Mucormycosis (zygomycosis) of renal allograft

Fungal infection is relatively common among renal transplant recipients from developing countries. Mucormycosis, also known as zygomycosis, is one of the most serious fungal infections in these patients. The most common of presentation is rhino-cerebral. Isolated involvement of a renal allograft is very rare. A thorough search of literature and our medical records yielded a total of 24 cases with mucormycosis of the transplanted kidney. There was an association with cytomegalovirus (CMV) infection and anti-rejection treatment in these patients and most of these transplants were performed in the developing countries from unrelated donors. The outcome was very poor with an early mortality in 13 (54.5%) patients. Renal allograft mucormycosis is a relatively rare and potentially fatal complication following renal transplantation. Early diagnosis, graft nephrectomy and appropriate antifungal therapy may result in an improved prognosis for these patients

Deferred pre-emptive switch from calcineurin inhibitor to sirolimus leads to improvement in GFR and expansion of T regulatory cell population: a randomized, controlled trial

BACKGROUND: Measures to prevent chronic calcineurin inhibitor (CNI) toxicity have included limiting exposure by switching to sirolimus (SIR). SIR may favorably influence T regulator cell (T(reg)) population. This randomized controlled trial compares the effect of switching from CNI to SIR on glomerular filtration rate (GFR) and T(reg) frequency. METHODS: In this prospective open label randomized trial, primary living donor kidney transplant recipients on CNI-based immunosuppression were randomized to continue CNI or switched to sirolimus 2 months after surgery; 29 were randomized to receive CNI and 31 to SIR. All patients received mycophenolate mofetil and steroids. The main outcome parameter was estimated GFR (eGFR) at 180 days. T(reg) population was estimated by flowcytometry. RESULTS: Baseline characteristics in the two groups were similar. Forty-eight patients completed the trial. At six months, patients in the SIR group had significantly higher eGFR as compared to those in the CNI group (88.94 ± 11.78 vs 80.59 ± 16.51 mL/min, p = 0.038). Patients on SIR had a 12 mL/min gain of eGFR of at the end of six months. Patients in the SIR group showed significant increase in T(reg) population at 30 days, which persisted till day 180. There was no difference in the adverse events in terms of number of acute rejection episodes, death, infections, proteinuria, lipid profile, blood pressure control and hematological parameters between the two groups. Four patients taking SIR developed enthesitis. No patient left the study or switched treatment because of adverse event. CONCLUSIONS: A deferred pre-emptive switch over from CNI to SIR safely improves renal function and T(reg) population at 6 months in living donor kidney transplant recipients. Registered in Clinical Trials Registry of India (CTRI/2011/091/000034)

Body composition analysis with bioelectric impedance in adult Indians with ESRD: Comparison with healthy population

Evaluation of body composition provides clinically useful information in several diseases including chronic kidney disease. Bioimpedance analysis (BIA) is a simple, cheap, and noninvasive tool for monitoring body composition. We performed BIA in 451 healthy adults and 162 end-stage renal disease (ESRD) patients. Resistance (R) and reactance (Xc) values were obtained at 50-kHz frequency using a tetrapolar impedance meter. Body compartments were derived using population-specific regression equations. Phase angles (arctan Xc/R) were calculated and impedance vector distribution was determined using the RXc graph method. Compared to healthy population, ESRD patients had similar post-dialysis resistance with lower reactance and phase angle, indicating decreased soft tissue mass and inadequate ultrafiltration. BIA equations estimated decreased fat mass index and intracellular water, whereas the total body and extracellular water percentages were increased. Sex-specific reference RXc plots with 95, 75, and 50% tolerance ellipses were drawn for the healthy population. A significant difference was noted in the vector positions and 95% confidence ellipses of the two sexes and body mass indices of ≤25 and >25. In conclusion, we present the reference BIA parameters for Indian population. ESRD patients show significant body compartment alterations. The RXc score graph can differentiate ESRD patient from normal controls and can be used to monitor nutrition and hydration status

Biliary atresia with hyaline cartilage at the porta hepatis: a novel finding of undetermined significance: a case report

Biliary atresia is an important cause of liver disease and morbidity in infants with unknown etiology. To date, only five cases of biliary atresia with hyaline cartilage at the porta hepatis have been described. We present the case of a 65-day-old male child, with further insight and detailed discussion of this heterotopia of undetermined significance.Keywords: biliary atresia, hyaline cartilage, liver diseas

Acute tubulo-interstitial nephritis leading to acute renal failure following multiple hornet stings

BACKGROUND: Hornet stings are generally associated with local and occasionally anaphylactic reactions. Rarely systemic complications like acute renal failure can occur following multiple stings. Renal failure is usually due to development of acute tubular necrosis as a result of intravascular haemolysis, rhabdomyolysis or shock. Rarely it can be following development of acute tubulo-interstitial nephritis. CASE PRESENTATION: We describe a young male, who was stung on face, head, shoulders and upper limbs by multiple hornets (Vespa orientalis). He developed acute renal failure as a result of acute tubulo-interstitial nephritis and responded to steroids. CONCLUSION: Rare causes of acute renal failure like tubulo-interstitial nephritis should be considered in a patient with persistent oliguria and azotemia following multiple hornet stings. Renal biopsy should be undertaken early, as institution of steroid therapy may help in recovery of renal functio

Cecum perforation due to tuberculosis in a renal transplant recipient: a case report

<p>Abstract</p> <p>Introduction</p> <p>Tuberculosis can present in many varied clinical situations in immunosuppressed patients. It has been reported that the sigmoid colon is the most common site for colonic perforation in renal transplant recipients and diverticulitis is its most common cause. Cecal perforation because of tuberculosis is extremely rare in a renal transplant recipient. We present the case of a renal transplant patient with cecal perforation due to tuberculosis, 10 years after renal transplantation.</p> <p>Case presentation</p> <p>A 39-year-old Caucasian man, who was a renal transplant recipient, was admitted to our emergency surgery unit with an acute abdomen. A cecal perforation was found at exploratory laparotomy, and a right hemicolectomy with an end ileostomy and transverse colonic mucous fistula were performed. Necrotizing granulomatous colitis due to tuberculosis was reported in the histopathologic examination.</p> <p>Conclusion</p> <p>Colonic perforations in immunosuppressed patients may have unusual presentations and unusual causes. Tuberculosis infection should be considered in the differential diagnosis during the histopathologic evaluation in immunocompromised patients such as renal transplant recipients.</p

What do we know about chronic kidney disease in India: first report of the Indian CKD registry

<p>Abstract</p> <p>Background</p> <p>There are no national data on the magnitude and pattern of chronic kidney disease (CKD) in India. The Indian CKD Registry documents the demographics, etiological spectrum, practice patterns, variations and special characteristics.</p> <p>Methods</p> <p>Data was collected for this cross-sectional study in a standardized format according to predetermined criteria. Of the 52,273 adult patients, 35.5%, 27.9%, 25.6% and 11% patients came from South, North, West and East zones respectively.</p> <p>Results</p> <p>The mean age was 50.1 ± 14.6 years, with M:F ratio of 70:30. Patients from North Zone were younger and those from the East Zone older. Diabetic nephropathy was the commonest cause (31%), followed by CKD of undetermined etiology (16%), chronic glomerulonephritis (14%) and hypertensive nephrosclerosis (13%). About 48% cases presented in Stage V; they were younger than those in Stages III-IV. Diabetic nephropathy patients were older, more likely to present in earlier stages of CKD and had a higher frequency of males; whereas those with CKD of unexplained etiology were younger, had more females and more frequently presented in Stage V. Patients in lower income groups had more advanced CKD at presentation. Patients presenting to public sector hospitals were poorer, younger, and more frequently had CKD of unknown etiology.</p> <p>Conclusions</p> <p>This report confirms the emergence of diabetic nephropathy as the pre-eminent cause in India. Patients with CKD of unknown etiology are younger, poorer and more likely to present with advanced CKD. There were some geographic variations.</p

Involvement of microRNA Lethal-7a in the Regulation of Embryo Implantation in Mice

MicroRNAs interact with multiple mRNAs resulting in their degradation and/or translational repression. This report used the delayed implantation model to determine the role of miRNAs in blastocysts. Dormant blastocysts in delayed implanting mice were activated by estradiol. Differential expression of 45 out of 238 miRNAs examined was found between the dormant and the activated blastocysts. Five of the nine members of the microRNA lethal-7 (let-7) family were down-regulated after activation. Human blastocysts also had a low expression of let-7 family. Forced-expression of a family member, let-7a in mouse blastocysts decreased the number of implantation sites (let-7a: 1.1±0.4; control: 3.8±0.4) in vivo, and reduced the percentages of blastocyst that attached (let-7a: 42.0±8.3%; control: 79.0±5.1%) and spreaded (let-7a: 33.5±2.9%; control: 67.3±3.8%) on fibronectin in vitro. Integrin-β3, a known implantation-related molecule, was demonstrated to be a target of let-7a by 3′-untranslated region reporter assay in cervical cancer cells HeLa, and Western blotting in mouse blastocysts. The inhibitory effect of forced-expression of let-7a on blastocyst attachment and outgrowth was partially nullified in vitro and in vivo by forced-expression of integrin-β3. This study provides the first direct evidence that let-7a is involved in regulating the implantation process partly via modulation of the expression of integrin-β3. (200 words)