Profile of Pediatric Kidney Transplantation at a Tertiary Care Centre in Southern India

Introduction: Renal transplantation offers the best chance of survival to children with End Stage Renal Disease (ESRD). Patient survival and growth are superior in children with a renal allograft compared to dialysis. The aim of the study was to evaluate the outcomes of pediatric transplants done at a tertiary care hospital in Kochi, India over the study period.Materials and Methods: In this retrospective study, the data of children who underwent renal transplantation at Amrita Institute of Medical Sciences from 2002 to 2016 Kochi were analyzed.Results: Thirty-four children underwent renal transplantation over a 14-year period. Thirty-three underwent live related transplant whereas one underwent deceased donor transplantation. The mean age and weight of the recipients at transplantation was 14.3 years and 35.7 kg, respectively. Fourteen children were boys and twenty were girls. Thirty-one patients underwent hemodialysis prior to transplant, 2 were taken up preemptively, and 1 patient was on continuous ambulatory peritoneal dialysis. There were 5 documented urinary tract infections. No surgical complications were noted in the immediate post-transplant period. There were 5 episodes of acute rejection (14.7%). Two cases experienced Delayed Graft Function and the patient survival rate was 100%.Conclusions: Renal transplantation is a viable option to manage children with ESRD with satisfactory long term results and can be done in a developing nation’s set-up. Keywords: Kidney transplantation; India; Child

Assessing insulin resistance : an overview

Insulin resistance, the condition in which there is a decreased response of target tissues to insulin is a significant predisposing factor to various metabolic abnormalities like type 2 diabetes, coronary artery disease, hypertension and dyslipidemia. It is also the common unifying mechanism in the constellation “Insulin resistance syndrome” or the metabolic syndrome whose prevalence is rising to alarming proportions. As diabetes and related disorders account for a high percentage of health cost incurred by the society, early detection of individuals at risk and appropriate intervention helps in preventing the onset of these disorders thus reducing the burden on the society. Despite a widespread awareness among clinicians about metabolic syndrome and insulin resistance, there is lack of awareness about its measurement. Hence this article discusses various methods to diagnose and quantify insulin resistance. The choice of technique to measure insulin sensitivity depend on the study objective, sample size and experimental limitation. The hyperinsulinemic euglycemic clamp technique still remains the ‘gold standard’ in measuring insulin sensitivity, as it is the most accurate index. However the cost, complexity and the required involved restricts it to highly specific metabolic studies. The ‘minimal models’ where a computer programme is used to derive insulin sensitivity from values obtained form in travenous glucose tolerance test correlates well with the clamp technique and is used much more frequently. A number of indices have been formulated form OGTT for estimating insulin sensitivity depending on the sampling intervals and has shown to have varying correlation with the clamp values. Values from OGTT also represent a true physiological state, as there is no intravenous infusion. As fasting insulin based indices such as HOMA IR and QUICKI are simple and relatively inexpensive, these are used in large-scale epidemiological studies where the end point is not necessarily insulin resistance. Himsworth in 1930s reported for the first time, a state in which there is a decreased response of target tissues to insulin. Insulin 'insensitivity' since then has been one of the most extensively investigated areas in medicine and continues to generate a great deal of research interest among clinicians and scientists around the world

Perioperative glycemic management in adults presenting for elective cardiac and non-cardiac surgery

Abstract Perioperative dysglycemia is associated with adverse outcomes in both cardiac and non-cardiac surgical patients. Hyperglycemia in the perioperative period is associated with an increased risk of postoperative infections, length of stay, and mortality. Hypoglycemia can induce neuronal damage, leading to significant cognitive deficits, as well as death. This review endeavors to summarize existing literature on perioperative dysglycemia and provides updates on pharmacotherapy and management of perioperative hyperglycemia and hypoglycemia in surgical patients

Laparoscopic management of recurrent pheochromocytoma: A case report

Recurrence of pheochromocytoma after a total adrenalectomy is uncommon. Such recurrent tumours are mostly managed by the open technique, with very few studies reporting laparoscopic management. We hereby report a case of successful laparoscopic management of a recurrent pheochromocytoma after total adrenalectomy for left adrenal pheochromocytoma

IgA nephropathy presenting with pulmonary thromboembolism and renal artery infarct

Background: Venous and arterial thromboembolism are frequently seen in nephrotic syndrome. They generally occur during periods of sustained proteinuria in patients who are not responding to treatment and more commonly seen in minimal change disease and membranous nephropathy. Case Presentation: A 28-year-old male presented to cardiology department of our hospital with worsening breathlessness for 1 week. We found pulmonary embolism and an infarct in the lower pole of the right kidney by CT pulmonary angiogram. He had no previous history or features of nephrotic syndrome. Urine analysis showed numerous red blood cells, 3+ proteinuria and granular casts. Urine protein creatinine ratio was 5.2 g/g of creatinine. Serum creatinine was 2.61 mg/dL. Renal biopsy was suggestive of IgA nephropathy and patient was started on steroids and warfarin and responded to treatment. Conclusions: Patients with nephrotic syndrome can rarely present initially with venous and arterial thromboembolism. Rarely even IgA nephropathy can present with such thromboembolic episodes

Impact of renal transplant on gonadal function

Objectives: We aimed at creating a clinical profile of end-stage renal disease patients' gonadal function and assessing the impact of renal transplant on gonadal dysfunction. We studied the influence of age, vascular anastomosis, dialysis vintage, and immunosuppression on sexual dysfunction. Materials and Methods: Twenty adults were included. Hormones (luteinizing hormone [LH], follicle-stimulating hormone [FSH], testosterone, prolactin (PRL), and estrogen), menstrual history and International Index of Erectile Function (IIEF)-5 questionnaires were assessed before and after renal transplantation. Hormone evaluation was done by chemiluminescent microparticle immunoassay technology. Results: Seventeen patients were male and three patients were female. Native kidney diseases were chronic glomerulonephritis (10%), IgA nephropathy (20%), autosomal dominant polycyctic kidney disease (5%), diabetic nephropathy (5%), focal segmental glomerulosclerosis (5%), renal calculus disease (5%), membranous nephropathy (5%), and pauci-immune vasculitis (5%). Fifteen males had erectile dysfunction (ED) before transplant. Eleven patients showed an increase and six patients showed a decrease in IIEF scores posttransplantation. Statistically significant changes were observed in the mean levels of testosterone, LH, PRL, and FSH. Age at transplant showed a negative correlation with IIEF score. In five patients with an end to side anastomosis to the external iliac artery, all had an increase in IIEF score posttransplant. In 12 patients with an end to end anastomosis to the internal iliac artery, 5 patients (42%) had a decrease in IIEF score posttransplant. Conclusions: Incidence of ED was 88% in our study. About 65% patients showed an increase in IIEF score posttransplantation. Increasing age at the time of transplant was a significant risk factor for the presence of ED. Renal transplantation corrected hormonal abnormalities in men. About 100% of patients with an end to side arterial anastomosis showed improvement in IIEF scores. There was no effect of dialysis vintage and immunosuppression regimes on sexual dysfunction