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Background: Equisetum diffusum D. Don commonly known as 'Himalayan horsetail', has been traditionally used in the treatment of back pain, bone fracture and dislocation, and arthritis by various tribal communities of India. Our previous study confirmed the anti-inflammatory efficacy of the plant through in silico, in vitro, and in vivo model studies. Therefore, the current research is focused on safety dose evaluation for the first-time of the whole-plant methanol extract (EDME) of E. diffusum through appropriate in silico, in vitro, and in vivo approaches. Method: The whole plant, along with its rhizomes, was collected, and the methanol extract was prepared. The in silico ADMET study was performed to predict the pharmacokinetics profile and toxicity of all the identified phyto-compounds of EDME previously screened by GC–MS study. In vitro cytotoxicity study of EDME was performed using two cell lines: kidney (HEK293) and liver (Huh7) cell lines. The in vivo toxicity study of EDME was validated by the acute toxicity (OECD 423, 2002) and sub-acute toxicity assays (OECD 407, 2008) in the Wistar Albino rat model. Results: The in silico ADMET study of all 47 bioactives predicted good pharmacokinetic and low toxicity profiles. In vitro cytotoxicity showed higher IC50 values of EDME viz., 672 ± 15.7 μg/mL and 1698 ± 6.54 μg/mL for both kidney (HEK293) and liver (Huh7) cell lines, respectively, which were considered as low-toxic. Based on acute oral toxicity, the LD50 value of the extract was considered "non-toxic" up to a feeding range of 2000 mg/kg of body weight. The regular consumption of the extract for an extended period (28 days) was also qualified as safe based on the body and organ weight, hematological, biochemical, and histoarchitecture results in the sub-acute toxicity assay. Conclusion: The detailed in silico, in vitro, in vivo (acute and sub-acute oral toxicity) studies gave us a new insight to the safety dose evaluation of Equisetum diffusum, which may serve as a reliable documentation for undertaking the experimental validation of the ethnobotanical uses of the plant which would help in the field of drug development for the treatment of inflammation related complications. [ABSTRACT FROM AUTHOR]

Background: A renal biopsy is essential for the identification and management of renal disorders. Although considered an invasive operation, it is necessary for a definitive diagnosis and treatment of many renal diseases. The primary goal of this study was to assess the clinicopathological aspect of renal diseases undergoing biopsy in children receiving tertiary care. Patients and Methods: Children (≤18 years) hospitalized with nephrotic syndrome were the subjects of this cross-sectional study, and comprehensive assessments confirmed the need for a kidney biopsy. Included were 277 children who met the inclusion and exclusion criteria. Data on patient outcomes, biopsy indications, complications, histopathologic results, and demographic information were documented. Results: Of the 277 patients who underwent renal biopsy, 63.2% were male, and 36.8% were female. Average age of the patients was 15 ± 2.9 years, with age distribution ranging from 3 to 18 years. The most frequent indication for renal biopsy was atypical age of <1 and >10-years-old (91.7%), steroidresistant (5.1%), asymptomatic hematuria (21.3%), abnormal glomerular filtration rate (16.2%), and proteinuria (14.8%). The most common histopathological findings were focal segmental glomerulosclerosis (FSGS) (36.5%), followed by minimal change disease (MCD) (13.4%), membranoproliferative glomerulonephritis (MPGN) (10.5%), membranous glomerulonephritis (MGN) (7.94%), IgA nephropathy (IGAN) (7.58%), non-proliferative glomerulonephritis (NPGN) (7.58%), diffuse proliferative glomerulonephritis (DPGN) (6.9%), crescentic GN (5.8%), and systemic lupus erythematosus (SLE) (3.97%). The high frequency of positive samples was seen in SLE, followed by DPGN, MPGN, IGAN, and MGN. In contrast, MCD, crescentic GN, and NPGN showed negativity in all differential item functioning (DIF) parameters. Conclusion: Renal biopsy is a safe and effective procedure in the diagnosis and treatment of in children with nephrotic syndrome. FSGS had the highest frequency in examined biopsies. [ABSTRACT FROM AUTHOR]

Background: The urinary biomarker response precedes the appearance of any renal structural or functional derangement. Transforming growth factor-Pi (TGF-P1), neutrophil gelatinase associated lipocalin (NGAL), and Cystatin C (CysC) can act as the early prognostic markers in posterior urethral valve (PUV) patients. Aim: To compare the urinary levels of TGF-β1, NGAL, and CysC between PUV cases and age matched controls and to correlate these with renal structural and functional parameters. Materials and Methods: This prospective study included children with PUV diagnosed using the standard investigations and an equal number of age-matched controls with nonurological problems. For the study subjects, the urinary samples were collected at three different time points (pre- and postoperatively at 3 and 6 months), whereas for controls, only single-voided samples were studied. The urinary levels of TGF-β1, NGAL, and CysC were estimated by the standardized techniques using the ELISA kits. Statistical methods were used to drive the comparisons between cases and controls. Results: Fifteen children with a median age of 10 (5-48) months were enrolled in each of the two groups. The mean uTGF-β1 in the case group was significantly higher at all three time points (43.20 ± 6.13 pg/ml, 43.33 ± 11.89 pg/ml and 40.71 ± 9.01 pg/ml) as compared to the control group (29.12 ± 8.31 pg/ml) (P ≤ 0.001). The median uNGAL in the case group was also higher (17.78 ng/ml, 2.35 ng/ml and 2.536 ng/ml) as compared to the control group (1.31 ng/ml). However, the difference was significant only preoperatively (P = 0.02). The median uCysC in case group was similarly higher (0.347 µ.g/ml, 0.439 µ.g/ml, and 0.382 µ.g/ml) than the control group (0.243 µ.g/ml) (P > 0.05). Serum creatinine in the case group (0.49 mg/dl) showed no significant rise above that of control (0.24 mg/dl). A cutoff value of uTGF-β1 = 36.55 pg/ml (P < 0.001), uNGAL = 0.879 ng/ml (P = 0.02), and uCysC = 0.25 µg/ml (P = 0.22) was found to be associated with renal damage in PUV. A significant correlation was found between uNGAL and S. creatinine at 3 months (r = 0.43, P = 0.017) and 6 months (r = 0.47, P = 0.08). Conclusion: The elevated uTGF-β1, a decline in uNGAL and an increase in uCysC suggests ongoing inflammation, improvement in hydronephrosis and a prolonged proximal tubular dysfunction in PUV patients, respectively. [ABSTRACT FROM AUTHOR]

Background: Renal Anomalies are relatively common. Problems with congenital anomalies of kidney are important as they may cause renal failure. Failure in Ascent of kidney can result in a pelvic kidney alternatively, the kidneys may fuse together at their caudal poles produces Horseshoe kidney. Objectives: The present study is to evaluate renal developmental anomalies Radiologically. Material and Methods: The present study was a Cross Sectional study in Tertiary Care Hospital who were referred to radiology department for CT abdomens. 3500 abdominal CT scans were observed for a period of 6 months. Among those male CT abdominal scans are 2060 and female CT abdominal scans are 1440, from Tertiary care hospital in Andhra Pradesh and observed for renal malformations. Results: 3500 abdominal C. T scans were studied for a period of 6 months. Out of the 3500 ct's males are 2060 and females are 1440. Conclusion: Renal Anomalies all though asymptomatic and accidental finding in most of the cases thorough evaluation of the patient is utmost important to rule out serious pathological conditions prior to the arrival of symptoms. [ABSTRACT FROM AUTHOR]

There is a global shortage of transplantable organs, especially in a resource‑limited country like India. Deceased pediatric donors provide an excellent opportunity to expand the donor pool. Herein, we report a rare case of multi‑organ harvesting from a 3‑year‑old brain‑dead donor, where both the kidneys were transplanted en bloc to an adult male recipient and the liver to a 4‑year‑old male child. This case report provides the surgical steps and our experience. [ABSTRACT FROM AUTHOR]

Tuberculosis is caused by Mycobacterium tuberculosis. If the treatment is inadequate or if host defenses are impaired, the apical lesion in primary tuberculosis expands into adjacent lung tissues and may spread via airways, lymphatic channels, or the vascular system. It may also circulate back to the lung and cause miliary pulmonary disease. Systemic miliary tuberculosis occurs when bacteria disseminate through the systemic arterial system to involve any organ. In the present study, we discuss five such cases of systemic miliary tuberculosis wherein the deceased succumbed to the illness. [ABSTRACT FROM AUTHOR]

The article focuses on India's substantial annual rate of solid organ transplants, ranking third globally after the USA and China, and its efforts to improve organ donation practices. Topics include the progress in organ donation rates from deceased donors, the need to raise awareness among physicians and the public, and the procedures and evaluations involved for potential donors.

Recently reports of orange chromide (Etroplus maculatus) stocked in the tanks showed mass mortality in Mangaluru, India. E. maculatus is an ornamental fish, which is exported to different countries around the globe and these belong to the genus of Etroplus where another two species share the same genus [E. canarensis (Canara pearlspot) and E. suratensis (Pearlspot)]. These native fish were discovered in the Western Ghats which is one of the highest biodiversity spots in the world. The goal of the current investigation was to pinpoint the aetiological agent linked to mass mortality of E. maculatus. The E. maculatus had internal symptoms of an enlarged spleen and kidney, while symptoms externally included discoloration of the body and petechial hemorrhages. Infectious spleen and kidney necrosis virus (ISKNV) of the genus Megalocytivirus was identified as the aetiological agent by polymerase chain reaction (PCR) amplification of the major capsid protein (MCP) gene with an amplicon size of 563 basepair (bp). The isolated ISKNV sequence was found to be closely related to the ISKNV isolated from Malaysian Molly fish (Xiphophorus hellerii) and Australian Angel fish (Pterophyllum scalare) according to phylogenetic analysis. The sequence was subsequently added to the NCBI GenBank database with the accession number ON149089.1. Girisha et al (2020) earlier reported that the SISS cell line was utilized for the purpose of virus propagation and same was followed in the present study. Cytopathic effects (CPEs) were evident in the infected SISS cells showing the rounding, expansion and eventually cell detachment from the flasks after 10 days. The current study confirms that E. maculatus, an endemic species is susceptible to ISKNV infection, suggesting that its host range has expanded especially in India after our report from 2020. [ABSTRACT FROM AUTHOR]

Purpose: In this study, we investigate renal function and anaemia during imatinib treatment in patients with chronic myeloid leukaemia. Methods: The patients with chronic myeloid leukaemia with chronic phase who had been treated with only imatinib for 12 months at Rajiv Gandhi Cancer Institute and Research Centre (New Delhi, India) were enrolled and prospectively analysed. The chronic renal impairment parameters, including estimated glomerular filtration rate and haemoglobin levels for anaemia from June 2020 to June 2022, were monitored in newly diagnosed in patients with chronic myeloid leukaemia-chronic phase. The data were analysed by SPSS software version 22. Results: In total 55 patients with chronic myeloid leukaemia chronic phase who had been on imatinib for 12 months were monitored. The mean estimated glomerular filtration rate was significantly decreased (74 ± 14 to 59 ± 12 mL/min/1.73m2, p < 0.001) with a decrease in mean haemoglobin levels after 12 months (10.9 ± 2.01 to 9.0 ± 1.02, p < 0.004). The decreased estimated glomerular filtration rate was negatively correlated with haemoglobin levels after 1 year of imatinib administration (correlation coefficient = 0.892, R2 = 0.7976, p < 0.05). Conclusion: We recommended close monitoring of renal function and haemoglobin levels in patients with chronic myeloid leukaemia patients. [ABSTRACT FROM AUTHOR]

Introduction: The basis for an obstetrician's capacity to successfully organise an intervention, administer prenatal care, and conduct prenatal testing. exact awareness of the gestational age. This study conducted to find out correlation of foetal kidney length with foetal biometric parameters like BPD, AC, HC and FL in the third trimester of pregnancy. Methodology: A cross-sectional observational research was carried out on third-trimester pregnant patients who were seen in the obstetrics and gynaecology outpatient department at a tertiary care hospital in India. The study included all women who were singleton pregnant in the third trimester (28 to 40 weeks), had date scans that were documented, were certain of their last menstrual cycle, had a normal prenatal period, and had no risk factors connected with them. Results: A reasonably excellent positive correlation between MKL and GA. With a decent fit and a R squared (R2) value of 0.599. There is a reasonably strong positive correlation (r) between MKL and GA by HC. With a decent fit and a R squared (R2) value of 0.545, this regression model explains 54.5 percent of changes in GA by HC with MKL. According to the Pearson Association Coefficient (r), there is a relatively strong positive correlation (r) between MKL and GA via AC. A high positive correlation (very good) between MKL and GA via FL. With a decent fit and a R squared (R2) value of 0.668, this regression model explains 66.8% of changes in GA by FL with MKL. Conclusion: That there is a high correlation between the mean kidney length of the foetus and established biometric markers of gestational age, including femur length, head size, belly circumference, and biparietal diameter. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease of unknown cause (CKDu) is an emerging health problem in India and other countries worldwide. However, clinical descriptions, including kidney pathology, are scarce. Methods: This is a descriptive case series of patients with CKDu from an endemic region in India, with a focus on clinical and biochemical characteristics, kidney biopsy findings, and environmental exposure. Patients with suspected CKDu, aged 20–65, and eGFR 30–80 mL/min/1.73 m2 from rural areas with endemic prevalence of CKDu were included. The exclusion criteria were diabetes mellitus, uncontrolled hypertension, proteinuria >1 g/24 h, or other known kidney diseases. The participants underwent kidney biopsies, and blood and urine samples were collected. Results: Fourteen participants (3 females, 11 males) with a mean eGFR of 53 (range 29–78) mL/min/1.73 m2 were included. Kidney biopsies showed a combination of chronic tubulointerstitial damage, glomerulosclerosis, and glomerular hypertrophy, with varying degrees of interstitial inflammation. Eight participants had polyuria (diuresis ≥ 3 L/day). The urinary sediments were bland, with no haematuria. Serum potassium and sodium levels were, in most cases, normal but within the lower reference interval. Conclusion: The kidney morphology and clinical characteristics in patients with CKDu in India were similar to those described for CKDu in Central America and Sri Lanka. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to study the prevalence of augmented renal clearance (ARC) and validate the utility of ARC and ARCTIC scores. We also aimed to assess the correlation and agreement between estimated GFR (eGFR-EPI) and 8-hour measured creatinine clearance (8 hr-mCLcr). Study design and methodology: This was a prospective, observational study done in the mixed medical-surgical intensive care unit (ICU) and 90 patients were recruited. 8 hr-mCLcr, ARC, and ARCTIC scores and eGFR-EPI were calculated for all patients. ARC was said to be present if 8 hr-mCLcr was ≥ 130 mL/min. Results: Four patients were excluded from the analysis. The prevalence of ARC was 31.4%. The sensitivity, specificity, and positive and negative predictive values of ARC and ARCTIC scores were found to be 55.6, 84.7, 62.5, 80.6, and 85.2, 67.8, 54.8, and 90.9 respectively. AUROC for ARC and ARCTIC scores were 0.802 and 0.765 respectively. A strong positive correlation and poor agreement were observed between eGFR-EPI and 8 hr-mCLcr. Conclusion: The prevalence of ARC was significant and the ARCTIC score showed good potential as a screening tool to predict ARC. Lowering the cut-off of ARC score to ≥5 improved its utility in predicting ARC. Despite its poor agreement with 8 hr-mCLcr, eGFR-EPI with a cut-off ≥114 mL/min showed utility in predicting ARC. [ABSTRACT FROM AUTHOR]

Background: Renal size can be affected by various causal elements such as age, sex, and demographic characteristics. It is crucial for medical professionals to consider these factors when making clinical decisions. The purpose of this investigation was to establish normograms for renal measurements and explore their association with the anthropometric variables in the natives of Northern India. Methods: A total of 105 individuals with presumed healthy kidneys were enrolled in the present study. Kidney length, width and parenchymal thickness were measured, and data were analysed to identify potential differences related to age, gender and side. Correlation analysis was conducted to examine the relationship between kidney measurements and body biometrics, including body height, body weight, body mass index (BMI) and body surface area (BSA). Results: Mean values for kidney length, width and parenchymal thickness in the 209 kidneys analysed were as follows: right kidney - length 10.65 ± 1.34 cm, width 4.5 ± 0.42 cm and parenchymal thickness 0.91 ± 0.16 cm; left kidney - length 10.7 ± 1.69 cm, width 4.78 ± 1.26 cm and parenchymal thickness 0.76 ± 0.40 cm. Thickness showed significant differences between the right and left kidneys. No significant differences in renal parameters were found between males and females. Analysis based on age groups revealed an increase in renal length and thickness with advancing age, while width decreased in the middle age group (31-40 years) and then increased. Weak positive correlations were observed between kidney parameters and body height, body weight, BSA, and BMI. Conclusion: Renal parameters can vary among different populations depending on age, demographic characteristics, and ethnicity. Therefore, relying on commonly cited values for renal sonographic interpretation or clinical decision-making may not be appropriate. Interpreting renal measurements should be based on reference data specific to the studied population. [ABSTRACT FROM AUTHOR]

With yearly incidence of 0.5% to 1.9%, kidney stones are one of the urinary tract conditions that are considered to impact at least 10% of the population in countries. 12% of Indians are estimated to have urinary stones and 50% of those cases result in the loss of one or both kidneys, as well as minor renal injury or loss. In the current investigation, a polyherbal formulation was made by choosing various herbs with strong antiurolithiatic properties. These plants have long been important in Indian culture. These plants are widely utilized throughout India and have been employed extensively in the ayurvedic medical system. The plant demonstrates a broad spectrum of pharmacological activities, including antibacterial, anti-helminthic, anti-pyretic, and many other effects. [ABSTRACT FROM AUTHOR]

Aim: To study the additional utility of pre‐nephrectomy whole and cortical kidney volumes (WKV, CKV) in predicting long‐term post‐nephrectomy kidney function in Indian living kidney donors (LKDs). Methods: This retrospective cohort study included all LKDs who underwent nephrectomy between 1 January 2006 and 31 December 2015 at our centre, had pre‐nephrectomy height, weight and computed tomography (CT) angiography with arterial and nephrographic phase documented, and 5‐year post‐nephrectomy creatinine values measured. Correlation between body surface area (BSA) adjusted pre‐nephrectomy total CKV, WKV and pre‐nephrectomy CKD EPI eGFR; BSA‐adjusted remnant pre‐nephrectomy CKV (rCKV), WKV (rWKV) and 5‐year post‐nephrectomy CKD EPI creatinine eGFR (5yeGFRCr); predictors of 5yeGFRCr < 70% of pre‐nephrectomy CKD EPI creatinine eGFR (pre‐eGFRCr), and an equation to predict 5yeGFRCr from pre‐nephrectomy variables were calculated. Results: A total of 196 LKDs (74% female, mean age 41.7 ± 11.0 years) were included in the study. Total WKV showed higher correlation with pre‐nephrectomy eGFR than CKV, the highest with CKD EPI cystatin eGFR. Remnant WKV showed higher correlation than rCKV with post‐nephrectomy eGFRCr and this increased over time. Older age, lower rWKV or rCKV, higher BSA, and higher pre‐eGFRCr identified LKDs with 5yeGFRCr < 70% of pre‐eGFRCr, with rCKV identifying a higher proportion (4.5%) of such LKDs. A model including rWKV or rCKV predicted 5yeGFRCr better than one including age, gender, BSA and pre‐eGFRCr alone. Conclusion: Inclusion of pre‐nephrectomy remnant CKV and WKV into models for 5yeGFRCr and sub‐optimal post‐nephrectomy adaptation in Indian LKDs improves their accuracy. CKD EPI cystatin eGFR correlates better with functional renal mass. Summary at a Glance: Pre‐nephrectomy whole and cortical kidney volume identify Indian living kidney donors with sub‐optimal renal adaptation 5 years after nephrectomy and improve the accuracy of prediction models for 5‐year post‐nephrectomy CKD EPI creatinine eGFR. CKD EPI cystatin C eGFR has a higher correlation with CT volumes than CKD EPI creatinine eGFR. [ABSTRACT FROM AUTHOR]

Background: Diabetes is a heterogeneous disease that is modified by many risk factors, most notably hypertension. Although its negative effects on the retinal, renal, cardiovascular, and peripheral nervous systems are well known, its impact on cognitive performance has received less attention. It has been shown that diabetes is linked to mild cognitive impairment, a transitional stage between normal aging and dementia. Methods: In this case-control study, 150 patients, which were further divided into three groups of 50 patients each with 50 patients who fulfilled the American Diabetes Association's (ADA) Guidelines 2018 for diabetes were in Group A, 50 patients who fulfilled both ADA Guidelines 2018 for diabetes and Joint National Committee 7 (JNC 7) Guidelines for hypertension in Group B while 50 healthy subjects in Group C, were included after applying the exclusion criteria and were subjected to cognitive assessment by Montreal cognitive assessment (MoCA) test. Results: In the diabetic arm of the study (n = 100), 65% (n = 65) of the patients had cognitive impairment as compared to the control group (n = 50), where only 12% (n = 6) of the patients had cognitive decline (P < 0.001). The mean MoCA scores were lowest in patients who had concomitant diabetes and hypertension (23.86 ± 1.78) as compared to patients having diabetes alone (24.76 ± 1.38) while the control group had the highest mean MoCA score (27.46 ± 1.69) (P < 0.001). Age correlated negatively with MoCA while no correlation was observed with gender distribution and area of residence. Duration of diabetes correlated negatively with MoCA scores in Group A (-0.874) (P < 0.001) and Group B (-0.801) (P < 0.001). Duration of hypertension also showed a negative correlation with MoCA scores in Group B (-0.745) (P < 0.001). A negative correlation was also observed between glycated hemoglobin and MoCA scores in Group A (-0.665) (P = 0.001) and Group B (-0.567) (P = 0.034). Conclusions: In conclusion, the incidence and severity of cognitive impairment was more in patients having concomitant diabetes and hypertension as compared to patients having diabetes alone, thus signifying the additional burden and contribution of hypertension to the cognitive decline. [ABSTRACT FROM AUTHOR]

INTRODUCTION: To accurately estimate the fetus age and follow up on the growth of different fetal organs, it is vital to know the accurate date of birth. It also helps to prevent prenatal and postnatal complications for the newborn. It is common for antenatal mothers to be unaware of last menstrual period (LMP). In such situations, it would be difficult to calculate the delivery date. According to various studies, up to 30% of women were not sure of their LMP. The treating obstetricians would have to be very careful when the exact LMP is unknown in order to prevent post maturity and prematurity deliveries. MATERIAL AND METHODS: The present study is prospective comparative study of Department of Obstetrics and Gynaecology in Guntur Medical College and Hospital, Andhra Pradesh, India. After 24 weeks of gestational age are included who are at age between 20-35 yrs which is of 200 sample size in the year 2020-21. Clinical assessment of gestational age was done by palpating the fundal height of the patient. Following this using ultrasound, meam fetal kidney length (FKL) along with other fetal parameters were calculated. RESULT: In the present study, BPD ranged from 28-40 wks, whereas the mean BPD was 35.25+2.67 HC ranged between 27-40 and the mean BPD was 35.35+2.88 MKL ranged between 27-41 and the mean MKL was 35.93+3.49. Upon the composite of multiple parameters GA ranged between 27.8-39.6 and the mean was 3.5.36+2.7. CONCLUSION: The FKL is very much useful in assessing the gestational age. From our study we state that there is a significant correlation between fatal kidney length and the gestational age. Hence fetal kidney is appropriate in estimation of gestational age. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) is associated with morbidity and mortality in COVID-19 patients. The incidence of AKI and its outcomes vary in different parts of the world. We aimed to analyze the AKI incidence, predictors of AKI, mortality, and renal function outcomes on follow-up in hospitalized patients with COVID-19. Materials and methods: The study was designed as a retrospective, observational study of electronically captured data on the hospital information system of laboratory-confirmed COVID-19 patients, with and without AKI, between March 2020 to June 2021. The predictor of AKI and mortality and residual damage in recovered AKI patients were analyzed. Results: Of the 3395 patients, 3010 COVID-19 patients were eligible. AKI occurred in 951 (31.5%); with stages 1, 2, and 3 in 605 (63.7%), 138 (14.5%), and 208 (21.8%) patients, respectively. AKI severity increased with COVID-19 severity. Of 951 AKI patients, 403 died, and 548 were discharged. AKI group had higher mortality (42.3%) than the non-AKI (6.6%). At discharge, complete recovery was noticed in 370(67.5%), while 178 (32.5%) had residual damage. At three months of follow-up, 108 (69.6%) of 155 patients showed complete recovery. Residual damage was observed in 47 (30.3%). In 14 (9%) patients, serum creatinine remained elevated above the baseline. Thirty-three (21.2%) patients showed proteinuria (n = 24) and microscopic hematuria (n = 9). Conclusions: AKI is common among patients hospitalized with COVID-19 and is associated with high mortality. Residual kidney damage post-COVID-19 in recovered AKI patients may increase the CKD burden. [ABSTRACT FROM AUTHOR]

Introduction: Living kidney donation is a complex psychological experience for donors. The present study examined the psychosocial impact of kidney donation on donors. Methods: The retrospective study included 506 donors who donated a kidney between 2010 and 2018 at a transplant centre in India. These donors responded via a donor insight questionnaire about their hospital anxiety, and their possible level of depression. The information included socio-demographic form with multiple information. The health survey was used periodically evaluate the psychosocial impact among donors following donation, including the transplant outcomes. Results: The majority of donors were females (79.4%). There was a significant improvement in the quality of life among donors (SF-36) following the donation of a kidney, especially among those donors who maintained good graft functions themselves as well as those who were informed about good kidney function in transplanted recipients. These donors showed a lesser degree of depressive and anxiety scores (HAD score 3.5 and BDI II 4.8) than donors who had problems themselves and/or whose donated kidneys did not function well. Most living donors (89.1%) felt that the act of donation had a positive impact on their lives and those donors would encourage others to donate a kidney. Overall, the graft outcomes impacted the donor's state of mind. Conclusion: The study showed a very positive impact of the acknowledgment of the donor by the recipient, especially those donors whose kidney transplants were well functioning. The state of depression, anxiety, and psycho-social outcomes correlated with the graft outcomes. Donors showed positive insight towards donation, with inner conscience still conclusively willing to donate and encourage others. [ABSTRACT FROM AUTHOR]

Introduction: Chick embryo is one of the most commonly used animals to study the adverse effects of various drugs for research purpose. In India, Malaria imposes incredible socio-economic burden on humankind. India reports approximately two million cases of malaria yearly, with large number of deaths. Surveys have demonstrated that the rates of treatment failure are higher than 50% due to Chloroquine resistance and poor efficacy of Sulphadoxine Pyrimethamine. Artesunate is a concentrate of Artemisia plant found in China, also called as Qinghaosu. It is a subordinate of a group of drugs artemisinin that have the most rapid action of all current drugs against Chloroquine resistant Plasmodium vivax and Plasmodium falciparum malaria. Aim: To understand the adverse effects of artesunate on kidney of developing chick embryo. Materials and Methods: The present study was an experimental study which comprised of steps like selection and sampling of eggs in groups (control and experimental), selection and preparation of drug (dose titration), drug administration, incubation of eggs, manual hatching to obtain chick embryo, isolation of kidney, sectioning of kidney and staining for slide preparation, microscopical analysis of the slides. In the present study, the fertilised eggs used were of White Leghorn chicken and were procured from King and King poultry farm Hapur, Uttar Pradesh, India. Hundred fertilised chicken eggs were divided into five experimental groups denoted by A, B, C, D, and E and five control groups denoted by a, b, c, d and e, one for each experimental group respectively. Each experimental and control group had 10 eggs. Experimental groups A, B, C, D and E were exposed to artesunate with dose of 0.0004 mg, 0.0005 mg, 0.0006 mg, 0.0007 mg and 0.0008 mg respectively and control group a, b, c, d and e were treated with same concentration of normal saline as artesunate. The eggs were broken by scalpel on 18th day of incubation and chick embryos were obtained. The kidneys were removed sectioned, stained and studied using light and compound microscope. Results: Histopathological changes like tubular degeneration, vacuolation in the cytoplasm of epithelium lining of Proximal Convoluted Tubules (PCT) and Distal Convoluted Tubules (DCT), congestion in Glomeruli, haemorrhage in urinary space and mild lymphocytic infiltration were observed. Conclusion: Exposure to artesunate increases the risk of nephrotoxicity with increase of embryonic age. [ABSTRACT FROM AUTHOR]

Background: While the majority of bleeding complications after a percutaneous kidney biopsy (PKB) occur early (≤24 h), delayed onset bleeding complications (>24 h) have been rarely reported and can be catastrophic for the patient. Purpose: To describe the incidence, risk factors, and outcomes of delayed bleeding complications after PKB. Material and Methods: We retrospectively studied native and graft kidney biopsies in patients who developed delayed bleeding complications (>24 h) after the biopsy performed in the Department of Nephrology and Renal Transplantation of a tertiary care medical institution in north India between January 2014 to December 2018. Results: Of the 4912 renal biopsies reviewed, 20 patients (16 men, 4 women; 0.40%) had a delayed biopsy bleeding complication. Of these patients, 95% had major bleeding complications requiring blood transfusions and 85% needed intervention like gelfoam/coil embolization. Despite intervention, one patient (5%) had mortality due to complications of bleeding and sepsis. When compared to a control group of patients with early biopsy bleed, patients with the delayed biopsy bleed had similar demographic and clinical profiles except for higher pre-biopsy hemoglobin and lower systolic and diastolic blood pressure. Conclusion: A post-PKB delayed onset bleed is not uncommon, and the vast majority of these patients had major bleeding complications requiring blood transfusions and/or intervention like embolization. They had a similar demographic and clinical profile presentation as early bleed patients. Meticulous outpatient monitoring and patient education after discharge may be useful to detect this complication promptly and to intervene early to have good patient outcome. [ABSTRACT FROM AUTHOR]

Introduction: This study was undertaken to evaluate the effect of nutrition on kidney size and to determine the correlation between renal parameters and different anthropometric parameters. Methods: This hospital-based descriptive observational study has been done in a tertiary care centre of Kolkata, West Bengal, India. Fifty malnourished children & 50 healthy children (Controls) within the age group of six months to five years were included in the study. Anthropometric parameters (e.g. weight, height, mid-arm circumference, skinfold thickness etc.) were measured manually and bilateral kidney sizes were measured by ultrasound. Results: Malnourished children had significantly lower weight, mid arm circumference, skinfold thickness, body mass index and body surface area [p < 0.001], but the difference in height / length was not significant (p = 0.074). The length, width, depth and volume of both left and right kidneys and relative renal volume were significantly lower in the malnourished children (p < 0.001). But, the same significance has not been found with kidney width, thickness or volume. Conclusions: Malnutrition adversely affects kidney growth in children of post-weaning age. [ABSTRACT FROM AUTHOR]

The article discusses the clinical findings and kidney morphology in chronic kidney disease of unknown cause (CKDu) in India. CKDu is a type of kidney disease that has been increasing worldwide, and it is believed that chronic dehydration from agricultural work in severe heat exposure may be a common risk factor. The study conducted kidney biopsies on 13 CKDu patients in India and found that their kidney biopsy findings were consistent with CKDu cases from other countries, showing focal glomerular collapse, periglomerular fibrosis, and tubulointerstitial scarring. The article also suggests that individuals with fewer nephrons may be more susceptible to CKDu when exposed to chronic dehydration. Additionally, there is a potential association between high temperature, dehydration, and the risk of CKDu across generations. [Extracted from the article]

Renal cell cancer (RCC) in renal allograft is a rare entity. We report a case of RCC successfully diagnosed in a 42-year-old renal allograft recipient which developed 13 years after engraftment. The patient was initially evaluated using ultrasound for two episodes of hematuria followed by contrast-enhanced CT scan revealing 9.7 cm x 8.6 cm x 6.5 cm heterogeneously enhancing mass at mid-pole with involvement of renal sinus. Allograft nephrectomy was performed. A genetic study with DNA microsatellite analysis showed de novo RCC from donor origin. Seven months after surgery, the patient is alive with no evidence of tumor recurrence and is now planned for a second renal transplant. To the best of our knowledge, this is the largest allograft RCC reported in the Indian scenario. [ABSTRACT FROM AUTHOR]

Background: Benign renal tumors are extremely rare and were studied here. This series also includes a renal teratoma in a horseshoe kidney, probably only the second in the pediatric literature. Materials and Methods: Retrospective review of children with benign renal tumors operated between 2006 and 2018 at one center. Results: Twelve patients (M:F ratio 10:2), age range 3 weeks (31-week gestation) to 13 years presented with large palpable renal swelling (n = 12) and hematuria (n = 3). Computed tomography (CT) scan showed features typical of the tumor. Final histopathology (age group [mean]) showed: multilocular cystic nephroma (MLCN) - n = 5 (41.7%), (11–16 months [13.6]); congenital mesoblastic nephroma (CMN) - n = 4 (33.3%) (classic 1, cellular 3) (0.75–5 months [2.125]); mature cystic teratoma - n = 1 (8.3%): (48 months, in a horseshoe kidney), and angiomyolipoma (AML) - n = 2 (16.7%) (144 months [sporadic] and 156 months [tuberous sclerosis]) One patient with cystic teratoma with no calcification on CT scan received pre-operative chemotherapy as fine-needle aspiration cytology (FNAC) reported malignant small blue cell tumor. Nephroureterectomy with Gerota's fascia could be done easily in all without intraoperative complications. Delay in presentation in MLCN and CMN led to increased symptoms and CT scan changes. All patients did well in 1.5–12 years (median 3 years) follow-up including cellular mesoblastic nephroma. Conclusions: Benign renal tumors often occur in specific age groups but may overlap that of Wilms tumor. Proper interpretation of clinical presentation, CT scan, and FNAC findings help in avoiding preoperative chemotherapy. Upfront nephroureterectomy is curative. Histopathological findings decide further treatment. Children with AML and tuberous sclerosis need lifelong follow-up. [ABSTRACT FROM AUTHOR]

Background and Aim: Malnutrition is a common disorder worldwide. Growth of visceral organs is affected by various factors including nutrition. Kidney size is an important parameter to assess renal growth. Kidney size in malnourished children is not well studied. We compared kidney size between severe acute malnourished (SAM) and normal children. Methods: This prospective case control study was carried out at a tertiary care center in North India. Children with SAM (n=124) were enrolled as cases and 86 age and sex matched healthy children were enrolled as controls. All children were subjected to anthropometric and sonographic kidney size measurement. Various renal size parameters were compared between cases and controls. Linear correlation coefficients of kidney dimensions with anthropometric parameters were derived. P-values <0.05 were considered significant. Results: The kidney length was significantly lower in malnourished cases compared to healthy controls. There was no difference in renal width and combined kidney volume (CKV) between the two groups. However, renal depth, combined relative kidney volume, CKV/body height ratio, and CKV/BSA ratio were significantly higher in malnourished child compared to healthy controls. Kidney size parameters (kidney length, width, depth, CKV) had significant correlations with anthropometric measurements in both groups but the correlations were stronger in healthy controls compared to malnourished children. Conclusion: Malnourished children had a significantly smaller kidney length. This point should be remembered while evaluating kidney size in these children to avoid unnecessary invasive investigations. [ABSTRACT FROM AUTHOR]

Infectious spleen and kidney necrosis virus (ISKNV), a member of family iridoviridae, reported for the first time in a wide range of ornamental fish species in India. Significant mortalities during the year 2018–19 were reported from a number of retailers in the region with various clinical signs. The samples of moribund, dead and apparently healthy ornamental fishes were collected from retailers, located in three districts of Karnataka, India. Out of 140 fish samples, 16 samples (11.42%) representing 10 different fish species were found positive to ISKNV by OIE listed primers and same samples were reported to amplify the major capsid protein (MCP) gene of ISKNV. Further, sequence analysis of MCP gene showed that all strains detected in this study were closely related to other documented isolates from different countries with an identity ranging from 98.76% to 100%. Further, they clustered in the clade of ISKNV, during the phylogenetic analysis. The sequence similarity was high (99.94%) to ISKNV strains from Japan, Australia and Malaysia. This is the first report of an ISKNV infection in India. Moreover, out of 10 ISKNV‐positive fish species, three species were reported positive to ISKNV for the first time in the world. Further, the in vitro experiment showed the growth of virus in Asian sea bass cell line, which is a natural host of ISKNV. Therefore, considering the lethal nature of megalocytiviruses to infect a vast range of species, proper biosecurity measures need to be taken to control these emerging pathogens. [ABSTRACT FROM AUTHOR]

Background: Repeat renal biopsy is usually done for lupus nephritis (LN) flare or resistant disease. We analyzed the changes between first and repeat biopsy and the contribution of repeat biopsy on renal outcome in LN patients. Methods: This was a retrospective study carried out at a tertiary care center in India. Sixty-two LN patients who underwent repeat biopsy for clinical indications, between January 2012 to December 2016, were included. Clinical and histological parameters at first and second biopsies were compared. Logistic regression analysis was done to determine parameters on repeat biopsy predicting response at last visit. Results: Repeat biopsy was done for relapse in 56% and for resistant disease in 44% patients. Seven (13.7%) out of 51 patients with baseline proliferative histology converted to non-proliferative lesion on second biopsy, while 2 (18.2%) out of 11 with baseline non-proliferative lesion converted to proliferative lesion on second biopsy. On repeat biopsy, the presence of endocapillary proliferation decreased, whereas glomerulosclerosis, interstitial fibrosis/tubular atrophy (IFTA), and glomerular basement membrane thickening increased. At the last visit (median follow-up of 38.6 months after first biopsy and 13.8 months after second biopsy), 79% of patients were in remission and 6.5% needed renal replacement therapy. The presence of IFTA >30% and thrombotic microangiopathy (TMA) on second biopsy independently predicted response at last visit. Conclusion: In Indian patients with LN, chronicity markers and superimposed membranous pattern increased on repeat biopsy done for clinical indications. The presence of IFTA and TMA on second biopsy predicted response at last visit. [ABSTRACT FROM AUTHOR]

Genitourinary tuberculosis (GUTB) is associated with significant morbidity and mortality. As patients with GUTB have no specific symptoms or clinical features, early diagnosis and treatment of GUTB is clinically challenging. The present study assessed the current spectrum of clinical presentation, urinary findings and radiological signs of patients with GUTB. Patients with confirmed GUTB (n = 53) were analysed for clinical presentation, diagnostic tests and management. Data about demographic details, clinical presentation, urine routine examination, urine acid-fast bacillus (AFB) smear test, urine Mycobacterium tuberculosis culture, routine blood investigations, radiological, cystoscopic and histopathological examinations were recorded for all study patients. Various surgical interventions were performed on the basis of the site involved. After surgical procedure, patients were treated with chemotherapy and followed up for one year to till date. The present study patients were from the age range of 19–75 years with female preponderance. The most common clinical presentation was irritative voiding symptoms (69.81%), haematuria and flank pain (56.60%, each). The most commonly affected organ was kidney (62.26%) following ureter (30.19%), urinary bladder (24.53%), prostate (9.43%) and epididymis (1.89%). The urine AFB smear and urine culture for M. tuberculosis tests were positive in 13.18% and 54.71% of patients, respectively. Surgical interventions were done in majority (75.47%) of patients. Accurate and early diagnosis is vital for the better management of patients with GUTB. Apart from the available course of chemotherapy, surgical intervention is also required for complete management. [ABSTRACT FROM AUTHOR]

Introduction: Horseshoe Shaped (HSK) Kidneys are often asymptomatic and are frequently diagnosed incidentally. The prevalence varies from approximately 1 in 400 to 600 with preponderance in males (male: female ratio of 2:1). This abnormality can affect the drainage of the kidney leading to Pelviureteric Junction Obstruction (PUJO), renal calculi, urinary tract infections and some renal cancers. The superficial location also makes it more vulnerable to injury during trauma or surgical procedures. Aim: To assess the prevalence of HSK and report their morphological features as evidenced following examination with a 64-slice Computed Tomography of the Kidney and Urinary Bladder (CT KUB). Materials and Methods: A retrospective study was conducted in the Department of Radiology, Sri Muthukumaran Medical College and Hospital, Chennai from January 2017 to December 2018. The study included 861 patients who underwent 64 slice CT KUB during that period and review of both plain and contrast enhanced CT KUB examinations were done. For deciding the fusion site, the isthmus, the authors measured a maximum diameter of the outline of the HSK on the axial image and decided the center of the kidneys. The HSK was classified based on fusion site and type of isthmic tissue connecting two kidneys. Results: HSK was found in 4 (3 male and 1 female) out of 861 patients examined. Thus the prevalence of HSK in the study population was 1 in 215 (0.46%). Two patients with a thick isthmus and anteriorly facing pelvises had PUJO and urolithiasis. Variant vascular anatomy was found in all four patients. No crossed fused ectopia was found in this study. Conclusion: This study showed that HSK is the most common congenital fusion anomaly and is more common in males. It also demonstrated that patients with a thick isthmus and associated anteriorly facing renal pelvises were more prone to develop PUJO and renal calculi. [ABSTRACT FROM AUTHOR]

Introduction: In a country like India, where ultrasonograms are an important part of the diagnostic and monitoring protocol of a pregnant female, obstetric sonograms are the go-to modality for fairly accurate gestational age detection incorporating multiple parameters. We conducted the present study to analyse the use of fetal kidney length for estimation of the gestational age as a discrete as well as adjunct parameters. Material and Methods: In present study, sonographic assessment of 95 women with single intrauterine pregnancies was done. Kidney length (KL) was measured as maximum cranio-caudal length in all patients. Other parameters like head circumference(HC) and femur length(FL) were assessed . The data was analysed with IBM SPSS Statistics software. Chi- square test and student t test were done to assess of level of significance. Results: The mean kidney length was found to be varying from 25.35±2.52 mm at 24-26 weeks to 39.17±2.22 mm at 36-38 weeks. as the gestational age progressed, a linear correlation between the kidney length and the gestational age was appreciated. Conclusion: Fetal kidney length can be used as an adjunct and potential discrete parameter in estimation of fetal gestational age in late second and third trimester. [ABSTRACT FROM AUTHOR]

Introduction: The spectrum of renal disorder in the elderly differs from the younger population. There is a paucity of literature regarding kidney biopsy in elderly. This study aims to highlight the clinical profile and histopathological spectrum of the elderly patient undergoing a renal biopsy. Materials and Methods: This retrospective study included all patients (age ≥60 years) undergoing native renal biopsies from January 2012 to December 2017. The clinical profile, laboratory parameters, and renal biopsy findings of these patients were recorded from the case files. Results: Out of 1656 renal biopsies performed during the study period, 230 (13.9%%) performed on the elderly were included. Mean age was 64.02 ± 7.87 years (Range: 60-87 years), and males were predominant (70.4%). The commonest indication for biopsy was nephrotic syndrome (NS) (49.6%) followed by Rapidly progressive renal failure (RPRF) (20.9%) and Acute Kidney Injury (AKI) (15.7%). The most frequent histological diagnosis was membranous nephropathy (15.2%) followed by amyloidosis (13.9%) and Focal Segmental Glomerulosclerosis (FSGS) (13.0%). The commonest cause of NS was MGN (29.8%) followed by FSGS (24.6%) and amyloidosis (22.8%). The commonest cause of nephritic syndrome was Diffuse Proliferative Glomerulonephritis (29.4%) and Membranoproliferative Glomerulonephritis (29.4%). Hypertensive nephrosclerosis (40.0%) and diabetic nephropathy (26.7%)) were the commonest histological diagnosis in the patients who underwent renal biopsy for clinical Chronic kidney disease. Crescentic GN (35.4%) and Myeloma cast nephropathy 14.6%) were the commonest cause of RPRF while Acute Tubular Necrosis (41.7%) was the commonest cause of AKI. None of the patients had major complications. Conclusion: Renal biopsy is safe in the elderly and provides a wealth of information with regards to the diagnosis and prognosis of renal disorder. [ABSTRACT FROM AUTHOR]

To study the trend among Indian women living kidney donation over the past 18 years and see if a gender bias still exists as described in literature before. This is a retrospective, single-center, observational cohort study with data collected from the medical records department of all living donor kidney transplants between January 2001 to December 2018, which were categorized into 2 groups of 9 years each for comparison using categorical variables in form of number, percentage, χ2 test, and Pearson correlation coefficient. A total of 557 kidney transplants were analyzed, with women having 78.5% higher incidence of donation (P <.001). Among them, parents (72.20% mothers), spouses (87.20% wives), siblings (47.50% sisters), and children (44.44% daughters) were the major participants. Further analysis revealed wife donation reduced from 92.3% to 85.6% (P =.41) and mother donation reduced from 72.5% to 71.7% (P =.91), whereas sister donation increased from 28.5% to 51.5% (P =.14) and daughter donation increased from 0% to 44.4% during the 18-year period. Also, female to male donation decreased from 63.8% to 51.6% (P =.02) during the same period. Thus, the overall percentage of female donation is decreasing (73.9% to 61.4%, P =.01), and a significant negative correlation with time was observed in this study (correlation coefficient, r = −0.55, P =.017). A lot has changed over the past 18 years, with more male kidney donors now coming forward. Larger prospective studies are required to understand the diverse reason for this sex discrepancy. [ABSTRACT FROM AUTHOR]

Aim: Melioidosis, caused by Burkholderia pseudomallei, is an important disease in some parts of the developing countries and is now categorized as an emerging infection and a global threat. The present study was carried out to ascertain the alterations on the hematological, hepatic, and renal parameters in the infected people. Materials and Methods: This was a retrospective study and was conducted in a tertiary care hospital in India. Data were analyzed in people who were diagnosed to be infected by B. pseudomallei during January 2010–December 2016. A total of 28 people were included in the study and compared with healthy individuals who were tested negative for any infectious and chronic diseases. Results: The results indicated that the infection caused diverse clinical manifestations such as fever, cough, dyspnea, joint pain, headache, bodyache, weight loss, swelling, and decrease in appetite. There was significant difference in the various hematological and hepatic endpoints, while there was no such difference in the renal function test parameters. Conclusions: For the first time, this study indicates that acute infection with melioidosis causes alterations in hematological and hepatic parameters in people with melioidosis. [ABSTRACT FROM AUTHOR]

This article is a response to a previous study on the possible link between birth weight, high temperatures, and the development of chronic kidney disease of unknown cause (CKDu). The authors discuss their ongoing research on kidney tissue gene expression and proteomics in CKDu patients, hoping to uncover the mechanisms behind the disease. They also agree with the suggestion to assess glomerular density and volume in future studies. Additionally, the authors acknowledge the impact of high temperatures on birth outcomes and the potential influence of global warming on CKDu. They emphasize the need for further epidemiological studies on these topics. [Extracted from the article]

Cleistanthus collinus is a poisonous shrub used for deliberate self-harm in rural areas of South India and intake of boiled decoction of leaves is a common method of self-harm. Distal renal tubular acidosis (dRTA) is an important clinical symptom observed in C. collinus poisoning, and renal V-ATPases may be potential targets of damage. However, a lack of understanding of molecular mediators involved hampers medical management, which is mainly supportive. We hypothesized that C. collinus poisoning induces renal oxidative stress; probably by inducing mitochondrial uncoupling, which compromises V-ATPase activity to ultimately produce dRTA. This was tested by exposing renal BBMV, kidney cells in culture, and Wistar rats to C. collinus poisoning. Exposure to C. collinus aqueous extract resulted in significant elevations in the lipid peroxidation marker, conjugated dienes, in cell culture and in vivo. A significant decrease in mitochondrial respiratory control ratio was observed in kidneys from C. collinus-treated animals suggesting that mitochondrial oxidative phosphorylation is uncoupled. This was accompanied by significant increase in ADP levels and a decrease in proton pump activity. Thus, these results demonstrate that C. collinus poisoning induces oxidative stress which influences proton pump activity, probably due to feedback inhibition by elevated ADP levels because of mitochondrial dysfunction in the rat kidney. [ABSTRACT FROM AUTHOR]

Objective: To assess renal unit survival and factors affecting renal salvageability in a cohort of patients receiving modern medical and surgical therapy for urinary tuberculosis. Methods: This was a retrospective single‐center study including all patients diagnosed and treated as urinary tuberculosis between 2005 and 2015 at Christian Medical College, Vellore, Tamil Nadu, India. The primary outcome was time to renal unit non‐salvageability (estimated glomerular filtration rate of <15 mL/min). Results: A total of 128 patients were included in the study. The mean age was 37.7 ± 11.3 years, 33% had microbiological and 73% had histopathological confirmation in addition to radiological diagnosis. The estimated median survival of the involved renal units (n = 187) on Kaplan–Meier estimate was 75 months (95% CI 39–99). On multivariate analysis, renal units with initial split function >15 mL/min had fivefold the survival estimate as compared with those ≤15 mL/min (P < 0.001); the presence of one, two and three infundibular strictures had a 2.2‐, 2.9‐ and fivefold higher hazard of renal unit loss respectively, and lower ureteric strictures had fivefold longer estimated survival (P = 0.015) after treatment. Renal units in the reconstruction group had 5.44‐fold (95% CI 2.71–10.88, P < 0.001) longer survival than the permanent diversion group, with a mean change in split function of +0.76 (±16.11) mL/min, versus −5.61 (±10.87) mL/min respectively. Conclusions: Loss of renal units is a function of time despite modern treatment. Baseline renal unit function, site of ureteric involvement and extent of infundibular involvement on imaging are helpful in predicting the duration of renal salvageability. When feasible, reconstruction is better at renal function preservation. [ABSTRACT FROM AUTHOR]

The objective of this study was to develop baseline topographical data of landmarks for locating kidneys and urinary bladder and to generate sonographic calliper measurements along with dynamic parameters of these organs. Ultrasonography was performed on 50 native adult (Spiti horses and Himalayan hill mules) healthy unsedated equines of either sex. The thickness, character and echo-architecture of these organs were recorded. The right kidney was found from 15th (±1) intercostal space (ICS) extending upto first lumbar vertebra, both in horses as well as in mules. The height of right kidney varied from 112.7 to 118.3 mm (Mean± SE= 115.6±1.01 mm) and its thickness varied from 58.4 to 71.2 mm (Mean± SE= 64.3±2.37 mm). While in mules height of right kidney varied from 90.7 to 109.2 mm (Mean± SE= of 101.1±3.14 mm) and its thickness varied from 47.3 to 56.8 mm (Mean± SE= 52.3±1.57 mm). The left kidney in horses was found between 16th ICS to 2nd lumbar vertebra, while in mules it was found from 16th ICS to 3rd lumbar vertebra. The height of left kidney varied from 87 to 107.8 mm (Mean± SE= 99.0±3.67 mm) and its thickness varied from 49.5 to 53.8 mm (Mean± SE= 51.8±0.72 mm). In mules the height of left kidney varied from 85.5 to 111.4 mm (Mean± SE= 95.3±2.36 mm) and its thickness varied from 43.4 to 55.7 mm (Mean± SE= 50.6±2.53 mm). During transrectal ultrasonography urinary bladder was observed as an oval to round structure in the caudal ventral abdomen, the wall thickness of urinary bladder varied from 2.7 to 2.8 mm (Mean± SE= 2.74±0.02 mm), 2.4 to 2.7 mm (Mean± SE= 2.62±0.05 mm) in horses and mules respectively. Hence detailed ultrasonographic examination of these organs helped us to compile baseline data, which will be helpful in future in management of the affections of these organs. [ABSTRACT FROM AUTHOR]

Study Objective: This study was undertaken to compare the analgesic efficacy of ultrasound-guided single-shot caudal block with ultrasound-guided single-shot paravertebral block in children undergoing renal surgeries.Design: Randomised, interventional, blinded clinical trial.Setting: Operating rooms of All India Institute of Medical Sciences, New Delhi, India.Patients: 50 children aged 2-10 years, of ASA status I/II, posted for elective renal surgeries.Interventions: The children were randomised into two groups (Group C-caudal block, Group P-paravertebral block). After induction of general anesthesia, single-shot caudal or paravertebral block was performed under ultrasound guidance, with 0.2% ropivacaine with 1:200000 adrenaline.Measurements: Time to first rescue analgesia, time to perform blocks, intraoperative and post-operative hemodynamics, post-operative FLACC scores, incidence of complications, parental satisfaction scores were recorded.Main Results: Children in Group P had significantly longer duration of analgesia (p < 0.0004) than Group C. Post-operative FLACC scores (p < 0.005) and analgesic requirements (p < 0.0004) were lower in Group P. The mean fentanyl requirement over 24 h in group P was 0.56 ± 0.82 μg/kg, compared to 1.8 ± 1.2 μg/kg in group C. Parents in Group P reported greater satisfaction (p < 0.02). No complications were seen in either of the groups.Conclusion: This study showed superior analgesia and parental satisfaction with single-shot paravertebral block in comparison to single-shot caudal block for renal surgeries in children. However, the block performance in children requires adequate expertise and practice. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the role of percutaneous nephrostomy (PCN) in patients of carcinoma bladder presenting with obstructive uropathy. Material and Methods: We evaluated medical records of 33 patients of bladder cancer with obstructive uropathy that presented to a tertiary care hospital in north India from January 2015 to December 2016. Outcome measures included technical success rates, change in blood urea and serum creatinine (measured on Day 1, 7, and 14); and complications of PCN according to Society of Interventional Radiology Guidelines for Percutaneous Nephrostomy. Results: PCN was done in 30 patients. The mean age of patients was 51 years (range 42-67). 24 patients were male and 6 patients were female. The technical success rates for PCN placement were 93.33%. In 12 patients there was no improvement after PCN insertion. Improvement in clinical condition/kidney function occurred in 18 patients. Out of these 6 patients underwent radical cystectomy with ileal conduit formation and palliative radiotherapy/chemotherapy was given to 5 cases. In the remaining 7 patients, after an initial improvement that lasted for 2 weeks after PCN progressive renal dysfunction developed due to malignancy. Minor complications of PCN were seen in 16.6% of patients and major complications were seen in 10 % of cases. Conclusion: In selected patients with bladder carcinoma with obstructive uropathy, PCN insertion may improve kidney function tests to normal levels and enable them to receive tumor-specific curative/palliative treatment. [ABSTRACT FROM AUTHOR]

Focal segmental glomerulosclerosis (FSGS) is a disease that is defined entirely by its histopathological appearance. The recent Columbian classification has grouped this disease into various types based on the light microscopic description. There is a paucity of data describing the distribution of its various subtypes from the Indian subcontinent. This study was undertaken with the aim to throw light on the epidemiology and clinical features of primary FSGS in Eastern India. This retrospective study includes our cohort of biopsy-proven FSGS who presented to us from June 2009 to July 2011 and the analysis of their presenting clinical and histopathological features from our center in East India. Out of 347 patients diagnosed with FSGS in this period, 224 patients were included in the study. A total of 167 cases were of not otherwise specified (NOS) variant (74.5%), 30 tip variant (13.39%), 14 perihilar (6.25%), 8 cellular (3.57%), and 5 to the collapsing variant (2.23%). The maximum proteinuria at presentation was seen with the tip variant (7.98 ± 6.6 g/24 h), and the renal functions were most deranged at presentation with the collapsing variant. These findings were different from those described in other populations including higher prevalence of the tip and the perihilar variant, significant difference in the degree of hypertension, proteinuria, and renal dysfunction among the different variants. The Columbian classification has helped to stratify the outcomes of this glomerular disease with respect to its clinical presentation as well as histopathological features. However, the characteristics of the various variants do show a distinctive pattern in various populations based on ethnicities. [ABSTRACT FROM AUTHOR]

Background: Horseshoe kidney (HSK) is a common renal fusion anomaly. We undertook this study to discuss various anomalies associated with HSKs. The objective of the study is to study various anomalies associated with HSKs and to assess the need for surgical intervention in patients with these anomalies.Patients and Methods: This is a retrospective cohort study of twenty patients who presented to our institute with the diagnosis of HSKs. The data were analysed with regard to age at presentation, symptoms, associated anomalies, investigations and surgical intervention.Results: Twenty patients were included in this study. They were referred either with a diagnosis of HSK or were diagnosed during investigations for symptoms and during workup for associated anomalies. Eleven patients were incidentally diagnosed and were asymptomatic, and there were no associated anomalies diagnosed in these patients. Nine patients were symptomatic and were diagnosed with various associated anomalies. Our results concur with recent literature review which suggests that nearly half of the patients with HSKs have associated anomalies. In the present series, all symptomatic patients with associated anomalies required surgical intervention.Conclusion: HSKs being a common fusion anomaly, necessitates a prompt and thorough search of the search for any associated anomalies. Many of these anomalies may require surgical intervention. [ABSTRACT FROM AUTHOR]

The presentation of primary hyperparathyroidism (PHPT) is variable throughout the world. The present study explored retrospective data submitted to the Indian PHPT registry ( http://www.indianphptregistry.com ) between July 2005 and June 2015 from 5 centres covering four different geographical regions. The clinical, biochemical, radiological and histopathological characteristics of PHPT patients across India were analysed for similarity and variability across the centres. A total of 464 subjects (137 men and 327 women) with histopathologically proven PHPT were analysed. The mean age was 41 ± 14 years with a female:male ratio of 2.4:1. The majority (95%) of patients were symptomatic. Common clinical manifestations among all the centres were weakness and fatigability (58.7%), bone pain (56%), renal stone disease (31%), pancreatitis (12.3%) and gallstone disease (11%). Mean serum calcium, parathyroid hormone and inorganic phosphorus levels were 11.9 ± 1.6 mg/dL, 752.4 ± 735.2 pg/mL and 2.8 ± 0.9 mg/dL, respectively. Sestamibi scanning had better sensitivity than ultrasonography in the localisation of parathyroid adenoma; however, when these two modalities were combined, 93% of the cases were correctly localised. Mean parathyroid adenoma weight was 5.6 ± 6.5 g (0.1-54 g). It was concluded that the majority of PHPT patients within India are still mainly symptomatic with >50% of patients presenting with bone disease and one-third with renal impairment. Compared to Western countries, Indian patients with PHPT are younger, biochemical abnormalities are more severe, and adenoma weight is higher. As our observation is largely derived from a tertiary care hospital (no routine screening of serum calcium level), the results do not reflect racial differences in susceptibility to PHPT. [ABSTRACT FROM AUTHOR]