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   2011| April-June  | Volume 21 | Issue 2  
    Online since June 28, 2011

 
 
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REVIEW ARTICLE
Diabetic nephropathy - Epidemiology in Asia and the current state of treatment
E Ritz, X Zeng
April-June 2011, 21(2):75-84
DOI:10.4103/0971-4065.82122  PMID:21769168
  6,614 675 2
IMAGES IN NEPHROLOGY
Upper arm brachial-axillary translocated superficial femoral vein for hemodialysis
N Sedki, Y Zrihni, H Jiber, TS Houssaini, A Bouarhroum
April-June 2011, 21(2):132-133
DOI:10.4103/0971-4065.82375  PMID:21769180
  5,741 100 -
ORIGINAL ARTICLES
Polyphenolic fraction of Algerian propolis protects rat kidney against acute oxidative stress induced by doxorubicin
K Boutabet, W Kebsa, M Alyane, M Lahouel
April-June 2011, 21(2):101-106
DOI:10.4103/0971-4065.82131  PMID:21769172
We evaluated the effects of propolis extract on renal oxidative stress induced by doxorubicin throughout an analytical and pharmacological study of the eastern Algerian propolis using thin layer chromatography, ultra-violet-high-performance liquid chromatography) and gas chromatography-mass spectrometry. The pharmacological study was carried out in vivo on Wistar rat pre-treated with propolis extract 100 mg/kg/day for seven days. Doxorubicin at 10 mg/kg of body weight was administered intravenously on Day 7. Serum creatinine concentration, scavenging effect of flavonoids, lipid peroxidation and glutathione concentration were measured. Chemical analysis allowed identification and quantification of the phenolic compounds including pinostrombin chalcone (38.91%), galangin (18.95%), naringenin (14.27%), tectochrysin (25.09%), methoxychrysin (1.14%) and a prenylated coumarin compound suberosin (1.65%). The total flavonoid concentration in the propolis extract was 370 mg (quercetin equivalents QE) /g dry weight (QE/g DWPE). Propolis extract restored the renal functions and reduced the toxic effect of doxorubicin. These data show a protective effect of Algerian propolis extract against doxorubicin-induced oxidative stress.
  4,404 244 9
CASE REPORTS
Postinfectious glomerulonephritis: Is there a role for steroids?
AS Kapadia, M Panda, AB Fogo
April-June 2011, 21(2):116-119
DOI:10.4103/0971-4065.82141  PMID:21769175
The role of steroids in treatment of postinfectious glomerulonephritis (PIGN) has been controversial. The reason for such controversy is the risk of infection relapse associated with steroid therapy. Steroids may have a place in the treatment of resistant cases where renal function does not improve despite aggressive antibiotic therapy as well as in patients with crescentic form of PIGN. We report a case of a 39 year-old Caucasian man who was diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia resulting in acute IgA dominant PIGN that failed to respond to antibiotic treatment alone, but responded significantly to steroids in addition to antibiotics. This anecdotal experience suggests that steroids could be considered in conjunction with antibiotic therapy for the treatment of refractory cases of PIGN or crescentic form of PIGN. More studies with long-term follow-up of patients treated with steroids in addition to antimicrobial agents are required to quantify the risk of infection relapse with steroid therapy.
  3,927 286 3
ORIGINAL ARTICLES
Non-infectious complications of continuous ambulatory peritoneal dialysis and their impact on technique survival
J Prakash, LK Sharatchandra Singh, S Shreeniwas, B Ghosh, TB Singh
April-June 2011, 21(2):112-115
DOI:10.4103/0971-4065.82125  PMID:21769174
Data on non-infectious complications of continuous ambulatory peritoneal dialysis (CAPD) are sparingly reported from different centres of the country. We studied the non-infectious complications in patients of end stage-renal disease (ESRD) undergoing CAPD. Double-cuffed straight catheter was inserted in all patients using the surgical method and CAPD was started on the 15 th day of catheter insertion. The nature of non-infectious complications was noted during follow-up in these patients. Forty-five (male 31, female 14) patients with the mean age of 54.5±11.6 years were studied. Diabetic nephropathy was the most common (59.5%) cause of ESRD. Overall, non-infectious complications were noted in 18/45 (40%) cases. Ultrafiltration failure was the most common (15.5%) followed by incisional hernia (6.6%), exit site leak (4.4%), hydrothorax (4.4%), catheter malposition (4.4%), scrotal swelling (2.2%) and hemoperitoneum (2.2%). Patients with ultrafiltration failure were either shifted to hemodialysis or underwent renal transplantation. The remaining (62%) non-infectious complications did not affect the catheter survival and CAPD could be continued. Non-infectious complications occurred in 40% of our CAPD patients and ultrafiltration failure was the most common (15.5%). A majority (62%) of the complications did not affect catheter survival.
  3,886 246 8
CASE REPORTS
Giant cell transformation of podocytes: A unique histological feature associated with cystinosis
A Sharma, R Gupta, SK Sethi, A Bagga, AK Dinda
April-June 2011, 21(2):123-125
DOI:10.4103/0971-4065.78067  PMID:21769177
Fanconi's syndrome is an unusual cause of renal insufficiency in pediatric patients. Infantile cystinosis is one of the identifiable and treatable etiologies of Fanconi's syndrome. Early diagnosis of cystinosis permits institution of specific therapy with cysteamine. A 3-year-old girl presented with failure to thrive, polyuria, and polydipsia. She was found to have renal tubular defect with renal dysfunction and bilateral small contracted kidneys. A renal biopsy revealed extensive giant cell transformation of podocytes in the glomeruli with focal tubular atrophy and dilatation. However, no crystals were identified. Subsequent ophthalmoscopic examination revealed fine cystine crystals in the cornea and a diagnosis of cystinosis causing Fanconi's syndrome was made. Polykaryocytic transformation of visceral epithelial cells is an important diagnostic clue of nephropathic cystinosis and should be carefully looked for in renal biopsy from a child with Fanconi's syndrome and renal insufficiency.
  3,420 110 -
ORIGINAL ARTICLES
Tunneled central venous catheters: Experience from a single center
K Sampathkumar, M Ramakrishnan, AK Sah, Y Sooraj, A Mahaldhar, R Ajeshkumar
April-June 2011, 21(2):107-111
DOI:10.4103/0971-4065.82133  PMID:21769173
In the past vascular surgeons were called in to place tunneled central venous catheter (TVC) for hemodialysis patients. Advent of percutaneous technique has resulted in an increasing number of interventional nephrologists inserting it. A single centre three year audit of 100 TVCs with a cumulative follow up of 492 patient months is presented here. From 2007 to 2010, 100 TVCs were placed by nephrologists in a percutaneous fashion in the operative room or the interventional nephrology suite. Those who completed minimum of three months on the catheter were included in analysis. There were 69 males and 31 females with a mean age of 52.3±13.6 years.(range: 25-76). Chronic glomerulonephritis was the commonest cause of CKD (45%) followed by diabetes (39%).Right internal jugular vein was the preferred site (94%). TVC was utilized as the primary access to initiate dialysis in 25% of patients in whom a live donor was available for renal transplant. The blood flow was 250-270 ml/min. The Kaplan-Meier analysis showed that 3 months and 6 months catheter survival rates were 80% and 55%, respectively. The main complications were exit site blood ooze, catheter block and kink. Catheter related bacteremia rate was low at 0.4/1000 patient days. Primary cause of drop out was patient death unrelated to the TVCs. Those under the age of 40 years showed better survival, but there was no bearing of gender, catheter site, and etiology of CKD on survival. Tunneled central venous catheters could find a niche as the primary access of choice for pretransplant live donor renal transplants in view of its immediate usage, high blood flows, low infection rates and adequate patency rates for 3-6 months.
  3,249 242 6
Fetuin-A, inflammation, and coronary artery calcification in hemodialysis patients
K Turkmen, N Gorgulu, M Uysal, A Ozkok, T Sakaci, A Unsal, A Yildiz
April-June 2011, 21(2):90-94
DOI:10.4103/0971-4065.82128  PMID:21769170
Hemodialysis patients have extremely increased cardiovascular mortality. Vascular calcification, inflammation, and low serum fetuin-A levels are implicated for increased mortality. In this study, relationship between coronary artery calcification, inflammation, and serum fetuin-A levels were investigated. Seventy-eight hemodialysis patients (38 male, 40 female, mean age: 52±14.5 years) were included. All patients were on dialysis for more than 6 months. Coronary artery calcium scores (CACS) are determined by electron-beam computed tomography. Serum CRP, IL-1β, IL-6, TNF-α, and serum fetuin-A levels were measured. Mean CACS value was 488.5±94.5. Serum fetuin-A levels were negatively correlated with CACS (r :−0.30, P=0.009). Patients are divided into two groups according to total CACS value; group 1 (CACS<10), group 2 (CACS≥10). There was a statistically significance difference in fetuin-A levels between CACS group 1 and group 2 (P=0.001). In this study, serum fetuin-A levels were associated with total CACS. This Fetuin-A may play a role in increased mortality in this group of patients via facilitating CAC.
  2,905 300 6
CASE REPORTS
Ulcerative colitis after renal transplantation: A case report and review of literature
S Parameswaran, K Singh, R Nada, M Rathi, H Kohli, V Jha, K Gupta, V Sakhuja
April-June 2011, 21(2):120-122
DOI:10.4103/0971-4065.78063  PMID:21769176
Diarrhea is common after kidney transplantation and is usually related to immunosuppressive medication or is infective in etiology. Inflammatory bowel disease (IBD) is rare after kidney transplantation and is unexpected because the patient is already immunosuppressed. Specific immunomodulatory actions of calcineurin inhibitors have been hypothesized to play a role in the development of IBD in such patients. We report a case of IBD developing de novo after kidney transplantation. Our case is unique in that the patient was not on calcineurin inhibitors for 8 years prior to the development of IBD.
  3,056 117 5
ORIGINAL ARTICLES
Effect of changes in the intravascular volume during hemodialysis on blood viscoelasticity
G Metry, R Adhikarla, D Schneditz, C Ronco, NW Levin
April-June 2011, 21(2):95-100
DOI:10.4103/0971-4065.82139  PMID:21769171
Adoption of high rate of ultrafiltration (UF) during hemodialysis (HD) may affect the hemorhelogical blood profile, by changing Hematocrit (Hct) and the concentration of plasma proteins, which may in turn interfere with tissue perfusion. The aim of this work is to examine the effect of acute volume change during dialysis on the hemorheological variables. The study included 21 hemodialysis patients. Hematocrit (Hct) and percent decrease in blood volume (BV) were recorded by blood volume monitor. Blood samples were taken before and at the end of dialysis, for measuring plasma fibrinogen and haemorheological variables, which included blood viscosity, plasma viscosity, red cells elasticity and aggregation. The UF volume was 3.52±1.54 L. Hct increased from 34.2±6.1 to 42.1±7.3% (P<0.001), and blood volume (BV) decreased to 85.5±6.4% (P<0.001). Blood and plasma viscosity significantly increased from 3.28±0.69 to 5.48±0.85 mPa.s (P<0.001), and from 1.24 ± 0.16 to 1.65±0.24 mPa.s (P<0.001), respectively. Changes in plasma viscosity were correlated to changes in plasma fibrinogen (r=0.63, P<0.05), while the increase in blood viscosity was correlated to the percent reduction in blood volume (r=0.85, P<0.005). Red cells elasticity increased from 0.26±0.12 to 0.48±0.18 mPa.s (P<0.05), and the aggregation index rose from 0.86±0.31 to 1.25±0.26 (P<0.01). This combination of increased plasma viscosity and red cell aggregability may lower the velocity of erythrocyte transfer inside the tissue capillaries after HD, which may affect tissue perfusion. Moreover, increased elasticity may require more energy from the heart to disaggregate the cells, and this may induce problems in the patients with cardiac dysfunction. In conclusion, the hemorheological variables change after dialysis in the direction which may impede the flow inside the microvessels.
  2,950 116 2
Bone mineral density in patients with end-stage renal disease and its evolution after kidney transplantation
S Govindarajan, N Khandelwal, V Sakhuja, V Jha
April-June 2011, 21(2):85-89
DOI:10.4103/0971-4065.82140  PMID:21769169
Renal transplantation is associated with abnormalities of the structure and function of the musculoskeletal system. No data are available on bone health in Indian patients with end-stage renal disease (ESRD) and its evolution after transplantation. Consecutive ESRD patients who underwent living donor renal transplantation were studied prospectively. Bone mineral density (BMD) was measured at lumbar vertebrae using quantitative computed tomography (CT) scan before transplantation and after 3 and 6 months. T and Z scores were calculated by comparing with normal control data, and values were correlated with various clinical and biochemical parameters. Of the 56 patients enrolled (mean age, 33.7 years; 47 males), 40 completed the 6-month follow-up. The vertebral trabecular bone density at the time of transplantation was 172±53 mg/cc and the average Z score was 0.26±1.7. There was a significant decline in BMD at 3 months (11.8%; P<0.0001) and 6 months (16%; P<0.0001) after transplantation. Both T and Z scores showed a significant decline at 3 and 6 months. There was a significant decline in intact parathormone (iPTH) levels after transplantation, but 15 (37.5%) patients continued to have raised iPTH 6 months after transplantation. The iPTH levels at 6 months had significant correlation with BMD decline (r=0.43, P=0.006). We conclude that Indian ESRD patients have relatively well-preserved BMD, but the density declines rapidly after transplantation. A significant proportion of patients exhibit persistent hyperparathyroidism 6 months after transplantation, which correlates with bone loss.
  2,532 237 4
LETTERS TO EDITOR
Drug-induced hemolytic uremic syndrome
G Li Cavoli, A Ferrantelli, C Tortorici, L Bono, C Giammarresi, R Passantino, U Rotolo
April-June 2011, 21(2):137-138
DOI:10.4103/0971-4065.82377  PMID:21769182
  2,242 119 -
IMAGES IN NEPHROLOGY
Renal iron deposition in aplastic anemia: Magnetic resonance imaging appearance
KS Madhusudhan, R Oberoi
April-June 2011, 21(2):134-135
DOI:10.4103/0971-4065.82145  PMID:21769181
  2,271 86 2
CASE REPORTS
Cytomegalovirus and Leishmania donovani coinfection in a renal allograft recipient
N Prasad, A Gupta, RK Sharma, S Gopalakrishnan, V Agrawal, M Jain
April-June 2011, 21(2):128-131
DOI:10.4103/0971-4065.78064  PMID:21769179
Infection is a leading cause of death in renal allograft recipients. Apart from the immunosuppressive drugs, immunomodulatory viral infections also predispose the recipient to many opportunistic infections. Kala-azar in renal allograft recipients is infrequently reported even in endemic areas. In majority of cases, there was delay in diagnosis and treatment. We report a case of renal allograft recipient, where we faced a diagnostic dilemma because of coinfection of cytomegalovirus and visceral leishmaniasis (kala-azar). Kala-azar was successfully treated with amphotericin B. Kala-azar should always be kept as differential diagnosis in patients with pyrexia and cytopenia, even in the absence of splenomegaly in patients residing in an endemic zone.
  2,212 125 -
NEWS AND FILLER
Renal evolution: Crossword
A Gupta, M Biyani
April-June 2011, 21(2):136-136
DOI:10.4103/0971-4065.82144  
  2,000 81 -
CASE REPORTS
Late post-transplant erythrocytosis in a hepatitis C-positive allograft recipient on sirolimus
A.A.M. Ali, P Khanna, A Mehrotra, G Abraham
April-June 2011, 21(2):126-127
DOI:10.4103/0971-4065.82142  PMID:21769178
Hematological complications in renal transplant recipients include anemia, leukopenia, and post-transplant erythrocytosis (PTE). There are numerous causes for these which include immunosuppressive drugs, viral infections, etc. We report here a hepatitis C (HCV)-positive case who developed PTE while receiving rapamycin. As both HCV infection and rapamycin through different mechanisms can produce anemia, this case report highlights the rarity of erythrocytosis.
  1,797 93 -
LETTERS TO EDITOR
Ultrasound-guided percutaneous nephrostomy
AP Ganpule
April-June 2011, 21(2):139-139
DOI:10.4103/0971-4065.82380  PMID:21769186
  1,675 109 1
Reaction size in tuberculin test positivity in hemodialysis patients - Authors' reply
SK Agarwal, S Gupta, D Bhowmik, S Mahajan
April-June 2011, 21(2):139-140
DOI:10.4103/0971-4065.82381  PMID:21769185
  1,299 102 -
Graft survival after living donor transplantation
MK Mani
April-June 2011, 21(2):138-138
DOI:10.4103/0971-4065.82378  PMID:21769184
  1,180 100 1
Authors' reply
J Hassanzadeh, AA Hashiani, A Rajaeefard, H Salahi, E Khedmati, F Kakaei
April-June 2011, 21(2):138-138
PMID:21769183
  732 84 1
Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07