Browsing by Author "Mohd Iqbal"

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Etiopathological study of crescentic glomerulonephritis and its outcome: A retrospective analysis
(Journal of Association of Physicians of India, 2019) Jai Prakash; Prem Shankar Patel; Suraj Prakash; Mohd Iqbal; Shiv Shankar Sharma; Shivendra Singh; Usha Singh
Introduction: Crescentic Glomerulonephritis (CGN) is most aggressive structural phenotype and accounts for 2%-7% of renal biopsy in most series. The aim of study was to assess the clinical feature and outcome of CGN at our centre. Material and Methods: The renal biopsy performed during the period of January 2015 to January 2018 was studied and patients showing crescentic glomerulonephritis on histology were selected for this study. The clinical presentation, immunological assay, biochemical and haematological investigations, treatment protocol and final outcome at three month of these patients were analysed in the present study. Results: Of 380 biopsy, 26 (male=17, female=9) patients had histological evidence of CGN (6.8%). The age of patients ranged between 13-75 (mean=43) years. Fibro cellular and cellular crescent was noted in 84.61% and 15.38% of patients respectively. Small vessels vasculitis and granuloma was observed in 5 (19.23%) cases. Based on immunohistopathology, we observed type I (n=3), type II (n=8), type III (n=5), type IV (n=3), and type V (n=7) crescentic GN in 11.53%, 30.76%, 19.23%, 11.53% and 26.92% of patients respectively. Haemodialysis was given to 22(84.61%) and 4(15.38%) patients were treated with immunosuppressive therapy. Plasmapheresis was used in two double positive (ANCA + Anti GBM Ab) patients. Remaining 21(80.76%) has progressed to ESRD over a period of 2-3 months. Conclusion: Type II (immune complex) CGN was most common type followed by type V (immune negative) and type III (pauci-immune) CGN. The crescentic GN had worse prognosis with >80% of patients progressed to ESRD within 3 month of time from onset of illness. Early diagnosis and treatment is associated with favourable outcome. © 2019 Journal of Association of Physicians of India. All rights reserved.
Histological Spectrum of Clinical Kidney Disease in Type 2 Diabetes Mellitus Patients with special Reference to nonalbuminuric Diabetic Nephropathy: A Kidney Biopsy-based Study
(Journal of Association of Physicians of India, 2022) Jai Prakash; Prem Shankar Patel; Mohd Iqbal; Shiv Shankar Sharma; Shivendra Singh; Neeraj K. Agrawal; Usha Singh
Background: Diabetic nephropathy (DN) is an important and catastrophic complication of diabetes mellitus (DM). Kidney disease has heterogeneity in histology in diabetes patients and includes both diabetic kidney disease (DKD) (albuminuric or nonalbuminuric) and nondiabetic kidney disease (NDKD) either in isolation or in coexistence with DN. Diabetic nephropathy is hard to overturn. While NDKD is treatable and reversible. Materials and methods: We enrolled a total of 50 type 2 diabetes mellitus (T2DM) patients with clinical kidney disease, of both genders and age >18 years, who underwent kidney biopsy from October 2016 to October 2018. Patients with proteinuria <30 mg per day were excluded from the study. The indications of the renal biopsy were nephrotic syndrome (NS), active urinary sediment, rapid decline in renal function, asymptomatic proteinuria, and hematuria. Result: A total of 50 (males: 42 and females: eight) patients with T2DM who underwent kidney biopsy were enrolled. The clinical presentation was: NS 26 (52%), chronic kidney disease (CKD) 11 (22%), asymptomatic proteinuria and hematuria six (12%), acute kidney injury (AKI) four (8%), and acute nephritic syndrome (ANS) three (6%). Diabetic retinopathy (DR) was noted in 19 (38%) cases. Kidney biopsy revealed isolated DN, isolated NDKD, and NDKD superimposed on DN in 26 (52%), 14 (28%), and 10 (20%) cases, respectively. Idiopathic membranous nephropathy (MN) (4) and amyloidosis (2) were the most common forms of NDKD, whereas diffuse proliferative glomerulonephritis (DPGN) was the main form of NDKD superimposed on DN. Diabetic nephropathy was observed in 15 (79%) cases in presence of DR and also in 11 (35.5%) cases even in absence of DR. Of eight patients with microalbuminuria four (50%) cases have biopsy-proven DN. Conclusion: About 48% of patients had NDKD either in isolation or in coexistence with DN. Diabetic nephropathy was found in absence of DR and in patients with a low level of proteinuria. The level of proteinuria and presence of DR does not help to distinguish DN vs NDKD. Hence, renal biopsy may be useful in selected T2DM patients with clinical kidney disease to diagnose NDKD. © The Author(s).
Outcome of HIV related kidney diseases treated with combined antiretroviral therapy (CART)
(Journal of Association of Physicians of India, 2019) Jai Prakash; Mohd Iqbal; Prem Shankar Patel; Suraj Prakash; Shyam Sundar; Usha Singh
Introduction: The safe and effective treatment of HIV-associated renal diseases with cART can decrease the progression to ESRD and also improve the morbidity and mortality secondary to renal failure. Material and Methods: HIV positive patients with clinical kidney disease were the subjects of this study. The diagnosis of HIV was established using immunochromatographic assays. The patients were subjected to meticulous history, physical examination, laboratory investigations and kidney biopsy. Patients were treated with combined antiretroviral therapy and enalapril. They were followed at 3 months interval for one year. Short term outcome was assessed using changes in serum creatinine and proteinuria. Long term outcome assessments were done using progression to end stage renal disease and patients survival. Result: Ten (Male=7; Female=3) HIV patients with clinical renal disease were included in this study. Their age ranged between 26-55 (Mean=40.5±8.8) years. The mean serum creatinine at the baseline, three, six, nine and twelve months was 2.46, 2.09, 2.43, 2.46 and 2.58 mg/dl respectively. The mean e-GFR by MDRD equation at 0, 3, 6, 9 and 12 months was 40.9, 45.5, 48.2, 51.1 and 52.5 ml/ min/1.73m2 respectively. The mean twenty four hour urinary protein excretion at 0, 3, 6, 9 and 12 months was 3.01, 2.82, 2.22, 2.02 and 1.79 grams respectively. Six patients showed improvement in creatinine and e-GFR, whereas worsening of renal function was seen in four patients. Proteinuria decreased in seven patients, whereas it remained unchanged in three patients. There was no mortality at the end of one year of follow up. Conclusion: Treatment with combined ART and ACEIs slows the progression of HIV-associated kidney disease, decreases proteinuria and improves the GFR. © 2019 Journal of Association of Physicians of India. All rights reserved.