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Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired, potentially life-threatening disease of blood, characterized by complement-induced intravascular hemolytic anemia and thrombosis. PNH can sometimes present directly with renal manifestations, without showing any hematological manifestation. It, therefore, becomes essential for clinicians and pathologists to be aware of the spectrum of renal changes in PNH. The aim of this study was to document the morphologic changes observed in renal biopsies in patients with PNH. This is an observational study. We report three cases that presented with acute or chronic renal insufficiency and were suspected as PNH on viewing their renal biopsy in light of their clinical and laboratory details. All the three cases were confirmed as PNH on the basis of flow cytometric analysis of CD55 and CD59. Renal biopsy in these patients showed a variety of morphologic changes, however the most consistent finding was moderate-to-heavy siderosis in their kidneys. PNH per se may be difficult to diagnose clinically and sometimes present directly with renal manifestations. It is, therefore, prudent for nephrologists and nephropathologists to be aware of the spectrum of renal changes in PNH. [ABSTRACT FROM AUTHOR]

Peritonitis in a continuous ambulatory peritoneal dialysis patient by two different species of enterococci is a rare condition. We report a case of peritonitis from which vancomycin sensitive Enterococcus faecalis and vancomycin resistant Enterococcus faecium were isolated. It also emphasizes the effectiveness of linezolid for the treatment of vancomycin resistant enterococcal infection. [ABSTRACT FROM AUTHOR]

Aims: Nepal cannot afford renal replacement therapy (RRT) for ESRD due to lack of resources. Early diagnosis of CKD and its risk factors may reduce the need of RRT. Materials and Methods: In this first community-based screening program in Nepal, 3218 people iÝ 20 years were assessed by door-to-door survey in Dharan. Health status, lifestyle habit, physical examination and blood pressure were evaluated. Spot urine was examined for proteins and glucose by dipstick. Fasting blood glucose and serum creatinine were measured in a subset of 1000 people and the prevalence of CKD was evaluated. A cardiovascular risk factor score was also determined. Results: Overweight, obesity, hypertension, diabetes and proteinuria were found in 20%, 5.0%, 38.6%, 7.5%, and 5.1% respectively. 47% hypertensives were newly detected during the screening. In the subset of 1000 subjects, CKD was detected in 10.6%. Multivariate logistic regression analysis showed that age (P <0.0001) and presence of diabetes (P = 0.027) were statistically significant predictors for CKD. Two or more cardiovascular risk factors were present in 47.3%. 848 patients entered the management phase of the program with lifestyle modification and pharmacologic intervention. 15% drop out during follow-up. Five patients died (2 on RRT). Glycemic (fasting glucose < 120 mg/dL) and blood pressure control (< 140/90 mmHg) was achieved in 60% and 72%, respectively. Regression or stabilization of proteinuria was reported in 52% of patients. Conclusion: Burden of CKD and cardiovascular risk factors are high at community level in Dharan. Reasonable control of blood sugar, hypertension and proteinuria was achieved in this program. These findings indicate the need of activating a large prevention and intervention program to tackle CKD and CVD in Nepal. [ABSTRACT FROM AUTHOR]

Aims: Access to hemodialysis (HD) is limited in Nepal due to geographical terrain and hemodialysis centers being mostly limited to capital city of the country. Therefore, CAPD is likely to be a better option of dialysis in Nepal. In 1998, continuous ambulatory peritoneal dialysis (CAPD) was initiated in Nepal without success. High rate of peritonitis was cited for failure. Hot tropical climate of Nepal along with poor sense of hygiene among patients is thought to be responsible for the high rate of peritonitis. A new CPD program was started in 2002 in our institute. As only center for dialysis in eastern Nepal, the institute serves to around 25% of the population of Nepal. We reviewed the incidence of peritonitis and factors predisposing to peritonitis. Materials and Methods: A total of 30 patients who were initiated on chronic peritoneal dialysis since 2002 to 2005 were included in the study. Two CAPD nursed follow-up this patients and were responsible for the data recording along with resident doctor in dialysis unit. Peritonitis was diagnosed if patient reported cloudy effluent and/or pain abdomen and had dialysate white cell count > 100/mL of which 50% or more were polymorphonuclear leukocytes. All patients were on prophylactic mupirocine ointment. Patients complicated with peritonitis (N = 8) and patients without peritonitis (N=22) were compared. Results: Most patients were male (N=26). Mean duration of dialysis was 12 month per patients (Total patients month= 362). Nine episodes of peritonitis in eight patients were recorded during this period. Six episode of peritonitis were culture positive (staphylocoocus aureous-2, Psedornonous aurigonosae-1, other gram negative organism-2, fungal-1). Culture sterile peritonitis was recorded in 3 episodes (patients). Two patients in each group were shifted to hemodialysis therapy. End stage related due to diabetes mellitus and low serum albumin were predisposing factors for development of peritonitis. Conclusion: Peritonitis is not a limiting factor for growth of CAPD in Nepal. Low serum albumin and diabetes patients are prone for CAPD related peritonitis. [ABSTRACT FROM AUTHOR]

Background: Patients with cirrhosis are susceptible to development of acute kidney injury (AKI), which leads to poor outcome. We conducted a study to evaluate the spectrum of AKI in patients with cirrhosis., Materials and Methods: This study was conducted in consecutive cirrhotic patients with AKI admitted in a tertiary care center of India from April 2020 to December 2022. Details including history, examination findings, and results of laboratory investigations were recorded., Results: A total of 243 patients were enrolled in this study. The majority (91.3%) of the patients were males. The most common etiology of cirrhosis was alcohol in 58.4% ( n = 142) followed by hepatitis B in 10.3% ( n = 25) of patients. Pre-renal form of AKI was present in 54.4% ( n = 132) of patients and hepatorenal syndrome (HRS) in 21.8% ( n = 53) of patients. IgA nephropathy was the commonest ( n = 6) glomerular pathology in nonresponders with intrinsic renal disease. Majority of the patients belonged to stage II (46.9%) and stage I AKI (37%), while only 16.1% had stage III AKI. Various stages of AKI showed a significant correlation ( P < 0.05) with Child-Turcotte-Pugh (CTP) score and Model for End-stage Liver Disease (MELD)-Na score. The overall in-hospital mortality rate was found to be 18.5% ( n = 45)., Conclusion: Renal dysfunction is a frequent complication among cirrhotic patients. Pre-renal factors were the most common cause of AKI in cirrhotics. Stages of AKI showed significant correlation with liver prognostic scores. Renal biopsy should be considered in patients not responding to treatment, to guide further management., Competing Interests: There are no conflicts of interest., (© 2024 Indian Journal of Nephrology | Published by Scientific Scholar.)

Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

Background and Aim: Primary glomerular disease accounts for one-sixth of all chronic kidney diseases (CKDs) in India. We remain limited in our ability to effectively treat these conditions because of lack of understanding of the disease mechanisms and lack of predictors to identify the clinical course and therapeutic responsiveness. We propose to develop a network of investigators in glomerular diseases, collect information in a systematic fashion to understand the clinical outcomes, answer translational research questions better, and identify and recruit patients for clinical trials., Materials and Methods: This is a prospective, observational study. The Indian TrANslational GlomerulonephrItis BioLogy nEtwork (I-TANGIBLE) cohort will enroll patients (>18 years) with biopsy-proven minimal change disease (MCD), focal segmental glomerulonephritis (FSGS), membranous nephropathy (MN), IgA nephropathy (IgAN), or membranoproliferative glomerulonephritis (MPGN) (immune complex- and complement-mediated), with first biopsy taken within 2 years of enrollment. Patients with estimated glomerular filtration (eGFR) rate <15 ml/min/1.73 m 2 for >3 months at the time of screening, kidney transplant or bone marrow transplant recipients, patients with active malignancy, and patients with active hepatitis B/C replication or human immunodeficiency virus (HIV)-I/II will be excluded. Clinical details including history, medication history and details, and family history will be obtained. Consenting patient's blood and urine samples will be collected and stored, aligned to their clinical follow-up., Expected Outcomes: The network will allow accurate ascertainment of disease burden of glomerular diseases across study sites, establishment of the treatment pattern of common glomerular diseases, investigation of medium- and long-term outcomes (remission, relapse, rate of eGFR decline), and building a suitable infrastructure to carry out clinical trials in primary glomerular disease., Competing Interests: Dr. Vivekanand Jha has received grant funding from GSK, Baxter, Astra Zeneca, Boerhringer Ingelheim, NephroPlus, and Zydus Cadilla, under the policy of all honoraria being paid to the organization. All the other authors do not have any conflict of interest to declare., (Copyright: © 2023 Indian Journal of Nephrology.)

Introduction: The spectrum of renal disorder in the elderly differs from the younger population. There is a paucity of literature regarding kidney biopsy in elderly. This study aims to highlight the clinical profile and histopathological spectrum of the elderly patient undergoing a renal biopsy., Materials and Methods: This retrospective study included all patients (age ≥60 years) undergoing native renal biopsies from January 2012 to December 2017. The clinical profile, laboratory parameters, and renal biopsy findings of these patients were recorded from the case files., Results: Out of 1656 renal biopsies performed during the study period, 230 (13.9%%) performed on the elderly were included. Mean age was 64.02 ± 7.87 years (Range: 60-87 years), and males were predominant (70.4%). The commonest indication for biopsy was nephrotic syndrome (NS) (49.6%) followed by Rapidly progressive renal failure (RPRF) (20.9%) and Acute Kidney Injury (AKI) (15.7%). The most frequent histological diagnosis was membranous nephropathy (15.2%) followed by amyloidosis (13.9%) and Focal Segmental Glomerulosclerosis (FSGS) (13.0%). The commonest cause of NS was MGN (29.8%) followed by FSGS (24.6%) and amyloidosis (22.8%). The commonest cause of nephritic syndrome was Diffuse Proliferative Glomerulonephritis (29.4%) and Membranoproliferative Glomerulonephritis (29.4%). Hypertensive nephrosclerosis (40.0%) and diabetic nephropathy (26.7%)) were the commonest histological diagnosis in the patients who underwent renal biopsy for clinical Chronic kidney disease. Crescentic GN (35.4%) and Myeloma cast nephropathy 14.6%) were the commonest cause of RPRF while Acute Tubular Necrosis (41.7%) was the commonest cause of AKI. None of the patients had major complications., Conclusion: Renal biopsy is safe in the elderly and provides a wealth of information with regards to the diagnosis and prognosis of renal disorder., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Nephrology.)

Competing Interests: There are no conflicts of interest.