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2019| November-December | Volume 29 | Issue 6
Online since
November 14, 2019
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CASE REPORTS
Gastrointestinal Involvement in Granulomatosis with Polyangiitis: Case Report and Review
Sahil Bagai, Aman Sharma, Rajesh Gupta, Vivek Kumar, Manish Rathi, Harbir S Kohli, Krishan L Gupta, Raja Ramachandran
November-December 2019, 29(6):415-418
DOI
:10.4103/ijn.IJN_141_18
PMID
:31798224
Granulomatosis with polyangiitis (GPA) commonly affects upper/lower respiratory tract and kidneys. It causes necrotizing vasculitis of small and medium-sized blood vessels. Gastrointestinal (GI) involvement is an uncommon manifestation of GPA, and presentation with predominant GI manifestation is noteworthy. We report a case of 50-year-old male with melena due to GI vasculitis along with other systemic involvement. The patient was treated with pulse methylprednisolone, cyclophosphamide, and plasmapheresis. To manage the refractory GI bleed, the patient underwent surgical resection, and the histology of the surgical specimen confirmed necrotizing vasculitis.
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ORIGINAL ARTICLES
Outcomes of primary arteriovenous fistula for hemodialysis in elderly patients (>65 Years) with end stage renal disease: A study on Indian population
P Gaur, A Srivastava, SK Sureka, R Kapoor, MS Ansari, UP Singh
November-December 2019, 29(6):387-392
DOI
:10.4103/ijn.IJN_65_18
PMID
:31798219
Introduction:
The outcome of arteriovenous fistula (AVF) for hemodialysis (HD) in elderly population remains an issue. The aim of our study was to evaluate the outcomes of arteriovenous fistulas created at our institute in patients older than 65 years.
Methods:
All chronic HD patients with age >65 years who had an AVF created between January 1, 2010 and January 1, 2017 were included retrospectively. Baseline demographic information including age, gender, etiology of renal failure and comorbidities were recorded. Access characteristics including access type and anatomic location were recorded. The end point of study was primary and secondary patency. Minimum follow up period of study was 1 year.
Results:
A total of 422 AVF were created within the study period. The mean age was 69.3 years. The anatomical site of AVF creation was radiocephalic (RCF) in 74.8% (
n
= 316), brachiocephalic (BCF) in 18.9% (
n
= 80) and brachiobasilic (BBF) in 6.1% (
n
= 26). At one year after creation, cumulative survival of the AVF was 64.7%. At 36 months the primary and secondary patency of RCF, BCF and BBF was 43.6%, 58.6%, 42.6% and 47.3%, 62.5%, 56.9% respectively. The overall median survival did not differ between RCF and BBF fistulas. However, when both were compared with BCF (median survival 1034 days), BBF (median survival 741 days) and RCF (median survival 592 days) had significantly poorer survival (
P
= 0.004). The most common reason for access failure was thrombosis (28.4%) followed by failure to mature (9%) and aneurysm related complications (9%).
Conclusions:
Age should not be a limiting factor when choosing AVF as the preferred HD access. Brachiocephalic AVF has better primary and secondary patency with higher overall median survival. However RCF also provides reasonably good survival rates with acceptable complications in elderly population. Thrombosis and fistulas that fail to mature present as a primary concern to patients in elderly population, and demand further study.
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CASE REPORTS
A rare case of acute kidney injury due to levofloxacin-induced crystal nephropathy
Faizan Ahmed Ansari, Sonu Manuel, Rohan Dwivedi, Shashikiran Kabbare Boraiah, Sree Bhushan Raju, Megha Uppin, Alok Sharma
November-December 2019, 29(6):424-426
DOI
:10.4103/ijn.IJN_295_18
PMID
:31798226
Crystal-induced acute kidney injury (AKI) is caused by the intratubular precipitation of crystals, which results in obstruction and kidney injury. Levofloxacin is commonly used fluoroquinolone antibiotic especially for respiratory and urinary tract infections. It rarely causes any serious adverse events. Several cases of crystal nephropathy after ciprofloxacin use have been reported. Pre-existing renal dysfunction, high dose of the drug, and advanced age are considered as risk factors. To best of our knowledge, only two cases of crystal nephropathy due to levofloxacin use have been reported, we add a new one to it. The patient responded to conservative treatment with complete recovery on follow-up.
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ORIGINAL ARTICLES
Heavy metals and pesticides in chronic kidney disease – Results from a matched case–control study from a rural population in Shivamogga district in South India
YJ Anupama, SK Kiran, Shrikanth N Hegde
November-December 2019, 29(6):402-409
DOI
:10.4103/ijn.IJN_325_18
PMID
:31798222
Introduction:
There is a high prevalence of chronic kidney disease (CKD) in the rural agrarian population of South India and it often appears unrelated to major known causes such as diabetes or glomerulonephritis.
Methods:
In a matched case–control study conducted in a rural population in Shivamogga district in South India, the association of heavy metals – lead (Pb), arsenic (As), cadmium (Cd) – and pesticides in CKD was studied. Blood and spot urine samples were tested quantitatively for heavy metals and qualitatively for pesticides.
Results:
In all, 69 matched pairs (40 female, 58%) were recruited. The mean estimated glomerular filtration rate (mL/min/1.73 m2) was 60.1 (14.2) in cases and 83.4 (13.4) in controls. Elevated blood lead level >5 μg/dL was seen in 15 cases and 25 controls, respectively [
P
= 0.035, matched odds ratio (MOR) 0.5, 95% confidence interval (CI) 0.22–1.05]. Urinary Pb was elevated in 16 cases and 13 controls, respectively (
P
= 0.28, MOR 1.25, 95% CI 0.58–2.73). There was no significant association with As and Cd, while pesticide residues were undetectable in cases as well as controls. These results did not change even after excluding CKD cases with diabetes, stage 2 hypertension, and significant proteinuria.
Conclusions:
There was no statistical significant association between any of the studied heavy metals and CKD, although there was a significant burden of heavy metals in the studied subjects.
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Hand grip strength in patients on maintenance hemodialysis: An observational cohort study from India
Neeraj Birajdar, Urmila Anandh, Sunita Premlatha, G Rajeshwari
November-December 2019, 29(6):393-397
DOI
:10.4103/ijn.IJN_251_18
PMID
:31798220
Introduction:
Malnutrition is a common manifestation in patients with dialysis and is a major cause of mortality in these patients. Various biochemical parameters are used to detect and monitor malnutrition in these patients. Confounding variables present in hemodialysis have an effect on the sensitivity and specificity of these tests.
Methods:
We studied hand grip strength (HGS) as a monitoring tool for protein malnutrition in these patients.
Results:
In a prospective observational study over 18 months, 83 patients (60 males) consented to be part of the study. The biochemical parameters showed the mean (±sd) of haemoglobin and albumin as 10.(±1.9) gm/dl and 3.5 (±0.5) gm/dl respectively. Majority of the patients (54/83) were well nourished according to subjective global assessment (SGA). The hand grip score in the cohort was weak in the majority of patients. It is interesting to note that majority of the males have weak HGS as compared with the general population of the same age group. The female patients had HGS which were in the normal range of values that of the population. A multiple regression analysis showed that there was a significant association with serum creatinine and HGS.
Conclusions:
No correlation between albumin and HGS was noted. Of the anthropometric variables a significant correlation was noted between mid arm muscle circumference and HGS.
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Direct correlation between age at diagnosis and severity of nephropathy in fabry disease patients
Sebastián P. A. Jaurretche, Norberto Antongiovanni, Fernando Perretta
November-December 2019, 29(6):398-401
DOI
:10.4103/ijn.IJN_167_18
PMID
:31798221
Introduction:
Nephropathy is one of the major complications of Fabry disease and mainly includes reduced glomerular filtration rate and proteinuria. Affected patients show different degrees of annual loss of renal function according to the magnitude of proteinuria and decrease in estimated glomerular filtration rate (eGFR) at the baseline.
Objetive:
To analyze the relationship between age at diagnosis and severity of nephropathy in a Fabry disease population.
Methods:
Cross-sectional design with retrospective data collection.
Results:
Seventy-two patients were studied with mean age of 26.26 ± 16.48 years and 30 men (41.6%). Twenty-seven paediatric patients and 45 adults were included. Thirteen genotypes were found: E398X, L415P, c886A>G, L106R, c.680G>A, A292T, c. 448.delG, R363H, C382Y, R301Q, D109G, del 3 and 4 exons, W81X, all pathogenic mutations of
GLA
gene. The mean eGFR in paediatric population was 115.81 ± 20.87 ml/min/1.73 m
2
and in adults was 80.63 ± 42.22 ml/min/1.73 m
2
. The Pearson's bilateral correlation coefficient test (value = −0.462) between the age at diagnosis and eGFR indicates inverse correlation between both variables with a strong statistical significance (
P
= < 0.01). Spearman's bilateral correlation coefficient (value = +0.385) between the variables at diagnosis and the degree of proteinuria indicates direct correlation between both variables with a strong statistical significance (
P
= <0.01).
Conclusions:
Diagnosis of Fabry disease patients at a younger age could be a key to improve the nephropathy prognosis and allow early and effective interventions.
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Low concentration trisodium citrate as a non-inferior locking agent for non-tunneled dialysis catheters in the Asian Setting
Varadharajan Jayaprakash, Dhakshinamoorthy Jagadeswaran, Krishnamoorthy Ezhilmathi, Arumugam Sathiapriya, Makkena Vamsikrishna, Elayaperumal Indhumathi, Matcha Jayakumar
November-December 2019, 29(6):410-414
DOI
:10.4103/ijn.IJN_360_18
PMID
:31798223
Introduction:
Unfractionated heparin is the commonly used catheter lock solution in patients with temporary dialysis catheters as hemodialysis access. The effectiveness of trisodium citrate as an alternate catheter lock agent has not been studied in Asian population.
Methods:
In this prospective quasi-experimental study, which included 180 patients with central venous dialysis catheter, patients were randomly allotted to citrate 4.67% and heparin 5000 units/ml arms in the ratio of 2:1. Baseline demographic and dialysis related data, incidence of catheter-related bloodstream infections, and mean catheter days in both the study cohorts were collected and compared. Formal cost analysis for citrate 4.67% use as catheter lock was done.
Results:
The mean age of the total study population was 50.49 ± 14.87 years. Sixty-six females (36.7%) and 80 (44.4%) diabetic patients were included in the study. The overall incidence of catheter-related bloodstream infection (CRBSI) was 11.11%. The majority had nontunneled dialysis catheters (95%;
n
= 114). On analyzing the data of patients with nontunneled catheters, it was found that the total number of catheter days for the citrate and heparin groups were 4,795 and 2,419 days, respectively. The number of CRBSI episodes per 1,000 catheter days for the citrate and heparin groups were 2.711 and 2.89, respectively. Citrate catheter lock cost only 6% of that of heparin lock.
Conclusions:
The incidence of catheter related bloodstream infections was comparable between the heparin and citrate 4.67% lock cohorts. The use of low concentration citrate as catheter lock was cost-effective when compared with heparin.
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CASE REPORTS
Takotsubo Syndrome during Haemodialysis
Nikolaos Tsigaridas, Stavros Mantzoukis, Marina Gerasimou, Konstantinos Bakas, Emilios Andrikos, Elisavet Kokkolou, Aphrodite Tsinta, Dimitrios Patsouras
November-December 2019, 29(6):419-423
DOI
:10.4103/ijn.IJN_267_18
PMID
:31798225
Takotsubo syndrome (TS) is typically characterized by transient (reversible) systolic dysfunction of the apical and mid segments of the left ventricle (LV), usually without obstruction of coronary arteries, in postmenopausal women after a stressful event. Usually, patients may experience symptoms such as chest pain, shortness of breath, palpitations, and rarely syncope or cardiogenic shock. There are many theories about pathophysiology of TS. Among these, most acceptable is the catecholamine theory. The prognosis is usually good with recovery of symptoms and imaging findings at most within a few weeks. However, complications may occur. We present the 11
th
published case of a patient on hemodialysis, who presented with TS and discuss why this situation may occur in patients on hemodialysis. Contrary to our patient, half of previously published cases presented with atypical symptoms. Therefore, it is important to be alert in order to timely diagnose, support the patient, and treat if any complications appear.
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Atheroembolic renal disease: A case series
KS Jansi Prema, Anila A Kurien
November-December 2019, 29(6):427-430
DOI
:10.4103/ijn.IJN_265_18
PMID
:31798227
Atheroembolic renal disease (AERD), a part of systemic cholesterol embolization syndrome, is caused by the occlusion of small arteries in the kidneys by cholesterol crystal emboli from ulcerated atherosclerotic plaques. Kidney is commonly involved because of its proximity to the abdominal aorta and its enormous blood supply. AERD is an under diagnosed condition. We report eight cases of AERD, highlighting the variability in its clinical presentation and the importance of a renal biopsy to arrive at a definitive diagnosis.
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COMMENTARY
Isothermic dialysis-a new panacea for intradialytic hypertension?
Anirban Ganguli
November-December 2019, 29(6):381-382
DOI
:10.4103/ijn.IJN_262_18
PMID
:31798216
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Multiorgan involvement with severe gastrointestinal system manifestations in a patient with granulomatosis with polyangiitis
Ashish Kataria, Sandeep Magoon
November-December 2019, 29(6):383-384
DOI
:10.4103/ijn.IJN_31_19
PMID
:31798217
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Takotsubo Syndrome in the Dialysis Patient - Challenging Diagnosis in a Unique Population
Charlotte Perrett, Debasish Banerjee
November-December 2019, 29(6):385-386
DOI
:10.4103/ijn.IJN_335_18
PMID
:31798218
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LETTERS TO EDITOR
His heart broke posttransplant: A rare disease with good outcome
Bhanu Mishra, Sunil Prakash, Subhash Chandra, Sanjeev Gera, Ashwini Goel, Amit K Yadav, Ganesh Dhanuka, Satendra Yadav
November-December 2019, 29(6):431-432
DOI
:10.4103/ijn.IJN_354_18
PMID
:31798228
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2,955
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De-Novo focal crescentic IgA nephropathy in a renal allograft recipient
Ashok Ramasamy, Dharshan Rangaswamy, Mahesha Vankalakunti, Ravindra Prabhu Attur, Shankar Prasad Nagaraju, Indu Rao
November-December 2019, 29(6):432-434
DOI
:10.4103/ijn.IJN_283_18
PMID
:31798229
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Asymptomatic nontyphoidal
Salmonella
bacteriuria in a patient with SLE nephritis: An ominous threat or innocent bystander?
Sutapa Rath, Shennaz Firdaus, Monalisa Mohanty, Rajeev Kumar Seth, Amit Kumar Satapathy, Bijayini Behera
November-December 2019, 29(6):434-435
DOI
:10.4103/ijn.IJN_21_19
PMID
:31798230
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2,062
107
A very rare unexpected fatal complication of nephrotic syndrome
Praveen Kumar Etta, Sujeeth Reddy, Mulpuru Venkateswar Rao, Madhavi Thatipamula
November-December 2019, 29(6):435-437
DOI
:10.4103/ijn.IJN_45_19
PMID
:31798231
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OBITUARY
Professor Dr. HL Trivedi pioneering nephrologist and patriot who cared for his country (31-08-1932 TO 2-10-2019)
Vivek Kute, Himanshu Patel, Pankaj Shah, Pranjal Modi, Vineet Mishra
November-December 2019, 29(6):379-380
DOI
:10.4103/ijn.IJN_348_19
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3,020
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© Indian Journal of Nephrology
Published by Wolters Kluwer -
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Online since 20
th
Sept '07