Use of furosemide stress test for edema control and predicting acute kidney injury in children with nephrotic syndrome

Background: Furosemide stress test (FST) involves measurement of 2‑h urine output after giving 1 mg/kg of furosemide in clinically euvolemic patients and has been shown to identify those with severe and progressive acute kidney injury (AKI). Objectives: To assess whether using FST could help in deciding whether to give diuretics only, or combination of diuretics with albumin infusion, in children with nephrotic syndrome with edema to prevent AKI. Materials and Methods: This prospective, pilot cohort study was conducted on the use of FST to manage edema in children with nephrotic syndrome. Consecutive patients 1–14 years were enrolledfrom October 2016 to April 2017 from the pediatric nephrology outpatient department of a tertiary care center. They were assessed for fluid overload using their present and baseline weight. Patients with fluid overload of ≥10% were screened for AKI by measurement of serum urea and creatinine and monitoring of urine output in the next 24 h. Systemic infections were excluded using clinical and laboratory criteria. AKI was defined using the pediatric RIFLE score. Children with fluid overload of ≥10% were given intravenous furosemide 1 mg/kg provided; they had no clinical signs of intravascular dehydration or shock. Urine output was measured over thenext 2 h. Children with urine output <1 ml/kg/h after FST were presumed to be at risk for progressive AKI. Differences between the average heart rate, serum albumin, and urea/creatinine ratio were analyzed by independent t‑test. Results: A total of 67 children with nephrotic syndrome were reviewed, and 34 with fluid overload of >10% were analyzed for inclusion in the study. Of them, 11 were excluded and 23 were finally analyzed. 19/23 had urine output >1 mg/kg/h in next 2 h and none had serum creatinine increase >0.3 mg/dl or >150% of the baseline value. 4 had urine output < 1 ml/kg/h. Significant difference was found in the post‑FSTheart rate and urea/creatinine ratio between the children who had urine output >1 ml/kg/h and which had < 1 ml/kg/h after furosemide. These children were assumed to be at risk for severe and progressive AKI as per FST and were thereafter given furosemide with albumin to prevent further intravascular dehydration. Conclusion: FST may be used as a bedside test to help identify the children with nephrotic syndrome with intravascular dehydration who are at high risk for AKI and helps rational use of diuretics.&nbsp

Prevalence of vitamin B12 deficiency among individuals with type 2 diabetes mellitus in a South Indian rural community

Background: To estimate the prevalence of vitamin B12 deficiency in a rural south Indian community and to evaluate the association between metformin use and prevalent vitamin B12 deficiency in people with T2DM stratified by oral vitamin B12 supplementation.Methods: Using a cross sectional study design, a random sample of people with T2DM (N=438) was recruited from a rural community. Vitamin B12 deficiency was defined as serum B12 ≤200pg/ml. Data on metformin dose, duration of use, oral vitamin B12 supplementation, and diet were collected. Laboratory measurements included complete blood count, tests for hepatic, renal, and thyroid function, as well as serum vitamin B12 levels and HbA1c.Results: The prevalence of vitamin B12 deficiency in people with T2DM was 11.2% (95% Confidence Interval (CI) 8.2%-14.1%). The odds of vitamin B12 deficiency in patients receiving a metformin dose of 2 grams/day were 4 times higher compared to those receiving ≤1 gram/day, after adjusting for oral B12 supplementation (odds ratio 4.2;95% CI 1.5-11.8). The odds of vitamin B12 deficiency in those taking metformin and receiving oral vitamin B12 supplementation were lower compared to those on metformin and not receiving vitamin B12 supplementation (adjusted odds ratio 0.20; 95% CI 0.06-0.70).Conclusions: Vitamin B12 deficiency affects 1 in 10 people with T2DM, is associated with higher dose metformin use, and oral vitamin B12 supplementation mitigates B12 deficiency in this group

Profile and outcomes of children presenting with infection-related glomerulonephritis

Poststreptococcal acute glomerulonephritis (PSGN) was reported as the most common cause of GN in children. There has been, however, a marked shift in epidemiology in recent years with the decline in poststreptococcal cases. Various other bacteria and rarely viral and fungal infections are associated with GN. More cases are now being reported with ongoing infection at the time GN is diagnosed. Therefore, the term infection-related GN (IRGN) is now being used increasingly. We describe the clinical profile and outcomes of children presenting with IRGN at a tertiary care center in the past 1 year. 5 children presented with features of GN. Only 1 of the 5 had the course typically described in PSGN. Two patients also had a post-infectious course but with some unusual features. Another patient had an ongoing systemic infection in the form of pneumonia at the time of onset of features GN, while our fifth patient developed an infection-related GN with dengue illness

Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions

No abstract available

Low-calorie diets for people with isolated impaired fasting glucose

Standard lifestyle interventions prove ineffective in preventing type 2 diabetes among individuals with isolated impaired fasting glucose, a highly prevalent prediabetes phenotype globally. Here, we propose low-calorie diets as a promising strategy for diabetes prevention in this high-risk population

Park availability and major depression in individuals with chronic conditions: Is there an association in urban India?

Green space exposure has been positively correlated with better mental-health indicators in several high income countries, but has not been examined in low- and middle-income countries undergoing rapid urbanization. Building on a study of mental health in adults with a pre-existing chronic condition, we examined the association between park availability and major depression among 1208 adults surveyed in Delhi, India. Major depression was measured using the Mini International Neuropsychiatric Interview. The ArcGIS platform was used to quantify park availability indexed as (i) park distance from households, (ii) area of the nearest park; and within one km buffer area around households - the (iii) number and (iv) total area of all parks. Mixed-effects logistic regression models adjusted for socio-demographic characteristics indicated that relative to residents exposed to the largest nearest park areas (tertile 3), the odds [95% confidence interval] of major depression was 3.1 [1.4-7.0] times higher among residents exposed to the smallest nearest park areas (tertile 1) and 2.1 [0.9-4.8] times higher in residents with mid-level exposure (tertile 2). There was no statistically significant association between other park variables tested and major depression. We hypothesized that physical activity in the form of walking, perceived stress levels and satisfaction with the neighborhood environment may have mediating effects on the association between nearest park area and major depression. We found no significant mediation effects for any of our hypothesized variables. In conclusion, our results provide preliminary and novel evidence from India that availability of large parks in the immediate neighborhood positively impacts mental well-being of individuals with pre-existing chronic conditions, at the opportune time when India is embarking on the development of sustainable cities that aim to promote health through smart urban design - one of the key elements of which is the inclusion of urban green spaces