Introduction: Acute kidney injury (AKI) can be a severe complication of the coronavirus 2019 (COVID-19) infection. Follow-up data of these AKI patients, including the rate of progression to chronic kidney disease (CKD), is limited. Methods: COVID-19 patients with AKI, admitted from June 1, 2020, to August 25, 2020, were enrolled prospectively. Their clinical profile, biochemical investigations, urine analysis, treatment, and outcome in terms of mortality or discharge were analyzed. The discharged patients were followed up 3 months later to determine their renal recovery status. Results: AKI was noted in 146 out of 4,613 COVID-19 patients with an incidence of 3.16%. The outcome was available for 111 patients. According to the KDIGO (Kidney Disease Improving Global Outcomes) AKI criteria, 20 (18%) patients were in Stage 1, 16 (14%) in Stage 2, and 75 (68%) in Stage 3 AKI. Proteinuria and hematuria were present in 66% and 41%, respectively. Renal replacement therapy (RRT) was required in 45 (40.5%) patients. A total of 53 (47.7%) patients turned RT-PCR negative and were discharged. The renal recovery at discharge was complete in 31 of 111 (28%), partial in 20 of 111 (18%), and none in two (2%) patients. At 3 months follow-up of discharged patients, total mortality rate was 55.85%. Twenty three of 53 (43%) recovered their renal functions to baseline and 26 of 53 (49%) had progressed to CKD. Diabetes mellitus, dyspnea, altered sensorium, severe acute respiratory distress syndrome, need for RRT, lymphopenia, high neutrophil–lymphocyte ratio, hyperglycemia, raised inflammatory markers, and hematuria were associated with high mortality rate and reached statistical significance. Conclusion: AKI in COVID-19 patients has a high mortality rate (55.85%) with a high CKD progression rate among survivors (49%).

Introduction: Catheter malfunction secondary to omental wrapping is a frequent complication of continuous ambulatory peritoneal dialysis (CAPD). Of the various methods of peritoneal dialysis catheter insertion (PDCI), open surgical insertion under local anesthesia is most widely practiced. Laparoscopic omentectomy is often undertaken as a salvage procedure in case of malfunctioning catheters. However, there is no randomized controlled trial (RCT) to evaluate the role of prophylactic laparoscopic omentectomy on catheter function. This pilot RCT was undertaken to evaluate the impact of laparoscopic omentectomy on the incidence of catheter malfunction. Materials and Methods: Consecutive patients were randomized into three groups: laparoscopic PDCI with omentectomy (Group A), laparoscopic PDCI without omentectomy (Group B) and open surgical PDCI (Group C). The primary outcome was the incidence of catheter malfunction at 6 weeks and 3 months. Results: Forty-one patients completed follow-up, with 16, 11, and 14 patients in Groups A, B, and C, respectively. Incidence of catheter malfunction was 6.2%, 27.3%, and 14.3% in Groups A, B, and C, respectively, at 6 weeks and 6.2%, 36.4%, and 21.4% at 3 months, respectively. In patients with previously failed catheter insertion (n = 23), malfunction at 3 months was 8.3% (1/12) in patients who had omentectomy, compared with 45.5% (5/11) in those who did not (P = 0.069). Operating time was significantly higher (P < 0.001) in Group A. Conclusions: Laparoscopic omentectomy may be associated with a lower incidence of catheter malfunction, especially in patients with previously failed peritoneal dialysis catheter. Data from this pilot RCT can be used to design a large trial with an adequate number of patients.

Introduction: Despite improvements in insertion techniques and catheter designs, catheter malfunction and infection pose a great source of morbidity and limitation to adequate dialysis. The two most used peritoneal dialysis (PD) catheters are the coiled and straight PD catheters. Existing studies show conflicting results. Methods: This study aims to look at the clinical outcomes and mortality between the two catheter types. This study was designed as an ambidirectional cohort study. A total of 126 patients undergoing PD, with 75 receiving the straight PD catheter and 51 receiving the coiled PD catheter, participated in the study. The primary outcome was catheter survival, and the secondary outcomes included PD failure, catheter-related infections, and all-cause mortality. Results: In the coiled catheter group, 30 (40%) patients had catheter malfunction, whereas the straight catheter group had 15 (29.4%) patients catheter malfunction. However, the survival functions represented by the Kaplan–Meier survival curve did not show any statistical significance (P = 0.659). In the coiled PD catheter group, 13 (17.3%) had PD failure, which was comparable with the straight PD catheter group of nine (17.6%) cases (P = 1.000). The catheter-related infections are similar in both groups. The mortality between two groups was also similar (P = 0.777). Conclusions: There is no difference in outcomes between the coiled and straight PD catheters.

Background: The data on long-term outcomes of posttransplant immunoglobulin A nephropathy (IgAN) are confounding and vary with geography and ethnicity worldwide. We aimed to study the long-term graft outcomes of patients with posttransplant IgAN in the northern Indian cohort. Methods: The long-term graft outcomes of 51 live donor renal transplant recipients with biopsy-proven posttransplant IgAN (recurrence/de novo) were analyzed. The risk factors for graft failure in the posttransplant IgA groups were analyzed using the Cox regression analysis. Results: Out of the total of 51 patients who had posttransplant IgAN, 40 patients had a biopsy-proven native kidney IgAN. The mean duration of the clinical presentation of posttransplant IgAN was 62.4 months (5.2 years) posttransplant. Proteinuria at the time of biopsy was 3.03 ± 2.2 g/day, and 41.2% had proteinuria of more than 3 g/day at the time of biopsy. The estimated 1, 5, 10, and 20 years patient survival was 98%, 95.4%, 75.9%, and 25.2%, respectively, and the estimated 1, 5, 10, and 20 years graft survival was 98%, 88.5%, 44.6%, and 11.9%, respectively, in patients who had posttransplant IgA. Many of the traditional risk factors associated with progression in native kidney IgAN, such as the degree of proteinuria, Oxford MEST (mesangial and endocapillary hypercellularity, segmental sclerosis, and interstitial fibrosis/tubular atrophy) scoring, recipient's age, and sex were not predictive of early graft failure among patients with posttransplant IgAN. In our cohort, the only significant graft failure predictor was serum creatinine at 5 years. Chronic antibody-mediated rejection (ABMR) was seen in 21.6% of patients with posttransplant IgAN. Whether this coexistence of chronic ABMR is an incidental finding or posttransplant IgAN predisposes to chronic ABMR requires further investigation. Conclusion: Posttransplant IgAN is associated with poor long-term graft outcomes in live donor renal transplants. Proteinuria and MEST scoring were not predictive of graft failure in living donor posttransplant IgAN.

Introduction: Steroid-resistant nephrotic syndrome (SRNS) is a rare condition that accounts for about 10% to 20% of all nephrotic syndromes in children. While calcineurin inhibitors induce remission in the majority, the data on long-term outcomes are limited. This retrospective study aimed to look at the clinical profile, biopsy findings, and long-term treatment outcomes in children with SRNS. Methods: The records of all children (1–18 years) with SRNS with biopsy findings of minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), or mesangioproliferative glomerulonephritis, who received treatment for a minimum period of 12 months and were in follow-up during the years 2007–2018 at a tertiary care teaching hospital were retrieved. The clinical, histopathological, and biochemical factors and treatment outcomes were recorded and analyzed. Results: Ninety-one (72 boys) children with a median (interquartile range [IQR]) age of onset of nephrotic syndrome as 48 (24–87) months were included. MCD and FSGS were the most common histopathological types (57.1% and 36.3%, respectively) and 62 (68.1%) patients had late steroid resistance. Calcineurin inhibitors (CNIs) were used in 86.8% of the children, and response rates with cyclosporine and tacrolimus for complete remission (CR) were 80% and 73.7%, respectively, with median (IQR) time to response being 3 (2–4) months. The presence of MCD on histology and the use of CNIs were significantly associated with CR (P < 0.01). At a median (IQR) follow-up of 5 (3–7) years, 76 (83.5%) children had either CR or partial remission, four (4.4%) developed chronic kidney disease and five (5.5%) died (three due to end-stage renal disease and two of infective complications). Conclusion: SRNS children with MCD on biopsy, late resistance, and response to CNIs have better long-term outcomes. Most patients respond to CNIs within the first 6 months of use and need therapy for at least 24 to 36 months.

Introduction: Patients with kidney disease and COVID-19, whether on hemodialysis (HD) or not, have a higher risk of contracting COVID-19 accompanied by a higher mortality rate due to suppressed immune functions. Diabetes, one of the ubiquitous etiology of kidney disease, is also associated with a composite of poor outcomes. Methods: Meta-analysis and meta-regression of 13 articles on COVID-19 patients with chronic kidney disease, with information on diabetes and mortality were performed using Review Manager 5.4 and OpenMetaAnalyst. Results: The meta-analysis of a pooled subject of 18,822 patients showed that the presence of diabetes in CKD patients with COVID-19 was associated with an increased risk of mortality (RR 1.41 (1.15, 1.72); P < 0.001; I2 70%, P < 0.001). Subgroup analysis showed that diabetes was not associated with mortality in the HD group (RR 1.27 (1.06, 1.54); P = 0.01; I2 0%, P = 0.70) but showed a significant association in the non-HD group (RR 1.66 (1.59, 1.73); P < 0.001; I2 85%, P < 0.001). Male gender (P = 0.070) contributed to the effect size differences (age: P < 0.001; hypertension: P = 0.007; CVD: P < 0.001; lung disease: P < 0.001). Conclusions: Diabetes was associated with higher mortality risk among CKD patients, primarily those who did not need RRT.

Introduction: Nutritional assessment in children undergoing chronic dialysis is challenging as no single objective reference tool is available. There is a need to explore the application of the subjective global nutritional assessment (SGNA) tool in these children. This study assessed the nutritional status of children on chronic dialysis using SGNA, evaluated the utility of SGNA parameters in the longitudinal assessment of nutrition, and compared the SGNA tool with other nutritional measures. Methods: Children 2-18 years of age on chronic dialysis for at least 1 month were prospectively studied over a period of 18 months with two follow-up visits at least 3 months apart. Malnutrition was diagnosed by SGNA (well-nourished, moderately, and severely malnourished), mid-arm circumference <5^th centile for age and gender, and serum albumin <3.8 g/l at baseline and follow-up. Results: In 41 children on dialysis (age: 124.8 ± 32 months), 73% had moderate or severe malnutrition by SGNA. Height for age (P = 0.008), weight for height (P = 0.004), dietary intake (P = 0.025) functional capacity (P = 0.001), loss of subcutaneous fat (P < 0.001), and muscle wasting (P < 0.001) were significantly associated with the presence and severity of malnutrition. SGNA showed a poor agreement with MUAC and serum albumin. On follow-up, there was no significant change in the category of nutritional status (P = 0.63) and no individual SGNA parameter was associated with the presence or severity of malnutrition. Conclusion: Two-thirds of the children on chronic dialysis were diagnosed with moderate to severe malnutrition by SGNA, while the majority remained in the same category of nutritional status on follow-up. Only half of the parameters used for assessment were strongly associated with the presence and severity of malnutrition. SGNA showed a poor agreement with objective nutritional measures and was not responsive in identifying a change in the nutritional status on follow-up.

Introduction: Renal manifestations associated with hematolymphoid malignancies are known. Primary or secondary involvement of the kidney by lymphomatous infiltration has various clinical presentations. Acute kidney injury is not an uncommon finding in relation to lymphomatous interstitial infiltration proven on kidney biopsy. However, diagnosing it solely on renal biopsy remains a challenge and needs expertise and aid of immunohistochemistry as the prognosis is dismal. Methods: This is a retrospective study of kidney biopsy-proven cases of renal lymphoma presenting with acute kidney injury. Results: The study included 12 patients with ages ranging from 4 to 50 years who presented with serum creatinine ranging 2.1–9.6 mg%. Renal biopsy findings showed interstitial lymphomatous infiltrate. Two cases were diagnosed as primary lymphoma and the other 10 as secondary lymphomas. Among the 12 cases, nine were B-cell non-Hodgkin lymphoma, of which diffuse large B-cell lymphoma was diagnosed in six (50%), low-grade B-cell type in two (16.6%), chronic lymphocytic leukemia in one (8.3%), and three were T-cell-type. Two were acute T-cell lymphoblastic lymphoma and one other was a high-grade T-cell lymphoma. Four patients succumbed. The other four patients are alive; one is on chemotherapy, while two of them are on hemodialysis. Conclusion: Acute kidney injury as a presenting feature with lymphomatous infiltration of renal parenchyma is not uncommon. The patchy involvement makes it challenging on kidney biopsy with definitive diagnosis being made with the help of immunohistochemistry. Appropriate multidisciplinary involvement improves patient outcome.

Introduction: There is a scarcity of information on the incidence and outcomes of acute kidney injury (AKI) in COVID-19 patients in India. Therefore, we analyzed the correlation of AKI risk factors, ventilatory support, and renal replacement therapy and compared the outcomes of first and second COVID-19 waves in this tertiary care center. Methods: We retrospectively analyzed the patients' medical records with a positive RT-PCR for COVID-19 between July 2020 and May 2021. We looked at the clinical outcomes of the first and second COVID-19 waves and documented the frequency, risk factors for AKI, and the relationship between AKI and in-hospital mortality. Univariate and multivariate binomial logistic regression yielded odds ratios for the risk variables of AKI. Risk differences and age-adjusted odds ratios, as well as 99.5% confidence intervals, were used to compare COVID-19 outcomes between the first and second waves. Results: Of the 1260 hospitalized patients with COVID-19, 86 (6.8%) presented with AKI and 8 (0.7%) patients required dialysis. The most common comorbidity was diabetes mellitus (55.2%), hypertension (42.1%), hypothyroidism (11.3%), and coronary artery disease (8.1%). A total of 229 (18.17%) patients were admitted to ICU, 574 (45.5%) received ventilation, and 26 (2.0%) required mechanical ventilation. The incidence of in-hospital death in the patients with AKI as per the stage from 1 to 3 was 9 (15.8%), 7 (35%), and 5 (55.6%), respectively. Compared to the first wave, the second wave cohort had a lower risk of AKI (adj OR: 0.426; CI: 0.232–0.782) and mortality (adj OR: 0.252; CI: 0.090–0.707). Conclusions: In our study, AKI prevalence was 6.8%, the need for ventilation was 45.5%, ECMO 0.2%, and the mortality rate 2.9%. Second wave of COVID-19 exhibits improved clinical outcomes compared to the first wave.

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological phenomenon commonly associated with kidney diseases, especially chronic kidney disease. A consequence of endothelial dysfunction, PRES is usually associated with uncontrolled blood pressures and can rarely have atypical radiological findings involving the brain stem and spinal cord, called posterior reversible encephalopathy with spinal cord involvement (PRES-SCI). These atypical features may be confused with other etiologies causing a delay in diagnosis and management. We describe a young male patient who presented with neurological symptoms suggestive of PRES; however, the atypical radiological findings along with concomitant rapidly progressive glomerulonephritis led to a diagnostic dilemma. Repeat neuro-imaging after appropriate blood pressure control showed disappearance of the lesions confirming the diagnosis of PRES-SCI, and kidney biopsy showed advanced IgA nephropathy. Knowledge of atypical features of PRES is crucial amongst nephrologists as it is a common association with kidney disease and prompt identification and management avoid irreversible sequelae and unnecessary investigations.

Phaeohyphomycosis is a rare fungal infection in renal transplant recipients. We describe here five cases of phaeohyphomycosis in renal transplant recipients, two with deep-seated unusual sites of infection. All patients received antifungals, and surgical excision was done where feasible. Outcomes included complete resolution of infection in three, partial resolution in one, and mortality in one case.

We hereby present a case of an atypical hemolytic uremic syndrome (aHUS) precipitated by coronavirus disease 2019 (COVID-19). A 26-year-old male was diagnosed with COVID-19 and acute kidney injury. His kidney biopsy was suggestive of thrombotic microangiopathy. Five sessions of plasmapheresis were done but were discontinued in view of nonrecovery of kidney function. He was then referred for a kidney transplant. On genetic analysis, he was found to have mutations in the complement system (CFHR1 and CFHR3), which suggested this was a case of aHUS precipitated by COVID-19. In view of the high risk of recurrence of the primary disease in live-related kidney donor transplantation, he was advised for simultaneous liver and kidney transplants.

Introduction: Tunneled femoral vein hemodialysis catheters are used when all other options for permanent vascular access or jugular central vein catheter are exhausted. There is little published literature on the outcome and survival of tunneled femoral vein catheters. Methods: Using a retrospective database, we identified all tunneled femoral dialysis catheters placed in the Nephrology department of our institute over a one-and-half year period. The outcomes, complications, and patency of these procedures was retrospectively evaluated. Results: Out of total 21 patients, 14 were female and 7 males with a mean age of 45 (range 17–73 years) and about one-fourth had diabetes mellitus (26%). Right-sided femoral catheter insertion was performed in 18 patients (85.7%) and 3 patients underwent left-sided insertion. Technical success of placement was 100% with no immediate complications. Median follow up period was 24 days. Primary catheter patency at 30, 60, 90, and 180 days were 81, 29, 18, and 12.5%, respectively. Three patients (15.7%) developed catheter-related deep venous thrombosis. Three catheters (14.2%) were removed for catheter-related infection and seven (33.3%) were removed because of absent blood flow. Conclusion: Our experience with tunneled femoral catheters revealed low catheter survival and significant complications (deep venous thrombosis and malfunction/occlusion).

With recent advances in the treatment of human immunodeficiency virus (HIV), renal transplantation is no longer considered a contraindication in properly selected HIV-positive patients. Several studies have demonstrated comparable patient and graft outcomes between HIV-negative and HIV-positive renal transplant recipients. Most of the information on outcomes of HIV-positive to HIV-positive transplantation is based on data from deceased donors. There are only a handful of case reports about living donor renal transplantation in an HIV-positive patient from an HIV-positive donor. Furthermore, there is no report in the world of preemptive living donor renal transplantation in this setting. Here, we report a case of successful preemptive renal transplantation in an HIV-positive recipient from an HIV-positive living donor performed at our center.

With the ongoing mass COVID vaccination program, various case reports link the COVID-19 vaccines with heightened off-target immune responses leading to de novo development or relapse of various glomerular diseases. Very few glomerular diseases (totally nine published cases to date) have been reported post ChAdOx1 nCoV-19 (Oxford–AstraZeneca) vaccination compared to more potent m RNA vaccine. In this case report, we present a case of de novo focal segmental glomerulosclerosis (FSGS) post ChAdOx1 nCoV-19 vaccination resistant to steroid and calcineurin inhibitor treatment. To our knowledge, this is the first case of FSGS tip variant reported after the ChAdOx1 nCoV-19 vaccination and the second de novo FSGS case post COVID vaccination (any types of COVID vaccines). We may expect more such types of cases resistant to conventional therapy as the global penetration of vaccination programs will improve.

Ochoa or urofacial syndrome is a rare autosomal recessive syndrome with around 150 cases reported in the medical literature comprising of neurogenic bladder and facial abnormalities, culminating in obstructive uropathy and chronic kidney disease. We report a 5-year-old boy presenting to us with Stage IV chronic kidney disease with bilateral hydroureteronephrosis secondary to chronic urinary incontinence. His peculiar facial expression with a grimace while smiling suggested the diagnosis of Ochoa syndrome. He was managed conservatively for neurogenic bladder and is under follow-up. We wish to highlight this unique syndrome and the simplicity in making this syndromic diagnosis, just by appreciating abnormal facial expressions.