Clinical profile of geriatric acute kidney injury in a tertiary care center from south India

The incidence of acute kidney injury (AKI) is high in the elderly, who comprise an ever-growing segment of the population. Elderly patients pose a different set of diagnostic and therapeutic challenge owing to their associated comorbidities. AKI in the elderly is associated with an increased risk of mortality, morbidity, prolonged length of stay, and progression to chronic kidney disease. Data regarding the clinical profile of AKI in the elderly from the South Indian population are limited. Hence, we present this analysis of the etiological and prognostic factors associated with AKI in elderly population from South India. This is a cross-sectional, prospective, observational study conducted in a tertiary care teaching hospital from Bengaluru, during the period from May 2011 to October 2012. Institutional Ethical Committee clearance was obtained. Informed consents were obtained from patients who fulfilled the inclusion criteria. Elderly patients >60 years of age with features of AKI (Risk, Injury, Failure, Loss, and End-stage criteria) 1 at admission and those who developed AKI following hospital admission were included in the study. Demographic details, detailed medical history, comorbid conditions, etiological factors, prognostic factors, and outcomes were collected. Statistical analysis was done using Statistical Package for the Social Sciences software. Two hundred patients fulfilled the inclusion criteria and were enrolled into the study. The mean age was 70.5 years. Fifty-nine percent were males and 41% were females. Peak incidence of AKI was in the age group 60–69 years. Diabetes was seen in 44%, hypertension in 35%, ischemic heart disease in 19%, and chronic obstructive pulmonary disease in 12% of cases. Ninety-one percent had AKI at admission, and the rest developed it during hospitalization. The average duration of hospital stay was seven days. Etiological factors for AKI were medical in 87% of the cases, surgical in 11%, and gynecological in 2%. Sepsis was the most common etiology of AKI among the medical cases. Among sepsis, pneumonia and urosepsis were the most common causes of AKI. Medical AKI had a better outcome compared to surgical causes of AKI. Fifty-six (28%) patients required dialysis. Forty-four patients received hemodialysis and 12 received peritoneal dialysis. The overall mortality in the study group was 15%. Mortality among oliguric AKI (25%) was higher than in nonoliguric AKI (5%) patients (P = 0.002). The mortality rate was higher among postsurgical AKI compared to the medical causes (P <0.001) and in patients who required dialysis. Sepsis is the most common cause of AKI in elderly with high morbidity and mortality. Oliguria, postsurgical AKI, and need for dialysis were independent predictors of mortality

Opportunistic infections in a renal transplant recipient

With the present progress in transplantation procedures, there is an improvement in patient and allograft survival. However, the immunosuppression necessary to sustain the allograft predisposes these transplant recipients to infection, which is now a significant cause of morbidity and mortality. We describe a case of a 30-year-old renal transplant recipient with two opportunistic infections, namely, primary cutaneous aspergillosis and intestinal tuberculosis, with terminal enterococcal pleuritis and peritonitis. Control of the degree of immunosuppression, and prompt recognition and treatment of infection are vital for successful organ transplantation

Nondiabetic Renal Disease in type 2 Diabetes Mellitus Patients: A Clinicopathological Study

Background: The prevalence of nondiabetic renal disease (NDRD) among type 2 diabetics varies widely depending on the populations being studied and the selection criteria. Also, for patients found to have NDRD different predicting factors have been identified by different studies. Objectives: To determine: (i) Frequency and spectrum of NDRD in type 2 diabetics with atypical clinical renal disease, in our set up and (ii) common clinical markers that are associated with NDRD in our local population. Materials and Methods: Ninety-three type 2 diabetic patients with atypical clinical renal disease who had undergone renal biopsy to rule out NDRD were recruited. Patients were grouped into Group 1 with isolated NDRD, Group 2 with NDRD superimposed on diabetic nephropathy (DN), and Group 3 with isolated DN; and their clinical and biochemical parameters were statistically analyzed using analysis of variance, Kruskal-Wallis test, and Chi-square tests of statistical significance. Results: 68.8% of the patients had NDRD with or without concurrent DN. Patients with isolated NDRD had shorter duration of diabetes compared to the other groups. Absence of retinopathy and presence of microscopic hematuria and active urinary sediment had positive predictive value of 79.24, 81, and 100%, respectively, for NDRD in type 2 diabetics. Chronic interstitial nephritis was the commonest NDRD and membranous glomerulonephritis was the commonest glomerular NDRD in our setup. Interpretation and Conclusions: The frequency of NDRD in type 2 diabetics with atypical clinical renal disease is high in our setup thereby making the renal biopsy procedure imperative to rule out the same. Shorter duration of diabetes, absence of retinopathy, presence of microscopic hematuria, and active urinary sediment are markers associated with NDRD in type 2 diabetes with clinical renal disease

Histopathologic patterns of nonrejection injury in renal allograft biopsies and their clinical characteristics; a single centre south Indian study

Introduction: Graft dysfunction (GD) is the major complication of renal transplantation, and may result in graft loss. The major causes of GD are immunological rejection and non-rejection injury (NRI), which have different prognostic and therapeutic connotations. Meticulous renal allograft biopsy (RAB) evaluation and its correlation with clinico-laboratory features are crucial for timely identification of the varied NRI. Objectives: To evaluate the clinico-laboratory characteristics and histopathologic features of NRI in "clinically indicated" RABs in our institution. Patients and Methods: This was a prospective study conducted over a period of five years on renal transplant recipients who underwent "clinically indicated" RAB for GD. Results: A total of 192 biopsies were evaluated which showed NRI, rejection and NRI with concurrent rejection in 57.3%, 26.6% and 3.6% cases respectively. The NRI category, with or without concurrent rejection, comprised of acute tubular injury (ATI) (44%), calcineurin inhibitor induced (CNI) toxicity (19.7%), infections (12.8%), recurrent glomerulonephritis (GN) (7.7%), de novo GN (1.7%), chronic interstitial nephritis (9.4%), thrombotic microangiopathy (2.6%) and renal vein thrombosis (1.7%). Mean patient age was 34.9 years with male: female ratio of 8:1. Conclusion: Timely differentiation between rejection and NRI is indispensable for improved allograft survival. Acute tubular injury is the major NRI causing delayed graft function (DGF), and is commonly associated with deceased donor renal transplantation. The blood concentration of CNI does not correlate with the extent of renal damage. Acute tubular injury and CNI toxicity are the major NRI, in the first six months post-transplantation and after six months post-transplantation, respectively

Evaluation of high sensitivity creactive protein and glycated hemoglobin levels in diabetic nephropathy

Diabetic nephropathy (DN) is one of the major long-term complications of diabetes mellitus (DM). Type 2 DM is frequently associated with an inflammatory status, but limited information is available on the relationship between low-grade inflammation and DN. The aim of the study is to determine the serum level of high sensitivity C-reactive protein (hsCRP) in DN patients and to compare with that of normal subjects and to study the association between serum hsCRP levels and glycated hemoglobin (HbA1c) levels. Fifty DN patients in the age group of 50- 60 years with more than ten years of duration of diabetes were recruited for this study and 25 age-and sex-matched healthy subjects were included in this study as controls. Serum hsCRP levels were measured by turbidometry method. There was a statistically significant increase in serum hsCRP levels in DN cases as compared to normal controls. The hsCRP levels showed a positive correlation with HbA1c in DN. These results suggest that estimation of serum hsCRP levels and aiming at good glycemic control help in early intervention and prevention of further com-plications in diabetic patients