Prevalence and outcomes of hypothyroidism-induced acute kidney injury.

INTRODUCTION: Hypothyroidism is an important reversible cause of acute kidney injury (AKI), acting through various mechanisms, including rhabdomyolysis, metabolic, and systemic effects. MATERIALS AND METHODS: We screened all patients presenting with AKI for hypothyroidism, and suspected hypothyroid-induced AKI patients were followed up. RESULTS: The prevalence of hypothyroidism-induced AKI was 1.9%, with the commonest presenting symptom being pedal edema. The mean thyroid-stimulating hormone levels (mIU/L) and estimated glomerular filtration rate (eGFR) (mL/min/1.73m2) were 123.5 ± 22.32 and 29.4 ± 20.54, respectively, at presentation, and 3.28 ± 4.91 and 71.39 ± 40.28, respectively, at the end of 8 weeks. Creatine Phosphokinase (CPK) was significantly elevated in only 1 patient. One patient became dialysis-dependent (11.1%), 2 had partial renal recovery (22.2%), and 6 patients had complete renal recovery (66.7%). There was a significant positive correlation between renal recovery and CPK at admission, eGFR at admission, and hemoglobin, and a significant negative correlation with the presence of chronic kidney disease, urea at admission, and creatinine at admission. DISCUSSION: Thyroid hormones exert various effects on the kidney, and their imbalance can significantly alter renal function. Elevated creatinine with normal GFR can occur due to increased release of creatinine. Our study is the first published series of hypothyroid-associated AKI with follow-up data.
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Clinicopathological profile and outcomes of infection-related glomerulonephritis in adults.

INTRODUCTION: Infection-related glomerulonephritis (IRGN) is an example of immune-mediated glomerular injury, with changing profile over the years. We analyzed the clinicopathological profile of IRGN from a single center. MATERIALS AND METHODS: Adult renal biopsies between July 2018 and January 2020 were screened, and biopsies with IRGN were included. The demographic, clinical, and laboratory data up to 6 months were analyzed. RESULTS: 27 patients were included, with 63% having evidence of current/recent infection, Staphylococcus and Streptococcus being most common (29.4%). The mean eGFR at presentation was 16.7 mL/min/1.73m2, with crescents in 70.4% of cases. 59.3% required dialysis, and 40.7% received steroids. Complete recovery was seen in 84.6%, while 11.1% developed chronic kidney disease, and 3.7% progressed to end-stage renal disease. Persistent proteinuria, hematuria, and hypertension at 6 months were seen in 11.1, 7.4, and 3.7%, respectively. There was significant negative correlation between renal recovery and history of diabetes, interstitial fibrosis and tubular atrophy (IFTA), glomerulosclerosis, and IgA deposits. There was no significant impact of steroid use on outcome. CONCLUSION: IRGN can have an aggressive course in adults, with renal recovery continuing beyond 3 months. IFTA, glomerulosclerosis, IgA deposits, and history of DM are significant negative predictors of clinical outcome, and there is no proven benefit of steroids.

COVID-19 in children treated with immunosuppressive medication for kidney diseases.

BACKGROUND: Children are recognised as at lower risk of severe COVID-19 compared with adults, but the impact of immunosuppression is yet to be determined. This study aims to describe the clinical course of COVID-19 in children with kidney disease taking immunosuppressive medication and to assess disease severity. METHODS: Cross-sectional study hosted by the European Rare Kidney Disease Reference Network and supported by the European, Asian and International paediatric nephrology societies. Anonymised data were submitted online for any child (age <20 years) with COVID-19 taking immunosuppressive medication for a kidney condition. Study recruited for 16 weeks from 15 March 2020 to 05 July 2020. The primary outcome was severity of COVID-19. RESULTS: 113 children were reported in this study from 30 different countries. Median age: 13 years (49% male). Main underlying reasons for immunosuppressive therapy: kidney transplant (47%), nephrotic syndrome (27%), systemic lupus erythematosus (10%). Immunosuppressive medications used include: glucocorticoids (76%), mycophenolate mofetil (MMF) (54%), tacrolimus/ciclosporine A (58%), rituximab/ofatumumab (11%). 78% required no respiratory support during COVID-19 illness, 5% required bi-level positive airway pressure or ventilation. Four children died; all deaths reported were from low-income countries with associated comorbidities. There was no significant difference in severity of COVID-19 based on gender, dialysis status, underlying kidney condition, and type or number of immunosuppressive medications. CONCLUSIONS: This global study shows most children with a kidney disease taking immunosuppressive medication have mild disease with SARS-CoV-2 infection. We therefore suggest that children on immunosuppressive therapy should not be more strictly isolated than children who are not on immunosuppressive therapy.

Prevalence and outcome of systemic fungal infections in renal transplant recipients - A tertiary care experience.

Fungal infections are an important cause of morbidity and mortality in renal transplant recipients. These infections account for 5% of all infections in renal transplant recipients. The symptoms of systemic fungal infections are nonspecific, particularly in their early stages, and this can lead to delay in diagnosis. Retrospective analysis was conducted on all renal transplants that were performed at our center over a 20-year period from 1996-2016. Cases of invasive fungal infections (IFIs) that occurred among renal transplant recipients were identified to describe the epidmeiology of these infections. A total of 67 (9.2%) IFI cases were identified among 725 renal transplant recipients. Of the 67 patients (9.24%) with IFI, 31 (46.2%) cases were seen in deceased donor transplant recipients. Of 67 cases with IFI, 42 (62.7%) had received induction therapy. The incidence of fungal infections according to the induction agent used was, 14.3% with basiliximab, 12.3% each with daclizumab and rabbit antithymocyte globulin, and 6.3% among patients not given any induction. Invasive candidiasis was the most common IFI overall, followed by mucormycosis, invasive aspergillosis, and cryptococcosis. Median time to onset of IFI was 117.9 days. Majority of infections occurred within 180 days after transplantation. Late posttransplant (>180 days after transplantation) IFI's were predominantly caused by Candida, followed by Cryptococcus. The longest time to infection was a case of histoplasma, occurring seven years posttransplant. The overall 12-month cumulative incidence (CI) for any IFI was 9.1%. The 12-month CI of the first IFI increased from 7.3% between 1996 and 2001 to 10.5% between 2010 and 2016. The overall mortality rate was 38.8%. The use of newer and more-effective immunosuppressive agents in recent years are associated with increased rates of fungal infections in renal transplant recipients. Therefore, early detection of fungal infections and proper therapy are important in improving survival and reducing mortality.

Successful Tenckhoff catheter salvage in a patient with peritoneovesical fistula: A case report.

INTRODUCTION: Many techniques are available for inserting peritoneal dialysis (PD) or continuous ambulatory peritoneal dialysis (CAPD) catheters, with varying possible complications. We report a case of bladder perforation that was managed with catheter salvage. CASE REPORT: A 48-year-old man with end-stage renal disease (ESRD) underwent CAPD catheter placement percutaneously, with tip in the pelvis. On the 3rd day after placement, the patient complained of increase in urinary volume with PD flushing. Urine analysis showed 3(+) glucose and absent creatinine. Cystogram showed the catheter abutting the bladder wall. CT of the abdomen showed the catheter piercing the bladder and exiting through the posterior wall. The PD catheter was repositioned under fluoroscopy. DISCUSSION: The complications surrounding insertion of CAPD catheter can be either mechanical or infectious. Peritoneo-vesical fistula or placement of the PD catheter into the urinary bladder is a very rare complication. The possibility of catheter salvage should be entertained while discussing management options.

Epidemiologic data of biopsy-proven renal diseases: Experience from a single center in South India.

An analysis of the renal biopsy data is important to understand the regional prevalence of various biopsy-proven renal diseases (BPRDs). We analyzed our renal biopsy registry over a period of 15 years. We retrospectively reviewed all the renal biopsies performed at Arun Kidney Centre, Vijayawada, Andhra Pradesh, from January 2004 to March 2018. All biopsies were analyzed using immunofluorescence and light microscopy. A total of 924 renal biopsies were considered for the analysis. The mean age of the patients was 32 ± 14.77 years, with a male:female ratio of 1.5:1. Nephrotic syndrome (46.1%) was the most common indication for renal biopsy, followed by rapidly progressive renal failure (11%) and rapidly progressive glomerulonephritis (9.9%). Primary glomerulonephritis (PGN) was the most common entity (66.8%), followed by tubulointerstitial disease (17.5%), secondary glomerulonephritis (SGN) (12.1%), and vascular nephropathies (3.5%). Among cases with PGN, the most common causes were minimal change disease (22.98%), immunoglobulin A nephropathy (21.3%), and membranous nephropathy (17%), whereas the most common SGN was lupus nephritis (60.7%). Acute tubulointerstitial nephritis (61.1%) was the most common tubulointerstitial disease, whereas antineutrophil cytoplasmic antibody vasculitis (56.3%) was the most common vascular nephropathy. We also noticed significant changing trends in many nephropathies. Our study provides epidemiologic data regarding the various BPRDs and also the changing trends of the individual renal diseases.