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   2014| May-June  | Volume 24 | Issue 3  
    Online since May 6, 2014

 
 
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IMAGES IN NEPHROLOGY
Chronic renal failure, hyperkalemia, and colonic ulcers
SA George, M Alboraie, A Maamoun
May-June 2014, 24(3):193-194
DOI:10.4103/0971-4065.132023  PMID:25120301
  1 1,581 111
LETTERS TO EDITOR
D-penicillamine-induced membranous nephropathy
RP Senthil Kumar, ND Srinivasa Prasad, S Tirumavalavan, M Edwin Fernando
May-June 2014, 24(3):195-196
DOI:10.4103/0971-4065.132024  PMID:25120302
  1 1,419 90
Membranous nephropathy and carbamazepine
B Sangeetha, P Sandeep, B Varalaxmi, V Chaitanya, R Ram, V Siva Kumar
May-June 2014, 24(3):201-202
DOI:10.4103/0971-4065.132030  PMID:25120308
  1 1,010 110
ORIGINAL ARTICLES
Direct costs associated with chronic kidney disease among type 2 diabetic patients in India
K Satyavani, H Kothandan, M Jayaraman, V Viswanathan
May-June 2014, 24(3):141-147
DOI:10.4103/0971-4065.132000  PMID:25120290
The aim of this study was to estimate the direct costs of medical care among hospitalized type 2 diabetic patients with chronic kidney disease (CKD). A total of 209 (M:F, 133:76) patients were divided into groups based on the severity of kidney disease. Group 1 subjects had undergone renal transplantation (n = 12), group 2 was CKD patients on hemodialysis (n = 45), group 3 was patients with CKD, prior to end-stage renal disease (ESRD) (n = 66), and group 4 (n = 86) consisted of subjects without any complications. Details about expenditure per hospitalization, length of stay during admission, direct medical and nonmedical cost, expenditure for the previous two years, and source of bearing the expenditure were recorded in a questionnaire. Diabetic patients with CKD prior to ESRD spend more per hospitalization than patients without any complications. [Median ₹ 12,664 vs. 3,214]. The total median cost of CKD patients on hemodialysis was significantly higher than other CKD patients (INR 61,170 vs. 12,664). The median cost involved in kidney transplantation was ₹ 392,920. The total expenditure for hospital admissions in two years was significantly higher for dialysis than transplantation. Patients on hemodialysis or kidney transplantation tend to stay longer as inpatient admissions. The source of funds for the expenditure was mainly personal savings (46%). The expenditure on hospital admissions for CKD was considerably higher, and so, there is a need to develop a protocol on a cost-effective strategy for the treatment of CKD.
  1 4,598 278
Differences among children, adolescents and adults with severe leptospirosis: A comparative analysis
EF Daher, A. P. F. Vieira, CN Jacinto, R. S. A. Lima, M. M. V. Girão, A. T. B. M. Fernandes, R. J. P. Neto, GB Silva
May-June 2014, 24(3):166-170
DOI:10.4103/0971-4065.132013  PMID:25120294
Leptospirosis is a zoonosis of global importance caused by Leptospira interrogans. The aim of this study was to compare the data between children, adolescents and adults with leptospirosis. This is a retrospective study including a total of 373 consecutive patients with leptospirosis, admitted to tertiary hospitals in Northeast of Brazil, from May 1985 to August 2010. The patients were divided into two groups (age ≤21 years and >21 years). The adults were 304 (81.5%) of the population, with a mean ge of 41 ± 13 (range 22-84) years. The pediatric group was 16 ± 3 (range 9-21) years. Signs and symptoms where similar between the groups, excepting arrhythmia, which was more frequent in adults and vomiting, more common in children (16% vs. 0%, P = 0.04 and 65% vs. 79%, P = 0.02), respectively. Adult group presented with higher serum urea (137 vs. 97 mg/dl, P = 0.002) and creatinine (4.3 vs. 3.0 mg/dl, P = 0.007). Acute kidney injury (AKI) was observed in 80%, mainly in adults (83% vs. 70% P < 0.005). Adults required renal replacement therapy more frequently than children (38% vs. 11%, P < 0.0001). Mortality was higher in adults (14.8% vs. 2.8%, P = 0.005) and in adults with AKI (93% vs. 7%, P < 0.05). There are important differences between the adults and children with leptospirosis. AKI was more frequent in adults and it was associated with increased mortality.
  1 1,871 202
CASE REPORTS
Wilson's disease - A rare cause of renal tubular acidosis with metabolic bone disease
D. K. S. Subrahmanyam, M Vadivelan, S Giridharan, N Balamurugan
May-June 2014, 24(3):171-174
DOI:10.4103/0971-4065.132017  PMID:25120295
We report a 16-year-old boy who presented with weakness of lower limbs. He was diagnosed to have Wilson's disease, renal tubular acidosis and osteoporosis. Screening of siblings showed that his younger sister was also affected by the disease.
  - 2,067 162
An interesting case of primary hypoparathyroidism
DA Kirpalani, J Patel, H Shah, A Kirpalani, D Amrapurkar, R Choudhary, A Dhurve
May-June 2014, 24(3):175-177
DOI:10.4103/0971-4065.132018  PMID:25120296
Primary hypoparathyroidism can occur due to an activating mutation of calcium sensing receptor (CaSR). Most patients remain asymptomatic and therefore not diagnosed until adulthood. We present a 38-year-old lady who had a history of muscle cramps since 8 years. She presented with vomiting, abdomen pain and body ache, showed clinical evidence of hypovolemia, severe hypocalcemia, hypokalemia, hypomagnesemia, hyperphosphatemia and metabolic alkalosis. Her 24 h urinary phosphorus was low and 24 h urinary excretion of sodium, potassium and chloride were high. Her intact parathormone was on the lower side of the normal range. She improved once we had corrected her biochemical abnormalities. By excluding acquired causes of hypoparathyroidism, we are able to conclude that this may be a case of primary hypoparathyroidism due to activating mutation of CaSR.
  - 1,782 116
Thyrocervical artery - jugular fistula following internal jugular venous catheterization
PP Zachariah, VN Unni, G Kurian, RR Nair, A Mathew
May-June 2014, 24(3):178-180
DOI:10.4103/0971-4065.132019  PMID:25120297
Arteriovenous fistula (AVF) is an anomalous communication between an artery and a vein, caused by an iatrogenic or traumatic etiology. Surgically created upper limb AVF remains the preferred vascular access for patients on maintenance hemodialysis. Nonetheless central vein cannulation for hemodialysis is a common procedure done in patients who need hemodialysis. We incidentally detected a thyrocervical artery - jugular fistula in a patient on maintenance hemodialysis. He underwent a successful intra arterial coil embolization of the feeding vessel. Review of literature has shown that, a thyrocervical artery - internal jugular vein arteriovenous fistula following a central venous catheterization has not been reported so far.
  - 1,998 91
IgA dominant postinfectious glomerulonephritis: Report of two cases
V Rajakumar, S. A. K. Noor Mohamed, AA Kurien, ME Fernando
May-June 2014, 24(3):181-184
DOI:10.4103/0971-4065.132020  PMID:25120298
Immunoglobulin A (IgA) dominant postinfectious glomerulonephritis (IgA PIGN) is a distinct clinical entity increasingly recognized in adult. It usually presents with reduced glomerular filtration rate, heavy proteinuria, and has unfavorable prognosis. Immunofluorescence study of renal biopsy specimens have IgA as dominant or codominant antibody. We encountered two cases of IgA dominant PIGN recently presenting as rapidly progr essive glomerulonephritis and managed conservatively. Both the patients are on follow-up and do not have complete recovery of renal function till date. Long-term follow-up is needed to assess the progression of the disease in these patients.
  - 1,416 139
Extending the longevity of a complicated arteriovenous fistula using endovascular intervention
B Pawar, K Fernandes, CT Sajiv
May-June 2014, 24(3):185-188
DOI:10.4103/0971-4065.132021  PMID:25120299
A brachiocephalic arteriovenous fistula was complicated by a central venous stenosis, which could not be relieved. A cephalojugular bypass was performed using an interpositoned graft, which later developed tight stenoses at both ends of the graft. This was successfully treated with endovascular intervention, extending the longevity of the vascular access.
  - 1,187 68
Multifocal bacterial osteomyelitis in a renal allograft recipient following urosepsis
AT Valson, VG David, V Balaji, GT John
May-June 2014, 24(3):189-192
DOI:10.4103/0971-4065.132022  PMID:25120300
Non-tubercular bacterial osteomyelitis is a rare infection. We report on a renal allograft recipient with osteomyelitis complicating urosepsis, manifesting as a multifocal infection poorly responsive to appropriate antibiotics and surgical intervention and culminating in graft loss.
  - 1,432 87
EDITORIAL
Cost of treating diabetic kidney disease
I Dasgupta
May-June 2014, 24(3):139-140
DOI:10.4103/0971-4065.131999  PMID:25120289
  - 1,536 169
LETTERS TO EDITOR
Apparent steroid resistance associated with prednisolone suspension
KP Sathe
May-June 2014, 24(3):196-197
DOI:10.4103/0971-4065.132025  PMID:25120303
  - 773 71
Comment on: Malignant hypertension and nephrotic range proteinuria without hematuria: IgA nephropathy
H Nasri
May-June 2014, 24(3):197-197
DOI:10.4103/0971-4065.132026  PMID:25120304
  - 910 61
Acute renal failure secondary to ingestion of unknown mercury containing medicine-not due to Ayurvedic medicine
KL Virupaksha Gupta, G Pallavi
May-June 2014, 24(3):198-199
DOI:10.4103/0971-4065.132027  PMID:25120305
  - 989 85
Immunosupression for patients of endocarditis with glomerulonephritis
K Chatterjee, C Sen
May-June 2014, 24(3):199-200
DOI:10.4103/0971-4065.132028  PMID:25120306
  - 885 79
Seminoma in undescended testes presenting with acute renal failure
T Ete, S Mondal, D Sinha, A Nag, A Chakraborty, K Pan, J Pal, A Ghosh
May-June 2014, 24(3):200-201
DOI:10.4103/0971-4065.132029  PMID:25120307
  - 836 73
ORIGINAL ARTICLES
Frequency and clinicopathological correlations of histopathological variants of pediatric idiopathic focal segmental glomerulosclerosis
S Shakeel, M Mubarak, JI Kazi
May-June 2014, 24(3):148-153
DOI:10.4103/0971-4065.132003  PMID:25120291
There is no information on the frequency and clinicopathological correlations of the histopathological variants of primary focal segmental glomerulosclerosis (FSGS) in children presenting with idiopathic nephrotic syndrome (INS) in Pakistan. All consecutive children (≤17 years) who presented with INS, and in whom the histological diagnosis of FSGS was made on renal biopsies, were included in this prospective study. Their clinical, laboratory, and histopathological features at the time of presentation were noted from the case files and the biopsy reports for analysis and clinicopathological correlations. Out of 138 children, 93 (67.4%) were males and 45 (32.6%) were females. The mean age was 8.95 ± 4.14 (range: 1.5-17) years. All had NS, with steroid dependant NS (SDNS) in 45 (32.6%) and steroid resistant NS (SRNS) in 93 (67.4%) cases. Renal dysfunction at the time of presentation was found in six (4.3%) children. Global glomerulosclerosis was found in 68 (49.3%) cases. The mean number of glomeruli involved by segmental scarring was 2.98 ± 2.44. FSGS, not otherwise specified (NOS) was the most prevalent variant, comprising 89.1% of all cases. Collapsing variant comprised 8%, tip variant 1.4%, perihilar 0.7%, and cellular 0.7%. Hyaline arteriolosclerosis was found in 13 (9.4%) cases. Mild interstitial fibrosis/tubular atrophy was found in 95 (68.6%) cases, moderate in 18 (13%), and severe in two (1.4%) cases. In conclusion, FSGS, NOS variant was the highly prevalent variant, while collapsing type was also found in small but significant number of cases. Remaining three variants were distinctly rare in our children.
  - 1,708 192
Prospective blood pressure measurement in renal transplant recipients
VG David, B Yadav, L Jeyaseelan, MN Deborah, S Jacob, S Alexander, S Varughese, GT John
May-June 2014, 24(3):154-160
DOI:10.4103/0971-4065.132006  PMID:25120292
Blood pressure (BP) control at home is difficult when managed only with office blood pressure monitoring (OBPM). In this prospective study, the reliability of BP measurements in renal transplant patients with OBPM and home blood pressure monitoring (HBPM) was compared with ambulatory blood pressure monitoring (ABPM) as the gold standard. Adult patients who had living-related renal transplantation from March 2007 to February 2008 had BP measured by two methods; OBPM and ABPM at pretransplantation, 2 nd , 4 th , 6 th , and 9 th months and all the three methods : OBPM, ABPM, and HBPM at 6 months after transplantation. A total of 49 patients, age 35 ± 11 years, on prednisolone, tacrolimus, and mycophenolate were evaluated. A total of 39 were males (79.6%). Systolic BP (SBP) and diastolic BP (DBP) measured by OBPM were higher than HBPM when compared with ABPM. When assessed using OBPM and awake ABPM, both SBP and DBP were significantly overestimated by OBPM with mean difference of 3-12 mm Hg by office SBP and 6-8 mm Hg for office DBP. When HBPM was compared with mean ABPM at 6 months both the SBP and DBP were overestimated by and 7 mm Hg respectively. At 6 months post transplantation, when compared with ABPM, OBPM was more specific than HBPM in diagnosing hypertension (98% specificity, Kappa : 0.88 vs. 89% specificity, Kappa : 0.71). HBPM was superior to OBPM in identifying patients achieving goal BP (89% specificity, Kappa : 0.71 vs. 50% specificity Kappa : 0.54). In the absence of a gold standard for comparison the latent class model analysis still showed that ABPM was the best tool for diagnosing hypertension and monitoring patients reaching targeted control. OBPM remains an important tool for the diagnosis and management of hypertension in renal transplant recipients. HBPM and ABPM could be used to achieve BP control.
  - 1,609 146
Renal outcome in biopsy proven cases of graft pyelonephritis
PP Varma, A Jairam, AK Hooda, S Badwal
May-June 2014, 24(3):161-165
DOI:10.4103/0971-4065.132009  PMID:25120293
The incidence, risk factors and outcome of graft pyelonephritis are variably described in literature. All patients who had been transplanted at our center between January 2002 and November 2006 and had presented with acute graft dysfunction were subjected to biopsy. Those patients who had neutrophilic casts and interstitial inflammation with predominant neutrophils were included in the study. Out of the 265 patients, 110 were transplanted in the period and underwent biopsy for graft dysfunction. Out of the 110 patients, 26 had biopsy proven acute graft pyelonephritis (AGPN). Nine patients had early AGPN (within 6 months) and the other 17 had late AGPN. Nearly 19% of patients were culture negative and five patients had no clinical features of urinary tract infection; AGPN being a surprise finding on biopsy. Among the risk factors, only hepatitis C virus infection was significantly associated with AGPN. All patients received 4-6 weeks of antibiotics with at least 3 weeks of parenteral antibiotics. Majority (75%) of our patients experienced relapse of AGPN. Graft function was significantly lower 6 months after onset when compared to baseline, portending a poor outcome for these patients. Out of 26, 7 (27%) of our patients had biopsy features of concomitant acute cellular rejection. The treatment of acute rejection, however, did not improve the outcome.
  - 1,781 132
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