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   2016| November-December  | Volume 26 | Issue 6  
    Online since November 10, 2016

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Follow-up rates of living kidney donor in Japan: A single center study
N Imai, Y Shibagaki, M Yazawa, K Kitajima, R Nakazawa, H Sasaki, T Chikaraishi
November-December 2016, 26(6):423-426
DOI:10.4103/0971-4065.172229  PMID:27942174
Long-term follow-up of kidney donors is needed not only for the individual donor's benefit but also to establish analyzable databases to improve the selection criteria for future donors. We collected data including the date of transplantation, the date of the last follow-up, donor's age, sex, their relationship to the recipient, renal function, proteinuria, and the prevalence of hypertension. Of 124 donors, 52 donors were not being followed up. The mean duration of follow-up was 4.3 ± 3.6 years. Follow-up rates were 83.9%, 74.6%, and 59.2% at 1 year, 2 years, and 5 years postdonation, respectively. Of those not being followed up, 75% dropped out. Follow-up rates did not differ between parent and spouse donors 5 years (57.1% vs. 71.4%; P = 0.4) postdonation. Similarly, follow-up rates at 5 years did not differ between donors aged 60 years or older and those younger than 60 (57.5% vs. 61.3%; P = 0.6). Of 72 donors being followed up, 75.0% had estimated glomerular filtration rate of <60 mL/min/1.73 m 2 , 8.3% had proteinuria, and 41.7% had hypertension requiring medication. There is a limitation to the endeavor of each transplant center to follow-up all their donors. Long-term donor follow-up in Japan requires a national registration system and mandates transplant center participation.
  5,936 71 -
Snakebite mediated acute kidney injury, prognostic predictors, oxidative and carbonyl stress: A prospective study
P Mukhopadhyay, R Mishra, D Mukherjee, R Mishra, M Kar
November-December 2016, 26(6):427-433
DOI:10.4103/0971-4065.175987  PMID:27942175
Snake bite is an occupational hazard in India and important preventable cause of acute kidney injury (AKI). This study was done to estimate the magnitude of snakebite-induced AKI (SAKI) who required renal replacement therapy, prognostic predictors, and final outcome, and to measure the oxidative and carbonyl stress (CS) level in SAKI patient who underwent hemodialysis (HD). All SAKI patients dialyzed between April 2010 and July 2011 in NRS Medical College were included. Demographical, clinical, and biochemical data were analyzed, and patients are followed to discharge or death. Oxidative and CS markers (advanced oxidation protein product [AOPP], advanced glycation end product, pentosidine, dityrosine, thioberbituric acid reactive substance, and methylglyoxal [MG]) were measured in 48 SAKI patient requiring HD. About 155 SAKI patients (M: F 2.2:1) received HD. Of them. The age was 36.2 (range 4-74) years. The most common site of the bite was lower limb (88.7%). Oliguria and bleeding manifestation were the common presentation. Hypotension was found in 52 (33.5%) cases, cellulitis and inflammation were found in about 63%. Mean creatinine was 4.56 ± 0.24 mg/dl. About 42 (27.1%) had disseminated intravascular coagulation (DIC). 36 (78.2%) had cellulites, 24 (52.2%) had hypotension or shock at initial presentation (P < 0.05), bleeding manifestation was found in 37 (80.4%), and 22 (47.8%) had DIC (P < 0.05). Forty-six (29.7%) patient died. DIC and hypotension/shock at initial presentation came out as an independent predictor of death. Among all markers measured for oxidative and CS (n = 48) AOPP and MG came out as an independent predictor (P < 0.05) of adverse outcome. Hypotension, DIC, AOPP, and MG were a poor prognostic marker in SAKI patients requiring dialysis.
  4,574 260 -
Assessment of hemodialysis adequacy in patients with chronic kidney disease in the hemodialysis unit at Tanta University Hospital in Egypt
M El-Sheikh, G El-Ghazaly
November-December 2016, 26(6):398-404
DOI:10.4103/0971-4065.168141  PMID:27942169
Worldwide, hemodialysis (HD) constitutes the most common form of renal replacement therapy. Many studies have shown strong correlation between HD dose and clinical outcome. The cross-sectional study was conducted on 100 patients in Hemodialysis Unit at Tanta University Hospital, Egypt. Data were collected using a reliable questionnaire (including clinical, demographic, dialysis, laboratory, and radiological data). SpKt/V was used to assess the adequacy of HD. The results revealed inadequate HD dose among 60% of the study population. The results also showed that increasing time and frequency of dialysis, blood flow rates, low recirculation percentages, reduction of intradialytic complaints, and well-functioning vascular access are associated with better HD adequacy. Our findings showed a positive correlation between dialysis dose and hemoglobin, serum albumin, normalized protein catabolic rate, and physical health. A great percentage of patients had inadequate HD. HD adequacy was influenced by several factors such as duration and frequency of dialysis session, patients' complaints, and well-functioning vascular access.
  4,274 336 -
Identification of urinary proteins potentially associated with diabetic kidney disease
RK Marikanty, MK Gupta, SVB Cherukuvada, SSS Kompella, AK Prayaga, S Konda, RV Polisetty, MM Idris, PV Rao, GR Chandak, KV Dakshinamurty
November-December 2016, 26(6):434-445
DOI:10.4103/0971-4065.176144  PMID:27942176
Diabetic nephropathy (DN) is the most common cause of chronic kidney disease. Although several parameters are used to evaluate renal damage, in many instances, there is no pathological change until damage is already advanced. Mass spectrometry-based proteomics is a novel tool to identify newer diagnostic markers. To identify urinary proteins associated with renal complications in diabetes, we collected urine samples from 10 type 2 diabetes patients each with normoalbuminuria, micro- and macro-albuminuria and compared their urinary proteome with that of 10 healthy individuals. Urinary proteins were concentrated, depleted of albumin and five other abundant plasma proteins and in-gel trypsin digested after prefractionation on sodium dodecyl sulfate polyacrylamide gel electrophoresis. The peptides were analyzed using a nanoflow reverse phase liquid chromatography system coupled to linear trap quadrupole-Orbitrap mass spectrometer. We identified large number of proteins in each group, of which many were exclusively present in individual patient groups. A total of 53 proteins were common in all patients but were absent in the controls. The majority of the proteins were functionally binding, biologically involved in metabolic processes, and showed enrichment of alternative complement and blood coagulation pathways. In addition to identifying reported proteins such as α2-HS-glycoprotein and Vitamin D binding protein, we detected novel proteins such as CD59, extracellular matrix protein 1 (ECM1), factor H, and myoglobin in the urine of macroalbuminuria patients. ECM1 and factor H are known to influence mesangial cell proliferation, and CD59 causes microvascular damage by influencing membrane attack complex deposition, suggestive their biological relevance to DN. Thus, we have developed a proteome database where various proteins exclusively present in the patients may be further investigated for their role as stage-specific markers and possible therapeutic targets.
  3,639 290 -
Attitude of medical professionals regarding controversial issues in kidney donation/transplantation
N Almeida, RF Almeida, K Almeida, A Almeida
November-December 2016, 26(6):393-397
DOI:10.4103/0971-4065.176147  PMID:27942168
There is a dire need to evaluate new strategies to bridge the wide kidney demand-supply gap. The current study examined the attitude of medical professionals regarding controversial issues pertaining to transplantation. A questionnaire, presenting controversial issues related to kidney transplantation, in an agree-disagree format with supporting reasons, was employed. The research was exploratory. Data were analyzed quantitatively and qualitatively. The sample comprised 140 doctors from Mumbai (mean = 38.1 years, standard deviation = 17.95; Males = 44.3%, Females = 55.7%). Whereas 47.1% of the participants felt that live donors should be given incentives for kidney donation, others (52.9%) disagreed, fearing commercialization and illegal activities. The eligibility of patients with HIV/hepatitis for a transplant was denied by 52.9% because of poor outcomes, with the others (47.1%) maintaining that these individuals too had a right to live. A substantial majority (90.7%) of the participants maintained that organ donors should be given priority in the event of a future need for an organ because their previous humane act should be rewarded (47.1%). Most of the participants (91.4%) felt that individuals from the higher socioeconomic strata should not receive preference for kidney transplantation. A majority (77.1%) of them were also against kidney selling getting legalized. Compulsory possession of a donor card elicited mixed responses, with some accepting (56.4%), but others rejecting (43.6%) this idea as donation was perceived to be a voluntary act (33.6%). While compulsory kidney donation found favor with 44.3%, it found disfavor with others (55.7%). This study will benefit transplant healthcare personnel to formulate new policies in relation to kidney donation/transplantation.
  3,348 137 -
Acute kidney injury associated with ingestion of star fruit: Acute oxalate nephropathy
AK Barman, R Goel, M Sharma, PJ Mahanta
November-December 2016, 26(6):446-448
DOI:10.4103/0971-4065.175978  PMID:27942177
Starfruit (Averrhoa carambola) and its juice are popular in the Indian subcontinent as an indigenous medicine. Oxalate concentration in this fruit and it's freshly prepared juice is very high. We present a report of patients presenting with acute kidney injury due to oxalate nephropathy admitted in a single center. All patients had history of ingesting star fruit. Patients became symptomatic after 10-12 h of eating and main symptoms were pain abdomen and decrease in urine output. Three patients needed hemodialysis. All improved with complete renal recovery. Taking star fruit in large amount on an empty stomach and in a dehydrated state is a risk factor for nephrotoxicity.
  3,241 130 -
Acquired Bartter syndrome following gentamicin therapy
J Singh, ML Patel, KK Gupta, S Pandey, A Dinkar
November-December 2016, 26(6):461-463
DOI:10.4103/0971-4065.177206  PMID:27942182
Aminoglycoside nephrotoxicity may manifest as nonoliguric renal failure or tubular dysfunction, such as Fanconi-like syndrome, Bartter-like syndrome (BS), or distal renal tubular acidosis. We report a case who developed severe renal tubular dysfunction on the the 7 th day of gentamicin therapy, resulting in metabolic alkalosis, refractory hypokalemia, hypocalcemia, hypomagnesemia, and polyuria. The patient was diagnosed as a case of transient BS associated with gentamicin exposure. The patient recovered with conservative management.
  3,210 110 -
Prevalence of obesity and risk of chronic kidney disease among young adults in Egypt
M Fouad, MI Ismail, A Gaballah, E Reyad, S ELdeeb
November-December 2016, 26(6):413-418
DOI:10.4103/0971-4065.172597  PMID:27942172
Increasing body mass index (BMI) has reached epidemic proportions globally and recently emerged as strong, independent risk factors for chronic kidney disease (CKD). We conducted this study to verify the prevalence of obesity and the associated risk of developing CKD among 3000 Egyptian students. The World Health Organization classification of BMI categorized study population into 1-5 groups, 1146 subjects with normal BMI (20-25), 951 subjects with BMI 25-29.9, 540 subjects with BMI 30-34.9, 225 with BMI 35-39.9, and 138 with BMI above 40. The participants were subjected to clinical examination, anthropometric measurements, laboratory investigation, including urinary albumin/creatinine ratio (ACR) and estimation of glomerular filtration rate (eGFR). The prevalence of overweight, obesity, and metabolic syndrome (MS) was 31.7%, 30.1%, and 16%, respectively. The prevalence of CKD among subjects with BMI >25 was 6.5%, almost all of them had BMI >35. ACR and eGFR rose progressively with increasing BMI. Elevated mean arterial pressure (MAP), high sensitivity C-reactive protein, and MS increased the risk of development of CKD. Moreover, MAP, waist to height ratio, and triglycerides to high-density lipoprotein ratios at levels of >95 mm Hg, >0.6, and >3 had sensitivity 91.7%, 88.4%, and 86.7%; and specificity 92.3%, 96.4%, and 96.5%, respectively to predict CKD. The prevalence of obesity among Egyptian young adults was high (30.1%) and was associated with increased the risk of CKD (6.5%).
  2,781 174 -
Combined surgical and immunosupressive therapy for encapsulating peritoneal sclerosis
PK Bipi, N Gracious, S Kumar, J George
November-December 2016, 26(6):458-460
DOI:10.4103/0971-4065.177139  PMID:27942181
Encapsulating peritoneal sclerosis (EPS) is an infrequent but serious complication of long-term peritoneal dialysis with 50% mortality and lack consensus on treatment. The pathogenesis of EPS is ill understood, and diagnosis lacks specificity and relies on clinical, radiographic and microscopic evaluation. Since there is no general agreement on managing EPS, we report a case treated successfully with surgery followed by immunosuppressive therapy with tamoxifen and steroids. He later successfully underwent deceased donor renal transplantation.
  2,786 77 -
White collar rhabdomyolysis with acute kidney injury
RK Bhakthavatsalam, G Venu, P Krishnam Raju, HC Madhusudan
November-December 2016, 26(6):449-451
DOI:10.4103/0971-4065.177209  PMID:27942178
Rhabdomyolysis is a clinical syndrome resulting from the disintegration of muscle cell and spillage of toxic intracellular contents into circulation. Strenuous, unaccustomed exercise leads to exertional rhabdomyolysis and cause AKI. We report a 26-year-old female who developed white collar rhabdomyolysis with AKI after performing sit-ups (Super Yoga Brain) for 108 times in temple. She was managed with hemodialysis and supporting therapy. She made a full recovery after 4 weeks. Awareness of this condition and early diagnosis is highlighted.
  2,230 130 -
Effect of Ferula assa-foetida oleo-gum-resin on renal function in normal Wistar rats
SM Bagheri, H Mohammadsadeghi, MH Dashti-R, SMM Mousavian, ZA Aghaei
November-December 2016, 26(6):419-422
DOI:10.4103/0971-4065.171245  PMID:27942173
In traditional Iranian medicine, asafoetida, an oleo-gum-resin obtained from the roots of Ferula assa-foetida, has been prescribed as a diuretic. This study was undertaken to investigate the diuretic effect of asafoetida in normal rats. Asafoetida was administered orally at the doses of 25 and 50 mg/kg and furosemide (10 mg/kg, intraperitoneal) was used as positive control. The diuretic effect was evaluated by measuring urine volume and sodium, potassium, urea, and creatinine content in urine and serum. Urine volume, excretion of sodium, and potassium were significantly increased by asafoetida as compared to the control group. A significant increase in creatinine clearance was observed in the groups treated with asafoetida at the doses of 25 and 50 mg/kg (P < 0.05). We conclude that asafoetida induced a diuretic effect comparable to that produced by the reference diuretic furosemide. This study provides a quantitative basis for explaining the folkloric use of asafoetida as a diuretic agent.
  2,213 107 -
An interesting case of renal amyloidosis
A Hajra, D Bandyopadhyay
November-December 2016, 26(6):467-469
DOI:10.4103/0971-4065.177143  PMID:27942184
In amyloidosis, there is an extracellular deposition of beta-sheet fibrils. Over 25 proteins have been demonstrated to form amyloid. One of them is Ig amyloid light (AL) chains. We are presenting a 40-year-old female who presented with progressive kyphoscoliosis for last 2 years following a minor trauma and bilateral pedal edema for last 3 months. On further investigation, we found that she had a biclonal variety of MM with amyloidosis of kidney leading to massive proteinuria. Very few case reports are available where patient with biclonal variety of MM develop renal amyloidosis.
  2,158 116 -
Magnetic resonance imaging as problem-solving tool in renal pseudotumor in chronic kidney disease: A case of nodular compensatory hypertrophy
V Indiran
November-December 2016, 26(6):470-471
DOI:10.4103/0971-4065.177140  PMID:27942185
  2,083 83 -
Development and validation of limited sampling strategy equation for mycophenolate mofetil in children with systemic lupus erythematosus
R Prabha, BS Mathew, V Jeyaseelan, TS Kumar, I Agarwal, DH Fleming
November-December 2016, 26(6):408-412
DOI:10.4103/0971-4065.174242  PMID:27942171
The aim of this study was to establish a limited sample strategy (LSS) to predict the mycophenolic acid (MPA) area under the curve (AUC) (0-12) in children with systemic lupus erythematosus (SLE). Three months after initiation of mycophenolate mofetil (MMF) 26 children with SLE presented for therapeutic drug monitoring of MPA. On the day of the test, 10 specimens were collected, analyzed, and MPA AUC (0-12) was calculated. Using step-wise regression analysis, LSS equations were developed. Using bootstrap validation, the predictive performance was calculated. The measured mean (standard deviation) for the trough concentration and AUC (0-12) were 2.55 (1.57) μg/ml and 62.6 (21.67) mg.h/L, respectively. The range of trough concentrations and AUC (0-12) were 0.7-5.54 μg/ml and 22.1-104.8 mg.h/L, respectively. The interindividual variability (%CV) for dose normalized AUC (0-12) and dose normalized C trough was 46.5% and 61.1%, respectively. The correlation between the concentrations at the different time points and MPA AUC (0-12) ranged from 0.05 (1.5 h) to 0.56 (4 h). Two LSS equations that included 4 or 5 time points up to 3 h were developed and validated. The 4 point LSS had a correlation (R2 ) of 0.88 and the 5 point LSS an R2 of 0.87. With respect to the 4 point and 5 point MPA LSS AUC (0-12) , the bias was 1.92% and 1.96%, respectively, and the imprecision was 11.24% and 11.28%, respectively. A 4 point LSS which concludes within 3 h after the administration of the MMF dose was developed and validated, to determine the MPA AUC (0-12) in children with SLE.
  2,024 101 -
Mixed acid-base disorder secondary to topiramate use in traumatic brain injury
S Golla, U Anandh, A Balasubramaniam
November-December 2016, 26(6):452-454
DOI:10.4103/0971-4065.177136  PMID:27942179
We report a case of a man with traumatic brain injury. He was started on to prophylactic topiramate which led to a mixed acid-base disorder. He had severe metabolic acidosis secondary to renal tubular acidification defect and respiratory alkalosis secondary to hyperventilation. Withdrawal of the offending drug led to the prompt resolution of the acid-base disturbance.
  1,958 121 -
Kidney donation: Clinical practice and ethical dilemmas
D Basu, A Ghosh
November-December 2016, 26(6):391-392
DOI:10.4103/0971-4065.179200  PMID:27942167
  1,910 136 -
Saprochaete capitata fungal infection in renal transplant recipient
S Mandarapu, V Krishna, SB Raju, U Pamidimukkala, S Nimmagadda
November-December 2016, 26(6):464-466
DOI:10.4103/0971-4065.177141  PMID:27942183
Saprochaete capitata is a fungus that rarely causes human infections; majority of infections were reported in patients with hematological malignancies. Here, we report a case of Saprochaete capitata infection in a renal transplant recipient. To the best of our knowledge, this is the first case report of infection with this unusual organism in renal transplant recipients. In our patient, this organism was isolated from broncho alveolar lavage, and it responded dramatically to the combination of amphotericin and voriconazole.
  1,937 73 -
Imerslund-Grasbeck syndrome in a 5-year-old Iranian boy
K Goudarzipour, N Zavvar, B Behnam, MA Ahmadi
November-December 2016, 26(6):455-457
DOI:10.4103/0971-4065.175984  PMID:27942180
Imerslund-Grasbeck syndrome (IGS) is a rare syndrome characterized by clinical symptoms and signs of Vitamin B 12 deficiency and proteinuria. Our patient was a 5-year-old boy with pallor, lack of appetite, and low weight gain. Laboratory studies showed severe macrocytic anemia, normal reticulocyte count, negative direct coombs test, normal osmotic fragility, and autohemolysis test. He has had intermittent proteinuria since 3 years ago despite normal creatinine level and absence of hematuria or hypertension. Finally, based on low level of serum B 12 vitamin and normal folate level accompanied by asymptomatic proteinuria, the diagnosis of IGS was made. Furthermore, his sister has had laboratory abnormalities without any symptoms. IGS responded to B 12 replacement therapy dramatically but intermittent proteinuria persisted even after appropriate therapy.
  1,908 97 -
Urban and rural population comparison of hepatic profile and associated etiology among children with end-stage renal disease
SR Shah, MT Alam, SA Shah, A Altaf, M Khan
November-December 2016, 26(6):473-474
DOI:10.4103/0971-4065.181885  PMID:27942187
  1,784 51 -
End-stage renal disease in Tunisian infants: Etiology and outcome
M Jellouli, A Boussetta, K Abidi, Y Hammi, C Zarrouk, T Gargah
November-December 2016, 26(6):405-407
DOI:10.4103/0971-4065.193753  PMID:27942170
End stage renal disease (ESRD) in infants has particular features in terms of etiologies and therapeutic modalities. The aim of our study is to describe the etiologies and the ESRD outcomes among Tunisian infants. This retrospective study was conducted over 15 years (from January 1998 to December 31, 2013) in the Pediatric Department at Charles Nicolle Hospital. In total, 157 pediatric patients had ESRD. The mean incidence was 4.25 million children. The study involved 24 infants; the sex ratio was equal to 2. The mean age at diagnosis of ESRD was 8 months (range, 1-21 months). Growth retardation was noticed in 14 patients. The main causes were Congenital Anomalies of the Kidneys and Urinary Tract (9 infants) and hereditary renal disease (9 infants). All patients were treated with peritoneal dialysis; 16 infants presented peritonitis. Mortality rate was about 28%. The leading causes of death were cardiovascular diseases and infections.
  1,501 61 -
Spontaneous callosal hemorrhage in a child on continuous ambulatory peritoneal dialysis
DN Gera, VA Ghodela, KN Patel, VB Kute, HL Trivedi
November-December 2016, 26(6):472-473
DOI:10.4103/0971-4065.183602  PMID:27942186
  1,396 60 -
Indian Journal of Nephrology
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Online since 20th Sept '07