Pub Date : 2023-12-01Epub Date: 2023-05-15DOI: 10.1007/s12070-023-03881-4
Rajeev Kumar, Smita Manchanda, Ashutosh Hota, K Devaraja, Rishikesh Thakur, P Mohammad Sherif, Prem Sagar, Maroof Ahmad Khan, Ashu Seith Bhalla, Rakesh Kumar
Introduction: Identification of occult lymph node metastasis is challenging in early tongue cancers. We conducted a prospective study to determine the most characteristics ultrasonic feature suggestive of metastatic node. Material and Methods: A preliminary study based on feasibility was planned on twenty five patients with squamous cell carcinoma of tongue (T1,T2) and N0 neck underwent ultrasonography of neck. The results of each ultrasonic parameters (size, shape, echogenicity, margin and hilum) for suspicion were analysed. Pathologic evaluation of surgical resected neck specimen served as the reference standard. Results: USG yielded sensitivity and specificity by size, by morphology, either size or morphology are 50.0% and 87.5%, 75.0% and 87.5, 75.0 and 83.3% respectively. Morphology alone has highest negative predictive value (NPV:91.3%) with accuracy of 84.3%. Conclusion: Morphology of the lymph node had highest sensitivity and specificity with highest negative predictive value correlating with its metastatic nature.
{"title":"Ultrasound Characteristics of Metastatic Occult Cervical Lymph Nodes in Early Tongue Cancer.","authors":"Rajeev Kumar, Smita Manchanda, Ashutosh Hota, K Devaraja, Rishikesh Thakur, P Mohammad Sherif, Prem Sagar, Maroof Ahmad Khan, Ashu Seith Bhalla, Rakesh Kumar","doi":"10.1007/s12070-023-03881-4","DOIUrl":"10.1007/s12070-023-03881-4","url":null,"abstract":"<p><p><b>Introduction:</b> Identification of occult lymph node metastasis is challenging in early tongue cancers. We conducted a prospective study to determine the most characteristics ultrasonic feature suggestive of metastatic node. <b>Material and Methods:</b> A preliminary study based on feasibility was planned on twenty five patients with squamous cell carcinoma of tongue (T1,T2) and N0 neck underwent ultrasonography of neck. The results of each ultrasonic parameters (size, shape, echogenicity, margin and hilum) for suspicion were analysed. Pathologic evaluation of surgical resected neck specimen served as the reference standard. <b>Results:</b> USG yielded sensitivity and specificity by size, by morphology, either size or morphology are 50.0% and 87.5%, 75.0% and 87.5, 75.0 and 83.3% respectively. Morphology alone has highest negative predictive value (NPV:91.3%) with accuracy of 84.3%. <b>Conclusion:</b> Morphology of the lymph node had highest sensitivity and specificity with highest negative predictive value correlating with its metastatic nature.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"30 1","pages":"2786-2791"},"PeriodicalIF":0.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79575532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Veeranki, Narayan Prasad, Shadab Hussain, M. Patel, R. Kushwaha, J. Meyyappan, Vinita Agarwal, Manoj Jain, Riti Yadav
{"title":"Severe and Recurrent Acute Kidney Injury Following Dichlorvos Exposure – A Rare Case Report and Review of Literature","authors":"V. Veeranki, Narayan Prasad, Shadab Hussain, M. Patel, R. Kushwaha, J. Meyyappan, Vinita Agarwal, Manoj Jain, Riti Yadav","doi":"10.4103/ijn.ijn_158_23","DOIUrl":"https://doi.org/10.4103/ijn.ijn_158_23","url":null,"abstract":"","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"361 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139232133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Infections frequently complicate the course of solid organ transplant recipientsHerpes simplex virus (HSV) infection can be acquired from the environment, and the disease may result from the reactivation of latent infection or transmission from the donor. Although graft dysfunction caused by the direct impact of HSV, such as interstitial nephritis, is recognized, only a few cases have histopathologically confirmed the presence of HSV. In this report, we present the clinical course of a kidney transplant recipient who developed HSV-related nephritis and subsequently achieved complete recovery following antiviral therapy. A 32-year-old gentleman was admitted for a second living-related kidney transplantation from his mother. He underwent fulguration of posterior urethral valves at the age of 10 years but gradually progressed to end-stage kidney disease over the next decade. He had undergone his first kidney transplantation in 2010 with his father as the donor. However, his creatinine levels increased to 1.5 mg/dL the following year, prompting a graft biopsy, which revealed features of chronic allograft nephropathy. The graft failed over the next decade, necessitating the evaluation for a pre-emptive kidney transplantation. He had a 8/12 HLA-allelic match and had low panel reactive antibody (Class 1%–4% and Class 2%–7%). Both the donor and the recipient were seropositive for cytomegalovirus (CMV) antibodies. He received 5 mg/kg antithymocyte globulin for induction and was initiated on triple-drug immunosuppressive therapy with tacrolimus, mycophenolate sodium, and prednisolone. The patient achieved good graft function, with a decline in serum creatinine to 0.7 mg/dL by postoperative day 3. However, on postoperative day 6, the patient developed odynophagia, prompting an upper GI endoscopy, which revealed esophageal ulcers, and the histopathology findings were suggestive of HSV-related ulcers [Figure 1]. Valganciclovir dosage was increased to 900 mg/day. His symptoms abated, and he was discharged after 2 days, with a serum creatinine level of 0.9 mg/dL.Figure 1: Esophageal ulcer shows keratinocytes with viral cytopathic changes in the form of nuclear enlargement with ground glass appearance (original magnification ×400; Hematoxylin and Eosin). HSV2 immunohistochemistry shows nuclear positivity in the affected keratinocytes (original magnification × 400; HSV2 immunohistochemistry)During a routine outpatient visit on postoperative day 14, the patient’s serum creatinine had risen to 2.1 mg/dL and tacrolimus level was 3.92 ng/mL. Systemic examinations, including genitals, were unremarkable. Suspecting acute rejection, a kidney biopsy was performed and the patient was pulsed with 250 mg methylprednisolone per day for 3 days. Biopsy revealed diffuse acute tubular injury with cytopathic changes in tubular cells [Figure 2]. Immunohistochemistry showed staining for HSV-2 in some tubular nuclei, consistent with HSV nephritis. Intravenous acyclovir was initiated
{"title":"Herpes Simplex Virus Type-2 Nephritis: An Unexpected Plot Twist in a Kidney Transplant Recipient","authors":"Lovy Gaur, Rajan Duggal, Manoj Kumar Singhal","doi":"10.4103/ijn.ijn_359_23","DOIUrl":"https://doi.org/10.4103/ijn.ijn_359_23","url":null,"abstract":"Infections frequently complicate the course of solid organ transplant recipientsHerpes simplex virus (HSV) infection can be acquired from the environment, and the disease may result from the reactivation of latent infection or transmission from the donor. Although graft dysfunction caused by the direct impact of HSV, such as interstitial nephritis, is recognized, only a few cases have histopathologically confirmed the presence of HSV. In this report, we present the clinical course of a kidney transplant recipient who developed HSV-related nephritis and subsequently achieved complete recovery following antiviral therapy. A 32-year-old gentleman was admitted for a second living-related kidney transplantation from his mother. He underwent fulguration of posterior urethral valves at the age of 10 years but gradually progressed to end-stage kidney disease over the next decade. He had undergone his first kidney transplantation in 2010 with his father as the donor. However, his creatinine levels increased to 1.5 mg/dL the following year, prompting a graft biopsy, which revealed features of chronic allograft nephropathy. The graft failed over the next decade, necessitating the evaluation for a pre-emptive kidney transplantation. He had a 8/12 HLA-allelic match and had low panel reactive antibody (Class 1%–4% and Class 2%–7%). Both the donor and the recipient were seropositive for cytomegalovirus (CMV) antibodies. He received 5 mg/kg antithymocyte globulin for induction and was initiated on triple-drug immunosuppressive therapy with tacrolimus, mycophenolate sodium, and prednisolone. The patient achieved good graft function, with a decline in serum creatinine to 0.7 mg/dL by postoperative day 3. However, on postoperative day 6, the patient developed odynophagia, prompting an upper GI endoscopy, which revealed esophageal ulcers, and the histopathology findings were suggestive of HSV-related ulcers [Figure 1]. Valganciclovir dosage was increased to 900 mg/day. His symptoms abated, and he was discharged after 2 days, with a serum creatinine level of 0.9 mg/dL.Figure 1: Esophageal ulcer shows keratinocytes with viral cytopathic changes in the form of nuclear enlargement with ground glass appearance (original magnification ×400; Hematoxylin and Eosin). HSV2 immunohistochemistry shows nuclear positivity in the affected keratinocytes (original magnification × 400; HSV2 immunohistochemistry)During a routine outpatient visit on postoperative day 14, the patient’s serum creatinine had risen to 2.1 mg/dL and tacrolimus level was 3.92 ng/mL. Systemic examinations, including genitals, were unremarkable. Suspecting acute rejection, a kidney biopsy was performed and the patient was pulsed with 250 mg methylprednisolone per day for 3 days. Biopsy revealed diffuse acute tubular injury with cytopathic changes in tubular cells [Figure 2]. Immunohistochemistry showed staining for HSV-2 in some tubular nuclei, consistent with HSV nephritis. Intravenous acyclovir was initiated","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"17 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135680064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trace elements are essential micronutrients required for the normal functioning of the body. Patients on hemodialysis (HD) exhibit altered levels of essential trace elements, predisposing them to oxidative stress, inflammation, and immune abnormalities. In particular, patients undergoing HD have disruption of zinc (Zn) and copper (Cu) levels, which has been suggested as a cause of clinical deterioration and adverse outcomes in HD patients.[1] Zn and Cu have been suggested to affect oxidative stress and to be associated with abnormal glucose tolerance and diabetes mellitus.[2] Cu is an essential trace element and a major constituent of the respiratory enzyme complex cytochrome c oxidase; Cu is also found in superoxide dismutase, which decreases oxidative stress. Oxidative stress is thought to promote the development of insulin resistance (IR) and diabetes.[2] IR is considered a substantial risk factor for the development of excessive vascular stiffening and consequent adverse cardiovascular disease events.[3] Strategies aimed at preventing or improving IR may represent novel interventions to improve poor clinical outcomes in HD patients. The hyperinsulinemic euglycemic clamp is the gold standard for the index of IR, but the technique is complicated because it requires time for equipment and inspection, making it difficult to use in daily medical treatment and large-scale clinical studies.[4] Since there is a lack of evidence in this area, we evaluated the relationship between IR and trace elements such as Zn and Cu in HD patients using an artificial pancreas. The hyperinsulinemic euglycemic clamp was performed with an artificial pancreas (STG-55; Nikkiso, Shizuoka, Japan). In brief, human regular insulin was automatically injected intravenously by the artificial pancreas at a rate of 1.25 mU/kg/min to achieve a blood glucose level of 95 mg/dL. The mean glucose infusion rate (GIR; mg/kg/min) over the last 30 min of the 120-min clamp represents insulin sensitivity. The high GIR means low IR because insulin is functioning well. This study and all its protocols were reviewed and approved by the International University of Health and Welfare Ethics Committee (approval no. 21-NR-060). Written informed consent was obtained from the patient for this study. In seven HD patients, GIR was measured by the hyperinsulinemic euglycemic clamp on two occasions, 6 weeks apart, before dialysis at the beginning of the week. The hyperinsulinemic euglycemic clamp requires two catheters, one for continuous blood collection and the other for glucose and insulin administration. In this study, the two indwelling needles used in subsequent HD were used as routes. Normality of data was evaluated with the Shapiro–Wilk test. Data are presented as the mean ± standard deviation (SD) or the median (25%–75% interquartile range), unless otherwise indicated. The relation between two variables was assessed with Pearson’s correlation coefficient for normal distribution and Spearman’s
微量元素是人体正常运转所必需的微量元素。血液透析(HD)患者表现出必需微量元素水平的改变，使他们易患氧化应激、炎症和免疫异常。特别是，HD患者的锌(Zn)和铜(Cu)水平被破坏，这被认为是HD患者临床恶化和不良结局的原因之一。[1]锌和铜被认为影响氧化应激，并与糖耐量异常和糖尿病有关。[2]铜是人体必需的微量元素，是呼吸酶复合体细胞色素c氧化酶的主要成分;铜也存在于能减少氧化应激的超氧化物歧化酶中。氧化应激被认为会促进胰岛素抵抗(IR)和糖尿病的发展。[2]IR被认为是血管过度硬化和随之而来的不良心血管疾病事件发展的重要危险因素。[3]旨在预防或改善IR的策略可能是改善HD患者不良临床结果的新干预措施。高胰岛素正血糖钳是IR指标的金标准，但由于设备和检查需要时间，技术复杂，难以在日常医疗和大规模临床研究中使用。[4]由于缺乏这方面的证据，我们评估了使用人工胰腺的HD患者IR与微量元素(如Zn和Cu)之间的关系。采用人工胰腺(STG-55;日本静冈县Nikkiso)。简言之，人常规胰岛素由人工胰腺以1.25 mU/kg/min的速度自动静脉注射，使血糖水平达到95 mg/dL。平均葡萄糖输注速率(GIR;Mg /kg/min)在120分钟钳夹的最后30分钟表示胰岛素敏感性。高GIR意味着低IR，因为胰岛素运作良好。本研究及其所有方案经国际卫生与福利大学伦理委员会审查和批准(批准号:21 - nr - 060)。本研究获得了患者的书面知情同意。在7例HD患者中，在周初透析前，间隔6周，两次使用高胰岛素正糖钳测量GIR。高胰岛素正糖钳需要两根导管，一根用于持续采血，另一根用于葡萄糖和胰岛素的给药。本研究以后续HD患者使用的两根留置针为途径。用Shapiro-Wilk检验评估数据的正态性。除非另有说明，数据以均数±标准差(SD)或中位数(25%-75%四分位数间距)表示。正态分布用Pearson相关系数评价，非正态分布用Spearman秩相关系数评价。所有统计分析均采用SPSS (statistical Package for Social Sciences)软件进行。P值<0.05认为有统计学意义。表1总结了纳入本研究的7例患者的人口学和临床特征。结果显示Cu与GIR有相关性(r = - 0.55, P = 0.042)， Zn与GIR无相关性(r = 0.31, P = 0.280)[图1]。微量元素在糖尿病患病率方面受到越来越多的关注，铜就是其中一种元素。铜是多种金属酶的重要组成部分，在氧化还原反应中起着重要作用。Cu通过Haber-Weiss和fenton样反应促进活性氧(ROS)的形成，并通过吸氢催化参与羟基自由基的生成，从而增加氧化应激[5]。这些后果被认为会导致IR，我们的结果与这一假设一致。锌是人体代谢过程中必需的微量营养素，它调节着300多种蛋白质折叠、基因表达、活性氧产生和中和的酶。锌是胰岛素加工和储存所必需的。特别是锌转运体ZnT8对于胰岛素的生物合成和分泌、锌被摄取到胰岛素分泌颗粒以及锌与胰岛素的共分泌至关重要。锌体内平衡的破坏与糖尿病和IR有关。[2]有几项研究调查了锌和IR之间的关系，但它们都没有定论。在目前的研究结果中，没有发现锌和IR之间的关联，但这可能是由于病例数量不足。HOMA-R与GIR、Zn或Cu无关，可能与HOMA-R不能准确反映IR有关，特别是在空腹血糖高的情况下。 表1:研究参与者的临床特征和实验室数据(n=7)图1:葡萄糖输注速率与铜(a)或锌(b)的相关性分析据我们所知，这是第一份表明铜与GIR之间存在关联的报告。在基础研究领域，有报道称Cu螯合剂降低了2型糖尿病小鼠的IR并改善了葡萄糖耐受不良。[6]但临床研究尚无相关报道。我们的结果支持Cu螯合剂是否有助于IR改善的研究。本研究及其所有方案均经国际健康福利大学伦理委员会审查和批准(批准号:21 - nr - 060)。本研究获得了患者的书面知情同意。财政支持及赞助无。利益冲突没有利益冲突。
{"title":"Evaluation of Relationship between Copper and Insulin Resistance by Hyperinsulinemic Clamp","authors":"Ryunosuke Mitsuno, Kozi Hosoya, Kiyotaka Uchiyama, Naoki Washida","doi":"10.4103/ijn.ijn_381_23","DOIUrl":"https://doi.org/10.4103/ijn.ijn_381_23","url":null,"abstract":"Trace elements are essential micronutrients required for the normal functioning of the body. Patients on hemodialysis (HD) exhibit altered levels of essential trace elements, predisposing them to oxidative stress, inflammation, and immune abnormalities. In particular, patients undergoing HD have disruption of zinc (Zn) and copper (Cu) levels, which has been suggested as a cause of clinical deterioration and adverse outcomes in HD patients.[1] Zn and Cu have been suggested to affect oxidative stress and to be associated with abnormal glucose tolerance and diabetes mellitus.[2] Cu is an essential trace element and a major constituent of the respiratory enzyme complex cytochrome c oxidase; Cu is also found in superoxide dismutase, which decreases oxidative stress. Oxidative stress is thought to promote the development of insulin resistance (IR) and diabetes.[2] IR is considered a substantial risk factor for the development of excessive vascular stiffening and consequent adverse cardiovascular disease events.[3] Strategies aimed at preventing or improving IR may represent novel interventions to improve poor clinical outcomes in HD patients. The hyperinsulinemic euglycemic clamp is the gold standard for the index of IR, but the technique is complicated because it requires time for equipment and inspection, making it difficult to use in daily medical treatment and large-scale clinical studies.[4] Since there is a lack of evidence in this area, we evaluated the relationship between IR and trace elements such as Zn and Cu in HD patients using an artificial pancreas. The hyperinsulinemic euglycemic clamp was performed with an artificial pancreas (STG-55; Nikkiso, Shizuoka, Japan). In brief, human regular insulin was automatically injected intravenously by the artificial pancreas at a rate of 1.25 mU/kg/min to achieve a blood glucose level of 95 mg/dL. The mean glucose infusion rate (GIR; mg/kg/min) over the last 30 min of the 120-min clamp represents insulin sensitivity. The high GIR means low IR because insulin is functioning well. This study and all its protocols were reviewed and approved by the International University of Health and Welfare Ethics Committee (approval no. 21-NR-060). Written informed consent was obtained from the patient for this study. In seven HD patients, GIR was measured by the hyperinsulinemic euglycemic clamp on two occasions, 6 weeks apart, before dialysis at the beginning of the week. The hyperinsulinemic euglycemic clamp requires two catheters, one for continuous blood collection and the other for glucose and insulin administration. In this study, the two indwelling needles used in subsequent HD were used as routes. Normality of data was evaluated with the Shapiro–Wilk test. Data are presented as the mean ± standard deviation (SD) or the median (25%–75% interquartile range), unless otherwise indicated. The relation between two variables was assessed with Pearson’s correlation coefficient for normal distribution and Spearman’s ","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"58 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135684208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Madhuvanthini Nethaji, Siddhartha K. Bhattaram, Vishnubhotla Sivakumar
Chronic kidney disease (CKD) is characterized by progressive nephron loss, leading to irreversible decrease in GFR and loss in renal function.[1] Five to ten percent of the world’s population is estimated to be suffering from CKD.[2] The Global Burden of Disease Study 2015 ranked CKD as the 8th leading cause of death in India.[3] The overall age-adjusted incidence rate of end-stage renal disease in India is 229 million.[4] Very few studies that assess the quality of life in various stages of CKD, including dialysis and transplantation, have been done in our country. The disease burden has a strong impact on the patient’s quality of life (QOL) and other associated factors. Our study included 120 subjects: 30 each in CKD, hemodialysis, peritoneal dialysis, and renal transplantation. The mean age of the study participants was 43.31 ± 11.99 years. The male-to-female ratio was 2:1. Of the total number of participants, 86.7% were married and 60.8% belonged to the upper-middle class. Sixty-one percent of the study participants belonged to the normal BMI range, and 28.3% were graduates. The aetiologies for CKD were chronic gloemrulonephritis(55/120; 45.83%), unknown aetiology (51/120;42.5%) and chronic pyelonephritis (14/120; 11%). The health-related QOL (HRQOL) was studied using Kidney Disease Quality of Life Short Form 36 (KDQOL-SF 36) version 1.3[5] from RAND corporation, which has been validated in our population. The kidney disease–specific instrument assesses the burden of kidney disease in 11 domains (symptoms or problems of kidney disease, burden of kidney disease, effects of kidney disease, work status, cognitive function, quality of social interaction, sexual function, sleep, social support, patient satisfaction, and dialysis staff encouragement). Each domain is scored on a 100-point scale, with higher scores representing better QOL. The individual scores can be averaged to a kidney disease component summary (KDCS) score. The SF-36 assesses the HRQOL in eight domains (physical functioning, role limitations caused by physical problems, role limitations caused by emotional problems, pain, general health, energy or fatigue, emotional well-being, and social function). Results from the SF-36 are further summarized into a physical composite summary (PCS) and a mental composite summary (MCS) score. The QOL in the four groups is listed in Table 1. Symptom burden and problem, effects of kidney disease, burden of kidney disease, and KDCS were highest. Quality of social interaction and sleep was higher in the transplant group. There seemed to be no difference in the dialysis groups. The work status was affected in all the groups, with better scores noted in the dialysis groups.Table 1: Healthrelated quality of life among CKD , hemodialysis, peritoneal dialysis, transplantThe SF-36 scores are tabulated in Table 1. Physical functioning, role physical, general health, role emotional, and PCS were well preserved in the transplant group. Emotional well-being a
{"title":"Assessment of Quality of Life and Associated Factors in Patients of Non-diabetic Chronic Kidney Disease in Various Stages: Pre-dialysis, Dialysis, and Kidney Transplant Recipients","authors":"Madhuvanthini Nethaji, Siddhartha K. Bhattaram, Vishnubhotla Sivakumar","doi":"10.4103/ijn.ijn_170_23","DOIUrl":"https://doi.org/10.4103/ijn.ijn_170_23","url":null,"abstract":"Chronic kidney disease (CKD) is characterized by progressive nephron loss, leading to irreversible decrease in GFR and loss in renal function.[1] Five to ten percent of the world’s population is estimated to be suffering from CKD.[2] The Global Burden of Disease Study 2015 ranked CKD as the 8th leading cause of death in India.[3] The overall age-adjusted incidence rate of end-stage renal disease in India is 229 million.[4] Very few studies that assess the quality of life in various stages of CKD, including dialysis and transplantation, have been done in our country. The disease burden has a strong impact on the patient’s quality of life (QOL) and other associated factors. Our study included 120 subjects: 30 each in CKD, hemodialysis, peritoneal dialysis, and renal transplantation. The mean age of the study participants was 43.31 ± 11.99 years. The male-to-female ratio was 2:1. Of the total number of participants, 86.7% were married and 60.8% belonged to the upper-middle class. Sixty-one percent of the study participants belonged to the normal BMI range, and 28.3% were graduates. The aetiologies for CKD were chronic gloemrulonephritis(55/120; 45.83%), unknown aetiology (51/120;42.5%) and chronic pyelonephritis (14/120; 11%). The health-related QOL (HRQOL) was studied using Kidney Disease Quality of Life Short Form 36 (KDQOL-SF 36) version 1.3[5] from RAND corporation, which has been validated in our population. The kidney disease–specific instrument assesses the burden of kidney disease in 11 domains (symptoms or problems of kidney disease, burden of kidney disease, effects of kidney disease, work status, cognitive function, quality of social interaction, sexual function, sleep, social support, patient satisfaction, and dialysis staff encouragement). Each domain is scored on a 100-point scale, with higher scores representing better QOL. The individual scores can be averaged to a kidney disease component summary (KDCS) score. The SF-36 assesses the HRQOL in eight domains (physical functioning, role limitations caused by physical problems, role limitations caused by emotional problems, pain, general health, energy or fatigue, emotional well-being, and social function). Results from the SF-36 are further summarized into a physical composite summary (PCS) and a mental composite summary (MCS) score. The QOL in the four groups is listed in Table 1. Symptom burden and problem, effects of kidney disease, burden of kidney disease, and KDCS were highest. Quality of social interaction and sleep was higher in the transplant group. There seemed to be no difference in the dialysis groups. The work status was affected in all the groups, with better scores noted in the dialysis groups.Table 1: Healthrelated quality of life among CKD , hemodialysis, peritoneal dialysis, transplantThe SF-36 scores are tabulated in Table 1. Physical functioning, role physical, general health, role emotional, and PCS were well preserved in the transplant group. Emotional well-being a","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135680065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Junha Ryu, Seolje Lee, Tae W. Lee, Eunjin Bae, Dong J. Park
Abstract Renal vein thrombosis (RVT) is not an uncommon condition in patients occurring nephrotic syndrome. Renal cyst by bacterial infection is also rare. Only one case for RVT complicated with infected renal cyst is reported in the English literature. A 78-year-old female was admitted for fever and drowsy mentality for 4 days. Contrast-enhanced computed tomography (CECT) of the abdomen showed 3.7 cm sized irregular shaped exophytic cyst well enhanced in left kidney upper pole and the left RVT. The culture of cystic fluid revealed Klebsiella pneumoniae. Our patient was effectively treated with antibiotics for 8 weeks and anticoagulant for 12 weeks. At 12-week follow-up, CECT of the kidney showed decreased cyst and nearly disappeared RVT. The possibility of RVT in patients with renal cyst infection by bacteria warrants consideration.
{"title":"A Case of Infected Renal Cyst Complicated by Renal Vein Thrombosis","authors":"Junha Ryu, Seolje Lee, Tae W. Lee, Eunjin Bae, Dong J. Park","doi":"10.4103/ijn.ijn_289_23","DOIUrl":"https://doi.org/10.4103/ijn.ijn_289_23","url":null,"abstract":"Abstract Renal vein thrombosis (RVT) is not an uncommon condition in patients occurring nephrotic syndrome. Renal cyst by bacterial infection is also rare. Only one case for RVT complicated with infected renal cyst is reported in the English literature. A 78-year-old female was admitted for fever and drowsy mentality for 4 days. Contrast-enhanced computed tomography (CECT) of the abdomen showed 3.7 cm sized irregular shaped exophytic cyst well enhanced in left kidney upper pole and the left RVT. The culture of cystic fluid revealed Klebsiella pneumoniae. Our patient was effectively treated with antibiotics for 8 weeks and anticoagulant for 12 weeks. At 12-week follow-up, CECT of the kidney showed decreased cyst and nearly disappeared RVT. The possibility of RVT in patients with renal cyst infection by bacteria warrants consideration.","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"57 14","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135684215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dear Editor, Primary adrenal leiomyosarcoma is arare malignant tumor. Metastatic adrenal leiomyosarcoma and extension from the retroperitoneum are more frequent. Leiomyosarcoma occurs primarily in the myometrium, retroperitoneum, and soft tissues of the extremities. Herein we report a case in a 31 year old female who presented with abdominal pain. Contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI) abdomen revealed a large heterogeneously enhancing mass in the right suprarenal region abutting the surrounding structures such as liver, superior pole of right kidney, adjacent inferior vena cava, second part of duodenum, and right renal vein, causing its upliftment [Figure 1a]. Further, she underwent resection of the mass along with right nephrectomy. Pathological findings revealed a nonencapsulated mass measuring 8.5 × 5.5 × 4.5 cm. Cut surface appeared fleshy with hemorrhagic and necrotic areas [Figure 1b]. Microscopically, solid pattern of spindle cells showing marked pleomorphism with 30% areas of necrosis and 10–12 muscle fibers/10 high power fields, with compressed adrenal gland at the periphery was seen [Figure 1c]. Immunohistochemically, intense positivity for desmin, smooth muscle actin [Figure 1d], caldesmon, and vimentin was observed. Considering the aforementioned features, a diagnosis of conventional primary leiomyosarcoma of the adrenal gland, FNCLCC Grade 2 was rendered. After 15 months of follow-up, the patient remained free of recurrence. Adrenal leiomyosarcomas are rare tumors, usually diagnosed at an advanced stage due to nonspecificity of symptoms, contributing to poor prognosis. The gold standard for treatment is surgical excision, followed by chemotherapy and radiotherapy.Figure 1: Images of Primary adrenal leiomyosarcoma. (a) Imaging showing a large heterogeneously enhancing mass in the right suprarenal region abutting the surrounding structures. (b) Gross photograph of right nephrectomy specimen with a well defined fleshy suprarenal mass. (c) Microphotograph showing solid pattern of spindle cells showing marked pleomorphism and focal necrosis (H and E X100). (d) Immunoreactivity for Smooth Muscle actin (IHC stain for SMA X400)Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
{"title":"An Uncommon Malignant Suprarenal Mesenchymal Tumor","authors":"None Prachi, Hema M. Aiyer, Gaurav Sharma","doi":"10.4103/ijn.ijn_278_23","DOIUrl":"https://doi.org/10.4103/ijn.ijn_278_23","url":null,"abstract":"Dear Editor, Primary adrenal leiomyosarcoma is arare malignant tumor. Metastatic adrenal leiomyosarcoma and extension from the retroperitoneum are more frequent. Leiomyosarcoma occurs primarily in the myometrium, retroperitoneum, and soft tissues of the extremities. Herein we report a case in a 31 year old female who presented with abdominal pain. Contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI) abdomen revealed a large heterogeneously enhancing mass in the right suprarenal region abutting the surrounding structures such as liver, superior pole of right kidney, adjacent inferior vena cava, second part of duodenum, and right renal vein, causing its upliftment [Figure 1a]. Further, she underwent resection of the mass along with right nephrectomy. Pathological findings revealed a nonencapsulated mass measuring 8.5 × 5.5 × 4.5 cm. Cut surface appeared fleshy with hemorrhagic and necrotic areas [Figure 1b]. Microscopically, solid pattern of spindle cells showing marked pleomorphism with 30% areas of necrosis and 10–12 muscle fibers/10 high power fields, with compressed adrenal gland at the periphery was seen [Figure 1c]. Immunohistochemically, intense positivity for desmin, smooth muscle actin [Figure 1d], caldesmon, and vimentin was observed. Considering the aforementioned features, a diagnosis of conventional primary leiomyosarcoma of the adrenal gland, FNCLCC Grade 2 was rendered. After 15 months of follow-up, the patient remained free of recurrence. Adrenal leiomyosarcomas are rare tumors, usually diagnosed at an advanced stage due to nonspecificity of symptoms, contributing to poor prognosis. The gold standard for treatment is surgical excision, followed by chemotherapy and radiotherapy.Figure 1: Images of Primary adrenal leiomyosarcoma. (a) Imaging showing a large heterogeneously enhancing mass in the right suprarenal region abutting the surrounding structures. (b) Gross photograph of right nephrectomy specimen with a well defined fleshy suprarenal mass. (c) Microphotograph showing solid pattern of spindle cells showing marked pleomorphism and focal necrosis (H and E X100). (d) Immunoreactivity for Smooth Muscle actin (IHC stain for SMA X400)Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"17 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135680062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dear Editor, Chronic kidney disease (CKD) affects 1 in 10 adults. Kidney disease-related mortality is projected to be the fifth leading cause of death by 2040.[1] Diabetic kidney disease, chronic interstitial nephritis, glomerulonephritis and CKD of unknown etiology (CKDu) are the common causes of CKD India.[2] The prevalence of diabetes in India, which is the most common cause of end-stage kidney disease (ESKD), has jumped from 77 million in 2019 to 101 million in 2023. This increase in diabetes cases will cause an epidemic of CKD in the near future. The Ministry of Health and Family Welfare, Government of India, released the Rural Health Statistics for the year 2021-2022 on January 12, 2023 about 31,053 primary health centres (PHC) and 6,064 functional community health centres in the country. Primary care physicians working at rural health sector need to be trained in early identification and treatment of acute CKDs. This can be achieved by linking PHCs to secondary and tertiary care centres to ensure continuous education, knowledge sharing, manpower training, infrastructure development, and referral. National Medical Council defines 31 competencies in nephrology for the undergraduate course.[3] Newer competency like interpretation of kidney health data and dialysis catheter insertion procedure should be included for proper management of kidney diseases at all levels. We suggest the following specific strategies Incorporation of newer competency in CBME curriculum Collaboration between hospitals providing nephrology services and community health services. Integrative classes on renal physiology, pathology, general medicine, and community medicine for a holistic approach toward prevention and management of kidney diseases in undergraduate curriculum. Case-based bedside teaching in undergraduates with emphasis on common kidney diseases. Clinical posting in Nephrology department for practical exposure but creating interest in this subject. Regular internal assessment during clinical posting. Exposure to nephrology services in the community health centre during internship. Promoting locally relevant research in the area of kidney health for undergraduates/interns/PG trainees. Nursing and paramedics including students studying public health should be properly oriented towards kidney diseases. Students should be trained to diagnose kidney disease in their own family and relatives. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
{"title":"Upgrading Nephrology Training among the Doctors to Combat Chronic Kidney Disease (CKD) Epidemic - Now is the Time to Act","authors":"Manoranjan Sahoo, Archana Malik, Saroj Kumar Tripathy, Sarthak Das, Swati Priya","doi":"10.4103/ijn.ijn_124_23","DOIUrl":"https://doi.org/10.4103/ijn.ijn_124_23","url":null,"abstract":"Dear Editor, Chronic kidney disease (CKD) affects 1 in 10 adults. Kidney disease-related mortality is projected to be the fifth leading cause of death by 2040.[1] Diabetic kidney disease, chronic interstitial nephritis, glomerulonephritis and CKD of unknown etiology (CKDu) are the common causes of CKD India.[2] The prevalence of diabetes in India, which is the most common cause of end-stage kidney disease (ESKD), has jumped from 77 million in 2019 to 101 million in 2023. This increase in diabetes cases will cause an epidemic of CKD in the near future. The Ministry of Health and Family Welfare, Government of India, released the Rural Health Statistics for the year 2021-2022 on January 12, 2023 about 31,053 primary health centres (PHC) and 6,064 functional community health centres in the country. Primary care physicians working at rural health sector need to be trained in early identification and treatment of acute CKDs. This can be achieved by linking PHCs to secondary and tertiary care centres to ensure continuous education, knowledge sharing, manpower training, infrastructure development, and referral. National Medical Council defines 31 competencies in nephrology for the undergraduate course.[3] Newer competency like interpretation of kidney health data and dialysis catheter insertion procedure should be included for proper management of kidney diseases at all levels. We suggest the following specific strategies Incorporation of newer competency in CBME curriculum Collaboration between hospitals providing nephrology services and community health services. Integrative classes on renal physiology, pathology, general medicine, and community medicine for a holistic approach toward prevention and management of kidney diseases in undergraduate curriculum. Case-based bedside teaching in undergraduates with emphasis on common kidney diseases. Clinical posting in Nephrology department for practical exposure but creating interest in this subject. Regular internal assessment during clinical posting. Exposure to nephrology services in the community health centre during internship. Promoting locally relevant research in the area of kidney health for undergraduates/interns/PG trainees. Nursing and paramedics including students studying public health should be properly oriented towards kidney diseases. Students should be trained to diagnose kidney disease in their own family and relatives. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"58 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135684206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lakshmi P. Aiswharya, A. Sunnesh, S. Mathini, Prasanna N. Kumar, M. Gurupriya, G. Vishwaeswar Rao, M. Raja Amarendra, K. Naveen, Bhatt G. Gayathri, G. Srilakshmi, Maria Bethasida Manuel, B. Alekhya, V. Kiran Kumar, K. Dinakar Reddy, K. P, Rahul, P. Lohitha, K. Pravallika, G. Jahnavi, B. Anil Kumar, G. Charishma, S. Taranum Bhanu, S. Soundarya, G. Ram Thulasi, P. Bhargav, S. Sailaja, R. Ram, V. Siva Kumar, B. Vengamma
On March 11, 2020, the World Health Organization recognized a new highly infectious-contagious SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection for humans as a pandemic.[1] Our tertiary care hospital of a medical university in South India started to function as hospital for COVID-19 patients on March 13, 2020. The aim of this article is to describe the clinical profile and outcomes of the end-stage renal disease patients on maintenance hemodialysis with COVID-19 disease at our center. Till December 31,2021, we had admitted and managed 15,719 COVID-19 disease patients. The overall mortality rate in all COVID-19 patients was 18.3% (2,878 deaths in 15,719 patients). We admitted all patients with end-stage renal disease (ESRD) on maintenance hemodialysis (MHD) who were –positive for SARS-CoV-2 by RT-PCR (reverse transcription polymerase chain reaction). These patients were both from our institute’s dialysis unit and patients referred to us from other dialysis centers. From March 2020 to March 1, 2021, we admitted 269 MHD patients, out of whom the patient files were available for 210 patients. From March 1, 2021 to till December 31, 2021, we admitted MHD 445 patients, out of whom the patient files were available for 385 patients. The total number of patients was 714. The patient files were available for 595 patients (83.3%). The minimum and maximum ages of the patients were 10 and 89 years, respectively[Supplementary Table 1]. The number of males was 435 (60.9%).Supplementary Table 1The etiology of ESRD comprised diabetes mellitus in 229 (38.4%) patients, hypertension in 126 (21.1%) patients, and other etiologies accounted for 240 (40.3%) patients. However hypertension was documented either at admission or during hospital stay in 392 patients. At admission, the mean systolic and diastolic blood pressures were 133.8 and 81.5 mm Hg. Majority of patients (606 out of 714/84.8%) were on MHD with an arteriovenous fistula. For 108 patients (out of 714/15.1%), femoral vein catheters were placed for these patients required initiation of MHD for the first time. In no patient, internal jugular vein catheterization was done. Out of 595 patients, noninvasive ventilation at admission was necessitated in 68 (11.4%) patients, and 253 (42.5%) patients required oxygen. However, 145 (out of 595/24.3%) patients required NIV in hospital stay (NIVh). This group included the patients transferred onto NIV from oxygen or admitted without oxygen requirement. The number of patients of ESRD on MHD with COVID-19 disease who expired in the hospital was 203 (34.1%). The age-wise mortality was compared in Supplementary Table 1. The data of the analysis of the mortality risk factors are described in Tables 1 to 2 and in Supplementary Tables 2–6. A table of comparison between the patients admitted in 2020 and 2021 is given in Supplementary Table 7.Table 1: NIV patients only versus non-NIV patientsTable 2: Risk factors for mortality: Multivariate regression analys
{"title":"A Retrospective Study of End-stage Renal Disease Patients on Maintenance Hemodialysis with COVID-19","authors":"Lakshmi P. Aiswharya, A. Sunnesh, S. Mathini, Prasanna N. Kumar, M. Gurupriya, G. Vishwaeswar Rao, M. Raja Amarendra, K. Naveen, Bhatt G. Gayathri, G. Srilakshmi, Maria Bethasida Manuel, B. Alekhya, V. Kiran Kumar, K. Dinakar Reddy, K. P, Rahul, P. Lohitha, K. Pravallika, G. Jahnavi, B. Anil Kumar, G. Charishma, S. Taranum Bhanu, S. Soundarya, G. Ram Thulasi, P. Bhargav, S. Sailaja, R. Ram, V. Siva Kumar, B. Vengamma","doi":"10.4103/ijn.ijn_230_23","DOIUrl":"https://doi.org/10.4103/ijn.ijn_230_23","url":null,"abstract":"On March 11, 2020, the World Health Organization recognized a new highly infectious-contagious SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection for humans as a pandemic.[1] Our tertiary care hospital of a medical university in South India started to function as hospital for COVID-19 patients on March 13, 2020. The aim of this article is to describe the clinical profile and outcomes of the end-stage renal disease patients on maintenance hemodialysis with COVID-19 disease at our center. Till December 31,2021, we had admitted and managed 15,719 COVID-19 disease patients. The overall mortality rate in all COVID-19 patients was 18.3% (2,878 deaths in 15,719 patients). We admitted all patients with end-stage renal disease (ESRD) on maintenance hemodialysis (MHD) who were –positive for SARS-CoV-2 by RT-PCR (reverse transcription polymerase chain reaction). These patients were both from our institute’s dialysis unit and patients referred to us from other dialysis centers. From March 2020 to March 1, 2021, we admitted 269 MHD patients, out of whom the patient files were available for 210 patients. From March 1, 2021 to till December 31, 2021, we admitted MHD 445 patients, out of whom the patient files were available for 385 patients. The total number of patients was 714. The patient files were available for 595 patients (83.3%). The minimum and maximum ages of the patients were 10 and 89 years, respectively[Supplementary Table 1]. The number of males was 435 (60.9%).Supplementary Table 1The etiology of ESRD comprised diabetes mellitus in 229 (38.4%) patients, hypertension in 126 (21.1%) patients, and other etiologies accounted for 240 (40.3%) patients. However hypertension was documented either at admission or during hospital stay in 392 patients. At admission, the mean systolic and diastolic blood pressures were 133.8 and 81.5 mm Hg. Majority of patients (606 out of 714/84.8%) were on MHD with an arteriovenous fistula. For 108 patients (out of 714/15.1%), femoral vein catheters were placed for these patients required initiation of MHD for the first time. In no patient, internal jugular vein catheterization was done. Out of 595 patients, noninvasive ventilation at admission was necessitated in 68 (11.4%) patients, and 253 (42.5%) patients required oxygen. However, 145 (out of 595/24.3%) patients required NIV in hospital stay (NIVh). This group included the patients transferred onto NIV from oxygen or admitted without oxygen requirement. The number of patients of ESRD on MHD with COVID-19 disease who expired in the hospital was 203 (34.1%). The age-wise mortality was compared in Supplementary Table 1. The data of the analysis of the mortality risk factors are described in Tables 1 to 2 and in Supplementary Tables 2–6. A table of comparison between the patients admitted in 2020 and 2021 is given in Supplementary Table 7.Table 1: NIV patients only versus non-NIV patientsTable 2: Risk factors for mortality: Multivariate regression analys","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"57 16","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135684213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 23-year-old female was admitted with fever and abdominal pain for 1 day. She was diagnosed with lupus nephritis, and she underwent a renal transplant, which was complicated by transplant rejection. She was on renal replacement therapy following that. She had a recent episode of autoimmune hemolytic anemia and was on azathioprine and hydroxychloroquine. Computed tomography of the abdomen performed as part of the workup for abdominal pain showed ill-defined sclerosis of the vertebral endplates at multiple contiguous levels, producing an alternating dense–lucent–dense appearance consistent with the rugger-jersey spine sign [Figure 1]. The imaging also showed acute cholecystitis. Her serum creatinine was 856 μmol/l (reference 40–100 μmol/l), calcium 1.7 mmol/l (reference 2.15–2.55 mmol/l), phosphate 2.4 mmol/l (reference 0.8–1.5 mmol/l), and parathyroid hormone 58 pmol/l (reference 1–8 pmol/l).Figure 1: Computed tomography abdomen shows bandlike regions of increased opacity at the superior and inferior margins of the vertebral bodies (alternating dense–lucent–dense appearance), consistent with the rugger-jersey spine signRugger-jersey spine is pathognomonic of hyperparathyroidism, particularly the secondary form related to chronic kidney disease. The imaging appearance is due to a difference in the density of normal mineralized bone and newly formed unmineralized bone (osteoid) at the vertebral endplates. In chronic kidney disease with untreated hyperparathyroidism, osteoclasts increase bone resorption, which subsequently causes an increase in osteoblast activity. The osteoblasts form the new bone in the presence of low calcium levels, and therefore, the osteoid is low in hydroxyapatite and appears more opaque on radiographs. This difference in hydroxyapatite content between osteoid and normal mineralized bone causes the distinct striped pattern of the rugger-jersey spine. Osteopetrosis and Paget’s disease are the two conditions that can have similar imaging findings. In osteopetrosis, there is a sharp demarcation between the peripheral bony sclerosis and the relative lucency of central vertebral bodies (in contrast the indistinct margins in Rugger-Jersey spine), producing the characteristic “sandwich vertebrae” appearance. In Paget’s disease, the characteristic bone expansion, trabecular thickening, and increased opacity of the cortex on all sides of the vertebral body cause the classical “picture frame vertebrae” appearance. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
{"title":"Rugger-Jersey Spine in Chronic Kidney Disease","authors":"Mansoor C. Abdulla","doi":"10.4103/ijn.ijn_387_23","DOIUrl":"https://doi.org/10.4103/ijn.ijn_387_23","url":null,"abstract":"A 23-year-old female was admitted with fever and abdominal pain for 1 day. She was diagnosed with lupus nephritis, and she underwent a renal transplant, which was complicated by transplant rejection. She was on renal replacement therapy following that. She had a recent episode of autoimmune hemolytic anemia and was on azathioprine and hydroxychloroquine. Computed tomography of the abdomen performed as part of the workup for abdominal pain showed ill-defined sclerosis of the vertebral endplates at multiple contiguous levels, producing an alternating dense–lucent–dense appearance consistent with the rugger-jersey spine sign [Figure 1]. The imaging also showed acute cholecystitis. Her serum creatinine was 856 μmol/l (reference 40–100 μmol/l), calcium 1.7 mmol/l (reference 2.15–2.55 mmol/l), phosphate 2.4 mmol/l (reference 0.8–1.5 mmol/l), and parathyroid hormone 58 pmol/l (reference 1–8 pmol/l).Figure 1: Computed tomography abdomen shows bandlike regions of increased opacity at the superior and inferior margins of the vertebral bodies (alternating dense–lucent–dense appearance), consistent with the rugger-jersey spine signRugger-jersey spine is pathognomonic of hyperparathyroidism, particularly the secondary form related to chronic kidney disease. The imaging appearance is due to a difference in the density of normal mineralized bone and newly formed unmineralized bone (osteoid) at the vertebral endplates. In chronic kidney disease with untreated hyperparathyroidism, osteoclasts increase bone resorption, which subsequently causes an increase in osteoblast activity. The osteoblasts form the new bone in the presence of low calcium levels, and therefore, the osteoid is low in hydroxyapatite and appears more opaque on radiographs. This difference in hydroxyapatite content between osteoid and normal mineralized bone causes the distinct striped pattern of the rugger-jersey spine. Osteopetrosis and Paget’s disease are the two conditions that can have similar imaging findings. In osteopetrosis, there is a sharp demarcation between the peripheral bony sclerosis and the relative lucency of central vertebral bodies (in contrast the indistinct margins in Rugger-Jersey spine), producing the characteristic “sandwich vertebrae” appearance. In Paget’s disease, the characteristic bone expansion, trabecular thickening, and increased opacity of the cortex on all sides of the vertebral body cause the classical “picture frame vertebrae” appearance. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"57 15","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135684214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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