Browsing by Author "Puneet Arora"

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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.
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.
Intramuscular Drotaverine and Diclofenac in Acute Renal Colic: A Comparative Study of Analgesic Efficacy and Safety
(Blackwell Publishing Inc., 2012) Amitabh Dash; Rituparna Maiti; Tejaswi Kumar Akantappa Bandakkanavar; Puneet Arora
Objective. To evaluate the analgesic efficacy and safety of intramuscular drotaverine hydrochloride vs diclofenac sodium in treatment of acute renal colic. Methods. We conducted a randomized, single-blind study comparing single intramuscular doses of drotaverine hydrochloride (80mg) vs diclofenac sodium (75mg) on 100 patients (50 in each arm) presenting to the emergency department (ED) with renal colic. Subjects with inadequate pain relief at 30minutes received rescue intramuscular tramadol (100mg). Pain intensity was recorded using a visual analog scale (VAS), which is the primary outcome measure of this study, before drug administration and 30 and 60minutes afterwards. The drug effectiveness was defined as ≥50% decrease in pain intensity 60minutes after intramuscular administration, without exacerbation during the following 2hours. The need for rescue medication and the presence of adverse effects were considered as secondary outcome of the study. Result. VAS decreased significantly (P<0.001) with both drotaverine (52.4%) and diclofenac (49%) at 30minutes. Reduction of VAS at 60minutes was 61.3% with drotaverine in comparison to 60.4% with diclofenac. Forty-five patients (90%) in the drotaverine group and 44 (88%) in the diclofenac group found the therapy effective. The need for rescue medication was in five patients of the drotaverine group and six patients in the diclofenac group. There was no significant difference in safety profile in the study groups. Conclusion. The efficacy and safety of drotaverine as analgesic in renal colic is noninferior to diclofenac and may be used as an alternative or add-on therapy to currently available options. © 2012.
Mesangioproliferative glomerulonephritis in a patient with Kimura's disease presenting as Nephrotic syndrome
(2015) Surendra S.ingh Rathore; Puneet Arora; Jai Prakash
Kimura's disease is a rare chronic eosinophilic inflammatory disorder of unknown etiology. Majority of cases have been reported from South East Asia, while sporadic occurrences have been reported worldwide, including the Indian subcontinent. Nephrotic syndrome may be the presenting manifestation of Kimura's disease, and a variety of renal lesions are observed histologically in such patients. We herein describe a case of steroid-responsive mesangioproliferative glomerulonephritis related to kimura's disease.