Autosomal dominant polycystic kidney disease with diffuse proliferative glomerulonephritis - an unusual association: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Autosomal dominant polycystic kidney disease is an inherited disorder that is characterized by the development and growth of cysts in the kidneys and other organs. Urinary protein excretion is usually less than 1 g/24 hours in autosomal dominant polycystic kidney disease, and an association of nephrotic syndrome with this condition is considered rare. There are only anecdotal case reports of autosomal dominant polycystic kidney disease associated with nephrotic syndrome, with focal segmental glomerulosclerosis being the most commonly reported histopathological diagnosis. Nephrotic-range proteinuria in the presence of autosomal dominant polycystic kidney disease, with or without an accompanying decline in renal function, should be investigated by open renal biopsy to exclude coexisting glomerular disease. To the best of our knowledge, this is the first case of autosomal dominant polycystic kidney disease with histologically proven diffuse proliferative glomerulonephritis presenting with nephrotic-range proteinuria. No other reports of this could be found in a global electronic search of the literature.</p> <p>Case presentation</p> <p>We report the case of a 35-year-old Indo-Aryan man with autosomal dominant polycystic kidney disease associated with nephrotic syndrome and a concomitant decline in his glomerular filtration rate. Open renal biopsy revealed diffuse proliferative glomerulonephritis. An accurate diagnosis enabled us to manage him conservatively with a successful outcome, without the use of corticosteroid which is the standard treatment and the drug most commonly used to treat nephrotic syndrome empirically.</p> <p>Conclusion</p> <p>Despite the reluctance of physicians to carry out a renal biopsy on patients with autosomal dominant polycystic kidney disease, our case supports the idea that renal biopsy is needed in patients with polycystic kidney disease with nephrotic-range proteinuria to make an accurate diagnosis. It also illustrates the importance of open renal biopsy in planning appropriate treatment for patients with autosomal dominant polycystic kidney disease with nephrotic-range proteinuria. The treatment for various histological subtypes leading to nephrotic syndrome is different, and in this modern era we should practice evidence-based medicine and should avoid empirical therapy with its associated adverse effects.</p

Perinatal outcomes in a South Asian setting with high rates of low birth weight

<p>Abstract</p> <p>Background</p> <p>It is unclear whether the high rates of low birth weight in South Asia are due to poor fetal growth or short pregnancy duration. Also, it is not known whether the traditional focus on preventing low birth weight has been successful. We addressed these and related issues by studying births in Kaniyambadi, South India, with births from Nova Scotia, Canada serving as a reference.</p> <p>Methods</p> <p>Population-based data for 1986 to 2005 were obtained from the birth database of the Community Health and Development program in Kaniyambadi and from the Nova Scotia Atlee Perinatal Database. Menstrual dates were used to obtain comparable information on gestational age. Small-for-gestational age (SGA) live births were identified using both a recent Canadian and an older Indian fetal growth standard.</p> <p>Results</p> <p>The low birth weight and preterm birth rates were 17.0% versus 5.5% and 12.3% versus 6.9% in Kaniyambadi and Nova Scotia, respectively. SGA rates were 46.9% in Kaniyambadi and 7.5% in Nova Scotia when the Canadian fetal growth standard was used to define SGA and 6.7% in Kaniyambadi and < 1% in Nova Scotia when the Indian standard was used. In Kaniyambadi, low birth weight, preterm birth and perinatal mortality rates did not decrease between 1990 and 2005. SGA rates in Kaniyambadi declined significantly when SGA was based on the Indian standard but not when it was based on the Canadian standard. Maternal mortality rates fell by 85% (95% confidence interval 57% to 95%) in Kaniyambadi between 1986–90 and 2001–05. Perinatal mortality rates were 11.7 and 2.6 per 1,000 total births and cesarean delivery rates were 6.0% and 20.9% among live births ≥ 2,500 g in Kaniyambadi and Nova Scotia, respectively.</p> <p>Conclusion</p> <p>High rates of fetal growth restriction and relatively high rates of preterm birth are responsible for the high rates of low birth weight in South Asia. Increased emphasis is required on health services that address the morbidity and mortality in all birth weight categories.</p

Metagenomic and Metabolic Profiling of Nonlithifying and Lithifying Stromatolitic Mats of Highborne Cay, The Bahamas

BACKGROUND: Stromatolites are laminated carbonate build-ups formed by the metabolic activity of microbial mats and represent one of the oldest known ecosystems on Earth. In this study, we examined a living stromatolite located within the Exuma Sound, The Bahamas and profiled the metagenome and metabolic potential underlying these complex microbial communities. METHODOLOGY/PRINCIPAL FINDINGS: The metagenomes of the two dominant stromatolitic mat types, a nonlithifying (Type 1) and lithifying (Type 3) microbial mat, were partially sequenced and compared. This deep-sequencing approach was complemented by profiling the substrate utilization patterns of the mats using metabolic microarrays. Taxonomic assessment of the protein-encoding genes confirmed previous SSU rRNA analyses that bacteria dominate the metagenome of both mat types. Eukaryotes comprised less than 13% of the metagenomes and were rich in sequences associated with nematodes and heterotrophic protists. Comparative genomic analyses of the functional genes revealed extensive similarities in most of the subsystems between the nonlithifying and lithifying mat types. The one exception was an increase in the relative abundance of certain genes associated with carbohydrate metabolism in the lithifying Type 3 mats. Specifically, genes associated with the degradation of carbohydrates commonly found in exopolymeric substances, such as hexoses, deoxy- and acidic sugars were found. The genetic differences in carbohydrate metabolisms between the two mat types were confirmed using metabolic microarrays. Lithifying mats had a significant increase in diversity and utilization of carbon, nitrogen, phosphorus and sulfur substrates. CONCLUSION/SIGNIFICANCE: The two stromatolitic mat types retained similar microbial communities, functional diversity and many genetic components within their metagenomes. However, there were major differences detected in the activity and genetic pathways of organic carbon utilization. These differences provide a strong link between the metagenome and the physiology of the mats, as well as new insights into the biological processes associated with carbonate precipitation in modern marine stromatolites

Association between age at disease onset of anti-neutrophil cytoplasmic antibody-associated vasculitis and clinical presentation and short-term outcomes

Objectives: ANCA-associated vasculitis (AAV) can affect all age groups. We aimed to show that differences in disease presentation and 6 month outcome between younger- A nd older-onset patients are still incompletely understood. Methods: We included patients enrolled in the Diagnostic and Classification Criteria for Primary Systemic Vasculitis (DCVAS) study between October 2010 and January 2017 with a diagnosis of AAV. We divided the population according to age at diagnosis: &lt;65 years or ≥65 years. We adjusted associations for the type of AAV and the type of ANCA (anti-MPO, anti-PR3 or negative). Results: A total of 1338 patients with AAV were included: 66% had disease onset at &lt;65 years of age [female 50%; mean age 48.4 years (s.d. 12.6)] and 34% had disease onset at ≥65 years [female 54%; mean age 73.6 years (s.d. 6)]. ANCA (MPO) positivity was more frequent in the older group (48% vs 27%; P = 0.001). Younger patients had higher rates of musculoskeletal, cutaneous and ENT manifestations compared with older patients. Systemic, neurologic,cardiovascular involvement and worsening renal function were more frequent in the older-onset group. Damage accrual, measured with the Vasculitis Damage Index (VDI), was significantly higher in older patients, 12% of whom had a 6 month VDI ≥5, compared with 7% of younger patients (P = 0.01). Older age was an independent risk factor for early death within 6 months from diagnosis [hazard ratio 2.06 (95% CI 1.07, 3.97); P = 0.03]. Conclusion: Within 6 months of diagnosis of AAV, patients &gt;65 years of age display a different pattern of organ involvement and an increased risk of significant damage and mortality compared with younger patients

PREVALENCE OF INTESTINAL PARASITISM AND ASSOCIATED SYMPTOMATOLOGY AMONG HEMODIALYSIS PATIENTS

Intestinal parasites are an important cause of morbidity and mortality. Immunocompromised individuals may develop more severe forms of these infections. Taking into account the immunity impairment in patients suffering from chronic renal failure (CRF), we will determine the prevalence and associated symptoms of intestinal parasites in these patients. Controls without CRF were used for comparison. Stool samples were collected and processed for microscopic identification of parasites using the Formalin-ether concentration method. For Cryptosporidium diagnosis, the ELISA technique was used. One hundred and ten fecal samples from hemodialysis patients were analyzed, as well as 86 from a community group used as control group. A result of 51.6% of intestinal parasites was observed in hemodialysis patients and 61.6% in the control group. Cryptosporidium and Blastocystis were the most common infections in patients with CRF (26.4% and 24.5%, respectively). Blastocystis was the most common infection in the control group (41.9%), however no individual was found positive for Cryptosporidium. Among the CRF patients, 73.6% were symptomatic, 54.3% of these tested positive for at least one parasite, in contrast to 44.8% in asymptomatic patients (p = 0.38). The most common symptoms in this group were flatulence (36.4%), asthenia (30.0%) and weight loss (30.0%). In the control group, 91.9% were symptomatic, 60.8% of these tested positive for at least one parasite, in contrast to 71.4% in asymptomatic patients (p = 0.703). A significant difference between the two groups was observed with regard to symptoms, with bloating, postprandial fullness, and abdominal pain being more frequent in the control group than in the hemodialysis group (all p < 0.05). Comparing symptomatic with asymptomatic, there was no association in either group between symptoms or the prevalence of parasitic infection, nor with the type of parasite or with multiple parasitic infections. Patients with chronic renal failure are frequent targets for renal transplantation, which as well as the inherent immunological impairment of the disease itself, results in immunosuppression by medication. For this reason, carriers of intestinal parasites with pathogenic potential can develop serious clinical complications influencing the success of transplantation. This fact, coupled with the high prevalence of intestinal parasites and the dissociation between symptoms and infection in CRF patients, suggests that the stool test should be incorporated in routine propedeutics. Furthermore, preventive measures for the acquisition of parasites through the fecal-oral contamination route should be introduced

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Not AvailableA 120 days growth study was conducted to assess the effect of tanniniferous oak leaves (Quercus semecarpifolia) on nutrient utilization, mineral bioavailability, and biochemical indices in goats. Eighteen growing kids (13.13 ± 0.99 kg; 7–9 months) were randomly divided into three homogenous groups of six each in a completely randomized design and fed native grass hay (Heteropogon contortus) in T1 (control), oak leaves (Quercus semecarpifolia) in T2 and supplemental tannic acid with grass hay in T3 keeping the concentrate mixture constant in all the treatments. At 90 days post feeding, a metabolism trial of six days duration was conducted. Blood was collected on day 0, 60 and 120. The nutrient intake per unit metabolic body size was higher (P < 0.05) in T2 than T1 and T3 without any alteration in plane of nutrition. Balance of Ca, Co, Cu, and Mn was higher (P < 0.05) in oak leaves fed goats, which was further reflected as higher (P < 0.05) serum mineral level of Ca and Mn in those animals. Serum urea level was lower (P < 0.05) in the oak leaves fed group (T2), whereas the serum cholesterol values were lower (P < 0.05) in T2 and T3. The levels of different serum enzymes viz. alkaline phosphatase and alkaline transaminase were higher (P < 0.05) in tannic acid supplemented group. These results suggest that feeding of oak leaves (condensed tannin, 0.85% and hydrolysable tannin, 4.4% in diet) improved bioavailability of Ca and Mn in goats as compared to animals fed local grass hay with or without supplementation of tannic acid.Not Availabl

Structure and microstructure evolution of a ternary Fe–Cr–Ni alloy akin to super martensitic stainless steel

A ternary Fe–Cr–Ni alloy, akin to super martensitic stainless steels was prepared in vacuum induction furnace. The as cast ingot was solution treated at 1200 °C for 25 h and then hot forged and rolled to reduce into plate form. The hot rolled plate of martensitic microstructure was then cold rolled to 80% of thickness reduction. The phase transformation studies by X-ray diffraction analysis of hot and cold rolled specimens showed presence of retained austenite in air cooled as well as in water quenched state after annealing/austenising temperature of 1060 °C. The reaustenisation behaviour of the cold rolled alloy in water quenched state was studied by high temperature X-ray diffraction analysis. It showed very stable martensitic phase and the completion of reaustenisation process were observed to occur at about 950 °C. The recrystallisation behaviour of cold rolled material under isothermal and repeated annealing treatment was studied in detail by electron microscope. The tensile properties of the material were evaluated after various annealing treatments. The study revealed that by a suitable sequence of repetitive annealing process microstructure could be tailored to achieve tensile strength above 1 GPa with good ductility in a super martensitic stainless stee

Rare earth metals addition to low carbon steel-thermodynamic aspects, process considerations and effect on mechanical properties

On the basis of thermodynamic data it is predicted that rare earth elements have a very strong affinity for oxygen and sulphur and the addition of rare earth metals to low carbon steel melt results in a considerable degree of desulphurization. Considering the process details, different methods of addition of rare earth metals to steel melt are evaluated. Rare earth recoveries are influenced by melt chemistry, steel-making refractories and by addition technique. The rare earth metal addition to low carbon steel brings about significant improvements in the mechanical properties

Microstructures and Textures of Hot Rolled and Hot Rolled-Normalized 2.9 % Silicon Steel Sheets

Effect of hot rolling and effect of hot rolled-normalizing on microstructures and textures of silicon steel sheets were investigated. In hot rolled steel sheets, fine elongated grains and etch pits were observed. , and were strong orientations at the core of steel sheet. At surface and subsurface, and orientations were dominant orientations. In hot rolled-normalized steel sheets, coarse elongated grains and randomly distributed etch pits were observed. Volume fraction (%) of orientation was found to be decreasing from core to surface, similar trend was found for and orientations. & orientations are the dominant orientations at the surface. Volume fraction (%) of is more than Goss at the surface