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Pseudoaneurysm is a well-recognized complication seen in arteriovenous fistula (AVF) which usually involves the venous segments. Ultrasound-guided manual compression (UGMC) is a non-invasive and effective treatment for the management of pseudoaneurysms involving the venous segment. Pseudoaneurysm of the arterial segment of AVF is rare complication which usually needs surgical intervention. We report the first successful treatment case of a brachial artery pseudoaneurysm in a brachiobasilic arteriovenous fistula using ultrasound-guided manual compression. The patient presented with a 30 × 30 mm pulsatile swelling below the cubital fossa after second session of hemodialysis using an AVF created 8 weeks earlier. Ultrasound doppler demonstrated a brachial artery pseudoaneurysm in the non-transposed brachiobasilic fistula. Complete occlusion of the cavity with thrombus formation was accomplished after 55 min of compression and the psuedoaneurysm did not recur. UGMC can be an alternative treatment option for select cases of arterial segment pseudoaneurysm in AVF.

BACKGROUND Calcineurin inhibitors (CNIs) are often associated with abnormalities in glucose and lipid metabolism. Tacrolimus is the most potent CNI which is nowadays used almost universally as a part of triple-drug immunosuppression after kidney transplantation. Tacrolimus can cause islet cell damage and decrease in insulin secretion which can lead to post-transplant diabetes mellitus and rarely diabetic ketoacidosis. Although rare, acute pancreatitis has also been implicated by a few case reports to be associated with tacrolimus. However, tacrolimus-induced acute pancreatitis has not been reported in pediatric kidney transplant recipient till date. CASE DESCRIPTION We report the first case of tacrolimus-induced acute pancreatitis in association with hypertriglyceridemia and DKA in a child early after kidney transplant. The patient was managed with supportive treatment, and tacrolimus was stopped for three days and then switched to cyclosporine-based regimen. The patient became euglycemic within 8 weeks of switching to cyclosporine and did not have any recurrence of pancreatitis. CONCLUSION Tacrolimus-induced pancreatitis is rare in the setting of kidney transplants and prompt diagnosis and management can lead to a successful outcome.

Background Preeclampsia is an important cause of pregnancy-related acute kidney injury (AKI). The objective of our study was to determine the incidence, characteristics, and maternal and neonatal outcomes of AKI in pregnant women with preeclampsia. Materials and methods A prospective, observational, single-center study from January 2019 to January 2020. Patients admitted with preeclampsia were included. Patients with obstetric complications were excluded. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria. Results Total number of patients with preeclampsia was 104, out of which 25% developed AKI. Among those with AKI, nulliparity (61.5%) was the most common risk factor for preeclampsia followed by prior history of preeclampsia (15.4%), pregestational hypertension (11.5%), pregestational diabetes mellitus (3.8%), and chronic kidney disease (3.8%). There was no significant difference in maternal mortality between those with AKI (15.4%) and without AKI (7.7%). Intermittent hemodialysis was needed in 15.4%. At the end of 90 days follow-up, complete recovery of renal function occurred in 53.8%, partial recovery in 23.1% and end-stage kidney disease (ESKD) in 7.7%. Perinatal death occurred in 26.9%, preterm birth in 23.1% and stillbirth in 7.7% of those with AKI and was not significantly different from those without AKI. The mean of birth weight in newborns delivered by patients with AKI (2.53 ± 0.73 kg) was significantly lower compared to those without AKI (2.82 ± 0.58 kg). Conclusion AKI was associated with a lower mean birth weight of newborns. Complete recovery of renal function was seen in 53.8% of patients with AKI and preeclampsia.

Background and Aims SLE patients have 40% to 70% life time risk of developing lupus nephritis (LN). In LN patients rate of end-stage renal disease is 10%, remaining constant in the last 30 years, even after the emergence of various immunosuppressive therapy. SLE is an example of classical antibody-mediated disease and hence treatment with B cell depleting agent (like the use of Rituximab ) appears to be a promising approach for this unwinnable disease from the Roman era. The aim of this study was to analyze the outcome in terms of - no renal response (NRR), complete renal response (CRR) or partial renal response (PRR) at week 24 after rituximab treatment initiation in refractory LN. CRR considered, if serum creatinine (S Cr) level returned to baseline, with a decline in the 24 hour urinary protein to < 500 mg/day. PRR defined as stabilization (+/-25%), or improvement of S Cr, plus a 50% decrease in 24 hour urinary protein (which was < 3.5 gm/day). NRR considered, if participant did not achieve either a CRR or PRR. Method It is a single center prospective observational study, comparing short term (24 week) outcomes in resistant lupus nephritis patients of >18 year age group with weekly (total 4) dose of rituximab therapy. The study was conducted on 25 refractory lupus nephritis patients admitted in Nephrology Department (not responding to conventional immunosuppressive drugs like cyclophosphamide, MMF). Repeat renal biopsy was performed, all baseline investigations were done. Injection Rituximab 375 mg/m2 weekly 0,1,2,3 week along with premedication treatment were given to every patient. The clinical outcome was assessed monthly post-treatment. Results In the study maximum patients were of class IV, n=21 (84 %). Sustained (6 months post treatment) CRR was achieved in n=6 (24%) patients, n=7 (28%) patients achieved PRR, rest n=12 (48%) patients had NRR. Mean blood absolute CD-19 count was significantly negatively correlated with response to rituximab treatment ( p< 0.001) .Mean absolute CD-19 count was 2.33/microliter in CRR, 2.14/microliter in PRR group and 21.25 / microliter in NRR group . No significant side effects of rituximab were observed. Limitations –Small sample size, single center study, long term follow up not considered. Conclusion In refractory LN patients, 24 weeks after Rituximab treatment

Background and Aims End-stage renal diseases (ESRD) that are referred late to dialysis usually need hemodialysis via central vein catheter (CVC). Urgent start peritoneal dialysis (PD) can be used in these patients to avoid need of CVC. Catheter patency and other complications related to urgent-start PD have not been thoroughly clarified. We evaluated the clinical outcomes of urgent-start PD in a North-Indian cohort. Method In this retrospective study, we enrolled ESRD patients who were started on urgent-start PD (starting PD within 14 days after catheter insertion) in our center from January 1, 2008 to December 31, 2017, and followed them up to 10 years. Catheter failure was primary outcome of study while as secondary outcomes included short-term and long-term complications related to urgent-start PD. Results In this study882 patients (60.3% male, mean age 47.28 ± 14.1years) were enrolled. There were few peri-operative complications with significant hemorrhage seen in 2 patients. Early peritonitis occurred in 8 (0.9%) patients. Within the first month of catheter insertion, abdominal wall complications (hernia, hydrothorax, hydrocele, and leakage) occurred in 24 (2.7%) patients while as functional catheter malfunction developed in 36 (4.1%) patients. On follow-up of the patients (median 35.7 months), 32 (3.6%) patients experienced catheter failure, and 141 (15.9%) had death-censoring technique failure. Catheter patency rate at the end of 1-month, 1 -year, 3-year, and 5-year, was 98.2, 94.9, 93.1,92.4%; and technique survival rate was 99.2, 96.9, 90.2, 82.8%, respectively. Every 5-year increase in age was associated with 17% decrease of risk for catheter failure (hazard ratio [HR]: 0.83, 95%confidence interval [CI]: 0.73–0.89). Risk factors for abdominal wall complications included male sex (HR: 1.45, 95% CI: 1.03–2.1), low hemoglobin levels (HR: 0.88, 95% CI: 0.79–0.98) and diabetic nephropathy (HR: 1.65, 95% CI:1.13–2.35). Conclusion Urgent-start PD is a safe option for ESRD who need urgent dialysis to avoid CVC insertion for HD. For a successful urgent start PD programs, a well-trained PD team, catheter insertion procedure by experienced personnel, and a well-designed PD prescription and a good follow-up care is needed.

Background and Aims Acute kidney injury (AKI) is rare in women during pregnancy and puerperium. Although sepsis remains the predominant cause of AKI in pregnancy in developing countries, pre-eclampsia and eclampsia are important causes and can be life threatening. The primary focus of this study was to analyze the clinical profile as well as maternal and fetal outcomes of AKI in pregnant females with pre-eclampsia and eclampsia. Method A prospective study of patients admitted with pre-eclampsia or eclampsia and AKI in Gauhati Medical College Hospital from June 2018 to June 2019. Clinical profiles and outcome data were recorded. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results A total of 26 cases were recorded. The mean maternal age at delivery was 27.5 ± 5.1 years. At least one recorded preexisting medical condition, including hypertension, diabetes mellitus, or chronic kidney disease was present in 5 cases (19.2%). Cesarean section was performed in 9 cases (34.6%). Eighteen patients (69.2%) developed AKI in third trimester and 6 (23.1%) within 12 weeks postpartum. Four patients (15.4%) were treated with dialysis. Four women (15.4%) died and 2 (7.7%) remained dialysis dependent 12 weeks after delivery. Low birth weight ( Conclusion AKI in pregnancies with pre-eclampsia or eclampsia can not only lead to maternal mortality and morbidity but also poor perinatal outcomes. Preeclampsia or eclampsia presenting with AKI early during gestation had worse fetal outcomes.