Indian Journal of Nephrology最新文献

Dysthyroid state affects kidneys in multiple ways. Hypothyroidism has been described as a cause of renal dysfunction in case reports, and a few large-scale epidemiological studies have shown association of hypothyroidism with abnormalities of renal function parameters. Restoration and improvement in renal functions have also been reported with treatment of hypothyroidism. We highlight two cases where hypothyroidism contributed to renal dysfunction and the treatment of hypothyroidism led to improvement in renal function.

Cupriavidus pauculus is a gram-negative rod isolated from water. It is rarely known to cause infections in humans. We present the case of a 72-year-old lady who developed Cupriavidus pauculus bacteremia probably originating from the water treatment plant of a hemodialysis unit. The patient improved with timely treatment with appropriate antibiotics.

Background: Children with frequently relapsing (FR) or steroid-dependent (SD) nephrotic syndrome (NS) show endothelial dysfunction and risk of endothelial injury during relapses, increasing the risk of accelerated atherosclerosis and adverse cardiovascular events. This study examines the plasma levels of markers of endothelial dysfunction [sE-selectin and vascular cell adhesion molecule-1 (VCAM-1)] in children aged 1-16 years with FRNS and SDNS in relapse.

Materials and methods: Fifty-six children with FRNS and SDNS between 1 and 16 years were enrolled at the time of relapse and followed till six weeks of steroid-induced remission. Markers of endothelial dysfunction (sE-selectin and VCAM-1) in plasma were measured in these children and in an equal number of controls.

Results: Plasma sE-selectin and VCAM-1 levels were significantly raised during relapse, declined after six weeks of steroid-induced remission, and became comparable to controls (p < 0.0001). We found high serum total cholesterol and triglycerides levels during relapse that remained elevated even after steroid-induced remission as compared to controls (p < 0.0001). Raised levels of these markers confirm endothelial dysfunction in FRNS and SDNS patients.

Conclusion: Children with FRNS and SDNS had endothelial dysfunction during relapse, which was largely dependent upon disease activity.

Background: Kidney biopsy or contrast studies are required to diagnose acute renal cortical necrosis (RCN). Both procedures may be potentially delayed in the postpartum setting. Contrast-enhanced ultrasound (CEUS) is a potential alternative for these patients but remains limited in availability. Due to sparse literature and the rarity of RCN, the role of conventional B-mode ultrasound (USG) in diagnosing RCN remains unexplored.

Materials and methods: This retrospective study involved postpartum patients with RCN who underwent kidney biopsy at a tertiary care center. Medical records and B-mode USG kidney images of all 23 patients with postpartum RCN over the past 24 months were retrieved. Gray-scale B-mode USG images of the kidney were assessed for size, presence of sonographic hypoechoic rim, USG kidney timing, echogenicity, and cortico-medullary differentiation.

Results: Among the 23 patients, sonographic hypoechoic rim was observed in 6 patients (26.1%). USG kidney timing ranged from 1.1 to 8 weeks, and kidney length varied from 9.0 to 10.8 cm. There were significant differences in mean USG kidney timing and mean kidney length between patients with and without hypoechoic rim (P= 0.020 and P= 0.036, respectively). The mean USG kidney timing was notably earlier in patients with sonographic rim signs than those without sonographic rim signs (2.5 ± 0.77 weeks and 4.81 ± 2.17 weeks, respectively).

Conclusion: Despite its lower sensitivity, the sonographic rim sign is an important diagnostic feature of postpartum renal cortical necrosis. In point-of-care ultrasonography, it should be looked for early in the disease course, especially in cases of postpartum anuric acute kidney injury.

Background: Human leukocyte antigens (HLA) are highly polymorphic glycoproteins required for immune response and recognizing self or non-self. Knowing the HLA diversity in a population may be helpful in the selection of organ allocation for transplantation. We aimed to retrospectively analyze the prevalence of HLA, A, B, C, DRB1, and DQA1 alleles frequency in the north Indian population.

Materials and methods: HLA antigen allele data were retrospectively analyzed from a transplant cohort of 2259 subjects. HLA-A, B, and DRB1 frequency were determined in 2259, HLA-C in 759 and DQA1 in 751 subjects.

Results: The most abundant HLA-A antigen alleles were HLA-A*01(25.41%), HLA-A*02 (24.83%), HLA-A*11 (17.53%), HLA-A*24 (10.27%), HLA-A*03 (9.07%). HLA-B antigen alleles were HLA-B*35 (20.54%), HLA-B*15 (15.36%), HLA-B*40 (13.59%), HLA-B*07 (10.14%), HLA-B*44 (7.79). HLA-C antigen alleles were HLA-C*07 (28.06%), HLA-C*04 (20.42%), HLA-C*03 (15.55%), HLA-C*06 (13.04%), HLA-C*12 (5.27%). HLA-DRB1 alleles were HLA-DRB1*07 (21.60%), HLA-DRB1*04 (19.74%), HLA-DRB1*10 (13.15%), HLA-DRB1*03 (10.80%), HLA-DRB1*11 (8.63%). HLA-DQA1 antigen alleles were HLA-DQA1*03 (35.42%), HLA-DQA1*02 (30.89%), HLA-DQA1*05 (21.84%), HLA-DQA1* 06 (10.12%), HLA-DQA1*04 (1.07%).

Conclusion: The most frequent HLA alleles were HLA-A*01(25.41%), HLA-B*35 (20.54%), HLA-C*07 (28.06%), HLA-DRB1*07(21.60%), HLA-DQA1*03(35.42%) in north Indian population.

Background: The etiology of chronic kidney disease of unknown cause (CKDu) remains unexplained, with environmental toxins, i.e., heavy metals and pesticides. being explored for their causal role. We measured pesticide levels in blood and urine in patients with CKDu in central India. We compared them with healthy and chronic kidney disease (CKD) controls.

Materials and methods: This case-control study compared patients with CKDu (n = 55), CKD (n = 53) and healthy controls (n = 50). Levels of 6 organophosphates (OPs) and 16 organochlorines were measured by GC-MS. Drinking water sources and pesticide use, and hours spent in sunlight were also evaluated.

Results: CKDu and CKD subjects were age and sex matched. CKDu and CKD subjects had higher median chlorpyrifos (CP) 3.69 (2.36-5.65) and 3.79 (1.9-5.53) µg/L; pesticide use 19.6% and 12.5%; and heat spent hours 3.0 (2.0, 5.0) compared to healthy subjects 1.49 (0.97-2.20) µg/L; 0%; and 1.0 (1.0, 3.0) hours, respectively (p ≤ 0.001 for all). Surface water use was higher in CKDu (49%) compared to CKD (20.7%) and healthy subjects (20%) (p<0.01). The CP (ρ -0.0532, p<0.01), and ethion (ET) (ρ 0.221, p<0.01) had inverse correlation with GFR. Urine CP and ET were significantly higher in healthy controls. On multinomial regression, CP was independently associated with CKDu (OR, 95%CI) (3.5, 2.1-5.9) and CKD (3.7, 2.2-6.1). ET was also associated with CKDu (2.2, 1.2-3.9) and CKD (1.9, 1.1-3.4). Spending 4 hours or more in sunlight was associated with CKDu (6.1, 1.7-22.3) and CKD (6.0,1.7-21.3) (P<0.01 for all) in reference to healthy subjects. Surface water was associated with CKDu (4.0, 1.3-12.7) (p<.01).

Conclusion: Environmental factors such as spending 4 hours or more in sunlight and higher levels of OP pesticides, namely, CP and ET, are associated with both CKDu and CKD. As higher levels of pesticides were seen in both groups of CKDu and CKD, the association of pesticides with CKDu could not be established. The higher levels could be due to low eGFR. Surface water use is independently associated with CKDu; however, larger studies are required to establish the causation.