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Introduction: Improvement in the standard of care of Thalassaemia by regular blood transfusion increases life expectancy. Multiple transfusions with concurrent iron overload and chronic anaemia, leading to tissue-level hypoxemia, cause significant renal dysfunction. Microalbuminuria is a sensitive marker of glomerular damage, and studies in thalassemic children have demonstrated variable prevalence rates of microalbuminuria. Aim: To study the prevalence of microalbuminuria and its association with clinical and laboratory parameters in children with Beta Thalassaemia Major (BTM). Materials and Methods: A cross-sectional study was conducted from January 2018 to June 2019 at Indira Gandhi Institute of Child Health, Bangaluru, Karnataka, India. A total of 155 children with Beta Thalassaemia Major (BTM) aged 2-18 years, attending the Thalassaemia Day Care Centre, were included in the study. Their demographic details such as age, gender, clinical parameters like frequency of transfusions, type of chelation therapy, height, weight, Body Mass Index (BMI), organomegaly, and laboratory parameters like serum creatinine, ferritin, pretransfusion Hb%, and Urinary Microalbumin Creatinine Ratio (UMCR) were studied as per a predesigned proforma. The association between microalbuminuria with clinical and laboratory parameters was evaluated using the independent sample T-test or Mann-Whitney U test and Chi-square/Fischer's-exact test. Results: A total of 155 children with BTM were studied. In the present study, out of a total of 155 patients, microalbuminuria was found in 66 (42.6%). A significant increase in the prevalence of microalbuminuria was observed as the age advanced, as the frequency of blood transfusions increased, with low pretranfusion haemoglobin (g%), and with elevated serum ferritin. Conclusion: In the present study, the prevalence of microalbuminuria was found to be 42.6%. Screening for microalbuminuria is recommended in all children with beta thalassaemia major for the early detection of renal dysfunction, prevention of disease progression, and improvement in the quality of their lives. [ABSTRACT FROM AUTHOR]

Background and Aim: Kidney dysfunction is reported in significant number of beta thalassemia major children. The aim of this study was to determine the prevalence of glomerular dysfunction in beta-thalassemia major children on regular blood transfusion (BT) and chelation therapy, and to find the correlation between glomerular filtration rate (GFR) estimated by Schwartz formula and Technetium 99m diethylenetriaminepentaacetic acid (99mTc-DTPA) renogram with ferritin level and cumulative transfusion load. Materials and Methods: An observational cross-sectional study conducted was done on 110 children diagnosed with beta-thalassemia major receiving regular BT and chelation therapy. Clinical examination, biochemical investigations (serum creatinine, ferritin) and DTPA renal scan were done. Estimated GFR calculation was done by Schwartz method and 99mTc-DTPA scan. The normal values of GFR were taken from the standard value as per KDIGO guidelines. P < 0.05 was considered statistically significant. Results: The prevalence of glomerular dysfunction by Schwartz formula and DTPA renogram was 44% and 24%, respectively. The GFR calculation (Schwartz formula and DTPA renogram) were weakly positively correlated (r = 0.126, P = 0.547). There was significant association between GFR Schwartz and duration of iron chelation, as children with abnormal GFR had significantly more duration of iron chelation >5 years (28% vs. 4%, P = 0.003). GFR (Schwartz formula and DTPA renogram) showed no association with cumulative transfusion load and disease duration (P > 0.05). GFR Schwartz formula and GFR-DTPA showed no correlation with serum ferritin with r = 0.179, (P = 0.392) and r = 0.278 (P = 0.178). Conclusion: There is a significant derangement in the renal function of children of beta-thalassemia major on chronic BT and iron chelation therapy. GFR holds a direct correlation with the increasing duration of iron chelation. [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: Perinatal asphyxia is relatively a significant etiology of morbidity and mortality among the neonates in various developing countries like India. Therefore the incidence of developing perinatal asphyxia in developed countries is observed to be 2 per 1000 live births but this rate is 10 times higher in many of the developing countries since there is inadequate access to the neonatal and maternal care. Hence the present study has been conducted to evaluate the renal function among the term neonates reported with perinatal asphyxia. Materials and Methodology: Throughout the study, veracity is well-maintained at any cost and the study participants are free to withdraw from the study at any time during the study progress. All the study participants were informed about the study procedure and a written informed consent is obtained from their parents/guardians. It will be taken in accordance with the principles of declaration of Helsinki as revised in 2013. This study has been intended to be carried out in Neonatal Intensive care unit (NICU, RIMS, Raichur) and this study has been adopted as a prospective case control study. The collected data were transformed into variables, coded and entered in Microsoft Excel. Quantitative data was expressed in mean ± standard deviation or median with interquartile range and depends on normality distribution difference between two comparable groups. Results: Out of 102 newborns were observed to be suffering from perinatal asphyxia, 73 (72%) were males and 29 (28%) were female neonates. A total of 33 (32%) newborns had reported with severe birth asphyxia (Apgar score 0-3 at 1 minute of life) and 69 (68%) had moderate birth asphyxia (APGAR score 4-6 at minute of life). When observed on the day-1, average serum urea and creatinine were seem to be 20.09±14.54 mg/dL and 0.88±0.51 mg/dL and the urine output was found to be 1.27±0.43 mL/kg/hr. Conclusion: The renal impairment in perinatal asphyxia could be effectively used as an early predictor or disease severity and are quite helpful in the early management and routine vigorous monitoring of the neonates. [ABSTRACT FROM AUTHOR]

Background: Multiple myeloma (MM) is the second most common hematological malignancy after non-Hodgkin lymphoma. The clinical spectrum varies from asymptomatic forms to manifestations of anemia, bone pains, and eventually spontaneous fractures, renal failure, and frequent infections. Aims and Objectives: The aims and objectives of the study are to assess the clinical and biochemical parameters in newly diagnosed cases of MM. Materials and Methods: This study was conducted in the Department of Clinical Hematology of a tertiary care hospital of North India. It was a prospective observational study over a period of 2-year duration. A total of 50 newly diagnosed patients of MM were enrolled and analyzed for clinical data. Results: Out of 50 MM patients, 68% were males and 32% were females. Mean±SD of age was 62.48±8.140 years. Forty patients (80%) had anemia (isolated anemia 4 patients), 22 patients had renal failure (44%), 20 patients (40%) had spontaneous fractures (isolated pathological fracture 6 patients), and 14 patients (28%) had bone pains (isolated bone pains 4 patients). Mean±SD of hemoglobin before the start of treatment was 8.69±2.85 g/dL. Twenty-six patients (52%) had associated comorbidity mainly hypertension (32%) and diabetes mellitus (8%), while 48% of patients had no history of previous comorbid illness. Immunoglobulin (Ig)G-λ type MM were 16 cases (32%), IgA-λ type were 6 cases (12%), IgG-κ were 10 cases (20%), IgA- κ were 4 cases (8%), Kappa type were 10 cases (20%), and biclonal 2 cases (4%). Twelve patients (24%) were in the International Staging System (ISS), 22 patients (44%) in ISS-II, and 16 patients (32%) in ISS-III disease stage. Conclusion: Treating physician should have a high index of suspicion for this disorder once elderly patients present with anemia, especially in combination with renal dysfunction and/spontaneous fractures for early diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background Sickle cell disease causes microvascular occlusion in different vascular beds. In kidneys, it leads to occult glomerular dysfunction causing asymptomatic microalbuminuria, proximal tubulopathy causing hyposthenuria and increased free water loss and distal tubulopathy causing poor urine acidification. We studied the prevalence of various types of renal dysfunction, the ability of different tests to detect it at an early stage and the correlation of these parameters in children receiving hydroxyurea (HU). Procedure Fifty-six children (sample size calculated using SAS9.2 package) attending paediatric clinical services in a tertiary care hospital between 2 and 12 years of age diagnosed by high-performance liquid chromatography (HPLC) were enrolled. Their demographic and laboratory data including renal and urine parameters were collected. Parameters like fractional excretion of sodium (FeNa), trans tubular potassium gradient (TtKg) and free water clearance (TcH2O) were derived by calculations. Data were analysed using IBM SPSS Version 21.0 and Microsoft Office Excel 2007. Results We found a significant number of children to have microalbuminuria (17.8%), hyposthenuria (30.4%) and impaired renal tubular potassium excretion (TtKg) (81.3%). A significant correlation was found between the dose of HU with urine osmolality (p  < 0.0005) and free water clearance (p  = 0.002), while all parameters showed a significant correlation with compliance with HU. Derangement in urine microalbumin and TcH2O correlated significantly with low mean haemoglobin levels (<9 g/dl). Conclusion Renal dysfunction is common in children with SCD and can be detected early using simple urine parameters and can be prevented with an early and appropriate dosage of HU with good compliance. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Kidney Disease (CKD) is common disorder showing decreased Glomerular Filtration Rate (GFR) value (<60 mL/min/1.73 m2). Because of limitations of creatinine as a biomarker of GFR, new alternative biomarkers are being investigated, such as Beta-Trace Protein (BTP) is low molecular weight proteins that are filtered by the glomeruli. Serum BTP have been shown to be more helpful for estimating GFR. Aim: To assess the role of Beta-Trace Protein (BTP) as a potential biomarker of Chronic Kidney Disease (CKD) in comparison to serum urea, serum creatinine, fasting blood sugar and Creatinine Clearance Rate (CCR). Materials and Methods: This case-control study was conducted at Government Medical College, Rajouri, Jammu and Kashmir, India, from February 2021 to December 2021. Total 50 known patients of kidney diseases and 50 healthy individuals above the age of 18 years were enrolled in the study. Blood samples were collected from all individuals and serum BTP, serum urea level, serum creatinine level, fasting blood sugar were measured. Correlation of BTP with serum urea level, serum creatinine level, Fasting Blood Glucose (FBG) level, and CCR was calculated by Pearson Correlation test. Results: In present study, 50 patients in case groups (33 male and 17 females) and 50 healthy controls (25 males and 25 females) were included. Among controls, the mean age of patients was 52.12±5.66 years and among cases 55.94±10.51 years. BTP level was increased two times (from 32.06±11.25 µg/ml to 66.36±27.80 µg/ml) in CKD patients than controls individuals. BTP level was positively correlated with serum urea level, serum creatinine level, and FBG level while negatively correlated with CCR. Conclusion: BTP may be a useful and reliable serum marker for identifying the magnitude of renal dysfunction in patients with CKD and may have its place beside serum creatinine as an alternative endogenous GFR marker. [ABSTRACT FROM AUTHOR]

Introduction: Renal dysfunction and progression to end stage renal disease is well known in human immunodeficiency virus (HIV) infection. We studied the role of microalbuminuria and urinary NGAL levels in children with HIV infection for the prediction of renal dysfunction. Design and Methods: A cross-sectional study was carried out and 60 HIV infected children, aged (18 months to 15 years) were screened for microalbuminuria by nephelometry and for uNGAL by ELISA. Thirty healthy children were screened for uNGAL for normative data in Indian children. Results: The prevalence of microalbuminuria in studied population was 3.3%. The mean uNGAL and uNGAL/creatinine in study population was higher than controls (26.94 ± 93.12 ng/ml vs. 88.94 ± 345.20 mcg/g, and 15.53 ± 37.52 ng/ml vs. 30.12 ± 78.66 ng/ml; P = 0.003, P = 0.002). Children with lower CD4 counts had significant higher mean Albumin Creatinine Ratio (ACR) and mean uNGAL; P = 0.03, P = 0.01. Conclusions: uNGAL and urine microalbumin are useful biomarkers of early tubular and glomerular injury in children with HIV infection. [ABSTRACT FROM AUTHOR]

Trypanosomiasis, an arthropod borne blood protozoan disease commonly known as Surra is caused by Trypanosoma evansi. Several species of hematophagous flies, including Tabanids and Stomoxys are implicated in transferring infection from host to host, acting as mechanical vectors. Trypanosomiasis is diagnosed based on the clinical evidences augmented with some parasitological methods. The "Office international des epizootics" categorized the disease under 'B' disease of significance (OIE, 2004). Surra in India is generally considered as a disease prevalent mostly in animals of Northern India (Soodan et al., 1995). The present case deals with the diagnosis of renal dysfunction associated with trypanosomiasis and its' successful therapeutic management in a mare. [ABSTRACT FROM AUTHOR]

Objective: The primary objective of this study is to estimate the prevalence of chronic kidney disease (CKD) among type 2 diabetes mellitus (T2DM) patients in India. Materials and Methods: This cross-sectional, observational, epidemiological, multi-center, study is enrolling T2DM patients of either gender aged 30 years or above. This study aimed to enroll a total of 3000 T2DM patients at 30 participating hospitals/clinics across India and the data from a planned interim analysis of 1500 patients are presented here. The primary endpoint of the study is to estimate proportion of T2DM patients with CKD (glomerular filtration rate [GFR] <60 ml/min/1.73 m² or albumin creatinine ratio [ACR] ≥30 mg/g or ≥3 mg/mmol or both). Routine treatment, as administered by the treating physician, was continued without any study specific intervention. Patients' data pertaining to demographic characteristics, medical history, current medication and physical examination were recorded. The blood/plasma and urine samples, were collected for estimation of hemoglobin A1c, microalbuminuria, serum creatinine, urine creatinine, and routine urine analysis. ACR was calculated from urine creatinine and albumin while GFR was estimated by using a modification of diet in the renal disease equation. Results: Study recruited 1500 patients from 18 centers across India. The study population included 840 (56.05%) males. Mean age, body mass index and systolic blood pressure were 55.1 years, 27.4 kg/m² and 134.5 mmHg respectively. The mean duration of diabetes was 102.2 months. History of co-morbid diseases such as dyslipidemia, hypertension, microvascular complications and macrovascular complications was present in 657 (43.8%), 655 (43.7%), 268 (17.9%) and 104 (6.93%), respectively. This interim analysis revealed that about 46% of the T2DM patients had CKD (urinary albumin creatinine ratio (UACR) ≥30 mg/g and/or estimated GFR [eGFR] <60 mL/min/1.73 m²). The renal dysfunction as per eGFR criteria (<60 mL/min/1.73 m²) was reported in about 23% while as per UACR criteria (≥30 mg/g) it was reported in about 35% patients. Conclusion: This interim analysis results suggests that over 40% of T2DM patients have CKD. Despite this high number of T2DM patients with CKD, eGFR analysis shows there are almost 80% of T2DM patients still have reasonably good renal function (eGFR above 60 ml/min), which ensures less restrictions in selecting oral anti-diabetic drugs. Full study results from Start-India study will provide detail insights into the occurrence of CKD in patients with T2DM in India. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance: Sida rhomboidea.Roxb (SR) known as “Mahabala” in Ayurveda and marketed as “Shahadeyi” is used in ethnomedicine to treat ailments such as dysuria and urinary disorders. Aim of the study: To evaluate nephroprotective potential of SR against gentamicin (GM) induced nephrotoxicity and renal dysfunction. Materials and methods: Nephrotoxicity was induced in rats with GM (100mg/kg bodyweight (i.p.) for 8 days) and were treated with SR extract (200 and 400mg/kg bodyweight (p.o.) for 8 days) or 0.5% carboxymethyl cellulose (vehicle). Plasma and urine urea and creatinine, renal enzymatic and non-enzymatic antioxidants along with lipid peroxidation were evaluated in various experimental groups. Results: GM treatment induced significant elevation (p <0.05) in plasma and urine urea, creatinine, renal lipid peroxidation along with significant decrement (p <0.05) in renal enzymatic and non-enzymatic antioxidants. SR treatment to GM treated rats (GM+SR) recorded significant decrement (p <0.05) in plasma and urine urea and creatinine, renal lipid peroxidation along with significant increment (p <0.05) in renal enzymatic and non-enzymatic antioxidants. Conclusion: SR leaf extract ameliorates GM induced nephrotoxicity and renal dysfunction and thus validates its ethnomedicinal use. [Copyright &y& Elsevier]

A number of patients of febrile thrombocytopenia increase during monsoon and postmonsoon period. Diseases like dengue fever, malaria, chikungunya fever, etc. are responsible for the clustering of febrile thrombocytopenia cases during this period. The diagnosis of fever with thrombocytopenia cases can be challenging and physicians should be aware of the regional and endemic seasonal cause of this syndrome., Study Design: It is a prospective observational study., Material and Methods: The study included 103 consecutive patients. The patients admitted with acute febrile illness defined by a duration of less than 2 weeks with thrombocytopenia were evaluated., Results: The present study included 103 consecutive cases of febrile thrombocytopenia. Out of these, 71.84% were male and 28.16% were female. The most common etiology for febrile thrombocytopenia was dengue fever (44.66%) and malaria (31.06%). Among clinical evaluation of the cases, fever was the inclusion criteria. Myalgia was the most common symptom found after fever, which was observed in 83.5% of the patients. The most common bleeding manifestation was petechiae/ purpura (12.62%) followed by hematuria (6.80%). Renal dysfunction was present in all 8(100%) cases of sepsis, followed by 14(43.75%) cases of malaria. All sepsis cases also had liver dysfunction, followed by 91.3% cases in dengue fever and 90.62 % cases in malaria had liver dysfunction., Conclusion: The study showed that acute febrile thrombocytopenia is an important seasonal syndrome. The common causes are dengue fever and malaria. Early identification of these diseases and prompt treatment decreases complications and reduces mortality., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Aim: The present study analysed the regular salt and macronutrients consumption of South Indian population with diabetes, hypertension and renal dysfunction., Methods: The cross sectional study was performed among 200 subjects, divided into four different groups consisted of control, subjects with type 2 diabetes (T2DM) without any other complications, T2DM subjects with chronic kidney disease (CKD) and T2DM subjects with hypertension (HTN). The dietary salt intake was estimated from 24-h urinary sodium excretion and the amount of macronutrients was calculated using 24-h dietary recall method., Results: Out of 200 study subjects, only 28 (14%) were consuming salt as per the recommended levels by WHO (i.e., 5-6 g/day). Thirty-eight (19%) subjects were consuming more than 18 g of salt per day, 67 (33.5%) were consuming 12-18 g of salt per day and another 67 (33.5%) were found to be consuming salt in a range of 6-12 g/day. Calorie contribution from the carbohydrates was significantly high compared to the calories from the proteins. Fat consumption and its corresponding energy contribution were also high among HTN group subjects., Conclusion: Observations of the study point out to the requirement of nationwide intensive and persistent efforts to enhance the public awareness on salt reduction., (Copyright © 2019. Published by Elsevier Ltd.)

Background: The prevalence and clinical significance of hyponatremia in cirrhotics have been well studied; however, there are limited data on hyperkalemia in cirrhotics., Aim: We evaluated the prevalence and prognostic significance of hyperkalemia in hospitalized patients with cirrhosis and developed a prognostic model incorporating potassium for prediction of liver-related death in these patients., Methods: The training derivative cohort of patients was used for development of prognostic scores (Group A, n = 1160), which were validated in a large prospective cohort of cirrhotic patients. (Group B, n = 2681) of cirrhosis., Results: Hyperkalemia was seen in 189 (14.1%) and 336 (12%) in Group A and Group B, respectively. Potassium showed a significant association that was direct with creatinine (P < 0.001) and urea (P < 0.001) and inverse with sodium (P < 0.001). Mortality was also significantly higher in patients with hyperkalemia (P = 0.0015, Hazard Ratio (HR) 1.3, 95% confidence interval 1.11-1.57). Combination of all these parameters into a single value predictor, that is, renal dysfunction index predicted mortality better than the individual components. Combining renal dysfunction index with other known prognostic markers (i.e. serum bilirubin, INR, albumin, hepatic encephalopathy, and ascites) in the "K" model predicted both short-term and long-term mortality with an excellent accuracy (Concordance-index 0.78 and 0.80 in training and validation cohorts, respectively). This was also superior to Model for End-stage Liver Disease, Model for End-stage liver disease sodium (MELDNa), and Child-Turcott-Pugh scores., Conclusions: Cirrhotics frequently have impaired potassium homeostasis, which has a prognostic significance. Serum potassium correlates directly with serum creatinine and urea and inversely with serum sodium. The model incorporating serum potassium developed from this study ("K"model) can predict death in advanced cirrhotics with an excellent accuracy., (© 2015 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Background: Contrast induced nephropathy (CIN) is associated with significant morbidity and mortality after percutaneous coronary intervention (PCI). The aim of this study is to evaluate the collective probability of CIN in Indian population by developing a scoring system of several identified risk factors in patients undergoing PCI., Methods: This is a prospective single center study of 1200 consecutive patients who underwent PCI from 2008 to 2011. Patients were randomized in 3:1 ratio into development (n = 900) and validation (n = 300) groups. CIN was defined as an increase of ≥25% and/or ≥0.5 mg/dl in serum creatinine at 48 hours after PCI when compared to baseline value. Seven independent predictors of CIN were identified using logistic regression analysis - amount of contrast, diabetes with microangiopathy, hypotension, peripheral vascular disease, albuminuria, glomerular filtration rate (GFR) and anemia. A formula was then developed to identify the probability of CIN using the logistic regression equation., Results: The mean (±SD) age was 57.3 (±10.2) years. 83.6% were males. The total incidence of CIN was 9.7% in the development group. The total risk of renal replacement therapy in the study group is 1.1%. Mortality is 0.5%. The risk scoring model correlated well in the validation group (incidence of CIN was 8.7%, sensitivity 92.3%, specificity 82.1%, c statistic 0.95)., Conclusion: A simple risk scoring equation can be employed to predict the probability of CIN following PCI, applying it to each individual. More vigilant preventive measures can be applied to the high risk candidates., (Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)