Indian Journal of Nephrology最新文献

Solid organ transplant (SOT) recipients are at increased risk of infective diarrheas. In such patients, diarrhea can be complicated by dehydration, leading to acute kidney injury or vascular thrombosis. Viral diarrhea in SOT is reported to be commonly due to cytomegalovirus and norovirus. As sapovirus is not routinely included in diagnostic evaluations, its epidemiology and natural history is not well documented. Anecdotal cases of sapovirus-associated diarrhea in renal transplant recipients have been treated with oral nitazoxanide, often with simultaneous reduction in immunosuppressants. We report sapovirus-associated diarrhea in a renal transplant recipient which responded well within two days to oral nitazoxanide. This, possibly, is the first such report from the Indian subcontinent of adequate control of sapovirus-associated diarrhea without any alteration in the immunosuppressant medications.

Background: It has been claimed that tacrolimus may have harmful effects on the auditory system, where it has been linked to ototoxicity and sensorineural hearing loss (SNHL). We evaluated silent SNHL in kidney transplant recipients (KTRs) receiving tacrolimus and the different factors affecting it compared to healthy controls.

Materials and methods: In this case control study, hearing functions were studied in 42 KTRs receiving tacrolimus as maintenance immunosuppressive therapy for more than 3 months in comparison to 27 age- and gender-matched healthy subjects using tympanometry, pure-tone audiometry (PTA), extended high frequency audiometry (EHFA), and transient evoked oto-acoustic emissions (TEOAEs). Also, different factors were studied in relation to SNHL.

Results: PTA showed that 23.8%, 21.4%, and 4.8% had mild, moderate, and severe SNHL, respectively. One-fifth of KTRs had severe SNHL, according to EHFA. According to TEOAEs, 28.6% of KTRs had abnormal hearing. There was a significant positive correlation between the tacrolimus trough levels and the results of both the PTA (P = 0.002) and EHFA (P = 0.035) tests.

Conclusion: SNHL was detected in about half of the studied KTRs. Silent SNHL in KTRs might be associated with higher tacrolimus trough levels.

Lupus nephritis (LN) is an important complication of systemic lupus erythematosus, for which glucocorticoids (GCs) are the primary treatment. Due to the side effects associated with GCs, their long-term use should ideally be tapered and discontinued. At present, no such possibility exists without problematic flares after discontinuation. We administered belimumab, a human monoclonal antibody that binds to a soluble B lymphocyte stimulator to reduce the number of activated B cells, to six patients with Type IV LN to discontinue GCs. The six patients were 10-15 years old when LN developed and 15-24 years old when belimumab treatment was initiated. Prednisolone was tapered from 6 to 20 mg by 2.5-5 mg every month until the dosage reached 5 mg, at which point the dosage was further reduced by 1 mg every 6 months. One patient was transferred to another hospital midway and five patients discontinued GCs. No flares occurred 8-38 months post discontinuation. No adverse effects were observed following belimumab treatment. In conclusion, belimumab was effective in the successful discontinuation of GCs.

Introduction: Acute kidney injury (AKI) is a frequent complication of chronic liver disease (CLD) contributing to high morbidity and mortality worldwide. While liver transplantation (LT) has shown favorable outcomes, early identification and management of AKI is imperative for survival. This review aims to highlight the epidemiology, pathophysiology, management, and prognosis of AKI in CLD.

Methods: An extensive literature search was performed using PubMed, Medline, and Google Scholar to identify literature related to epidemiology, burden, clinical presentations, prognosis, and management of AKI in CLD.

Results: The identified studies highlighted a wide range of prevalence of AKI in hospitalized patients with CLD. The etiology and pathophysiology are multifactorial and include prerenal AKI, acute tubular injury, sepsis, gastrointestinal bleeding, bacterial translocation from the gut, and hepatorenal syndrome (HRS). AKI is associated with a higher risk of morbidity and mortality and progression to chronic kidney disease following LT. Management of AKI in CLD varies based on the underlying etiology. While vasoconstrictors like terlipressin have shown great potential in the treatment of HRS-AKI and is widely used in Europe and United States, LT remains the definitive therapy of choice. In most cases, kidney replacement therapy serves as a bridge to liver transplant.

Conclusion: AKI is a serious complication of CLD and early identification is essential. Diagnosis and management, particularly HRS is challenging and requires a high index of suspicion. More research is required to identify novel therapies to improve outcomes of AKI in patients with CLD.

Fibrillary and immunotactoid glomerulonephritis represent the pathological entities characterized by structured fibrillary/microtubular deposits, whose identification is possible only by electron microscopy. We report a 46-year-old female who presented with proteinuria 15 years after the onset of psoriasis. Diffuse global glomerulosclerosis pattern was noted on light microscopy. In immunofluorescence microscopy, predominant IgA deposition was observed and electron microscopy showed organized randomly arranged fibrillary deposits with diameter ranging between 10 and 23 nm in mesangial, subendothelial, intramembranous, and subepithelial sites.

Paroxysmal nocturnal haemoglobinuria (PNH), although a rare type of acquired hemolytic anemia, can be life-threatening if not diagnosed early. Kidney involvement in PNH varies from reversible acute kidney injury to irreversible chronic damage. Here, we report a case of recurrent acute kidney injury in a young male requiring renal replacement support. Repeated history of AKI with coombs negative hemolytic anemia led us to perform PNH profile after ruling out other causes. Although kidney involvement in PNH is not apparent, this case shows the importance of having a high index of suspicion which will help in preventing further episodes of AKI and thus, chronic kidney disease burden.