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Cardiovascular disease is the leading cause of morbidity and mortality in maintenance hemodialysis (MHD) patients. We evaluated the role of serum catalytic iron (SCI) as a biomarker for coronary artery disease (CAD) in patients on MHD. SCI was measured in 59 stable MHD patients. All patients underwent coronary angiography. Significant CAD was defined as a > 70% narrowing in at least one epicardial coronary artery. Levels of SCI were compared with a group of healthy controls. Significant CAD was detected in 22 (37.3%) patients, with one vessel disease in 14 (63.63%) and multi.vessel disease in eight (36.36%) patients. The MHD patients had elevated levels of SCI (4.70 ± 1.79 μmol/L) compared with normal health survey participants (0.11 ± 0.01 μmol/L) (P < 0.0001). MHD patients who had no CAD had SCI levels of 1.36 } 0.34 μmol/L compared with those having significant CAD (8.92 ± 4.12 μmol/L) (P < 0.0001). Patients on MHD and diabetes had stronger correlation between SCI and prevalence of CAD compared with non.diabetics. Patients having one vessel disease had SCI of 8.85 ± 4.67 μmol/L versus multi.vessel disease with SCI of 9.05 ± 8.34 μmol/L, P = 0.48. In multivariate analysis, SCI and diabetes mellitus were independently associated with significant CAD. We confirm the high prevalence of significant CAD in MHD patients. Elevated SCI levels are associated with presence of significant coronary disease in such patients. The association of SCI is higher in diabetic versus the non.diabetic subgroup. This is an important potentially modifiable biomarker of CAD in MHD patients. [ABSTRACT FROM AUTHOR]

Contrast-induced nephropathy is well-known sequelae of iodinated contrast (diatrizoate meglumine). Carbon dioxide (CO2) can be used as an alternative contrast agent. The aim of this study was to compare the renal injury and the quality of images of aortogram using iodinated contrast versus CO2 using digital subtraction angiography (DSA). This prospective randomized study was done in 29 healthy dogs using DSA aortogram. Dogs were randomly assigned to receive iodinated contrast or CO2. 6-F pigtail catheter was introduced via femoral artery approach to perform aortogram under general anesthesia. Serum creatinine (S.Cr.) and urinary enzymes, namely: N-acetyl D-glucosaminidase (NAG), alanine aminopeptidase (AAP), and gamma glutamyl transferase (GGT), were measured before and 48 hours after aortogram. There was no change in S.Cr. in both the groups. Significantly more enzymuria was seen following iodinated contrast than CO2. Enzymuria pre and postaortogram following the iodinated contrast was GGT: 14.9 ± 5.92 vs. 26.2 ± 15.1 (P = 0.001), NAG: 1.63 ± 0.90 vs. 3.6 ± 2.14 (P = 0.0001), and AAP: 1.51 ± 0.75 vs. 3.38 2.41 (P = 0.001), and in the CO2 group was GGT: 15.5 ± 4.9 vs. 21.1 ± 9.04 (P = 0.02), NAG: 2.12 ± 1.06 vs. 3.82 3.27 (P = 0.08), and AAP: 1.28 ± 0.76 vs. 2.51 ± 1.72 (P = 0.03). More than 50% increase over the preprocedural value was significantly less following CO2. Images obtained with iodinated contrast were superior to those with CO2, however, the quality of image with CO2 was adequate for delineation of the renal artery and major branches. Both iodinated contrast and CO2 cause significant enzymuria. More severe enzymuria (>50% increase) was seen significantly less with the use of CO2. Quality of images is better with iodinated contrast. [ABSTRACT FROM AUTHOR]

Background: Radiographic contrast media (RCM) can cause a reduction in the renal function by multiple mechanisms; reactive oxygen species is one of them. Whether the reduction can be prevented by the administration of antioxidants is still debatable. N-acetylcysteine (NAC) has shown some benefit in patients with renal dysfunction in the prevention of radiocontrast-induced nephropathy (RCIN). Materials and Methods: We prospectively studied 95 healthy kidney donors, who were undergoing intravenous urography (IVU) followed by digital subtraction renal angiography (DSRA) with ionic, high-osmolar contrast agent for pretransplant evaluation. Patients were randomly assigned either to receive the N-acetylcysteine 600 mg orally twice daily (acetylcysteine group) or placebo (control group) on the day before and that of RCM administration in addition to the intravenous 0.45% saline (1 ml/kg body weight per hour) on the day and following day of the procedure. Serum creatinine, urinary enzymes N-acetyl β glucosaminidase (NAG), γ glutamyl-1-transferase (GGT), alanine amino peptidase (AAP), fractional excretion of sodium (FeNa) and 24-h urinary creatinine clearance were performed before and 48 h after the procedure. The levels of urinary enzymes measured after 96 h of DSRA were available in only 57 donors. Radiocontrast-induced nephropathy was defined as an increase in the baseline serum creatinine of at least 0.5 mg/dl within 48 h after injection of radiocontrast media (RCM). Results: Increase in the urinary enzymes (NAG, GGT and AAP) and reduction in creatinine clearance was observed in both groups after receiving the contrast media. However, the number of patients with significant increase in enzymuria (at least > 50% increase above the baseline value) and mean drop in creatinine clearance was statistically not different between the acetylcysteine and control groups. Conclusion: Renal damage in the form of reduction in creatinine clearance and increase in urinary enzymes has been observed after administration of radiocontrast. However, clinically significant RCM-induced acute kidney injury is uncommon in patients with normal renal function. Prophylactic oral administration of the antioxidant N-acetylcysteine at a dose of 600 mg twice daily before and on the day of contrast administration is probably not required in patients with normal renal function. [ABSTRACT FROM AUTHOR]

Aim: Atherosclerotic renal artery stenosis (ARAS) can cause both renovascular hypertension and progressive renal failure. ARAS is now recognized as one of the commonest causes of chronic kidney disease in the elderly, especially in those with unexplained renal impairment. Diagnosis of ARAS is important because it is a treatable condition and percutaneous interventions are being done increasingly with negligible complications. ARAS is likely to progress if left untreated. We present our experience of Percutaneous transluminal renal angioplasty (PTRA) in 159 patients with ARAS who presented to our centre from 1993 to 2004. Materials and Methods: Between Oct 1993 and Oct 2004, 243 patients with clinical features suggestive of renovascular disease were selected for digital renal angiography at our Institute. Nephrologists performed all the renal angiographies and interventions. We evaluated the outcome of patients undergoing intervention for renovascular disease about, renal function, blood pressure control and antihypertensive medicines requirement. Results: 243 patients underwent 251 angiograms. Renal artery stenosis (RAS) was detected on angiography in 191 patients. RAS was due to Atherosclerotic disease in 159 cases. Successful intervention was done in 130 patients (95.6 %). Intervention in the form of PTRA was done in 64 patients and PTRAS (Stent placement) in 66 patients (Total-130). Mean Age: 56.0 ± 11.8 years, Gender: M:F- 98/32, Mean eGFR: 33.0 ± 27.5 ml/min, Mean follow up:10.6 ± 16.2 months. 64 lesions were unilateral and 66 were bilateral. Blood pressure showed improvement in the form significant reduction post procedure (123.5 ± 19.2 pre to 113.8 ± 12.9 post, P< 0.0001**), as well as reduction in antihypertensive medication requirement (pre 2.2 ± 1.1 to post 1.8 ± 0.9, P = 0.0009**). eGFR did not show any significant improvement. When patients were classified as either improved or stabilized versus deteriorated, 119 patients (91.5%) showed improvement or stabilization of Blood pressure, 103 patients (79.2%) showed either improvement or stabilization of eGFR, and 113 (86.9%) patients showed either stabilization or decrease in the number of medications required for the hypertension control. Conclusion: Renal angioplasty in selected patients reduces the Blood pressure as well as requirement of anti hypertension medications. It helps to slow the progression of renovascular renal failure. [ABSTRACT FROM AUTHOR]

Introduction: Nonatherosclerotic diseases such as Nonspecific Aortoarteritis (NSAA) and Fibro muscular dysplasia (FMD) contribute to the prevalence of Renovascular disease in the younger population. We present our experience of Renovascular intervention, in Non-Atherosclerotic Renal Artery stenosis (N-ARAS). Materials and Methods: Between Oct 1993 and July 2007, forty five patients were diagnosed to have Non-Atherosclerotic renal artery stenosis during the renal angiography performed at our Institute. We evaluated the outcome of these patients who underwent intervention for renovascular disease about, renal function, blood pressure control and antihypertensive medicines requirement. Results: Forty five patients were detected to have Non Atherosclerotic Renal Artery stenosis. NSAA-34, FMD-9, Coarctation of aorta-1, External compression due to pheochromocytoma-1. Mean age of patients: 28.2±14.4 Years, M / F: 22 / 23, Mean follow-up: 18.0±21.8 Months (Minimum-1 Month, Maximum-6 Years). Significant renal artery stenosis was detected in 29 (62.2%), Angioplasty attempted: 29, No Intervention done: 16, Unilateral: 14/29 [48.3%], Bilateral: 15/29 (51.7%), Successful Interventions: 29 (100%), Total Angioplasties: 29, Total Stents put: 16(55.2%).Mean BP showed either stabilization or improvement in 89.6% patients, 75.9% Patients showed either reduction or stabilization in Anti hypertension medication requirement. 86% Patients showed either stabilization or improvement in eGFR. Conclusion: Renal angioplasty in selected patients reduces the blood pressure as well as requirement of anti hypertension medications. It helps to slow the progression of renovascular renal failure. [ABSTRACT FROM AUTHOR]

Introduction: ABO-incompatible kidney transplantation (ABOiKTx) expands the living donor pool. There is limited long-term outcome data from India especially in comparison with ABO-compatible kidney transplantation (ABOcKTx). Here we report outcomes of the first 100 ABOiKTx compared to ABOcKTx from our center., Methods: Between August 2013 and December 2019, 100 consecutive ABOiKTx were compared with 100 ABOcKTx done during the same period.Controls were matched for age, donor characteristics, HLA mismatches, and date of transplantation., Results: Mean (SD) follow up period was 25.9 ± 20.5 and 27.2 ± 20.6 months in ABOi and ABOcKTx respectively. Patient survival at 1 and 5 years post-transplant was 93.3 and 73.5% vs. 95.4 and 93% ( P = 0.03), while graft survival rates were 85 and 60% vs. 93.1 and 83% in ABOi and ABOcKTx respectively ( P = 0.03). The incidence of antibody-mediated rejections was 15% vs. 4%, and that of T-cell-mediated rejections was 10 vs. 12% respectively. Infections, malignancies, and surgical complications were similar. Level of anti ABO titers, HLA mismatches, recipient age, donor age, and presence of diabetes did not impact graft survival amongst ABOiKTx. The predicted survival and incidence of acute rejections and infections in the later 50 ABOiKTx transplants were better than the first 50 ABOiKTx when compared to their respective controls., Conclusion: Outcomes of ABOiKTx were inferior to ABOcKTx but tends to improve as more experience is gained. Incidence of ABMR was higher but infections and surgical complications were comparable. This data provides evidence that ABOiKTx is viable option for those without a ABO compatible donor., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Indian Journal of Nephrology.)