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Background Despite its utility, uncertainty exists on the feasibility of acute peritoneal dialysis (PD) and optimal PD catheter type for very low birth weight (VLBW < 1500 g) and extremely low birth weight (ELBW < 1000 g) infants. We hereby report our experience of acute PD among these high-risk infants and compare the outcome between stylet-based rigid catheter (SRC) and Cook Mac-Loc Multipurpose Drainage catheters® (CMMDC). Methods Case notes of infants < 1500 g undergoing PD between 2012 and 2021 in a network of five participating neonatal units supported by a tertiary paediatric nephrology centre in Kolkata, India, were retrospectively reviewed. PD was conducted either with SRC or after 2018 with CMMDC. Outcome parameters included complications, survival during PD, and survival to discharge. Results 24 infants (VLBW: n = 13 and ELBW: n = 11) underwent PD at median age 4.5 days (IQR 3-6) with either CMMDC (n = 14) or SRC (n = 10). Significant improvement in biochemical parameters and fluid removal was seen in both ELBW and VLBW infants. CMMDC was associated with significantly fewer PD-related complications 7/14 (50%) vs. 9/10 (90%) (p = 0.04) and higher survival during PD 13/14 (93%) vs. 5/10 (50%) (p = 0.02), without significant difference in survival to hospital discharge 8/14 (57%) vs. 3/10 (30%) (p = 0.25). CMMDC also enabled longer duration of PD, higher ultrafiltration, and better control of acidosis. Consumable cost was higher for CMMDC (USD$60) than SRC (USD$14). Conclusions In a low resource setting, CMMDC had lower PD complications and superior short-term survival among ELBW/VLBW infants. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information, Author(s): Rajiv Sinha [sup.1] [sup.2] , Rana Saha [sup.1] [sup.3] [sup.4] , Deblina Dasgupta [sup.1] , Niladri Bose [sup.1] , Shamik Ghosh [sup.5] , Ashok Modi [sup.4] , Bikramjit Das [...]

Background Inherited tubulopathies are a heterogeneous group of genetic disorders making whole-exome sequencing (WES) the preferred diagnostic methodology. Methods This was a multicenter descriptive study wherein children (< 18 years) with clinically suspected tubular disorders were recruited for molecular testing through WES. Multiplex ligation-dependent probe amplification (MLPA) and Sanger sequencing were done when required. Variants were classified as per American College of Medical Genetics 2015 guidelines and pathogenic (P)/likely pathogenic (LP) variants were considered causative. Results There were 77 index cases (male =73%). Median age at diagnosis was 48 months (IQR 18.5 to 108 months). At recruitment, the number of children in each clinical group was as follows: distal renal tubular acidosis (dRTA) = 25; Bartter syndrome = 18; isolated hypophosphatemic rickets (HP) = 6; proximal tubular dysfunction (pTD) = 12; nephrogenic diabetes insipidus (NDI) = 6; kidney stone/nephrocalcinosis (NC) = 6; others = 4. We detected 55 (24 novel) P/LP variants, providing genetic diagnoses in 54 children (70%). The diagnostic yield of WES was highest for NDI (100%), followed by HP (83%; all X-linked HP), Bartter syndrome (78%), pTD (75%), dRTA (64%), and NC (33%). Molecular testing had a definite impact on clinical management in 24 (31%) children. This included revising clinical diagnosis among 14 children (26% of those with a confirmed genetic diagnosis and 18% of the overall cohort), detection of previously unrecognized co-morbidities among 8 children (sensorineural deafness n = 5, hemolytic anemia n = 2, and dental changes n = 1) and facilitating specific medical treatment for 7 children (primary hyperoxaluria n = 1, cystinosis n = 4, tyrosinemia n = 2). Conclusion WES is a powerful tool in the diagnosis and management of children with inherited tubulopathies in the Indian population. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information, Author(s): Rajiv Sinha [sup.1] [sup.2] , Subal Pradhan [sup.3] , Sushmita Banerjee [sup.1] [sup.4] , Afsana Jahan [sup.5] , Shakil Akhtar [sup.1] , Amitava Pahari [sup.2] , Sumantra Raut [sup.6] [...]

Author(s): Niladri Bose [sup.1] , Kaustabh Chaudhuri [sup.2] , Mordi Muorah [sup.3] , Rajiv Sinha [sup.1] [sup.4] Author Affiliations: (1) grid.414710.7, 0000 0004 1801 0469, Institute of Child Health, , [...]

Acute kidney injury (AKI) is a well-known life-threatening systemic effect of snake envenomation which commonly happens secondary to snake bites from families of Viperidae and Elapidae. Enzymatic toxins in snake venom result in injuries to all kidney cell types including glomerular, tubulo-interstitial and kidney vasculature. Pathogenesis of kidney injury due to snake envenomation includes ischaemia secondary to decreased kidney blood flow caused by systemic bleeding and vascular leakage, proteolytic degradation of the glomerular basement membrane by snake venom metalloproteinases (SVMPs), deposition of microthrombi in the kidney microvasculature (thrombotic microangiopathy), direct cytotoxic action of venom, systemic myotoxicity (rhabdomyolysis) and accumulation of large amounts of myoglobin in kidney tubules. Clinical features of AKI include fatigue, loss of appetite, headache, nausea, vomiting, oliguria and anuria. Monitoring of blood pressure, fluid balance, serum creatinine, blood urea nitrogen and serum electrolytes is useful in managing AKI induced by snake envenomation. Early initiation of anti-snake venom and early diagnosis of AKI are always desirable. Biomarkers which will help in early prediction of AKI are being explored, and current studies suggest that urinary clusterin, urinary neutrophil gelatinase-associated lipocalin, and serum cystatin C may play an important clinical role in the future. Apart from fluid and electrolyte management, kidney support including early and prompt initiation of kidney replacement therapy when indicated forms the bedrock in managing snake bite-associated AKI. Long-term follow-up is important because of chances of progression towards CKD., Author(s): Subhankar Sarkar [sup.1] , Rajiv Sinha [sup.1] [sup.2] , Arpita Ray Chaudhury [sup.3] , Kalana Maduwage [sup.4] , Asiri Abeyagunawardena [sup.5] , Niladri Bose [sup.2] , Subal Pradhan [sup.6] [...]

The impact of ecosystem conservation and restoration activities are rarely monitored from a global, multidimensional and multivariable perspective. Here we present an approach to quantify the environmental impact of landscape restoration using long-term and high-resolution satellite observations. For two restoration areas in Tanzania, we can likely attribute an increase in the amount of water retained by the soil (∼0.01 m³ m⁻³, ∼13% average increase), a soil temperature drop (∼-0.5°C) and an increase in surface greenness (∼50% average increase) in 3.5 years. These datasets illuminate the impact of restoration initiatives on the landscape and support the reporting of comprehensive metrics to donors and partners. Satellite observations from commercial providers and space agencies are now achieving the frequency, resolution, and accuracy that can allow for the effective evaluation of restoration activities. [ABSTRACT FROM AUTHOR]