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   2016| January-February  | Volume 26 | Issue 1  
    Online since December 30, 2015

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Cardiac and vascular changes with kidney transplantation
A Ali, I Macphee, JC Kaski, D Banerjee
January-February 2016, 26(1):1-9
DOI:10.4103/0971-4065.165003  PMID:26937071
Cardiovascular event rates are high in patients with chronic kidney disease (CKD), increasing with deteriorating kidney function, highest in CKD patients on dialysis, and improve with kidney transplantation (KTx). The cardiovascular events in CKD patients such as myocardial infarction and heart failure are related to abnormalities of vascular and cardiac structure and function. Many studies have investigated the structural and functional abnormalities of the heart and blood vessels in CKD, and the changes that occur with KTx, but the evidence is often sparse and occasionally contradictory. We have reviewed the available evidence and identified areas where more research is required to improve the understanding and mechanisms of these changes. There is enough evidence demonstrating improvement of left ventricular hypertrophy, except in children, and sufficient evidence of improvement of left ventricular function, with KTx. There is reasonable evidence of improvement in vascular function and stiffness. However, the evidence for improvement of vascular structure and atherosclerosis is insufficient. Further studies are necessary to establish the changes in vascular structure, and to understand the mechanisms of vascular and cardiac changes, following KTx.
  3,095 331 -
Validity of nutrition risk index as a malnutrition screening tool compared with subjective global assessment in end-stage renal disease patients on peritoneal dialysis
N Prasad, A Sinha, A Gupta, D Bhadauria, R Manjunath, A Kaul, RK Sharma
January-February 2016, 26(1):27-32
DOI:10.4103/0971-4065.158449  PMID:26937075
We undertook this study to compare subjective global assessment (SGA) and nutrition risk index (NRI) as malnutrition screening tools in peritoneal dialysis (PD) patients. Nutrition status of the patients was categorized into low, moderate and high risk of malnutrition based on both NRI and SGA. The sensitivity, specificity and predictive values of NRI were compared with SGA, an already validated tool of nutrition status assessment in PD patients. Two hundred and eighty-three end-stage renal disease patients (age 50.02 ± 13.76 years; 204 males, 150 diabetic) were included. Based on SGA, 71/283 (25.08%) had normal nutrition, 192/283 (67.84%) mild–moderate and 20/283 (7.07%) severe malnutrition. Based on NRI, 38/283 (13.43%) patients had normal nutritional status, 193/283 (68.20%) mild-moderate and 52/283 (18.37%) severe malnutrition. Twenty-three of 283 (8.1%) were correctly classified as normal by NRI (true negative) and 197/283 (69.6%) as malnourished (true positive), 15/283 (5.3%) as false negative, 48/283 (16.96%) were misclassified as malnourished (false positive). NRI has sensitivity of 92.9% and specificity of 32.39%. Positive predictive value and Negative predictive values (NPVs) of NRI are 80.41% and 60.53%, respectively. Accuracy of the test is 78%. The receiver operating characteristic curve of NRI is 0.63. To conclude, NRI carries high sensitivity but low specificity as compared to SGA. It can be used as screening tool but not as a diagnostic tool for assessment of nutritional status in PD patients because of its low specificity and NPV.
  2,885 228 -
Prevalence and predictors of chronic kidney disease in newly diagnosed human immunodeficiency virus patients in Owerri, Nigeria
EN Anyabolu, II Chukwuonye, E Arodiwe, CK Ijoma, I Ulasi
January-February 2016, 26(1):10-15
DOI:10.4103/0971-4065.156115  PMID:26937072
Human immunodeficiency virus (HIV) infection is a common cause of chronic kidney disease (CKD) in Sub-Saharan Africa. This study aims at identifying the prevalence and predictors of CKD in newly diagnosed HIV patients in Owerri, South East Nigeria. This was a cross-sectional study consisting of 393 newly diagnosed HIV-seropositive subjects and 136 age- and sex-matched seronegative subjects as controls. CKD was defined as 24-hour urine protein (24-HUP) ≥0.3 g and/or glomerular filtration rate (GFR) < 60 ml/min. Subjects were recruited from the HIV clinic and the Medical Outpatient Department of Federal Medical Centre, Owerri. Clinical and anthropometric data were collected. Relevant investigations were performed, including HIV screening and relevant urine and blood investigations. The mean age of the HIV subjects was 38.84 ± 10.65 years. CKD was present in 86 (22.9%) HIV subjects and 11 (8.l %) controls. Low waist circumference (WC), high serum creatinine, high spot urine protein/creatinine ratio (SUPCR), high 24-HUP/creatinine Ratio (24-HUPCR), high 24-HUP/osmolality Ratio (24-HUPOR) predicted CKD in HIV subjects. CKD prevalence is high (22.9%) among newly diagnosed HIV patients in South East Nigeria. The predictors of CKD included WC, serum creatinine, SUPCR, 24-HUPCR, and 24-HUPOR.
  2,729 203 -
Renal lymphangiectasia: One disease, many names!
K Bansal, B Sureka, S Pargewar, A Arora
January-February 2016, 26(1):57-58
DOI:10.4103/0971-4065.155730  PMID:26937083
  2,650 114 -
Fetuin-A and vascular calcification in Indian end-stage renal disease population
A Mann, V Makkar, S Mann, P Dhamija, P Soundarajan
January-February 2016, 26(1):33-38
DOI:10.4103/0971-4065.157007  PMID:26937076
Fetuin-A levels, its correlation with vascular calcification and other biochemical markers of chronic kidney disease-mineral and bone disorder (CKD-MBD) has not been studied in Indian end-stage renal disease population. Forty patients on dialysis for more than 3 months were studied. Biochemical parameters of CKD-MBD, highly sensitive-C reactive protein (hs-CRP), lipid profile and fetuin-A levels were estimated. Multi-slice computed tomography (MSCT) at the level of L1–L4 was done, and calcification score calculated using AJ 130 smart score. Levels of fetuin-A were correlated with calcification score and biochemical markers of CKD–MBD. Mean fetuin-A levels were 0.33 ± 0.098 g/l. Positive correlation of abdominal aortic calcification scores was found with age (P < 0.01) and duration of dialysis (P = 0.018). No correlation was detected between MSCT score, calcium phosphate product, intact parathyroid hormone, vitamin D, triglycerides and fetuin-A, and there was no correlation between fetuin-A levels, age, dialysis duration and calcium phosphate product but a significant correlations with vitamin D3 (P = 0.034), serum albumin (P = 0.002) was detected. Inverse correlation with hs-CRP was obtained. Patients with ischemic heart disease had numerically lower levels of fetuin-A (P = 0.427) and numerically higher MSCT score (P = 0.135). Patients with low hs-CRP (<10) had numerically higher fetuin-A levels (P = 0.090) and significantly low MSCT scores (P = 0.020). Calcium deposition seen on MSCT increases with age and duration of dialysis but is not related to fetuin-A levels. Inconclusive relationship exists with other parameters of CKD-MBD. Large controlled studies are needed to establish the role of fetuin-A in vascular calcification in Indian population.
  2,325 162 -
Biopsy-proven renal disease in Ile-Ife, Nigeria: A histopathologic review
IM Onwubuya, KA Adelusola, D Sabageh, KN Ezike, OO Olaofe
January-February 2016, 26(1):16-22
DOI:10.4103/0971-4065.155732  PMID:26937073
Although various patterns of renal diseases have been reported from different renal biopsy registries worldwide, data from Nigeria remain scanty. A 10-year retrospective review of renal biopsies was conducted in our tertiary health care facility. All cases were reclassified based on their light microscopic features after the application of standard histochemical stains. A total of 165 cases were reviewed with a male:female ratio of 1.8:1 and a mean age of 15.4 ± 12.0 years. About 69.7% of the cases were below the age of 16 years, while only 2.4% were older than 50 years. The most common indications for biopsy were nephrotic syndrome (72.1%) and acute renal failure of unknown etiology (11.5%). Overall, glomerulonephritis (80%) was the most common histologic category and occurred only in individuals younger than 50 years old. Minimal change disease (22.9%) and membranoproliferative glomerulonephritis (21.9%) were the most common varieties in children, while membranous glomerulonephritis (30.6%) and focal segmental glomerulosclerosis (27.8%) were the commonest among the adult population. The initial histologic diagnosis was revised in 18 cases while a diagnosis was arrived at in seven cases initially adjudged as inadequate for assessment. This study showed that renal biopsy was predominantly performed in children and adolescents. Although glomerulonephritis was the predominant disease, the predominant histologic patterns varied with the patient age. Despite the scarcity of advanced diagnostic tools in resource-poor environments, routine use of histochemical stains is helpful in the evaluation of renal biopsies.
  2,287 152 -
Survival of elderly dialysis patients is not dependent on modality or “older” age
T Jeloka, P Sanwaria, A Periera, S Pawar
January-February 2016, 26(1):23-26
DOI:10.4103/0971-4065.157801  PMID:26937074
While discussing renal replacement therapy, the choice of modality and survival on dialysis are important considerations. These issues are even more important in elderly group of patients. We studied the survival and factors affecting survival of our elderly dialysis patients. All incident patients who started dialysis from November 2006 to March 2014 were considered for inclusion. Patients who initiated dialysis at or >65 years of age and had completed 90 days of dialysis were included. Overall survival of elderly dialysis patients was determined. Patients were divided into two groups based on the modality of dialysis and age: elderly (65–70 years) and older (>70 years). The baseline data and survival were then compared between groups. Mean age of the study population was 71.8 ± 6 years with 73.8% males, and 71.4% had diabetes. Median overall survival of the patients was 26.6 months. Median survival of elderly dialysis patients was 26.5 months and of older dialysis patients was 30.1 months (P = 0.9). Median survival of hemodialysis and PD patients was also similar (30.1 and 25.2 months respectively. Multivariate analysis showed diabetes as the only determining factor affecting survival (P = 0.01). To conclude, there is no difference between survival of elderly and “older” or between elderly hemodialysis and PD patients.
  2,158 166 -
An unusual case of nephrotic syndrome
M Sahay, PS Vali, K Ismal, S Gowrishankar, MD Padua, M Swain
January-February 2016, 26(1):55-56
DOI:10.4103/0971-4065.158575  PMID:26937082
Nephrotic syndrome can be rarely due to inherited disorders of enzymes. One such variety is lecithin cholesterol acyltransferase deficiency. It leads to accumulation of unesterified cholesterol in the eye and other organs. We report a case of nephrotic syndrome with cloudy cornea and hypocholesterolemia with foam cells and lipid deposits on renal biopsy. Awareness about this rare disease may help in the early institution of specific measures to prevent progression to end-stage renal disease.
  2,160 158 -
Cytomegalovirus infection inducing flare of Behcet's disease with possible recurrence of glomerulonephritis after renal transplantation
RA Annigeri, M Rajagopalan, RM Mani, SS Kaveripattu
January-February 2016, 26(1):45-48
DOI:10.4103/0971-4065.157418  PMID:26937079
We present a case of young male with end-stage renal disease due to type III membranoproliferative glomerulonephritis (GN) and clinical features consistent with Behcet's disease (BD). He developed flare of BD 3 months after deceased donor renal transplantation following cytomegalovirus infection, in the form of oral and genital ulcers. He also had GN characterized by mild mesangial proliferation, neutrophilic infiltration and subepithelial, mesangial and intramembranous electron dense deposits, which could possibly be attributed to recurrence of renal disease due to BD. The clinical flare of BD was treated with colchicine with good response.
  2,099 110 -
Dobrin syndrome: A case report and review of the literature
KI Al Qumaizi, K Halim, KA Brekeit
January-February 2016, 26(1):39-41
DOI:10.4103/0971-4065.157009  PMID:26937077
Dobrin syndrome or tubulointerstitial nephritis and uveitis syndrome is a rare disease with excellent prognosis. We report a 60-year-old male of Indian origin who presented with acute interstitial nephritis (AIN) and unilateral anterior immune-mediated uveitis. The syndrome has been reported sporadically. This is only the third case from a patient of Indian origin. We highlight this case and evaluate the long-term use of nonsteroidal anti-inflammatory drug-induced AIN and uveitis as a potential causative factor.
  2,037 162 -
Ataxia in a chronic kidney disease patient on anti-tubercular therapy
D Pathania, MK Phanish, J Vishal, V Kher
January-February 2016, 26(1):52-54
DOI:10.4103/0971-4065.157803  PMID:26937081
Isoniazid is the mainstay of anti-tubercular therapy. Used in isolation or in combination with other anti-tubercular drugs, it is generally well-tolerated. While hepatotoxicity and neurotoxicity are reported, significant neurotoxicity remains uncommon. In this report, we present a case of rare neurological complication secondary to anti-tubercular therapy in a patient with stage 5 chronic kidney disease.
  1,805 131 -
Bladder diverticula
PK Guru, DR Reddy, CE Daniels
January-February 2016, 26(1):59-60
DOI:10.4103/0971-4065.155729  PMID:26937084
  1,830 89 -
Plasma exchange in Immunoglobulin A nephropathy with thrombotic microangiopathy and acute cortical necrosis
P Doddi, K Gowda, R Ramachandran, R Nada, V Kumar, M Rathi, HS Kohli, KL Gupta
January-February 2016, 26(1):42-44
DOI:10.4103/0971-4065.163423  PMID:26937078
A 25-year-old female presented with decreased urine output, deranged renal function, thrombocytopenia, and hemolytic anemia. Kidney biopsy was consistent with thrombotic microangiopathy with acute cortical necrosis and Immunoglobulin A nephropathy (IgAN). Hemolytic anemia, thrombocytopenia and urine output improved after five sessions of plasma exchange. Renal function showed a delayed recovery and serum creatinine normalized by 3 months. This is first case of successful use of plasma exchange in hemolytic uremic syndrome with cortical necrosis associated with IgAN.
  1,732 115 -
An unusual case of cocoon abdomen in a patient on hemodialysis
A Jaryal, M Rathi, A Bal, A Goyal, R Ramachandran, V Kumar, HS Kohli, KL Gupta
January-February 2016, 26(1):49-51
DOI:10.4103/0971-4065.157420  PMID:26937080
“Cocoon abdomen” or sclerosing encapsulating peritonitis is a rare cause of intestinal obstruction. It has been described in patients on continuous ambulatory peritoneal dialysis. The exact etiology is unknown, but pathogenesis rests on chronic peritoneal inflammation. No case has been reported so far in patients on hemodialysis. We hereby report a case of cocoon abdomen presenting as refractory ascites with intestinal obstruction in a patient on maintenance hemodialysis.
  1,689 97 -
Chronic active antibody mediated rejection associated with human leukocyte antigen-C*07 antibodies
P Dorwal, M Phanish, R Duggal, R Chauhan, V Raina, V Kher
January-February 2016, 26(1):63-65
DOI:10.4103/0971-4065.167282  PMID:26937087
  1,635 71 -
Purple urine bag syndrome in chronic kidney disease
P Sriramnaveen, YS Reddy, AVSSN Sridhar, CK Kishore, Y Manjusha, V Sivakumar
January-February 2016, 26(1):67-68
DOI:10.4103/0971-4065.172230  PMID:26937089
  1,449 139 -
Nephrotic syndrome and acute renal failure as a presenting symptom of acute lymphoblastic leukemia
HR Pahadiya, M Lakhotia, R Gandhi, A Choudhary
January-February 2016, 26(1):62-63
DOI:10.4103/0971-4065.168478  PMID:26937086
  1,371 114 -
Pityriasis rubra pilaris and mesangial proliferative glomerulonephritis in a child: Association or coincidence?
S Sarkar, S Misra, M Nandi
January-February 2016, 26(1):61-62
DOI:10.4103/0971-4065.165005  PMID:26937085
  1,295 84 -
Act faster for your chronic kidney disease patients
AK Dey, A Taraphder
January-February 2016, 26(1):69-69
DOI:10.4103/0971-4065.167278  PMID:26937090
  1,183 94 -
Adnexal torsion in an adolescent renal transplant recipient
VV Mishra, T Tanvir, R Aggarwal, R Nawal
January-February 2016, 26(1):66-67
DOI:10.4103/0971-4065.167774  PMID:26937088
  1,143 67 -
Indian Journal of Nephrology
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Online since 20th Sept '07