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   2014| March-April  | Volume 24 | Issue 2  
    Online since February 27, 2014

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Impact of smoking on microalbuminuria and urinary albumin creatinine ratio in non-diabetic normotensive smokers
RK Gupta, R Gupta, VD Maheshwari, M Mawliya
March-April 2014, 24(2):92-96
DOI:10.4103/0971-4065.127893  PMID:24701041
Smoking is associated with an excessive morbidity and mortality from a variety of diseases. The aim of this study was to find out the effects of smoking on renal function study in non-diabetic, normotensive subjects. A community-based, prospective, cross-sectional cohort study was conducted on 120 subjects; 80 (66.66%) were smokers and 40 (33.33%) age matched non-smokers; with age range of 30 to 70 years. Measurement of fasting sugar, urea, creatinine, lipids and one time screening of urinary albumin and urinary creatinine was done. Smokers had significantly higher urinary albumin and albumin creatinine ratio (ACR) (52.84 ± 46.42 mg/L, 93.98 ± 78.68 μg/mg) than non-smokers (19.25 ± 7.77 mg/L, 18.99 ± 6.65 μg/mg), respectively (P =< 0.001, P =< 0.001). Microalbuminuria and urinary ACR level were directly related to the amount of smoking (pack-years). Among smokers, 73 (91.25%) had microalbuminuria (>20 mg/L) and 64 (80%) had increased urinary ACR (>30 μg/mg). Smoker had significantly lower high-density lipoprotein level (36.66 ± 10.28 mg/dl) compared to non-smokers (41.22 ± 11.72 mg/dl) (P = 0.031). Urea, creatinine, creatinine clearance, total cholesterol, low density lipoprotein, triglyceride levels were comparable (p = NS). In conclusion, smokers have a 4-fold higher prevalence of microalbuminuria than non-smokers.
  12,544 721 -
Changing histologic spectrum of adult nephrotic syndrome over five decades in north India: A single center experience
M Rathi, RL Bhagat, P Mukhopadhyay, HS Kohli, V Jha, KL Gupta, V Sakhuja, K Joshi
March-April 2014, 24(2):86-91
DOI:10.4103/0971-4065.127892  PMID:24701040
Glomerular diseases are an important cause of chronic renal failure in developing countries. The spectrum of diseases causing nephrotic syndrome is changing globally in the last few decades. The aim of this prospective study was to look at this spectrum at a tertiary care center in North India and to analyze the changing trends over the last five decades. Patients in the age group 18-60 years with nephrotic syndrome were consecutively included in the study. Renal biopsies were performed in all patients and were subjected to light microscopy, immunofluorescence (IF) and electron microscopy (EM). While the IF was performed in 78% of cases, EM was available in one-fourth of cases. During 2002-2007, 364 patients (60.2% males) were included in the study. The mean age was 31.5 years. Primary glomerular diseases accounted for 89% of cases while lupus nephritis was the most common secondary glomerular disease. Focal segmental glomerulosclerosis (FSGS) accounted for 30.6% of primary glomerular diseases making it the most common cause of nephrotic syndrome. It was followed by membranous glomerulonephritis (MGN) in 24.4%, mesangiocapillary glomerulonephritis in 17.9% and minimal change disease in 14.8%. In the age group >40 years, MGN was the most common lesion (32.5%) followed by FSGS (27.7%). Over the last five decades, there was a nearly five-fold increase in the incidence of FSGS, 3-fold increase in MGN and a 10-fold reduction in diffuse proliferative glomerulonephritis while there was no major change in incidence of other diseases. The biopsy diagnosis of FSGS has increased considerably in last few decades and it is now the most common cause of nephrotic syndrome in adults in North India. MGN is the most common lesion in patients over 40 years of age.
  2,974 337 -
Profile of incident chronic kidney disease related-mineral bone disorders in chronic kidney disease Stage 4 and 5: A hospital based cross-sectional survey
AT Valson, M Sundaram, VG David, MN Deborah, S Varughese, G Basu, A Mohapatra, S Alexander, J Jose, J Roshan, B Simon, G Rebekah, V Tamilarasi, CK Jacob
March-April 2014, 24(2):97-107
DOI:10.4103/0971-4065.127897  PMID:24701042
Chronic kidney disease related-mineral bone disorder (CKD-MBD) has been poorly studied in pre-dialysis Indian CKD patients. We aimed to study the clinical, biochemical and extra skeletal manifestations of untreated CKD-MBD in pre-dialysis Stage 4 and 5 CKD patients attending nephrology out-patient clinic at a tertiary care hospital in South India. A hospital based cross-sectional survey including, demographic profile, history of CKD-MBD symptoms, measurement of serum calcium, phosphate, parathyroid hormone, 25 hydroxy vitamin D (25(OH) D) and alkaline phosphatase; lateral abdominal X-rays for abdominal aortic calcification (AAC) and echocardiography for valvular calcification (VC) was carried out. Of the 710 patients surveyed, 45% had no CKD-MBD related symptom. Prevalence of hypocalcemia, hyperphosphatemia, hyperparathyroidism (>150 pg/mL) and 25(OH) D levels <30 ng/mL was 66.3%, 59%, 89.3% and 74.7% respectively. Echocardiography was carried out in 471 patients; 96% of whom had VC (calcification score ≥1). Patients with VC were older and had lower 25(OH) D levels than those without. Lateral abdominal X-rays were obtained in 558 patients, 6.8% of whom were found to have AAC, which was associated with older age. Indian patients with incident CKD-MBD have a high prevalence of hypocalcemia, 25(OH) D deficiency and VC even prior to initiating dialysis while AAC does not appear to be common. The association between 25(OH) D deficiency and VC needs further exploration.
  2,675 282 -
Syndrome of rapid onset end stage renal disease in incident Mayo Clinic chronic hemodialysis patient
M. A. C. Onuigbo, NT Onuigbo, CG Musso
March-April 2014, 24(2):75-81
DOI:10.4103/0971-4065.127886  PMID:24701038
Despite decades of research, a full understanding of chronic kidney disease (CKD)-end stage renal disease (ESRD) progression remains elusive. The common consensus is a predictable, linear, progressive and time-dependent decline of CKD to ESRD. Acute kidney injury (AKI) on CKD is usually assumed to be transient, with recovery as the expected outcome. AKI-ESRD association in current nephrology literature is blamed on the so-called "residual confounding." We had previously described a relationship between AKI events and rapid onset yet irreversible ESRD happening in a continuum in a high-risk CKD cohort. However, the contribution of the syndrome of rapid onset-ESRD (SORO-ESRD) to incident United States ESRD population remained conjectural. In this retrospective analysis, we analyzed serum creatinine trajectories of the last 100 consecutive ESRD patients in 4 Mayo Clinic chronic hemodialysis units to determine the incidence of SORO-ESRD. Excluding 9 patients, 31 (34%) patients, including two renal transplant recipients, had SORO-ESRD: 18 males and 13 females age 72 (range 50-92) years. Precipitating AKI followed pneumonia (8), acutely decompensated heart failure (7), pyelonephritis (4), post-operative (5), sepsis (3), contrast-induced nephropathy (2), and others (2). Time to dialysis was shortest following surgical procedures. Concurrent renin angiotensin aldosterone system blockade was higher with SORO-ESRD - 23% versus 5%, P = 0.0113. In conclusion, SORO-ESRD is not uncommon among the incident general US ESRD population. The implications for ESRD care planning, AV-fistula-first programs, general CKD care and any associations with renal ageing/senescence warrant further study.
  2,225 220 -
Chronic kidney disease and the aging population
M Tonelli, M Riella
March-April 2014, 24(2):71-74
DOI:10.4103/0971-4065.127881  PMID:24701037
  2,095 273 -
Atypical presentation of post infectious glomerulonephritis as malignant hypertension and thrombotic microangiopathy
M Vankalakunti, P Malleshappa, H Hussain, A Marilingegouda
March-April 2014, 24(2):110-113
DOI:10.4103/0971-4065.127900  PMID:24701044
Infection-related glomerulonephritis presents commonly as acute nephritic illness, hypertension, hypocomplementinemia following an episode of pharyngitis or pyoderma. Atypical features like thrombotic microangiopathy (TMA), produced by neuraminidase antigen targeting endothelium have been described rarely. We report a case of TMA secondary to malignant hypertension, coexisting with post infectious glomerulonephritis.
  2,141 118 -
Hemodialysis performance and outcomes among end stage renal disease patients from Sokoto, North-Western Nigeria
MA Makusidi, HM Liman, A Yakubu, MD Isah, S Abdullahi, A Chijioke
March-April 2014, 24(2):82-85
DOI:10.4103/0971-4065.127889  PMID:24701039
The cost of managing end stage renal disease (ESRD) is prohibitive in Nigeria and the burden is solely borne by patients and their relatives. Despite increasing number of dialysis centers in urban areas, actual utilization of such facilities is very low. It is unclear if the outcomes of these patients have improved in recent times. We evaluated pattern of hemodialysis (HD) performance and outcome among ESRD patients. A 5-year prospective cross-sectional study of all ESRD patients on HD was undertaken. The final outcomes included duration on maintenance dialysis, death from inability to sustain dialysis, absconded, confirmed deaths within or outside health facility or referral for kidney transplant. A total of 540 (54%) of 976 cases of ESRD commenced HD, out of which 7 (1.3%) eventually had live-related kidney transplant in India. The male to female ratio was 2:1 with male and female mean ages of 43 ± 17 and 36 ± 16 years respectively. There was a progressive annual increase in the number of ESRD patients. The commonest underlying renal disorder was chronic glomerulonephritis. The mean HD session duration was 8.11 ± 5.4 hours, while the mean duration of stay on HD was 8.72 ± 1.0 weeks. In conclusion, ESRD is common and is being increasingly recognized. Financial constraint and late presentation are major contributory factors to poor outcomes despite the widespread availability of HD facilities. Therefore, effort should be geared towards aggressive strategies for early detection and treatment. Government commitment in terms of funding and/or subsidy for patient with ESRD is advocated.
  1,908 167 -
Mesangial proliferative glomerulonephritis with acute tubule interstitial nephritis leading to acute kidney injury in influenza A (H1N1) infection
VB Kute, AV Vanikar, PR Shah, MR Gumber, HV Patel, HL Trivedi
March-April 2014, 24(2):114-116
DOI:10.4103/0971-4065.127902  PMID:24701045
Respiratory complications and renal failure are the leading causes for morbidity and mortality due to influenza (H1N1) virus infection. There has been limited information on histopathology of H1N1 influenza-related acute kidney injury (AKI). We describe AKI with H1N1 infection in a 52-year-old female. Renal biopsy showed mesangial proliferative glomerulonephritis with acute tubule interstitial nephritis. Her condition improved rapidly with oseltamivir, fluid replacement, steroid and dialysis. Our case suggests that H1N1 infection may have a causative link to the development of mesangial proliferative glomerulonephritis with acute tubulointerstitial nephritis.
  1,945 117 -
Tenofovir induced Fanconi syndrome: A rare cause of hypokalemic paralysis
EP Venkatesan, MB Pranesh, G Gnanashanmugam, J Balasubramaniam
March-April 2014, 24(2):108-109
DOI:10.4103/0971-4065.127898  PMID:24701043
We report a 55-year-old female who presented to the emergency department with acute onset quadriparesis. She was diagnosed to have acquired immunodeficiency syndrome 7 years ago and was on tenofovir based anti-retroviral therapy for past 10 months. As the patient also had hypophosphatemia, glucosuria and proteinuria Fanconi syndrome (FS) was suspected. She improved dramatically over next 12 h to regain normal power and also her renal functions improved over next few days. Tenofovir induced FS presenting as hypokalemic paralysis is very rare complication and is the first case reported from India.
  1,889 147 1
Karyomegalic interstitial nephritis with focal segmental glomerulosclerosis: A rare association
S Radha, A Tameem, BS Rao
March-April 2014, 24(2):117-119
DOI:10.4103/0971-4065.127905  PMID:24701046
Karyomegalic interstitial nephritis (KIN) is a rare form of, progressive chronic interstitial nephritis. We present a case of KIN in a child, who was also found to have nephrotic syndrome because of focal segmental glomerulosclerosis on renal biopsy. To our knowledge, this is the first case of KIN associated with glomerulopathy.
  1,831 114 -
Valacyclovir associated neurotoxicity in a patient on dialysis
NP Singh, HR Shah, N Aggarwal, LK Jha, S Behura
March-April 2014, 24(2):128-129
DOI:10.4103/0971-4065.127915  PMID:24701050
  1,827 86 1
Pulmonary histoplasmosis in a renal allograft recipient
V Lobo, A Joshi, P Khatavkar, MK Kale
March-April 2014, 24(2):120-123
DOI:10.4103/0971-4065.127907  PMID:24701047
Histoplasmosis, seen rarely in kidney transplantracipients, can vary from an innocuous illness often misdiagnosed as tuberculosis to a severe disseminated disease with a high mortality. We describe a case with non-specific signs in whom the diagnosis was made by histopathological examination of the lesion. Prompt introduction of specific treatment led to Histoplasmosis, seen rarely in kidney transplantracipients, can vary from an innocuous illness often misdiagnosed as tuberculosis to a severe disseminated disease with a high mortality. We describe a case with non-specific signs in whom the diagnosis was made by histopathological examination of the lesion. Prompt introduction of specific treatment led to the patient making an excellent recovery.the patient making an excellent recovery.
  1,515 96 -
Percutaneous injection of acrylic glue into renal allograft pseudoaneurysm for control of intractable post-biopsy hematuria
A Lal, M Singhal, R Ramachandran, M Rathi, V Jha, N Khandelwal
March-April 2014, 24(2):124-126
DOI:10.4103/0971-4065.127909  PMID:24701048
We report a 44-year-old male, renal allograft recipient of 1-year duration who had two episodes of steroid responsive acute rejection. He presented with graft dysfunction for which a graft biopsy was performed and was suggestive of mixed rejection. At 2 weeks post-biopsy, patient developed severe pain over the graft site with anuria and graft hydronephrosis (HDN). The HDN and anuria intermittently settled with the passage of blood clots per-urethra. Contrast enhanced computerized tomography was suggestive of pseudoaneurysm in the graft kidney. The case was successfully managed with ultrasound guided percutaneous cyanoacrylate glue injection into the pseudoaneurysm.
  1,311 79 -
Small bowel intussusception in an adult with nephrotic syndrome
T Ete, S Mondal, D Sinha, A Nag, A Chakraborty, J Pal, A Ghosh
March-April 2014, 24(2):136-137
DOI:10.4103/0971-4065.127930  PMID:24701057
  1,250 107 -
An unusual complication of bortezomib therapy: Acute pancreatitis
H Gupta, R Bansal, S Khanna, S Saxena
March-April 2014, 24(2):135-136
DOI:10.4103/0971-4065.127928  PMID:24701056
  1,252 91 1
Regular monthly prescription with knowledge of each medicine may improve drug adherence in hemodialysis patients
T Jeloka, D Toraskar, P Sanwaria, S Niture
March-April 2014, 24(2):131-132
DOI:10.4103/0971-4065.127920  PMID:24701053
  1,205 75 -
Over-immunosuppression can be life threatening in minimal change disease
G Bakul, VN Unni, A Mathew, R Rajesh, G Kurien
March-April 2014, 24(2):132-134
DOI:10.4103/0971-4065.127922  PMID:24701054
  1,121 70 -
Epidemiology of vitamin D deficiency in West African hemodialysis patients: A pilot study from Senegal
SM Seck, MM Cisse, EF Ka, D Doupa
March-April 2014, 24(2):127-128
DOI:10.4103/0971-4065.127913  PMID:24701049
  1,070 92 -
Percutaneous renal biopsy in children: Are British Association of Pediatric Nephrology standards achievable?
YR Chopra, A Saha, K Kapoor, N Bagri, NK Dubey, VV Batra
March-April 2014, 24(2):130-131
DOI:10.4103/0971-4065.127936  PMID:24701052
  1,035 78 -
Splenectomy and unilateral nephrectomy complicating granulomatosis with polyangitis
SA George, I Francis
March-April 2014, 24(2):134-135
DOI:10.4103/0971-4065.127923  PMID:24701055
  1,022 49 -
Medical management of chyloretroperitoneum following retroperitoneoscopic donor nephrectomy
S Sharma, SJ Rizvi, PR Modi
March-April 2014, 24(2):129-130
DOI:10.4103/0971-4065.127916  PMID:24701051
  938 52 -
Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07