10 results on '"Rathi, Manish"'
Search Results
2. Mycophenolate or cyclophosphamide in lupus nephritis: Which one to use in Indian patients?
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Rathi, Manish and Sharma, Aman
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TREATMENT of chronic kidney failure , *AMENORRHEA , *DIARRHEA , *IMMUNOSUPPRESSION , *STEROIDS , *SYSTEMIC lupus erythematosus , *LUPUS nephritis , *TREATMENT effectiveness , *CYCLOPHOSPHAMIDE , *DISEASE progression , *METHYLPREDNISOLONE , *MYCOPHENOLIC acid , *DRUG administration , *DRUG dosage , *THERAPEUTICS - Published
- 2018
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3. Tacrolimus therapy in adult-onset steroid-resistant nephrotic syndrome due to a focal segmental glomerulosclerosis single-center experience.
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Ramachandran, Raja, Kumar, Vivek, Rathi, Manish, Nada, Ritambhra, Jha, Vivekanand, Gupta, Krishan Lal, Sakhuja, Vinay, and Kohli, Harbir Singh
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TACROLIMUS , *STEROIDS , *NEPHROTIC syndrome , *GLOMERULOSCLEROSIS , *NEPHROTOXICOLOGY , *HYPERGLYCEMIA , *DIABETES , *THERAPEUTICS - Abstract
Introduction Management of adults with steroid-resistant (SR) nephrotic syndrome due to focal segmental glomerulosclerosis (FSGS) is a challenging task. Is tacrolimus (TAC) effective in this situation without serious adverse effects? This prospective study was done to answer this question. Materials and methods In patients with SR nephrotic syndrome due to FSGS, oral TAC (0.1 mg/kg/day) was started targeting a trough level of 5–10 ng/mL along with oral prednisolone (0.15 mg/kg/day) for 48 weeks. In patients with complete remission (CR), TAC dose was reduced to a target of 3–6 ng/mL whereas in partial responders, TAC trough levels were kept at 5–10 ng/mL. TAC was discontinued in those with no remission at 24 weeks and was deemed TAC resistant. Outcome, namely CR and partial remission (PR), was assessed at the end of 24 and 48 weeks. All patients were prospectively followed for 60 weeks. Relapses after CR or PR were recorded; adverse effects, namely nephrotoxicity (>25% rise in creatinine), cosmetic effects, infections and hyperglycemia, were recorded every month. Results A total of 44 SR-FSGS [not otherwise specified 33 (75%), tip lesion 03 (6.8%) and cellular variant 8 (18.1%)] were analyzed. Mean age was 25.16 ± 8.26 (18–51) years. Of 44 patients, CR and PR were achieved in 17 (38.6%) and 06 (13.6%) patients, respectively. TAC resistance was seen in 21 (47.7%) patients. Time taken to achieve remission was 15.2 ± 6 weeks. Five (21.7%) patients with CR had relapse on tapering the dose and seven (30.4%) after stopping TAC. Reversible nephrotoxicity was seen in seven (15.9%) and irreversible in four patients (9%). TAC-related diarrhea was the problem in 10 (22.7%), and infections were seen in 19 patients (43.1%). Impaired fasting glucose and diabetes mellitus were seen in 10 patients (22.7%). Conclusion TAC is an effective agent in the management of SR-FSGS. However, strict renal function and blood sugar monitoring is required due to its potential nephrotoxicity and diabetogenic potential. [ABSTRACT FROM AUTHOR]
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- 2014
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4. Anti-Nuclear Antibody-Negative Lupus Nephritis or Post-Infectious Glomerulonephritis: Diagnostic Dilemma in a Young Male.
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Bharati, Joyita, Quaiser, Saif, Nada, Ritambhra, Ramachandran, Raja, Kohli, Harbir Singh, and Rathi, Manish
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SYSTEMIC lupus erythematosus diagnosis , *STEROID drugs , *AUTOANTIBODIES , *PHYSICAL diagnosis , *PROTEINS , *LUPUS nephritis , *FEVER , *HEMOGLOBINS , *COMPLEMENT (Immunology) , *BIOPSY , *INFLAMMATION , *ORAL drug administration , *DIFFERENTIAL diagnosis , *MYCOPHENOLIC acid , *SERUM albumin , *ELECTRON microscopy , *LEUKOCYTE count , *PLATELET count , *FLUORESCENT antibody technique , *ENZYME-linked immunosorbent assay , *GLOMERULONEPHRITIS , *SYSTEMIC lupus erythematosus , *BLOOD cell count , *POST-infectious disorders , *CREATININE , *THERAPEUTICS - Abstract
Proliferative lupus nephritis (LN) is histologically characterized by endocapillary hypercelMarity and large immune deposits on light microscopy. Immunofluorescence shows almost all immunoglobulins and complement staining. The presence of antinuclear antibodies (ANA) is important for diagnosing systemic lupus erythematosus (SLE). Absence of ANA rules out the possibility of SLE according to the 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for SLE. We report a young boy with fever, nephrotic-nephritic syndrome and pancytopenia consistent with hemophagocytic lymphohistiocytosis. Renal biopsy was consistent with LN; however, his initial ANA was negative. In view of pathological features of LN and persistent pancytopenia, high dose steroid therapy was started. Repeat ANA, done during the illness, turned positive. In this report, we describe the relevance of pathological patterns and the uncertainties of ANA positivity in making a diagnosis of SLE. [ABSTRACT FROM AUTHOR]
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- 2021
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5. Complete Remission of Lupus Nephritis Following Chemoradiotherapy of Carcinoma Cervix: An Association.
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Girimaji, Niveditha, Nada, Ritambhra, Sharma, Aman, Bharati, Joyita, and Rathi, Manish
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LUPUS nephritis , *BIOPSY , *STEROIDS , *MYCOPHENOLIC acid , *CHEMORADIOTHERAPY , *CISPLATIN , *SYSTEMIC lupus erythematosus , *IMMUNOSUPPRESSIVE agents , *DISEASE remission , *DISEASE complications , *THERAPEUTICS ,CERVIX uteri tumors - Abstract
Systemic lupus erythematosus (SLE) is associated with a higher incidence of solid organ malignancies, including cervical carcinoma, creating a paradox in their management in the context of autoimmunity. We present a case of 45-year-old female presented with mucocutaneous, musculoskeletal symptoms of SLE. Renal biopsy showed class IV lupus nephritis (LN); modified NIH activity score: 8/24, chronicity score: 6/12. Post NIH regimen induction, she achieved partial remission; further developed proteinuric relapse which was re-induced with mycophenolate mofetil (MMF) to which she failed to respond. Subsequently diagnosed with carcinoma cervix stage IIB, she received four cycles of concurrent cisplatin-based chemoradiotherapy. MMF was stopped; low dose steroids continued. Following this, the patient achieved complete remission (CR) of LN and is in remission for 5 years. This is an unexpected association between chemoradiotherapy of cervical carcinoma and CR of class IV LN, allowing long-term discontinuation of immunosuppression. [ABSTRACT FROM AUTHOR]
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- 2021
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6. Establishing Surrogate Kidney End Points for Lupus Nephritis Clinical Trials: Development and Validation of a Novel Approach to Predict Future Kidney Outcomes.
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Mackay, Meggan, Dall'Era, Maria, Fishbein, Joanna, Kalunian, Kenneth, Lesser, Martin, Sanchez‐Guerrero, Jorge, Levy, Deborah M., Silverman, Earl, Petri, Michelle, Arriens, Cristina, Lewis, Edmund J., Korbet, Stephen M., Conti, Fabrizio, Tesar, Vladimir, Hruskova, Zdenka, Borba, Eduardo F., Bonfa, Eloisa, Chan, Tak Mao, Rathi, Manish, and Gupta, K. L.
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LUPUS nephritis , *ACUTE kidney failure , *BIOMARKERS , *CHRONIC kidney failure , *CLINICAL trials , *CREATININE , *DATABASES , *MEDICAL information storage & retrieval systems , *KIDNEY diseases , *LONGITUDINAL method , *PROTEINURIA , *RACE , *RISK assessment , *THERAPEUTICS , *PROPORTIONAL hazards models , *SEVERITY of illness index , *DISEASE progression , *DIAGNOSIS - Abstract
Objective: End points currently used in lupus nephritis (LN) clinical trials lack uniformity and questionably reflect long‐term kidney survival. This study was undertaken to identify short‐term end points that predict long‐term kidney outcomes for use in clinical trials. Methods: A database of 944 patients with LN was assembled from 3 clinical trials and 12 longitudinal cohorts. Variables from the first 12 months of treatment after diagnosis of active LN (prediction period) were assessed as potential predictors of long‐term outcomes in a 36‐month follow‐up period. The long‐term outcomes examined were new or progressive chronic kidney disease (CKD), severe kidney injury (SKI), and the need for permanent renal replacement therapy (RRT). To predict the risk for each outcome, hazard index tools (HITs) were derived using multivariable analysis with Cox proportional hazards regression. Results: Among 550 eligible subjects, 54 CKD, 55 SKI, and 22 RRT events occurred. Variables in the final CKD HIT were prediction‐period CKD status, 12‐month proteinuria, and 12‐month serum creatinine level. The SKI HIT variables included prediction‐period CKD status, International Society of Nephrology (ISN)/Renal Pathology Society (RPS) class, 12‐month proteinuria, 12‐month serum creatinine level, race, and an interaction between ISN/RPS class and 12‐month proteinuria. The RRT HIT included age at diagnosis, 12‐month proteinuria, and 12‐month serum creatinine level. Each HIT validated well internally (c‐indices 0.84–0.92) and in an independent LN cohort (c‐indices 0.89–0.92). Conclusion: HITs, derived from short‐term kidney responses to treatment, correlate with long‐term kidney outcomes, and now must be validated as surrogate end points for LN clinical trials. [ABSTRACT FROM AUTHOR]
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- 2019
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7. A prospective study of collapsing focal segmental glomerulosclerosis.
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Raja, Ramachandran, Nada, Ritambhra, Yadav, Ashok K., Kumar, Ashwani, Goyal, Ajay, Kumar, Vivek, Rathi, Manish, Kohli, H. S., Gupta, K. L., Sakhuja, Vinay, and Jha, Vivekanand
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CHRONIC kidney failure , *TREATMENT of chronic kidney failure , *GLOMERULOSCLEROSIS , *TACROLIMUS , *CREATININE , *PATIENTS , *PROGNOSIS , *THERAPEUTICS - Abstract
Collapsing focal segmental glomerulosclerosis (cFSGS) is characterized by rapid progression to end-stage renal disease (ESRD). We evaluated the clinicopathological spectrum of cFSGS and compared its clinical behavior to steroid and tacrolimus (TAC)-resistant noncollapsing focal segmental glomerulosclerosis (FSGS). All patients (>14 years) diagnosed with cFSGS were enrolled in the study. Staining for differentiated podocyte markers such as WT 1, PAX and KI67 were performed in all patients. The outcome and histological features of cFSGS was compared with a prospectively followed cohort of steroid and TAC-resistant noncollapsing FSGS. The study included 22 cFSGS patients and 19 cases of steroid and TAC-resistant FSGS. Complete remission, partial remission, steroid resistance, progression to ESRD and death were observed in 13.6%, 4.5%, 27.3%, 36.4% and 18.2% patients, respectively. Patients with cFSGS had higher serum creatinine and more advanced tubulointerstitial changes compared to resistant FSGS. Twenty-six percent of therapy resistant noncollapsing FSGS progressed to ESRD after two years of stopping TAC. However, there was no difference in progression to ESRD between cFSGS and therapy-resistant noncollapsing FSGS at the end of two years. Glomerular collapse in the setting of FSGS is poorly responsive to treatment and has a high rate of progression to ESRD. The long-term prognosis of cFSGS and steroid and TAC-resistant FSGS are similar. [ABSTRACT FROM PUBLISHER]
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- 2016
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8. A Rare Case Report of Emphysematous Cyst Infection in Autosomal Dominant Polycystic Kidney Disease.
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Sethi, Jasmine, Ramachandran, Raja, Kumar, Vivek, Rathi, Manish, Kohli, Harbir S., and Gupta, Krishan L.
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COMPUTED tomography , *CREATININE , *CYSTS (Pathology) , *ESCHERICHIA coli , *EXUDATES & transudates , *OUTPATIENT services in hospitals , *INTRAVENOUS therapy , *KIDNEYS , *LEUCOCYTE disorders , *PAIN , *POLYCYSTIC kidney disease , *URINALYSIS , *FAMILY history (Medicine) , *RESPIRATORY aspiration , *AMPICILLIN , *LEUKOCYTE count , *MEDICAL drainage , *DISEASE complications , *THERAPEUTICS ,ULTRASONIC imaging of the abdomen - Published
- 2019
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9. Acute Kidney Injury Due to Acute Cortical Necrosis Following a Single Wasp Sting.
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Kumar, Vivek, Nada, Ritambhra, Kumar, Sravan, Ramachandran, Raja, Rathi, Manish, Kohli, Harbir S., Sakhuja, Vinay, and Jha, Vivekanand
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KIDNEY injuries , *WASP stings , *ETIOLOGY of diseases , *NEPHROTOXICOLOGY , *DRUG toxicity , *THROMBOTIC thrombocytopenic purpura , *THERAPEUTICS ,KIDNEY necrosis - Abstract
Acute kidney injury (AKI) can develop after multiple wasp or bee stings. The etiology is the acute tubular necrosis secondary to shock, pigment toxicity, interstitial nephritis, or direct nephrotoxicity of venom. We report a 40-year-old female who presented with oliguric AKI after a single wasp sting on her hand. Her history, examination, and investigations did not support any of the established causes of AKI in such settings. She did not improve with supportive management and dialysis, and kidney biopsy showed acute cortical necrosis (ACN). This is the first report of ACN after a single wasp sting. [ABSTRACT FROM AUTHOR]
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- 2013
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10. <italic>Nocardia</italic> pyomyositis in a patient with granulomatosis with polyangiitis.
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Sagar, Vinay, Pinto, Benzeeta, Lal, Anupam, Kumar, Mukesh, Rathi, Manish, Sharma, Kusum, Ray, Pallab, and Sharma, Aman
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WEGENER'S granulomatosis , *SINUSITIS , *PREDNISOLONE , *AZATHIOPRINE , *HEMATURIA , *THERAPEUTICS - Abstract
The article presents a case study of a 63-year old man with granulomatosis with polyangiitis (GPA) who had been diagnosed with GPA 3.5 years ago when he suffered from sinusitis, nasal crusting, microscopic hematuria and renal dysfunction. He was put on prednisolone and azathioprine. The article discusses Pyomyositis, a purulent disease and its various risk factors.
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- 2017
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