Indian Journal of Nephrology最新文献

The emergence of COVID-19 triggered a global health crisis, sparking concerns within the medical community about its interaction with chronic kidney disease (CKD) and the heightened vulnerability of individuals with compromised renal function to severe viral infection and mortality. This retrospective study encompassed all adult patients with laboratory-confirmed COVID-19 and pre-existing CKD admitted between May 2020 and May 2023. Their demographic data, relevant clinical parameters, and laboratory values were collected. Kaplan-Meier curve analysis and Log Rank test were employed to compare survival times between CKD patients and those developing acute kidney injury (AKI), while Cox regression analyses were conducted to pinpoint factors influencing the hazard of a fatal outcome. The study, involving 150 COVID-19 patient records with pre-existing CKD, revealed that male gender, advanced age, requirement for invasive ventilation, and elevated levels of inflammatory markers such as total leukocyte count, lactate dehydrogenase, C-reactive protein, D-dimer, and IL-6 significantly increased the risk of death. These findings underscore the necessity for tailored care and meticulous management in COVID-19 patients with coexisting CKD, emphasizing the importance of addressing factors such as gender, age, and inflammatory status to mitigate mortality risks effectively.

Background: Knowledge of kidney size is important in the assessment of kidney function. Changes in kidney size can occur in various kidney diseases due to different causes, hence knowledge of normal kidney dimensions in a population is crucial for diagnosis, follow-up and prognostication. While data from other parts of the world does not apply to the Indian population due to differences in ethnicity, diet and body sizes, and there is also a lack of standardized data on normal kidney sizes in healthy Indian adults.

Materials and methods: Kidney dimensions from 600 healthy adult volunteers ranging between 20 and 70 years of age were measured with sonography by a single radiologist. Differences in dimensions between men and women, and right and left kidney were analyzed. Finally, kidney sizes were correlated with anthropometric variables such as weight, age, body surface area (BSA), height and body mass index. Estimated glomerular filtration rate (eGFR) was correlated with kidney length and renal parenchymal volume (RPV).

Results: The mean kidney length of the whole cohort, irrespective of gender was found to be 9.6 ± 0.7 cm on the right and 9.9 ± 0.7 cm on the left. Mean kidney length in males was significantly more as compared to females on both sides. Both the kidney length and RPV were significantly associated with BSA, weight and height (in that order) in females, whereas in males, kidney length and RPV best correlated with height, BSA and weight (in that order). In both sexes, there was a significant negative correlation between age and kidney length, RPV. eGFR had a significant positive correlation with kidney length and RPV in the cohort.

Conclusion: Normal sonographic mean kidney length was 9.6±0.7 cm and 9.9±0.7 cm on the right and left sides respectively in healthy North Indian population, with the left kidney being larger than the right in all dimensions (length, width, thickness and RPV). Kidney sizes in males were found to be larger than females. Correlation with anthropometric parameters in our study, emphasizes the need to give due consideration to normal variations in kidney sizes with age, gender, height, weight and BSA to differentiate between a normal and a pathologically small or large kidney.

The cytosolic capping protein, Arp2/3 and myosin-I linker protein 2 or CARMIL2 plays an important role in T/B/NK cell function. Biallelic disease causing variants in CARMIL2 are known to cause immunodeficiency 58. We report a 13-year-old girl with recurrent infections, dermatitis and nephrotic syndrome since childhood. Her renal biopsy was suggestive of membranous nephropathy. Exome sequencing showed a homozygous novel stopgain variant, c.520C>T in CARMIL2 (NM_001013838.3). We expand the phenotypic spectrum of CARMIL2 related immunodeficiency to include membranous nephropathy secondary to probable immune dysregulation.

Background: Doppler ultrasound examination of blood vessels has a significant role in planning and identifying parameters that affect the functioning and maturation of arteriovenous fistula (AVF). Our goal was to determine the predictive parameters of Doppler ultrasound, measured at different time distances, which affect the maturation of AVF for hemodialysis.

Materials and methods: The research was a retrospective cohort study. The criteria for selecting patients in our study was the existence of information on ultrasound examinations of the lumen of blood vessels before the creation of AVF, as well as lumens of fistula conduits and blood flow measurements, at time intervals of 6-8 weeks and 2-4 months, after the creation of AVF, which we recorded in 105 patients. The respondents were divided into two groups: a group of patients with immature, and mature fistulas. Basic demographic data, clinical characteristics of the responders and laboratory parameters were analyzed.

Results: By comparing clinical and laboratory parameters between the group of subjects with and without AVF maturation, a statistically significant difference was determined between the lumen of the proximal radial vein (p = 0.008) and the lumen of the distal radial vein (p = 0.001). The diameter of the fistulous veins (p = 0.037), and the blood flow through the AVF 6-8 weeks (p = 0.001) and 2-4 months (p = 0.001) after its creation were statistically significantly higher in subjects with mature fistulas. By univariate regression analysis, brachial vein (p = 0.04), proximal (p = 0.011) and distal radial artery (p = 0.001), fistula vein, after 6-8 weeks (p = 0.002), blood flow through AVF 6-8 weeks (p = 0.001) and 2-4 months (p = 0.001) after AVF creation, are statistically significant parameters. Predictive parameters of AVF maturation are AVF blood flow after 6-8 weeks (p = 0.010) and AVF blood flow after 2-4 months (p = 0.001).

Conclusion: Our research confirmed that greater the blood flow through AVF, at time intervals of 6-8 weeks and 2-4 months after creation, the better the maturation.

2,4-dimethyalmine is a herbicide commonly used by agriculturalist. Acute intoxication can cause fatal multiorgan damage. No antidote is available. We report a rarely encountered manifestation of this toxin, that is, spontaneous rhabdomyolysis, acute kidney injury and the effectiveness of alkaline diuresis as a life saving treatment in 2,4-dimethylamine intoxication.

Perirenal adipose tissue (PRAT) has been identified as an important factor in local and general homeostasis of the human body and is especially important in regulating renal and cardiovascular functions. It has also been identified as a crucial risk factor to consider in cardiovascular and renal disorders, malignancies, and various other diseases. Having a concrete idea of the effects of therapeutic interventions on the size and metabolism of the PRAT could prove highly beneficial. This review summarizes what is known about the PRAT and provides a collection of studies on the effects of therapeutic interventions on PRAT and its related diseases. We used papers written on a variety of subjects, mainly concerning adipose tissue and the effects of therapeutic procedures on it. Our main challenge was to excerpt the information specifically related to the PRAT in these papers. These effects vary greatly, from an increase or decrease in mass or size of the PRAT to changes in metabolism and drug residue accumulation. The current studies often fail to consider PRAT as an individual subject of research and only examine the adipose tissue of the entire body as a whole. This leads us to believe this field could benefit greatly from further research.

C3 glomerulonephritis (C3GN) is rare. It is a proliferative glomerulonephritis resulting from glomerular deposition of complement factors due to dysregulation of the alternative pathway of complement. The association between monoclonal protein production and development of C3GN was described. We report a 74-year-old man with rapid worsening of kidney function and dialysis needed due to C3GN. In this case, serum protein electrophoresis showed no monoclonal spike but serum immunoelectrophoresis showed a lambda light chain monoclonal gammopathy. Once the diagnosis was made, the patient was treated with immunosuppression with complete kidney recovery. This case shows the importance of accurate and prompt diagnosis and appropriate treatment.