Browsing by Author "Biplab Ghosh"

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Changing epidemiology of community-acquired acute kidney injury in developing countries: Analysis of 2405 cases in 26 years from eastern India
(2013) Jai Prakash; Takhellambam Brojen Singh; Biplab Ghosh; Vinay Malhotra; Surendra Singh Rathore; Rubina Vohra; Rabindra Nath Mishra; Pramod Kumar Srivastava; Usha
BackgroundThe epidemiology of acute kidney injury (AKI) differs from country to country and varies from center to center within a country. Owing to the absence of a central registry, data on overall epidemiology of AKI are scanty from India.MethodsThis study aimed at describing changes in epidemiology of community-acquired AKI (CAAKI) over a time span of 26 years in two study periods, namely, 1983-95 and 1996-2008.ResultsWe studied 2405 (1375 male and 1030 female) cases of AKI in the age range 1-95 (mean: 40.32) years. The incidence of CAAKI in 1983-95 and 1996-2008 was 1.95 and 4.14 per 1000 admission, respectively (P < 0.01). Obstetrical AKI has decreased because of the declining number of post-abortal AKI. Surgical AKI decreased from 13.8% in 1983-95 to 9.17% in 1996-2008(P < 0.01). Malarial AKI increased significantly from 4.7% in the first half of the study to 17% in the later period (P < 0.01). Diarrhea-associated AKI had significantly decreased from 36.83% in 1983-95 to 19% in 1996-2008 (P < 0.01). Sepsis-related AKI had increased from 1.57% in 1983-95 to 11.43% in 1996-2008 (P < 0.01). Nephrotoxic AKI showed an increasing trend in recent years (P < 0.01) and mainly caused by rifampicin and NSAIDs. Liver disease-related AKI increased from 1.73% in 1983-95 to 3.17% in 1996-2008 (P < 0.01). Myeloma-associated acute renal failure (ARF) accounted for 1.25% of the total number of ARF cases in the period 1996-2008. HIV infection contributed to 1.65% of ARF of the total number of AKI cases in the second period (1996-2008). Incidence of renal cortical necrosis (RCN) decreased significantly from 5.8% in 1983-95 to 1.3% in 1996-2008 of the total number of ARF cases (P < 0.01). However, during the same period ARF due to acute tubular necrosis, acute glomerulonephritis and acute interstitial nephritis remained unchanged. The mortality rate from AKI decreased significantly from 20% in 1983-95 to 10.98% in 1996-2008 (P < 0.01).ConclusionsThe epidemiological characteristics of CAAKI have changed over the past three decades. There has been an increase in the overall incidence of ARF with the changing etiology of AKI in recent years. Incidences of obstetrical, surgical and diarrheal AKI have decreased significantly, whereas those of AKI associated with malaria, sepsis, nephrotoxic drugs and liver disease have increased. RCN has decreased significantly. In contrast to developed nations, community-acquired AKI is more common in developing countries. It often affects younger individuals and is caused by single and preventable diseases. © 2013 The Author.
Clinical spectrum of renal disorders in patients with cirrhosis of liver
(2011) Jai Prakash; Amit Kumar Mahapatra; Biplab Ghosh; Puneet Arora; Ashok Kumar Jain
Background: There are limited studies describing various renal disorders and their prognostic impact in patients with cirrhosis of liver. The aim of this work was to study the clinical spectrum of renal disorders in patients with cirrhosis of liver and their prognostic impact. Methods: Patients with diagnosis of cirrhosis of liver were included in this study. Cirrhosis was diagnosed using standard clinical criteria. The cirrhotic patients were prospectively analyzed for the presence of renal diseases during the study period from January 2008 to April 2009. Results: Four hundred and four patients were included in this study and renal diseases were present in 44% (n = 178) patients. The spectrum of renal diseases were acute kidney injury (AKI; 24.5%), chronic kidney disease (CKD; 15.6%), acute on chronic renal failure (1.5%), nephritic syndrome (1.5%), and nephrotic syndrome (1%). The types of AKI were acute tubular necrosis (ATN; 44.4%), prerenal failure (36.4%), and hepatorenal syndrome (19.2%). The incidence of renal diseases was 15.7% in class A, 50% in class B, and 54.8% in class C cirrhosis. There was significant increase in mortality in patients with class C cirrhosis versus without renal disease (78.1% vs. 53.2%; p < 0.001). Conclusions: Renal diseases were present in a significant proportion (44%) of cirrhotic patients. ATN was the commonest form of AKI and we noted that the prevalence of CKD was 15.6% in our cirrhotic patients. The incidence of renal disease increased with increase in severity of cirrhosis of liver. The presence of renal disease seems to have adverse prognostic impact on class C cirrhosis. © 2011 Informa Healthcare USA, Inc.
Comparison of clinical characteristics of acute kidney injury versus acute-on-chronic renal failure: Our experience in a developing country
(Elsevier (Singapore) Pte Ltd, 2015) Jai Prakash; Surendra Singh Rathore; Puneet Arora; Biplab Ghosh; Takhellambam Brojen Singh; Tribhuwan Gupta; Rabindra Nath Mishra
Background From developing countries, there is paucity of information regarding epidemiological characteristics of acute-on-chronic renal failure (ACRF) that differs from acute kidney injury (AKI). Methods In this prospective study, we analyzed and compared clinical characteristics and outcome of ACRF with AKI from January 2007 to August 2012. Results A total of 1117 patients with community-acquired AKI were included in study (AKI = 835; ACRF = 282). Patients with ACRF were older than patients with AKI (p < 0.001). Sepsis was the main cause of acute decline in renal functions in patients with ACRF in comparison to AKI (p < 0.001). Volume depletion/renal hypoperfusion was the most common cause of AKI and the difference was statistically significant as compared to ACRF (33.9% vs. 17.7%; p < 0.001). Need for dialysis was significantly less in patients with ACRF as compared to AKI (68% vs. 77.4%; p 0.002). Lower inhospital mortality was observed in ACRF in comparison to AKI (5% vs. 8.9%, p = 0.04), while no significant difference was noted in terms of duration of hospital stay between the two groups (p = 0.67). However, a significantly higher proportion of patients with ACRF did not recover and progressed to end-stage renal disease as compared to AKI (20% vs. 7.8%; p < 0.001). Conclusion ACRF constituted an important cause (25%) of AKI. An episode of superimposed AKI is associated with significantly increased risk of progression to end-stage renal disease in patients with chronic kidney disease. Copyright © 2015, Hong Kong Society of Nephrology Ltd. Published by Elsevier Taiwan LLC. All rights reserved.
Early posttransplant erythrocytosis in renal allograft recipients
(2010) Jai Prakash; Shivendra Singh; Sanjeev Kumar Behura; Biplab Ghosh; L.K. Sharatchandra; U.S. Dwivedi
Posttransplant erythrocytosis (PTE) is defined as a persistently elevated hematocrit to a level greater than 51% after renal transplantation. It usually develops 8 to 24 months after transplantation. We report occurrence of PTE in two male renal allograft recipients within first 8 months of transplantation. © JAPI.
Interstitial nephritis with moderate-to-heavy proteinuria: an unusual combination.
(2012) Biplab Ghosh; Rana Gopal Singh; Usha; Sanjeev Kumar Behura; Ashutosh Soni; Lou Krakpam Sharatchandra; Shivendra Singh
Interstitial nephritis with proteinuria >1 g/day is uncommon and almost always the result of drug-induced ATIN with an associated minimal change glomerulonephritis (GN). Here, we present a series of five unusual cases of interstitial nephritis without GN but with proteinuria >1 g/day, and they were identified from renal biopsies done from February 2008 to March 2009. Out of 236 patients who underwent renal biopsy, only five met the inclusion criteria. Three patients presented with edema and two with oliguria, while none had frank hematuria, fever, arthralgia, skin rash or history of exposure to nonsteroidal antiinflamatory drugs, analgesics, antibiotics, allopurinol, or Chinese herb before presentation. Urinalysis revealed hematuria in two patients, pyuria in three and nephrotic range proteinuria in two. All had normal complement levels and were negative for antinuclear antibodies, Anti-dsDNA antibody, and antineutrophil cyto-plasmic antibodies. Clinical diagnosis was nephrotic syndrome in two patients, the third had diagnosis of rapidly progressive GN, the fourth had HIV associated nephropathy, and the fifth had unexplained advanced renal failure. Though three patients had renal dysfunction only one required dialysis. Light microscopy of renal biopsies revealed granulomatous interstitial nephritis in three patients and small vessel vasculitis in two of them. One patient had nongranulomatous interstitial nephritis along with vasculitis. Acute interstitial nephritis was the only finding in one patient. In conclusion, patients with interstitial nephritis can present with moderate-to-heavy proteinuria probably due to cytokine-like permeability increasing factor secreted by inflammatory cells in the interstitium.
Intradialytic complications of hemodialysis
(2011) Loukrakpam Sharatchandra Singh; Shivendra Singh; T. Brojen Singh; Sanjeev Kumar Behura; Biplab Ghosh; Sashidhar Shreeniwas
Aim of study: To study the intradialytic complications of hemodialysis. Methods: 275 patients of renal failure comprising of 125 acute renal failure and 150 chronic renal failure patients who were registered for conventional hemodialysis during the period of May 1, 2007 and May 15, 2008 were taken up for the intradialytic complications of hemodialysis regardless of age, sex,race and cause of renal failure. Special emphasis has been given for complications related to vascular access sites like femoral, arterio-venous and internal jugular venous punctures. During the study period there were 1075 bicarbonate dialyses on these patients. Most of the ARF and CRF patients were dialysed by femoral vein access. Among the patients on CRF, 10 patients were on arterio-venous fistula and 8 were on internal jugular venous catheterizations. Results: In the ARF patients, common intradialytic complications were hypotension (12.2%), vomiting (5.2%), headache (5.2%), rigor (2.4%), hypertension (1.2%), nausea (1%), cramps (0.8%), oedema (0.9%), fever (0.6%), first-use syndrome (0.4%), hypoglycemia (0.4%), and itching (0.2%). In the CRF group, common complications were hypertension (11.4%), hypotension (10.48%), vomiting (8.7%), rigor (5.7%), chest pain (4.6%), nausea (3.1%), headache (3.1%), fever (1.6%), cramps (0.71%), itching (0.35%) and haematoma (0.35%). Intracerebral hemorrhage and migration of fractured catheter tip were noted in one patient each. Conclusion: There is a need for a special attention for the diagnosis and management of intradialytic complications of hemodialysis because such complications could be managed successfully without the need of subsequent termination of dialysis procedure.
Renal amyloidosis: A rare presenting manifestation of Hodgkin's disease
(2011) Jai Prakash; Sanjeev Kumar Behura; Biplab Ghosh; Shivendra Singh; Usha
Renal amyloidosis leading to nephrotic syndrome is very rare in Hodgkin's disease as compared to minimal change disease. Amyloidosis usually develops insidiously after many years of active Hodgkin's disease, and is often a late and irreversible complication. Concomitant presentation of Hodgkin's disease and nephrotic syndrome are rarely reported in the literature. We describe a 35-year-old female who presented simultaneously with Hodgkin's disease and nephrotic syndrome, which was found to be secondary to renal amyloidosis on renal biopsy. © 2011, Hong Kong Society of Nephrology Ltd. Published by Elsevier Taiwan LLC. All rights reserved.
Subclavian artery- internal jugular vein fistula and heart failure: complication of internal jugular vein catheterization.
(2013) Jai Prakash; Brojen Takhellambam; Biplab Ghosh; Tauhidul Alam Choudhury; Shivendra Singh; Om Prakash Sharma
Hemodialysis in patients with end-stage renal disease (ESRD) requires vascular access which can be either temporary or permanent. However, these procedures are not without complications. Arterial puncture is the most common immediate complication and pseudoaneurysm formation is the most common late sequel of internal jugular venous catheterization (IJVC). However, arterio-venous fistula (AVF) formatiorn following IJVC is rare. We are reporting a case of AVF formation between subclavian artery (SCA) and internal jugular vein (IJV) following IJVC which later on leads to the development of cardiac failure.