Contrast Induced Acute Kidney Injury (CI- AKI) - Myths and realities

Contrast Induced Acute Kidney Injury (CI-AKI) is one of the most common causes of acute kidney injury in hospitalized patients. These days, contrast agents are widely being used in both cardiology and radiology procedures. Old age, history of diabetes, heart failure, proteinuria and low blood pressure are some important risk factors in the pathogenesis of CI-AKI. Apart from risk stratification and the use of low and iso-osmolar contrast agents, intravenous fluid hydration with crystalloids is the only recommended strategy for the prevention of CI-AKI. Agents like N-acetylcysteine (NAC), atrial natriuretic peptide, ascorbic acid, theophylline, and fenoldopam have failed to show any proven beneficial role in the prevention of CI-AKI. Though hemodialysis is still being perceived by many clinicians as the modality for contrast removal but prophylactic hemodialysis is now not recommended for the prevention of CI-AKI

Harnessing Social Media to Enhance Nephrology Academia

The process of learning has been confined to the realms of educational institutions. Over the last ten years, the semantics of social media networks have evolved with the use of mobile gadgets. Consequently, nephrologists have realised the potential benefits of using these platforms for their educational and career development. Social media can change the horizon of nephrology education. The concept of bedside examination, teaching and sharing experiences have changed with the advent of Facebook, YouTube, Instagram and X (former Twitter). Other networking portals, such as WhatsApp, Telegram, X (former Twitter), and Pinterest, have also amassed the attention of selected users. Despite split opinions on the utility of social media, it is undeniable that it has influenced interaction between students and mentors. Resources ranging from online networks, blogs, visual aids, podcasts, online journal clubs, videos, live conference coverages, and tutorials have made it possible for nephrologists to stay informed and educated with recent updates. In this review, we discuss how social media can enrich nephrology academia, facilitate the sharing of research and access to fellowships and mentorship programs, provide career prospects to trainees, and broadcast scientific conferences while bringing nephrology societies together

Crescentic membranoproliferative glomerulonephritis in HIV infection; a mini-review with case study

HIV-related renal diseases have become more evident and easier to treat due to the prolonged survival of patients with HIV infection on antiretroviral therapy (ART). There are multiple factors involved in the pathogenesis of this entity. However, very little has been described regarding secondary membranoproliferative glomerulonephritis and especially a crescentic disease in these patients. Herein, we describe a patient who was incidentally detected to have HIV infection while evaluating for a rapidly progressive renal failure and was detected to have crescentic glomerulonephritis. We have reviewed the literature pertinent to the case in the present report

BK Virus nephropathy in living donor renal allograft recipients: An observational study from a large transplant center in India

BK virus is a polyoma virus which remains in latent phase in the urinary tract, particularly in the renal tubular epithelial cells. In immunosuppressed patients, it is activated and manifests as tubule-interstitial nephritis causing renal allograft dysfunction. A total of 402 patients who underwent renal allograft biopsy from 2013 to 2016 were included in this study; six patients were diagnosed to have BK virus nephropathy. Histopathology showed ground glass intra-nuclear inclusions accompanied by acute tubular injury, interstitial inflammation, and varying degree of interstitial fibrosis and tubular atrophy. Patients were managed with reduction in the overall immunosuppression. Only one patient progressed to graft failure on follow-up. The overall prevalence of polyoma virus at our center is 1.49%

Prevalence, risk, and outcomes of venous thromboembolic events in kidney transplant recipients: a nested case-control study

AbstractIntroduction Thromboembolism is more common in kidney transplant recipients (KTRs) than in the general population. Studies evaluating arterial and venous thromboembolism (VTE) in KTRs are scarce and the magnitude and risk factors are mostly undefined.Methods A nested control study was conducted from January 1, 2007, to December 31, 2019. Adult KTRs who were detected to have VTE events during this period were included. The primary outcome was to assess the prevalence of VTE in this population. Secondary outcomes were the assessment of the time to occurrence of the thromboembolic events after transplantation and assessing the risk factors and patient survival. For each subject studied, 4 controls were matched from the data set.Results Amongst 2158 patients, 97 (4.5%) were found to have VTE. The median follow-up time was 3.9 years (6–156 months). A total of 101 VTE events were recorded. The most common site of VTE was the lower limb deep vein thrombosis in 79 patients (0.03%)).In multivariate Cox regression analysis, serum creatinine of more than 3 mg/dl [HR 1.30, 95% CI (1.03–1.38)] was independently associated with increased VTE risk. Patients who developed a VTE had higher mortality as compared to patients who did not develop VTE. No increased risk of graft failure was found in VTE patients.Conclusion This study suggests that kidney transplantation surgery is a moderate risk factor for VTE, and VTE is associated with higher morbidity and mortality. However, prospective studies are needed to establish a definite role of VTE in outcomes in KTRs

Implications of oxidative stress in chronic kidney disease: a review on current concepts and therapies

Moderate levels of endogenous reactive oxygen species (ROS) are important for various cellular activities, but high levels lead to toxicity and are associated with various diseases. Levels of ROS are maintained as a balance between oxidants and antioxidants. Accumulating data suggest that oxidative stress is a major factor in deterioration of renal function. In this review, we highlight the possible mechanism by which oxidative stress can lead to chronic kidney disease (CKD). This review also describes therapies that counter the effect of oxidative stress in CKD patients. Numerous factors such as upregulation of genes involved in oxidative phosphorylation and ROS generation, chronic inflammation, vitamin D deficiency, and a compromised antioxidant defense mechanism system cause progressive detrimental effects on renal function that eventually lead to loss of kidney function. Patients with renal dysfunction are highly susceptible to oxidative stress, as risk factors such as diabetes, renal hypertension, dietary restrictions, hemodialysis, and old age predispose them to increased levels of ROS. Biomolecular adducts (DNA, proteins, and lipids) formed due to reaction with ROS can be used to determine oxidative stress levels. Based on the strong correlation between oxidative stress and CKD, reversal of oxidative stress is being explored as a major therapeutic option. Xanthine oxidase inhibitors, dietary antioxidants, and other agents that scavenge free radicals are gaining interest as treatment modalities in CKD patients

Something fishy: Raw fish bile-induced acute kidney injury

Acute kidney injury (AKI) can be caused by a number of etiologies. A rare but potentially life-threatening cause is the consumption of raw fish. This practice is rampant in certain parts of India as well as Asia due to the traditional belief that it can cure a number of chronic diseases such as bronchial asthma, arthritis and diabetes mellitus. A toxin present in fish gallbladder can cause multiorgan failure. Renal involvement is generally in the form of oliguric AKI and in majority of the cases requires renal replacement therapy. Early institution of supportive therapy is essential to prevent mortality. We report the case of a middle-aged diabetic female who consumed raw fish gallbladder in the hope of curing her diabetes and landed up with renal dysfunction requiring dialysis. Renal biopsy showed acute interstitial nephritis which was treated with steroids. She made a full recovery on follow-up

Deceased-Donor renal transplantation: A single-center experience from a tertiary care hospital in North India

Introduction: Deceased-donor renal transplants can help cope up with the increasing demand of renal allografts in India. We evaluated the outcomes of deceased-donor renal transplantation at our center. Methods: This retrospective study analyzed the donor and recipient characteristics along with graft and patient survival in deceased-donor renal transplant recipients at our center between April 2011 and October 2021. Results: The mean age of recipients (n = 21) and deceased donors was 48 ± 9.4 and 39.3 ± 8.7 years, respectively. Male:female ratio among recipients was 1.6:1 while that in donors was 2:1. Chronic glomerulonephritis (71.4%) was the most common native kidney disease. Most patients received antithymocyte globulin (80.9%) as induction and tacrolimus-based triple-drug regimen (80.4%) as maintenance therapy. The median follow-up duration was 32.8 months. Graft dysfunction was reported in 57.1% (n = 12/21) patients; acute tubular necrosis was the most common reason (n = 5). Six patients died, and sepsis was the most common reason for death (n = 3/6; 50%); 66.7% (n = 4/6) deaths occurred within the first 6 months. The mean graft survival time was 106.2 months (95% confidence interval: 95.4–116.6). The cumulative proportion of graft survival was 95.2% (n = 20/21) at 3 and 5 years. The cumulative proportion of patient survival was 80.9% at 3 years and 76.2% at 5 years. Conclusion: Patient outcomes over 5 years follow-up were good and suggest that deceased-donor transplants should be encouraged along with living-donor transplants to cover the huge demand–supply mismatch in renal replacement therapy