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   2012| March-April  | Volume 22 | Issue 2  
    Online since June 12, 2012

 
 
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ORIGINAL ARTICLES
A prospective study of cutaneous abnormalities in patients with chronic kidney disease
EA Thomas, B Pawar, A Thomas
March-April 2012, 22(2):116-120
DOI:10.4103/0971-4065.97127  
There are diverse ways in which the skin is affected by chronic kidney disease (CKD). Various specific and nonspecific skin abnormalities are observed in patients with CKD. The aim of the study was to document the prevalence of skin diseases that commonly occur in patients with CKD on medical treatment and dialysis. A total of 99 patients with CKD were examined for evidence of skin diseases. Ninety-six had at least one cutaneous abnormality attributable to CKD. The most prevalent finding was xerosis (66.7%), followed by pallor (45.45%), pruritus (43.4%), and cutaneous pigmentation (32.3%). Other cutaneous manifestations included dermatitis (27.27%); Kyrle's disease (17.17%); fungal (8.08%), bacterial (11.1%), and viral (5.05%) infections; purpura (10.1%); gynecomastia (4.04%); and yellow skin (5.05%). The common nail changes were half and half nails (36.36%) and onycholysis (13.13%). CKD is associated with various cutaneous abnormalities caused either by the disease or by treatment, the most common being xerosis and pruritus. The dermatologic complications can significantly impair the quality of life in certain individuals; therefore, earlier diagnosis and treatment is important to improve their quality of life.
  3 4,729 335
SPECIAL FEATURES
The global role of kidney transplantation
G Garcia-Garcia, P Harden, J Chapman
March-April 2012, 22(2):77-82
DOI:10.4103/0971-4065.97101  
World Kidney Day on 8 March 2012 provides a chance to reflect on the success of kidney transplantation as a therapy for end-stage kidney disease that surpasses dialysis treatments both for the quality and quantity of life that it provides and for its cost effectiveness. Anything that is both cheaper and better, but is not actually the dominant therapy, must have other drawbacks that prevent replacement of all dialysis treatments by transplantation. The barriers to universal transplantation as the therapy for end-stage kidney disease include the economic limitations which, in some countries, place transplantation, appropriately, at a lower priority than public health fundamentals such as clean water, sanitation, and vaccination. Even in high-income countries, the technical challenges of surgery and the consequences of immunosuppression restrict the number of suitable recipients, but the major finite restrictions on kidney transplantation rates are the shortage of donated organs and the limited medical, surgical, and nursing workforces with the required expertise. These problems have solutions which involve the full range of societal, professional, governmental, and political environments. World Kidney Day is a call to deliver transplantation therapy to the 1 million people a year who have a right to benefit.
  3 2,474 184
LETTERS TO EDITOR
Collapsing glomerulopathy in renal allograft biopsies: A study of nine cases
M Mubarak
March-April 2012, 22(2):150-150
DOI:10.4103/0971-4065.97145  
  2 894 59
ORIGINAL ARTICLES
Modality of choice for renal replacement therapy for children with acute kidney injury: Results of a survey
A Vasudevan, A Iyengar, K Phadke
March-April 2012, 22(2):121-124
DOI:10.4103/0971-4065.97130  
Information on current practices in India for management of renal replacement therapy (RRT) in acute kidney injury (AKI) is lacking. We mailed a questionnaire to 26 pediatric nephrology centers across India to obtain information on the current choice of dialysis modality for management of AKI in children. Acute intermittent peritoneal dialysis was available at all centers surveyed, whereas intermittent hemodialysis and continuous RRT were available in 86% and 17% centers, respectively. Peritoneal dialysis was the predominant modality (accounting for more than 80% of all dialysis) in 14 of the 22 centers, while 4 centers used hemodialysis more commonly. The most important factors influencing the modality choice were patient size, hemodynamic stability, and duration of AKI. These results provide insight into the choice of modality and factors influencing their selection in the management of pediatric AKI in our country.
  2 2,554 189
Association between -1486 T>C and +1174 G>A single nucleotide polymorphisms in TLR9 gene and severity of lupus nephritis
R Ramachandran, V Sharma, M Rathi, AK Yadav, A Sharma, HS Kohli, V Sakhuja, V Jha
March-April 2012, 22(2):125-129
DOI:10.4103/0971-4065.97133  
Signaling through Toll-like receptor-9 (TLR9), a mediator of innate immune responses, could have a role in the pathogenesis of systemic lupus erythematosus (SLE). Some studies have shown an association between polymorphisms in the TLR9 gene and disease manifestations. We investigated whether two single nucleotide polymorphisms (-1486 T>C and +1174 G>A) in the TLR9 gene are associated with the risk of renal involvement in SLE. DNA samples from 112 SLE patients (62 with lupus nephritis) and 100 healthy controls were obtained. TLR9 polymorphisms (-1486 T>C and +1174 G>A) were analyzed by polymerase chain reaction-restriction fragment length polymorphism. Genotype and allelic frequencies were compared between lupus patients and healthy controls. Clinical and laboratory manifestations and activity scores on renal biopsy of patients with lupus nephritis were compared between various genotypes. There was no difference in the frequency of genotype or allele distribution at either of the two loci between lupus patients and controls and in lupus patients with or without nephritis. Patients with CC/CT genotype at the -1486 position had higher serum creatinine (P = 0.03) and Austin activity scores (P = 0.015). Patients with AA/AG genotype at +1174 position showed higher serum creatinine (P = 0.04), proteinuria (P = 0.011), anti-dsDNA titers (P <</i> 0.001) and Austin activity scores (P = 0.003) than the GG genotype. Variations at the -1486 and +1174 positions of TLR9 gene are not associated with increased risk of SLE or that of kidney involvement in North Indians. CC/CT genotypes at -1486 and AA/AG at +1174 positions are associated with more severe kidney disease at presentation.
  2 2,002 111
Comparison of glomerular filtration rate estimated by plasma clearance method with modification of diet in renal disease prediction equation and Gates method
N Prasad, S Barai, S Gambhir, DS Parasar, M Ora, A Gupta, RK Sharma
March-April 2012, 22(2):103-107
DOI:10.4103/0971-4065.97123  
Glomerular filtration rate (GFR) prediction equations are widely used in clinical practice for quick assessment of kidney function. Gates method using radionuclide technique is an alternative to prediction equations for quick assessment of GFR. Aim of the study was to compare Gates method and modification of diet in renal disease (MDRD) equation in a sizeable patient population with wide range of renal function to evaluate their clinical utility. GFR was estimated in 897 subjects with wide range of renal function by gates method, and MDRD equation and results were compared against measured GFR. Subjects were divided in to 4 groups (0-30 ml, 31-60 ml, 61-90 ml, >90 ml) on the basis of measured GFR and comparison between two methods done through linear regression analysis. Analysis of R 2 indicated that 56% of the interindividual variability for Gates GFR was in accordance to variation in measured GFR, in the GFR range of (0-30 ml), this value dropped to 39% in the GFR range of 31-60 ml, 40% in the GFR range of 61-90 ml, 26.4% in the GFR range of >90 ml, the corresponding figure for MDRD GFR were 47.9%, 31.1%, 17.6% and 16.1%, respectively. Gates method is more precise for GFR estimation at all levels of renal function.
  2 2,072 190
CASE REPORTS
Bilateral emphysematous pyelonephritis in autosomal dominant polycystic kidney disease
G Lakshminarayana, A Mathew, R Rajesh, G Kurien, VN Unni
March-April 2012, 22(2):136-138
DOI:10.4103/0971-4065.97138  
Emphysematous pyelonephritis (EPN) is an uncommon infection of renal parenchyma with gas-forming organisms. EPN is usually seen in patients with diabetes mellitus (DM). The association of EPN with conditions other than DM is extremely rare. We report a case of autosomal dominant polycystic kidney disease with bilateral EPN who had to undergo bilateral nephrectomy.
  1 2,050 112
Urinary ascites
K Abirami, G Sivaramakrishna, AY Lakshmi, V Sivakumar
March-April 2012, 22(2):143-144
DOI:10.4103/0971-4065.97140  
A middle-aged male presented with abdominal pain and ascites following a fall in alcoholic intoxicated state. Evaluation revealed microscopic hematuria and severe renal failure. Ascitic fluid analysis showed high urea and creatinine values suggesting it to be a urinary ascites. Retrograde cystography confirmed intraperitoneal bladder rupture. Following continuous bladder drainage ascites subsided and serum creatinine has reduced to 3 mg/dL. This case report highlights the importance of ascitic fluid analysis as a pointer to diagnose urinary ascites secondary to intraperitoneal bladder rupture.
  1 1,567 100
LETTERS TO EDITOR
C4d staining in allograft biopsies
P Kulkarni, MS Uppin, AK Prayaga, U Das, KV Dakshinamurthy
March-April 2012, 22(2):155-156
DOI:10.4103/0971-4065.97155  
  1 1,043 79
ORIGINAL ARTICLES
Is there any correlation between hypercalciuria and nocturnal enuresis?
A Nikibakhsh, H Poostindooz, H Mahmoodzadeh, M Karamyyar, R Rasoul Ghareaghaji, N Sepehrvand
March-April 2012, 22(2):88-93
DOI:10.4103/0971-4065.97110  
Nocturnal enuresis is a common problem among children. Hypercalciuria has been proposed as an important etiology of bedwetting. We investigated the incidence of hypercalciuria among children with nocturnal enuresis and age- and sex-matched healthy controls. In this case-control study 118 children with nocturnal enuresis and 100 age-, sex-, and educational district-matched healthy controls were recruited. Urine samples were obtained from each subject twice: immediately after awakening and 2 hours later at school. Urinary calcium and creatinine levels were measured and the subjects with a urinary calcium/creatinine ratio more than 0.2 were considered as hypercalciuric. Serum Ca, P, Na, K, and PTH levels were measured for all hypercalciuric subjects. The mean urine calcium to creatinine ratio in the second urine sample was 0.070±0.06 mg/mg and 0.050±0.046, respectively in the case and control groups (P=0.008). There were 12/118 and 3/100 hypercalciuric subjects in the case and control groups respectively (P=0.032). The serum Ca, P, Na, K, and PTH levels were in normal range in all hypercalciuric subjects. In our study there was a significant difference in the frequency of hypercalciuria among children with nocturnal enuresis and healthy controls, so we can suggest adding the measurement of urine electrolytes especially the calcium level in patients with nocturnal enuresis.
  1 1,854 148
Management and outcome of children with end-stage renal disease in northwest Iran
F Mortazavi, M Maleki
March-April 2012, 22(2):94-97
DOI:10.4103/0971-4065.97113  
Outcome of end-stage renal disease (ESRD) in children has considerably improved since the development of dialysis and kidney transplantation. This study was conducted to evaluate the management and outcome of ESRD children in a referral pediatric center in northwest Iran. A cross-sectional study of medical records of ESRD children (glomerular filtration rate less than 15 ml/min/1.73 m 2 ) younger than 16 years who were admitted in Children's Hospital of Tabriz between October 1999 and October 2009 was performed. Ninety-four children with ESRD including 51 boys (54.3%) and 43 girls (45.7%) with a mean age of 7.9 ± 3.49 years were studied. Parents of nine patients (7.8%) refused treatment. Eighty patients underwent renal replacement therapy (RRT) and were followed for a mean period of 4.86 ± 2.77 years. Initial modality of RRT was hemodialysis in 81.25%, continuous ambulatory peritoneal dialysis in 16.25%, and preemptive kidney transplantation in 2.5%. Thirty-two patients (34%) underwent renal transplantation. The mean duration of staying on dialysis before transplantation was 12.4 ± 11 months. Twenty-nine of kidney donors (90.6%) were living unrelated donors. The 1-and 3-year graft survival rates were 81.2% and 68.8% and the 1- and 3-year patient survival rates were 96.9% and 93.8%, respectively. Thirty-one patients died (33%). The mortality of girls was significantly higher than boys (P=0.04). There was a significant negative correlation between age and mortality (P=0.01). Heart failure and infections were the most common cause of death. This study showed that ESRD children in our area have a poor outcome in comparison with developed countries.
  1 1,904 141
Retarding the progression of chronic kidney disease with renin angiotensin system blockade
M Limesh, RA Annigeri, MK Mani, PC Kowdle, B Subba Rao, S Balasubramanian, R Seshadri
March-April 2012, 22(2):108-115
DOI:10.4103/0971-4065.97126  
We assessed the effect of renin angiotensin system blockade (RASB) in chronic kidney disease (CKD) of diverse etiology. Two hundred and sixty-five consecutive CKD patients attending our renal clinic, with estimated glomerular filtration rate (eGFR) of 20-70 ml/min/1.73m 2 at baseline and a minimal follow-up of 1 year, were studied retrospectively. We devised a scoring system to quantify RASB, wherein the maximum dose of an agent recommended for control of hypertension was scored as 1. The renal endpoints studied were the rate of change in eGFR (ΔeGFR) and decline of eGFR>50%. The mean age was 48 ± 11.2 years and 69% were male. The mean duration of follow-up was 4 ± 2.7 years. The rate of ΔeGFR was−1.5 ± 5.0 ml/min/1.73 m 2 per year in patients who received RASB (N=168) and −6.0 ± 5.4 in those who did not (N=97) (P < 0.001). The incidence of decline of eGFR >50% was 11.3% with RASB and 24.7% without (P=0.003). In a subgroup of patients who received RASB, the incidence of decline of eGFR >50% was 17.8% in the low-dose RASB group (N=84, RASB score 0.63 ± 0.38) and 4.8% in the high-dose group (N=84, RASB score 2.5 ± 0.7) (P=0.001). RASB was associated with significantly better renoprotection in CKD of diverse etiology, even in nonproteinuric diseases. This effect appeared to be dose-dependent, with higher supramaximal doses exhibiting better renoprotection than the lower conventional doses. Our results make a strong case for use of aggressive RASB in all CKD patients to postpone end-stage renal disease.
  1 2,133 190
CASE REPORTS
Renal transplantation in HIV patients: A series of four cases
DK Agarwal, JK Hota, N Nag, SN Mehta
March-April 2012, 22(2):139-142
DOI:10.4103/0971-4065.97139  
Human immunodeficiency virus (HIV) infection in a patient with end-stage renal disease was considered a contraindication for renal transplantation till now despite the advent of highly active antiretroviral therapy with the apprehension that immunosuppression would further jeopardize the already compromised immune status of the patients. Renal transplantation in HIV patients is rare in developing countries including ours. Here we report a series of four cases of renal transplantation in HIV patients.
  - 1,532 100
Recombinant activated factor VII for diffuse alveolar hemorrhage in microscopic polyangiitis
SK Mandal, G Sagar, M Sahoo, S Jasuja
March-April 2012, 22(2):130-132
DOI:10.4103/0971-4065.97134  
Diffuse alveolar hemorrhage is a serious complication of the small vessel vasculitis syndromes and carries a high mortality. Recombinant activated factor VII (rFVIIa) is a powerful hemostatic agent developed for treatment of bleeding in patients with hemophilia and antibodies to factors VIII or IX. It has been used increasingly in life-threatening hemorrhage in a variety of other settings in which conventional medical or surgical therapy is unsuccessful. We report the successful use of rFVIIa for massive pulmonary hemorrhage in a patient of microscopic polyangiitis, which was later complicated by thrombotic microangiopathy and posterior reversible encephalopathy syndrome.
  - 1,719 67
Transmission of human immunodeficiency virus infection by renal transplantation
P Mukhopadhyay, V Kumar, M Rathi, HS Kohli, V Jha, V Sakhuja
March-April 2012, 22(2):133-135
DOI:10.4103/0971-4065.97135  
The rare occurrence of human immunodeficiency virus (HIV) transmission through organ transplantation cannot override the huge impact that it has on the patient. We report a case of HIV transmission by renal transplantation in a 33-year-old housewife, who received a living related transplantation from her sister. Both the patient and her donor were negative by HIV antibody testing prior to transplantation, but were found to be infected in the ninth month after transplant. Further testing suggested that the donor was in the window period at the time of organ donation after having acquired the infection from her husband.
  - 1,393 82
IMAGES IN NEPHROLOGY
Spontaneous kidney rupture in a patient on chronic hemodialysis
G Li Cavoli, L Bono, C Tortorici, A Ferrantelli, C Giammarresi, I Di Lorenzo, U Rotolo
March-April 2012, 22(2):145-146
DOI:10.4103/0971-4065.97141  
  - 1,520 80
LETTERS TO EDITOR
Easy method of detection of chyle in urine
Md M Rahman
March-April 2012, 22(2):147-148
DOI:10.4103/0971-4065.97142  
  - 2,182 153
Blogging during IPNA meeting : Reaching out to fellows at home
SK Sethi, J Sharma, M Matnani, KD Jhaveri
March-April 2012, 22(2):148-149
DOI:10.4103/0971-4065.97143  
  - 1,223 46
Cyclophosphamide-induced nail hyperpigmentation in a child
A Saha, N Arora, N Mehra, NK Dubey
March-April 2012, 22(2):149-149
DOI:10.4103/0971-4065.97144  
  - 1,772 71
Authors' reply
R Gupta, A Sharma, SK Agarwal, AK Dinda
March-April 2012, 22(2):151-151
  - 772 68
Relapse of nephrotic syndrome after a bee sting
M Ceri, I Kurultak
March-April 2012, 22(2):151-152
DOI:10.4103/0971-4065.97147  
  - 964 68
Congenital nephrotic syndrome and nonsteroidal anti-inflammatory drugs
B Aoun, CP Schmitt, T Ulinski, H Fakhoury, G Kalkas, S Sanjad
March-April 2012, 22(2):152-153
DOI:10.4103/0971-4065.97149  
  - 1,338 80
Posterior reversible encephalopathy syndrome in minimal change disease
G Swarnalatha, R Ram, B. H. S. Pai, KV Dakshinamurty
March-April 2012, 22(2):153-154
DOI:10.4103/0971-4065.97153  
  - 1,424 80
ORIGINAL ARTICLES
Renal disease in human immunodeficiency virus - Not just HIV-associated nephropathy
PS Vali, K Ismal, S Gowrishankar, M Sahay
March-April 2012, 22(2):98-102
DOI:10.4103/0971-4065.97117  
The aim of the study was to determine the various histopathological lesions in human immunodeficiency virus (HIV) patients with renal dysfunction and to establish clinicopathological correlation. Over a period of two years from January 2008 to March 2010, 27 HIV positive patients with renal dysfunction were subjected to renal biopsy. Of the 27 patients, 23 were males and four were females (85.2% males, 14.8% females). Mean age was 38.2 ± 10.36 (range 20 - 60) years. The probable mode of acquisition of HIV infection was sexual in 22 patients (81.5%). Thirteen patients (48%) had nephrotic proteinuria. The CD4 count ranged from 77 to 633/microliter. The kidneys were of normal size in 19 (70.4%) and bulky in eight (29.6%) patients. Thirteen patients required renal replacement therapy. Eleven patients had acute tubule-interstitial lesions (40.7%) while 15 (55.5%) had glomerular lesions. The various glomerular lesions were, focal segmental glomerulosclerosis in five, amyloidosis in three, diffuse proliferative GN in two, and membranoproliferative glomerulonephritis (GN), membranous GN, minimal change disease, diabetic nephropathy, crescentic GN, and thrombotic microangiopathy were seen in one each. None of the clinical or laboratory variables, except hypertension, was found to predict glomerular versus non-glomerular lesions on biopsy. In conclusion we show that a variety of glomerular and tubulointerstitial lesions can be seen on renal histology. Hence, renal biopsy is indicated in renal dysfunction associated with HIV for making proper diagnosis and therapy.
  - 2,135 270
Deceased donor organ transplantation: A single center experience from Cape Town, South Africa
EM Muller, Z Barday, F McCurdie, D Kahn
March-April 2012, 22(2):86-87
DOI:10.4103/0971-4065.97108  
Deceased donor kidney transplantation have been in place for more than ten years at Groote Schuur Hospital in Cape Town, South Africa. This retrospective review between 1995 and 2005 reports the experience with 824 deceased donor referrals. Race breakdown showed that 321 donors were black, 154 white, 318 mixed race and 30 unrecorded. Consent remains a major problem in South Africa and we were unable to obtain consent in 43% of our patients. Only 20% of donors had natural causes of death - the majority died because of trauma/unnatural circumstances. For this reason the average age of our donors are 26 years. A and O blood group donors were the most prevalent with A blood group patients making up 38% and O blood group 39% of the donor population.
  - 1,446 104
SPECIAL FEATURES
The case for renal artery stenting for treatment of atherosclerotic renal artery stenosis
S Gang
March-April 2012, 22(2):83-85
DOI:10.4103/0971-4065.97104  
  - 1,348 132
Indian Journal of Nephrology
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Online since 20th Sept '07