Browsing by Author "Shivendra Singh"

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A Case of Post Traumatic Delayed CAPD Catheter Fistula with Uterus and Bowel
(Scientific Scholar LLC, 2024) Shivendra Singh; Nikhil Chaudhary
[No abstract available]
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.
Community-acquired acute kidney injury in India: data from ISN-acute kidney injury registry
(Elsevier Ltd, 2024) Narayan Prasad; Akhilesh Jaiswal; Jeyakumar Meyyappan; Natrajan Gopalakrishnan; Arpita Roy Chaudhary; Edwin Fernando; Manish Rathi; Shivendra Singh; Mohan Rajapurkar; Tarun Jeloka; Jai Kishun; Valentine Lobo
Background: Acute kidney injury (AKI), particularly community-acquired AKI (CA-AKI), is a major health concern globally. The International Society of Nephrology's “0 by 25” initiative to reduce preventable deaths from AKI to zero by 2025 is not achievable in low and middle income countries, such as India, possibly due to a lack of data and measures to tackle this urgent public health issue. In India, CA-AKI predisposes younger patients to hospitalization, morbidity, and mortality. This is the first multicenter, prospective, cohort study investigating CA-AKI and its consequences in India. Methods: This study included data from patients with CA-AKI (>12 years of age) housed in the Indian Society of Nephrology-AKI registry, involving 9 participating tertiary care centers in India, for the period between November 2016 and October 2019. The etiological spectrum and renal and patient outcomes of CA-AKI at the index visit and at 1-month and 3-month follow-ups were analyzed. The impact of socioeconomic status (SES) on outcomes was also analyzed. Findings: Data from 3711 patients (mean [±SD] age 44.7 ± 16.5 years; 66.6% male) were analyzed. The most common comorbidities included hypertension (21.1%) and diabetes (19.1%). AKI occurred in medical, surgical, and obstetrical settings in 86.7%, 7.3%, and 6%, respectively. The most common causes of AKI were associated with sepsis (34.7%) and tropical fever (9.8%). Mortality at the index admission was 10.8%. Complete recovery (CR), partial recovery (PR), and dialysis dependency among survivors at the time of discharge were 22.1%, 57.7%, and 9.4%, respectively. Overall, at 3 months of follow-up, mortality rate, CR, PR, and dialysis dependency rates were 11.4%, 72.2%, 7.2%, and 1%, respectively. Multivariate analysis revealed that age >65 years, alcoholism, anuria, hypotension at presentation, thrombocytopenia, vasopressor use, transaminitis, and low SES were associated with mortality at the index admission. Interpretation: Sepsis and tropical fever were the most common causes of CA-AKI. Presentation of CA-AKI to tertiary care units was associated with high mortality, and a significant number of patients progressed to CKD. Individuals with a low SES had increased risk of mortality and require immediate attention and intervention. Funding: This study was funded by the Indian Society of Nephrology. © 2024 The Authors
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.
Early posttransplant erythrocytosis in renal allograft recipients
(2010) Jai Prakash; Shivendra Singh; Sanjeev Kumar Behura; Biplab Ghosh; L.K. Sharatchandra; U.S. Dwivedi
Posttransplant erythrocytosis (PTE) is defined as a persistently elevated hematocrit to a level greater than 51% after renal transplantation. It usually develops 8 to 24 months after transplantation. We report occurrence of PTE in two male renal allograft recipients within first 8 months of transplantation. © JAPI.
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.
Heterogeneity in Kidney Histology and Its Clinical Indicators in Type 2 Diabetes Mellitus: A Retrospective Study
(MDPI, 2023) Shivendra Singh; Prem Shankar Patel; Archana Archana
The heterogeneous spectrum of kidney disease in diabetes ranges from albuminuric or non-albuminuric diabetic kidney disease to non-diabetic kidney diseases. Presumptive clinical diagnosis of diabetic kidney disease may lead to an erroneous diagnosis. Material and Method: We analyzed the clinical profile and kidney biopsy of a total of 66 type 2 diabetes patients. Based on kidney histology, they were divided into—Class I (Diabetic Nephropathy), Class II (Non-diabetic kidney disease), and Class III (Mixed lesion). Demographic data, clinical presentation, and laboratory values were collected and analyzed. This study tried to examine the heterogeneity in kidney disease, its clinical indicator, and the role of kidney biopsy in the diagnosis of kidney disease in diabetes. Results: Class I consisted of 36(54.5%), class II 17(25.8%), and class III 13(19.7%) patients. The commonest clinical presentation was nephrotic syndrome 33(50%) followed by chronic kidney disease 16(24.4%) and asymptomatic urinary abnormality 8(12.1%). Diabetic retinopathy (DR) was present in 27(41%) cases. DR was significantly higher in the class I patients (p < 0.05). Specificity and positive predictive values of DR for DN were 0.83 and 0.81, respectively (sensitivity 0.61; negative predictive values 0.64). The Association of the duration of diabetes and the level of proteinuria with DN was statistically not significant (p > 0.05). Idiopathic MN (6) and Amyloidosis (2) were the most common isolated NDKD; whereas diffuse proliferative glomerulonephritis (DPGN) (7) was the commonest NDKD in mixed disease. Another common form of NDKD in mixed disease was Thrombotic Microangiopathy (2) and IgA nephropathy (2). NDKD was observed in 5(18.5%) cases in presence of DR. We noted biopsy-proven DN even in 14(35.9%) cases without DR, in 4(50%) cases with microalbuminuria and 14(38.9%) cases with a short duration of diabetes. Conclusion: Almost half (45%) of cases with atypical presentation have non-diabetic kidney disease (NDKD), though even among these cases with atypical presentation diabetic nephropathy (either alone or in mixed form) is commonly seen in 74.2% of cases. DN has been seen in a subset of cases without DR, with microalbuminuria, and with a short duration of diabetes. Clinical indicators were insensitive in distinguishing DN Vs NDKD. Hence, a kidney biopsy may be a potential tool for the accurate diagnosis of kidney disease. © 2023 by the authors.
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).
Insulin resistance in predialytic, nondiabetic, chronic kidney disease patients: A hospital-based study in Eastern Uttar Pradesh, India
(NLM (Medline), 2017) Neha Srivastava; R.G. Singh; Alok Kumar; Shivendra Singh
Most investigations have focused on patients with end-stage renal disease (ESRD). More recently, due to increased recognition of the high prevalence of moderate-to-severe chronic kidney disease (CKD), attention has been redirected to this patient population to identify risk factors associated with hospitalization, death, and progression to ESRD. The objective of this study was to examine the degree and determinants of insulin resistance (IR) in predialytic, nondiabetic, CKD patients. Our study is a hospital-based cross-sectional study. The participants were aged 18 years and above with CKD due to any cause, were all nondiabetic patients, and the mean serum creatinine was 1.41-5 mg/dL. Anthropometric parameters included body weight, height, and skinfold thickness. Homeostasis model assessment of IR (HOMA-IR) score was 2.5 ± 1.2 in CKD patients and 1.9 ± 0.7 in controls. In the unadjusted analysis, there was a significant (P <0.05) correlation between HOMA-IR and body mass index (BMI), waist circumference, cholesterol, and triglyceride (TG) levels. Upon adjusting for age and sex, total body fat (BF), globulin, TG, and C-reactive protein were having positive, significant (P <0.05) correlation with HOMA-IR. In multivariate regression models, BMI and total BF% were significant (P <0.05) predictors of IR in patients with CKD but not in controls. BF% and BMI are indicators of IR in CKD as in non-CKD population.
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.
Intradialytic complications of hemodialysis
(2011) Loukrakpam Sharatchandra Singh; Shivendra Singh; T. Brojen Singh; Sanjeev Kumar Behura; Biplab Ghosh; Sashidhar Shreeniwas
Aim of study: To study the intradialytic complications of hemodialysis. Methods: 275 patients of renal failure comprising of 125 acute renal failure and 150 chronic renal failure patients who were registered for conventional hemodialysis during the period of May 1, 2007 and May 15, 2008 were taken up for the intradialytic complications of hemodialysis regardless of age, sex,race and cause of renal failure. Special emphasis has been given for complications related to vascular access sites like femoral, arterio-venous and internal jugular venous punctures. During the study period there were 1075 bicarbonate dialyses on these patients. Most of the ARF and CRF patients were dialysed by femoral vein access. Among the patients on CRF, 10 patients were on arterio-venous fistula and 8 were on internal jugular venous catheterizations. Results: In the ARF patients, common intradialytic complications were hypotension (12.2%), vomiting (5.2%), headache (5.2%), rigor (2.4%), hypertension (1.2%), nausea (1%), cramps (0.8%), oedema (0.9%), fever (0.6%), first-use syndrome (0.4%), hypoglycemia (0.4%), and itching (0.2%). In the CRF group, common complications were hypertension (11.4%), hypotension (10.48%), vomiting (8.7%), rigor (5.7%), chest pain (4.6%), nausea (3.1%), headache (3.1%), fever (1.6%), cramps (0.71%), itching (0.35%) and haematoma (0.35%). Intracerebral hemorrhage and migration of fractured catheter tip were noted in one patient each. Conclusion: There is a need for a special attention for the diagnosis and management of intradialytic complications of hemodialysis because such complications could be managed successfully without the need of subsequent termination of dialysis procedure.
Intravenous catheter associated complications
(Journal of Association of Physicians of India, 2010) Shivendra Singh; Jai Prakash; V.K. Shukla; L.K. Sharatchandra Singh
Two cases of intravenous catheter associated complications are reported herewith. © JAPI.
Nonmedical factors and health-related quality of life in CKD in India
(American Society of Nephrology, 2020) Gopesh K. Modi; Ashok K. Yadav; Arpita Ghosh; Kajal Kamboj; Prabhjot Kaur; Vivek Kumar; Shobhit Bhansali; Narayan Prasad; Manisha Sahay; Sreejith Parameswaran; Santosh Varughese; Sishir Gang; Shivendra Singh; Dipankar Sircar; Natarajan Gopalakrishnan; Ajay Jaryal; Sanjay Vikrant; Seema Baid Agarwal; Vivekanand Jha
Background and objectives Patient-reported outcomes have gained prominence in the management of chronic noncommunicable diseases. Measurement of health-related quality of life is being increasingly incorporated into medical decision making and health care delivery processes. Design, setting, participants, & measurements The Indian Chronic Kidney Disease Study is a prospective cohort of participants with mild to moderate CKD. Baseline health-related quality of life scores, determined by the standardized Kidney Disease Quality of Life 36 item instrument, are presented for the inception cohort (n52919). Scores are presented on five subscales: mental component summary, physical component summary, burden, effect of kidney disease, and symptom and problems; each is scored 0–100. The associations of socioeconomic and clinical parameters with the five subscale scores and lower quality of life (defined as subscale score <1 SD of the sample mean) were examined. The main socioeconomic factors studied were sex, education, occupation, and income. The key medical factors studied were age, eGFR, diabetes, hypertension, and albuminuria. Results The mean (SD) subscale scores were physical component summary score, 4369; mental component summary score, 48610; burden, 61633; effects, 87613; and symptoms, 90620. Among the socioeconomic variables, women, lower education, and lower income were negatively associated with reduced scores across all subscales. For instance, the respective b-coefficients (SD) for association with the physical component summary subscale were 22.6 (23.4 to 21.8), 21.5 (22.2 to 20.7), and 21.6 (22.7 to 20.5). Medical factors had inconsistent or no association with subscale scores. The quality of life scores also displayed regional variations. Conclusions In this first of its kind analysis from India, predominantly socioeconomic factors were associated with quality of life scores in patients with CKD. © 2020 by the American Society of Nephrology.
Norepinephrine augmented in vitro growth of uropathogenic E. coli in Type 2 diabetes mellitus and its suppression by silodosin (alpha blocker)
(Elsevier Inc., 2018) Dinesh Prasad Gond; Shivendra Singh; N.K. Agrawal
Norepinephrine is secreted under conditions of stress in humans. The ability of bacteria to sense mammalian hormone may have a role in propagation of infection. The present study investigated the effect of norepinephrine on in vitro growth of uropathogenic E. coli (UPEC) and the effect of silodosin on norepinephrine-induced changes. The spot urine samples were collected from 56 individuals (14 diabetic patients with UTI, 14 diabetic without UTI, 14 non-diabetic UTI and 14 healthy volunteer controls) for the measurement of urinary norepinephrine concentrations. The concentration of norepinephrine, as found in urine of human subjects, was reproduced in artificial urine medium to study the growth of UPEC. The norepinephrine concentration showing maximum growth response was selected to study the effect of silodosin on the growth inhibition of UPEC. Result showed significantly elevated urinary norepinephrine in diabetic patients with and without UTI and also in nondiabetic UTI groups. The norepinephrine concentration equivalent to that in diabetic UTI patients enhanced the growth of UPEC. Furthermore, silodosin (0.32 μM) inhibited the growth of the UPEC. © 2018 Elsevier Inc.
Outcomes of hospital-acquired acute kidney injury in elderly patients: a single-centre study
(Springer Science and Business Media B.V., 2019) Shivendra Singh; Prem Shankar Patel; Prodip Kumar Doley; Shiv Shankar Sharma; Mohd. Iqbal; Anupam Agarwal; Neelam Singh; Alok Kumar
Background HAAKI is a common clinical problem in hospitalized patients. Its incidence is high in older patients and carries worse prognosis. The presence of multiple co-morbidities, aging process, and frequent diagnostic and therapeutic interventions predispose elderly patients to HAAKI. This study aims to evaluate the spectrum, risk factors and determinants of outcome of elderly patients with HAAKI. Methods This prospective study was conducted during January 2014 to September 2015 in the Department of nephrology, Institute of Medical Sciences, BHU, Varanasi, UP, India. First 100 HAAKI elderly (> 60 years) patients, who fulfilled the inclusion criteria were enrolled for study. HAAKI was defined as per RIFLE criteria after minimum 48 h of hospitalization. Clinical, biochemical, and radiological evaluation were done. Follow up was done till discharge or up to 30 days whichever was later. Results Till selection and enrollment of first 100 HAAKI patients, total 23507 patients were hospitalized. 11.2% (n = 2635) patients were ≥ 60 years of age. Among 2635 elderly patients, 3.79% (n = 100) developed HAAKI. Commonest causes of HAAKI were sepsis (37%) followed by drugs like NSAID, Contrast agent, Amphotericin B, and antibiotics including amino glycosides in (24%) patents. DM and HTN were the commonest risk factors. Mortality was noted in 45% cases and rest 55% patients recovered with partial or full recovery of renal function. ICU admission, Oliguria, RIFLE-F, need of RRT, and SOFA score > 11 were independent determinants of outcome of elderly patients with HAAKI. Conclusion HAAKI is associated with increased morbidity and mortality in elderly patients. Associated co-morbid conditions predispose elderly patients to HAAKI. ICU admission, Oliguria, severity of renal failure, requirement of RRT, and initial SOFA score were strong predictors of survival of elderly patients with HAAKI. © Springer Nature B.V. 2019.
Outcomes of symptomatic coronavirus disease 19 in maintenance hemodialysis patient in India
(John Wiley and Sons Inc, 2021) Narayan Prasad; Manas Ranjan Behera; Mansi Bhatt; Sanjay Kumar Agarwal; N. Gopalakrishnan; Edwin Fernando; Arpita Roy Chaudhary; Manisha Sahay; Shivendra Singh; Apoorva Jain; Shruti Tapiawala; Aniket Kamble; Umesh Khanna; Rubina Bohra; Anurag Gupta; Urmila Anandh; Vivekanand Jha
Background: Maintenance hemodialysis (MHD) patients face disadvantages with higher risk of acquiring SARS-CoV-2 infection, atypical manifestations, and associated multiple comorbidities. We describe patients' outcomes with symptomatic COVID-19 on MHD in a large cohort of patients from India. Methods: Data were collected prospectively from hemodialysis units in 11 public and private hospitals between March 15, 2020, and July 31, 2020. The survival determinants were analyzed using stepwise backward elimination cox-regression analysis. Results: Of the 263 total patients (mean age 51.76 ± 13.63 years and males 173) on MHD with symptomatic COVID-19, 35 (13.3%) died. Those who died were older (p = 0.01), had higher frequency of diabetic kidney disease (p = 0.001), comorbidities (p = 0.04), and severe COVID-19 (p = 0.001). Mortality was higher among patients on twice-weekly MHD than thrice-weekly (p = 0.001) and dialysis through central venous catheter (CVC) as compared to arteriovenous fistula (p = 0.001). On multivariate analysis, CVC use (HR 2.53, 95% CI 1.26–5.07, p = 0.009), disease severity (HR = 3.54, 95% CI 1.52–8.26, p = 0.003), and noninvasive ventilatory support (HR 0.59, 95% CI 0.25–0.99, p = 0.049) had significant effect on mortality. Conclusion: The adjusted mortality risk of COVID-19 in MHD patients is high in patients associated with severe COVID-19 and patients having CVC as vascular access. © 2021 Wiley Periodicals LLC.
Predicting the Risk of Progression in Indian ADPKD Cohort using PROPKD Score - A Single-Center Retrospective Study
(Wolters Kluwer Medknow Publications, 2023) Shivendra Singh; H.C. Sreenidhi; Parimal Das; Chandra Devi
Background: With the variable genotype-phenotype expression of autosomal dominant polycystic kidney disease (ADPKD) and availability of novel targeted therapies, it is important to find predictors for rapid progression. The PROPKD score, consisting of genetic and clinical parameters like sex, hypertension, and urological events, is a useful tool in predicting the risk of progression. This study was aimed to determine the risk of ADPKD progression in Indian patients using the PROPKD score. Materials and Methods: A retrospective study was done from 2006 to 2021. ADPKD patients with ESRD were included in the study. Scoring was done as per the PROPKD score as follows: male sex: 1, onset of hypertension before 35 years: 2, first urological event before 35 years: 2, PKD1 truncating mutation: 4, PKD1 non-truncating mutation: 2, and PKD2 mutation: 0. Two types of risk classifications were done as follows: (a) considering the clinical variables in all 73 patients (male sex, onset of hypertension before 35 years, and first urological event before 35 years), they were classified into three risk groups: low-risk group (0-1), intermediate-risk group (2-3), and high-risk group (4-5) and (b) considering the clinical variables and type of mutation in 39 patients, they were classified into three risk groups: low-risk group (0-3), intermediate-risk group (4-6), and high-risk group (7-9). Results: Total number of patients included was 73, with the median age at ESRD being 54 years. High-risk group of clinical variables with hazard ratio (HR) of 4.570 (2.302-9.075, P < 0.001) and high-risk group of the PROPKD score with HR of 6.594 (1.868-23.284, P = 0.003) were associated with early ESRD. High-risk groups of both classifications were associated with early ESRD. Conclusion: High-risk groups based on the PROPKD scoring and clinical variables were associated with early progression to ESRD. © 2023 Wolters Kluwer Medknow Publications. All rights reserved.
Prescription Practices in Patients With Mild to Moderate CKD in India
(Elsevier Inc., 2021) Narayan Prasad; Ashok Kumar Yadav; Monica Kundu; Jasmin Sethi; Ajay Jaryal; Dipankar Sircar; Gopesh K. Modi; Kajal Kamboj; Manisha Sahay; Natarajan Gopalakrishnan; Prabhjot Kaur; Sanjay Vikrant; Santosh Varughese; Seema Baid-Agrawal; Shivendra Singh; Sishir Gang; Sreejith Parameswaran; Vivek Kumar; Arpita Ghosh; Vivekanand Jha
Introduction: Patients with chronic kidney disease (CKD) require multiple medications. There is no information on prescription patterns or the use of evidence-based therapies for management of CKD from low-middle-income countries. Using baseline data from the Indian CKD (ICKD) cohort, we describe the drug prescription practices in patients with mild to moderate CKD. Methods: The ICKD study is a prospective, observational cohort study of mild to moderate kidney disease across 11 centers in India. We analyzed all the prescriptions captured at enrollment in the ICKD study. Drugs were categorized into 11 different groups. We provide descriptive data on prescription details and evaluate the appropriateness of medication use. Results: Complete prescription data were available in 3966 out of 4056 (97.8%) subjects enrolled in the ICKD database. Most patients had stage 3 CKD, 24.9% had diabetic kidney disease, 87% had hypertension, and 25.5% had moderate to severe proteinuria. Renin-angiotensin-aldosterone system blockers were prescribed in less than half (47.9%) and in 58.8% of patients with proteinuric CKD. Metformin was prescribed in 25.7% of diabetic subjects with CKD. Only 40.4% of patients were taking statins; 31.1% and 2.8% subjects with anemia were receiving iron and erythropoiesis-stimulating agents, respectively. Conclusion: This study highlights the missed opportunities for improving outcomes through appropriate prescriptions of drugs in patients with CKD. There is need for dissemination of evidence-based guidelines and institution of sustainable implementation practices for improving the overall health of patients with CKD. © 2021 International Society of Nephrology
Prognostic value of modified National Institute of Health activity and chronicity scoring in determining complete renal response in newly diagnosed lupus nephritis: a retrospective single centre study
(Springer Science and Business Media B.V., 2022) Shivendra Singh; H.C. Sreenidhi
Introduction: Early response to therapy is associated with favourable long-term outcome in LN. The working group of revision of ISN/RPS classification guidelines for LN recommended modified National Institute of Health (NIH) activity and chronicity scoring system to evaluate active and chronic lesions. Data on usefulness of modified NIH scoring system to determine complete renal response (CR) in LN are sparse. Methods: We retrospectively studied 80 LN patients diagnosed from June/2018 to April/2020, who has followed up for more ≥ 6 months in our hospital. CR was defined by inactive urinary sediment, urine PCR of 0.5 g/g in a 24 h urine collection and normalization/stabilization of renal function. Pathologic lesions were described as per revised 2018 ISN/RPS classification and the modified NIH scoring system. Patients were grouped by AI (low, 0–5; moderate, 6–11; high, 12–24) and CI (low, 0–2; moderate, 3–5; high, 6–12). Time to event was analysed using Kaplan–Meier curves. Prognostic variables for CR were analysed by multivariable Cox proportional hazard models. Results: With a median follow-up of 8 months, 50 patients (62.5%) achieved CR. Kaplan–Meier curves showed lower CR with high AI groups (p value = 0.001) and moderate/high CI groups (p value < 0.001). Moderate and high CI with HR of 0.088 (0.034–0.229) p value < 0.001 and Glomerulosclerosis Score with HR of 0.155 (0.072–0.331) p value < 0.001 were significant determinant of CR. Conclusion: Moderate and high CI scores were associated with lower chances of CR in LN. Glomerulosclerosis of CI was significant determinant of CR. © 2022, The Author(s), under exclusive licence to Springer Nature B.V.
Prolonged elevated postprandial sugar augments severity in kidney disease: A North Indian hospital-based study
(2014) Subhash Chandra; Alok K. Singh; Mritunjai Singh; Parimal Das; Shivendra Singh; Haushila P. Pandey; Rana G. Singh
Aim: Diabetes plays a major role in progression of renal failure. The risk-factor profile changes during the progression of chronic kidney disease (CKD) from mild/moderate to end-stage renal disease. The relationship between glycemic indices, blood pressure, body mass index (BMI) and age at diagnosis in Indians has been less investigated. We assessed association of these risk factors with CKD stages in Indian population. Methods: This study was carried out on patients (n=162) who were diagnosed with CKD and normal control group (n=155). For BMI, National Institutes for Health criteria were used to categorize the patients. Result: The mean age of CKD patients were significantly increased with the advancement of stage. BMI, systolic blood pressure (SBP), postprandial sugar level (PP), urea and creatinine were also significantly higher with elevated stages, whereas no differences were observed in diastolic blood pressure (DBP) and fasting blood sugar (FBS). The logistic regression study gave a significant result (p=0.000) when we compared the group of CKD patients with established/prolonged postprandial blood sugar. It was independently associated with mild CKD [odds ratio (OR)=5.213, 95% confidence interval (CI)=2.06-13.21, p=0.000], moderate CKD (OR=7.724, 95% CI=4.05-14.74, p=0.000) and severe CKD (OR=7.610, 95% CI=4.03-14.36, p=0.000). Conclusion: SBP and PP were the best predictors of prevalent nephropathy in this population, while DBP and FBS were found to be less effective. This may have implication for kidney disease risk stratification and protection. © 2014 Informa Healthcare USA, Inc.