Introduction: Scores are available to predict the probability of contrast-induced nephropathy (CIN) after cardiac interventions, but not many scores are available for non-cardiac interventions and there are none for intravenous exposure... more
Introduction: Scores are available to predict the probability of contrast-induced nephropathy (CIN) after cardiac interventions, but not many scores are available for non-cardiac interventions and there are none for intravenous exposure to contrast. We designed this study to develop a simplified score to determine the probability of developing CIN in patients exposed to the parenteral contrast medium. Methods: This was a prospective study of patients who received parenteral contrast. Of 1300 patients, the first 1000 comprised the derivation cohort and the next 300 comprised the validation cohort. The patient variables in the development cohort were studied using univariate analysis. Statistically significant individual variables were used as independent variables, and CIN was used as the dependent variable in the final multivariate logistic regression model. Then, the risk score was obtained and validated. Results: The incidence of CIN was 3.8%. The risk factors, namely the presence...
Research Interests: Endocrinology, Mathematics, Computer Science, Artificial Intelligence, Statistics, and 13 moreMultivariate Statistics, Medicine, Logistic Regression, Internal Medicine, Diabetes mellitus, Disease, Cohort Study, Cohort, Nephropathy, Univariate Analysis, Contrast-induced Nephropathy, Prospective Cohort Study, and Medical and Health Sciences
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It is essential to determine the optimum protein intake in renal transplant recipients on steroids with renal dysfunction to maintain a neutral nitrogen balance. Our aim was to study the effect of higher (1.2 g/kg/day) and lower (0.8... more
It is essential to determine the optimum protein intake in renal transplant recipients on steroids with renal dysfunction to maintain a neutral nitrogen balance. Our aim was to study the effect of higher (1.2 g/kg/day) and lower (0.8 g/kg/day) protein intakes on nitrogen balance, body composition, glomerular filtration rate (GFR), and proteinuria in renal transplant recipients with low estimated GFR (eGFR) (15–44 mL/min/1.73 m2). This prospective, open-labeled, randomized, cross-over, interventional study enrolled patients who were ≥4 months posttransplant with eGFR between 15 and 44 mL/min/1.73 m2. Subjects were randomized to either Group 1 [Diet: proteins (1.2 g/kg/day), 35 kcal/kg/day] or Group 2 [Diet: proteins (0.8 g/kg/day) and 35 kcal/kg/day] for one month. Subjects crossed over to the other diet for 2nd month. Body composition analysis, serum creatinine, blood urea nitrogen, serum protein, serum albumin, 24-h proteinuria, GFR measurement (24 h creatinine clearance), three-da...
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Despite the availability of multiple therapies for chronic kidney disease (CKD), there still exists an unmet need for better options to slow down disease progression and prevent complications. The Dapagliflozin and Prevention of Adverse... more
Despite the availability of multiple therapies for chronic kidney disease (CKD), there still exists an unmet need for better options to slow down disease progression and prevent complications. The Dapagliflozin and Prevention of Adverse Outcomes in CKD (DAPA-CKD) trial, which demonstrated the renoprotective effects of the sodium-glucose cotransporter-2 inhibitor (SGLT2i) dapagliflozin, independent of diabetes, with improved survival, even in patients with CKD with estimated glomerular filtration rate (eGFR) as low as 25 mL/min/1.73 m2 , has highlighted the potential beneficial role of SGLT2i in patients with CKD. These benefits were also achieved in patients who were already receiving optimal therapies for slowing the progression of CKD. The potential candidature of SGLT2i for CKD therapy is now being widely discussed in the nephrology community. Therefore, a consensus meeting was held in September 2020 with a group of expert nephrologists from India, to discuss the need to improve ...
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Aim: Tacrolimus has proven efficacy as an immunosuppressive therapy to prevent transplant rejection and is widely used as an immediate-release formulation in a twice-daily regimen. Once-daily prolonged-release tacrolimus aims to improve... more
Aim: Tacrolimus has proven efficacy as an immunosuppressive therapy to prevent transplant rejection and is widely used as an immediate-release formulation in a twice-daily regimen. Once-daily prolonged-release tacrolimus aims to improve the outcomes by reducing variability in exposure and improving adherence. However, there are limited published data available on prolonged-release tacrolimus in routine clinical practice in India. Methods: This was a Phase IV, multicenter, prospective study of prolonged-release tacrolimus conducted over 12 weeks in adult patients eligible for de novo kidney or liver transplantation in India. Primary efficacy end-point was the event rate of biopsy-confirmed acute rejections (BCARs). Secondary end-points included corticosteroid-resistant rejection incidence, time to first BCAR, graft loss, and death. Safety end-points included renal function, lipid profile, incidence of new-onset diabetes mellitus after transplantation (NODAT), and infection. Results: The study enrolled 92 patients undergoing kidney (81 [88.0%]) or liver transplantation (11 [12.0%]); a total of 76 patients (82.6%) completed the study. Ten kidney transplant patients (overall 10.9%) experienced BCAR. There were seven corticosteroid-sensitive and three corticosteroid-resistant rejections. Median (range) time to kidney transplant rejection was 6.5 (1.0–76.0) days. Renal function was stable or improved. Lipid levels showed a significant increase. Eleven instances of NODAT and seven infections occurred and there were eight deaths (8.7%; six kidney and two liver transplant patients). Conclusions: In de novo kidney and liver transplant recipients in India, prolonged-release tacrolimus was well-tolerated and efficacious with a low incidence of acute rejection. Safety profile was similar to immediate-release tacrolimus from published data.
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Paradoxical response (PR) in patients on anti-tuberculosis drugs and immune reconstitution inflammatory syndrome (IRIS) in patients started on antiretroviral therapy are well known phenomenon. We encountered a case of a paradoxical... more
Paradoxical response (PR) in patients on anti-tuberculosis drugs and immune reconstitution inflammatory syndrome (IRIS) in patients started on antiretroviral therapy are well known phenomenon. We encountered a case of a paradoxical response in cerebral nocardiosis in a renal transplant recipient. To our knowledge this phenomenon in cerebral nocardiosis has not been reported earlier in literature.
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Background: Hemodialysis among critical care patients with acute kidney injury (AKI) is challenging, especially if heparin is contraindicated. Objectives: This study assessed the utility of citrate dialysis for such patients in a... more
Background: Hemodialysis among critical care patients with acute kidney injury (AKI) is challenging, especially if heparin is contraindicated. Objectives: This study assessed the utility of citrate dialysis for such patients in a limited-resource setting. Methods: In this prospective study, patients were divided into group A (heparin-free saline flush dialysis), group B (heparin-free citrate dialysis without flushing), and group C (heparin-free citrate dialysis with flushing). The subjects underwent completed sustained low-efficiency daily dialysis (blood flow = 150 mL/minute, dialysate = 300 mL/minute) or intermittent hemodialysis (blood flow = 250 mL/minute, dialysate flow = 500 mL/minute). Statistical tests using SPSS software (version 26) were used to determine safety and effectiveness differences. Results: Among 25 patients studied with multiple hemodialysis sessions, blood flow and dialysate flow were observed to be better in heparin-free citrate dialysis with flushing. There ...
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Epidemiology and risk factors of chronic kidney disease in India – results from the SEEK in non-CKD group while 79.5 % in the CKD group had proteinuria. Prevalence of CKD stages 1, 2, 3, 4 and 5 was 7%, Singh et al. BMC Nephrology 2013,... more
Epidemiology and risk factors of chronic kidney disease in India – results from the SEEK in non-CKD group while 79.5 % in the CKD group had proteinuria. Prevalence of CKD stages 1, 2, 3, 4 and 5 was 7%, Singh et al. BMC Nephrology 2013, 14:114
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Copyright © 2011 Sangita U. Sawant et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work... more
Copyright © 2011 Sangita U. Sawant et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. The present study is to look for a correlation between oxidative stress and thyroid function in patients with the nephrotic syndrome in the remission phase as well as in a persistent proteinuric state. Introduction. Nephrotic syndrome is a form of chronic kidney disease due to which blood loses protein through the urine. We wanted to know if there was an increased loss of thyroid hormones in urine affecting thyroid function. Methods. 60 patients with nephrotic syndrome and 20 healthy non-proteinuric individuals as control subjects were enrolled in the study. We measured their serum tri-iodothyronine, thyroxine and thyroid-stimulating hormone. Estimation of lipid peroxidation (LPx) catalase, superoxide dismutase (SOD), ...
Background: There are no national data on the magnitude and pattern of chronic kidney disease (CKD) in India. The Indian CKD Registry documents the demographics, etiological spectrum, practice patterns, variations and special... more
Background: There are no national data on the magnitude and pattern of chronic kidney disease (CKD) in India. The Indian CKD Registry documents the demographics, etiological spectrum, practice patterns, variations and special characteristics. Methods: Data was collected for this cross-sectional study in a standardized format according to predetermined criteria. Of the 52,273 adult patients, 35.5%, 27.9%, 25.6 % and 11 % patients came from South, North, West and East zones respectively. Results: The mean age was 50.1 ± 14.6 years, with M:F ratio of 70:30. Patients from North Zone were younger and those from the East Zone older. Diabetic nephropathy was the commonest cause (31%), followed by CKD of undetermined etiology (16%), chronic glomerulonephritis (14%) and hypertensive nephrosclerosis (13%). About 48% cases presented in Stage V; they were younger than those in Stages III-IV. Diabetic nephropathy patients were older, more likely to present in earlier stages of CKD and had a high...
Background: There is a rising incidence of chronic kidney disease that is likely to pose major problems for both healthcare and the economy in future years. In India, it has been recently estimated that the age-adjusted incidence rate of... more
Background: There is a rising incidence of chronic kidney disease that is likely to pose major problems for both healthcare and the economy in future years. In India, it has been recently estimated that the age-adjusted incidence rate of ESRD to be 229 per million population (pmp), and >100,000 new patients enter renal replacement programs annually. Methods: We cross-sectionally screened 6120 Indian subjects from 13 academic and private medical centers all over India. We obtained personal and medical history data through a specifically designed questionnaire. Blood and urine samples were collected. Results: The total cohort included in this analysis is 5588 subjects. The mean ± SD age of all participants was 45.22 ± 15.2 years (range 18–98 years) and 55.1% of them were males and 44.9% were females. The overall prevalence of CKD in the SEEK-India cohort was 17.2% with a mean eGFR of 84.27 ± 76.46 versus 116.94 ± 44.65 mL/min/1.73 m2 in non-CKD group while 79.5% in the CKD group ha...
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Using survival status at T months as the primary endpoint in a phase II trial with interim looks is sometimes challenging. The primary issue is censoring at the time of the interim analysis – not all subjects are followed for T months.... more
Using survival status at T months as the primary endpoint in a phase II trial with interim looks is sometimes challenging. The primary issue is censoring at the time of the interim analysis – not all subjects are followed for T months. The simple proportion of all subjects surviving the required time is a biased estimate of the survival probability if some have incomplete follow-up. However, suspending accrual to allow all the subjects to be followed for the required length of time is impractical. Case and Morgan (2003) developed a two-stage design for evaluating survival probabilities with a planned interim analysis without interrupting the trial. In this report, the authors review the design, and describe development of analysis tools for calculating the test statistic for the interim analysis. Both a SAS macro and R-code were developed. The SAS macro is convenient if SAS is used as the analysis platform for the trial. The R-code is also easy to use if R is the preferred analysis ...
Central-line-associated blood-stream infection (CLABSI) is a highly consequential nosocomial infection. The most effective management includes the removal of the infected catheter. Retention of the catheter and antibiotic lock therapy... more
Central-line-associated blood-stream infection (CLABSI) is a highly consequential nosocomial infection. The most effective management includes the removal of the infected catheter. Retention of the catheter and antibiotic lock therapy (ALT) along with systemic antibiotics may be attempted only if there are unusual extenuating circumstances. CLABSIs due to Gram-negative bacteria (GNB) is more common in our setting and the organisms are often highly resistant. Hence, there is a need to explore the use of novel antimicrobials for catheter lock solutions along with antibiofilm agents. We report the use of antibiotic lock therapy in the first 29 patients who had 37 episodes of bacteremia (CLABSI/symptomatic colonization) due to long-term catheters in our unit from February 2008 to September 2014. Patients received ALT if they had CLABSI or were symptomatic with a colonized catheter. Patients who needed removal of the catheter were ineligible for ALT. Patients received systemic antibiotic...
... Fluconazole was given for oral thrush, his diabetes was controlled with the help of dietary ... infection), the time of infection in relation to the onset of immunocompromised state, presence of ... indicates infection through the... more
... Fluconazole was given for oral thrush, his diabetes was controlled with the help of dietary ... infection), the time of infection in relation to the onset of immunocompromised state, presence of ... indicates infection through the donor organ, blood product, or contact with a CMV shedder. ...
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A 34-year-old man was referred for evaluation of renal failure. The illness had started with a 2-month history of easy fatiguability, nausea and vomiting which was followed by puffiness of face and oedema feet and a decrease in urinary... more
A 34-year-old man was referred for evaluation of renal failure. The illness had started with a 2-month history of easy fatiguability, nausea and vomiting which was followed by puffiness of face and oedema feet and a decrease in urinary output. He did not provide a long-standing history of renal symptomatology or that of any systemic disorder. His past medical history revealed a fully treated tuberculous lymphadenitis, 8 years prior to presentation and a history of multiple unprotected sexual encounters with penile ulcerations on 3 occasions, treated with unspecified medications. He was a chronic smoker, but a teetotaler. On presentation, he had clinical features of uncontrolled hypertension (170/116 mm of Hg) with grade III hypertensive retinopathy, facial and pedal oedema and cardiac failure. Investigations revealed a haemoglobin concentration of 7.6 gm%, mild leucocytosis (neutrophils 80%, lymphocytes 20%); urine protein 2+ with 12-15 red blood cells per high power field; Blood ur...
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Serum thyroid stimulating hormone (TSH) levels were measured in 127 patients with varying grade of chronic renal failure (CRF). Sensitive immunoradiometricassays (IRMA) were used so that small changes in TSH levels if any, could be... more
Serum thyroid stimulating hormone (TSH) levels were measured in 127 patients with varying grade of chronic renal failure (CRF). Sensitive immunoradiometricassays (IRMA) were used so that small changes in TSH levels if any, could be appreciated, and to see if such alterations exhibit some relationship with those in thyroid hormone levels. Mean serum TSH levels in the patient group of 2.33 microU/ml (0.07-7.3) was significantly higher in comparison to 1.73 microU/ml (0.25-4.6) in normal subjects (p < 0.001). However, they were not significantly different when measured by radioimmunoassay (RIA) as compared to normals. Serum triiodothyronine (T3), thyroxine (T4) and free triiodothyronine (FT3) levels of 72 +/- 32 ng/dl, 7.4 +/- 2.6 micrograms/dl and 2.9 +/- 0.9 pg/ml were significantly lower than in normal subjects, whereas serum free thyroxine (FT4) showed a slight though not significant elevation. When patients were divided in three subgroups according to the degree of renal insuff...
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Research Interests: Adolescent, Medicine, Humans, Child, Blood Pressure, and 6 moreFemale, Male, Middle Aged, Adult, Renal Dialysis, and Antihypertensive agents
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... Plasma exchange vs cyclosporine retrieval therapy in steroid-resistant acute rejection of renal allografts. Dikshit MP, Acharya VN, Trivedi HS, Almeida AF. Department of Nephrology, KEM Hospital, Parel, Bombay, India. PMID: 1412811... more
... Plasma exchange vs cyclosporine retrieval therapy in steroid-resistant acute rejection of renal allografts. Dikshit MP, Acharya VN, Trivedi HS, Almeida AF. Department of Nephrology, KEM Hospital, Parel, Bombay, India. PMID: 1412811 [PubMed - indexed for MEDLINE]. ...
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... Fluconazole was given for oral thrush, his diabetes was controlled with the help of dietary ... infection), the time of infection in relation to the onset of immunocompromised state, presence of ... indicates infection through the... more
... Fluconazole was given for oral thrush, his diabetes was controlled with the help of dietary ... infection), the time of infection in relation to the onset of immunocompromised state, presence of ... indicates infection through the donor organ, blood product, or contact with a CMV shedder. ...
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The effect of low dose rHuEPO therapy in ESRD patients on regular dialysis therapy was assessed in a prospective study in 22 patients. Routine hematological and biochemical tests, bone marrow aspiration, serum iron and ferritin studies... more
The effect of low dose rHuEPO therapy in ESRD patients on regular dialysis therapy was assessed in a prospective study in 22 patients. Routine hematological and biochemical tests, bone marrow aspiration, serum iron and ferritin studies were performed. The quality of life was also assessed. rHuEPO was administered in a dose of 25 units/kg i.v. post dialysis 3 times a week for 8 weeks, followed by 36 units/kg for further 4 weeks. Significant rise (p = 0.0001) in Hb & PCV with rise in reticulocyte count (0.016) was noted. Serum ferritin was a better index of iron status of the body. Significantly improved anemia and quality of life of ESRD patients on hemodialysis was seen in 95% of the patients.
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Twenty-seven live related donor renal allograft recipients were evaluated for dyslipoproteinemia. Twenty-two patients received dual immunosuppression with prednisolone and azathioprine. Five patients received cyclosporin as well. Total... more
Twenty-seven live related donor renal allograft recipients were evaluated for dyslipoproteinemia. Twenty-two patients received dual immunosuppression with prednisolone and azathioprine. Five patients received cyclosporin as well. Total cholesterol (Tch), triglycerides (TG), HDL cholesterol (HDLch), LDL cholesterol (LDLch) and VLDL cholesterol (VLDLch) levels were estimated. Fifteen (56%) patients showed significant lipoprotein abnormalities. Renal allograft recipients showed significantly lower levels of Tch (p < 0.05) and LDLch (p < 0.05) and higher levels of TG (p < 0.005) and HDLch (p < 0.05). Diet and beta blockers did not influence lipoprotein levels. A significant negative correlation was noted between post-transplant duration and Tch, TG and VLDLch levels. Increased TG levels were associated with increase in weight and higher daily prednisolone dosage at the time of evaluation. The study confirms the existence of dyslipoproteinemia in renal allograft recipients.
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Non-invasive assessment of left ventricular function was performed by echocardiography and radionuclide ventriculography in 17 end-stage renal disease patients on maintenance hemodialysis. Patients with diabetes mellitus, ischemic heart... more
Non-invasive assessment of left ventricular function was performed by echocardiography and radionuclide ventriculography in 17 end-stage renal disease patients on maintenance hemodialysis. Patients with diabetes mellitus, ischemic heart disease and pericardial or valvular heart disease were excluded from the study. Parameters studied on echocardiography were left ventricular internal diameter in diastole (LVIDd), left atrial diameter (LAD), Aortic root diameter (ARD), Left ventricular posterior wall thickness in systole (LVPWs), End diastolic volume (EDV), End Systolic volume (ESV), fractional shortening percentage (FS%) and ejection fraction (EF). Parameters studied on radionuclide ventriculography were Peak ejection rate (PER), Peak filling rate (PFR) and Ejection fraction (EF). Significantly abnormal values for echocardiographic parameters LVIDd, LVPWs, EDV, ESV and FS% were found. On evaluation by MUGA scans, it was observed that the PER was significantly decreased while the PFR...
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... J Postgrad Med 1984;30:69-74. How to cite this URL: Ravichandran RR, Dudani RA, Almeida AF, Chawla KP, Acharya VN. ... The outbreak of methanol poisoning described in this paper occurred in a suburban area of Bombay (in a locality... more
... J Postgrad Med 1984;30:69-74. How to cite this URL: Ravichandran RR, Dudani RA, Almeida AF, Chawla KP, Acharya VN. ... The outbreak of methanol poisoning described in this paper occurred in a suburban area of Bombay (in a locality between Chembur and Ghatkopar). ...
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Research Interests: Kidney diseases, Leukemia, Adolescent, Medicine, Lymphoma, and 10 moreProspective studies, Humans, Child, Kidney, Female, Multiple Myeloma, Male, Aged, Middle Aged, and Adult
... How to cite this URL: Shah BV, Almeida AF, Chawla KP, Shah AB, Mittal BV, Kinare SG, AcharyaVN. ... the cause and the speed with which the condition is detected and treated.[5] We wish to record our experience in 51 paediatric cases... more
... How to cite this URL: Shah BV, Almeida AF, Chawla KP, Shah AB, Mittal BV, Kinare SG, AcharyaVN. ... the cause and the speed with which the condition is detected and treated.[5] We wish to record our experience in 51 paediatric cases of ARF seen at the KEM Hospital, Bombay ...
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... 8. 9. Kalpan, BS, Katz, J., Krawitz, S. and Laurie, A.: An analysis of the results of therapy in 67 cases of hemolytic uremic syndrome. J. Paediair., 78: 420-423, 1971. ... 13. 14. Waddell, AJ andMatz, LZ: Hemolytic uremic syndrome-a... more
... 8. 9. Kalpan, BS, Katz, J., Krawitz, S. and Laurie, A.: An analysis of the results of therapy in 67 cases of hemolytic uremic syndrome. J. Paediair., 78: 420-423, 1971. ... 13. 14. Waddell, AJ andMatz, LZ: Hemolytic uremic syndrome-a report of two cases in adult. Med. ...
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A leprosy patient who developed acute renal failure on multidrug therapy is reported. The patient had initially received a once-weekly dose of rifampin and after he had stopped taking the drug for a time, was given rifampin on a... more
A leprosy patient who developed acute renal failure on multidrug therapy is reported. The patient had initially received a once-weekly dose of rifampin and after he had stopped taking the drug for a time, was given rifampin on a once-monthly dose schedule. He recovered completely from his acute renal failure. Kidney biopsy showed interstitial nephritis with mononuclear and eosinophilic cellular infiltrates.
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Research Interests: Adolescent, STEROIDS, Medicine, India, Humans, and 6 moreChild, Systemic Lupus Erythematosus, Female, Male, Adult, and Lupus Nephritis
Fifty patients of acute renal failure following Viperine snake bite were studied. Oliguria (100%), local swelling (48%) and bleeding tendencies (42%) were the predominant clinical features encountered. Of the 25 patients in whom detailed... more
Fifty patients of acute renal failure following Viperine snake bite were studied. Oliguria (100%), local swelling (48%) and bleeding tendencies (42%) were the predominant clinical features encountered. Of the 25 patients in whom detailed coagulation studies were done, 24 patients had disseminated intravascular coagulation (DIC) and 1 had primary fibrinolysis. DIC was commoner with Russell's viper bite (62%) in comparison to Echis carinatus bites (40%). Renal histology obtained in 29 cases revealed tubular necrosis (35%), cortical necrosis (24%) tubular degeneration (17%) and glomerular changes (17%). Ballooning of glomerular capillaries (59%), splitting of glomerular basement membrane (40.7%), swelling of endothelial cells (29.6%), and focal proliferation of mesangial cells (17%) were the significant glomerular changes encountered. 20 (40%) patients succumbed, DIC (50%), irreversible shock (30%) and septicaemia (20%) being the immediate causes of death. Development of oliguria w...