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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.
  30,934 3,598 29
REVIEW ARTICLE
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.
  25,879 2,601 37
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.
  20,176 1,622 1
PERSPECTIVE
The Economics of Dialysis in India
Umesh Khanna
January-March 2009, 19(1):1-4
DOI:10.4103/0971-4065.50671  PMID:20352002
  19,717 1,629 33
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.
  19,809 1,130 14
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.
  17,668 1,597 16
ORIGINAL ARTICLES
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.
  17,125 1,877 31
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.
  15,128 821 5
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.
  14,835 1,009 2
REVIEW ARTICLES
Basics of kidney biopsy: A nephrologist's perspective
SK Agarwal, S Sethi, AK Dinda
July-August 2013, 23(4):243-252
DOI:10.4103/0971-4065.114462  PMID:23960337
The introduction of the kidney biopsy is one of the major events in the history of nephrology. Primary indications of kidney biopsy are glomerular hematuria/proteinuria with or without renal dysfunction and unexplained renal failure. Kidney biopsy is usually performed in prone position but in certain situations, supine and lateral positions may be required. Biopsy needles have changed with times from Vim-Silverman needle to Tru-cut needle to spring-loaded automatic gun. The procedure has also changed from blind bedside kidney biopsy to ultrasound marking to real-time ultrasound guidance to rarely computerized tomography guidance and laparoscopic and open biopsy. In very specific situations, transjugular kidney biopsy may be required. Most of the centers do kidney biopsy on short 1-day admission, whereas some take it as an outdoor procedure. For critical interpretation of kidney biopsy, adequate sample and clinical information are mandatory. Tissue needs to be stained with multiple stains for delineation of various components of kidney tissue. Many consider that electron microscopy (EM) is a must for all kidney biopsies, but facilities for EM are limited even in big centers. Sophisticated tests such as immunohistochemistry and in-situ hybridization are useful adjuncts for definitive diagnosis in certain situations.
  14,352 1,332 15
ORIGINAL ARTICLES
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.
  14,066 340 17
REVIEW
Nocturnal enuresis in india: Are we diagnosing and managing correctly?
NM Reddy, H Malve, R Nerli, P Venkatesh, I Agarwal, V Rege
November-December 2017, 27(6):417-426
DOI:10.4103/ijn.IJN_288_16  PMID:29217876
Nocturnal enuresis is a common problem affecting school-aged children worldwide. Although it has significant impact on child's psychology, it is always under-recognized in India and considered as a condition which will outgrow with advancing age. Nocturnal enuresis classified as primary or secondary and monosymptomatic or nonmonosymptomatic. Factors that cause enuresis include genetic factors, bladder dysfunction, psychological factors, and inappropriate antidiuretic hormone secretion, leading to nocturnal polyuria. Diagnosis consists of detailed medical history, clinical examination, frequency-volume charts, and appropriate investigations. The frequency-volume chart or voiding diary helps in establishing diagnosis and tailoring therapy. The first step in treating nocturnal enuresis is to counsel the parents and the affected child about the condition and reassure them that it can be cured. One of the effective strategies to manage enuresis is alarm therapy, but currently, it is not easily available in India. Desmopressin has been used in the treatment of nocturnal enuresis for close to 50 years. It provides an effective and safe option for the management of nocturnal enuresis. This review covers the diagnosis and management of nocturnal enuresis and introduces the concept of “bedwetting clinics” in India, which should help clinicians in the thorough investigation of bedwetting cases.
  13,305 899 2
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.
  12,504 1,260 17
ORIGINAL ARTICLES
Clinico-microbiological profile of urinary tract infection in South India
M Eshwarappa, R Dosegowda, I Vrithmani Aprameya, MW Khan, P Shiva Kumar, P Kempegowda
January-March 2011, 21(1):30-36
DOI:10.4103/0971-4065.75226  PMID:21655167
The knowledge of etiology and antibiotic resistance pattern of the organisms causing urinary tract infection is essential. This study was taken up to determine the presentation and risk factors associated with community-acquired urinary tract infection (CA-UTI). The distribution of bacterial strains isolated from these patients and their resistance pattern were also studied. This multidisciplinary prospective observational study was conducted in M. S. Ramaiah Hospital, Bangalore, between January and December, 2008. Patients who had CA-UTI confirmed by positive urine culture reports were included in the study. Statistical analysis was done using the SPSS version 16. Symptomatology and others risk factors for CA-UTI were studied in these patients and the causative organisms and their resistance patterns were recorded. Of the total 510 patients included, 57% belonged to the elderly age group (50-79 years). Fever and dysuria were the most common clinical presentation, but were not specific in predicting CA-UTI. Escherichia coli (66.9%) was the most common organism causing CA-UTIs with extended spectrum beta lactamase (ESBL) resistance seen in nearly two-thirds of these cases (42.2%). The organisms recorded least resistance against carbapenems (3.9%). A high resistance rate was seen for fluoroquinolones (74.1%). In conclusion, a high rate of ESBL-positive organisms and their resistance to commonly used antibiotics brings a concern for future options in treating these conditions.
  12,543 1,013 29
Spectrum of lymphoproliferative disorders following renal transplantation in North India
V Sakhuja, R Ramachandran, HS Kohli, V Jha, KL Gupta, M Rathi, K Joshi, R Nada, A Sharma, M Minz
July-August 2013, 23(4):287-291
DOI:10.4103/0971-4065.114504  PMID:23960346
Post-transplant lymphoproliferative disorder (PTLD) is a well-recognized, but uncommon complication of organ transplantation. This study was a retrospective analysis of 2000 patients who underwent renal transplantation over a period of 30 years (1980-2010). Forty malignancies were diagnosed in 36 patients. Of these, 29 patients (1.45%) had PTLD (7 females, 22 males) accounting for 72.5% of all malignancies after transplantation. Twenty-two (75.8%) developed non-Hodgkin lymphoma and seven patients (24.2%) had myeloma. Diagnosis was made by biopsy of the involved organ in 21 patients (72.4%) and aspiration cytology in five patients (17.2%). In three patients, the diagnosis was made only at autopsy. Mean age at the time of diagnosis of PTLD was 41.9 years (range 21-69 years). Time interval from transplantation to the diagnosis of PTLD ranged from 3 months to 144 months with a median of 48 months. Only five patients (17.2%) developed PTLD within a year of transplantation. Twelve patients developed PTLD 1-5 years and 12 patients 5-10 years after transplantation. Organ involvement was extra nodal in 18 patients (82%). Thirteen (59%) patients had disseminated disease and nine (41%) had localized involvement of a single organ (brain-3, liver-1, allograft-1, perigraft node-1, retroperitoneal lymph nodes-3). Infiltration of the graft was noted in two patients. Patients with myeloma presented with backache, pathological fracture, unexplained anemia or graft dysfunction. PTLD was of B cell origin in 20 cases (70%). CD 20 staining was performed in 10 recent cases, of which 8 stained positive. Of the 26 patients diagnosed during life, 20 (69%) died within 1 year of diagnosis despite therapy. In conclusion, PTLD is encountered late after renal transplantation in the majority of our patients and is associated with a dismal outcome. The late onset in the majority of patients suggests that it is unlikely to be Epstein Barr virus related.
  13,209 174 1
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.
  12,933 383 -
ORIGINAL ARTICLES
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.
  12,683 590 14
REVIEWS
Acute kidney injury in pregnancy-specific disorders
J Prakash, VC Ganiger
July-August 2017, 27(4):258-270
DOI:10.4103/0971-4065.202406  PMID:28761227
The incidence of acute kidney injury in pregnancy (P-AKI) has declined significantly over the last three decades in developing countries. However, it is still associated with significant fetomaternal mortality and morbidity. The diagnosis of P-AKI is based on the serum creatinine increase. The usual formulas for estimating glomerular filtration rate (GFR) are not validated in this population. The incidence of P-AKI with respect to total AKI cases has decreased in the last three decades from 25% in 1980s to 9% in 2000s at our centre. During the first trimester of gestation, AKI develops most often due to septic abortion or hyperemesis gravidarum. Septic abortion related AKI with respect to total AKI decreased from 9% to 5% in our study. Prevention of unwanted pregnancy and avoidance of septic abortion are keys to eliminate abortion associated AKI in early pregnancy. However, we have not seen AKI on account of hyperemesis gravidarum over a period of 33 years at our center. In the third trimester, the differential diagnosis of AKI in association with pregnancy specific conditions namely preeclampsia/HELLP syndrome, acute fatty liver of pregnancy and thrombotic microangiopathies of pregnancy (P-TMA) is more challenging, because these 3 conditions share several clinical features of thrombotic microangiopathy which makes the diagnosis very difficult on clinical grounds. It is imperative to distinguish these conditions to make appropriate therapeutic decisions. Typically, AFLP and HELLP syndrome improve after delivery of the fetus, whereas plasma exchange is the first-line treatment for pregnancy associated thrombotic microangioathies (P-TMA). We observed that preclampsia/eclampsia is the most common cause of AKI in late third trimester and postpartum periods followed by puerperal sepsis and postpartum hemorrhage. Pregnancy-associated thrombotic microangiopathies (aHUS/TTP) and AFLP are rare causes of AKI during pregnancy in developing countries.
  11,656 1,497 18
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.
  12,178 736 18
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.
  12,292 551 5
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  
  12,232 434 -
CASE REPORTS
Eculizumab for atypical hemolytic-uremic syndrome in India: First report from India and the challenges faced
SK Sethi, S Rohatgi, MA Dragon-Durey, V Raghunathan, M Dhaliwal, A Rawat, P Jha, SB Bansal, R Raina, V Kher
January-February 2017, 27(1):58-61
DOI:10.4103/0971-4065.179369  PMID:28182046
Much progress has been made in understanding the pathophysiology and treatment of atypical hemolytic uremic syndrome (aHUS). Plasma therapy is the mainstay of treatment for aHUS. The availability of the first effective anti-complement therapeutic agent, eculizumab, has dramatically changed the outlook of this disease. However, its use in clinical practice raises important questions, such as who should receive the drug, when to start such therapy, and is it safe to stop treatment once the disease is controlled. We describe here for the 1st time in India, use of eculizumab in a 12-year-old boy with aHUS. We also describe in this report challenges faced in procuring the drug, and an ideal, evidence-based method of treating aHUS in children.
  11,759 224 1
LETTERS TO EDITOR
Cyst-like tumors in renal osteodystrophy
Gioacchino Li Cavoli, Francesca Finazzo, Rosalia Mongiovi', Barbara Oliva, Vitalba Azzolina, Tancredi Vincenzo Li Cavoli
November-December 2021, 31(6):595-596
DOI:10.4103/ijn.IJN_204_20  
  11,809 108 -
CASE REPORTS
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.
  11,410 464 7
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.
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Indian Journal of Nephrology
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Online since 20th Sept '07