Indian Journal of Nephrology最新文献

Background: Most cases of acute kidney injury (AKI) in the Indian subcontinent are community-acquired. Some causes of AKI like poisonings are unique to the local demographics. This study examined the clinical features, spectrum, and outcomes of AKI in patients with poisoning and evaluated the predictors of mortality.

Materials and methods: This was a prospective observational study conducted in patients admitted to Jawaharlal Nehru Medical College, Aligarh with an alleged history of poisoning orsnake bite. Relevant history, laboratory tests, mode of treatment, and outcome were recorded for all patients who were followed up after 3 months post discharge.

Results: During the study period, 394 patients were admitted with a provisional diagnosis of poisoning/snake bite analyzed, of whom 56 (14.2%) developed AKI. Final data analysis was done for 51 patients as 5 patients were lost to follow up. Paraquat poisoning was the most common cause of AKI, seen in 12 patients, followed by methanol in 9 patients. Hemodialysis was required in 29 (56.8%) patients. Complete recovery was seen in 33 (64.7%) patients, and 14 patients (27.5%) died during the acute phase of the illness. Late presentation to the hospital and presence of shock (mean arterial pressure <65 mmHg) on presentation were found to be associated with adverse outcomes (mortality/failure of return of renal function at 3 months). The most common cause of death was septic shock seen in 8 patients.

Conclusion: This study, which is probably the first from North India, highlights the fact that cases of poisoning/envenomation-related AKI contribute to a sizeable amount of morbidity/mortality.

Background: Nephrotic syndrome (NS) is relapsing-remitting illness affecting children and characterized by proteinuria, edema, and hypoalbuminemia. The disease involves the significant formative years of a child's life and profoundly impacts their physical and psychosocial well-being. There is a scarcity of literature exploring the quality of life (QoL) of children with NS and the factors influencing them. The study aimed to discuss the QoL of children with NS and the factors influencing it.

Materials and methods: A systematic search of electronic databases, including PubMed, Google Scholar, and Embase, was carried out from 2004 to August 2023. Nineteen original articles in English language that focused on evaluating the QoL of children with NS were included. Articles in languages other than English, letters, and editorial reviews, studies involving populations other than children, were excluded.

Results: Children with NS tend to have a better QoL as compared to those with other chronic diseases (p = <0.001), but it remains lower than that of healthy children (p<0.05). School functioning was the most affected domain. Recurrent relapses, prolonged illness, high steroid dosages, and multiple medications are significant contributors to impaired QoL. Children with steroid-resistant nephrotic syndrome (SRNS) had poorer QoL among the clinical subtypes.

Conclusion: Children with NS face various challenges that impact their QoL. Comprehensive care strategies to enhance QoL are the need of the hour.

Malnutrition, encompassing both undernutrition and overnutrition, is prevalent among patients with chronic kidney disease (CKD). It is influenced by a myriad of factors, including dietary restrictions, metabolic irregularities, inflammation, and comorbidities. It leads to increased morbidity, mortality, and diminished quality of life. In children, malnutrition hinders growth and development, particularly during infancy and early childhood. This article provides a comprehensive overview of current terminologies delineating undernutrition and overnutrition in CKD, and discusses age-specific nutritional assessment tools. It delves into macro- and micronutrient prescriptions tailored for both adults and children with CKD, emphasizing special considerations such as low and very low protein diets. A focus on the nutrient content of Indian foods is also provided, alongside available nutritional supplements, with insights into enteral feeding and the fortification of feeds in young children. Distinctive nuances in nutritional therapy between adults and children are elucidated throughout the article, drawing upon established guidelines, including Kidney Disease Outcomes and Quality Initiative (KDOQI) 2009 and 2020 and KDIGO CKD 2024 guidelines as well as Pediatric Renal Nutrition Task Force clinical practice recommendations, to inform dietary management strategies for individuals across the lifespan living with CKD.

Background: The job profile of security officers in tropical countries involves prolonged standing in hot conditions causing heat stress as well as complications of sedentary lifestyle. The objectives of this study were to estimate the prevalence of noncommunicable diseases and heat stress in security officers and analyze factors affecting heat stress and estimated glomerular filtration rate (eGFR).

Materials and methods: This was an observational cross-sectional study conducted among security personnel working at a tertiary care hospital in South India during the hottest months of March to May 2020. Screening camps were conducted during which anthropometric measurements were taken and blood was collected for hemoglobin, creatinine, and fasting glucose estimation. Urine dipstick analysis for glucose, protein, pH, and red and white blood cells were done on early morning voided sample. Heat stress was assessed by a validated 18-item questionnaire called heat strain score index (HSSI). A structured questionnaire was prepared for surveillance of risk factors of noncommunicable diseases.

Results: A total of 678 security officers were screened. Majority (659/678, 97.2%) were men and mean age of the cohort was 45.4 ± 9.2 years. Fifty-two percent (355/678) of participants were engaged in outdoor work for a median duration of 6 (IQR, 0-8) hours/day. Prevalence of obesity, diabetes, hypertension, and chronic kidney disease (CKD) were 70.9, 25.5, 15.9 and 1.3 percentage, respectively. Half of the cohort (324/678) had definite heat stress and 0.9% (6/678) developed CKD of undetermined etiology. Heat stress was higher in those working outdoors and longer employment duration and lower in those with abdominal obesity. eGFR was lower in older officers, smokers, hypertensives, and those with longer employment duration, but was unaffected by HSSI scores.

Conclusion: Kidney function was unaffected by high levels of heat stress experienced by security personnel working at a tertiary hospital in South India. Future studies are needed to understand the pathomechanisms of differential impacts of heat stress on kidney function of agricultural various worker categories.

Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are oral drugs for patients with renal anemia. This study aimed to synthesize evidence on HIF-PHIs for anemia in dialysis-dependent chronic kidney disease (DD-CKD) patients. We searched PubMed, CINAHL, and Cochrane Central Register of Controlled Trials databases and trial registries for randomized controlled trials (RCTs) reporting HIF-PHIs versus erythropoietin-stimulating agents (ESA) for anemia in DD-CKD patients. Two authors independently conducted screening, data extraction, and assessed risk of bias. We used RevMan 5.3 software for meta-analysis using standard methods. Certainty of evidence was assessed by Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). We included 20 RCTs involving 14,999 patients with anemia of kidney disease. The studies included roxadustat (n = 9), daprodustat (n = 5), vadadustat (n = 2), molidustat (n = 2), enarodustat (n = 1), and desidustat (n = 1). Overall, daprodustat as an alternative to ESAs reported a substantial net benefit while roxadustat showed more damage than benefit as compared to ESAs. While other HIF inhibitors demonstrated little to no difference or small benefit, daprodustat reduces the need for intravenous iron supplementation up to 52 weeks as compared to ESAs [Odds Ratio (OR): 0.77 (95% CI 0.53-1.13); p = 0.18; two studies; 674 participants; moderate certainty evidence]. Roxadustat increased treatment-emergent adverse events up to 6-52 weeks as compared to ESAs [OR: 1.45 (95% CI 1.08-1.96); p = 0.01; six studies; 1715 participants; moderate certainty evidence]. The study provided evidence on the use of HIF-PHIs for treating renal anemia in DD-CKD patients as an alternative to ESAs.

Patients with chronic kidney disease (CKD) display a variety of metabolic and nutritional irregularities, with majority of patients already being malnourished before starting dialysis. The screening, assessment and monitoring of nutritional status using an amalgamation of valid, complementary methods is crucial. Early and suitable dietary intervention is vital for preventing, diagnosing and treating malnutrition. All the misconceptions and myths about diet and food need to be resolved. Patient-centric realistic meal plans and dietary counseling are initiated at the early stages of CKD and the commencement of dialysis, with regular follow-ups on an ongoing basis with diet diaries that help prevent malnutrition. This review article will discuss the practical and simple dietary approaches for counseling patients to increase dietary compliance and meet the recommended requirements.

Background: Chronic kidney disease (CKD) is associated with an increased tendency of bleeding and thrombosis. There are multiple factors that interact with each other to cause either in CKD patients. Conventional or standard coagulation tests (SCT) have several limitations. Global coagulation test (GCT), such as Sonoclot, gives a real-time detailed analysis of coagulation status.

Materials and methods: This is a prospective observational cross-sectional study of 50 adult CKD stage 5D (dialysis) patients conducted from January 2020 to January 2022. Clinical details were noted and blood samples were taken for conventional and global coagulation tests prior to dialysis. Correlation between SCT and GCT as well as clinical hemostatic events was analyzed.

Results: Fifty patients were enrolled. Bleeding and thrombosis occurred in 7 and 5 patients, respectively. There was a significant correlation between some SCT and GCT parameters. None of the SCT parameter derangement was associated with any thrombotic episodes except increased fibrinogen level which was associated with thrombotic events. On the contrary, patients with hypocoagulability according to SCT actually had thrombotic events. Parameters of GCT, such as clot rate, time to peak, and platelet function were significantly associated with thrombotic episodes.

Conclusion: SCT and GCT parameters do not correlate with each other. SCT is not associated with clinically significant bleeding and thrombotic events. Some GCT parameters are associated with thrombotic events. GCT are real time and are better than SCT to reflect the coagulation status in patients on dialysis.