Epidemiology and risk factors of chronic kidney disease in India – results from the SEEK (Screening and Early Evaluation of Kidney Disease) study

Background: There is a rising incidence of chronic kidney disease that is likely to pose major problems for both healthcare and the economy in future years. In India, it has been recently estimated that the age-adjusted incidence rate of ESRD to be 229 per million population (pmp), and >100,000 new patients enter renal replacement programs annually. Methods: We cross-sectionally screened 6120 Indian subjects from 13 academic and private medical centers all over India. We obtained personal and medical history data through a specifically designed questionnaire. Blood and urine samples were collected. Results: The total cohort included in this analysis is 5588 subjects. The mean ± SD age of all participants was 45.22 ± 15.2 years (range 18–98 years) and 55.1% of them were males and 44.9% were females. The overall prevalence of CKD in the SEEK-India cohort was 17.2% with a mean eGFR of 84.27 ± 76.46 versus 116.94 ± 44.65 mL/min/1.73 m2 in non-CKD group while 79.5% in the CKD group had proteinuria. Prevalence of CKD stages 1, 2, 3, 4 and 5 was 7%, 4.3%, 4.3%, 0.8% and 0.8%, respectively. Conclusion: The prevalence of CKD was observed to be 17.2% with ~6% have CKD stage 3 or worse. CKD risk factors were similar to those reported in earlier studies. It should be stressed to all primary care physicians taking care of hypertensive and diabetic patients to screen for early kidney damage. Early intervention may retard the progression of kidney disease. Planning for the preventive health policies and allocation of more resources for the treatment of CKD/ESRD patients are imperative in India

Research Journal of Pharmaceutical, Biological and Chemical Sciences Development and Validation of a HPTLC Method for Simultaneous Determination of Furosemide and Spironolactone in Its Tablet Formulation

ABSTRACT The objective of the current study was to develop a simple, precise and accurate High Perfomance Thin Layer Chromatographic [HPTLC] assay method and validated for determination of furosemide and spironolactone in solid pharmaceutical dosage forms. The mobile phase comprising of ethyl acetate: haxane in the volume ratio of [80: 20, v/v] was employed for the elution. Standard solution was prepared in methanol. The standard concentration was 40 µg ml -1 of furosemide and 100 µg ml -1 of spironolactone. Chromatographic analysis was performed on a HPTLC plates precoated with 0.25 mm layer of chromatographic silica gel mixture [Silica GF254] on aluminum sheets. After development of the chromatographic plate, the detection was carried out using an Ultraviolet scanning densitometer set at a wavelength of 254 nm. The method was validated for specificity, linearity, precision, accuracy, robustness and solution stability. The method was linear in the drug the concentration range from 0.016-0.064 mg ml -1 for furosemide and 0.040-0.160 mg ml -1 for spironolactone with correlation coefficient 0.9958 and for Spironolactone with correlation coefficient 0.9975. The (relative standard deviation -RSD) values for intraday precision study and interday precision study was < 2.0 % for furosemide and spironolactone. The mean recovery for furosemide was 98.51 -98.81 % and 98.20 -98.98 % for spironolactone

Protein energy wasting in chronic kidney disease: An update with focus on nutritional interventions to improve outcomes

Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD). PEW is one of the strongest predictors of mortality in patients with CKD. The International Society of Renal Nutrition and Metabolism (ISRNM) expert panel has defined PEW as a, “state of decreased body stores of protein and energy fuels (body protein and fat masses)”. The ISRNM panel has also proposed diagnostic criteria of PEW with four categories. Cachexia is a severe form of PEW. The proposed causes of PEW are multi-factorial and include nutritional and non-nutritional mechanisms. The literature indicates that PEW can be mitigated or corrected with an appropriate diet and enteral nutritional support that targets dietary protein intake. Dietary requirements and enteral nutritional support must also be considered in patients with CKD and diabetes mellitus and in children with CKD, in addition to dialysis patients. Features of ideal dietary supplement have also been discussed. Dietary interventions such as enteral feeding with high-protein meals or supplements might improve the nutritional status and outcomes in dialysis patients

Urosepsis Causing Gastric Ischemia: A Rare but Deadly Complication

A 70-year-old male presented with abdominal pain and altered mental status. He was found to have sepsis secondary to a urinary tract infection with imaging showing hepatic portal venous gas and gastric pneumatosis. Esophagogastroduodenoscopy revealed gastric ischemia extending to the midbody with necrosis and biopsies confirming ischemia. The patient was treated conservatively with intermittent nasogastric tube suctioning, acid suppression therapy and broad-spectrum antibiotics. The patient improved clinically and repeat imaging and EGD showed resolution of the ischemia. The patient’s diet was advanced and he was discharged to a long-term acute care facility. Gastric ischemia is a rare condition caused by local or diffuse vascular insufficiency. Management is either surgical or conservative with acid suppression, nasogastric tube suctioning and broad-spectrum antibiotics. Gastric ischemia is often diagnosed late and can have complications such as gastric perforation which carries high morbidity and mortality

Vitamin D deficiency in hemodialysis patients

Background : Vitamin D [(25(OH)D] deficiency and insufficiency is common in patients with chronic kidney disease (CKD). 25(OH)D has been found to have beneficial effects on bone, cardiovascular and immune functions. There are little data about vitamin D levels in Indian patients on dialysis. This study was undertaken to determine the vitamin D status of Indian CKD patients on hemodialysis. Materials and Methods : We included 45 patients on maintenance hemodialysis coming to Medanta, Medicity, Gurgaon. 25(OH)D levels were measured with radioimmunoassay (Diasorin) method and parathyroid hormone (PTH) was measured using electrochemiluminiscence immunoassay (ECLIA). Results : The mean age of patients was 55 ± 13 years. 32/45 (71%) were males. 23/45 (51%) were diabetics. The median duration of hemodialysis was 5.5 months (range 1-74 months). 33/45 (74%) patients were on thrice weekly hemodialysis. The mean level of vitamin D was 10.14 ± 8.7 ng/ml. Majority of the patients [43/45 (95.5%)] were either vitamin D deficient or had insufficient levels. 40/45 (88.9%) were vitamin D deficient (levels <20 ng/ml); of these, 29/40 (64.4%) had severe vitamin D deficiency (levels <10 ng/ml) and 3/45 (6.7%) had insufficient levels (20-30 ng/ml) of vitamin D. Only 2/45 (4.4%) patients had normal levels of vitamin D. 23/45 (51%) of patients were receiving calcitriol. The mean levels of serum calcium, phosphorus, alkaline phosphatase, and albumin were 8.8 ± 0.64 mg/dl, 5.0 ± 0.7 mg/dl, 126 ± 10.3 IU/l and 3.6 ± 0.62 g/dl, respectively. PTH levels ranged from 37 to 1066 pg/ml, and the median was 195.8 pg/ml. There was a weak correlation between 25(OH)D levels and weight, sex, hemoglobin, albumin, alkaline phosphatase, and presence of diabetes. There was, however, no correlation with duration of dialysis or PTH levels. Conclusion : Vitamin D deficiency and insufficiency are universal in our hemodialysis patients, with severe vitamin D deficiency in two-third of patients

Endoscopic posterior decompression of lumbar canal stenosis

Lumbar canal stenosis (LCS) is quite common. Surgery is indicated when patient fails to improve after conservative treatment. Endoscopic technique can be used in LCS and lateral recess stenosis. It can be performed in degenerative canal stenosis or with disc bulges. Bilateral severe bony canal stenosis and unstable spine are the contraindications. This procedure should be avoided in patients with a history of trauma. Detailed history and thorough physical examination should be performed to find out exact level of pathology responsible for symptoms. Patient’s symptoms must correlate with radiological findings. Magnetic resonance imaging is the investigation of choice because of its superior visualization of soft-tissue. Computed tomography scan does give a more accurate and detailed picture of the bony anatomy. Although the operative time and the complication rate could be more in the initial learning curve, the results of endoscopic decompression are comparable with conventional open procedures with the additional benefit of decreased complications and lower morbidity, when sufficient experience is gained. Complications in endoscopic surgery for LCS could be dural tears, hematomas and root and facet injury. This procedure is also associated with limitations such as steep learning curve and the contra lateral decompression may not be as good as ipsilateral side. Some of the limitations of this technique can be overcome by attending live operative workshop, practice on models and hands on cadaveric dissection. Conversion to an open procedure may be required when there is disorientation, management of dural tear and for control of bleeding

Pneumocephalus in cerebellopontine angle and meningitis secondary to chronic otitis media in a child

Pneumocephalus is a rare complication of chronic otitis media. Despite its rarity intra-cranial air carries a potential risk of increased intra-cranial pressure or meningitis, which requires immediate therapy. A 10-year-old child presented to us with complaints of fever, headache, vomiting, and decreased hearing from left ear. He had history of left ear discharge since 2 years. Clinical examination revealed neck rigidity and left chronic otitis media. Contrast enhanced computed axial tomography scan of head [Figure 1] and [Figure 2] showed pneumocephalus in left cerebellopontine angle, opacification of left middle ear and nonpneumatisation of left mastoid. Child was immediately put on empirical intravenous antibiotics and decongestants. He showed clinical improvement in 3 days. Pneumocephalus secondary to chronic otitis media is extremely rare; we are reporting one such case in a child with review of literature