Search

Monoclonal gammopathy of renal significance (MGRS) is where kidney injury occurs due to the accumulation or effects of abnormal monoclonal proteins. These proteins, originating from non-cancerous or pre-cancerous plasma cells or B cells, deposit in specific areas of the kidney. Mechanisms contributing to MGRS include high levels of vascular endothelial growth factor secretion, autoantibodies targeting complement components, and targeting specific receptors leading to nephropathy. Kidney lesions in monoclonal gammopathy of renal significance (MGRS) are classified based on the presence of organized or nonorganized deposits, including fibrillar, microtubular, or crystal inclusions. Kidney biopsy is essential for confirming the diagnosis of MGRS by identifying monoclonal immunoglobulin deposits. Immunofluorescence helps determine the class of light and/or heavy chain involved in MGRS. The treatment approach is clone-directed and hence it depends on the presence of B cell clone or plasma cell clone or any detectable monoclonal protein. Chemotherapy targeting plasma cell or B cell malignancies and autologous hematopoietic cell transplantation may be used to manage MGRS. Kidney outcomes in MGRS patients strongly correlate with the hematologic response to chemotherapy.

Depression is the most common psychiatric disorder in patients on hemodialysis. An imbalance between proinflammatory and anti-inflammatory cytokines is thought to play a role in the pathogenesis of depression in patients on dialysis. We undertook this study to assess the correlations of the proinflammatory cytokine interleukin 6 (IL-6) and the anti-inflammatory cytokine IL-10 with depression in patients on maintenance hemodialysis. This cross-sectional observational study was carried out at our hospital, a tertiary care referral government teaching hospital, over 2 years. Depression was assessed using the Becks Depression Inventory score. A higher cutoff of >16 was taken for a diagnosis of depression. Clinical, demographic, and laboratory parameters were analyzed. Cytokines were assessed using enzyme-linked immunosorbent assays. Eighty patients satisfied the inclusion criteria. The prevalence of depression in our study was 41.5%. Depression was more common in those who were unemployed and/or illiterate. Mild depression was found in patients from the upper-lower and lower-middle classes, but severe depression was seen in lower-economic classes. Serum levels of IL-6 showed a positive correlation with the severity of depression. Depression was common in patients on maintenance hemodialysis. High levels of serum IL-6 were observed in those with depression. Depression in patients on maintenance hemodialysis is associated with a considerable risk of mortality.

To analyze the outcomes of severe acute kidney injury in patients with paraquat ingestion. This retrospective analysis of case records was done in our institute, a tertiary care government teaching hospital, over a period of 4 years. Of the total 1310 acute paraquat poisonings during this period, severe acute kidney injury (AKI), referred for nephrology management was observed in 60 patients. Common symptoms at presentation include vomiting, oral ulcers, and abdominal pain. Oliguric AKI was present in 26%. Need for renal replacement therapy was observed in 95% of the cases. Mortality was observed in 38 of the 60 patients (68%). Factors associated with mortality on Cox regression analysis include amount of consumption. Estimated duration of survival on analysis curves was 8 days in 50% after admission and 15 days after consumption in 50%. Paraquat poisoning is associated with grave outcomes of morbidity and mortality. Severity of AKI is significant in this poisoning. Amount of consumption, latency of referral play a major role in outcomes.

Abstract. In Chronic Kidney disease (CKD) there are various abnormalities in hormonal levels that lead to impairment of sexual functions, fertility, and pregnancy outcomes. Sex hormonal dysfunction not only affects the sexual aspect of human life but has a direct and indirect impact on other aspects like bone health, the central nervous system, and cognitive function. In this study, we looked at the testosterone and gonadotropins levels and their correlation with the quality of life using the SF-36 form. Methods. In this cross-sectional observational study, we included 50 male patients on hemodialysis (HD) with a dialysis vintage of at least 6 months. Serum testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were done from the mid-week pre-hemodialysis sample. Other hematological and biochemical parameters were assessed as well. Quality of life was assessed using the SF-36 form. Further analysis was done to find the correlation between SF 36 score and hormonal levels. Results. The mean age of our patients was 34.86±8.12 years and dialysis vintage was 24.24±18.74 months. The mean serum LH level was 8.58±3.56 mIU/ml, the mean serum FSH level was 8.9±4.05, and the mean testosterone was 217.46±96.44 ng/dl. In our study 15 patients (30%) had normal testosterone levels >270 ng/dl, 35 patients (70%) had low testosterone level (

With the declaration of severe acute respiratory syndrome novel coronavirus-2019 as pandemic by the World Health Organization on March 11, 2020, there has been a steady rise in number of cases. Chronic kidney disease and dialysis population are risk factors for increased severity of illness. Literature about the coronavirus disease 2019 (COVID-19) in dialysis population is scarce. Management of COVID-19 patients in resource poor setting in a developing country does vary compared to developed nations. Nonavailability of the advanced laboratory facility and the newer medicines forces the treating team to manage the patients with available investigations and drugs. We aimed at analysis of clinical characteristics and outcomes of 84 patients on maintenance hemodialysis (HD). Data of all COVID-positive patients on maintenance HD, who were referred to our center were collected. All patients were given HD on NIKISSO machines. Outcomes of all the admitted patients were analyzed. Maintenance HD group formed majority of the kidney referrals (54%). Age group that was commonly affected was >50 years. Factors associated with mortality were age, diabetes, thrombocytopenia, prolonged baseline activated partial thromboplastin time, admission hypoxemia, high qSOFA score. Institutional Ethics Committee approval has been obtained for the study. Methodology of the study was in accordance with the Declaration of Helsinki. Verbal consent was obtained from patients/ attendants. In the ongoing COVID pandemic, in a developing nation where resources are constrained, it is difficult to salvage the critically ill patients. With the drugs available and the changing strategies, treatment was given to all the patients admitted with bedside renal replacement therapies. Our mortality rate was high compared to other studies due to delay in referral, admission hypoxemia, and late initiation of steroids.

When the transplant act was brought in by the Central Government of India, the number of centers performing organ transplants and the number of patients undergoing transplants were much lesser compared to the present-day statistics. Knowing that the shortage of organs is the driving force behind illegal organ trade, strategies for legal and ethical expansion of the donor pool should be framed. Although Transplantation of Human Organs Act (Amended 2011 and Transplantation of Human Organs and Tissues Act Rules 2014) included swap transplantation and laid down certain rules for empowerment of deceased donor organ transplantation, certain changes are the need of the hour to expand the donor pool. Safeguarding the physicians' security and the recipient and donor rights is of prime concern in the process of organ transplantation. The present Act needs certain changes which clearly define the legal definition of brain death, legal issues involved in brain death, ethical and legal means of expansion of donor pool, and objective assessment of altruism.

Pregnancy is identified as one of the risk factors for increased severity of illness in severe acute respiratory syndrome novel coronavirus 2019 infection. The severity of illness may range from mild infection to severe multi-organ failure. Acute kidney injury (AKI) may occur in pregnant patients with coronavirus disease (COVID) either due to obstetric cause or due to severe COVID illness. We report six cases of COVID–pregnancy with AKI and their outcomes.

Cognitive impairment (CI) is common in patients with chronic kidney disease, and its prevalence increases in patients on hemodialysis (HD). Different factors were identified to be the cause of cognitive dysfunction, of which Vitamin D, which is known to have pleiotropic effects, has been implicated for the neurocognitive decline of functions. We assessed the prevalence of cognitive dysfunction in patients on HD in our center and also studied the deficiency of Vitamin D on CI.

Introduction: Echocardiography is a simple and established method of evaluating cardiac functions, assessing left ventricle geometry, and systolic and diastolic functions. Patients with chronic kidney disease have a tremendous burden of cardiovascular disease (CVD), and patients with end-stage renal disease (ESRD) are at a greater risk of CVD and deaths. Materials and Methods: In this study, 245 incident dialysis patients were included, and none of the patient was on erythropoietin. All the patients were aged >18 years. Patients with ESRD, already on maintenance dialysis, were not included in this study. Patient’s data such as demographic details, comorbidities, laboratory values, echocardiographic changes, management, and outcome were recorded. Results: Out of 245 patients, 165 (67.3%) were males and 80 (32.6%) females. The mean age of the patients was 49.7 years. Left ventricular hypertrophy (LVH) was observed in 188 (76.7%), mild left ventricular dysfunction (LVD) in 25.7%, moderate LVD in 23.67%, severe LVD in 8.5%, global hypokinesia in 33.8%, valvular heart disease in 26.5%, regional wall motion abnormality in 4.4%, and pericardial effusion in 1.6% patients. Echocardiographic changes, such as LVD, LVH, and global hypokinesia, were observed in greater number in hypertensive group com-pared to normotensive group (P < 0.05). On regression analysis adjusted for age and gender, we found that hypertension and anemia (

The Organ Transplantation Act issued by the Government of India 1994 has undergone major and minor changes in the form of addition of rules and amendments in order to improve the Act to make it much acceptable legally. Over a period of time, with an increase in cadaver organ donations, the rules and policies with regard to the same have been defined and redefined over the years. In this article, the Act, the rules, the amendments, the quick essentials of approach, and the forms are reviewed.

We present a renal allograft recipient with pulmonary tuberculosis presenting with multiple subcutaneous abscesses involving left forearm, left thigh, suture site and left loin, which on later evaluation revealed to be due to Mycobacterium tuberculosis.

Diabetic nephropathy (DN), one of the major complications of diabetes mellitus, is diagnosed by the presence of pedal edema, 24-h proteinuria >300 mg/day, and retinopathy. However, in view of variable clinical presentations and deviation from the above-said clinical features, it has become difficult to diagnose DN or the presence of nondiabetic renal disease (NDRD). Many biomarkers have been identified which could predict the progression of DN. Despite such advancement in science, it is still difficult to differentiate between DN and NDRD. Diabetes is a state of chronic inflammation. Among the pro-inflammatory cytokines, it has been shown that transforming growth factor-beta (TGF-β) and bone morphogenetic protein-7 (BMP-7) play a key role in the development and progression of DN. We assessed whether the levels of serum BMP-7 and TGF-β can help differentiate between DN and NDRD, thus serving as surrogate markers of DN.

C4d-negative isolated endarteritis is an entity yet to be recognized as an independent entity in Banff Classification. Pathogenesis and treatment of this entity are not well understood. Although it was identified as an entity similar to T-cell rejection based on the response to T-cell depletion therapies in a large retrospective study, this observation is yet to be supported in molecular experimental studies.

This is a prospective cohort study to assess the prevalence of frailty in patients undergoing maintenance hemodialysis (HD) under the government-funded scheme at our center and to assess the relationship between frailty and falls, hospitalizations, and mortality. This was done at our center which is completely supported by the government, which provides HD to all the patients under poverty line. Epidemiological data, anthropometric measurements, comorbidities assessment, frailty assessment using Fried criteria, subsequent hospitalizations, falls, and mortality were recorded in our prevalent dialysis population at our center between October 2014 and October 2015. Two hundred and twenty-six patients were enrolled during this period. Twenty-one patients were excluded as they did not satisfy the inclusion criteria. Two hundred and five prospective patients were studied for the predictors of frailty. Frailty was present in 82% of the study population. Mean age of our study population was 44.95 ± 13.27 years. On univariate analysis, diabetes mellitus, hypertension (HTN), cerebrovascular accident (CVA), left ventricular dysfunction (LVD), peripheral vascular disease (PVD), smoking, hepatitis C, inadequate dialysis, intradialytic hypotension (IDH), interdialytic weight gain, low serum creatinine

The incidence of juvenile lupus varies widely ranging between 4 and 250 per 100,000 population. Most common organ involvement in juvenile lupus is kidney. Neurological, cutaneous and hematological involvements are also involved. Skeletal muscle involvement in the form of myositis is rare. Myositis as presenting manifestation in juvenile lupus is also unusual. Herein, we report one such case wherein myositis preceded the onset of lupus nephritis

Acute renal infarction is rare. Its true incidence is not known. The paucity of literature and unawareness among the physicians makes it an underdiagnosed entity. Herein, we report a case of renal infarction following coronary intervention.

Poisoning due to insecticides such as organophosphorus and super vasmol presenting as acute kidney injury (AKI) is well-reported. Poisoning due to fipronil (phenylpyrazole) is known to present with mild neurological and dermatological complaints. However, fipronil poisoning presenting as AKI and hepatic dysfunction is not known. Herein, we are presenting a case of fipronil poisoning presenting with severe AKI.

Venous thrombosis is one of the major complications associated with nephrotic syndrome. Among the primary glomerular diseases, membranous nephropathy is associated with a high incidence of thrombotic events. Although this is well described in adults, there is paucity of the literature regarding venous thrombosis in children. Herein, we report such a thrombotic event involving both the lower limb veins and the inferior vena cava in a child with membranous nephropathy.

The aim of our study was to study the clinical profile of type 2 diabetes mellitus patients admitted with the diagnosis of acute kidney injury (AKI) due to bilateral acute non-obstructive pyelonephritis. The bilateral involvement was identified on various imaging modalities (ultrasound, computed tomography, nuclear scintigrapy). All the patients had AKI. Those with severe AKI underwent hemodialysis. The factors associated with the severity of illness were identified. Twenty-five patients of type 2 diabetes mellitus admitted with the diagnosis of AKI due to bilateral acute non-obstructive pyelonephritis were identified. On ultrasound, bilateral involvement was found in 12 patients and in 17 patients on computed tomography and eight patients on nuclear scintigraphy. Fourteen of them needed dialysis support. Bilateral acute pyelonephritis needs to be considered while evaluating the AKI in type 2 diabetes mellitus patients.

In the presence of systemic lupus erythematosus or related autoimmune disorders, antiphospholipid syndrome (APS) is termed secondary APS. Pregnancy-related renal failure due to SAPS is rarely reported in the literature. We present the case of a young primgravida woman with bilateral renal cortical necrosis due to secondary APS in late pregnancy.