Indian Journal of Nephrology最新文献

{"title":"Study of Caregiver Burden in Continuous Ambulatory Peritoneal Dialysis","authors":"S. Dhareshwar, R. Nithin, Jairam Anantharam, Prashant G. Kedlaya, Renuka Satish, VijoyKumar Jha, R. Akal","doi":"10.25259/ijn_424_23","DOIUrl":"https://doi.org/10.25259/ijn_424_23","url":null,"abstract":"\u0000\u0000Increased caregiver burden undermines caregivers’ mental and physical health and is an under recognized but critical aspect for the success of continuous ambulatory peritoneal dialysis (CAPD). This study was undertaken to quantify and identify the factors determining CAPD caregiver burden.\u0000\u0000\u0000\u0000A cross-sectional study was conducted among 51 caregivers of CAPD patients visiting the centers from July to August 2023. Caregiver burden score was determined using “Zarit Burden Interview” by interview method.\u0000\u0000\u0000\u0000The mean age of caregivers was 42.8 ± 10.83 years with 52.9% females. The mean Zarit burden score of the caregivers was 29.18 ± 11.81. Younger caregivers experienced significantly higher burden (r = −0.34, P = 0.013). Lesser educated caregivers were perceiving a higher burden. Lower socioeconomic strata people had significantly higher burden (P < 0.001) and especially so when there was a loss in income attributed to caregiving. Patients who were covered by state insurance experienced a notably lower caregiver burden (19.2 ± 6.1) when compared to those who were self-financed (32.4 ± 11.08) or had company insurance (37.2 ± 13.6). Gender, religion, marital status, and type of family had no bearing on the caregiver burden.\u0000\u0000\u0000\u0000Age, loss of income, education, and socioeconomic status are important determinants of caregiver burden. State sponsored program lowers caregiver burden significantly. A CAPD program should address these factors to mitigate caregiver burden.\u0000","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141669643","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":"Obinutuzumab in Difficult to Treat Phospholipase A2 Receptor Positive Membranous Nephropathy: Our Experience at a Tertiary Care Center in North India","authors":"VijoyKumar Jha, S. Panda, S. K. Rai, A. Srivastava","doi":"10.25259/ijn_498_23","DOIUrl":"https://doi.org/10.25259/ijn_498_23","url":null,"abstract":"Obinutuzumab is a glycoengineered type II anti-CD20 monoclonal antibody with superior B cell cytotoxicity compared to rituximab. Various case reports suggest that in refractory phospholipase A2 receptor (PLA2R) positive membranous nephropathy (MN) patients, Obinutuzumab led to immunologic remission and improvement in proteinuria. In the present case series, we present six cases of difficult-to-treat PLA2R-associated MN refractory to prednisolone, calcineurin inhibitor (CNI), cyclophosphamide, and rituximab but subsequently responded to Obinutuzumab. Five out of six cases showed partial /complete clinical remission and immunological remission (IR) with normalization of serum albumin and stable renal function. Though this drug’s long-term efficacy and impact remain unclear, it is being increasingly considered for PLA2R-associated MN resistant to standard therapy.","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141667776","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":"Impact of Angiotensin Receptor Blockers (ARB) versus Other Antihypertensive Medication on Blood Pressure in Patients on Dialysis: A Meta-Analysis","authors":"Karthika Devi D.S., J. J. F. Mary, Reena Mohan, Dominika Gavlasova, G. Kalaiselvan, E. Kathiravan, J. Foppiani, V. Saravanan, Archana Devi M., Samuel J. Lin","doi":"10.25259/ijn_365_23","DOIUrl":"https://doi.org/10.25259/ijn_365_23","url":null,"abstract":"\u0000\u0000Hypertension is an important factor driving mortality among dialysis patients. Angiotensin-II receptor blocker (ARB) has been effective similarly to angiotensin-converting enzymes (ACEs) but with a low incidence of side effects.\u0000\u0000\u0000\u0000The meta-analysis included all published studies that investigated the effect of ARB on the hypertension in adult dialysis patients (≥18 years). Data extraction was guided by a predetermined checklist. Data sources of the retrieved studies were PubMed, MEDLINE, ScienceDirect, SCOPUS, Cochrane, Web of knowledge, and Google Scholar were systematically searched until February 2023. Using the RevMan 5 software, the mean difference for systolic and diastolic BP (SBP and DBP) and the risk ratio (RR) of the adverse events (AEs) were pooled from the selected studies. The random-effects model was used to compare the difference in the pre-and post-dialysis of the SBP and DBP. Data analyses were performed from December 2022 to February 2023. The primary outcome was the reduction in SBP and DBP in dialysis hypertensive patients who were on anti-hypertensive agents, and the secondary outcome was assessment of AE associated with the drug after dialysis (PROSPERO Registration: CRD42022355369).\u0000\u0000\u0000\u0000The initial search yielded 1,679 records, of which 84 studies underwent full-text evaluation, which identified 13 studies and 1,462 patients. The pooled standard MD for losartan with other anti-hypertensive agents, where the pre-dialysis SBP was 0.17 (95% confidence interval [CI]: −0.21–0.55) and the post-dialysis was 0.35 (95% CI: −0.17–1.02); yet, both are statistically non-significant, implies that there was no difference between Losartan and ARB drugs regarding the effect on the SBP. Diastolic BP for predialysis was −0.01 (95% CI: −0.65–0.63) and post-dialysis was 0.03 (95% CI: −0.24−0.30) and statistically non-significant. AEs by the ARB agents were lower compared to other anti-antihypertensive agents (relative risk [RR]: 1.01; 95% CI: 0.59–1.75) and statistically non-significant.\u0000\u0000\u0000\u0000This systematic review and meta-analysis of RCT demonstrated that ARB and other anti-hypertensive medications had similar impacts on the treatment of hypertension.\u0000","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141667846","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":"Collagenofibrotic Glomerulopathy—An Unexpected Finding in a Young Female","authors":"Naga Sarika Vennavalli, S. Annavarajula, Shaila Raju Khubchandani, Dhiraj Vilas Wasnik","doi":"10.25259/ijn_164_2024","DOIUrl":"https://doi.org/10.25259/ijn_164_2024","url":null,"abstract":"","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141669392","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":"Gender Disparity in Hemodialysis Practices and Mortality: A Nationwide Cross-Sectional Observational Study","authors":"Mythri Shankar, Suresh Sankarasubaiyan, Savitha Kasiviswanathan, Kamal D Shah, Valerie Luyckx","doi":"10.25259/ijn_559_23","DOIUrl":"https://doi.org/10.25259/ijn_559_23","url":null,"abstract":"\u0000\u0000Disparities between genders are well documented in incidence, progression, and outcomes of chronic kidney disease (CKD). This study aimed to describe demographic characteristics, clinical and socio-economic factors among males and females on maintenance hemodialysis and to determine any association with mortality among males and females.\u0000\u0000\u0000A nationwide cross-sectional study was conducted in a hemodialysis network in India. All adult (>18 years) patients who died while receiving maintenance hemodialysis and an equal number of surviving control patients on maintenance hemodialysis (MHD) between January 1, 2021 to March 31, 2021 were included in the study. The demographic, socioeconomic, and hemodialysis factors were compared between both the genders.\u0000\u0000\u0000A total of 1177 patients who died during the study period were included. The majority were males (824, 70.01%). Males were more educated than females (P < 0.001). The proportion of female patients dialysed with temporary catheters where more than males, who had definite vascular access such as AV fistula or AV graft (P < 0.001). More female patients required out-of-pocket expenditure (P = 0.005). Multivariate logistic regression demonstrated that lower educational status, hypoalbuminemia, previous history of hospitalization, and dialysis in centres run by Public Private Partnership (PPP) were associated with mortality in males. Lower educational status, heart failure and previous history of hospitalization were the factors associated with mortality in females.\u0000\u0000\u0000Males predominated on hemodialysis. Females were less educated and were less likely to be covered under public or private health insurance compared to males.\u0000","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141713530","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":"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":"Ambulatory Hypertension in Children with Kidney Failure on Maintenance Dialysis","authors":"Seher Kamal, J. M. Raj, Priya Pais","doi":"10.25259/ijn_505_23","DOIUrl":"https://doi.org/10.25259/ijn_505_23","url":null,"abstract":"","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141694862","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":"Renal Amyloidosis in a Child with Recessive Dystrophic Epidermolysis Bullosa Due to a Novel Variant in <i>COL7A1</i> Gene.","authors":"Roshan Daniel, Lesa Dawman, Ritambhra Nada, Aravind Sekar, Rahul Mahajan, Karalanglin Tiewsoh","doi":"10.4103/ijn.IJN_26_21","DOIUrl":"10.4103/ijn.IJN_26_21","url":null,"abstract":"<p><p>Secondary amyloidosis may complicate inherited dermatoses, but recessive dystrophic epidermolysis bullosa (RDEB) complicated by renal amyloidosis is rare. We report a case of a 12-year-old male child with RDEB presenting with progressive generalized anasarca for 20 days. Kidney biopsy showed diffuse expansion of mesangial matrix by pale acellular Periodic Acid-Schiff (PAS)-negative amorphous material, which was congophilic on Congo red stain and gave apple green birefringence on polarization and extending along the glomerular basement membrane, suggestive of amyloidosis. Genetic analysis showed a compound heterozygous pathogenic variant in the <i>COL7A1</i> gene with autosomal recessive inheritance.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11328055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47769702","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}