Indian Journal of Nephrology最新文献

Leprosy, an infectious disease known for its debilitating effects on the skin and nerves, can trigger immunologic reactions affecting multiple organs. We present the case of a 57-year-old male who developed acute glomerulonephritis following leprosy treatment. Clinical examination revealed newly developed pitting edema in the legs, along with residual nerve thickening and skin changes. Laboratory findings showed elevated serum creatinine (3.2mg/dl) accompanied by low C3 and C4 levels. Urinalysis supported the diagnosis of glomerulonephritis. Renal biopsy demonstrated immune complex deposition on immunofluorescence, suggesting a diagnosis of leprosy-related post-treatment immune-mediated glomerulonephritis. Treatment with oral steroids led to complete resolution of the condition.

The rising prevalence of chronic kidney disease poses a future challenge for healthcare and the economy. For patients diagnosed with kidney failure, hemodialysis is the sole recourse until a suitable renal donor is acquired, exerting a discernible impact on the overall quality of life. Yoga and meditation emerge as pivotal elements in enhancing quality of life (QoL), significantly influencing diverse aspects of well-being. The study aimed to identify the effectiveness of yoga and meditation on QoL among hemodialysis patients. An experimental research design with one group pretest - post-test on 100 participants was conducted in Muljibhai Patel Urology Hospital, Nadiad. Pre-tests were conducted on day 1, followed by a 12-week yoga and meditation program with a post-test. Data analysis utilised SPSS-20 software, employing descriptive and inferential statistics. Yoga and meditation effectively demonstrated improvement in QoL in each domain (p < 0.001.) post-intervention. These results emphasize QoL enhancement after incorporating these practices into hemodialysis care.

Eucalyptus oil consumption is well known to cause adverse effects on central nervous system like seizures, ataxia and unconsciousness. No antidote is available and treatment is largely supportive. We report a case of rhabdomyolysis with pigment cast nephropathy and acute kidney injury in a young female following eucalyptus oil consumption and its successful management.

Background: Malnutrition and suboptimal food intake are common concerns among chronic kidney disease (CKD) patients. Medical nutrition therapy plays a significant role in ensuring the well-being of CKD patients undergoing maintenance hemodialysis (MHD). The present study explored the dietary intake and quality of life (QOL) of CKD patients on MHD.

Materials and methods: Adult CKD patients (n = 107, >20 years, 72% male) on MHD were conveniently selected from dialysis centers across India. This cross-sectional exploratory study elicited information on general profile, height, dry body weight, biochemical parameters, food intake, and QOL of the patients. Nutrient intake was compared with Kidney Disease Outcomes Quality Initiative (KDOQI) Guidelines.

Results: The average energy and protein intake per kg body weight was below the recommendations (energy ∼21 kcal/kg vs. 30-35 kcal/kg body weight and protein ∼0.7g/kg vs. 1-1.2 g/kg body weight). Majority of them (>75%) had inadequate energy and protein intake. The sodium intake of the participants (3109.42 ± 1012.31 mg) was higher than the suggested limit. The energy and protein intake/kg ideal body weight of female patients was significantly higher than male patients (p < 0.05). Overall, their QOL was satisfactory. However, nearly half of them (47%) reported moderate-level problem in the pain and discomfort dimension.

Conclusion: Patients were not meeting the recommendations especially for energy and protein. Patient-specific customized nutrition counseling along with routine nutrition assessment, follow-up of patients and continued nutrition education, and motivation and support from the medical care team, especially the dietitian is needed for better dietary compliance and overall improvement of QOL.

Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis reported across the world and is characterized by immunoglobulin A (IgA) dominant mesangial deposits, which are poorly O-glycosylated. This deposition leads to a cascade of glomerular and tubulointerstitial inflammation and fibrosis, which can progress to chronic kidney disease. The variability in rate of progression reflects the many genetic and environmental factors that drive IgAN. Here, we summarize the contemporary understanding of the disease mechanisms that drive IgAN and provide an overview of new and emerging therapies, which target these mechanisms.

Background: Acute tubular injury (ATI) is a common diagnosis on renal biopsy. There are no accepted parameters to assess the severity of injury or predict recovery. An objective histologic grading system would be of immense value in clinical practice. The macrophage response to injury involves the MI phenotype which is proinflammatory and M2 which is prorepair. The study of these macrophages could aid in studying the severity and the recovery.

Materials and methods: A total of 58 native kidney biopsies with features of ATI and a minimum follow-up of 12 weeks were graded into mild, moderate and severe, using scores for simplification, sloughing, and mitosis. These scores and the density of macrophages stained with CD68, CD163, and HLA-DR were correlated with serum creatinine at presentation and with recovery. The effect of chronicity index as measured by glomerulosclerosis, tubular atrophy, and interstitial fibrosis and of co-morbidities of age, hypertension, and diabetes on the recovery pattern was also studied.

Results: All three histologic scores and the grades of ATI showed positive correlation with the serum creatinine level. The densities of CD 68 + and CD163 + macrophages also showed a significant correlation with serum creatinine level. However, none of these these histological features nor the macrophage densities predicted clinical recovery. Age >60 years, hypertension, diabetes, and chronicity score on biopsy were indicators of partial and delayed recovery.

Conclusion: The histopathological semiquantitative scoring system can be used routinely to grade ATI. However none of the studied parameters predicted recovery.

Potential kidney transplant patients with HLA-specific antibodies have reduced access to transplantation. Their harmful effects are mediated by the Fc portion of IgG, including activation of the complement system and Fc receptor-initiated cytotoxic processes by circulating leucocytes. Avoiding antibody incompatibility is the conventional approach, but for some patients this can mean extended waiting times, or even no chance of a transplant if there are no alternative, compatible donors. For these cases, pretransplant antibody removal may provide access to transplantation. Plasmapheresis is currently used to achieve this, with acceptable outcome results, but the process can take days to reduce the antibody levels to a safe level, so has limited use for deceased donors. There is now an alternative, in the form of an IgG-digesting enzyme, Imlifidase, which can be administered for in vivo IgG inactivation. Imlifidase cleaves human IgG, separating the antigen-binding part, F(ab')₂ from Fc. Typically, within six hours of dosing, most, if not all, of the circulating IgG has been inactivated, allowing safe transplantation from a previously incompatible donor. For deceased donor transplantation, where minimizing cold ischaemia is critical, this six-hour delay before implantation should be manageable, with the compatibility testing processes adjusted to accommodate the treatment. This agent has been used successfully in phase 2 clinical trials, with good short to medium term outcomes. While a donation rate that matches demand may be one essential answer to providing universal access to kidney transplantation, this is currently unrealistic. IgG inactivation, using Imlifidase, is, however, a realistic and proven alternative.

Immunocompromised patients are prone to various opportunistic infections. Most of the infections are easily detectable through staining, culture, and polymerase chain reaction techniques. Nevertheless, it is also important to have wet smear examinations of samples. We present a case of pneumonia in a post-transplant recipient who was on immunosuppressants and detected to have an infection from the parasite, lophomonas blattarum, which usually resides in the hindgut of cockroaches.

Type-II Xanthanuria is an genetic disorder associated with diminished serum uric acid levels. Patients with xanthanuria has absence of xanthine oxidase or xanthine dehydrogenase activity, the enzyme that converts hypoxanthine to xanthine and xanthine to uric acid. Deficiency of these enzyme leads to elevated levels of xanthine in urine which further leads to precipitation of xanthine in urine which further helps to formation of renal stones and ultimately leads to chronic kidney disease and end stage renal disease. We report a 23 years old male, who reached ESRD due to Type 2 xanthinuria, which was confirmed by genetic studies, who later successfully underwent renal transplant surgery and currently having normal life with functioning graft.