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   2009| April-June  | Volume 19 | Issue 2  
    Online since July 10, 2009

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Microalbuminuria in diabetes mellitus: Association with age, sex, weight, and creatinine clearance
NK Chowta, P Pant, MN Chowta
April-June 2009, 19(2):53-56
DOI:10.4103/0971-4065.53322  PMID:20368924
Studies in the Western literature show a linear relationship between degree of microalbuminuria and body mass index (BMI), blood pressure, and duration of diabetes. This study was aimed to determine the correlation of microalbuminuria with age, sex, duration of diabetes, BMI, and creatinine clearance in type-2 diabetics in Indian population. One hundred patients (59 males and 41 females) with type-2 diabetes mellitus of duration six months or more and negative for albumin in urine by albustic method were included in the study. Detailed clinical history was taken followed by a thorough physical examination that included neurological examination in the selected patients. Micral test was used for estimation of microalbuminuria. Overall prevalence of microalbuminuria in the present study was 37%. Among the patients with microalbuminuria, 20 were males and 17 were females. Pearson correlation of microalbuminuria with age showed statistically significant linear relationship. Gender-wise correlation analysis of microalbuminuria failed to show any statistical significance. Correlation of microalbuminuria with BMI was also not significant ( r = 0.063, P > 0.05). Creatinine clearance negatively correlated with microalbuminuria, but this was statistically insignificant. There was a statistically significant correlation of microalbuminuria with duration of diabetes. Prevalence of microalbuminuria is around 37% in type-2 diabetes mellitus. Incidence of microalbuminuria increases with age as well as with increased duration of diabetes mellitus. There is no effect of BMI and sex on the prevalence of microalbuminuria.
  9,069 920 6
Ponticelli regimen in idiopathic nephrotic syndrome
U Das, KV Dakshinamurty, N Prasad
April-June 2009, 19(2):48-52
DOI:10.4103/0971-4065.53321  PMID:20368923
Various studies have demonstrated that treatment with methyl prednisolone and chlorambucil could increase the chance of remission of idiopathic nephrotic syndrome (INS) of varied histology in patients who do not respond to the conventional treatment. This study was done to assess the safety and efficacy of methyl prednisolone and chlorambucil regimen in patients with various types of glomerulonephritides which were resistant to the usual conventional immunosuppressive drugs. Thirty nine patients were treated between June 1998 and December 2003 with Ponticelli regimen for six months. Twenty three patients (58.98%) were men and 16 (41.02%) were women. Mean age at the onset of NS was 23.59 1.28 (range 10-51) years. Four patients (10.2%) had minimal change disease (MCD), six patients (15.4%) had membranoproliferative glomerulonephritis (MPGN), two (5.1%) had IgA nephropathy, and 18 patients (46.1%) had focal segmental glomerulosclerosis (FSGS). Eleven patients were excluded from the final analysis. Of the remaining 28 patients, mean baseline proteinuria was 3.31 3.09 g/day. Mean baseline plasma albumin was 2.84 1.002 g/dl and mean baseline serum creatinine was 0.87 0.42 mg/dl. At the end of six months of treatment, mean proteinuria was 1.02 0.85 g/day. Mean plasma albumin was 3.69 0.78 g/day, and mean serum creatinine was 0.85 0.26 mg/dl. Mean followup was 13.21 7.7 times in 18.92 12.58 months. At the end of six months of treatment, seven patients (25%) achieved complete remission (CR), 10 patients (35.71%) partial remission (PR), and 11 patients (39.3%) did not show any response to the therapy. Most of the patients in responder group had FSGS (64.70%), whereas in nonresponder group patients had MPGN and mesangioproliferative glomerulonephritis (MesPGN). Out of 13 FSGS cases five (38.46%) achieved CR, six (46.15%) PR, and only two (15.38%) failed to respond. The incidence of side effects was 39.3%. Responders had more side effects than nonresponders (47 vs 27.3%). Methyl prednisolone and chlorambucil therapy (Ponticelli regimen) is safe and efficacious in achieving remission in significant number of INS patients other than membranous nephropathy, without any serious side effect on short term followup. However, a longer followup is required to demonstrate the sustained efficacy and long-term side effect of this regimen.
  7,083 907 1
Delayed onset interstitial nephritis following multiple wasp stings
JB Ghosh, M Roy, AK Bala
April-June 2009, 19(2):71-73
DOI:10.4103/0971-4065.53326  PMID:20368928
A wasp sting rarely causes delayed / late onset hypersensitivity reaction. Although unknown, the mechanism of such a delayed hypersensitivity reaction is thought to be an immunologically mediated, type III hypersensitivity reaction with the deposition of immune complexes and activation of the complement system. We present here the case of a seven year-old girl with acute interstitial nephritis following multiple wasp stings. To the best of our knowledge, this is the first such report of delayed presentation in a child from India.
  5,619 342 3
Prevalence and associations of hepatitis C viremia in hemodialysis patients at a tertiary care hospital
S Jasuja, AK Gupta, R Choudhry, V Kher, DK Aggarwal, A Mishra, M Agarwal, A Sarin, MK Mishra, V Raina
April-June 2009, 19(2):62-67
DOI:10.4103/0971-4065.53324  PMID:20368926
Hepatitis C virus (HCV) infection in hemodialysis (HD) is a significant problem. We evaluated the prevalence and associations of HCV viremia in our HD patients. All patients undergoing maintenance HD at our center were tested for HCV RNA by PCR after written informed consent. Detailed history regarding age, sex, and duration of dialysis, frequency of dialysis, blood transfusions in one year, number of dialysis centers, dialyzer reuse/fresh use, and recent laboratory data was recorded. A total of 119 patients (77 males and 42 females) were tested for HCV RNA. Thirty three (27.7%) tested positive. Duration of dialysis was significantly longer in HCV RNA positive group ( P = 0.001). 45.2% of patients with duration of dialysis more than 16 months were HCV RNA positive while only 7.4% of patients with dialysis duration ≤16 months were HCV RNA positive ( P < 0.001). In univariate analysis, in HCV RNA group patients, ALT, AST, and GGTP were significantly elevated and albumin was significantly lower. 39% of patients who had dialysis at more than one center were HCV RNA positive as compared to 20% for patients undergoing dialysis at single center ( P = 0.024). Binary logistic regression analysis showed albumin, duration of dialysis, and serum ALT to be significant variables. Sensitivity and specificity of anti-HCV ELISA was 72.7 and 97.7%, respectively. Prevalence of HCV RNA in the HD population is 27.7%. Duration of dialysis, getting dialysis at more than one center, elevated transaminase levels, and low serum albumin are important associations for HCV RNA positivity.
  5,103 575 12
Questionnaire survey of physicians: Design and practical use in nephrology
Varun Agrawal, PS Garimella, SJ Roshan, AK Ghosh
April-June 2009, 19(2):41-47
DOI:10.4103/0971-4065.53320  PMID:20368922
As medicine grows in complexity, it is imperative for physicians to update their knowledge base and practice to reflect current standards of care. Postgraduate training offers a golden opportunity for resident physicians to create a strong foundation of concepts in medicine. There is a need for assessing the knowledge of residents regarding established clinical practice guidelines and their perceptions regarding patient care and management. In this paper, we review how questionnaire surveys can be designed and applied to identify significant gaps in resident knowledge and inappropriate attitudes and beliefs. This evaluation has important implications for program directors who can then initiate measures to improve resident education. Such efforts during residency training have the potential of improving patient outcomes. We discuss the design of the questionnaire, its pre-testing and validity measures, online distribution, efficient response collection, data analysis, and possible future research. Finally, we illustrate this method of educational research with a questionnaire survey designed to measure the awareness of chronic kidney disease among internal medicine residents.
  4,805 804 4
Randomized controlled trial of clopidogrel to prevent primary arteriovenous fistula failure in hemodialysis patients
A Ghorbani, M Aalamshah, H Shahbazian, A Ehsanpour, A Aref
April-June 2009, 19(2):57-61
DOI:10.4103/0971-4065.53323  PMID:20368925
The optimal vascular access for chronic maintenance hemodialysis is the arteriovenous fistula (AVF). Several studies suggest a role for antiplatelet agents in the prevention of primary AVF failure. A double-blind, randomized trial was conducted to assess the efficacy and safety of clopidogrel in hemodialysis patients. Ninety three patients were randomized to receive 75 mg/daily of clopidogrel or placebo. The treatment was initiated 7-10 days prior to scheduled access surgery and continued up to six weeks postoperatively, and then patients were monitored for six months. The primary outcome was AVF failure eight weeks after fistula creation. With a permuted block randomization schedule, 46 patients received clopidogrel and 47 patients received control placebo. The primary AVF failures at two months were 21.6% in placebo group and 5.2% in clopidogrel group ( P = 0.03). The hazard ratio for the incidence of primary AVF failure was 0.72 (CI 95%, 0.41-1.01). Analysis of covariables indicated that this effect occurred principally as a result of clopidogrel administration. First hemodialysis from newly created AVF in clopidogrel group was significantly more successful than placebo group ( P = 0.008). No life-threatening adverse event or severe bleeding was recorded in both groups. Clopidogrel seems to be effective and safe for prevention of primary AVF failure in hemodialysis patients.
  4,019 447 7
Post transplant thrombotic microangiopathy causing acute renal failure
S Qutube, KG Arun, N Jayaram, S Ramakrishnan, R Dilip
April-June 2009, 19(2):74-76
DOI:10.4103/0971-4065.53327  PMID:20368929
Acute Renal Failure (ARF) in the immediate post transplant period is most commonly due to acute tubular necrosis, acute cellular rejection and calcineurin inhibitor toxicity apart from usual prerenal and post renal causes. In this report, we discuss an interesting and unusual cause of ARF due to thrombotic micro angiopathy in the immediate post transplant setting.
  3,416 305 2
Kidney biopsy in west of Iran: Complications and histopathological findings
M Rahbar
April-June 2009, 19(2):68-70
DOI:10.4103/0971-4065.53325  PMID:20368927
In this retrospective study, we reviewed the medical records and histopathology findings of 135 patients who underwent renal biopsies at two special hospitals affiliated to Kermanshah medical university during a six-year period (2003-2007). All were performed using Tru-Cut needle under ultrasound guidance. Twenty four specimens were unsatisfactory. There were 38 males (34.2%) and 73 females (65.7%) in 111 patients with adequate specimens (each specimen has more than 5 glomeruli); the mean age was 16.5 years (range 2-64 years). Side effects of the renal biopsies included pain at the site of biopsy in 2 (2.7%), gross hematuria in 1 (0.9%). Nephrotic syndrome was the most common indication for biopsy followed by acute renal failure of unknown etiology and nephritic syndrome. Primary glomerular disease was reported in 78 patients (70.2%) and also secondary glomerular disease in 33 patients (29.7%). Among the primary glomerulonephritis disease, minimal change disease and membranous glomerulonephritis were the commonest findings in children below the age of 16 years. Minimal change disease ranked first in adults whole membranous glomerular disease and focal segmental glomerulosclerosis were more common in the elderly. In all patients lupus glomerular disease was the commonest secondary glomerular disease. We conclude that study on renal biopsy makes final diagnosis which is associated with an acceptably low rate of complications in our practice, and in all,the patterns of renal histology in our study vary slightly from those reported from other countries.
  2,597 357 2
Kidney transplantation in a patient with HIV disease
SB Bansal, M Singhal, R Ahlawat, V Kher
April-June 2009, 19(2):77-79
DOI:10.4103/0971-4065.53328  PMID:20368930
Human immunodeficiency virus (HIV) disease was considered an absolute contraindication to kidney transplantation until recently. The main reason was the concern regarding the side effects of immunosuppressive drugs in already immunocompromised patients. Kidney transplantation is considered to be the best form of renal replacement therapy in most patients with kidney failure. Nowadays, many world medical centers are successfully doing kidney transplantation in HIV patients with kidney failure. However, HIV disease is still considered a contraindication to kidney transplantation in most Indian centers. Here, we report a case of a patient with HIV infection and ESRD, who underwent successful kidney transplantation in our center.
  2,458 299 3
Sirolimus-induced pneumonitis
U Singh, A Gupta, S Jasuja
April-June 2009, 19(2):80-81
DOI:10.4103/0971-4065.53329  PMID:20368931
  1,674 217 4
Posttransplant lymphoproliferative disease presenting as jejunal perforation
KC Krishna, G Sivaramakrishna, PM Kumar, T Kannan, KM Reddy, V Sivakumar
April-June 2009, 19(2):82-82
DOI:10.4103/0971-4065.53330  PMID:20368932
  1,531 159 -
Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07