Indian Journal of Nephrology最新文献

Chimeric antigen receptor (CAR) T-cell therapy has recently evolved beyond cancer therapy's boundary to treating autoimmune diseases such as lupus nephritis. In CAR T-cell therapy, the genetically engineered patient's T cells express a receptor specifically targeting antigens such as CD19, a protein found on the surface of B cells. By directing the immune system to eliminate B cells, which play a central role in the pathogenesis of systemic lupus erythematosus, CAR T-cell therapy offers a novel and potent approach to resetting the immune system and achieving remission in difficult-to-treat lupus nephritis patients and many such conditions in nephrologists' practice.

Artificial intelligence (AI) is a rapidly advancing tool in healthcare, which might have significant implications in nephrology. Integrating AI, particularly through models like GPT-3 and GPT-4, has potential in medical education and diagnostics, achieving accuracy in clinical assessments. AI's ability to analyze large, complex datasets from diverse modalities (electronic health records, imaging, and genetic data) might enable early detection, personalized treatment planning, and clinical decision-making. Key developments include AI-driven chronic kidney disease and acute kidney injury predictive models, which utilize machine learning algorithms to predict risk factors and disease onset, thereby allowing timely intervention. AI is enhancing non-invasive diagnostics like retinal imaging to detect kidney disease biomarkers, offering a promising and cost-effective approach to early disease detection. Despite these advancements, AI implementation in clinical practice faces challenges, including the need for robust data integration, model generalizability across diverse patient populations, and ethical and regulatory standards adherence. Maintaining transparency, explainability, and patient trust is crucial for AI's successful deployment in nephrology. This article explores AI's role in kidney care, covering its diagnostic applications, outcome prediction, and treatment, with references to recent studies that highlight its potential and current limitations.

Pediatric hypertension (HTN) is a public health concern with significant possible long-term adverse outcomes. This review is a comprehensive guide for pediatricians, nephrologists, and trainees, focusing on the latest approaches for HTN diagnoses in children and highlighting the importance of accurate blood pressure measurement techniques. We also explore current classification systems and offer evidence-based HTN management strategies tailored to pediatric patients. Lifestyle modifications are the recommended first-line interventions, including dietary changes, physical activity, and weight management. Pharmacological treatments are for severe cases or when lifestyle modifications are insufficient. The guidelines provide an overview of commonly prescribed antihypertensive medications, potential complications associated with untreated HTN, including target organ damage and increased cardiovascular risk in adulthood, and the importance of early recognition and intervention. This review aims to help healthcare professionals thoroughly understand pediatric HTN to improve diagnosis, treatment, and long-term outcomes.

Glomerulocystic kidney disease (GCKD) is a rare cause of cystic kidney disease. It is a disease of infants and neonates, but it can also be seen in adults. We present a case of a 22-year-old married female with renal failure who was later found to have GCKD on renal biopsy.

Background: Upper gastrointestinal (GI) lesions are common in patients with chronic kidney disease and may contribute to anemia and increased morbidity, especially in patients on hemodialysis (HD). They become even more significant in patients undergoing kidney transplantation about to be subjected to lifelong immunosuppressive drugs.

Materials and methods: This cross-sectional study conducted at Bangabandhu Sheikh Mujib Medical University's Departments of Gastroenterology and Nephrology analyzed 128 prospective kidney transplant patients following upper GI endoscopy. Lesions were histopathologically examined and factors contributing to and consequences of the lesions were investigated.

Results: A total of 52.3% patients had at least one upper GI lesion. Gastritis was the most prevalent one, comprising 55.7% of the lesions, followed by duodenitis (21.6%), ulcer (12.5%), esophagitis (2.3%), and others (8%). Lesions did not vary significantly between symptomatic and asymptomatic patients (p = 0.9). Those on HD had 3.6-fold higher odds of having a lesion (p = 0.005). Patients with lesions had significantly longer CKD duration (p = 0.0002). Mean hemoglobin level was 8.8 g/dl in those with lesions, which was significantly lower compared to those without lesion, who had a mean of 10.3 g/dl (p < 0.0001). Iron deficiency was more common in patients with lesions (p = 0.0004). The mean serum calcium level was significantly higher in patients with lesions (p = 0.0002).

Conclusion: Upper GI lesions are fairly common in Bangladeshi CKD population. Routine endoscopic screening and treatment of asymptomatic lesions are recommended for advanced CKD patients in Bangladesh, given their frequency and potential impact.