The study of clinico-pathological correlation and treatment outcome in acute allograft rejection in the immediate post renal transplant period

Background: The kidney Tx is the treatment of choice for patients with ESRD. However, episodes of AR have a negative impact on short- and long-term graft survival. In spite of immunosuppressive medications, CNI, MMF and steroid, the AR remains a crucial problem for Tx. This analysis was performed to evaluate the changing profile of early AR (during first week of transplant) and its repercussions on graft survival.Methods: This study was an observational cohort study and included 50 renal transplant patients irrespective of age, sex and race who developed bx proven AR within first week of transplant. Three groups were made according to histopathology: ACR, AMR and mixed rejection group. The patients were followed for 6 months thereafter.Results: AR within a week of renal Tx were less symptomatic except decrease in UO. ACR was more common (72%) than AMR and mixed rejections. AMR and Mixed group required more therapeutic modalities than ACR. More patients required HD during AR in AMR and mixed rejection group than ACR. The mean s.cr at 6 months was 1.3,1.5 and 1.6 in ACR, AMR and mixed group respectively. There were more incidences of BK viremia, CMV infection UTI and rejection fronts follow up in AMR and mixed group than ACR group.Conclusions: Acute rejections within a week are less symptomatic and ACR occurred more frequently than AMR and mixed rejection There were more incidences of BKV, CMV and UTI for 6 months follow up in AMR and Mixed rejection group

Pulmonary Aplasia with Unusual Associations in a Woman

Failure of development of the primitive lung bud leads to an extremely rare congenital anomaly with a prevalence of 34 per 10 lac live births termed pulmonary aplasia. In half of such cases, associated congenital malformations of the cardiovascular, skeletal, gastrointestinal, or genitourinary systems are present. The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is defined as the congenital aplasia of the uterus and the upper two thirds of the vagina with normal secondary sexual characteristics, ovaries, and a normal karyotype (46, XX). We report an extremely rare association of right lung aplasia, MRKH syndrome, and right renal agenesis with left pelvic kidney, which to the best of our knowledge is the first such association reported

A prospective study of clinical presentation, need for hospitalisation, microbiology and outcome of urinary tract infections in diabetes mellitus

Background: Diabetics are more prone to infections than their non diabetic counterparts. The urinary tract is the most common site of infection in diabetes mellitus patients. Urinary tract infections (UTIs) most of the time in diabetic patients are relatively asymptomatic, which can lead to renal failure and severe kidney damage. A combination of local risk factors and host factors in diabetes mellitus lead to bacteriuria commonly compared to non diabetics. Objective: To evaluate clinical presentation, need for hospitalisation, microbiology and outcome of UTI in diabetes mellitus. Methods: This prospective, descriptive study was conducted at Kerala Institute of Medical Sciences, a tertiary level multispecialty hospital in South India to study the clinical profile of UTI (clinical presentation, need for hospitalisation, microbiological profile and outcome) in Diabetes mellitus; also to find out reasons for hospitalisation and for UTI in Diabetes mellitus. Results: Among study population, 24% patients were in age group of 30 to 50 years, 52% patients were in age group of 51 to 70 year, 13% were in 71 to 80 year group. 32% (32patients) had growth of E. coli in urine, 14% (14 patients) had growth of k. pneumonia, 10%(10 patients) had growth of proteus, 9% (9 patients) had growth of S. aureus, 5%(5 patients) had growth of C. perfringens, 5% (5 patients) had growth of candida, 4% (4 patients) had growth of pseudomonas and Enterococcus. 52% (52 patients) had sepsis as the reason for hospitalization, 32% (32 patients) had fever as the reason, and 14% (14 patients) had flank pain as the reason and 1 patient each had pelvic pain and vomiting as the reason for hospitalisation. 18% (18 patients) had renal dysfunction and 32% (32 patients) had proteinuria. Conclusion: UTI requiring hospitalization in Diabetes mellitus was more common after 50 years of age and equal in men and women. Diabetics are at risk of an increased susceptibility to infections of the urinary tract and occur with increased frequency and severity, and complications are more common

“Excess gooD can be Dangerous”. A case series of iatrogenic symptomatic hypercalcemia due to hypervitaminosis D

Vitamin D is increasingly recognized to have several beneficial effects. Its toxicity, causing hypercalcemia, is considered as extremely rare. We report case series of 15 patients (most of them being elderly subjects) with iatrogenic symptomatic hypercalcemia in whom toxicity occurred due to empirical excessive administration of vitamin D by oral and parenteral rout