A prospective, multi-centre, observational study to examine kidney disease progression in adults with chronic kidney disease - CKDOD - Study design and preliminary results.

BACKGROUND: The objective of this article is to describe the organisation of an international, clinical registry, the Chronic Kidney Disease Observational Database (CKDOD), the processes of enrolling patients and entering data and preliminary results to date. DESIGN: The Chronic Kidney Disease Observational Database (CKDOD) is designed to assess the association between different factors with a known influence on chronic kidney disease (CKD) progression as well as treatment strategies such as dietary modifications, blood pressure control and pharmacological interventions in Asian countries (India, China, Malaysia and Thailand). The only inclusion criterion is the presence of CKD stage 2 or higher as defined by the KDIGO guidelines. Demographic and clinical information are collected by a standardised electronic questionnaire, available in English and Chinese. The data are transferred to the CKDOD database either by e-mail or via web access. All data are checked for consistency and missing values. Collection of data started in September 2011 and by April 2015, data on 1323 individual patients had been submitted. The mean age at inclusion was 57 ± 14 years, 67 % were male and 36 % were diabetic. The baseline estimated glomerular filtration rate was 26 ml/min/1.73 m(2). Of all enrolled patients, 324 (24 %) received ketoanalogue supplementation during at least one recorded visit. DISCUSSION: The CKDOD is a very large and comprehensive data repository, currently focused in subjects recruited from Asia. The database is expected to provide important long-term information on CKD progression, nutritional and metabolic derangements that accompany CKD progression and treatment strategies to ameliorate progression and complications of CKD. TRIAL REGISTRATION: Clinical Trial Registry - India: CTRI/2012/06/002743 ; 25th July 2012.

What do we know about chronic kidney disease in India: first report of the Indian CKD registry.

BACKGROUND: There are no national data on the magnitude and pattern of chronic kidney disease (CKD) in India. The Indian CKD Registry documents the demographics, etiological spectrum, practice patterns, variations and special characteristics. METHODS: Data was collected for this cross-sectional study in a standardized format according to predetermined criteria. Of the 52,273 adult patients, 35.5%, 27.9%, 25.6% and 11% patients came from South, North, West and East zones respectively. RESULTS: The mean age was 50.1 ± 14.6 years, with M:F ratio of 70:30. Patients from North Zone were younger and those from the East Zone older. Diabetic nephropathy was the commonest cause (31%), followed by CKD of undetermined etiology (16%), chronic glomerulonephritis (14%) and hypertensive nephrosclerosis (13%). About 48% cases presented in Stage V; they were younger than those in Stages III-IV. Diabetic nephropathy patients were older, more likely to present in earlier stages of CKD and had a higher frequency of males; whereas those with CKD of unexplained etiology were younger, had more females and more frequently presented in Stage V. Patients in lower income groups had more advanced CKD at presentation. Patients presenting to public sector hospitals were poorer, younger, and more frequently had CKD of unknown etiology. CONCLUSIONS: This report confirms the emergence of diabetic nephropathy as the pre-eminent cause in India. Patients with CKD of unknown etiology are younger, poorer and more likely to present with advanced CKD. There were some geographic variations.

Xanthogranulomatous pyelonephritis: critical analysis of 18 cases from a rural tertiary care centre of India.

Xanthogranulomatous pyelonephritis is an uncommon disorder of the kidney that is characterised by chronic inflammation and extensive destruction of the involved kidney usually associated with renal calculus and obstruction. It commonly involves the middle aged people with an increased incidence among females and diabetic population. Confirmed diagnosis can be done only after histopathological examination of the diseased nephrectomy specimen. So early suspicion and timely intervention is important to reduce the morbidity. In this retrospective study, we analysed the case records of all patients diagnosed with xanthogranulomatous pyelonephritis in our institute over a period of 11 years. A total 18 patients were treated and diagnosed with xanthogranulomatous pyelonephritis from January 2002 to December 2012. Among them 13 were female and 5 male. Most common clinical presentation was flank pain, fever, dysuria and weight loss. Left kidney was affected in 15 cases and right kidney in 3 cases. All patients were having urinary calculus causing obstruction to the pelvicalyceal system of the kidney. Only 2 patients were diabetic. Urine culture was sterile in all patients. All patients were treated with antibiotics, other supportive measures pre-operatively and ultimate nephrectomy having good recovery. Early suspicion and prompt treatment is necessary in minimising morbidity and mortality from the condition.

Genito-urinary tuberculosis in 67 cases: experience from a tertiary core centre in India.

Tuberculosis is very much prevalent in developing countries like India. Genito-urinary tuberculosis usually occurs after 5 to 15 years of the primary lung infection. After lymph node involvement,it is the second common form of extrapulmonary tuberculosis. In this retrospective study, case records of 67 patients diagnosed with genito-urinary tuberculosis in our institute were thoroughly reviewed regarding age, sex, the urogenital organ involved by tuberculosis,mode of diagnosis,and treatment given to the patients. Median age of the patients was 38.5 years, males were more commonly involved than females, kidney was the most common organ involved by tuberculosis followed by ureter and urinary bladder.HIV infection was present in a single patient who had developed tuberculous perinephric abscess. Most common mode of diagnosis was by histopathological examination of the organ involved. Hydronephrosis of the involved kidney with echogenic debris in the dilated pelvicalyceal system on ultrasonography and non-visualised kidney on intravenous urogram was the most common findings on imaging studies who underwent nephrectomy. One patient was seen with tuberculosis of the glans penis which is not much common. Surgical intervention was ablative in nature in most of the cases in the form of nephrectomy. Early diagnosis is important and can prevent the anatomical defor- mity and loss of function of the involved organ.

Spontaneous rupture of renal allograft: an uncommon complication with an uncommon cause.

Renal allograft rupture is defined as a renal laceration, which involves two or more surfaces of the graft and extends beyond renal capsule with or without involvement of the collecting system. Acute and hyperacute rejections are the causes in most of the cases. Non-rejection aetiologies of graft rupture include acute tubular necrosis, renal vein thrombosis, ureteric obstruction, polyarteritis nodosa, ischaemia, hypertension and biopsy. Early detection of these causes is of prime importance for graft salvage. Here we report an uncommon case of spontaneous renal allograft rupture due to intrarenal ischaemia leading to infarction and hypertensive crisis.

The value of vaccination in chronic kidney disease.

There has been much attention directed toward the high mortality of patients with end-stage renal disease (ESRD), with much of the focus on cardiovascular disease. However, infectious disease is the second most common cause of death in late-stage chronic kidney disease (CKD) patients. Although CKD patients are immunocompromised, some vaccines such as influenza, retain their efficacy and reduce infection rates with a standard immunization schedule. Other vaccines, such as hepatitis B and pneumococcal vaccines, require more frequent and/or higher doses to produce and maintain protective antibody levels. Attention has recently been given to the efficacy of influenza vaccination in ESRD patients in reducing morbidity and mortality. Centers with vaccination protocols have demonstrated reduced infection rates and resultant decreased morbidity and mortality. It could be extrapolated from this that widespread vaccination would reduce the total cost of ESRD patient care, and potentially improve patient well-being. However, vaccination appears to be underutilized in CKD patients, and it is a readily available intervention to improve outcomes.