Browsing by Author "Rana Gopal Singh"

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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.
Clinicopathological study of renal amyloidosis
(2006) Usha; Rana Gopal Singh; Jai Parkash; Ruchi Kapoor; Sunita Rai; D.K. Sinha
Study included 13 cases of renal amyloidosis. Oedema, feet and face was the commonest manifestation (100%), two patients (18.18%) also presented with loose motions, ascites and pain in abdomen and one patient had ankylosing spondylitis and cervical spondylitis. On clinical grounds only one case was diagnosed as primary amyloidosis of light chain type, who presented initially with cervical lymphadenopathy and 4 years later with nephrotic syndrome. About 72.72% cases had some chronic disease in the terms of tuberculosis, ankylosing spondylitis, chronic ulcerative colitis, lepromatous leprosy, rheumatoid arthritis and one patient had carcinoma caecum. Congo red stain was positive in both, light chain deposit disease (LCDD) and amyloidosis but polarizing microscope showed mixed birefringence (red, green, yellow) only in amyloidosis. In AFOG and PAS stain, amyloid appeared negative, only peripheral portion revealed blue and pink staining and central area appeared as cutout spaces. Congo red and methyl violet stains and potassium permanganate treatment was not helpful in distinguishing AL amyloidosis from secondary amyloidosis. Hence immunohistochemistry and myeloma profile is a must. It might be possible that in light chain amyloidosis, treatment with methotrexate and prednisolone may improve survival.
Evaluation of serum interleukin 6 and tumour necrosis factor alpha levels, and their association with various non-immunological parameters in renal transplant recipients
(2013) Gyanendra Kumar Sonkar; Sangeeta Singh; Satyendra Kumar Sonkar; Usha Singh; Rana Gopal Singh
Introduction Renal transplant rejection involves both immunological and non-immunological factors. The objective of the present study was to investigate the association between immunological factors, such as serum interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α), and non-immunological parameters, such as age, serum creatinine (SCr), creatinine clearance (CrCl) and dyslipidaemia, in renal transplant recipients (RTRs). Methods This study included 90 RTRs and 90 healthy controls. Biochemical parameters, including serum IL-6 and TNF-α, were estimated using standard protocols. CrCl was calculated using the Cockroft-Gault equation, and the type of rejection was confirmed on biopsy. Student's t-test and univariate and multivariate analyses were performed using the Statistical Package for the Social Sciences for Windows version 15. Results The mean levels of serum IL-6 and TNF-α were significantly higher in RTRs than in the control group (p < 0.001). These parameters were also found to be significantly different between the transplant rejection (TR) and transplant stable (TS) groups (p < 0.001). CrCl was significantly decreased in the TR group when compared to the TS group (p < 0.001). The two cytokines, IL-6 and TNF-α, correlated significantly with all metabolic parameters, such as SCr, CrCl and dyslipidaemia. Multiple regression analysis showed that TNF-α and CrCl were the strongest predictors of IL-6. Conclusion We conclude that immunological factors, as well as non-immunological factors such as CrCl, SCr and dyslipidaemia, play important roles in the pathogenesis of graft rejection and renal graft dysfunction.
Host-mimetic metabolomics of endophytes: Looking back into the future
(Springer India, 2014) Vijay Chandra Verma; Satya Prakash; Rana Gopal Singh; Alan Christopher Gange
Endophytic research is now gaining pace together with the technological advancement and refinements. The phenomenal potential of endophytes as prolific producer of a wide range of bioactive compounds occupies a complimentary domain of natural product research. The discovery of paclitaxel (Taxol) as bioactive natural product of endophytic origin seems to draw indisputable attention not only for their antitumor activity but as potential microbial alternative for this high in-demand drug. Plenty of opinion is given by the enthusiasts on microbial production of paclitaxel as phylogenetic process and driving paradigm of evolution; however, skeptics described it as phylogenetic anomalies. But despite being highly controversial, the horizontal gene transfer (HGT) theory still seems quite justifiable. Let's have another example: maytansinoid, a potent cytotoxic agent, was isolated and characterized from microbial endophyte of the same plant; however in both cases, further investigations recorded their occurrence not only in same host but also from deferent distant hosts and even from different endophytes. So the report of taxane and related taxoids from a taxonomically distant host raises several questions. One may assume that this might be due to evolutionary invention; however, it is very unlikely to accept that all modules of gene responsible for biosynthesis of these molecules invented in microbial systems during long evolutionary symbiosis. With this chapter we are trying to get into the mechanistic aspects of host-specific chemicals synthesized by endophytic microbes together with our experience with isolation and characterization of host-specific compounds like piperine and azadirachtin. Nevertheless, the significance of this potential of endophytes cannot be ignored, as it provides not only alternative source to existing pharmaceuticals but also on the other hand save the valuable biodiversity of highly medicinal plants. © 2014 Springer India. All rights reserved.
Immunomodulating and antiproteinuric effect of hippophae rhamnoides (Badriphal) in idiopathic nephrotic syndrome
(2013) Rana Gopal Singh; Parampal Singh; Praveen Kumar Singh; Usha; Aruna Agrawal; B.N. Upadhyay; Ashutosh Soni
Objective: The treatment of idiopathic nephrotic syndrome is still not well settled and at times is very frustrating. Number of protocols have been reported with variable results outcome in various conditions. The main pillar of treatment of idiopathic nephrotic syndrome is use of immunomodulating and suppressive drugs in various combinations. The herbal preparations have also been reported to have immunomodulating property. The study has been planned to record Immunomodulating and antiproteinuric effect of Hippophae rhamnoides. Material and Methods: In the present study had 2 groups having 28 patients of idiopathic nephrotic syndrome in each group have been included. The patients were subjected to haematological, biochemical, immunological investigation at 0, 1, 2 and 3 months interval with dietic advise. Group A have been put on standard treatment, whereas group B on Badriphal in the well worked up doses. The hydroalcoholic extract of 350 mg twice daily of Badriphal was given to group B as add on treatment. Patients were followed up with definite protocol at monthly interval for 3 months. Results: At the end of 3 month patients showed improvement in the symptoms of oedema, anorexia, oliguria in the herbal group. The urinary estimation of protein showed significant decrease in Group B with elevation of S. albumin levels. The inflammatory cytokines has show ed significant decrease at the end of 3 month. Conclusion: Thus the pilot study showed beneficial effect of the herbal preparation Hippophae rhamnoides as add on treatment. A large perspective study is recommended to establish these findings. © 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.
Litholytic property of Kulattha (Dolichous biflorus) vs potassium citrate in renal calculus disease: A comparative study
(2010) Rana Gopal Singh; Sanjeev Kumar Behura; Rakesh Kumar
Objective: Renal calculus disease is associated with recurrence after its surgical removal in large number of cases. Kulattha is acclaimed to have litholytic property in ayurvedic literature. We decided to compare the litholytic property of Kulattha with potassium citrate, an agent used to reduce stone recurrence in modern medicine. Methods: Forty seven patients with diagnosis of calcium oxalate renal calculi were taken in study. Twenty four patients received Kulattha (Group I) and 23 patients were given potassium citrate(Group II) for a period of 6 months. The size of renal calculi was studied by periodic ultrasound assessment in both groups. Results: Mean size of stone in group I at 0 month and at 6 month were 5.42±1.55 mm and 4.26±1.2 mm. mean size of stone in group II at 0 month and at 6 month was 6.46±3.08 mm and 4.64±1.40 mm. Statistical analysis showed that P value of less than 0.05 was seen in the first group from 0 to 6 month. There was no significant difference in the stone size within group II when the 3rd month and 6th month visit was compared with initial visit. Conclusion: Kulattha can be used to reduce the recurrence of calcium oxalate stone and it is shown to have a better result than the use of conventional potassium citrate in such patients. © JAPI.
Multidisciplinary Consensus Document on the Management of Uncontrolled Hypertension in India
(Adis, 2020) R. Padmanabhan; Rana Gopal Singh; Govindan Unni; Bhupen Desai; Sanjeev Kumar Hiremath; Vidyut Jain; Saikat Bhawal; Sanjeev Gulati; Mukesh Shete; Ramesh Nair; Sunil Prakash; Vijay Kher; Bijan Bhattacharya
Cardiovascular disease is predicted to be the largest cause of death and disability in India by 2020. Hypertension (HT), one of the main contributing factors, presents a significant public health burden. Inability to achieve adequate blood pressure (BP) control results in uncontrolled hypertension (UHT). The prevalence of UHT is high in India, with only about 9–20% of patients achieving target BP goals. Presently, there are no guidelines specific to UHT, which if left uncontrolled can lead to resistant HT, chronic kidney disease and other complications of HT. A multidisciplinary panel, comprising of specialists in cardiology, nephrology and internal medicine, was convened to address the diagnosis and management of UHT in the Indian population. The panel identified key points concerning UHT and discussed management recommendations in the Indian clinical setting. © 2020, Italian Society of Hypertension.
Mutational screening of PKD1 and PKD2 in Indian ADPKD patients identified 95 genetic variants
(Elsevier B.V., 2020) Sonam Raj; Rana Gopal Singh; Parimal Das
Background: Mutation screening of autosomal dominant polycystic kidney disease (ADPKD) cases imply the major involvement of PKD1 mutations in 85% of patients while rest of the cases harbor mutation in PKD2, DNAJB11 and GANAB. This essentially indicates that individual's genotype holds the key for disease susceptibility and its severity. Methods: For finding genetic variability underlying the disease pathophysiology, 84 Indian ADPKD cases, 31 family members (12 susceptible) and 122 age matched control were screened for PKD1 and PKD2 using Sanger sequencing, PCR-RFLP and ARMS-PCR. Results: Genetic screening of Indian ADPKD cases revealed total 67 variants in PKD1 and 28 variants in PKD2. Among the identified variants in PKD1 and PKD2 genes, 35.79% were novel variants and 64.2% recurrent. Further, subcategorization of PKD1 variants showed 14 truncation/frameshift, 21 nonsynonymous, 25 synonymous and 7 intronic variants. Moreover, we observed 40 families with PKD1 pathogenic variants, 7 families with PKD2 pathogenic variants, 9 families with PKD1 & PKD2 pathogenic variants, and 26 families with PKD1/PKD2/PKD1-PKD2 non-pathogenic genetic variants. Conclusion: Present study represented genetic background of Indian ADPKD cases which will be helpful in disease management as well as finding the genetically matched donor for kidney transplant. © 2020 Elsevier B.V.
Mutational screening of PKD2 gene in the north Indian polycystic kidney disease patients revealed 28 genetic variations
(Springer India, 2017) Sonam Raj; Rana Gopal Singh; Parimal Das
Polycystic kidney disease (PKD) is a systemic disorder which adds majority of renal patients to end stage renal disease. Autosomal dominant polycystic kidney disease (ADPKD) is more prevalent and leading cause of dialysis and kidney transplant. Linkage analysis revealed some closely linked loci, two of which are identified as PKD1, PKD2 and an unidentified locus to ADPKD. This study was performed using PCR and automated DNA sequencing in 84 cases and 80 controls to test potential candidature of PKD2 as underlying cause of PKD by in silico and statistical analyses. Two associated symptoms, hypertension (19%) and liver cyst (31%) have major contribution to PKD. Gender-based analysis revealed that familial female patients (27%) and familial male patients (33%) are more hypertensive. Liver cyst, the second major contributing symptom presented by large percentage of sporadic males (46%). Genetic screening of all 15 exons of PKD2 revealed eight pathogenic (c.854_854delG, c.915C>A, c.973C>T, c.1050_1050delC, c.1604_1604delT, c.1790T>C, c.2182_2183delAG, c.2224C>T) and eight likely pathogenic (g.11732A>G, c.646T>C, c.1354A>G, g.39212G>C, c.1789C>A, c.1849C>A, c.2164G>T, c.2494A>G) DNA sequence variants. In our study, 27.38% (23/84) cases shown pathogenic / likely pathogenic variants in PKD2 gene. Some regions of PKD2 prone for genetic variation suggested to be linked with disease pathogenesis. This noticeable hot spot regions hold higher frequency (50%) of pathogenic / likely pathogenic genetic variants constituting single nucleotide variants than large deletion and insertion that actually represents only 41.08% of coding sequence of PKD2. Statistically significant association for IVS3-22AA genotype was observed with PKD, while association of IVS4+62C>T was found insignificant. © 2017, Indian Academy of Sciences.
Outcome of malaria-associated acute kidney injury: A prospective study from a single center
(2013) Vishnu Shanker Shukla; Rana Gopal Singh; Surendra Singh Rathore; Usha
Objective: The aim of this prospective study was to determine the outcome of patients suffering from malaria with acute renal dysfunction. Methods: All adult patients of laboratory-proven malaria with acute kidney injury (AKI) admitted during the period of May 2010 to June 2011 were included. Patient characteristics, physical examination findings, and laboratory parameters were recorded. Patient outcome was assessed in terms of peak serum creatinine level, duration of hospital stay, need for dialysis, and in-hospital mortality rate. Surviving patients were followed up for 3 months to determine progression to chronic kidney disease. Results: This study enrolled 101 patients of malarial AKI. Mean age was 33.70 ± 15.39 years. Oliguric AKI was observed in 44.6% cases. Mean duration of hospital stay was 8.75 ± 7.60 days. Renal replacement therapy was required in 36.6% patients. Ten (9.9%) patients succumbed to illness during hospital stay. Majority of deaths occurred shortly after admission. Mortality risk was significantly associated with raised LDH (p = 0.019), lower hemoglobin level (p = 0.015), raised aspartate transaminases (p < 0.001), and elevated alanine transaminases (p = 0.016). Cerebral malaria was an important determinant of mortality (p = 0.002). Renal parameters, including severity of renal dysfunction and need for dialysis, were not associated with mortality risk. Among 91 survivors, 79 patients completed a 3-month follow-up and all of them had normalization of renal function. Conclusion: We observed 9.9% in-hospital mortality rate in the study cohort. Cerebral malaria was an important risk factor for mortality in malarial AKI patients. Severity of renal dysfunction did not correlate with the mortality risk in our study. © 2013 Informa Healthcare USA, Inc.
Prevalence of autoantibodies and HLA DR, DQ in type 1 diabetes mellitus
(Journal of Clinical and Diagnostic Research, 2016) Shailja Singh; Usha; Gyanendra Singh; Neeraj Kumar Agrawal; Rana Gopal Singh; Shashi Bhushan Kumar
Introduction: Type I diabetes Mellitus (T1DM) is caused by autoimmune destruction of β-cells of pancreas. Two forms of T1DM are known called as 1A (autoimmune) and 1B (idiopathic). Aim: Aim was to study the prevalence of Anti-TTG IgA, Anti-TPO, GADA, ZnT8 and IA-2 autoantibodies and HLA DR and DQ genes and its diagnostic value in T1DM.Materials and Methods: Thirty four T1DM patients, 59 type 2 diabetes mellitus (T2DM) patients and 28 healthy controls were included in study. Antibodies levels were estimated by ELISA and HLA typing was performed by SSP-PCR method.Result: The prevalence of various autoantibodies in T1DM were Anti-TTG 14.7%, Anti-TPO 17.65%, GADA 38.23%, ZnT8 11.76% and IA-2 5.88%. Only GADA and ZnT8 were significantly positive in T1DM. GADA (66.67%) and ZnT8 (33.33%) positivity was more in patients below 15 years age while levels of other antibodies were higher after 15 years age. All autoantibodies were detected in higher frequency in T1DM than in T2DM and controls.HLA DR and DQ typing showed highly significant increase in DRB1*0301 (61.76%, p=0.00) and DQB1*0201 (64.71%, p=0.00) in T1DM. Subjects with HLA DRB1*0301 and DQB1*0201 had 80-100% positive prevalence of GADA, ZnT8, IA-2, Anti-TTG and Anti-TPO autoantibodies.Conclusion: Combination of GADA antibody with DRB1 and DQB1 estimation improved diagnosis of T1A than insulin antigen specific antibodies alone. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.
Renal biopsy findings in patients with hypothyroidism: Report of 16 cases
(Journal of Clinical and Diagnostic Research, 2016) Usha Singh; Varnika Rai; Rajeev Singh; Deepa Santosh; Jai Parkash; Rana Gopal Singh; Shivendra Singh
Introduction: Hypothyroidism is prevalent in India. Its association with renal diseases though not very common but have been described in many studies. Here we are reporting renal biopsy findings in 16 cases, all of whom were already diagnosed cases of hypothyroidism. Aim: To study renal parenchymal diseases associated in patients with hypothyroidism. Materials and Methods: Formalin fixed paraffin embedded sections of renal biopsy were examined after staining with H&E, PAS and Acid Fuschin Orange G (AFOG) stain. Serum urea/ creatinine measurements done by semi-autoanalysers and urine analysis were done by using urine strips and light microscopy. Results: In 16 cases, M:F ratio was 9:7. Duration of disease varied from 6 months to 14 years. Blood urea and serum creatinine were raised in 10 cases (62.5%) and nephrotic range proteinuria was present in 13 cases (81.25%). Two of the patients had co existing systemic lupus erythaematous. Renal pathology revealed membranous glomerulonephritis (GN) in both cases. In renal biopsy seven cases (43.75%) had pure Membranous Glomerulonephritis (MGN), 4 cases (25%) had mixture of Mesangial cell proliferation and membranous Glomerulonephritis(GN) also called MembranoProliferative GN (MPGN). Another four cases (25%) had Focal Segmental Glomerulosclerosis (FSGS) with chronic interstitial nephritis and one case was having minimal change disease. Conclusion: Thus present study concludes that hypothyroidism can cause renal parenchymal disease like membranous GN, mesangiocapillary GN which is also called as membranoproliferative GN and FSGS. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.
Serum Prolidase Activity and Oxidative Stress in Diabetic Nephropathy and End Stage Renal Disease: A Correlative Study with Glucose and Creatinine
(Hindawi Publishing Corporation, 2014) Akhilesh Kumar Verma; Subhash Chandra; Rana Gopal Singh; Tej Bali Singh; Shalabh Srivastava; Ragini Srivastava
Association of oxidative stress and serum prolidase activity (SPA) has been reported in many chronic diseases. The study was aimed at evaluating the correlation of glucose and creatinine to SPA and oxidative stress in patients with diabetic nephropathy (DN) and end stage renal disease (ESRD) concerned with T2DM. 50 healthy volunteers, 50 patients with T2DM, 86 patients with DN, and 43 patients with ESRD were considered as control-1, control-2, case-1, and case-2, respectively. Blood glucose, creatinine, SPA, total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) were measured by colorimetric tests. SPA, TOS, and OSI were significantly increased in case-1 and case-2 than control-1 and control-2, while TAS was significantly decreased (P<0.001). Blood glucose was linearly correlated to SPA, TOS, TAS, and OSI in control-2, case-1 and case-2 (P<0.001). Serum creatinine was linearly correlated with SPA, TOS, TAS and OSI in control-2 and case-1 (P<0.001). In case-2, serum creatinine was significantly correlated with SPA only (P<0.001). Thus, the study concluded that SPA and oxidative stress significantly correlated with blood glucose and creatinine. SPA, TOS, TAS, and OSI can be used as biomarkers for diagnosis of kidney damage. © 2014 Akhilesh Kumar Verma et al.
Variation of body fat percentage with special reference to diet modification in patients with chronic kidney disease: a longitudinal study.
(2014) Neha Srivastava; Rana Gopal Singh; Kumar Alok; Shivendra Singh
Visceral adiposity causes hypertension, hyperglycemia and dyslipidemia. This study was conducted to evaluate whether a correlation exists between body fat percentage (BFP) of chronic kidney disease (CKD) patients and their dietary intake. In this hospital-based, quasi-experimental study, 135 incident cases of CKD were included, of whom 76 completed the study. The patients included were aged 18 years and above and had a body mass index (BMI) between 18 and 25 kg/m [2] , had CKD of any etiology and serum creatinine of up to 5 mg/dL. Patients with acquired immunodeficiency syndrome, active hepatitis B or C, malignancy, previous kidney transplantation, current participation in any trial, diabetes mellitus and those who were on dia-lysis were excluded. The study patients were put on a diet of 25-30 kcal/kg/day, with 60% of the calories coming from carbohydrates and 20% each from protein and fat. Assessment was made at baseline (BL) and at 12 months (TM) for anthropometric parameters, skin-fold thickness, nutritional parameters, serum albumin and dietary intake (3-day dietary record) and clinical characteristics. No significant change was seen in BFP, waist circumference (WC) and BMI at BS and at TM. There was significant improvement in serum albumin (P <0.05) and e-GFR (P <0.01) while CRP was elevated both at BL and TM. The dietary intake was within the prescribed limit, with significant improvement in energy intake between BS and TM (P <0.05). The intake of delta dietary protein and fat positively correlated with delta e-GFR (P <0.001). There was a significant association between change in BFP and change in BMI (P <0.005). During follow-up, there was no significant change in biochemical parameters and BFP as well as stage of CKD of the study patients. This study supports the fact that dietary counseling is an important part of treatment in patients with CKD.