Indian Journal of Nephrology最新文献

{"title":"State-of-Art Therapeutics in IgA Nephropathy.","authors":"Mohit Mathur, Manisha Sahay, Brian J G Pereira, Dana V Rizk","doi":"10.25259/ijn_319_23","DOIUrl":"10.25259/ijn_319_23","url":null,"abstract":"<p><p>Immunoglobulin-A nephropathy (IgAN) is the most common primary glomerulonephritis in the world, with up to 40% of patients progressing to end-stage kidney disease (ESKD) within 30 years of diagnosis. IgAN is characterized by elevated serum levels of galactose-deficient IgA1 (Gd-IgA1), which leads to immune complex formation and deposition in the glomerular mesangium, causing kidney injury. A diverse disease course and the long-term follow-up required for clinically relevant endpoints (e.g., ESKD) have been barriers to the development of novel therapies in IgAN. Disease management has focused on supportive care with inhibitors of the renin-angiotensin system and, more recently, sodium-glucose transporter inhibitors to control proteinuria. The recent acceptance of proteinuria as a surrogate endpoint by regulatory bodies and a better understanding of disease pathology have helped to initiate the development of several novel treatments. Subsequently, a targeted-release formulation of budesonide and a dual endothelin/angiotensin inhibitor (sparsentan) have received accelerated approval for patients with IgAN. However, additional therapies are needed to target the different pathogenic mechanisms and individualize patient care. Several compounds currently under investigation target various effectors of pathology. There are promising clinical results from emerging compounds that target the generation of Gd-IgA1 by B cells, including inhibitors of A PRoliferation-Inducing Ligand (APRIL) and dual inhibitors of APRIL and B-cell activating factor (BAFF). Other investigational therapies target the complement cascade by inhibiting proteins of the lectin or alternative pathways. As the therapeutic landscape evolves, it will be important to revise treatment guidelines and develop updated standards of care.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"34 5","pages":"417-430"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune-Mediated Glomerulonephritis as Type 2 Lepra Reaction Posttreatment of Lepromatous Leprosy: A Case Report.","authors":"Divya Kantak, Marius Dsouza","doi":"10.25259/ijn_536_23","DOIUrl":"10.25259/ijn_536_23","url":null,"abstract":"<p><p>Leprosy, an infectious disease known for its debilitating effects on the skin and nerves, can trigger immunologic reactions affecting multiple organs. We present the case of a 57-year-old male who developed acute glomerulonephritis following leprosy treatment. Clinical examination revealed newly developed pitting edema in the legs, along with residual nerve thickening and skin changes. Laboratory findings showed elevated serum creatinine (3.2mg/dl) accompanied by low C3 and C4 levels. Urinalysis supported the diagnosis of glomerulonephritis. Renal biopsy demonstrated immune complex deposition on immunofluorescence, suggesting a diagnosis of leprosy-related post-treatment immune-mediated glomerulonephritis. Treatment with oral steroids led to complete resolution of the condition.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"34 5","pages":"520-521"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Yoga and Meditation on Quality of Life Among Patients Undergoing Hemodialysis.","authors":"Arpitaben Jashbhai Parekh, Anita Prakasam","doi":"10.25259/IJN_98_2024","DOIUrl":"10.25259/IJN_98_2024","url":null,"abstract":"<p><p>The rising prevalence of chronic kidney disease poses a future challenge for healthcare and the economy. For patients diagnosed with kidney failure, hemodialysis is the sole recourse until a suitable renal donor is acquired, exerting a discernible impact on the overall quality of life. Yoga and meditation emerge as pivotal elements in enhancing quality of life (QoL), significantly influencing diverse aspects of well-being. The study aimed to identify the effectiveness of yoga and meditation on QoL among hemodialysis patients. An experimental research design with one group pretest - post-test on 100 participants was conducted in Muljibhai Patel Urology Hospital, Nadiad. Pre-tests were conducted on day 1, followed by a 12-week yoga and meditation program with a post-test. Data analysis utilised SPSS-20 software, employing descriptive and inferential statistics. Yoga and meditation effectively demonstrated improvement in QoL in each domain (p < 0.001.) post-intervention. These results emphasize QoL enhancement after incorporating these practices into hemodialysis care.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"34 5","pages":"533-536"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rhabdomyolysis and Pigment Nephropathy - An Uncommon Manifestation of Eucalyptus Oil Consumption.","authors":"Sabarinath Shanmugam, Ramasami Sethuraman, T Chakravarthy, Gobi Krishnan, Baby Kavitha, Jeya Shakila, N Karthikeyan, Rajendran Ranjith, Preethi Sekar","doi":"10.25259/ijn_390_23","DOIUrl":"10.25259/ijn_390_23","url":null,"abstract":"<p><p>Eucalyptus oil consumption is well known to cause adverse effects on central nervous system like seizures, ataxia and unconsciousness. No antidote is available and treatment is largely supportive. We report a case of rhabdomyolysis with pigment cast nephropathy and acute kidney injury in a young female following eucalyptus oil consumption and its successful management.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"34 5","pages":"516-517"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutrition Profile and Quality of Life of Adult Chronic Kidney Disease Patients on Maintenance Hemodialysis in India: An Exploratory Study.","authors":"Apeksha Ekbote, Suparna Ghosh-Jerath, Vidisha Sharma, Suresh Sankara Subbaiyan, Kamal D Shah, Vidya Rajesh Joshi, Ganesh Rameshwar Ankush, Shruti Sharma, Savitha Kasiviswanathan","doi":"10.25259/ijn_562_23","DOIUrl":"10.25259/ijn_562_23","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition and suboptimal food intake are common concerns among chronic kidney disease (CKD) patients. Medical nutrition therapy plays a significant role in ensuring the well-being of CKD patients undergoing maintenance hemodialysis (MHD). The present study explored the dietary intake and quality of life (QOL) of CKD patients on MHD.</p><p><strong>Materials and methods: </strong>Adult CKD patients (n = 107, >20 years, 72% male) on MHD were conveniently selected from dialysis centers across India. This cross-sectional exploratory study elicited information on general profile, height, dry body weight, biochemical parameters, food intake, and QOL of the patients. Nutrient intake was compared with Kidney Disease Outcomes Quality Initiative (KDOQI) Guidelines.</p><p><strong>Results: </strong>The average energy and protein intake per kg body weight was below the recommendations (energy ∼21 kcal/kg vs. 30-35 kcal/kg body weight and protein ∼0.7g/kg vs. 1-1.2 g/kg body weight). Majority of them (>75%) had inadequate energy and protein intake. The sodium intake of the participants (3109.42 ± 1012.31 mg) was higher than the suggested limit. The energy and protein intake/kg ideal body weight of female patients was significantly higher than male patients (p < 0.05). Overall, their QOL was satisfactory. However, nearly half of them (47%) reported moderate-level problem in the pain and discomfort dimension.</p><p><strong>Conclusion: </strong>Patients were not meeting the recommendations especially for energy and protein. Patient-specific customized nutrition counseling along with routine nutrition assessment, follow-up of patients and continued nutrition education, and motivation and support from the medical care team, especially the dietitian is needed for better dietary compliance and overall improvement of QOL.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"34 5","pages":"493-500"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IgA Nephropathy: Emerging Mechanisms of Disease.","authors":"Lydia E Roberts, Chloe E C Williams, Louise Oni, Jonathan Barratt, Haresh Selvaskandan","doi":"10.25259/ijn_425_23","DOIUrl":"10.25259/ijn_425_23","url":null,"abstract":"<p><p>Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis reported across the world and is characterized by immunoglobulin A (IgA) dominant mesangial deposits, which are poorly <i>O</i>-glycosylated. This deposition leads to a cascade of glomerular and tubulointerstitial inflammation and fibrosis, which can progress to chronic kidney disease. The variability in rate of progression reflects the many genetic and environmental factors that drive IgAN. Here, we summarize the contemporary understanding of the disease mechanisms that drive IgAN and provide an overview of new and emerging therapies, which target these mechanisms.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"34 4","pages":"297-309"},"PeriodicalIF":0.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histopathological and Immunohistochemical Study of Acute Tubular Injury in Native Kidney Biopsy.","authors":"Vrushali Mahajan, Swarnalata Gowrishankar","doi":"10.25259/ijn_282_23","DOIUrl":"10.25259/ijn_282_23","url":null,"abstract":"<p><strong>Background: </strong>Acute tubular injury (ATI) is a common diagnosis on renal biopsy. There are no accepted parameters to assess the severity of injury or predict recovery. An objective histologic grading system would be of immense value in clinical practice. The macrophage response to injury involves the MI phenotype which is proinflammatory and M2 which is prorepair. The study of these macrophages could aid in studying the severity and the recovery.</p><p><strong>Materials and methods: </strong>A total of 58 native kidney biopsies with features of ATI and a minimum follow-up of 12 weeks were graded into mild, moderate and severe, using scores for simplification, sloughing, and mitosis. These scores and the density of macrophages stained with CD68, CD163, and HLA-DR were correlated with serum creatinine at presentation and with recovery. The effect of chronicity index as measured by glomerulosclerosis, tubular atrophy, and interstitial fibrosis and of co-morbidities of age, hypertension, and diabetes on the recovery pattern was also studied.</p><p><strong>Results: </strong>All three histologic scores and the grades of ATI showed positive correlation with the serum creatinine level. The densities of CD 68 + and CD163 + macrophages also showed a significant correlation with serum creatinine level. However, none of these these histological features nor the macrophage densities predicted clinical recovery. Age >60 years, hypertension, diabetes, and chronicity score on biopsy were indicators of partial and delayed recovery.</p><p><strong>Conclusion: </strong>The histopathological semiquantitative scoring system can be used routinely to grade ATI. However none of the studied parameters predicted recovery.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"34 4","pages":"310-316"},"PeriodicalIF":0.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imlifidase: Is it the Magic Wand in Renal Transplantation?","authors":"Nithya Krishnan, David Briggs","doi":"10.25259/ijn_325_23","DOIUrl":"10.25259/ijn_325_23","url":null,"abstract":"<p><p>Potential kidney transplant patients with HLA-specific antibodies have reduced access to transplantation. Their harmful effects are mediated by the Fc portion of IgG, including activation of the complement system and Fc receptor-initiated cytotoxic processes by circulating leucocytes. Avoiding antibody incompatibility is the conventional approach, but for some patients this can mean extended waiting times, or even no chance of a transplant if there are no alternative, compatible donors. For these cases, pretransplant antibody removal may provide access to transplantation. Plasmapheresis is currently used to achieve this, with acceptable outcome results, but the process can take days to reduce the antibody levels to a safe level, so has limited use for deceased donors. There is now an alternative, in the form of an IgG-digesting enzyme, Imlifidase, which can be administered for <i>in vivo</i> IgG inactivation. Imlifidase cleaves human IgG, separating the antigen-binding part, F(ab')₂ from Fc. Typically, within six hours of dosing, most, if not all, of the circulating IgG has been inactivated, allowing safe transplantation from a previously incompatible donor. For deceased donor transplantation, where minimizing cold ischaemia is critical, this six-hour delay before implantation should be manageable, with the compatibility testing processes adjusted to accommodate the treatment. This agent has been used successfully in phase 2 clinical trials, with good short to medium term outcomes. While a donation rate that matches demand may be one essential answer to providing universal access to kidney transplantation, this is currently unrealistic. IgG inactivation, using Imlifidase, is, however, a realistic and proven alternative.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"34 4","pages":"291-296"},"PeriodicalIF":0.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autosomal Dominant Polycystic Kidney Disease in Older Adults.","authors":"Henry H L Wu, Grahame Wood, Rajkumar Chinnadurai","doi":"10.25259/ijn_561_23","DOIUrl":"10.25259/ijn_561_23","url":null,"abstract":"","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"34 4","pages":"407"},"PeriodicalIF":0.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Parasitic Infection from the Common Cockroach: A Case of Lophomonas Blattarum from a Tertiary Center in Kerala.","authors":"Priya Padmanabhan Mavoor, Sunil George, Ravindran Chetambath, M V Poornima","doi":"10.25259/ijn_520_23","DOIUrl":"10.25259/ijn_520_23","url":null,"abstract":"<p><p>Immunocompromised patients are prone to various opportunistic infections. Most of the infections are easily detectable through staining, culture, and polymerase chain reaction techniques. Nevertheless, it is also important to have wet smear examinations of samples. We present a case of pneumonia in a post-transplant recipient who was on immunosuppressants and detected to have an infection from the parasite, lophomonas blattarum, which usually resides in the hindgut of cockroaches.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"34 4","pages":"387-389"},"PeriodicalIF":0.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}