HPT-control and the AG-control. There was a significant correlation between age, FBS, and HbA1c with VD and PD. There was no significant association between CKD profile and FAZ.Conclusion: Our study showed the meaningful reduction of VD and PD in patients with diabetes and CKD. However, the use of OCTA to screen or predict CKD in patients living with diabetes mellitus, hypertension, or autoimmune nephritis was not shown to be useful.