Automobile Paint Reducer Induced Acute Kidney Injury: A Case Series

The various aspects of the automobile industry also carry with it the risk for occupational health hazards with it. Toluene has also evolved as a commonly used drug by substance abusers. Accidental exposure or self-poisoning with these substances has been reported in literature. These substances can also cause distal renal tubular acidosis (RTA), acute tubular necrosis, glomerulonephritis and interstitial nephritis, rhabdomyolysis and myoglobinemia. In this series, we report about three patients who developed renal manifestations because of organic solvents. Two of the three patients had ingested the paint reducer substance and the third one was addicted to sniffing the toluene based paint reducer. All the patients had in taken these substances s with suicidal intent and developed acute kidney injury (AKI) and severe metabolic acidosis. One of the patients had features of rhabdomyolysis as well. The third patient was a substance abuser and had inhaled higher than usual dose and developed severe and refractory acidosis and mild kidney injury and required Renal Replacement Therapy (RRT) for acidosis. All the patients eventually recovered their kidney functions and were doing well during their follow-up. Toluene based organic solvents lead to acute neurological symptoms, accompanied by severe metabolic alterations, organ injury and dysfunction. An association of the development of hypokalemic paralysis and metabolic acidosis with toluene intoxication has been observed. The management of acute toluene toxicity is mainly conservative, consisting of electrolytes correction, acid-base and fluid abnormalities and renal replacement therapy in severe AKI. Organic solvent exposure may result in acute tubular necrosis, rhabdomyolysis, RTA and AKI irrespective of the intake route. Clinical suspicion of organ dysfunction and failure and timely induction of supportive care leads to a good outcome

Metabolic Syndrome in Adults with Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance, obesity, and other features of metabolic syndrome. It is identified as the most common cause of liver enzyme derangement. Lately, NAFLD has generated interest in exploring treatment options, including weight loss and dietary interventions. An association of NAFLD with metabolic syndrome has been suggested in contemporary literature. In this study, we attempted to look into the association of NAFLD with metabolic syndrome. In this study, 80 adult NAFLD patients were recruited from a tertiary care hospital. Among these, 42 were males and 38 females with a mean age of 44.46±13.146 years (range 18–82 years). Grades of fatty liver and presence or absence of metabolic syndrome were studied in this patient population. Patients who did not qualify for the criteria of metabolic syndrome were placed in Group 1 and those who fulfilled the stated criteria were considered in Group 2. There were 29 (36.25%) patients in Group 1 and 51 (63.75%) in Group 2. All the patients in Group 1 were having Grade I fatty liver whereas patients in Group 2 were found to having varying grades of fatty liver, with six patients having Grade III fatty liver. We found statistically significant difference in various parameters of study (liver enzymes, high-density lipoprotein (HDL), triglycerides, and blood pressure) between Group 1 and Group 2. Ultrasound evidence of a fatty liver should be considered as a predictor of metabolic syndrome, and these patients must be investigated for the different components of metabolic syndrome so as to have early diagnosis and intervention to alter development of long-term metabolic disorders and their inherent complications

Clinicopathologic Spectrum of Xanthogranulomatous Pyelonephritis: A Single Center Experience over 8 Years

Xanthogranulomatous pyelonephritis (XGP) is a chronic pyelonephritis subtype in which destruction of the renal parenchymal occurs, resulting in progressive loss of kidney functions. Although middle age is the predominant age group affected, but it can be spotted at any age. There is accumulation of macrophages (lipid-laden), leading to renal parenchymal destruction and fibrosis. In this study, we present our data of 15 patients who had undergone nephrectomy and had biopsy-proven XGP. XGP constituted 4.53% of the 331 nephrectomies performed for infective causes over a period of 8 years. All our patients had undergone unilateral total nephrectomy. Demographic and clinical data were analyzed after taking consent from all the patients. The age range of patients in our study was 18–65 years with a mean age of 43.93 ± 13.86 years. Ten (66.6%) of our patients were females. Diabetes was present in 40% of the patients. Three patients had imaging, suggestive of pyonephrosis, 3 had perinephric collection and 9 patients (60%) had concomitant nephrolithiasis. All the kidneys were grossly enlarged and were nonfunctional on renal scintigraphy. XGP is a form of chronic pyelonephritis, which, although less common, is devastating because of destruction of the renal parenchyma and associated morbidity. Clinicoradiologic correlation cannot be overemphasized. Definitive diagnosis is established through histopathologic examination

Echocardiographic Changes in Patients with End-Stage Renal Disease at Initiation of Dialysis

Introduction: Echocardiography is a simple and established method of evaluating cardiac functions, assessing left ventricle geometry, and systolic and diastolic functions. Patients with chronic kidney disease have a tremendous burden of cardiovascular disease (CVD), and patients with end-stage renal disease (ESRD) are at a greater risk of CVD and deaths. Materials and Methods: In this study, 245 incident dialysis patients were included, and none of the patient was on erythropoietin. All the patients were aged >18 years. Patients with ESRD, already on maintenance dialysis, were not included in this study. Patient’s data such as demographic details, comorbidities, laboratory values, echocardiographic changes, management, and outcome were recorded. Results: Out of 245 patients, 165 (67.3%) were males and 80 (32.6%) females. The mean age of the patients was 49.7 years. Left ventricular hypertrophy (LVH) was observed in 188 (76.7%), mild left ventricular dysfunction (LVD) in 25.7%, moderate LVD in 23.67%, severe LVD in 8.5%, global hypokinesia in 33.8%, valvular heart disease in 26.5%, regional wall motion abnormality in 4.4%, and pericardial effusion in 1.6% patients. Echocardiographic changes, such as LVD, LVH, and global hypokinesia, were observed in greater number in hypertensive group com-pared to normotensive group (P < 0.05). On regression analysis adjusted for age and gender, we found that hypertension and anemia (<10 g/dL) were associated with LVH. Further, hypertension and anemia (Hb < 10 g/dL) were associated with LVD. Similarly, anemia (Hb < 10 g/dL) was associated with global hypokinesia and valvular heart disease. LVD was associated with death in our study. Conclusion: Echocardiography is a noninvasive diagnostic test which detects early changes in cardiac parameters. All ESRD patients with hypertension and anemia at the time of initiation of renal replacement therapy must undergo echocardiography screening

Clinicopathologic Spectrum of Nephrotic Syndrome in the Elderly

The elderly population is affected by a wide range of kidney diseases like young adult patients. However, their clinical course and morphological manifestations are affected by aging. Recognition, diagnosis, and management of glomerular disease in elderly persons have several unique challenges. We aimed to study the clinicopathologic spectrum of elderly patients with nephrotic syndrome (NS). In this retrospective study, we looked at 234 patients of adult NS who were biopsied during the last 5 years. Among them, 31 patients were above the age of 60 years (Elderly). Mean age in elderly patients was 67.48 ± 6.11 years, with age range from 60 to 86 years. Elderly NS patients constituted 13.2% of total adult NS patients. Nineteen patients (61.2%) were males and 12 (38.7%) were females. Hematuria was observed in 19% and hypertension in 48% patients. Mean serum albumin was 2.79 ± 0.39 g/dl and mean 24 h urinary protein was 3.77 ± 0.8 grams. Membranous nephropathy (MN) followed by minimal change disease (MCD) was the most common diagnosis. No major complication with biopsy was reported in our study as has been the case with most studies

Gabapentin Toxicity and Role of Dialysis; Case Series and Literature Review

Gabapentin is frequently used as an analgesic in patients with chronic kidney disease (CKD). It is excreted exclusively through kidney, and therefore impairment in kidney function could lead to gabapentin accumulation and hence toxicity. We present our experience of 3 cases with Gabapentin toxicity who were managed according to the severity of symptoms. Case 1: A 32-year-old male was found lying unconscious after consuming around 12,000 mg of gabapentin and had respiratory depression, rhabdomyolysis, and acute kidney injury (AKI). Patient was managed with supportive care and hemodialysis (HD). Case 2: A 64-year-old male CKD Stage 5 (5D) patient with diabetic neuropathy was started on gabapentin 300 mg daily by his primary care physician 1 week back. Patient started to feel sleepy and developed altered sensorium and myoclonus. Discontinuation of gabapentin and a session of HD led to dramatic improvement in patient’s status. Case 3: A 70-year-old female diabetic patient with CKD Stage 3 and had diabetic neuropathy. Her neuropathic symptoms had improved with gabapentin 300 mg twice daily, but lately patient was feeling sleepy during the day and was confused. Discontinuation of the drug led to improvement in symptoms. Gabapentin is a relatively safe medication, but in certain clinical scenarios, particularly in impaired renal functions, can lead to severe complications. Moreover, it per se can rarely lead to rhabdomyolysis and AKI. Clinical suspicion and timely decontamination are needed, and sometimes dialytic therapy may be needed

Histopathological Spectrum of Nephrectomies; a Single Centre Experience of over 14 Years

Nephrectomy is conducted either as an open or a laparoscopic procedure for a variety of clinical indications. These include both neoplastic and non-neoplastic conditions, such as the non-functioning kidney. In many patients the final diagnosis is established on the histopathology of the retrieved kidney. In this study, retrospective analysis of data of last 14 years was studied pertaining to the number and indications of nephrectomy at the present study centre. Demographic and clinical details were assessed. Gross and microscopic histopathological details were recorded. Diagnosis was established on the basis of clinical features and histopathology. A total of 638 total nephrectomy specimens were received. Of these, 280 cases were of neoplastic and 358 of non-neoplastic lesions, with a male-to-female ratio of 1.21:1. The age range varied widely according to clinical manifestations. The age range in the present study was 5–84 years. Patients operated for non-neoplastic disorders were younger (mean age: 38.1 years) than those operated for neoplastic disorders (mean age: 54.4 years). Clear renal cell carcinoma (RCC) was the commonest RCC type (150 patients) followed by papillary RCC (51 cases). Nephrectomy is done due to both benign and malignant clinical indications as observed in this study. The most common indication was chronic pyelonephritis with the non-functioning kidney

Ultrasound assessment of kidney size and its correlation with body mass index in healthy volunteers without renal disease

Introduction:Renal length as well as renal cortical thickness has been closely related to creatinine clearance in patients with chronic kidney disease. Our primary aim was to establish a normal range of values for kidney length in our adult population with normal renal function.Materials and Methods:This was a prospective observational study. Ultrasonographic assessment of renal parameters in 499 healthy volunteers between 18 to 80 years of age was done. Volunteers with any known renal condition or any comorbidity were excluded from the study population. Correlation between BMI and renal parameters was assessed. Results:Out of 499 volunteers 327 (65%) were males and 172(35%) were females. 17.8% volunteers were less than 30 years of age, 51.5% volunteers were in the age group of 30-60 years and 30.7 % were above 60 years of age. Mean Body mass index (BMI) in males was 25.20 +/- 3.96 whereas mean BMI in females was 24.08+/- 3.28. In males the mean cortical thickness in Right kidney was 13.68+/- 2.47 mm and in left kidney CT was 13.94+/- 2.6 mm. In females right kidney cortical thickness was 12.63+/- 1.91 mm and left kidney CT was 13.40+/-2.37 mm. In the present study the right mean renal length was 9.9± 40cm and left renal length was 10.19±0.97cm.Discussion:In the present study, we analyzed renal size in terms of length, breadth, and cortical thickness which are simple, reproducible, reliable and objective measurements. Our finding that left side kidney length is greater than right sided kidney length is similar to the previous studies showing left side kidney length is greater than right sided kidney length. We observed positive correlation BMIwith renal length.Conclusion: Size of kidney has significant ethnic and geographic basis and there is a positive correlation between BMI and kidney size in our study population

Study of clinicoetiologic and biochemical profile of incident end stage kidney disease patients

Introduction :Chronic kidney disease (CKD) is emerging to be an important chronic disease globally. One reason is the rapidly increasing worldwide incidence of diabetes and hypertension. Diabetic kidney disease is the commonest cause of end stage Kidney disease (ESKD) in the world.Symptoms and overt signs of kidney disease are often subtle or absent until renal failure supervenes.This study was conducted as there is scare data available in our country regarding demographic, etiological and clinical profile of CKDMaterials and Methods:In this observational prospective study conducted over a period of 1 year, we included 180 consenting incident ESKD patients (age &gt; 18 years). Clinocoetiologic profile including the search for risk factors was done. Both biochemical and radiologic profile was studied in the included patient population. Long-term therapy preference by patients was also studied. Results:Of the 180 newly diagnosed ESKD patients enrolled over 12 months, most were males (Sex ratio male: female was 2.3:1). Mean age was 43.66 +/-14 years. Although diabetes or hypertension was present in a substantial proportion of our patients,most had no identifiable risk factor for CKD. Anemia was universal as were clinical features like anorexia, nausea or vomiting. Most of our patients continued on haemodialysis as a form of RRT 10 out of the surviving 174 patients underwent Kidney transplant. Discussion :As against diabetes being the most common cause of ESKD world over, more than half of our study population had no identifiable risk factor. Similarly most had shrunken kidneys and hence the histopathologic diagnosis couldn’t be done. CKD of unknown origin is being recognized as a significant health problem in many regions across India and kidney transplantation rates are low as seen in our study. Large scale studies are needed to identify risk factors for CKD and detection of CKD at the earliest to retard the progression of disease

Does SARS-CoV2 infection increase hyperglycemia risk? Case series and review

Introduction &nbsp; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has been observed to cause serious complications &nbsp;and higher mortality in patients with type 2 diabetes mellitus (DM). Conversely, new-onset diabetes and metabolic complications of pre-existing diabetes (including DKA and hyperosmolarity) have also been seen in patients with COVID-19. &nbsp; Materials and Methods &nbsp; We report a &nbsp;series of 7 patients with&nbsp; mean age of 30.71+/-1.38 years. Our series included 2 female patients. None of our patients had any&nbsp; underlying known comorbidity. All patients were RT PCR positive for SARS-Cov2.&nbsp; All patients had lymphopenia at presentation and raised inflammatory markers. All patients received IV steroids (methylprednisolone)&nbsp; for 5 days and subsequently oral. All patients improved with no major complication except one patient developed hyperglycemia on day 3 of institution of steroids. His Hba1c was suggestive of prediabetic status (6.1%). No other treatment related complication was observed.&nbsp; &nbsp; Discussion &nbsp; Given the capability of COVID-19 to trigger an intense inflammatory response, it has been challenging to disentangle whether hyperglycemia in COVID-19 is a cause or a consequence of severe disease. Some authors have hypothesized a potential diabetogenic effect of COVID-19, in addition to the well-recognized stress-induced hyperglycemia associated with critical illnesses. However, we observed that not all patients had hyperglycemia despite receiving steroids at the same dose and for the same duration. &nbsp; Conclusion We postulate that the combination of SARS-CoV2 infection and steroids impairs the glucose metabolism resulting in hyperglycemia only in patients who have underlying risk factors for the same. &nbsp