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Background and objective Infection-related glomerulonephritis (IRGN) in adults, particularly the diabetic population, has a grave prognosis with many patients progressing to dialysis-dependent renal failure. Indian data on this entity are very scarce. This study attempts to correlate the clinicopathological factors related to diabetic IRGN and its short-term outcomes. Subjects and methods A retrospective analysis of all diabetic patients with biopsy-proven IRGN between January 2017 and August 2021 was conducted. Factors affecting outcomes such as clinical characteristics, urine examination, complete blood count, serum biochemistry, renal biopsy, and follow-up data were obtained and analyzed to determine the risk of progression to chronic kidney disease (CKD)/end-stage renal disease (ESRD). Univariate/multivariate analysis and receiver operating characteristic (ROC) curve were performed to identify independent risk factors affecting outcomes. Results A total of 40 diabetic patients with IRGN was included in the study, with a mean age of 53.08 ± 10 years, comprising predominantly males (60%). Infective foci were occult in majority (37.5%). Isolated low C3 levels were documented in the majority, while three patients (7.5%) had normal complement levels. Complete renal recovery was noted in 15 patients (37.5%), while 12 patients (30%) progressed to ESRD. Anuria or uremia at presentation, glomerulosclerosis >28.6%, interstitial fibrosis with tubular atrophy (IFTA) >17.5%, and diabetic nephropathy correlated to poor renal recovery. No correlation was observed between endocapillary proliferation, the pattern of deposits, the prevalence of crescents, and complement levels with the outcome. Conclusion IRGN is a common immune-mediated clinical entity among diabetics and often requires renal replacement therapy. Anuria or uremia at presentation, diabetic nephropathy, elevated glomerulosclerosis, and IFTA were associated with poor renal recovery. Complement levels and crescents had no impact on the outcome.
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Background: Acute kidney injury (AKI) is a severe complication of acute diarrheal diseases; however, there is limited data on post-diarrheal AKI (PD-AKI) epidemiology and outcomes. This study aimed to investigate the clinicodemographic profile and outcomes of PD-AKI in our hospital. Materials and Methods: We retrospectively analyzed data from 93 patients admitted with PD-AKI during a diarrheal illness epidemic. Patients were stratified based on the Kidney Disease: Improving Global Outcomes (KDIGO) AKI stage and quick Sequential Organ Failure Assessment (qSOFA) score. Clinicodemographic data and outcomes were recorded and analyzed. Results: The mean age of the patients was 45.7 ± 11.9 years, with a majority being men (n = 55, 59%). All patients presented with watery diarrhea, 85% (n = 79) had vomiting, and 66% (n = 61) presented in shock. At presentation, 59% were oliguric, while 32% were anuric. KDIGO stage 3 AKI was observed in 71% (n = 66) of patients. Dialytic support was required in 29% (n = 27) of cases. The mortality rate was 6.5% (n = 6), mostly due to refractory shock, while the remaining patients recovered. Risk factor analysis demonstrated a higher qSOFA score, and peak serum creatinine levels were associated with an increased likelihood of requiring renal replacement therapy and delayed renal recovery. Conclusion: This study provides valuable insights into the clinicodemographic characteristics and outcomes of PD-AKI. The high prevalence of severe AKI emphasizes the importance of early recognition and appropriate management strategies for these patients.
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Aim To study the clinical profile and course and to assess the outcome of patients with biopsy-proven primary membranous nephropathy (MN). Methods This study was carried out in a tertiary care hospital between December 2017 and December 2021 on four-year retrospective biopsy-proven patients with membranous nephropathy (MN). Urinary proteins, serum albumin, and serum creatinine were the baseline investigations that were performed. Special tests were done whenever necessary. Patients were treated with a modified Ponticelli (MP) regimen whenever needed. Patients were followed up after treatment administration for a minimum of a year. Results The study was done in 48 biopsy-proven MN patients. Thirty-six patients had primary MN with a mean age of 47+/-11.7 years. The male-female ratio was 2.6:1. Hypertension was present in 39% (14 patients), microscopic hematuria in 28% (10 patients), and acute kidney injury in 22% (8 patients). The mean 24-hour urinary protein was 11.2+/-2.9 g/day. PLA2R was positive in 78% (28 patients) of primary MN patients. Spontaneous remission was noted in 13.8% (5 patients) who were treated conservatively. Spontaneous remission was associated with lower baseline proteinuria (p<0.001), higher baseline serum albumin (p<0.001), and PLA2R negativity (p=0.04). Complete or partial treatment response was noted in 74.2% (23 patients). Treatment remission was associated with lower baseline proteinuria (p=0.018). Secondary membranous nephropathy (secondary MN) was diagnosed in 12 patients. Eleven were class V lupus nephritis, all women, and one male person living with HIV/AIDS (PLHA). Conclusions The majority of our primary MN patients were PLA2R positive on renal biopsy. Statistically significant factors associated with spontaneous remission were lower proteinuria, higher serum albumin at baseline, and PLA2R negativity. Treatment response was associated with lower proteinuria at presentation. The most common cause of secondary MN was lupus nephritis.
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Background: Renal allograft rejection contributes to significant morbidity and graft loss. In this setting, early detection of rejection is of paramount importance, which currently relies on histopathology. A reliable non-invasive marker to predict rejection would make surveillance and decision-making easier. Donor-derived cell-free DNA (dd-Cf-DNA) has recently been reported as an emerging tool to predict rejection noninvasively. The utility of cell-free DNA in clinical practice has so far not been studied in an Indian setting. As it offers direct clinical application, we have chosen to investigate this biomarker as a tool to predict rejection. Materials and Methods: A pilot study with convenient sample size was designed, as this is the first of its kind study so far reported from India. Patients being evaluated with a graft biopsy for graft dysfunction were included. Patients with stable graft function, defined as creatinine within 10% of their best creatinine and no proteinuria for the preceding 12 months, were also included. Ten milliliters of whole blood from each of the recipients was collected in DNA isolation tubes. Two milliliters of donor blood was also obtained in ethylenediaminetetraacetic acid (EDTA) tubes. All recipients also provided a buccal swab. Total cell-free DNA was extracted from 2 ml of recipient plasma using circulating DNA isolation kit. Upon identification of the donor-specific DNA marker for each of the patients from the paired donor sample, presence of the cell-free DNA fraction in the recipient's plasma was detected and quantified. Renal biopsy reports and clinical details were also recorded. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were analyzed. Receiver operating characteristic (ROC) curve analysis was also performed. Results: A total of 31 patients were recruited. Twenty patients underwent graft biopsies for graft dysfunction, of which 12 patients had features of active rejection and eight had nonrejection causes of graft dysfunction. Eleven patients with stable graft were included in the study. In our study, dd-Cf-DNA performed best in predicting antibody-mediated rejection (ABMR) and higher grades of T-cell-mediated rejection (TCMR) (1B). It did not detect TCMR 1A accurately. It serves as a good marker to rule out rejection. It gave a NPV of 100% for TCMR 1B or ABMR, 100% for ABMR alone, and 81% for any rejection. dd-Cf-DNA percentages outperform absolute concentrations in their discriminatory ability. Conclusion: We have demonstrated the diagnostic accuracy of dd-Cf-DNA in predicting active rejection of the renal allograft. It performs well in ABMR and higher grades of TCMR. This is the first of its kind study reported from India, to the best of our knowledge. This tool serves as a good rule out test for ABMR and higher grades of TCMR. It performs poorly in TCMR 1A.
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Aim To study the prevalence of frailty in patients with chronic kidney disease stage 5 (CKD5) and to assess coexisting factors associated with frailty in chronic kidney disease. Patients and methods We studied the prevalence of frailty in CKD5 patients from November 2021 to November 2022. CKD5 patients over 18 years of age were included. Patients on maintenance hemodialysis and CKD5 patients on pre-dialysis care were included. Patients with active infection and significant morbidity were excluded. We performed a history and clinical examination and recorded laboratory data. We performed frailty assessments using modified Fried's criteria. Frailty was defined based on previously validated Fried's criteria, which included 1. Slowness, 2. Weakness, 3. Unintentional weight loss, 4. Exhaustion, 5. Low physical activity. A patient is considered frail if three or more components are present. We evaluated the prevalence of frailty in pre-dialysis and dialysis care participants and the association of frailty with coexisting factors. Results Of the 139 patients, 84 were on thrice-weekly hemodialysis, and 55 were on pre-dialysis care. We found the prevalence of frailty to be 41%. The prevalence of frailty was similar in patients on pre-dialysis care and hemodialysis. The prevalence of frailty in hemodialysis patients and those in pre-dialysis care was 43% and 40%, respectively. The prevalence of frailty among the elderly (over 55) was 82%. The prevalence of frailty among diabetes patients was 75%. Factors with a statistically significant association with frailty included old age (p < 0.005), native kidney disease (p < 0.005), edema (p < 0.001), intradialytic hypotension (p = 0.002), and various comorbidities like diabetes (p < 0.001), heart failure (p < 0.001), coronary artery disease (p = 0.001), and cerebrovascular accidents (p = 0.016). We observed no significant association with the duration of chronic kidney disease (CKD) (p = 0.458), duration of dialysis (p = 0.838), or body mass index (BMI) (p = 0.267). The most commonly reported frailty components were exhaustion (61.9%), low physical activity (61.2%), and weak handgrip (55.4%). Conclusion Frailty is a marker of increased vulnerability to adverse outcomes. A significant proportion, 41% of CKD5 patients, are frail. Dialysis does not affect the prevalence of frailty in CKD5 patients. Old age, native kidney disease, edema, intradialytic hypotension, and comorbidities like diabetes, heart failure, coronary artery disease, and cerebrovascular accident are significantly associated with frailty in CKD5 patients. CKD patients with those conditions should receive special care to reduce the development of frailty.