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

Tocilizumab Use in a Chronic Hemodialysis Patient for the Management of COVID-19-Associated Pneumonia and Acute Respiratory Distress Syndrome

Novel coronavirus disease 2019 (COVID-19) is a highly infectious, rapidly spreading viral disease. As of writing this article, there are over 4.4 million people affected by COVID-19, and unfortunately, 300,000 have succumbed to the infection. In this article, we address a particularly more susceptible group of the population of end-stage renal disease (ESRD) patients on dialysis who may potentially benefit from being treated with tocilizumab. The use of tocilizumab has not been reported widely in ESRD patients on dialysis to treat COVID-19. In this case report, we describe a patient with ESRD on hemodialysis who was admitted to the intensive care unit, with severe pneumonia secondary to COVID-19 infection. This patient was treated with tocilizumab 400 mg intravenous and had a favorable outcome with no apparent adverse events

Renal transplantation in HIV-positive patients – No more a scare!

Human immunodeficiency virus (HIV) infection has posed as a major global health epidemic for almost three decades. With the advent of highly active antiretroviral therapy in 1996 and the application of prophylaxis and management of opportunistic infections, acquired immunodeficiency syndrome mortality has decreased markedly. The most aggressive HIV-related renal disease is end-stage renal disease due to HIV-associated nephropathy. Presence of HIV infection used to be viewed as a contraindication to renal transplantation for multiple reasons; concerns for exacerbation of an already immunocompromised state by administration of additional immunosuppressants; the use of a limited supply of donor organs with unknown long-term outcomes. Multiple studies have reported promising outcomes at three to five years after kidney transplantations in patients treated with highly active antiretroviral therapy, and HIV is no longer a contraindication for renal transplant. Hence, we present eight HIV-positive patients who received live-related renal transplantation at our center and their follow-up

Spectrum of renal injury in pregnancy-induced hypertension: Experience from a single center in India

Pregnancy-induced hypertension (PIH) is a known complication of late pregnancy and is an important cause of maternal and fetal morbidity and mortality. Data on clinical profile, especially renal profile of preeclampsia and eclampsia in Indian women are lacking. The aim of our study was to examine the renal profile and clinical outcomes of patients diagnosed with PIH in our institution with a focus on the spectrum of acute kidney injury (AKI). In this prospective, observational study, 347 patients with a diagnosis of preeclampsia-eclampsia, who were undergoing treatment at the M. S. Ramaiah Medical College, were included in the study. The study duration was from 2010 to 2014. Details regarding epidemiologic data, obstetric data, laboratory parameters as well as maternal, renal, and fetal outcomes were noted. Patients with preexisting hypertension, diabetes mellitus, or chronic kidney disease were excluded from analysis. The overall incidence of preeclampsia was 3.4%. Hemolysis, elevated liver enzymes, and low platelets syndrome was seen in 31 patients (9%); 56 patients (19%) had AKI with a mean serum creatinine of 3.2 mg/dL and mean proteinuria of 2.8 g/24 h. Nineteen patients required dialysis. Persistent renal failure was seen in 2.5% of the cohort. Maternal mortality was 2.5%, largely secondary to sepsis. Primiparity was a major risk factor. In this study, we found a low rate of preeclampsia in a low-to-moderate risk cohort, with an incidence of AKI and maternal mortality consistent with reported literature

Histologic patterns of primary adult onset nephrotic syndrome and their clinical characteristics; a single center study from South India

Background: The histologic pattern causing nephrotic syndrome (NS) and their clinical outcome varies depending on age, sex, race, socioeconomic status and geographic location. There has been a changing trend in the histologic spectrum of NS in the last few decades, in India as well as worldwide. Objectives: The objective of the present study was to see the histologic spectrum of adult NS in our institution and to compare it with data from other centers. Patients and Methods: All adults (≥ 18 years) with nephrotic range proteinuria who underwent renal biopsy from August 2012 to February 2015, were consecutively included in this prospective study. NS caused by diabetes and other secondary glomerular diseases were excluded. Results: Eighty (65.4%) patients were males and 42 (34.4%) were females. The median age at the time of biopsy was 36 years (interquartile range [IQR]: 24.8–45). The most common lesions were minimal change disease (MCD) in 40.2%, membranous nephropathy (MN) in 24.6% and focal segmental glomerulosclerosis (FSGS) in 16.4% of the patients. MCD was observed mostly commonly in the age group 18-35 years and MN was seen mostly commonly in age group 36-55 years. Conclusions: MCD still continues to be leading cause of NS in south Indian adults as evidenced from previous studies from this region. Other common causes include MN and FSGS. The incidence of MPGN is on the decline

Unusual Fungal Infections in Renal Transplant Recipients

Fungal infections are an important cause of morbidity and mortality in renal transplant recipients. The causative agent and the risk factors differ depending on the period after the kidney transplant. Also the incidence varies according to the geographical area. We are reporting three cases of fungal infections in renal transplant recipients. Two of them have etiological agents which are common among immunosuppressed patients, but with an atypical clinical presentation, while one of them is a subcutaneous infection caused by a less frequent dematiaceous fungus, Aureobasidium pullulans. These cases highlight how a high index of clinical suspicion and prompt diagnosis is very much essential for better outcome. The emerging fungal infections and paucity of data regarding their management pose a challenge to the transplant physicians

The origin of the inferior phrenic artery: a study in 32 South Indian cadavers with a review of the literature Origem da artéria frênica inferior: estudo em 32 cadáveres da Índia do Sul com revisão da literatura

BACKGROUND: Considering the paucity of information presently available concerning inferior phrenic arteries, a more definitive study seemed appropriate and necessary, both for its potential clinical applications and to provide additional data to contemporary anatomical literature. OBJECTIVE: Most anatomical textbooks of gross anatomy offer very little information concerning the anatomy and distribution of the inferior phrenic artery (IPA). For that reason, the origin of the IPA has been studied and the available literature has been reviewed. METHODS: Thirty-two human adult cadavers preserved in formalin obtained from the departments of Anatomy, Kasturba Medical College, Manipal and Mangalore were dissected and the origin of the IPA was studied. RESULTS: The IPA had its usual origin from the abdominal aorta in 28 cases but in the remaining four cases, two were arising from the celiac trunk, one from the left gastric artery and one from the right renal artery. CONCLUSION: The IPA usually originates from the aorta or celiac artery, and less frequently from the renal, hepatic or left gastric arteries. The IPA is a major source of collateral or parasitized arterial supply to hepatocellular carcinoma, second only to the hepatic artery. Literature on the IPA origin and clinical implications of variation in its origin have been reviewed in this article.<br>CONTEXTO: Considerando a escassez de informações atualmente disponíveis sobre artérias frênicas inferiores, umestudo mais definitivo nos pareceu apropriado e necessário, tanto por suas potenciais aplicações clínicas quanto para fornecer dados adicionais à literatura anatômica contemporânea. OBJETIVO: A maioria dos livros-texto de anatomia oferece muito poucas informações referentes à anatomia e distribuição da artéria frênica inferior (AFI). Por este motivo, a origem da AFI foi investigada e a literatura disponível foi revisada. MÉTODOS: Trinta e dois cadáveres humanos adultos preservados em formol e obtidos dos departamentos de anatomia do Kasturba Medical College, Manipal and Mangalore foram dissecados, e a origem da AFI foi investigada. RESULTADOS: A AFI teve sua origem habitual na aorta abdominal em 28 casos; no entanto, nos quatro casos restantes, duas originavam-se do tronco celíaco, uma da artéria gástrica esquerda e uma da artéria renal direita. CONCLUSÃO: A AFI geralmente origina-se da aorta ou artéria celíaca, e menos freqüentemente das artérias renal, hepática ou gástrica esquerda. A AFI é a maior fonte de fornecimento arterial colateral ou parasitado para carcinoma hepatocelular, ficando atrás somente da artéria hepática. A literatura sobre a origem da AFI e as implicações clínicas de variação em sua origem foram revisadas neste artigo