Indian Journal of Nephrology最新文献

{"title":"Infection Patterns and Survival Among Renal Transplant Recipients","authors":"Dalvi Sayali Vishnu, P. Tilve, Sachin Bodke, Satarupa Deb, Mukund Andankar, U. Oza, D. Usulumarty, V. Billa, S. Bichu","doi":"10.25259/ijn_453_23","DOIUrl":"https://doi.org/10.25259/ijn_453_23","url":null,"abstract":"\u0000\u0000The outcome of kidney transplantation is determined by multiple factors and infections represent one of the major factors affecting graft and patient survival. Recent COVID-19 pandemic have adversely affected the transplant population. Very little data is available on post-transplant infections and patient survival from India.\u0000\u0000\u0000\u0000In this retrospective observational study, data related to post-transplant infections from patients who had undergone renal transplantation between October 2014 and October 2021 were collected.\u0000\u0000\u0000\u0000A total of 255 infections episodes were observed in 118 patients. Bacterial infections were the most common (55%) followed by viral (35%), fungal (5%), mycobacterial (4%), and parasitic (1%). The most common bacterial and viral infections were urinary tract infections (70.5%) and COVID-19 (56%), respectively. BK virus and COVID-19 were associated with increased graft loss (p < 0.05). The majority of deaths due to infections were related to COVID-19 infection (71.42%). Kaplan-Meier survival analysis showed 1-, 3-, and 5-year patient survival of 98.23%, 96.36%, and 92.90% and graft survival of 98.14%, 95.97%, and 91.78, respectively.\u0000\u0000\u0000\u0000Infections with their adverse impact remain a concern in kidney transplant patients. Comparable patient and graft survival to the Western data despite the high infection burden and the COVID-19 pandemic suggests that effective management can reduce the impact of infections on survival.\u0000","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141924129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Frequency, Causes and Patterns of Asymptomatic Cardiac Arrhythmias in Patients on Maintenance Hemodialysis","authors":"Yamita Sakhare, Alan Almeida, Deepak Phalgune, Aditi Erande, Sanjay M Mehendale","doi":"10.25259/ijn_412_23","DOIUrl":"https://doi.org/10.25259/ijn_412_23","url":null,"abstract":"\u0000\u0000The knowledge of the incidence of non-severe and clinically significant arrhythmias is limited in patients with chronic kidney disease (CKD). The present study was conducted to determine the incidence, pattern and identify the factors predisposing to cardiac arrhythmias in patients on maintenance hemodialysis.\u0000\u0000\u0000\u0000Forty-five patients were included in this prospective observational study conducted between June 2020 and November 2021. Patients ≥ 18 years of age on maintenance hemodialysis (three times/week for at least three months), with no intercurrent illness, uremic symptoms, and not hospitalized in the previous 3 months were included. Demographic and clinical characteristics of the patients were noted. Arrhythmias were recorded by attaching the Holter machine to all study patients undergoing hemodialysis. We estimated the incidence, identified the pattern of cardiac arrhythmias, and explored the factors predisposing to cardiac arrhythmias.\u0000\u0000\u0000\u0000Premature atrial complexes (17.8%), premature ventricular complexes (31.1%), ventricular bigeminy (8.9%), trigeminy (8.9%), and ventricular couplets (22.2%) were observed. The patients with hyperparathyroidism, hyper/hypomagnesemia, and poor blood pressure control had significantly higher percentages of total and ventricular arrhythmias. The patients with hypomagnesemia, reduced left ventricular ejection fraction (<50%), poor blood pressure control, and receiving statins had significantly higher percentages of atrial arrhythmias. There was no statistically significant association between age, gender, diabetes mellitus, ischaemic heart disease, interdialytic weight gain, dialysis vintage, low hemoglobin, serum calcium levels, serum potassium levels, presence of left ventricular hypertrophy, pulmonary hypertension, and diastolic dysfunction with arrhythmias.\u0000\u0000\u0000\u0000A high incidence of cardiac arrhythmias was noted among patients on hemodialysis.\u0000","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141925417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Rarity to Reality: Nivelon-Nivelon-Mabille Syndrome Presenting with Renal Tubular Acidosis","authors":"Abhishek Abhinay, Satyabrata Panda, Ankur Singh, Nitish Kumar","doi":"10.25259/ijn_308_2024","DOIUrl":"https://doi.org/10.25259/ijn_308_2024","url":null,"abstract":"","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141924812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Mortality Among Patients on Hemodialysis in India: A Case-Control Study","authors":"Suresh Sankarasubbaiyan, Carol A. Pollock, Urmila Anandh, Savitha Kasiviswanathan, Kamal D. Shah","doi":"10.25259/ijn_563_23","DOIUrl":"https://doi.org/10.25259/ijn_563_23","url":null,"abstract":"\u0000\u0000Mortality in hemodialysis (HD) exceeds that of many solid organ cancers, despite advancements in care. This study was conducted to understand mortality in a large dialysis network of Indian HD patients and attempt to elucidate risk factors for mortality.\u0000\u0000\u0000\u0000We performed a case-control study of deaths among patients undergoing HD across 203 centers in India from January 1 to March 31, 2021 with an age-matched control of survivors. We reviewed demographic, dialysis, clinical, and socioeconomic factors.\u0000\u0000\u0000\u0000Out of 17,659 patients on dialysis, 554 cases (non-survivors) and 623 age-matched controls (survivors) patients were followed up. The mean age was 54.9 ± 13.8 years, 70.5% (391) of them were males. Gender, BMI, dialysis frequency, HD vintage time, history of diabetes, and heart failure were similar between non-survivors and survivors. Lower education level, payment under public insurance, dialysis facility under a public-private partnership, vascular access via catheter, hemoglobin <8 g/dL levels, serum albumin <3.5 g/dL were significantly higher, hospitalizations in 3 months prior to death were more frequent among non-survivors.\u0000\u0000\u0000\u0000Factors including Hb <8 g/dL, temporary catheter, serum albumin less <3.5 g/dL, lower educational status, and dialysis under public insurance are associated with poorer survival in our population. Our findings have implications for designing interventions needed to improve outcomes for evolving policy and public-payer systems.\u0000","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141927112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The High Burden of Asymptomatic Kidney Diseases in Individuals with HIV: A Prospective Study from a Tertiary Care Center in India","authors":"Kajaree Giri, M. Sahay, Kiranmai Ismail, Anuradha Kavadi, E. Rama, S. Gowrishankar","doi":"10.25259/ijn_10_24","DOIUrl":"https://doi.org/10.25259/ijn_10_24","url":null,"abstract":"\u0000\u0000HIV infection is associated with a significant kidney disease burden. This study is aimed to screen for kidney disease in all HIV patients on highly active anti retroviral therapy (HAART), study clinico-histological correlation, and assess the impact of early diagnosis on the clinical course.\u0000\u0000\u0000\u0000It was a prospective, longitudinal study done in a tertiary care hospital. Adult HIV-infected patients, on HAART for at least 3 months, were screened for kidney disease. Kidney biopsy was done if indicated. Patients were treated as per standard guidelines. Results were analyzed at 3 months.\u0000\u0000\u0000\u0000Among 1600 patients, 966 were compliant with HAART and were tested. Two hundred and sixty-two patients completed the study duration. Out of these 262 patients 78.2% were receiving tenofovir-based ART regimen. Around 31.2% were hypertensive and 19.8% were diabetic. The mean eGFR was 57.5 ± 24 mL/min/1.73 m2. Around 19.8% had asymptomatic urine abnormalities, 40.1% had proteinuria, and 27.1% had AKI. Acute nephritic syndrome was seen in 16.4%, rapidly progressive renal failure (RPRF) in 13.3%, and CKD in 10.6% patients. Out of 74 patients who underwent biopsy, histology showed chronic tubulointerstitial nephritis in 16 (21.6%), acute tubulointerstitial nephritis in 11 (14.8%), diabetic nephropathy in 10 (13.5%), and thrombotic microangiopathy in 7 patients (9.4%). Higher viral load levels, diabetes mellitus, and age above 60 years were associated with kidney disease.\u0000\u0000\u0000\u0000Asymptomatic HIV infection has a significant burden of kidney disease. Kidney biopsy is crucial for correct diagnosis and management. The absence of HIV associated nephropathy in proteinuric HIV patients is notable in this study.\u0000","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141809884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tetany in a Patient with Gastroesophageal Reflux Disease","authors":"S. Sathiavageesan","doi":"10.25259/ijn_239_2024","DOIUrl":"https://doi.org/10.25259/ijn_239_2024","url":null,"abstract":"","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141810279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent Updates in the Diagnosis and Management of Kidney Diseases in Multiple Myeloma","authors":"K. Jhaveri, Priti Meena, Joyita Bharati, Srikanth Bathini","doi":"10.25259/ijn_491_23","DOIUrl":"https://doi.org/10.25259/ijn_491_23","url":null,"abstract":"Multiple myeloma (MM) represents a difficult-to-treat plasma cell malignancy and the second most common hematologic malignancy in adults, significantly impacting kidney function. The spectrum of kidney involvement in MM is broad, encompassing electrolyte imbalances, tubular injury, and even rare glomerular diseases. The evolution of MM treatment modalities has led to notable improvements in the long-term survival of patients experiencing kidney-related complications. Over the past decade, groundbreaking therapeutic agents have emerged, including proteasome inhibitors, immunomodulatory drugs, anti-CD38 monoclonal antibodies, selective inhibitors of nuclear export, and antibody-drug conjugates. These novel therapies have revolutionized the landscape of MM management, offering new hope for patients and challenging the traditional treatment paradigms. This comprehensive review explores recent advances in the diagnosis and management of MM, emphasizing the pivotal role of these innovative therapeutic agents in improving patient outcomes. We delve into the intricacies of diagnosing MM, highlighting the significance of early detection and precise diagnostic tools. We elucidate the evolving treatment strategies, emphasizing the mechanisms of action and clinical efficacy of the latest agents. This manuscript provides valuable insights into the ever-evolving field of MM management, shedding light on the remarkable progress achieved in enhancing the prognosis and quality of life of MM patients.","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141808644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oxidative Stress, DNA Damage, Inflammation and Endothelial Dysfunction in Snakebite-Induced Acute Kidney Injury","authors":"L. Pavuluri, A. Bitla, S. K. Vishnubotla, Ram Rapur","doi":"10.25259/ijn_545_23","DOIUrl":"https://doi.org/10.25259/ijn_545_23","url":null,"abstract":"\u0000\u0000Snakebite-induced acute kidney injury (SAKI) is a life-threatening complication. Despite its impact on public health, the understanding of the underlying cellular and molecular mechanisms remains limited. There is a lack of studies investigating the role of oxidative stress, oxidative deoxyribonucleic acid (DNA) damage, inflammation, and endothelial dysfunction in SAKI. This study aims to address this knowledge gap.\u0000\u0000\u0000\u0000Biomarkers of oxidative stress, including oxidative DNA damage, inflammation, and endothelial dysfunction were assessed in 30 patients with SAKI and 30 healthy controls. Malondialdehyde (MDA), protein carbonyl content (PCC), advanced glycation end products (AGEs), 8-hydroxy-2’-deoxyguanosine (8-OHdG), ferric reducing ability of plasma (FRAP), high-sensitivity C-reactive protein (hs-CRP), and nitric oxide (NO) were used as biomarkers.\u0000\u0000\u0000\u0000We found significantly elevated levels of MDA (2.1590±0.68221 µmol/L vs 0.8769±0.2958 µmol/L, p = <0.001), PCC (0.0905±0.040 nmol/L vs 0.0501±0.024 nmol/L, p = <0.001) and 8-OHdG (47.0757±37.09105 ng/mL vs 18.8450±9.31479 ng/mL, p = <0.001) in SAKI patients compared to controls, indicating increased oxidative damage to lipids, proteins, and DNA respectively. Although AGEs showed higher levels in SAKI patients, the difference was not significant. FRAP levels were significantly reduced [0.214 (0.051-0.489) mmol/L vs 0.470 (0.136-0.564) mmol/L, p = 0.024], indicating compromised antioxidant capacity. Significantly elevated levels of hs-CRP [40.18 (16.96-77.56) mg/L vs 1.44 (0.5-4.45) mg/L, p = <0.001] and NO [25.59 (22.75-28.43) µmol/L vs 14.218 (11.37-16.35) µmol/L, p = <0.001] confirmed the presence of inflammation and endothelial dysfunction in these patients.\u0000\u0000\u0000\u0000Our study demonstrated oxidative stress, including oxidative DNA damage, inflammation, and endothelial dysfunction, in SAKI patients. Understanding these intricate mechanisms could lead to the development of novel diagnostic tools and therapeutic strategies.\u0000","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141816164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservatively Managed Spontaneous Splenic Rupture in a Hemodialysis Patient","authors":"Prem P. Varma, Mehak Singla, Shreya Saxena","doi":"10.25259/ijn_134_2024","DOIUrl":"https://doi.org/10.25259/ijn_134_2024","url":null,"abstract":"","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141817039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemato-Renal Profile of Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits","authors":"Joseph Johny, E. John, Sanjeet Roy, R. Alam, S. Mani, N. Jose, M. Lalwani, J. Eapen, S. Yusuf, Athul Thomas, V. David, S. Varughese, S. Alexander","doi":"10.25259/ijn_489_23","DOIUrl":"https://doi.org/10.25259/ijn_489_23","url":null,"abstract":"\u0000\u0000Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) is a rare entity classified under the umbrella of monoclonal gammopathy of renal significance. The clinical implications of circulating monoclonal immunoglobulin (MIg), light chain restriction on immunofluorescence (IF) microscopy, histopathological pattern, and type of therapy on renal outcomes are not clearly defined.\u0000\u0000\u0000\u0000Sixteen patients of PGNMID diagnosed between 2013 and 2020 were included from a biopsy registry of 11,459 patients at a single center. Follow-up data was collected from electronic medical records until June 2021.\u0000\u0000\u0000\u0000The mean age of the cohort was 41.7 ± 13.5 years. Forty-four (7/16) percent showed monoclonal protein on serum or urine electrophoresis, 25% (3/12) had IgG kappa by serum immunofixation electrophoresis (IFE) and 38% (5/13) had abnormal kappa: lambda free light chain (FLC) ratio. The predominant light microscopy pattern, membranoproliferative glomerulonephritis (MPGN) was seen in 7/16 (43.7%) patients. The predominant heavy chain detected by IF microscopy was IgG (13/16, 81.3%). Kappa and lambda light chain restriction were seen in 56.3 (9/16) and 43.8 (7/16) percent of patients respectively. Circulating monoclonal kappa light chains were detected in 50 and 29% of kappa-PGNMID patients by IFE and FLC assay respectively. None of the lambda-PGNMID patients had detectable circulating monoclonal lambda light chains. Patients with circulating MIg had more proteinuria, lower estimated glomerular filtration rate, and a higher percentage of plasma cells on bone marrow biopsy. Thirty-eight percent of our cohort (5/13) progressed to kidney failure over a median (range) period of 3 (IQR, 1-7) months. Of these, 4/5 received immunosuppression, and 1/5 were treated with plasma cell-targeted chemotherapy.\u0000\u0000\u0000\u0000PGNMID is a rare disease with a biopsy incidence of 0.1%. Only a quarter of patients with PGNMID have circulating MIg. Presence of circulating MIg, type of monoclonal light chain restriction in kidney biopsy, and type of therapy did not predict renal outcomes. Patients with MPGN pattern had favorable renal outcomes despite a higher degree of proteinuria at presentation.\u0000","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141817163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}