Indian Journal of Nephrology最新文献

Background: BK polyomavirus nephropathy (BKPyVN) remains an important cause of allograft dysfunction and loss. There is little data about prevalence and outcome of BKPyVN infection from India in living donor kidney transplant recipients.

Materials and methods: This is a retrospective analysis of all biopsy-proven BKPyVN among kidney transplant recipients at our center from January 2010 to January 2022. We compared them to age, sex, and type of immunosuppression received matched (1:2) non-BKPyVN-infected recipients transplanted during the same period.

Results: During the study period, 2465 patients underwent kidney transplants at our center, of which 26 (1.05%) developed biopsy-proven BKPyVN. Four recipients (16%) lost their graft over a median period of 65 (IQR, 57-83) months from the time of diagnosis. The mean serum creatinine at the recent follow-up was higher in the BKPyVN arm as compared to controls (2.05 ± 1.39 vs 1.35 ± 0.46, p = 0.001.) Both BKPyVN and control arms had similar death-censored graft survival (82% vs 94%, p = 0.09) and patient survival (88% vs 96%, p = 0.184).

Conclusion: BKPyVN was uncommon in our kidney transplant recipients. Most patients were able to maintain their kidney function for many years, albeit at a somewhat reduced level compared with the controls, and about a fifth of our patients lost their graft.

Background: The COVID-19 pandemic had a major impact on solid organ transplant recipients. COVID-19 vaccination plays a crucial role in pandemic management.There is limited data on replication-defective viral vectors [ChAdOx1-nCOV (COVISHIELD^TM)] and whole inactivated one BBV-152 (COVAXIN^TM) in kidney transplant recipients (KTRs). This study aims to assess the humoral immune response and adverse effects of these vaccines in KTRs after the first and second doses of vaccination.

Materials and methods: Anti-SARS-CoV-2 anti-spike antibody titers were measured in 285 KTRs recipients prior to vaccination, 3 weeks ± 3 days after first dose and 3 weeks ± 3 days after second dose of the COVISHIELD (n = 232) and COVAXIN (n = 55) vaccines. Anti-spike antibodies were measured by the chemiluminescence immunoassay method. The primary outcome was seroconversion after two doses of COVAXIN and COVISHIELD and secondary outcome was the incidence of adverse events to COVID-19 vaccines within one week of vaccination.

Results: At baseline, 25 (39.7%) and 67 (30.2%) of KTRs were found to be seropositive before receiving COVAXIN^TM and COVISHIELD^TM, respectively. After first dose of vaccination, 46 (73.0%) and 158 (71.2%) were seropositive and after second dose, 51 (81.0%) and 177 (79.7%) were seropositive, respectively. Common adverse effects were fever, chills, myalgia, and headache which settled in 1-2 days. There was no episode of rejection.

Conclusion: Both ChAdOx1-nCOV and BBV-152 were well tolerated and induced robust antibody formation in KTRs in the Indian population.

Tumoral calcinosis is a rare syndrome characterized by calcium salt deposition in different periarticular soft tissue regions. We report this case of tumoral calcinosis with history of persistent soft tissue calcifications for over three decades. He presented with nephrotic syndrome and kidney biopsy revealed secondary amyloidosis. Genetic evaluation revealed GALNT3 mutation and diagnosis of hyperphosphatemic familial tumoral calcinosis was made. With this case report, we want to reiterate the need to consider tumoral calcinosis in secondary amyloidosis differentials and the pivotal role of genetic workup in chronic soft tissue calcifications.

Background: Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) is a new therapy option for anemia in chronic kidney disease (CKD) patients. We aimed to evaluate evidence from randomized controlled trials (RCTs) on HIF-PHIs for anemia in non-dialysis dependent (NDD)-CKD patients.

Materials and methods: We searched three electronic databases (PubMed, CINAHL, Cochrane Central Register of Controlled Trials databases), trial registries, and manually screened reference list. Two authors independently conducted screening, data extraction, and assessed risk of bias. We used RevMan 5.3 for meta-analysis using standard methods. Certainty of evidence was assessed by Grading of Recommendations, Assessment, Development, and Evaluations.

Results: We included 12 RCTs involving 8611 patients with anemia of kidney disease. The studies included roxadustat (n = 2), daprodustat (n = 3), molidustat (n = 3), vadadustat (n = 2), enarodustat (n = 1), and desidustat (n = 1). Desidustat and daprodustat reported no difference in the hemoglobin levels from baseline up to 24-52 weeks as compared to darbepoetin alpha [Mean Difference (MD): 0.09 g/dL (CI 95% 0.15-0.33); p = 0.46; 529 participants; low certainty evidence; and MD: 0.08 g/dL (CI 95% 0.08-0.08); p < 0.00001; two studies; 4089 participants; low certainty evidence, respectively]. Broadly, HIF-PHI molecules exhibited little difference when compared to other alternatives like erythropoietin stimulating agents (ESAs), but the evidence is not of high certainty.

Conclusion: Our meta-analysis provides evidence on the use of HIF-PHIs as an alternative to ESAs for anemia in NDD-CKDs.