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   2016| July-August  | Volume 26 | Issue 4  
    Online since July 1, 2016

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Changing picture of acute kidney injury in pregnancy: Study of 259 cases over a period of 33 years
J Prakash, P Pant, S Prakash, M Sivasankar, R Vohra, PK Doley, LK Pandey, U Singh
July-August 2016, 26(4):262-267
DOI:10.4103/0971-4065.161018  PMID:27512298
The incidence of acute kidney injury (AKI) in pregnancy is declining in developing countries but still remains a major cause of maternal and fetal morbidity and mortality. The aim of the study was to analyze the changing trends in pregnancy related AKI (PR-AKI) over a period of thirty-three years. Clinical characteristics of PR-AKI with respect to incidence, etiology and fetal and maternal outcomes were compared in three study periods, namely 1982-1991,1992-2002 and 2003-2014. The incidence of PR-AKI decreased to 10.4% in 1992-2002, from 15.2% in 1982-1991, with declining trend continuing in 2003-2014 (4.68%).Postabortal AKI decreased to 1.49% in 2003-2014 from 9.4% in 1982-1991of total AKI cases.The AKI related to puerperal sepsis increased to 1.56% of all AKI cases in 2003-2014 from 1.4% in 1982-1991. Preeclampsia/eclampsia associated AKI decreased from 3.5% of total AKI cases in 1982-1991 to 0.54% in 2003-2014. Pregnancy associated - thrombotic microangiopathy and acute fatty liver of pregnancy were uncommon causes of AKI. Hyperemesis gravidarum associated AKI was not observed in our study. Incidence of renal cortical necrosis (RCN) decreased to 1.4% in 2003-2014 from 17% in 1982-1991.Maternal mortality reduced to 5.79% from initial high value 20% in 1982-1991. The progression of PR-AKI to ESRD decreased to1.4% in 2003-2014 from 6.15% in 1982-1991. The incidence of PR-AKI has decreased over last three decades, mainly due to decrease in incidence of postabortal AKI. Puerperal sepsis and obstetric hemorrhage were the major causes of PR-AKI followed by preeclampsia in late pregnancy. Maternal mortality and incidence and severity of RCN have significantly decreased in PR-AKI. The progression to CKD and ESRD has decreased in women with AKI in pregnancy in recent decade. However, the perinatal mortality did not change throughout study period.
  3,041 236 -
Effect of low dose nicotinic acid on hyperphosphatemia in patients with end stage renal disease
NS Zahed, N Zamanifar, H Nikbakht
July-August 2016, 26(4):239-243
DOI:10.4103/0971-4065.161020  PMID:27512294
Hyperphosphatemia is a risk factor for ectopic calcification and coronary artery diseases in end stage renal diseases (ESRD). The aim of this study was to assess the effect of low-dose nicotinic acid on hyperphosphatemia in patients with ESRD. This randomized, double-blind clinical trial was done on 70 ESRD patients with serum phosphoure ≥5.5 mg/dl. Patients were randomly divided into two equal groups (n = 35) and the intervention group received niacin 25 mg/day as the initial dose. After 4 weeks, in patients who did not respond to treatment, niacin dose was increased up to 50 mg/dl. At the end of week 8, in case there was no treatment effect, the dose was raised to 100 mg/day. The appropriate response to treatment was defined as serum phosphorous level reductions <5.5 mg/dl. The age was 50.5 ± 14.3 years and duration of dialysis 5.1 ± 5.3 months. In the niacin group, mean phosphorus level decreased from 6.7 ± 0.84 mg/dl at the end of the 1st month to 5.8 ± 1.0 mg/dl at the end of the 2nd month and to 4.4 ± 1.4 mg/dl at the end of the 3rd month (P = 0.004). In the placebo group, mean phosphorus level increased from 6.5 ± 1.2 mg/dl to 7.2 ± 0.91 mg/dl at the end of the 3rd month (P = 0.006). In the niacin group, high density lipoprotein (HDL) increased significantly from 45.00 ± 14.9 to 47.2 ± 11.6 (P = 0.009). We conclude that niacin (100 mg/day) decreased phosphorus serum level and increased HDL serum level in patients on dialysis.
  2,654 215 -
Clinical spectrum and outcomes of crescentic glomerulonephritis: A single center experience
SK Rampelli, NG Rajesh, BH Srinivas, KT Harichandra Kumar, RP Swaminathan, PS Priyamvada
July-August 2016, 26(4):252-256
DOI:10.4103/0971-4065.158574  PMID:27512296
There is limited data on the etiology, clinical and histopathological spectrum and outcomes of crescentic glomerulonephritis (CrGN) in adult Indian population. This prospective study was done to evaluate the etiology, clinicohistological patterns and predictors of outcome of CrGN in South Indian population. All the patients received standard protocol based immunosuppression in addition to supportive care. Immune-complex glomerulonephritis (ICGN) was the most common etiology (n = 31; 77.5%) followed by pauci-immune glomerulonephritis (PauciGN; n = 8; 20%) and anti-glomerular basement membrane disease (n = 1; 2.5%). The most common etiology of ICGN was IgA nephropathy (n = 11; 27.5%) followed by lupus nephritis (n = 7; 17.5%) and post-infectious glomerulonephritis (PIGN) (n = 7; 17.5%). The patients with PauciGN were significantly older compared to those with ICGN (44.5 ± 15 years vs. 31.8 ± 11 years; P = 0.01). The patients with PauciGN presented with significantly higher serum creatinine (9.7 ± 4.4 vs. 6.6 ± 3.3 mg/dl; P = 0.03). The histopathologic parameters of ICGN and PauciGN were comparable except for a higher proportion of sclerosed glomeruli in ICGN. At the end of 3 months follow-up, only two patients went into complete remission (5.4%). Majority of the patients had end-stage renal failure (48.6%) and were dialysis dependent and seven patients (18.9%) expired. There was no signifi difference in the renal survival (10.9 ± 1.9 vs. 9.6 ± 3.3 months) or patient survival (17.5 ± 2.1 vs. 17.3 ± 4.3 months). The parameters associated with adverse outcomes at 3 months were hypertension (odds ratio [OR]: 0.58; confidence interval [CI]: 0.36–0.94), need for renal replacement therapy (OR: 0.19; CI: 0.04–0.9), serum creatinine at admission (P = 0.019), estimated glomerular filtration rate (P = 0.022) and percentage of fibrocellular crescents (P = 0.022).
  2,408 220 -
Prevalence of serum anti M-type phospholipase A2 receptor antibody in primary membranous nephropathy: A single center experience
N Gopalakrishnan, P Abeesh, T Dineshkumar, S Murugananth, R Sakthirajan, G Srinivasa Raman, J Dhanapriya, T Balasubramaniyan, Md Haris
July-August 2016, 26(4):257-261
DOI:10.4103/0971-4065.160334  PMID:27512297
We conducted a prospective study to assess utility of detection of antibodies to phospholipase A2receptor (PLA2R) in the serum of patients with membranous nephropathy. Seventy five patients with biopsy proven membranous nephropathy admitted between January 2011 and September 2014 were studied. Serum anti- PLA2R was tested by indirect immunofluorescence. The test was positive in 45 out of 60 patients with primary membranous nephropathy (PMN) and in none of the 15 patients with secondary membranous nephropathy, with a sensitivity of 75% and specificity of 100% for PMN. Anti PLA2R positivity also showed a significant correlation with quantum of proteinuria and negative correlation with serum albumin.This study has validated detection of serum anti PLA2R in PMN as a non invasive diagnostic tool in Indian patients.
  2,360 151 -
Pegylated interferon monotherapy for hepatitis C virus infection in patients on hemodialysis: A single center study
SK Agarwal, D Bhowmik, S Mahajan, S Bagchi
July-August 2016, 26(4):244-251
DOI:10.4103/0971-4065.172228  PMID:27512295
There is no published study from India on hepatitis C virus (HCV) treatment in dialysis patients. Patients on dialysis with HCV infection treated with pegylated interferon (Peg-INF) monotherapy were studied. All patients were subjected to HCV-polymerase chain reaction, viral load, genotype, and liver biopsy. Quantitative HCV-RNA was performed monthly. Patients with genotype 1 and 4 were given 12 month therapy while those with genotypes 2 and 3 were given 6 months therapy. Response was classified as per standard criteria of rapid virological response (RVR), early virological response (EVR), end of treatment response (ETR), and sustained virological response (SVR). A total of 85 patients were treated. Mean age was 35.2 ± 10.5 (range 15–67) years, and 77.6% were males. HCV genotypes were 1 in 40.9%, 2 in 12%, 3 in 36.1%, 4 in 3.6%, and others in 7.2%. Mean viral load was 106 copies/mL. Mean liver biopsy grade was 4 ± 1.7 and stage 0.8 ± 0.8. Mean time from diagnosis of HCV infection and the treatment start was 10.7 ± 14.3 months. One patient died of unrelated illness, one was lost to follow-up, and three could not sustain treatment due to cost. Forty-three of the 80 (54%) patients had RVR while 49 (61%) patients had EVR and ETR. There was no difference in term of RVR related to genotype. Fifty -four percentage had SVR. Mild flu-like symptoms were seen in all patients. Sixty-four (80%) patients required increase in erythropoietin doses. Twenty-eight (35%) patients developed leukopenia (three treatment-limiting) and 16 (20%) developed thrombocytopenia (one treatment-limiting). Five patients developed tuberculosis, five bacterial pneumonia, and one bacterial knee monoarthritis. None of the patients developed depression. Our study concludes that Peg-INF monotherapy resulted in 54% RVR and SVR in dialysis patients with HCV infection. Therapy was well-tolerated with minimal side effects. There was no effect of viral genotype on response to therapy.
  2,300 164 -
Lupus podocytopathy: An important differential diagnosis of nephrotic syndrome in systemic lupus erythematosus
AR Chaudhury, T Rajarajan, R Yousuf, E Fernando, AA Kurien
July-August 2016, 26(4):284-287
DOI:10.4103/0971-4065.169566  PMID:27512302
Some patients with systemic lupus erythematosus (SLE) present with sudden onset of nephrotic syndrome and biopsy findings may be of minimal change disease or focal segmental glomerulosclerosis with diffuse foot process effacement on electron microscopy but without significant immune deposits. This entity is termed lupus podocytopathy. Clinicians and renal pathologists need to be aware of this condition. Though steroid sensitive, it needs follow-up to recognize flare and class change, thereby optimizing therapy.
  2,000 211 -
Acquired perforating dermatosis in a diabetic patient on hemodialysis
R Hemachandar
July-August 2016, 26(4):304-305
DOI:10.4103/0971-4065.161026  PMID:27512308
  2,095 77 -
Niacin for phosphate control: A case of David versus Goliath
K Sampathkumar
July-August 2016, 26(4):237-238
DOI:10.4103/0971-4065.161029  PMID:27510758
  1,932 197 -
Karyomegalic interstitial nephropathy following ifosfamide therapy
R Jayasurya, BH Srinivas, M Ponraj, S Haridasan, S Parameswaran, PS Priyamvada
July-August 2016, 26(4):294-297
DOI:10.4103/0971-4065.171233  PMID:27512305
Ifosfamide (IFO), an alkylating agent used for the management of solid organ tumors, can cause reversible Fanconi's syndrome and acute kidney injury. Karyomegalic interstitial nephropathy (KIN) is a rare form of chronic tubulointerstitial nephritis, initially described as a familial nephropathy in adults. So far, four cases of KIN have been reported in pediatric and adolescent population following treatment with IFO. We report a 22-year-old man who developed renal dysfunction following IFO therapy for relapsed Hodgkin's lymphoma. Renal biopsy revealed chronic tubulointerstitial nephritis with atypical tubular epithelial cells showing nuclear enlargement and hyperchromasia, consistent with a diagnosis of KIN. The renal function improved following a short course of corticosteroids.
  1,976 90 -
Comparison of outcomes between surgically placed and percutaneously placed peritoneal dialysis catheters: A retrospective study
R Sivaramakrishnan, S Gupta, SK Agarwal, D Bhowmik, S Mahajan
July-August 2016, 26(4):268-274
DOI:10.4103/0971-4065.163425  PMID:27512299
There is lack of adequate data on comparison of outcomes between percutaneously placed peritoneal dialysis (PD) catheters inserted by nephrologists and PD catheters placed by surgeons. The aim of this study is to retrospectively analyze the outcomes of PD catheters inserted by surgeons (by open surgical or laparoscopic technique) and compare them with those inserted by nephrologists among ESRD patients who underwent elective PD catheter insertions between January 2009 and December 2012. The primary outcome measure was the proportion of catheters removed because of primary nonfunction. The secondary outcome measures were catheter survival, patient survival, and incidence of complications of catheter insertion. A total of 143 PD catheter insertions (88 by surgeons and 55 by nephrologists) performed in 132 patients were considered for the analysis. The primary nonfunction rate of PD catheter insertions in both groups was comparable (18.2% and 7.3%, P = 0.08). Break-in period was shorter in Group N (p = <0.001). No differences were noted in patient or catheter survival. Percutaneously placed PD catheters performed by nephrologists have comparable outcomes with surgically placed PD catheters among selected cases and have the advantage of lower costs, avoidance of operation theater scheduling issues, smaller incision length, and shorter break-in period. Therefore, more nephrologists should acquire the expertise on percutaneous PD catheter placement as it leads to lesser waiting times and better utilization of PD.
  1,904 121 -
Epstein-Barr virus-positive multiple myeloma following an ABO incompatible second renal transplantation
B Kirushnan, B Subbarao, P Prabhu
July-August 2016, 26(4):280-283
DOI:10.4103/0971-4065.168143  PMID:27512301
ABO incompatible kidney transplant recipients receive higher dose of immunosuppression. Previous data indicate that the incidence of malignancy is not higher in these patients. Compared to the general population, renal transplant recipients are at 4.4-fold higher risk of developing myeloma. We describe a case of posttransplant multiple myeloma in an ABO incompatible renal transplant recipient of a second graft.
  1,735 91 -
Lymphoblastic lymphoma presenting as bilateral renal enlargement diagnosed by percutaneous kidney biopsy: Report of three cases
V Rajakumar, V Balaraman, R Balasubramaniam, S Shankar, TS Ganesan, AA Kurien
July-August 2016, 26(4):298-301
DOI:10.4103/0971-4065.179368  PMID:27512306
Renal involvement by lymphoma can be a diagnostic challenge. Acute kidney injury (AKI) is an unusual manifestation of lymphomatous infiltration in the kidneys. We report three cases of lymphoblastic lymphoma, a very rare form of lymphoma, presenting with AKI and bilateral enlargement of kidneys, diagnosed by percutaneous kidney biopsy. Lymphomatous infiltration should be suspected with such clinical presentation. Kidney biopsy is a valuable diagnostic tool, to establish the correct diagnosis and subtype of lymphoma for timely initiation of therapy for these aggressive hematological malignancies.
  1,731 74 -
Secret in the eyes - fish eye disease
VK Ingle, PK Maharana, P Rajesh
July-August 2016, 26(4):313-314
DOI:10.4103/0971-4065.179304  PMID:27512314
  1,616 74 -
Collapsing glomerulopathy associated with hepatitis B infection: A case report
M Mantan, R Grover, S Kaur, V Batra
July-August 2016, 26(4):291-293
DOI:10.4103/0971-4065.171243  PMID:27512304
Collapsing glomerulopathy has been classified as a variant of focal segmental glomerulosclerosis. It is associated with infections, inflammations, and certain medications. While its association with human immunodeficiency virus has been well established its occurrence with hepatitis B has not been reported. We present here a case of collapsing glomerulopathy in a child with hepatitis B infection.
  1,503 80 -
Association of chemokine receptor CX3CR1 V249I and T280M polymorphisms with chronic kidney disease
AK Yadav, V Kumar, V Jha
July-August 2016, 26(4):275-279
DOI:10.4103/0971-4065.163426  PMID:27512300
The chemokine fractalkine (CX3CL1) and its receptor CX3CR1 are involved in the activation of leukocytes. Two common single-nucleotide polymorphisms of the CX3CR1 gene, V249I and T280M, have been associated with reduced fractalkine signaling, leading to decreased adhesive function and leukocyte chemotaxis. We hypothesized that variation in the CX3CR1 gene could be associated with chronic kidney disease (CKD), a disease of inflammatory activation. We studied the association between CX3CR1 V249I and T280M polymorphisms, and fractalkine and highly sensitive C-reactive protein (hs-CRP) levels in 123 patients with CKD and 100 healthy controls (HCs). Genotype analysis was done by polymerase chain reaction-restriction fragment length polymorphism, and fractalkine and hs-CRP levels were analyzed by enzyme-linked immunosorbent assay. MM genotype of T280M was absent in CKD patients, while in controls it was seen in 1% of the individuals. The allele frequencies in both the groups were similar (P = 0.059). Compared to HC, M280M + T280M genotype was more frequent in CKD (P = 0.041). The frequency of II genotype of V249I was 0.8% in CKD, whereas in HC, it was 2%. I249I + V249I genotype was more frequent in CKD as compared to HC (P = 0.034). No difference in allelic frequency of V249I was noted between the two groups (P = 0.061, odds ratios = 1.74, 95% confidence intervals = 0.96–3.12). Plasma fractalkine and serum hs-CRP levels were higher in CKD subjects (P = 0.004 and P 's 0.0001). No association of either genotype was found with fractalkine and hs-CRP levels. Polymorphisms at I249 and M280 genotype in CX3CR1 gene are associated with CKD; however, there was no association of fractalkine or inflammatory marker with these genotypes.
  1,490 76 -
Recurrent truncating mutations in alanine-glyoxylate aminotransferase gene in two South Indian families with primary hyperoxaluria type 1 causing later onset end-stage kidney disease
AK Dutta, BK Paulose, S Danda, S Alexander, V Tamilarasi, S Omprakash
July-August 2016, 26(4):288-290
DOI:10.4103/0971-4065.171244  PMID:27512303
Primary hyperoxaluria type 1 is an autosomal recessive inborn error of metabolism due to liver-specific peroxisomal enzyme alanine-glyoxylate transaminase deficiency. Here, we describe two unrelated patients who were diagnosed to have primary hyperoxaluria. Homozygous c.445_452delGTGCTGCT (p.L151Nfs*14) (Transcript ID: ENST00000307503; human genome assembly GRCh38.p2) (HGMD ID CD073567) mutation was detected in both the patients and the parents were found to be heterozygous carriers. Our patients developed end-stage renal disease at 23 years and 35 years of age. However, in the largest series published from OxalEurope cohort, the median age of end-stage renal disease for null mutations carriers was 9.9 years, which is much earlier than our cases. Our patients had slower progressions as compared to three unrelated patients from North India and Pakistan, who had homozygous c.302T>C (p.L101P) (HGMD ID CM093792) mutation in exon 2. Further, patients need to be studied to find out if c.445_452delGTGCTGCT mutation represents a founder mutation in Southern India.
  1,443 69 -
Collapsing focal segmental glomerulosclerosis in a patient with systemic lupus erythematosus
R Midhun, M Praveen, KA Biji
July-August 2016, 26(4):308-309
DOI:10.4103/0971-4065.176224  PMID:27512310
  1,379 82 -
Microfilaria associated macroscopic hematuria and nephrotic range proteinuria
GK Prakash, M Vankalakunti, HS Ballal
July-August 2016, 26(4):302-303
DOI:10.4103/0971-4065.161025  PMID:27512307
  1,357 87 -
Membranous glomerulonephritis overlapping with scabies
G Li Cavoli, L Bono, C Tortorici, TV Li Cavoli, U Rotolo
July-August 2016, 26(4):312-313
DOI:10.4103/0971-4065.179303  PMID:27512313
  1,320 68 -
Bilateral renal cortical necrosis in a patient undergoing in vitro fertilization
N Raveendran, K Gandhi, A Dsouza, D Prasad, V Malhotra, D Agrawal, P Beniwal
July-August 2016, 26(4):311-312
DOI:10.4103/0971-4065.175980  PMID:27512312
  1,287 68 -
Spontaneous reno-colic fistula in an elderly patient
A Chawla, D Chinchure, M Subramanian, D Singh
July-August 2016, 26(4):306-307
DOI:10.4103/0971-4065.167273  PMID:27512309
  1,153 56 -
Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07