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GUIDELINES
Revised guidelines for management of steroid-sensitive nephrotic syndrome
Arvind Bagga
January-March 2008, 18(1):31-39
DOI:10.4103/0971-4065.41289  PMID:20368921
Justification: In 2001, the Indian Pediatric Nephrology Group formulated guidelines for management of patients with steroid-sensitive nephrotic syndrome. In view of emerging scientific evidence, it was felt necessary to review the existing recommendations. Process: Following a preliminary meeting in March 2007, a draft statement was prepared and circulated among pediatric nephrologists in the country to arrive at a consensus on the evaluation and management of these patients. Objectives: To revise and formulate recommendations for management of steroid-sensitive nephrotic syndrome. Recommendations: The need for adequate corticosteroid therapy at the initial episode is emphasized. Guidelines regarding the initial evaluation, indications for renal biopsy and referral to a pediatric nephrologist are updated. It is proposed that patients with frequently relapsing nephrotic syndrome should, at the first instance, be treated with longterm, alternate-day prednisolone. The indications for use of alternative immunosuppressive agents, including levamisole, cyclophosphamide, mycophenolate mofetil, and cyclosporin are outlined. The principles of dietary therapy, management of edema, and prevention and management of complications related to nephrotic syndrome are described. These guidelines, formulated on the basis of current best practice, are aimed to familiarize physicians regarding principles of management of children with steroid-sensitive nephrotic syndrome.
  19,458 2,554 8
PERSPECTIVE
The Economics of Dialysis in India
Umesh Khanna
January-March 2009, 19(1):1-4
DOI:10.4103/0971-4065.50671  PMID:20352002
  15,560 1,301 21
REVIEW ARTICLE
Psychiatric issues in renal failure and dialysis
A De Sousa
April-June 2008, 18(2):47-50
DOI:10.4103/0971-4065.42337  PMID:20142902
This article aims to bring to the fore, issues regarding the interface of psychiatry and renal failure. Depression, anxiety, suicide and delirium are common complications observed in patients with renal failure. Pharmacological management of these problems need stringent monitoring on part of the psychiatrist. This article examines the various complications that may be observed in patients with renal failure while discussing treatment approaches and also emphasizing the need for interdisciplinary team work in improving the quality of life of patients with renal failure and those on dialysis.
  11,028 746 5
Pathogenesis and management of renal osteodystrophy
AS Narula, A Jairam, KV Baliga, KJ Singh
October-December 2007, 17(4):150-159
DOI:10.4103/0971-4065.39168  
Renal osteodystrophy is a common complication of chronic kidney disease (CKD). It is the part of a broad spectrum of disorders of mineral and bone metabolism that develop in this clinical setting and result in both skeletal and extraskeletal consequences. Insights into the mechanisms of bone remodeling, mineral metabolism and vascular calcification have shed light on the systemic nature of the disorder. Central to the assessment of disturbances in the bone and mineral metabolism is the ability to assess the bone disease accurately by noninvasive means. Recent emphasis is on the requirement to begin the therapy early in the course of CKD. Guidelines on a 'step care' approach to the detection and management of alterations in calcium, phosphorus and parathyroid hormone metabolism in various stages of CKD are now available. Although constant improvements in the technicalities of the parathyroid hormone assays have improved the diagnostic capability, controversies regarding this aspect still exist. Noncalcium, nonaluminum-based phosphate binders hold promise for the future developments in the management of calcium-phosphate metabolism. Further research and progress in this area continue to evaluate the appropriate interventions to address both the skeletal and extraskeletal consequences targeted toward improving patient outcomes.
  10,413 1,318 1
ORIGINAL ARTICLES
Impact of smoking on microalbuminuria and urinary albumin creatinine ratio in non-diabetic normotensive smokers
RK Gupta, R Gupta, VD Maheshwari, M Mawliya
March-April 2014, 24(2):92-96
DOI:10.4103/0971-4065.127893  PMID:24701041
Smoking is associated with an excessive morbidity and mortality from a variety of diseases. The aim of this study was to find out the effects of smoking on renal function study in non-diabetic, normotensive subjects. A community-based, prospective, cross-sectional cohort study was conducted on 120 subjects; 80 (66.66%) were smokers and 40 (33.33%) age matched non-smokers; with age range of 30 to 70 years. Measurement of fasting sugar, urea, creatinine, lipids and one time screening of urinary albumin and urinary creatinine was done. Smokers had significantly higher urinary albumin and albumin creatinine ratio (ACR) (52.84 ± 46.42 mg/L, 93.98 ± 78.68 μg/mg) than non-smokers (19.25 ± 7.77 mg/L, 18.99 ± 6.65 μg/mg), respectively (P =< 0.001, P =< 0.001). Microalbuminuria and urinary ACR level were directly related to the amount of smoking (pack-years). Among smokers, 73 (91.25%) had microalbuminuria (>20 mg/L) and 64 (80%) had increased urinary ACR (>30 μg/mg). Smoker had significantly lower high-density lipoprotein level (36.66 ± 10.28 mg/dl) compared to non-smokers (41.22 ± 11.72 mg/dl) (P = 0.031). Urea, creatinine, creatinine clearance, total cholesterol, low density lipoprotein, triglyceride levels were comparable (p = NS). In conclusion, smokers have a 4-fold higher prevalence of microalbuminuria than non-smokers.
  10,686 670 -
Percutaneous CAPD catheter insertion by a nephrologist versus surgical placement: A comparative study
K Sampathkumar, AR Mahaldar, YS Sooraj, M Ramkrishnan, Ajeshkumar , R Ravichandran
January-March 2008, 18(1):5-8
DOI:10.4103/0971-4065.41280  PMID:20368912
Peritoneal dialysis catheter (PDC) for continuous ambulatory peritoneal dialysis is inserted into the abdominal cavity either by a surgeon, interventional radiologist or nephrologist. Various innovations have been made in the methodology adopted in the placement of the PDC. We compared the percutaneous approach for PDC insertion with the open surgical technique. From January 2006 to May 2007, 25 of the 46 catheters were successfully inserted using the percutaneous Seldinger technique. The incision size (2.6 0.7 vs 7.3 0.6 cm) and the length of hospital stay (11.9 5.9 vs 17.3 6.8 d) were considerably less in the percutaneously placed group compared to the surgically placed group. Early initiation of exchanges and reduction in the expenses were other important advantages of this method.
  9,989 483 -
REVIEW ARTICLE
Prevention of chronic kidney disease in children
M Vijayakumar, BR Nammalwar, N Prahlad
April-June 2007, 17(2):47-52
DOI:10.4103/0971-4065.37020  
Chronic kidney disease (CKD) is being increasingly recognized in children, especially prevalent in those who recover from serious illness. The ability to recognize the pathophysiological conditions that predispose to renal parenchymal damage or disorders and the application of preventive measures or institution of ameliorating therapy may lessen the burden of the parenchymal damage leading to CKD. These measures include antenatal immunization, antenatal diagnosis, fetal surgical interventions and postnatal screening procedures for proteinuria, hypertension, dyslipidemia and prevention of obesity - all of which could play a significant role in the prevention of CKD or its progression to end stage renal disease.
  9,401 868 1
Approach to urinary tract infections
MS Najar, CL Saldanha, KA Banday
October-December 2009, 19(4):129-139
DOI:10.4103/0971-4065.59333  PMID:20535247
Urinary tract infection (UTI) is the most common infection experienced by humans after respiratory and gastro-intestinal infections, and also the most common cause of both community-acquired and nosocomial infections for patients admitted to hospitals. For better management and prognosis, it is mandatory to know the possible site of infection, whether the infection is uncomplicated or complicated, re-infection or relapse, or treatment failure and its pathogenesis and risk factors. Asymptomatic bacteriuria is common in certain age groups and has different connotations. It needs to be treated and completely cured in pregnant women and preschool children. Reflux nephropathy in children could result in chronic kidney disease; otherwise, urinary tract infections do not play a major role in the pathogenesis of end-stage renal disease. Symptomatic urinary tract infections occur most commonly in women of child-bearing age. Cystitis predominates, but needs to be distinguished from acute urethral syndrome that affects both sexes and has a different management plan than UTIs. The prostatitis symptoms are much more common than bacterial prostatic infections. The treatment needs to be prolonged in bacterial prostatitis and as cure rates are not very high and relapses are common, the classification of prostatitis needs to be understood. The consensus conference convened by National Institute of Health added two more groups of patients, namely, chronic prostatitis/chronic pelvic pain syndrome and asymptomatic inflammatory prostatitis, in addition to acute and chronic bacterial prostatitis. Although white blood cells in urine signify inflammation, they do not always signify UTI. Quantitative cultures of urine provide definitive evidence of UTI. Imaging studies should be done 3-6 weeks after cure of acute infection to identify abnormalities predisposing to infection or renal damage or which may affect management. Treatment of cystitis in women should be a three-day course and if symptoms are prolonged, then a seven day course of antibiotics should be given. Selected group of patients benefits from low-dose prophylactic therapy. Upper urinary tract infection may need in-patient treatment. Treatment of acute prostatitis is 30-day therapy of appropriate antibiotics and for chronic bacterial prostatitis a low dose therapy for 6-12 months may be required. It should be noted that no attempt should be made to eradicate infection unless foreign bodies such as stones and catheters are removed and correctable urological abnormalities are taken care of. Treatment under such circumstances can result only in the emergence of resistant organisms and complicate therapy further.
  8,347 1,582 7
CPC
A case with paraplegia, urinary tract infection and renal failure
Vivekanand Jha, Kartar Singh, Subhash Varma, Vikas Suri, Ashim Das
April-June 2007, 17(2):80-86
DOI:10.4103/0971-4065.37029  
  9,536 365 -
REVIEW ARTICLES
The evolution of the Banff classification schema for diagnosing renal allograft rejection and its implications for clinicians
DM Bhowmik, AK Dinda, P Mahanta, SK Agarwal
January-March 2010, 20(1):2-8
DOI:10.4103/0971-4065.62086  PMID:20535263
Till the early 1990s there was no standardized international classification of renal allograft biopsies resulting in considerable heterogeneity in reporting among the various centers. A group of dedicated renal pathologists, nephrologists, and transplant surgeons developed a schema in Banff, Canada in 1991. Subsequently there have been updates at regular intervals. The following review presents the evolution of the Banff classification and its utility for clinicians.
  8,749 1,062 9
ORIGINAL ARTICLES
Clinical and biochemical parameters in chronic kidney disease with pulmonary hypertension
P Patel, G Abraham, B Pratap, R Ramalakshmi, M Mathew, JM Jeevan, TR Muralidharan, A Moorthy, N Leslie
January-March 2007, 17(1):4-6
DOI:10.4103/0971-4065.35012  
Background: Pulmonary hypertension is said to be present when the systolic and mean pressures in the pulmonary artery exceeds 30 and 20 mmHg, respectively. There is a paucity of data on the incidence and prevalence of pulmonary hypertension in chronic kidney disease (CKD) in Indian patients. Materials and Methods: A total of 100 CKD patients (male 69, female 31), who were on conservative management, hemodialysis, or continuous ambulatory peritoneal dialysis at a tertiary care center, were studied for the presence of pulmonary hypertension. None of the patients were smokers. The variables studied were hypertension, diabetes, and duration of dialysis, and the hemoglobin, blood urea nitrogen (BUN), creatinine, and serum bicarbonate levels. Results: Forty-one percent of the patients had pulmonary hypertension, 96% had anemia (Hb<10 gm/dl), and 85% had metabolic acidosis. The dialysis vintage was less than 10 months in 29% of the patients. Conclusion: The prevalence of pulmonary hypertension was highest in the hemodialysis group (33%). Multivariate regression analysis showed that age, duration of renal failure, vintage of dialysis, hemoglobin, BUN, serum creatinine, and bicarbonate levels were all positively correlated with pulmonary hypertension; in all cases, the correlation was statistically significant.
  8,454 434 2
An assessment of the quality of life in hemodialysis patients using the WHOQOL-BREF questionnaire
BS Sathvik, G Parthasarathi, MG Narahari, KC Gurudev
October-December 2008, 18(4):141-149
DOI:10.4103/0971-4065.45288  PMID:20142925
A cross-sectional study was conducted to evaluate the quality of life (QOL) of hemodialysis patients. An attempt was made to compare the QOL of hemodialysis patients with the QOL of the general population, renal transplant patients, and patients with a chronic disease, in this case, asthma. The WHOQOL-BREF questionnaire was used to assess the quality of life. Hemodialysis patients who had completed three months of maintenance hemodialysis ( n = 75) were enrolled into the study. The quality of life of hemodialysis patients was found to be significantly impaired ( P < 0.05) in comparison to healthy individuals of the general population, particularly with respect to the physical, psychological, and social relationship domains. In comparison to the quality of life of renal transplant patients, the quality of life of hemodialysis patients was significantly ( P < 0.05) lower in all the four WHOQOL-BREF domains. Only in the environmental dimension was the quality of life of hemodialysis patients found to be significantly lower than that of the asthma patients. Female hemodialysis patients showed significantly ( P < 0.05) lower quality of life than did male patients in the psychological and environmental dimensions of WHOQOL-BREF. A positive association was seen between higher education and the psychological functioning and the environmental dimensions of WHOQOL-BREF. Thus, the quality of life of hemodialysis patients was found to be considerably impaired when compared to that of healthy individuals of the general population as well as of renal transplant patients.
  7,857 1,007 9
CASE REPORTS
Hyponatremia and hypokalemia in a continuous ambulatory peritoneal dialysis patient
CH Ramakrishna, K Sunil Kumar, S Padmnabhan, V Siva Kumar
January-March 2007, 17(1):20-22
DOI:10.4103/0971-4065.35017  
Patients on dialysis cannot independently regulate salt and water removal. Although hypokalemia has been reported to occur in 10-36% of peritoneal dialysis patients, hyponatremia is uncommon. We describe a rare case in whom hyponatremia and hypokalemia developed while on continuous ambulatory peritoneal dialysis and discuss the management.
  8,469 306 -
Bardet-Biedl syndrome with end-stage kidney disease: A case report and review of literature
M Rathi, A Ganguli, SK Singh, HS Kohli, KL Gupta, V Sakhuja, V Jha
January-March 2007, 17(1):10-13
DOI:10.4103/0971-4065.35014  
Bardet-Biedl syndrome (BBS) is a rare autosomal recessive condition characterized by retinitis pigmentosa, postaxial polydactyly, central obesity, and renal involvement. Renal failure is the commonest cause of death. We report the first case of BBS with documented end-stage kidney disease from India. The diagnosis had been missed until the patient presented at our hospital. The relevant literature has also been reviewed.
  8,383 371 6
ORIGINAL ARTICLES
Microalbuminuria in diabetes mellitus: Association with age, sex, weight, and creatinine clearance
NK Chowta, P Pant, MN Chowta
April-June 2009, 19(2):53-56
DOI:10.4103/0971-4065.53322  PMID:20368924
Studies in the Western literature show a linear relationship between degree of microalbuminuria and body mass index (BMI), blood pressure, and duration of diabetes. This study was aimed to determine the correlation of microalbuminuria with age, sex, duration of diabetes, BMI, and creatinine clearance in type-2 diabetics in Indian population. One hundred patients (59 males and 41 females) with type-2 diabetes mellitus of duration six months or more and negative for albumin in urine by albustic method were included in the study. Detailed clinical history was taken followed by a thorough physical examination that included neurological examination in the selected patients. Micral test was used for estimation of microalbuminuria. Overall prevalence of microalbuminuria in the present study was 37%. Among the patients with microalbuminuria, 20 were males and 17 were females. Pearson correlation of microalbuminuria with age showed statistically significant linear relationship. Gender-wise correlation analysis of microalbuminuria failed to show any statistical significance. Correlation of microalbuminuria with BMI was also not significant ( r = 0.063, P > 0.05). Creatinine clearance negatively correlated with microalbuminuria, but this was statistically insignificant. There was a statistically significant correlation of microalbuminuria with duration of diabetes. Prevalence of microalbuminuria is around 37% in type-2 diabetes mellitus. Incidence of microalbuminuria increases with age as well as with increased duration of diabetes mellitus. There is no effect of BMI and sex on the prevalence of microalbuminuria.
  6,829 855 6
REVIEW ARTICLE
Revised guidelines on management of antenatal hydronephrosis
A Sinha, A Bagga, A Krishna, M Bajpai, M Srinivas, R Uppal, I Agarwal
March-April 2013, 23(2):83-97
DOI:10.4103/0971-4065.109403  PMID:23716913
Widespread antenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. The present guidelines update the recommendations published in 2000. Antenatal hydronephrosis (ANH) is transient and resolves by the third trimester in almost one-half cases. The presence of oligohydramnios and additional renal or extrarenal anomalies suggests significant pathology. All patients with ANH should undergo postnatal ultrasonography; the intensity of subsequent evaluation depends on anteroposterior diameter (APD) of the renal pelvis and/or Society for Fetal Urology (SFU) grading. Patients with postnatal APD exceeding 10 mm and/or SFU grade 3-4 should be screened for upper or lower urinary tract obstruction and vesicoureteric reflux (VUR). Infants with VUR should receive antibiotic prophylaxis through the first year of life, and their parents counseled regarding the risk of urinary tract infections. The management of patients with pelviureteric junction or vesicoureteric junction obstruction depends on clinical features and results of sequential ultrasonography and radionuclide renography. Surgery is considered in patients with increasing renal pelvic APD and/or an obstructed renogram with differential renal function < 35-40% or its subsequent decline. Further studies are necessary to clarify the role of prenatal intervention, frequency of follow-up investigations and indications for surgery in these patients.
  6,454 913 3
ORIGINAL ARTICLES
Pregnancy-related acute renal failure: A single-center experience
KR Goplani, PR Shah, DN Gera, M Gumber, M Dabhi, A Feroz, K Kanodia, S Suresh, AV Vanikar, HL Trivedi
January-March 2008, 18(1):17-21
DOI:10.4103/0971-4065.41283  PMID:20368915
Pregnancy-related acute renal failure (ARF) is a common occurrence and is associated with substantial maternal and fetal mortality. It also bears a high risk of bilateral renal cortical necrosis. We conducted this study to evaluate the contributing factors and to assess the frequency of cortical necrosis. In this prospective study, of the 772 patients with ARF admitted at our institute between January 2004 and May 2006, 70 had ARF associated with pregnancy complications. ARF was diagnosed by documenting oliguria (urine output <400 ml/d) or mounting azotemia in the presence of normal urine output. (serum creatinine >2 mg%). Renal biopsy was performed if a patient was found to be oliguric or required dialysis support at the end of three weeks. The incidence of pregnancy-related ARF was 9.06%. Approximately 20% cases occurred due to postabortal complications in early pregnancy and 80% following complications in late pregnancy. Puerperal sepsis was the most common etiological factor in 61.42% of the patients. Preeclampsia accounted for 28.57% of ARF. Two-thirds of patients recovered with dialysis and supportive care. The incidence of biopsy proven renal cortical necrosis was 14.8% (10 of the 70 patients). The incidence of renal cortical necrosis was 28.57% in the early pregnancy group and 10.71% in the late pregnancy group. Postabortal sepsis was the most common precipitating event for renal cortical necrosis. Maternal mortality was 18.57%. Sepsis accounted for a majority of deaths (61.53%). Pregnancy-related ARF is common in western India. Puerperal sepsis is the most frequent etiological factor. Renal cortical necrosis is common and postabortal sepsis was the most common precipitating event. Sepsis accounted for a majority of maternal mortality.
  6,767 590 5
Continuous ambulatory peritoneal dialysis: A viable modality of renal replacement therapy in a hilly state of India
S Vikrant
October-December 2007, 17(4):165-169
DOI:10.4103/0971-4065.39171  
Objective: Chronic ambulatory peritoneal dialysis (CAPD) has been an established form of therapy in adult patients with end-stage renal failure in India for more than a decade and has emerged as accepted form of renal replacement therapy in urban areas. The objective of this paper is to report the experience with CAPD as a modality of renal replacement therapy from a tertiary care hospital in a hilly state of India with predominant rural population. Design: Retrospective study. Setting: A government-owned tertiary care hospital in Himachal Pradesh, a state with a population of 6 million. Materials and Methods: This study involved the patients who were initiated on CAPD between October 2002 and December 2006 and who survived and/or had more than 6 months follow up on this treatment with last follow up till June 30, 2007. Results: A total of 25 patients were included in the analysis. The mean age of the patients was 61 10.2 years. 13 (52%) patients were female. 18 (72%) patients out of these lived in rural areas. The total follow up was 553.1 patient-months with a mean follow up of 22.1 12.4 months. The total duration on peritoneal dialysis treatment was 541.1 patient-months with a mean duration of 21.6 12.2 months and median duration of 19 patient-months (range: 6-56.3 patient-months). No patient had exit-site infection. There were 26 episodes of peritonitis. The rate of peritonitis was 1 episode per 21 patient-months or 0.6 per patient-year during the treatment period. The main cause of death was cardiovascular complications. Patient and technique survival at 1, 2 and 3 years was 80, 36 and 12%, respectively. Conclusion: Chronic ambulatory peritoneal dialysis (CAPD) is a safe and viable mode of renal replacement in remote and rural places. It can emerge as a revolutionized procedure for ESRD patients dwelling in remote and geographically difficult regions in developing countries such as India.
  6,866 306 2
CPC
A case of systemic vasculitis
Ashim Das, Vinay Sakhuja, Dheeraj Khurana, Nandita Kakkar, Naveen Kalra, Pradeep Bambery
January-March 2007, 17(1):29-38
DOI:10.4103/0971-4065.35020  
  6,639 390 -
CASE REPORTS
Complete remission of lambda light chain myeloma presenting with acute renal failure following treatment with bortezomib and steroids
M Pavan, KA Ashwini, R Ravi, LH Suratkal
April-June 2010, 20(2):94-96
DOI:10.4103/0971-4065.65304  PMID:20835325
About one in five people with multiple myeloma produce only light chains. Patients with lambda light chain disease have a three times worse prognosis than kappa light chain disease. We report a case of lambda light chain deposition disease in a 35-year-old female who presented with acute renal failure requiring hemodialysis. She had complete recovery and is now in complete remission following treatment with bortezomib and steroids.
  6,821 167 2
REVIEW ARTICLE
The kidney in pregnancy: A journey of three decades
J Prakash
May-June 2012, 22(3):159-167
DOI:10.4103/0971-4065.98750  PMID:23087548
The spectrum of kidney disease occurring during pregnancy includes preeclampsia, hypertensive disorders of pregnancy, urinary tract infection, acute kidney injury, and renal cortical necrosis (RCN). Preeclampsia affects approximately 3-5% of pregnancies. We observed preeclampsia in 5.8% of pregnancies, and 2.38% of our preeclamptic women developed eclampsia. Severe preeclampsia and the eclampsia or hemolysis, elevated liver enzymes levels, and low platelets count (HELLP) syndrome accounted for about 40% of cases of acute kidney injury (AKI) in pregnancy. Preeclampsia/eclampsia was the cause of acute renal failure (ARF) in 38.3% of the cases. Preeclampsia was the most common (91.7%) cause of hypertension during pregnancy, and chronic hypertension was present in 8.3% of patients. We observed urinary tract infection (UTI) in 9% of pregnancies. Sepsis resulting from pyelonephritis can progress to endotoxic shock, disseminated intravascular coagulation, and AKI. The incidence of premature delivery and low birth weight is higher in women with UTI. The incidence of AKI in pregnancy with respect to total ARF cases has decreased over the last 30 years from 25% in 1980s to 5% in 2000s. Septic abortion-related ARF decreased from 9% to 3%. Prevention of unwanted pregnancy and avoidance of septic abortion are key to eliminate abortion-associated ARF in early pregnancy. The two most common causes of ARF in third trimester and postpartum periods were puerperal sepsis and preeclampsia/HELLP syndrome. Pregnancy-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome and acute fatty liver of pregnancy were rare causes of ARF. Despite decreasing incidence, AKI remains a serious complication during pregnancy.
  5,741 945 3
ORIGINAL ARTICLES
Ponticelli regimen in idiopathic nephrotic syndrome
U Das, KV Dakshinamurty, N Prasad
April-June 2009, 19(2):48-52
DOI:10.4103/0971-4065.53321  PMID:20368923
Various studies have demonstrated that treatment with methyl prednisolone and chlorambucil could increase the chance of remission of idiopathic nephrotic syndrome (INS) of varied histology in patients who do not respond to the conventional treatment. This study was done to assess the safety and efficacy of methyl prednisolone and chlorambucil regimen in patients with various types of glomerulonephritides which were resistant to the usual conventional immunosuppressive drugs. Thirty nine patients were treated between June 1998 and December 2003 with Ponticelli regimen for six months. Twenty three patients (58.98%) were men and 16 (41.02%) were women. Mean age at the onset of NS was 23.59 1.28 (range 10-51) years. Four patients (10.2%) had minimal change disease (MCD), six patients (15.4%) had membranoproliferative glomerulonephritis (MPGN), two (5.1%) had IgA nephropathy, and 18 patients (46.1%) had focal segmental glomerulosclerosis (FSGS). Eleven patients were excluded from the final analysis. Of the remaining 28 patients, mean baseline proteinuria was 3.31 3.09 g/day. Mean baseline plasma albumin was 2.84 1.002 g/dl and mean baseline serum creatinine was 0.87 0.42 mg/dl. At the end of six months of treatment, mean proteinuria was 1.02 0.85 g/day. Mean plasma albumin was 3.69 0.78 g/day, and mean serum creatinine was 0.85 0.26 mg/dl. Mean followup was 13.21 7.7 times in 18.92 12.58 months. At the end of six months of treatment, seven patients (25%) achieved complete remission (CR), 10 patients (35.71%) partial remission (PR), and 11 patients (39.3%) did not show any response to the therapy. Most of the patients in responder group had FSGS (64.70%), whereas in nonresponder group patients had MPGN and mesangioproliferative glomerulonephritis (MesPGN). Out of 13 FSGS cases five (38.46%) achieved CR, six (46.15%) PR, and only two (15.38%) failed to respond. The incidence of side effects was 39.3%. Responders had more side effects than nonresponders (47 vs 27.3%). Methyl prednisolone and chlorambucil therapy (Ponticelli regimen) is safe and efficacious in achieving remission in significant number of INS patients other than membranous nephropathy, without any serious side effect on short term followup. However, a longer followup is required to demonstrate the sustained efficacy and long-term side effect of this regimen.
  5,749 882 1
Monthly cost of three exchanges a day peritoneal dialysis is same as of thrice a week hemodialysis in self-paying Indian patients
TK Jeloka, S Upase, S Chitikeshi
January-February 2012, 22(1):39-41
DOI:10.4103/0971-4065.83739  PMID:22279341
In India, majority of patients on dialysis are 'self paying' because of limited health insurance coverage available from government as well as private insurance providers. Hence, cost of treatment becomes one deciding factor to choose between the two modalities of dialysis - hemodialysis (HD) and peritoneal dialysis (PD). Aim is to compare the monthly cost of maintenance hemodialysis and peritoneal dialysis at our center. Majority of patients at our center are on thrice a week hemodialysis and three times a day peritoneal dialysis. These patients were asked to submit their total direct cost of treatment of last three months. It included cost of dialysis, erythropoietin, other medicines, monthly laboratory tests, hospitalization cost, travel cost, and any other directly involved in the treatment. Monthly cost (Indian Rupees, Rs.) was then calculated by averaging the three month cost for each patient. The monthly cost of hemodialysis and peritoneal dialysis was then compared using 'independent sample t-test'. Thirty five patients were finally included in the analysis (21 on HD and 14 on PD). Demographic profile between the two groups was similar in terms of age, sex ratio, period on dialysis, hemoglobin, blood urea nitrogen, and creatinine. Total monthly cost of dialysis was similar in both the groups (Rs. 29,252 ± 6859 vs. Rs. 28,763 ± 5486, P = 0.85). The lower cost of hemodialysis procedure per se as compared to peritoneal dialysis procedure cost (Rs. 14,669 ± 1376 vs. Rs. 19,528 ± 4072, P = 0.000) was compensated by higher cost of erythropoietin (Rs. 7160 ± 3353 vs. Rs. 3093 ± 1889, P = 0.002) and travel cost (Rs. 1654 ± 1085 vs. Rs. 76 ± 66, P < 0.0001) to equalize the monthly cost between the two groups. Our analysis showed no difference in the monthly cost of hemodialysis and peritoneal dialysis and hence, for self-paying patient in India, cost of treatment should not be a deciding factor while choosing between the two modalities.
  6,370 204 6
CASE REPORTS
Senior-Loken syndrome in a Saudi child
M Alfadhel, A Alamir
April-June 2007, 17(2):76-77
DOI:10.4103/0971-4065.37027  
We present an 11-year-old girl with Senior-Loken syndrome, a rare familial syndrome of retinopathy and nephronophthisis. The patient presented to us with renal insufficiency. There was a strong family history of renal and ocular involvement. This is the first report of this syndrome from the Arabian peninsula.
  6,018 204 -
IMAGES IN NEPHROLOGY
Acute pyelonephritis complicated with renal abscesses
Anupam Lal, Manphool Singhal
April-June 2007, 17(2):87-88
DOI:10.4103/0971-4065.37030  
  5,603 319 -
Indian Journal of Nephrology
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Online since 20th Sept '07