EFFICACY AND SAFETY OF SEVELAMER CARBONATE VERSUS CALCIUM ACETATE IN PATIENTS WITH CHRONIC RENAL DISEASE ON DIALYSIS

Purpose: Powdered sevelamer carbonate is a new phosphate binder with unproven therapeutic benefit in Indian population. Hence, we aimed to compare its efficacy and safety with calcium acetate in patients with Chronic Renal Disease on hemodialysis. Methods: This was a randomized, prospective, cross over and open labeled study, conducted in the Department of Nephrology, Christian Medical College and Hospital, Ludhiana. Fifty patients were included in data analysis and were randomization into two groups, A & B. Group A patients first received powdered sevelamer carbonate for  4 weeks (n= 25) followed by 1 week of washout and calcium acetate for the next 4 weeks (n=25). Group B: vice-versa.  Serum phosphorus, calcium, C-reactive protein (CRP), total cholesterol, triglycerides (TGs) and low density lipoprotein (LDL) levels were performed before and after each drug was administered. Results: Mean baseline serum phosphorus and calcium phosphorus product in group A, reduced from 6.59 ± 0.31mg/dl & 53.18 ± 2.5mg2/dl2 to 5.26± 0.33mg/dl & 44.76mg2/dl2 respectively. In group B these reduced from 6.42±0.33 mg/dl & 52.06±2.5 mg2/dl2 to 5.44±0.3 mg/dl & 44.5mg2/dl2 respectively. The reduction in these values in both groups was statistically significant (p<0.05). Reductions in serum CRP, total cholesterol, triglycerides and low density lipoprotein (LDL) levels were not statistically significant in either group. Conclusion: Powdered sevelamer carbonate and calcium acetate are equally efficacious with no serious adverse effects. Both the drugs were well tolerated. Hence, powdered sevelamer carbonate can be a useful alternate to calcium based binders in Indian patients. Keywords: powdered sevelamer carbonate, calcium acetat

Isolated Neurogenic Bladder Associated With Human T-Lymphotropic Virus Type 1 Infection in a Renal Transplant Patient From Central Australia: A Case Report

© 2018 Elsevier Inc. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (Sept 2018) in accordance with the publisher’s archiving policyHuman T-lymphotropic virus type 1 (HTLV-1) is endemic amongst the Aborigines of the Northern Territory of Australia. HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) has been associated with this infection. In general population, isolated neurogenic bladder dysfunction in HTLV-1-infected individuals without HAM/TSP has been reported, and the HTLV-1 proviral load has been found to be higher in such patients compared with asymptomatic carriers. In solid organ transplantation, few cases of HAM/TSP have been reported worldwide, but not an isolated neurogenic bladder. Case A 50-year-old indigenous women from Alice Springs with end stage renal disease secondary to diabetic nephropathy with no prior history of bladder dysfunction received a cadaveric renal allograft following which she developed recurrent urinary tract infections. The recipient was seropositive for HTLV-1 infection. HTLV-1 status of donor was not checked. Urodynamic studies revealed stress incontinence and detrusor overactivity without urethral intrinsic sphincter deficiency. She had no features of myelopathy. There was elevation of the serum and cerebrospinal fluid HTLV-1 proviral load. The magnetic resonance imaging myelogram was normal. Pyelonephritis was diagnosed based on clinical features, positive cultures, and renal allograft biopsy. Continuous suprapubic catheter drainage helped preventing further episodes of allograft pyelonephritis in spite of chronic colonization of the urinary tract. Conclusion Isolated bladder dysfunction is a rare manifestation of HTLV-1 infection and is probably associated with high proviral loads. This may adversely affect renal allograft and patient outcomes

Successful renal transplantation after two separate urinary tract malignancies

A patient who was treated for renal cell carcinoma and transitional cell carcinoma, later presented with end stage renal disease. He was managed with hemodialysis and later underwent successful renal transplantation. There was no evidence of tumor recurrence nearly nine years post-renal transplantation

Nonrejection pathology of renal allograft biopsies: 10 years experience from a tertiary care center in north India

Background: Renal dysfunction in allograft transplant is common and its assessment is done using Revised Banff ′97 working classification, which is the accepted formulation for the evaluation of histological appearance of renal allograft biopsies. The nonrejection category under the Banff working classification of renal allograft pathology forms a large group resulting in allograft dysfunction. Aim: To evaluate the spectrum of histopathological changes seen in renal allograft dysfunction. Materials and Methods: A total of 119 renal biopsies were studied over 10 years presenting with renal allograft dysfunction from a tertiary center in North India. Results: Majority of the biopsies were in the nonrejection category (47.1%), which included few cases of acute tubular necrosis (25.2%), cyclosporine nephrotoxicity (16%), infections (10.9%), and thrombotic microangiopathy (3.4%). The second largest category in our study was acute/active cellular rejection group (31.9%), which displayed moderate to severe tubulitis, mononuclear cell infiltrate in the interstitium, and vasculitis. Antibody-mediated rejection cases were seen in 28.6% of the renal biopsies followed by chronic allograft nephropathy cases (12.6%) showing features of tubular atrophy and interstitial fibrosis. Borderline changes with features of mild tubulitis contributed to 7.6% of the biopsies. The smallest group comprised of only 4.2%, which were within normal histological limits. Conclusion: Timely accurate diagnosis of renal allograft dysfunction is essential for prompt, effective management of renal transplant patients. Thus, nonrejection pathology forms a significant cause of renal dysfunction in patients with renal allograft transplantation

Thrombotic thrombocytopenic purpura and systemic lupus erythematosus: Successful management of a rare presentation

Thrombotic thrombocytopenic purpura (TTP) and systemic lupus erythematosus (SLE) very rarely present simultaneously and pose a diagnostic and therapeutic dilemma to the critical care team. Prompt diagnosis and management with plasma exchange and immunosuppression is life-saving. A patient critically ill with TTP and SLE, successfully managed in the acute period of illness with plasma exchange, steroids and mycophenolate mofetil is described

Rhodococcus equi peritonitis in continuous ambulatory peritoneal dialysis: a first in Australia.

A 33-year-old Caucasian man with end-stage renal disease secondary to biopsy-proven IgA nephropathy, managed with continuous ambulatory peritoneal dialysis (PD), presented with PD-related peritonitis, the causal organism being a non-branching Gram-positive bacillus, Rhodococcus equi. Initial empirical Gram positive and negative coverage with cefazolin and ceftazidime was unsuccessful, but following isolation of the organism, and conversion to intraperitoneal vancomycin and oral ciprofloxacin, the peritonitis episode resolved. At day 10, vancomycin was switched to azithromycin for a total of 6?weeks of antimicrobial therapy. The PD catheter was preserved, and the patient remained peritonitis-free at 6?months of follow-up

Wasp sting: An unusual fatal outcome

Wasp stings are not uncommon especially in populations living in proximity of forested areas all over the world. Local manifestations following stings are common and un-usually life threatening anaphylaxis may occur, requiring prompt treatment. Multi organ failure and acute renal failure following wasp stings are rare and histological evaluation suggest acute tubular necrosis secondary to hemolysis, rhabdomyolysis and direct venom toxicity. A rare com-plication of a patient following multiple wasp stings with disseminated intravascular coagulation, acute renal failure and thrombotic microangiopathy is presented

Spontaneous rupture of tuberculous spleen in a HIV seropositive patient on maintenance hemodialysis

Spontaneous rupture of the spleen usually occurs secondary to infection, hematolo-gical disorders or infiltrative lesions of the spleen. In patients with positive human immuno-deficiency virus (HIV) antibodies and the acquired immunodeficiency syndrome (AIDS) who pre-sent with acute abdomen, splenic rupture should be considered as a possible cause and should addi-tionally be investigated for co-infection with tuberculosis. Spontaneous rupture of spleen in asymp-tomatic patients requires a high index of suspicion for diagnosis. We herein report on a HIV-positive patient on maintenance hemodialysis, who presented with spontaneous rupture of a tuberculous spleen