Introduction: In developing countries, the incidence of Pregnancy-Related Acute Kidney Injury (PRAKI) has significantly decreased over the past three decades. However, it remains a major contributor ...to maternal and foetal morbidity and mortality. Aim: This retrospective longitudinal study aims to determine the aetiology, outcomes, and factors associated with maternalfoetal outcomes of PRAKI. Materials and Methods: The study was conducted at a tertiary care Medical College Hospital in Dharwad district, Karnataka, India. It included patients with AKI during pregnancy and the peripartum period, admitted between January 2014 and December 2021. A total of 156 subjects at risk of PRAKI were identified. Data was collected from the Medical Records Department (MRD), and three months of patient follow-up data were also collected. PRAKI diagnosis and staging were done using the Acute Kidney Injury Network (AKIN) criteria. Primary outcomes included the need for dialysis, renal recovery, renal biopsy findings, and development of CKD. Secondary outcomes were maternal and foetal mortality and birth weight. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 21.0. Results: The mean age of the participants was 26.34±4.67 years. The most common cause of PRAKI was Pregnancy Induced Hypertension (PIH) (75 cases, 48.1%), followed by sepsis (67 cases, 42.90%), and Haemolysis, Elevated Liver enzymes, Low Platelet count (HELLP) syndrome (32 cases, 20.50%). Out of the 156 PRAKI patients, one-fourth (42 cases, 26.92%) required haemodialysis, 126 (93%) achieved complete renal recovery, 12 (7.6%) required renal biopsy, 9 (6.6%) developed chronic kidney disease, and 3 (2.2%) developed end-stage renal disease (ESRD). Maternal mortality was observed in 21 patients (13.46%), and foetal mortality occurred in 47 patients (31%) out of 156 perinatal outcomes. Conclusion: PRAKI was associated with poor maternal and neonatal outcomes. PIH, followed by sepsis, remained the leading cause of PRAKI. Immediate referral of patients to a higher centre and comprehensive antenatal care in peripheral areas can reduce the overall health and economic burden.
Introduction:
Kidney transplant recipients appear to be at high risk for severe COVID-19 illness due to chronic immunosuppression and coexisting conditions.
Objectives:
We aimed to study the clinical ...characteristics, laboratory and radiological results, treatment aspects and clinical outcomes of kidney transplant patients with COVID-19.
Patient and Methods:
Twenty consecutive kidney transplant patients with COVID-19 pneumonia from two tertiary care centers from India were retrospectively studied from July 1 to Oct 31, 2020.
Results:
Of 20 patients, 18 required admission; mean age was 42.8±9.39 years and 18 out of 20 (90%) were male. Symptom onset to testing time was a mean of 3.05±1.47 days. All patients were on triple immunosuppression. The median time since transplantation to COVID-19 was 3.75 years (IQR 2.37-5.41). Fever, cough and breathlessness were the most common presenting symptoms. Nine out of twenty (45%) had severe COVID-19 while six out of 20 (30%) required intensive care. Twelve (60%) patients had lymphopenia. Additionally mycophenolate was withheld in seventeen out of twenty (85 %) and enoxaparin and intravenous methylprednisolone were administered in all hospitalized patients while remdesivir was prescribed in 16 out of 20 (80%). Moreover, acute kidney injury (AKI) was seen in five out of 20 (25%) since one of died (5%). After a median hospital stay of 8.5 days (IQR 6.75-15.5), seventeen patients were discharged from the hospital.
Conclusion:
COVID-19 infection in kidney transplant recipients is usually a moderate-severe form. COVID-19 should be a differential diagnosis for fever in this high-risk population however lymphopenia may not be seen in all. Antimetabolite withdrawal, intravenous steroid, anticoagulation and early remdesivir were all found to be safe and effective strategies for improving outcomes. Early diagnosis and timely treatment may decrease mortality in this high-risk population.
Renal involvement in tuberculosis occurs due to lympho-hematogenous dissemination. However, glomerular involvement is an uncommon event. Crescentic nephritis complicating tuberculosis is a ...therapeutic dilemma and weighs the risk of worsening the infection after immunosuppressive therapy. We present here a case of miliary tuberculosis with immune complex crescentic nephritis with advanced renal injury requiring renal replacement therapy. A diagnosis of miliary tuberculosis was made on the basis of positive sputum AFB, lymph node biopsy showing caseating granulomas and urinary polymerase chain reaction being positive for mycobacterial antigens. The patient recovered renal function with anti-tuberculous therapy with-out requiring immunosuppressive therapy.
Screening school children for urinary abnormalities is an inexpensive task but is not commonly undertaken in India. Although debated in western countries, its utility in early diagnosis of kidney ...disorders has been proved by studies from Asia. We examined the prevalence of asymptomatic urinary abnormalities (AUA), obesity, and hypertension in school children and analyzed data to identify potential risk factors among those detected with such abnormalities.
Children and adolescents 8 to 18 years of age of either gender, attending 14 public schools in West Bengal, were screened prospectively from July 2013 to July 2016 for detecting asymptomatic urinary abnormalities by a spot urine test using a dipstick. Sociodemographic profile, medical examination (weight, height, and blood pressure), and questionnaire-based data were recorded.
A total of 11,000 children were screened. Of these, data from 9306 children were available for AUA, obesity, and hypertension. The prevalence rate was 7.44% (95% confidence interval CI = 6.91%-7.97%) for at least 1 AUA. Isolated hematuria was present in 5.2% (95% CI 4.75%-5.65%), whereas isolated proteinuria was present in 1.9% (95% CI = 1.62%-2.18%). The prevalence of prehypertension was 13.43% (95% CI = 12.74%-14.12%) and that of hypertension and abnormal body mass index was 4.05% (95% CI = 6.43%-7.47%) and 38.67 (95% CI = 37.68%-39.66%) respectively.
The prevalence rates of AUA were comparable with those in some Asian countries but higher than in most developed countries. Of children and adolescents 8 to 18 years of age, those 13 to 18 years had significantly more high risk factors such as AUA, hypertension, and obesity.
In this study we observed, increased urinary Galectin-9 and albumin excretion in type-2 diabetic nephropathy patients could be related to the micro and macro vascular complications leading to chronic ...kidney disease.
Background
Snake bite continues to be an important public health problem in tropical countries, and Russell’s viper is common in south-Asian countries such as India, Sri Lanka, and Myanmar.
...Case-Diagnosis/Treatment
Russell’s viper envenomation can cause acute kidney injury (AKI) by various mechanisms. Few studies address AKI following Russell’s viper bite in the pediatric population.
Conclusions
In this study, we report our center’s 6-year experience of such pediatric patients and identify the poor prognostic factors.
Background: Snake bite can cause acute kidney injury (AKI) through multiple mechanisms. Many of these patients have severe kidney injury requiring renal replacement therapy. The long-term outcome of ...survivors of such severe AKI is not known. Methods: We prospectively followed up 60 patients who developed dialysis-requiring severe AKI following snake bite and had survived the hospital stay. Results: A total of 25 (41%) patients showed persistent renal involvement in the form of renal dysfunction, proteinuria, or hypertension at a mean period of follow-up of 45 months. Totally 5% of the patients progressed to end-stage renal disease (ESRD) while 20% had glomerular filtration rate (GFR) <45 mL/min. Conclusions: Long-term outcome of snake bite and AKI is not benign with a significant percentage of patients continuing to have features of persistent renal damage.
BACKGROUND OF STUDYThere are insufficient data regarding the various adverse events of the antiretroviral drugs in Indian HIV-positive patientsOBJECTIVESTo record and analyze the various adverse ...events of the antiretroviral drugs in HIV-positive patientsDESIGNProspective study.METHODSWe studied 100 HIV patients coming to ART center in Bowring and Lady Curzon hospital. Various adverse events due to different regimens containing three different antiretroviral drugs were recorded. Patients were followed up and systematic method regarding the adverse events and the respective drug was used. Measurements were statistically analyzed.RESULTSOut of 100 patients 29% developed GI adverse events, 27% developed allergic reactions, 18% developed CNS adverse events,4% developed hematological adverse events, 15% developed metabolic adverse events, 9% developed hyperpigmentation of skin and nails and 43% developed others adverse events. Frequency of other adverse events were (n=100), 19% patients developed headache, 13% patients developed fatigue, 4% patients developed hepatitis, 4% patients developed Peripheral neuropathy, 12% patients developed myalgia, 3% patients developed myopathy, 6% patients developed alopecia. Most of the reported reactions were Grade I (57%) to Grade II (16%). Frequency of irregular ART use was 14%. No death was recorded.CONCLUSIONAdverse events are common after ART and one of the main reasons for discontinuation and non-adherence to ART.
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