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2015| March-April | Volume 25 | Issue 2
Online since
March 9, 2015
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CASE REPORTS
Collapsing glomerulopathy following anabolic steroid use in a 16-year-old boy with IgA nephropathy
SM Matthai, G Basu, S Varughese, AB Pulimood, T Veerasamy, A Korula
March-April 2015, 25(2):99-102
DOI
:10.4103/0971-4065.140714
PMID
:25838648
Collapsing glomerulopathy (CG) is a proliferative podocytopathy, increasingly recognized in a variety of disease conditions. We report a case of CG in a 16-year-old boy with IgA nephropathy (IgAN) who presented with acute kidney injury, marked proteinuria and hypertension following a short period of anabolic steroid use. Although CG has been associated with long-term anabolic steroid use among body builders, there is no data on the effect of anabolic steroid use in persons with underlying renal disease like IgAN. We postulate that development of CG in our patient could be temporally linked to intake of body-building steroids along with a predisposing background renal disease of IgAN.
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4,407
160
1
ORIGINAL ARTICLES
Maternal, fetal and renal outcomes of pregnancy-associated acute kidney injury requiring dialysis
A Krishna, R Singh, N Prasad, A Gupta, D Bhadauria, A Kaul, RK Sharma, D Kapoor
March-April 2015, 25(2):77-81
DOI
:10.4103/0971-4065.136890
PMID
:25838643
Pregnancy-associated acute kidney injury (PAKI) is encountered frequently in developing countries. We evaluated the maternal, fetal and renal outcomes in women with PAKI who needed at least one session of dialysis. Of the total of 98 cases (mean age 28.85 ± 5.13 years; mean parity 2.65 ± 1.28) of PAKI, the most common cause of PAKI was postabortal sepsis. Eighteen patients died; those with oligoanuria, sepsis and central nervous system (CNS) involvement were at greater risk of mortality. The relative risk (RR) of neonatal mortality was lower after with full-term delivery (RR: 0.17, 95% confidence interval (CI): 0.03-0.96,
P
= 0.02) compared to preterm delivery. Of the 80 surviving patients, 60 (75%) patients achieved complete recovery of renal function at the end of 3 months; and of the remaining 14 had presumed (
n
= 4) or, biopsy-proven (
n
= 10) acute patchy cortical necrosis. The RR of non-recovery of renal function was high (RR: 24.7, 95% CI: 3.4- 179.5) in patients who did not recover at 6 weeks. Of the 14 patients with cortical necrosis, 3 (21.42%) became independent of dialysis at 6 months. PAKI patients should be watched for dialysis independency for 6 months.
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4,165
367
6
Prevalence and dynamics of cytomegalovirus infection among patients undergoing chronic hemodialysis
T Vilibic-Cavlek, B Kolaric, S Ljubin-Sternak, M Kos, B Kaic, G Mlinaric-Galinovic
March-April 2015, 25(2):95-98
DOI
:10.4103/0971-4065.139488
PMID
:25838647
Cytomegalovirus (CMV) is an important pathogen in immunocompromised individuals. The aim of this study was to analyze prevalence and dynamics of CMV infection among patients undergoing chronic hemodialysis. From 2010 to 2012, a total of 162 patients and 160 control subjects were tested for the presence of CMV IgM and IgG antibodies using enzyme-linked immunosorbent assay. IgM/IgG reactive samples were further evaluated for IgG avidity to confirm or rule out recent primary CMV infection. The overall IgG seropositivity was higher in hemodialysis patients compared to controls (90.7% vs. 81.9%; crude odds ratio [OR] =2.02, 95% confidence interval [CI] =1.05-3.89; OR adjusted for age and gender = 2.18, 95% CI = 1.05-4.55). CMV IgG antibody titers were similar in both groups. There was no difference in CMV prevalence between males (87.9%) and females (96.3%). According to age, a progressive increase in seropositivity was observed in both hemodialysis patients and the control group. Three hemodialysis patients (1.9%) developed recurrent CMV infection (positive IgM with high avidity IgG antibodies). In one patient (2.9%), seroconversion was documented during the second year of the follow-up period indicating primary infection. In contrast, in the control group, recent primary CMV infection (positive IgM with low/borderline IgG avidity) was demonstrated in three subjects (1.9%), whereas one (0.6%) developed recurrent infection. On multivariate logistic regression, hemodialysis and older age were significant predictors for CMV seropositivity.
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3
Single dose rasburicase in the management of tumor lysis syndrome in childhood acute lymphoblastic leukemia: A case series
SM Latha, D Krishnaprasadh, P Murugapriya, JX Scott
March-April 2015, 25(2):91-94
DOI
:10.4103/0971-4065.139092
PMID
:25838646
Tumor lysis syndrome (TLS) occurs in malignancies with high proliferative potential and tumor burden, such as lymphomas and leukemias. TLS syndrome is an oncologic emergency, requiring prompt intervention. The metabolic derangements cause acute kidney failure and may lead to cardiac arrhythmias, seizures, and death. With the advent of rasburicase, a recombinant urate oxidase, there has been a decline in the TLS-mediated renal failure and the need for dialysis. The recommended regimen and doses pose a heavy financial burden for patients in developing countries like India. With data and studies proving a similar efficacy for the reduced dose and lesser number of rasburicase, we report here a case series of seven children with acute leukemias, whose TLS was managed by a single dose of rasburicase. A retrospective analysis of case records of seven children with acute lymphoblastic leukemia and TLS, admitted to our Pediatric Oncology Unit of our Hospital between the period 2011 and 2013, was done. All our patients responded to a single dose, indicating that in appropriately monitored patients, single dose followed by as-needed dosing can be cost-saving.
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2
EDITORIAL
Chronic kidney disease in disadvantaged populations
G Garcia-Garcia, V Jha
March-April 2015, 25(2):65-69
DOI
:10.4103/0971-4065.150078
PMID
:25838641
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10
ORIGINAL ARTICLES
Focal segmental glomerulosclerosis in renal allografts: Is it possible to diagnose the etiology?
S Radha, T Afroz, Ch R Prasad, G Sridhar, KG Rajaram, S Reddy
March-April 2015, 25(2):82-85
DOI
:10.4103/0971-4065.137173
PMID
:25838644
Recurrence of FSGS in renal allo grafts is a major cause of graft loss. In this context, we tried to diagnose and classify FSGS in renal allografts. Indications for biopsy included graft dysfunction and/or proteinuria. Three hundred and sixty-three graft biopsies were studied over a period of 2 years. We classified FSGS into recurrent FSGS, new-onset primary FSGS and FSGS secondary to chronic humoral rejection, calcineurin inhibitor toxicity, and nephron loss and hyperfiltration injury. Twenty-four cases were diagnosed as FSGS, constituting 6.6%. Secondary FSGS was the most common FSGS in grafts in our study. Incidence of recurrent FSGS may not be accurate as pretransplant biopsy is available in very few cases.
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3,687
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1
Acute kidney injury in patients with human immunodeficiency virus infection
J Prakash, T Gupta, S Prakash, SS Rathore, Usha , S Sunder
March-April 2015, 25(2):86-90
DOI
:10.4103/0971-4065.138696
PMID
:25838645
Acute kidney injury (AKI) is an important cause of hospitalization and morbidity in human immunodeficiency virus (HIV)-positive patients. However, the data on AKI in such patients is limited. The aim of the present study was to analyze the incidence, causes and outcome of AKI in HIV-positive patients from our antiretroviral therapy centre. All HIV-positive patients were evaluated for evidence of clinical AKI. AKI was noted in 138/3540 (3.9%) patients. Of 138 AKI patients, 96 (69.6%) had acquired immuno deficiency syndrome and 42 (30.4%) were HIV seropositive. Majority of AKI patients belonged to AKI network (AKIN) Stage II (42%) or III (48.5%) at presentation. Prerenal, intrinsic and postrenal AKI were noted in 53.6%, 44.2% and 2.2% of cases, respectively. Hypovolemia (44.2%) and sepsis (14.5%) contributed to AKI in vast majority of cases. AKI was multifactorial (volume depletion, sepsis and drugs) in 39% of patients. Acute tubular necrosis (ATN) was the most common intrinsic lesion. Acute interstitial nephritis and diffuse endocapillary proliferative glomerulonephritis were noted in five and two cases, respectively. In-hospital mortality was 24.64%. Lower CD4 count, decreased serum albumin level and Stage 4 WHO disease were associated with higher mortality. At 3 months or more follow-up complete recovery of renal function, chronic kidney disease Stage 3-5 and progression to end stage renal disease were noted in 58.69%, 14.5% and 2.2% of cases, respectively. Thus, prerenal factors and ischemic ATN were the most common cause of AKI in HIV-infected patients. Recovery of renal function was seen in 59% of cases, but AKI had high in-hospital mortality.
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3,419
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3
CASE REPORTS
Severe peritonitis caused by
Citrobacter freundii
and successful treatment with double antibiotic coverage
A Kataria, E Saad
March-April 2015, 25(2):117-118
DOI
:10.4103/0971-4065.138702
PMID
:25838653
Serratia
,
Pseudomonas
/
Providencia
, indole-positive
Proteus
/
Acinetobacter
/
Morganella
,
Citrobacter
,
Enterobacter
and
Hafnia
group of organisms cause peritoneal dialysis (PD)-related peritonitis with high morbidity and mortality. Peritonitis caused by
Citrobacter freundii
is uncommon, and it may lead to catheter removal despite antimicrobial treatment. We describe a case of PD-related peritonitis caused by
C. freundii
, which was successfully treated with double antibiotic coverage.
[ABSTRACT]
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1
REVIEW ARTICLE
Hepatocyte nuclear factor-1
β
: A regulator of kidney development and cystogenesis
V Singh, SK Singla, V Jha, V Puri, S Puri
March-April 2015, 25(2):70-76
DOI
:10.4103/0971-4065.139492
PMID
:25838642
The understanding of the genomics of the renal tissue has gathered a considerable interest and is making rapid progress. The molecular mechanisms as well as the precise function of the associated molecular components toward renal pathophysiology have recently been realized. For the cystic kidney disease, the regulation of gene expression affecting epithelial cells proliferation, apoptosis as well as process of differentiation/de-differentiation represent key molecular targets. For the cystic disorders, molecular targets have been identified, which besides lending heterogeneity to cysts may also provide tools to unravel their functional importance to understand the renal tissue homeostasis. This review focuses on providing comprehensive information about the transcriptional regulatory role of hepatocyte nuclear factor-1β, a homeoprotein, as well as its interacting partners in renal tissue development and pathophysiology.
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3,318
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3
CASE REPORTS
Successful salvage of thrombosed arterio-venous fistula with thrombolytic therapy using tissue plasminogen activator
S Parameswaran, S Satheesh, S Morkhandikar, V Shankar, R Jayasurya, RK Padhi, PS Priyamvada, RP Swaminathan
March-April 2015, 25(2):110-112
DOI
:10.4103/0971-4065.136888
PMID
:25838651
A functioning vascular access is crucial to the wellbeing of patients on hemodialysis. Thrombosis is the most common complication of arteriovenous fistula (AVF) resulting in late fistula failure; Its treatment is difficult, and results are often suboptimal. Interventional treatment of AVF thrombosis may not be available all the time, and timely application of an available noninterventional treatment may salvage the fistula. We report the successful treatment of AVF thrombosis using local thrombolytic therapy using tissue plasminogen activator in a patient, for the first time in India.
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3,163
153
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Light chain proximal tubulopathy with cast nephropathy in a case of multiple myeloma
KK Gowda, K Joshi, R Nada, R Ramachandran, M Sachdeva
March-April 2015, 25(2):119-122
DOI
:10.4103/0971-4065.138700
PMID
:25838654
The renal diseases most frequently associated with myeloma include cast nephropathy (CN), amyloidosis and monoclonal immunoglobulin deposition disease. Light chain proximal tubulopathy (LCPT) is reported less frequently. Majority of the cases with κ-restriction present with Fanconi syndrome (FS) and show crystals in proximal tubular epithelial cytoplasm. In contrast, those with λ-restriction are infrequently associated with FS and show cytoplasmic vacuolations in proximal tubular epithelial cytoplasm. Combination of morphologies in kidney affected by plasma cell dyscrasias is rare and co-existence of LCPT and CN is one of the rarest. We report a case of multiple myeloma having this rare combination of morphologies.
[ABSTRACT]
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3,101
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4
Immunoglobulin G4-related tubulointerstitial nephritis associated with interstitial pulmonary disease: Report of a case with review of literature
M Saravanan, S Alexander, SM Matthai, A Korula, S Varughese, V Tamilarasi
March-April 2015, 25(2):113-116
DOI
:10.4103/0971-4065.136886
PMID
:25838652
Immunoglobulin G4-related disease (IgG4-RD) is an emerging clinicopathological entity. Renal involvement is dominated by tubulointerstitial nephritis (TIN) with IgG4-positive plasma cells and fibrosis. IgG4-RD commonly affects middle-aged to elderly men with accompanying extra-renal lesions such as sialadenitis, lymphadenopathy, or type 1 autoimmune pancreatitis, all of which respond favorably to corticosteroid therapy. The disease burden of IgG4-related kidney disease (IgG4-RKD) in India remains largely underestimated. We report a case of IgG4-RKD manifesting as TIN associated with interstitial pulmonary disease, illustrating typical clinico-pathologic, serologic, immuno-histochemical, and ultrastructural features of this condition. In view of potential amelioration of renal dysfunction with appropriate therapy, the need for awareness of this condition and early diagnosis is highlighted.
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3,073
131
1
Hypokalemic paralysis due to thyrotoxicosis accompanied by Gitelman's syndrome
S Baldane, SH Ipekci, S Celik, A Gundogdu, L Kebapcilar
March-April 2015, 25(2):103-105
DOI
:10.4103/0971-4065.140719
PMID
:25838649
A 35-year-old male patient was admitted with fatigue and muscle weakness. He had been on methimazole due to thyrotoxicosis for 2 weeks. Laboratory tests showed overt hyperthyroidism and hypokalemia. Potassium replacement was started with an initial diagnosis of thyrotoxic hypokalemic periodic paralysis. Later on, despite the euthyroid condition and potassium chloride treatment, hypokalemia persisted. Further investigations revealed hyperreninemic hyperaldosteronism. The patient was considered to have Gitelman's syndrome (GS) and all genetic analysis was done. A c. 1145C>T, p.Thr382Met homozygote missense mutation located on solute carrier family 12, member gene 3, exon 9 was detected and GS was confirmed.
[ABSTRACT]
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3,034
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4
Heavy and Light chain amyloidosois presenting as complete heart block: A rare presentation of a rare disease
PS Priyamvada, S Morkhandikar, BH Srinivas, S Parameswaran
March-April 2015, 25(2):106-109
DOI
:10.4103/0971-4065.135911
PMID
:25838650
Amyloidosis is an uncommon disease characterized by deposition of proteinaceous material in the extracellular matrix, which results from abnormal protein folding. Even though more than 25 precursor proteins are identified, majority of systemic amyloidosis results from deposition of abnormal immunoglobulin (Ig) light chains. In heavy chain amyloidosis (AH), deposits are derived from both heavy chain alone, whereas in heavy and light chain amyloidosis (AHL), the deposits are derived from Ig heavy chains and light chains. Both AH and AHL are extremely rare diseases. Here, we report an unusual presentation of IgG (lambda) AHL amyloidosis in the background of multiple myeloma, where the initial clinical presentation was complete heart block, which preceded the definitive diagnosis by 18 months.
[ABSTRACT]
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2,963
146
2
LETTERS TO EDITOR
Expanding the living renal donor pool by using a horseshoe kidney
S Kumar, DK Agarwal, S Guleria, P Pushkar
March-April 2015, 25(2):124-125
DOI
:10.4103/0971-4065.148306
PMID
:25838656
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2,335
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1
Neutrophil lymphocyte ratio in aute renal failure
E Erdem
March-April 2015, 25(2):126-127
DOI
:10.4103/0971-4065.145099
PMID
:25838658
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2,288
120
6
Membranous nephropathy associated with the use of levodopa-carbidopa combination
V Chaitanya, B Sangeetha, VN Madhav Rao, R Ram, B Vengamma, V Siva Kumar
March-April 2015, 25(2):127-128
DOI
:10.4103/0971-4065.145130
PMID
:25838659
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2,181
124
1
Obstructive uropathy: Is it always urolithiasis?
V Jain, B Sureka, K Bansal, A Arora
March-April 2015, 25(2):123-124
DOI
:10.4103/0971-4065.147372
PMID
:25838655
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2,127
144
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Tubercular constrictive pericarditis after renal transplantation
A Anitha, V Siddini, HS Ballal
March-April 2015, 25(2):125-126
DOI
:10.4103/0971-4065.145098
PMID
:25838657
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1,829
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© Indian Journal of Nephrology
Published by Wolters Kluwer -
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Online since 20
th
Sept '07