Browsing by Author "Prabhakar"

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Clinicopathologic spectrum of crescentic glomerulonephritis: a hospital-based study.
(2014) Tauhidul Alam Choudhury; Rana Gopal Singh; Usha; Shivendra Singh; Takhellambam Brojen Singh; Surendra Singh Rathore; Prabhakar
Recent data regarding the clinical and histopathologic spectrum of crescentic glomerulonephritis (CSGN) among the Indian adult population is unknown. Our aim is to study the clinicopathological features and outcome of CSGN. It is a retrospective observational study from a tertiary care hospital in India over 3.5 years. Biopsy-proven cases of CSGN (i.e., >50% crescents in glomeruli) were included in the study. Cases with insufficient data were excluded. There were 34 cases of CSGN, accounting for an incidence of 5.5% among kidney biopsies. The mean age was 32.2 ± 16.09 years, with male to female ratio of 12:22. Clinical presentations of CSGN include rapidly progressive glomerulonephritis in 23 (67.7%), chronic renal failure (CRF) in seven (20.5%), nephrotic syndrome in two (5.8%) and acute nephritic syndrome in two (5.8%) patients. The immunological profile of CSGN showed MPO-ANCA in nine (26.4%), PR3-ANCA in one (2.9%), both PR3 and MPO-ANCA in one (2.9%), anti-GBM antibody in five (14.7%) and lupus nephritis in six (17.6%) patients. All the three antibodies were present in one patient. The percentage of glomeruli showing crescents were 100% in nine (26.4%) and ≥80% in seven (20.5%) patients. Type of crescents seen were cellular in 11 (32.3%) and fibrocellular in 22 (64.7%) patients and fibrous in one (2.9%) patient. Interstitial fibrosis was found in seven (20.5%) patients. Dialysis dependency was seen in 11 (32.3%) patients. After 3 months of follow-up, mortality was seen in three (8.8%), remission in eight (23.5%), CRF in 15 (44.1%) and ESRD in five (14.7%) patients. CSGN carries a poor prognosis. The disorder may have an insidious onset and a slowly progressive course. ANCA, anti-GBM-antibody and anti-dsDNA can coexist in CSGN.
Rhabdomyolysis induced acute renal failure: A rare complication of falciparum malaria
(Journal of Association of Physicians of India, 2014) Prabhakar; Surendra Singh Rathore; Tauhidul Alam Choudhury; A. Kishan; Tribhuan Gupta; Jai Prakash
[No abstract available]
Spectrum of acute kidney injury in intensive care unit: A single centre experience
(Meldip Academy, 2017) Suresh Kumar Sinha; Mukteshwar Rajak; Prabhakar; Rajneesh; Vivek Tripathi
Background: Acute kidney injury (AKI) in the intensive care unit (ICU) is associated with high mortality. A thorough understanding of the clinical spectrum of the disease is needed in order to device methods to improve the final outcome due to this problem. Aims and Objectives: The aim of present study was to analyze the clinical spectrum, causes, risk and prognostic factors and final outcome of AKI in the setting of ICU. Materials and Methods: This prospective study involved patients admitted to ICU during the period between June 09 to June 10. Patients who developed AKI during the ICU stay were included in the study. The clinical and laboratory data were collected at admission and then on daily basis. Data recorded includes patients demographic profile, underlying clinical illness responsible for ICU admission, dialysis requirement, need for ventilation, total duration of ICU stay, acute physiology and chronic health evaluation (APACHE) IV score and final outcome and these data were analyzed for predicting survival using univariate and multivariate analysis. Results: 574 patients were admitted to ICU from June 09 to June 10 and (n = 124; 21.6%) patients developed AKI after admission to ICU. Mean age 44.87 ± 15.14 years and (n = 71; 57.1%) were males and (n = 53; 42.9%) were females. Out of 124 patients (50.80%; n = 63) had medical, (33.87% n = 42) had surgical and (15.32%; n = 19) had obstetric cause of admission in ICU. Of the 574 patients (12.02%; n = 69) had associated co morbidities, hypertension is the most common associated morbidities (4.7%; n = 27), others were diabetes mellitus (3.6%; n = 21), coronary artery disease (3.0%; n = 17), cerebrovascular disease (0.3%; n = 2), chronic obstructive pulmonary disease (0.3%; n = 2;). The etiology of AKI was multi factorial, sepsis were the most common cause observed in (69.64%; n = 39), hypotension (67.84%; n = 38), volume depletion (19.64%; n = 11), nephrotoxic drugs (64.28%; n = 36) patients. Multi organ system failure (MOSF) was noted in (29.03%; n = 36) patients. MOSF and sepsis were found to be significant adverse prognostic factors when multiple logistic regression analysis was done. Conclusion: AKI was seen in 21.6% of cases in our ICU and associated with poor prognosis. Presence of sepsis, MOSF, higher APACHE IV scores and ventilation requirement were correlated with higher mortality in AKI patients in ICU. Early recognisition and intervention improves the outcome.