Browsing by Author "Jai Prakash"

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Acute glomerulonephritis, vasculitis, and pulmonary renal syndrome
(Springer Berlin Heidelberg, 2010) Jai Prakash
Inflammatory diseases of glomeruli (glomerulonephritis [GN]) and renal vessels (vasculitis) are important causes of intrinsic acute kidney failure (ARF), accounting for approximately 10% of cases. Both acute glomerulonephritis and vasculitis (particularly ANCA-associated vasculitis) are more common in the elderly while poststreptococcal GN causing ARF is relatively more common in children than in adults. The clinical presentation is often that of a rapidly progressive glomerulonephritis (RPGN) with or without signs and symptoms of extrarenal manifestations. The diagnostic workup must include an immunologic screening for autoantibodies (ANA, anti-ds DNA antibodies, ANCA, anti-GBM antibodies, and cryoglobulins). Patients with hematuria/proteinuria, active urinary sediment, and/or acute renal dysfunction with or without systemic symptoms must be subjected to renal biopsy for the precise diagnosis. Early recognition is essential because treatment may result in preservation or recovery of renal function. © Springer-Verlag Berlin Heidelberg 2010.
Acute kidney injury in late pregnancy in developing countries
(2010) Jai Prakash; Shashidhar Shree Niwas; Aashish Parekh; Laxmi Kant Pandey; Loukrakpam Sharatchandra; Puneet Arora; Amit Kumar Mahapatra
Introduction: The data directly evaluating acute renal failure (ARF) in third trimester of pregnancy from Indian subcontinent are scanty. This study analyzes the clinical spectrum of ARF with respect to total birth in third trimester of pregnancy. Material: All pregnant women after the 28th week of pregnancy or in early postpartum period (up to 7 days) admitted to our hospital between August 2006 and August 2008 were screened for clinical evidence of ARF. Pregnant women with clinical diagnosis of ARF in third trimester were included in this study. Results: Of the 4758 pregnant women in third trimester, ARF developed in 85 cases (1 in 56 births). Preeclampsia, puerperal sepsis, and intrauterine death were responsible for ARF in 35.29, 24.7, and 16.67 of cases, respectively. Postpartum hemorrhage and antepartum hemorrhage were the causes of ARF in 10.59 and 8.29 of patients, respectively. Acute fatty liver of pregnancy was noted in one patient. Complicated preeclampsia (hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, eclampsia, and uterine hemorrhage) was associated and higher incidence of ARF. Live birth occurred in 61.2 of patients with vaginal delivery in 70 cases. Renal cortical necrosis was diagnosed in two cases. Overall, mortality was 20. The puerperal sepsis contributed 41 of total death. Conclusion: ARF complicated 1.78 of total delivery in third trimester of pregnancy. Preeclampsia was the most common cause of ARF followed by puerperal sepsis. In contrast to the developed countries, incidence of ARF is still very high in late pregnancy in the developing countries. Overall mortality was 20 with highest (33) mortality in puerperal sepsis group. © 2010 Informa UK, Ltd.
Acute kidney injury in pregnancy with special reference to pregnancy-specific disorders: a hospital based study (2014–2016)
(Springer International Publishing, 2018) Jai Prakash; Vivek C. Ganiger; Suraj Prakash; Mohammad Iqbal; Deba Prasad Kar; Usha Singh; Ashish Verma
Introduction: There are numerous reports in the literature describing acute kidney injury in pregnancy (P-AKI) due to various obstetric complications. However, there is a dearth of studies on AKI related to pregnancy-specific disorders from India. We aimed to analyze clinical features and outcome of P-AKI related to pregnancy-specific disorders compared to total pregnancy, in India. Method: All pregnant women attending the department of Obstetrics and Gynecology from November 2014 to July 2016 were screened for AKI based on: (1) sudden elevation of serum creatinine ≥ 1 mg/dl; (2) oligoanuria for > 12 h; and (3) need for dialysis. The detailed clinical profile of AKI in patients with preeclampsia/eclampsia (PE/E), hemolysis/elevated liver enzymes/low platelet count (HELLP) syndrome, acute fatty liver of pregnancy (AFLP), and pregnancy-associated thrombotic microangiopathy (P-TMA) was analyzed. Laboratory investigations included: complete blood count, renal function tests, urinalysis, coagulation profile (platelet count, INR, prothrombin time and activated partial thromboplastin time), and immunological assay (C3, C4, ANA, anti-dsDNA antibody, antiphospholipid antibody). Contrast-enhanced CT scan of kidney ureter and bladder (KUB) and renal biopsy were performed in selected cases. Maternal and fetal outcome were analyzed individually. The patients were followed for 3 months or longer to determine the recovery of renal function or progression to chronic kidney disease (CKD). Results: Overall, 4741 pregnant women (mean age 26.8 ± 4.8 years) were evaluated for AKI. P-AKI was found in 132/4741 (2.78%) patients. In the majority (91.6%), AKI developed in the late 3rd trimester and post-partum period. P-AKI was related to obstetric complications (in 61.4%), pregnancy-specific disorders (in 57.5%) and miscellaneous factors (7.5%). Puerperal sepsis, ante-partum and post-partum hemorrhage were contributing factors for P-AKI in 34 (25.8%), 11 (8.3%) and 28 (21.2%) patients, respectively. P-AKI due to pregnancy-specific disorders developed in 76/4741 patients, i.e. in 1:62 pregnancies. PE/E was the cause of P-AKI in 62 patients (46.9%) followed by HELLP syndrome in 9 (6.8%) and AFLP in 05 (3.8%). P-TMA causing AKI was not observed. Complete recovery of renal function occurred in 89.4% of patients while 6 (4.6%) progressed to CKD (ESRD: 3 and CKD stage IV: 3). Maternal mortality was 6%. Puerperal sepsis was the sole cause of patchy cortical necrosis in 5 (3.7%) cases. Premature delivery occurred in 40.9% patients and full-term delivery in 35.6%. Perinatal mortality was 23.5%, mainly due to intrauterine death (17.5%) and prematurity (6%). Conclusion: PE/E was the commonest cause of P-AKI in our study, similar to the situation in developed countries. Post-partum hemorrhage was the second-most common (21.5%) cause. Puerperal sepsis contributed to AKI in one-fourth of pregnant women. P-TMA was not recorded in this study and AFLP was an uncommon cause of P-AKI in our country. Renal function returned to normal in all patients with P-AKI due to pregnancy-specific disorders. However, perinatal mortality was high despite the good prognosis of P-AKI. © 2018, Italian Society of Nephrology.
Acute renal failure due to intrinsic renal diseases: Review of 1122 cases
(2003) Jai Prakash; D. Sen; N. Sarat Kumar; H. Kumar; L.K. Tripathi; R.K. Saxena
In this study we have analyzed incidence, causes and clinical course of ARF due to primary intrarenal disease other than acute tubular necrosis. Thousand hundred and twenty two cases of ARF of diverse etiology were studied over a period of 16 years; July 1984 to Dec, 1999. Surgical ARF 231 (20.6%) were not included in the present study. Intrinsic renal diseases were responsible for ARF in 891 (79.4%) of cases. The most common intrinsic renal diseases 705 (79.4%) causing ARF were ischemic/toxic acute tubular necrosis, but not included in this study. Acute renal failure was related to acute glomerulonephritis (9.3%), acute interstitial nephritis (7%), and renal cortical necrosis in (4.6%) of cases. Therefore intrinsic renal diseases other than ATN were the causative factor for acute renal failure in 186 (20.8%) patients in our study. Crescentic (51.8%) and endocapillary proliferative glomerulonephritis (34.9%), were the main glomerular diseases responsible for ARF and 75.9% of GN was related to infectious etiology. Fifty three percent of acute interstitial nephritis was drug induced and in 25 (40%) patients it was related to an infectious etiology. Renal cortical necrosis due to HUS was observed in 16 (39%) children and majority (76.47%) of the cases had a diarrhoeal prodrome. Obstetrical complications were the main causes (61%) of cortical necrosis in adults with acute renal failure. Thus, intrinsic renal diseases other than ATN were responsible for ARF in 186 (20.8%) cases. Post-infectious glomerulonephritis, acute interstitial nephritis and renal cortical necrosis (complicating HUS in children and obstetrical complications in adult) are the main causes of acute renal failure in our study. Both acute GN and interstitial nephritis had excellent prognosis, however renal cortical necrosis was associated with a very high mortality.
Acute renal failure in epidemic dropsy
(Marcel Dekker Inc., 1999) Jai Prakash
Acute renal failure (ARF) complicating epidemic dropsy is reported in three patients. In this study, ARF resolved in two patients over a period of 4-6 weeks with conservative and dialytic support. One patient died of refractory heart failure. To the best of our knowledge ARF in association with epidemic dropsy has not been reported before in the literature from India.
Acute renal failure in pregnancy in a developing country: Twenty years of experience
(2006) Jai Prakash; Hemant Kumar; D.K. Sinha; P.G. Kedalaya; L.K. Pandey; P.K. Srivastava; R. Raja; Usha
Acute renal failure (ARF) has become a rare complication of pregnancy in developed countries. The aim of this study was to describe changing trends in pregnancy-related acute renal failure (PR-ARF) in two successive periods; 1982-1991 and 1992-2002. From July1982 to December 2002, 190 cases of PR-ARF were observed in Eastern India (11.6% of total number of ARF needing dialysis). Obstetrical complications were causative factors for ARF in 15% (65/426) and 10% (125/1201) of patients in the two periods, respectively. The incidence of PR-ARF fell from 15% in 1982-1991 to 10% in 1992-2002, with respect to the total number of acute renal failure cases. Post-abortal ARF showed a declining trend, 9% in the 1980s to 7% in the 2000s, of the total number of ARF cases. Preeclampsia-eclampsia was the cause of obstetrical ARF in 23% (1982-1991) and 14.4% (1992-2002) of cases in these two periods. The percentage of total ARF due to eclampsia declined from 3.5% during the period 1982-1991 to 1.4% in 1992-2002. Puerperal sepsis contributed to 0.8% of total ARF in recent years, compared to 2.4% in the earlier period. The incidence of cortical necrosis decreased significantly (p < 0.001) from 17% in 1982-1991 to 2.4% in the 2000s. The maternal mortality reduced to 6.4% in 1992-2002 from initial high mortality of 20% in the period of 1982-1991. Conclusion. PR-ARF which remained high in the initial period has decreased in recent years. This is associated with a declining trend in post-abortal ARF and a reduction in maternal mortality as well. We noted a significant decrease (p < 0.001) in the incidence of cortical necrosis in PR-ARF. The reasons for this favorable outcome in obstetrical ARF seem to be due to improved medical care, decrease in the number of septic abortions, effective care of obstetrical complications, and legalization of abortion. Copyright © Taylor & Francis Group, LLC.
Anatomical anomalies of femoral vein are not observed in Indian patients with renal failure: Ultrasound-based study
(Elsevier (Singapore) Pte Ltd, 2009) Jai Prakash; Naveen Sharma; Rubina Vohra; Amit Dwivedi; Raja Ramachandran; Rabindra Nath Mishra; Om Prakash Sharma
Background: Femoral vein catheterization is the easiest and safest method for obtaining temporary vascular access in hemodialysis patients. We studied the structure and anatomical variation of femoral veins in uremic patients using ultrasound imaging. Methods: Ultrasonography of femoral vessels was carried out bilaterally in patients with acute renal failure (ARF) and chronic renal failure (CRF). The relationship between ultrasonographic measurements of femoral vessels and anthropometric data were evaluated using Pearson's method. Results: A total of 157 patients (67 ARF, 90 CRF) were included in the study. The majority of the patients were male (68.8 %), and mean age was 43.29 ± 16.74 years. Mean height, weight, and body mass index were 163.94 ± 9.53 cm, 61.96 ± 12.37 kg, and 22.99 ± 3.68 kg/m2, respectively. Mean depth of the femoral artery was 10.74 ± 4.74 mm on the left side and 9.92 ± 3.98 mm on the right side. Mean diameter of the femoral artery was 7.77 ± 1.57 mm on the left side and 7.64 ± 1.45 turn on the right side. Mean distance of the femoral vein from the skin surface was 13.68 ± 4.98 mm on the left side and 12.76 ± 4.85 mm on the right side. Mean diameter of the femoral vein was 9.47 ± 2.15 mrn on the left side and 9.37 ± 2.25 mm on the right side. The femoral vein had adequate diameter (≥ 5 mm) on both sides in all patients. Abnormal location of the femoral vein was not observed in our study. The depth of femoral vasculature was deeper in overweight and obese patients compared to normal weight patients. Femoral artery puncture, multiple attempts before successful catheterization, and hematoma formation were observed in 11.0%, 13.5%, and 5.4% of patients, respectively. Conclusion: Anatomical variation and location anomalies of the femoral vein were not observed in Indian uremic patients. Femoral vein diameter was adequate (≥ 5 mm) in all patients bilaterally. However, there was a slight variation in depth (≥ 1 mm) and diameter (0.1 mm) of femoral vasculature between the left and right sides (left > right).
Burden and predictors of hypertension in India: Results of SEEK (Screening and Early Evaluation of Kidney Disease) study
(BioMed Central Ltd., 2014) Youssef Mk Farag; Bharati V Mittal; Sai Ram Keithi-Reddy; Vidya N Acharya; Alan F Almeida; Anil C; Ballal Hs; Gaccione P; Issacs R; Sanjiv Jasuja; Kirpalani Al; V. Kher; Modi Gk; Georgy Nainan; Jai Prakash; Mohan M Rajapurkar; Rana Ds; Rajanna Sreedhara; Sinha Dk; Bharat V Shah; Sham Sunder; Raj Kumar Sharma; Sridevi Seetharam; Tatapudi Ravi Raju; Ajay K Singh
Background: Hypertension (HTN) is one of the major causes of cardiovascular morbidity and mortality. The objective of the study was to investigate the burden and predictors of HTN in India. Methods. 6120 subjects participated in the Screening and Early Evaluation of Kidney disease (SEEK), a community-based screening program in 53 camps in 13 representative geographic locations in India. Of these, 5929 had recorded blood pressure (BP) measurements. Potential predictors of HTN were collected using a structured questionnaire for SEEK study. Results: HTN was observed in 43.5% of our cohort. After adjusting for center variation (p < 0.0001), predictors of a higher prevalence of HTN were older age ≥40 years (p < 0.0001), BMI of ≥ 23 Kg/M2 (p < 0.0004), larger waist circumference (p < 0.0001), working in sedentary occupation (p < 0.0001), having diabetes mellitus (p < 0.0001), having proteinuria (p < 0.0016), and increased serum creatinine (p < 0.0001). High school/some college education (p = 0.0016), versus less than 9th grade education, was related with lower prevalence of HTN. Of note, proteinuria and CKD were observed in 19% and 23.5% of HTN subjects. About half (54%) of the hypertensive subjects were aware of their hypertension status. Conclusions: HTN was common in this cohort from India. Older age, BMI ≥ 23 Kg/M2, waist circumference, sedentary occupation, education less, diabetes mellitus, presence of proteinuria, and raised serum creatinine were significant predictors of hypertension. Our data suggest that HTN is a major public health problem in India with low awareness, and requires aggressive community-based screening and education to improve health. © 2014 Farag et al.; licensee BioMed Central Ltd.
Carcinoma of the tongue in a renal transplant recipient: a rare post-transplant malignancy
(2015) Jai Prakash; Mohan Kumar; Kishan Aralapuram
Current immunosuppression improved long-term outcome of transplant patients, but it also increased the incidence of de novo malignancy. Organ transplant recipients have a three to four-fold increased risk of developing carcinoma in comparison with the general population. Common malignancies encountered after transplantation include cancer of the skin, lips, post-transplant lymphoproliferative disease, ano-genital carcinoma and Kaposi sarcoma. Squamous cell carcinoma of the tongue is very rare. We report here a case of squamous cell carcinoma of the tongue in an adult male patient who developed it 11 years post-transplant. He underwent right hemiglossectomy and his graft function remained stable.
Changing epidemiology of acute kidney injury in pregnancy: A journey of four decades from a developing country
(NLM (Medline), 2019) Jai Prakash; Suraj Prakash; Vivek C. Ganiger
The incidence of acute kidney injury in pregnancy (P-AKI) has markedly decreased over the last three decades in India, particularly due to decreased incidence of postabortion AKI. However, P-AKI still accounts for 3%-5% of cases of total AKI. Postabortion sepsis has decreased to between 0.9% and 1.5% in 2014 from 9.4% in 1980-1990 in the new millennium. Currently, in India, majority of P-AKI (70%-90%) occurs in the postpartum period and in late 3rd trimester similar to the developed countries, but causes are different. We observed that preeclampsia/eclampsia is the most common cause of P-AKI in the late 3rd trimester and postpartum period followed by puerperal sepsis and postpartum hemorrhage (PPH). Both puerperal sepsis and PPH are treatable and preventable etiologies of P-AKI. Timely and aggressive management of antepartum hemorrhage (APH/PPH) and puerperal sepsis are required to reduce the burden of P-AKI in developing countries. Specific-pregnancy disorders such as P-aHUS/thrombotic thrombocytopenic purpura, pregnancy-associated thrombotic microangiopathy, and acute fatty liver of pregnancy are the uncommon/rare causes of P-AKI in India and possibly also because of the lack of awareness toward diagnosis. Despite decreasing incidence of P-AKI, fetal mortality remained high and unchanged. However, maternal mortality has decreased to 5% from initial high mortality of 20%-25%. The incidence and severity of renal cortical necrosis have significantly decreased at our center.
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.
Chemical composition and source apportionment of total suspended particulate in the central himalayan region
(MDPI, 2021) Rahul Sheoran; Umesh Chandra Dumka; Dimitris G. Kaskaoutis; Georgios Grivas; Kirpa Ram; Jai Prakash; Rakesh K. Hooda; Rakesh K. Tiwari; Nikos Mihalopoulos
The present study analyzes data from total suspended particulate (TSP) samples collected during 3 years (2005–2008) at Nainital, central Himalayas, India and analyzed for carbonaceous aerosols (organic carbon (OC) and elemental carbon (EC)) and inorganic species, focusing on the assessment of primary and secondary organic carbon contributions (POC, SOC, respectively) and on source apportionment by positive matrix factorization (PMF). An average TSP concentration of 69.6 ± 51.8 µg m−3 was found, exhibiting a pre-monsoon (March–May) maximum (92.9 ± 48.5 µg m−3) due to dust transport and forest fires and a monsoon (June–August) minimum due to atmospheric washout, while carbonaceous aerosols and inorganic species expressed a similar seasonality. The mean OC/EC ratio (8.0 ± 3.3) and the good correlations between OC, EC, and nss-K+ suggested that biomass burning (BB) was one of the major contributing factors to aerosols in Nainital. Using the EC tracer method, along with several approaches for the determination of the (OC/EC)pri ratio, the estimated SOC component accounted for ~25% (19.3–29.7%). Furthermore, TSP source apportionment via PMF allowed for a better understanding of the aerosol sources in the Central Himalayan region. The key aerosol sources over Nainital were BB (27%), secondary sulfate (20%), secondary nitrate (9%), mineral dust (34%), and long-range transported mixed marine aerosol (10%). The potential source contribution function (PSCF) and concentration weighted trajectory (CWT) analyses were also used to identify the probable regional source areas of resolved aerosol sources. The main source regions for aerosols in Nainital were the plains in northwest India and Pakistan, polluted cities like Delhi, the Thar Desert, and the Arabian Sea area. The outcomes of the present study are expected to elucidate the atmospheric chemistry, emission source origins, and transport pathways of aerosols over the central Himalayan region. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
Clinical perspectives towards improving risk stratification strategy for renal transplantation outcomes in Indian patients
(Wolters Kluwer Medknow Publications, 2022) Vijay Kher; Vivek B. Kute; Sarbeswar Sahariah; Deepak S. Ray; Dinesh Khullar; Sandeep Guleria; Shyam Bansal; Sishir Gang; Anil Kumar Bhalla; Jai Prakash; Abi Abraham; Sunil Shroff; Madan M. Bahadur; Pratik Das; Urmila Anandh; Arpita Ray Chaudhury; Manoj Singhal; Jatin Kothari; Sree Bhushan Raju; Dilip Kumar Pahari; G. Vishwanath Siddini; G. Sudhakar; Santosh Varughese; Tarun K. Saha
Graft loss and rejections (acute/chronic) continue to remain important concerns in long-term outcomes in kidney transplant despite newer immunosuppressive regimens and increased use of induction agents. Global guidelines identify the risk factors and suggest a framework for management of patients at different risk levels for rejection; however, these are better applicable to deceased donor transplants. Their applicability in Indian scenario (predominantly live donor program) could be a matter of debate. Therefore, a panel of experts discussed the current clinical practice and adaptability of global recommendations to Indian settings. They also took a survey to define risk factors in kidney transplants and provide direction toward evidence- and clinical experience-based risk stratification for donor/recipient and transplant-related characteristics, with a focus on living donor transplantations. Several recipient related factors (dialysis, comorbidities, and age, donor-specific antibodies [DSAs]), donor-related factors (age, body mass index, type - living or deceased) and transplantation related factors (cold ischemia time [CIT], number of transplantations) were assessed. The experts suggested that immunological conflict should be avoided by performing cytotoxic cross match, flow cross match in all patients and DSA-(single antigen bead) whenever considered clinically relevant. HLA mismatches, presence of DSA, along with donor/recipient age, CIT, etc., were associated with increased risk of rejection. Furthermore, the panel agreed that the risk of rejection in living donor transplant is not dissimilar to deceased donor recipients. The experts also suggested that induction immunosuppression could be individualized based on the risk stratification. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
Clinical spectrum of chronic renal failure in the elderly: A hospital based study from Eastern India
(2006) Jai Prakash; J.K. Hota; S. Singh; O.P. Sharma
The aim of this study was to describe the clinical spectrum of chronic renal failure (CRF) in the elderly. The diagnosis of CRF was made using standard clinical criteria. The elderly was defined as person with over 60 years of age. In total, 200 elderly patients with CRF were evaluated between July 2002 and February 2004. Their age (male: 146; female: 54) ranged between 60 and 90 (mean 64.31 ± 4.18) years. Diabetic nephropathy was the most common (46%) cause of CRF. Hypertensive nephrosclerosis, chronic interstitial nephritis and obstructive uropathy were responsible for CRF in 18%, 14% and 13% of patients, respectively. We observed chronic glomerulonephritis in 7% of elderly CRF. Urinary tract infection (55.5%), hypovolemia (22.2%), accelerated hypertension (11.1%) and sepsis (11.1%) were responsible for acute exacerbation of renal failure in 36 (18%) patients. Associated co-morbid conditions were noted in 93 (46.5%) patients. They included; coronary artery disease 46 (49.46%), cerebrovascular disease 20 (21.50%), osteoarthritis 13 (13.97%), chronic obstructive pulmonary disease 6 (6.45%), dilated cardiomyopathy 5 (5.37%), and malignancy in 3 (3.22%) patients. Acute dialytic support was required in 164 (82%) cases and remaining 36 (18%) patients received conservative management. Mortality was noted in 25 (12.5%) cases. The coronary artery disease (48%), acute pulmonary edema (20%) and hyperkalemia (12%) were the main causes of death. Subsequent evaluation revealed that 102 (51%) patients had ESRD of which only 3 (2.94%) patients could afford CAPD. A total of 11 (10.7%) patients underwent chronic maintenance hemodialysis for 3-4 months and then discontinue dialysis mainly because of financial constraints. Remaining 88 (86.27 %) patients with ESRD were discharged from hospital after symptomatic improvement with acute dialysis. Thus, diabetic nephropathy related to type-2 diabetes was the commonest cause of CRF in our elderly patients. Chronic renal failure in elderly was associated with a number of co-morbid conditions, which contributed significantly to morbidity and mortality. Acute on chronic renal failure with severe uremic complications were an important cause of hospitalization. The financial constraint was the major limiting factor for the management of elderly ESRD patients. © Springer Science+Business Media B.V. 2006.
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.
Comparison of conventional straight and swan-neck straight catheters inserted by percutaneous method for continuous ambulatory peritoneal dialysis: a single-center study
(Kluwer Academic Publishers, 2015) Shivendra Singh; Jai Prakash; R.G. Singh; P.K. Dole; Pragya Pant
Objective: To evaluate the incidence of mechanical and infectious complications of conventional straight catheter (SC) versus swan-neck straight catheter (SNSC) implanted by percutaneous method. Patient and methods: We retrospectively analyzed 45 catheter insertions being done by percutaneous method from January 1, 2011, to May 31, 2014. SC was inserted in 24 patients, and SNSC was inserted in 21 patients. Baseline characteristics for the two groups were similar with respect to age, sex and diabetic nephropathy as the cause for end-stage renal disease. Results: Incidence of mechanical and infectious complications in SNSC group was found to be low as compared to the SC group and was statistically significant (1 in 11.6 patient months vs. 1 in 14.4 patient months, p = 0.02). Catheter migration was found to be the most common mechanical complication (20 %), and peritonitis was found to be the most common infectious complication in conventional SC group (27 episodes in 420 patient months vs. 11 episodes in 333 patient months, p = 0.03). The incidence of exit site and tunnel infection rates revealed no difference between the groups. Conclusion: SNSC insertion by percutaneous method is associated with low mechanical and infectious complications. © 2015, Springer Science+Business Media Dordrecht.
Coordination of a mesogenic Schiff-base with MnII, CoII, NiII, CuII and ZnII: Synthesis, spectral studies and crystal structures
(Elsevier Ltd, 2008) Angad Kumar Singh; Sanyucta Kumari; T.N. Guru Row; Jai Prakash; K. Ravi Kumar; B. Sridhar; T.R. Rao
A novel mesogenic (nematic) Schiff-base, N,N′-di-4-(4′-pentyloxybenzoate)salicylidene diaminoethane, H2dpbsde (abbreviated as H2L5) was synthesized and its structure studied. The Schiff-base crystallizes in the non-centrosymmetric space group Pna21 with Z = 4, and the mesogenic isomorphous nickel and copper complexes, [NiL5]2 and [CuL5], in the centrosymmetric space group P21/c with Z = 4. The (L5)2- species coordinates to the metal ions through two phenolate oxygens and two azomethine nitrogens. Both the [NiL5]2 and [CuL5] complexes involve cis-MN2O2 planes; the former complex has a low-spin distorted square-pyramidal geometry with a Ni-Ni bonding of 3.337 Å and the latter, a square-planar geometry. © 2008 Elsevier Ltd. All rights reserved.
Crescentic glomerulonephritis in association with traumatic arteriovenous fistula following gun shot injury
(1998) H. Kumar; R.G. Singh; Jai Prakash; Usha; C.R. Kar; K.S. Basavaraj
[No abstract available]
Deceased-donor organ transplantation in india: Current status, challenges, and solutions
(Baskent University, 2020) Vivek Kute; Vasanthi Ramesh; Sunil Shroff; Sandeep Guleria; Jai Prakash
Tamil Nadu, Gujarat, Telangana, Maharashtra, Kerala, Chandigarh, Karnataka, National Capital Territory of Delhi, and Rajasthan are states and union territories having active deceased-donor organ transplant programs in India. Transplant data (2013-2018) have been collected by the National Organ and Tissue Transplant Organization from all states and union territories of India and submitted to the Global Observatory on Donation and Transplantation. From 2013 to 2018, 49 155 transplants were reported in India, including 39 000 living-donor organ recipients and 10 155 deceased-donor organ recipients. These transplants were for kidney (living donor = 32 584, deceased donor = 5748), liver (living donor = 6416, deceased donor = 2967), heart (deceased donor = 895), lung (deceased donor = 459), pancreas (deceased donor = 78), and small bowel (deceased donor = 8). According to 2018 data, India was the second largest transplanting country in the world in terms of the absolute number of transplants. Here, we discuss the status, progress, challenges, and solutions for deceased-donor organ transplantation. The plan to increase rates of organ donation in India include the following points: teamwork and focus by intensive care unit doctors; public education on organ donation using social media; professional education and family donation conversation programs for brain death declaration and donor management; organ procurement organizations; international collaboration and regular meetings and updates for organizations working in the field of organ transplantation; grief counseling and reporting of potential donation for families of recently deceased people; nonfinancial incentivization to families of potential organ donors; expert committees and standard operating protocols for use of marginal donor organs, donation after circulatory death programs, and machine perfusion; maintenance of transparency and ethics in organ donation, allocation, and transplantation as directed by governmental, nongovernmental, and intergovernmental entities; and regular audit of progress and registry data. © 2020, Baskent University. All rights reserved.