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  ~ Table of Contents - Current issue
Coverpage
May-June 2020
Volume 30 | Issue 3
Page Nos. 0-214

Online since Thursday, June 11, 2020

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OBITUARY  

Obituary p. 0
Chittaranjan Kar
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EDITORIAL Top

Covid-19: Why the kidney care is so much affected? p. 141
Sanjay K Agarwal, Narayan Prasad
DOI:10.4103/ijn.IJN_228_20  
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SYMPOSIUM: COVID-19 AND KIDNEY DISEASES Top

Epidemiology, genomic structure, the molecular mechanism of injury, diagnosis and clinical manifestations of coronavirus infection: An overview p. 143
Narayan Prasad, N Gopalakrishnan, Manisha Sahay, Amit Gupta, Sanjay K Agarwal, On behalf of Covid-19 Working Group of Indian Society of Nephrology
DOI:10.4103/ijn.IJN_191_20  
COVID-19 is caused by a novel beta coronavirus (SARS-CoV-2) strain that was first discovered in 2019 in the Wuhan city of China. Based on virus genome sequencing studies, the bat is suspected as the natural host of virus, and infection might be transmitted from bats via unknown intermediate hosts like reptiles and snakes etc., to infect humans. COVID-19 is transmitted from person to person contact, primarily via droplet infection within the incubation period or after clinical manifestations of fever, cough, sneezing, sputum, dyspnea, and pneumonia and through contaminated fomites. COVID-19 enters the respiratory tract through the ACE2 receptor on alveoli through binding of s-protein of the virus and causes injuries though the cytopathic effect, as well as cytokines and other mediators, released after developing sepsis. ACE 2 is almost 100-fold higher in kidneys than lung, and the virus can also involve the kidney in the same manner. Kidney involvement manifests in the form of proteinuria, hematuria, and an acute rise in serum creatinine. Kidney involvement is an independent risk factor for mortality. Diagnosis is primarly made by detecting viral RNA by reverse transcriptase polymerase chain reaction (rtPCR) in nasopharyngeal swab samples. Role of antibodies, both IgM and IgG are still evolving and at best restricted for epidemiological purpose. Though a large number of treatments, including hydroxychloroquine, anti-viral, convalescent plasma etc., are being tried, as of now treatment is symptomatic only.
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Chronic kidney disease and hypertension with reference to COVID-19 p. 155
Manish Rathi, Tarun Jeloka, Narayan Prasad, Shyam Bansal, Sanjay Kumar Agarwal, AK Bhalla, On behalf of COVID-19 Working Group of Indian Society of Nephrology
DOI:10.4103/ijn.IJN_168_20  
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Glomerular diseases with reference to COVID-19 p. 158
Sanjeev Gulati, Narayan Prasad, Manisha Sahay, Vivek Kute, Sanjay K Agarwal, On behalf of COVID-19 Working Group of Indian Society of Nephrology
DOI:10.4103/ijn.IJN_167_20  
COVID pandemic affected every individual across the world. Patients with primary glomerular disease and glomerular disease secondary to systemic diseases who are on moderate to high doses of immunosuppression are at an increased risk of COVID because of their immunosuppressed state. The data to quantify the degree of risk in relation to the amount of immunosuppression or their duration of use is not robust. The patients on immunosuppression need to modify the drugs balancing the risk relapse and flare of the disease, simultaneously minimizing the risk of developing COVID. We tried to develop a guideline about the modification of the treatment regimen in such conditions.
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COVID 19 and acute kidney injury p. 161
Narayan Prasad, Sanjay K Agrawal, On behalf of COVID-19 Working Group of Indian Society of Nephrology
DOI:10.4103/ijn.IJN_120_20  
Coronavirus disease 19 (COVID-19) is caused by severe acute respiratory syndrome-corona virus (SARS-CoV-2), a beta coronavirus, mainly involves the respiratory tract, and the clinical features simulate to a severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) of the past. The genome of the SARS-CoV-2, isolated from a cluster-patient with a typical pneumonia after visiting Wuhan, had 89% nucleotide identitical with bat SARS-like-CoVZXC21 and 82% with that of human SARS-CoV. It enters the respiratory tract through angiotensin converting enzyme-2 (ACE2) receptors on alveoli. It may induce lung injury through direct cytopathic effect, involving effector T cells or causing sepsis and inducing cytokine storm.With a similar mechanism, it can cause acute kidney injury (AKI). The overall incidence of AKI is 5.1%, and AKI is an independent risk factor for mortality. The hazard ratio of death increases with the increasing severity of AKI. Management of COVID-19 with AKI is primarily supportive care, and at present, there are no evidence based effective antivirals for the treatment.
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Guidelines for dialysis with reference to COVID-19 p. 166
Valentine Lobo, Umesh Khanna, Mohan Rajapurkar, Himanshu Sekhar Mahapatra, Himanshu Verma, Narayan Prasad, Sanjay K Agarwal, On behalf of Indian Society of Nephrology
DOI:10.4103/ijn.IJN_166_20  
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Peritoneal dialysis patients during COVID 19 pandemic p. 171
Tarun Jeloka, Amit Gupta, Narayan Prasad, Santosh Varughese, Sandeep Mahajan, KS Nayak, Sanjay Kumar Agarwal, Georgi Abraham, On behalf of COVID-19 Working Group of Indian Society of Nephrology
DOI:10.4103/ijn.IJN_192_20  
COVID pandemic poses challenges to peritoneal dialysis patients, caretaker, and service provider to the PD patients as well. The chronic peritoneal dialysis (PD) patients are trained to do the PD procedure at home, therefore can avoid in-center hospital visit unlike patients on hemodialysis. Thus, PD patients can avoid undue exposure to the novel coronavirus. The PD can be offered in COVID induced AKI patients, even in remote places where hemodialysis cannot be offered. The paper is aimed to provide guidelines about the safe use of PD and treatment of complications during the COVID pandemic.
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COVID 19 and hemodialysis anxiety p. 174
Mohan P Patel, Vivek B Kute, Narayan Prasad, Sanjay K Agarwal, On behalf of COVID-19 Working Group of Indian Society of Nephrology
DOI:10.4103/ijn.IJN_203_20  
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Renal transplant guidelines with reference to COVID-19 infection p. 176
Vivek Kute, Santosh Varugese, Narayan Prasad, Sunil Shroff, Sanjay Kumar Agarwal, On Behalf of COVID 19 Working Group of Indian Society of Nephrology
DOI:10.4103/ijn.IJN_221_20  
Development of COVID-19 pandemic has affected organ transplant activity significantly. To start with, government of India had adviced stoppage of “elective” surgeries so as to cope with resources and manpower for COVID-19 patients. As majority of hospitals are having both COVID and Non-COVID patients, there is obvious fear of cross-infection. Also, transplant patients being immunocompromised, there is higher risk of acquiring COVID-19 infection along with atypical presentation and unpredicted course of the disease. Result was that across India, elective living related kidney transplant came to a halt. Cadaver renal transplant, being emergency in nature still done, though very few. With passing time, once it became clear that pandemic is not going to be controlled sooner, need has been felt to restart renal transplant activity. Keeping various issues in mind in relation to elective living related renal transplant and emergency deceased donor renal transplant, these guidelines have been framed to help transplant professionals for restarting renal transplant program again in the country, while keeping both health care workers and patient safe.
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Anti-corona Drugs: Current scenario p. 179
Edwin Fernando, Sishir Gang, Narayan Prasad, Arpita Roy Chaudhary, Sanjay Kumar Agarwal, On behalf of COVID 19 Working Group of Indian Society of Nephrology
DOI:10.4103/ijn.IJN_164_20  
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Infection prevention and control guidelines for COVID p. 185
Sandeep Mahajan, HS Kohli, KL Gupta, Narayan Prasad, Sanjay K Agarwal, On behalf of COVID19 Working Group of Indian Society of Nephrology
DOI:10.4103/ijn.IJN_165_20  
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“Infodemic” of COVID 19: More pandemic than the virus p. 188
Mohan P Patel, Vivek B Kute, Sanjay K Agarwal, On behalf of COVID-19 Working Group of Indian Society of Nephrology
DOI:10.4103/ijn.IJN_216_20  
Coronavirus disease (COVID 19), which was started in Wuhan, China in December 2019 has become a pandemic, leading to unprecedented risk to the human race. However, fear wave accelerating ahead of pandemic worldwide is driven by prejudice or erroneous information. This has been termed as “infodemics” by WHO considering its fake nature, which triggered discrimination and stigma of disease along with the failure of rapid response policies. Additionally, the lack of adequate pandemic preparedness plans identified in many countries may be responsible for infodemics. NonCOVID medical illnesses have taken a back seat at many places while implementing COVID 19 control strategies and patients are diverted to COVID 19 screening hospitals leading to a potential health crisis. Now, we also have to focus on mitigating infodemics and its implications at the social front while strategic planning to control current and future pandemics.
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CASE REPORTS Top

Lymphomatous interstitial nephritis coexistent with paraneoplastic crescentic membranoproliferative glomerulonephritis in a case of mantle cell lymphoma p. 192
Praveen Kumar Etta, MV Rao, Sujeet Reddy, Swarnalata Gowrishankar, Neha Agarwal
DOI:10.4103/ijn.IJN_160_19  
Mantle cell lymphoma (MCL) is a rare aggressive lymphoproliferative disorders (LPD) of B-cell lymphoma, which usually presents in advanced stages at initial diagnosis. Renal involvement in MCL is very rare, especially the combined presence of both glomerular and interstitial disease. We report on a patient with lymphomatous interstitial nephritis (LIN) coexistent with paraneoplastic crescentic membranoproliferative glomerulonephritis (MPGN), subsequently diagnosed to have disseminated MCL with bone marrow and lymph nodal infiltration. He was treated with rituximab-based chemotherapy and went into complete renal remission at 6-months of follow up.
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A case of intra-abdominal abscess due to sphingomonas paucimobilis in a patient on peritoneal dialysis: A case report and review of literature p. 196
Lim Chiao Yuen, Tan Jackson
DOI:10.4103/ijn.IJN_271_19  
Sphingomonas paucimobilis is an aerobic gram-negative bacillus, widely distributed in the water and soil. It has also been found in nosocomial environments causing nosocomial infections. S. paucimobilis is a rare cause of peritoneal dialysis (PD)-related peritonitis. Here, we report the 14th case, with a literature review. Our case is unique as this is the first reported case of intra-abdominal abscess associated with S. paucimobilis PD-related peritonitis.
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Page kidney complicating kidney biopsy after stopping Apixaban: A physician's dilemma p. 201
Macaulay A. C. Onuigbo, Vivek Sharma, Omotola Balogun, Allina Ghimire
DOI:10.4103/ijn.IJN_269_19  
Page kidney was described by Page, following very elaborate experiments with animal kidneys in 1939, with persistent arterial hypertension from “cellophane perinephritis.” Subsequently, it was reported after trauma, from renal cysts and tumors, and from intrarenal hematoma complicating percutaneous kidney biopsy. We describe Page kidney associated with acute kidney injury 26 days after an uncomplicated ultrasound-guided right native kidney biopsy. Patient was on Apixaban, a non-vitamin K antagonist oral anticoagulant (NOAC) for atrial fibrillation which was withheld 3 days before the procedure. It was restarted 3 days after. The evidence-base supporting guidelines and recommendations for the peri-procedural management of the NOACs is inadequate, sparse, and often conflicted. More research is warranted.
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Rare, yet emerging cause of graft dysfunction—ALECT 2 amyloidosis p. 204
Kulwant Singh, Jasmine Sethi, Rajan Duggal, Kusum Joshi, Arjinder S Bains
DOI:10.4103/ijn.IJN_258_19  
Amyloidosis is characterized by pathological deposition of abnormal protein aggregates in various tissues, AL protein being the commonest. Amyloidosis derived from leukocyte cell-derived chemotaxin 2 (LECT2) is a recently recognized form of amyloidosis in the United States with predominant involvement of kidney and liver. We present a case of ALECT2 renal amyloid in a transplant recipient who presented with gradual worsening of graft function and subnephrotic proteinuria. To our knowledge, this is first case of LECT2 amyloidosis from Northern India in a transplant recipient. There is no effective therapy for amyloidosis derived from leukocyte cell-derived chemotaxin 2.
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LETTERS TO EDITOR Top

Solitary pelvic ectopic kidney and limb anomalies: Rare variant of acrorenal syndrome Highly accessed article p. 207
Malsawmkima Chhakchhuak, Jony Agarwal
DOI:10.4103/ijn.IJN_178_19  
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Clopidogrel induced thrombotic microangiopathy successfully treated with conservative approach p. 209
Praveen Kumar Etta, Swarnalata Gowrishankar
DOI:10.4103/ijn.IJN_194_19  
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Guillain-Barre syndrome in a pregnant-live-related ABO-incompatible renal allograft recipient p. 211
Praveen K Etta, Sreepada Subhramanyam, Karopadi S Nayak
DOI:10.4103/ijn.IJN_206_19  
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Short Term Renal Outcome of Bortezomib Based Therapy in Patients with Multiple Myeloma Requiring Dialysis Highly accessed article p. 213
Alok Kumar Pandey, Dhananjai Agarwal, Vinay Rathore, Gaurav Sekhar Sharma, Shyam Sunder Nowal, Pankaj Beniwal, Rajesh Jhorawat, Vinay Malhotra, Sanjeev Sharma
DOI:10.4103/ijn.IJN_229_18  
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Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07