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  Citation statistics : Table of Contents
   2014| July-August  | Volume 24 | Issue 4  
    Online since July 11, 2014

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Survival analysis of patients on maintenance hemodialysis
A Chandrashekar, S Ramakrishnan, D Rangarajan Rangarajan
July-August 2014, 24(4):206-213
DOI:10.4103/0971-4065.132985  PMID:25097332
Despite the continuous improvement of dialysis technology and pharmacological treatment, mortality rates for dialysis patients are still high. A 2-year prospective study was conducted at a tertiary care hospital to determine the factors influencing survival among patients on maintenance hemodialysis. 96 patients with end-stage renal disease surviving more than 3 months on hemodialysis (8-12 h/week) were studied. Follow-up was censored at the time of death or at the end of 2-year study period, whichever occurred first. Of the 96 patients studied (mean age 49.74 ± 14.55 years, 75% male and 44.7% diabetics), 19 died with an estimated mortality rate of 19.8%. On an age-adjusted multivariate analysis, female gender and hypokalemia independently predicted mortality. In Cox analyses, patient survival was associated with delivered dialysis dose (single pool Kt/V, hazard ratio [HR] =0.01, P = 0.016), frequency of hemodialysis (HR = 3.81, P = 0.05) and serum albumin (HR = 0.24, P = 0.005). There was no significant difference between diabetes and non-diabetes in relation to death (Relative Risk = 1.109; 95% CI = 0.49-2.48, P = 0.803). This study revealed that mortality among hemodialysis patients remained high, mostly due to sepsis and ischemic heart disease. Patient survival was better with higher dialysis dose, increased frequency of dialysis and adequate serum albumin level. Efforts at minimizing infectious complications, preventing cardiovascular events and improving nutrition should increase survival among hemodialysis patients.
  17 4,375 479
Prevalence of chronic kidney disease among adults in a rural community in South India: Results from the kidney disease screening (KIDS) project
YJ Anupama, G Uma
July-August 2014, 24(4):214-221
DOI:10.4103/0971-4065.132990  PMID:25097333
Prevalence of chronic kidney disease (CKD) appears to be increasing in India. A few studies have studied the prevalence of CKD in urban populations, but there is a paucity of such studies in the rural populations. This project was undertaken to study the prevalence of CKD among adults in a rural population near Shimoga, Karnataka and to study the risk factor profile. Door-to-door screening of 2091 people aged 18 and above was carried out. Demographic and anthropometric data were obtained, urine was analyzed for protein by dipstick and serum creatinine was measured in all participants. Glomerular filtration rate was estimated (eGFR) using the 4-variable modification of diet in renal disease (MDRD) equation and Cockcroft-Gault equation corrected to the body surface area (CG-BSA). The total number of subjects studied was 2091. Mean age was 39.88 ± 15.87 years. 45.57% were males. The prevalence of proteinuria was 2.8%. CKD was seen in 131 (6.3%) subjects when GFR was estimated by MDRD equation. The prevalence of CKD was 16.54% by the CG-BSA method. There was a statistically significant relationship of CKD with gender, advancing age, abdominal obesity, smoking, presence of diabetes and hypertension. The prevalence of CKD is higher compared to the previous studies from rural India and is comparable to that in the studies from the urban Indian populations. The wide difference between the CKD prevalence between MDRD and CG-BSA equations suggests the need for a better measure of kidney function applicable to Indian population.
  9 6,937 523
Acute kidney injury and dermonecrosis after Loxosceles reclusa envenomation
A Nag, J Datta, A Das, AK Agarwal, D Sinha, S Mondal, T Ete, A Chakraborty, S Ghosh
July-August 2014, 24(4):246-248
DOI:10.4103/0971-4065.133017  PMID:25097339
Spiders of the Loxosceles species can cause dermonecrosis and acute kidney injury (AKI). Hemolysis, rhabdomyolysis and direct toxin-mediated renal damage have been postulated. There are very few reports of Loxoscelism from India. We report a case of AKI, hemolysis and a "gravitational" pattern of ulceration following the bite of the brown recluse spider (Loxosceles spp).
  3 4,290 132
Zygomycetes peritonitis in ambulatory peritoneal dialysis: Case report and review of literature
M Rathi, U Sengupta, TD Yadav, S Kumar
July-August 2014, 24(4):252-254
DOI:10.4103/0971-4065.133028  PMID:25097341
We present a case of CAPD peritonitis caused by zygomycetes infection. A 46-year-old male patient presented with refractory peritonitis requiring catheter removal. He had persistence of fever and an ultrasonography abdomen done revealed loculated collections. An initial pigtail drainage followed by open laparotomy was performed. Intra-operative peritoneal and omental biopsy revealed large areas of necrosis with broad aseptate fungal hyphae consistent with zygomycosis. He was managed with 3 gm of intravenous amphotericin and is doing well at 6 months of follow-up.
  2 2,275 83
Urinary ascites after an alcohol binge: An uncommon treatable cause of acute kidney injury
A Jairam, R Kachhela, D Mukherjee, AK Hooda
July-August 2014, 24(4):255-256
DOI:10.4103/0971-4065.133032  PMID:25097342
A 38-year-old male presented after a binge of alcohol with acute onset, rapidly progressive distension of abdomen, hematuria, oligoanuria and dialysis dependent renal failure. Evaluation revealed ascitic fluid with high creatinine and computed tomography cystogram showed contrast leak into the peritoneum. Retrograde cystoscopy confirmed rupture of the bladder. He had prompt diuresis after indwelling Foley's catheter was placed. By 2 weeks, he had recovered renal function completely. A high index of suspicion can make an early diagnosis and avoid unnecessary investigations. The mechanism of spontaneous rupture of bladder after an alcohol binge is discussed.
  1 2,688 98
Maternal drugs and neonatal renal failure
M Sahay, K Ismal, PS Vali, D Saivani
July-August 2014, 24(4):249-251
DOI:10.4103/0971-4065.133023  PMID:25097340
Maternal use of drugs during pregnancy may cause irreversible renal failure in the newborn. This report highlights the adverse effect of telmisartan during the last trimester of pregnancy. The neonate presented with oliguric renal failure and the renal histology showed proximal tubular dysgenesis.
  1 2,286 116
Concern, counseling and consent for bariatric surgery
S SenthilKumaran, SS David, RG Menezes, P Thirumalaikolundusubramanian
July-August 2014, 24(4):263-264
DOI:10.4103/0971-4065.133045  PMID:25097346
  1 2,051 68
Renal histology in diabetic nephropathy: "A novel perspective"
M Sahay, RK Mahankali, K Ismal, PS Vali, RK Sahay, G Swarnalata
July-August 2014, 24(4):226-231
DOI:10.4103/0971-4065.132999  PMID:25097335
Diabetic nephropathy (DN) is the leading cause of end-stage renal disease all over the world. India has a high incidence and prevalence of diabetes and >30% have nephropathy. Recently, a histological classification has been proposed. This study analyzed the renal histology in 114 diabetic patients with renal dysfunction. Nearly 75% of patients had DN. Fifty five (63.95%) were males. Mean duration of diabetes was 7.04 ± 4.9 years. Mean serum creatinine in study group was 5.2 ± 2.9 mg/dl, with mean estimated glomerular filtration rate of 23.43 ± 21.48 ml/min/1.732 m 2 . Forty eight patients (55.81%) had diabetic retinopathy (DR); prevalence of DR was more in patients who had diabetes for > 10 years than patients who had diabetes for <6 years (P = 0.022). The most common histological class was Class IV observed in 37 (43.02. %) cases, Class III DN in 24 (27.90%) cases, Class IIa and Class IIb in 11 (12.79%) cases each and Class I DN in 3 (3.48%) cases. Higher histological class was associated with higher proteinuria, lower glomerular filtration rate (P < 0.001) and was more likely to be associated with retinopathy (P = 0.012) and hypertension (P = 0.0003) but did not correlate with duration of diabetes (P = 0.85). There was a poor correlation between retinopathy and DN. Biopsy helps to stage the renal lesions in diabetics with renal dysfunction.
  1 3,424 282
Medullary sponge kidney and isolated hemihyperplasia
PS Priyamvada, S Parameswaran, M Sandeep, V Shankar, RP Swaminathan
July-August 2014, 24(4):243-245
DOI:10.4103/0971-4065.133013  PMID:25097338
The term hemihyperplasia refers to an enlargement of body parts beyond the normal asymmetry. Hemihyperplasia can be isolated or associated with various well-described malformation syndromes. Medullary sponge kidney (MSK) has been described with isolated and syndromic hemihyperplasia; the actual prevalence is not known The hemi hypertrophy can be so subtle that it may be easily overlooked. MSK need not be limited to the side of hemihyperplasia - most often it is bilateral. Around 33 cases has been reported from different parts of the world of which 15 cases are isolated hemi hyperplasia (IHH), the remaining occurring in the context of various malformation syndromes So far only one case has been reported from India. We report a case of IHH involving right side of the body, recurrent renal stones, incomplete distal renal tubular acidosis hypercalciuria and imaging showing bilateral MSKs.
  - 2,950 91
Takayasu arteritis in an infant
S Sandeep, VN Unni, KP Sreekumar, A Mathew, RR Nair, G Kurian
July-August 2014, 24(4):257-259
DOI:10.4103/0971-4065.133036  PMID:25097343
Takayasu arteritis (TA), a chronic inflammatory arteritis affecting the aorta and its main branches, is a rare condition mainly affecting young women in the second and third decades of life. Occurrence of TA in infants is extremely rare, with only less than 10 cases reported all over the world until date. We report a case of a 2-year-old girl who presented with hypertension and was diagnosed to have TA with bilateral renal artery stenosis and this is probably the youngest case reported from India.
  - 2,878 131
Amelogenesis imperfecta and nephrocalcinosis syndrome
V Chaitanya, B Sangeetha, P Sandeep, B Varalaxmi, A. V. S. S. N. Sridhar, G Aparna, M Venkateswarlu, R Ram, VS Kumar
July-August 2014, 24(4):260-261
DOI:10.4103/0971-4065.133043  PMID:25097344
  - 1,904 108
Effect of exercise program on lumbosacral strain in patients on continuous ambulatory peritoneal dialysis
SR Krishna, K Madhavi, CK Kishore, VS Kumar
July-August 2014, 24(4):262-263
DOI:10.4103/0971-4065.133787  PMID:25097345
  - 1,844 64
Author response on: Malignant hypertension and nephrotic range proteinuria without hematuria: IgA nephropathy
RP Goswami, D Sinha, S Mondal, S Mandal, T Ete, A Nag, J Pal, AR Chowdhury, A Ghosh
July-August 2014, 24(4):264-264
DOI:10.4103/0971-4065.133048  PMID:25097347
  - 1,679 80
Spontaneous pneumomediastinum and subcutaneous emphysema in continuous ambulatory peritoneal dialysis patient
Q Nadri
July-August 2014, 24(4):265-266
DOI:10.4103/0971-4065.133052  PMID:25097348
  - 1,960 55
Unusual finding of cellular glomeruli infiltrated with lymphocytes in end stage renal disease due to obstructive nephropathy
VL Gaopande, AR Joshi, S. G. S. Khandeparkar, S Dwiwedi
July-August 2014, 24(4):266-267
DOI:10.4103/0971-4065.133056  PMID:25097349
  - 1,605 55
In memoriam
AF Almeida
July-August 2014, 24(4):268-269
  - 1,226 86
Early corticosteroid withdrawal regimen in a living donor kidney transplantation program
SB Bansal, S Sethi, R Sharma, M Jain, P Jha, R Ahlawat, R Duggal, V Kher
July-August 2014, 24(4):232-238
DOI:10.4103/0971-4065.133004  PMID:25097336
Steroids have been the essential component of transplant immunosuppression. Recently, with availability of better immunosuppressive agents, many centers have started steroid free transplant with good success rates. We analyzed the outcomes of early corticosteroid withdrawal (CSW) protocol in our living donor kidney transplant programme. We included 73 patients on CSW protocol on basiliximab + tacrolimus and mycophenolate mofetil and compared them with 67 recipients on similar regimen with corticosteroids (CSs). CSW group received prednisolone 40 mg on day 1, which was stopped on day 5. Outcomes were evaluated in terms of acute rejection (AR), infections, new onset diabetes after transplant (NODAT), renal function and graft or patient loss. In CSW group, 15/73 (20.5%) patients developed AR, when compared to 5/67 (7.5%) in CS group, (P = 0.02). Biopsy proven acute rejection was seen in 12/72 (16.6%) in CSW group and 5/67 (7.5%) in CS (P = 0.1). One patient in CSW group developed antibody mediated rejection. NODAT was similar (9% in CS vs. 3.7% in CSW, P = 0.09), but infections were higher in CSW group (20.5% vs. 7.5%, P = 0.02). Mean serum creatinine was similar at 6 months (1.24 ± 0.6 in CS and 1.25 ± 0.3 in CSW, P = 0.9). Graft survival was 100% and 97% (P = 0.1) and patient survival was 98.6% and 98.5% (P = 0.9) in CSW and CS groups. Early corticosteroid withdrawal with basiliximab induction was associated with increased risk of AR but did not have any effect on short term graft and pateint survival.
  - 3,107 194
Idiopathic collapsing glomerulopathy: A clinicopathologic analysis of 30 cases
A Ahuja, R Gupta, A Sharma, A Bagga, DM Bhowmik, SK Agarwal, AK Dinda
July-August 2014, 24(4):239-242
DOI:10.4103/0971-4065.133009  PMID:25097337
Collapsing glomerulopathy (CG) is a distinct clinicopathologic entity associated with various infections, medications and acute ischemia. There have been few scattered reports of CG from India. This study aimed at evaluating the clinicopathologic features of idiopathic CG in Indian patients with comparison between adult-onset and childhood CG. This study included all cases of idiopathic CG diagnosed over a period of 4 years (2006-2009). Appropriate clinical details and laboratory findings were retrieved. Renal biopsies were reviewed and detailed pathologic features assessed. Statistical analysis was performed to compare various features between adult-onset and childhood CG. Over these 4 years, 30 cases of idiopathic CG were diagnosed. Of these, 11 were children. Childhood CG cases had longer duration of symptoms and lower serum urea and creatinine levels compared with adult patients. In renal histology, tubular atrophy and interstitial fibrosis was frequent in our cases. Pediatric cases of CG showed a higher proportion of segmental glomerulosclerosis. On clinical follow-up, nine of the 30 patients progressed to end-stage renal disease and these included two pediatric patients. Idiopathic CG is a significant cause of renal dysfunction in both pediatric and adult patients. Childhood and adult-onset CG differ in few clinicopathologic features. Early and accurate diagnosis of CG is imperative for appropriate management of these patients.
  - 2,444 133
A study of impact of cost-effective nutritional supplement in patients on maintenance hemodialysis
D Rangarajan, S Ramakrishnan, KC Patro, G Vakrani, S Badrinath
July-August 2014, 24(4):222-225
DOI:10.4103/0971-4065.132995  PMID:25097334
Nutritional status in patients on hemodialysis is always of concern as malnutrition predisposes to excess morbidity and mortality. Most of the nutritional supplements available in the market are expensive. We explored the possibility of improving nutrition of the patients on maintenance hemodialysis by supplementation of calories and proteins that can be given in the form of a palatable and economical gruel in this prospectively designed, open labeled study. Patients who were on maintenance hemodialysis (twice a week) for a period of at least 6 months were divided into two groups. The study group was given the gruel supplement and the control group was not given the gruel supplement. Nutritional status was assessed in the study group and controls at 0 and 3 months by the following parameters: percentage body fat, mid arm muscle circumference and serum albumin. Analysis of results revealed that there was a significant decline in the protein intake at the end of the 3 rd month in the control group (P = 0.01). Other parameters did not show significant change at the end of the study period in both groups. The nutritional supplement can be assumed to have helped at least in the maintenance of protein intake over this short period and could possibly in the long run contribute to improvement of nutritional parameters.
  - 2,482 202
Taking alcohol with a (large) pinch of salt: Understanding the osmoles in "beer potomania" and "starvation potomania"
TH Imam
July-August 2014, 24(4):203-205
DOI:10.4103/0971-4065.133041  PMID:25097331
Alcoholism is a major problem globally and beer drinking is on the rise. Many of the alcoholics sustain only on beer for days and do not get adequate solutes in the form of food. Similar situation can arise in cases of decreased food intake due to severe deliberate restriction or other factors like decreased appetite from cocaine. In these cases, salt free liquid intake may still be adequate. Such situations are conducive to the development of hyponatremia. Some of the solutes in diet, such as salt and protein, act as osmoles in urine. In these conditions, understanding the role played by solutes in diet and osmoles in urine is of vital importance for appropriate treatment of hyponatremia.
  - 4,293 193
Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07