Browsing by Author "Surendra Singh Rathore"

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Changing epidemiology of community-acquired acute kidney injury in developing countries: Analysis of 2405 cases in 26 years from eastern India
(2013) Jai Prakash; Takhellambam Brojen Singh; Biplab Ghosh; Vinay Malhotra; Surendra Singh Rathore; Rubina Vohra; Rabindra Nath Mishra; Pramod Kumar Srivastava; Usha
BackgroundThe epidemiology of acute kidney injury (AKI) differs from country to country and varies from center to center within a country. Owing to the absence of a central registry, data on overall epidemiology of AKI are scanty from India.MethodsThis study aimed at describing changes in epidemiology of community-acquired AKI (CAAKI) over a time span of 26 years in two study periods, namely, 1983-95 and 1996-2008.ResultsWe studied 2405 (1375 male and 1030 female) cases of AKI in the age range 1-95 (mean: 40.32) years. The incidence of CAAKI in 1983-95 and 1996-2008 was 1.95 and 4.14 per 1000 admission, respectively (P < 0.01). Obstetrical AKI has decreased because of the declining number of post-abortal AKI. Surgical AKI decreased from 13.8% in 1983-95 to 9.17% in 1996-2008(P < 0.01). Malarial AKI increased significantly from 4.7% in the first half of the study to 17% in the later period (P < 0.01). Diarrhea-associated AKI had significantly decreased from 36.83% in 1983-95 to 19% in 1996-2008 (P < 0.01). Sepsis-related AKI had increased from 1.57% in 1983-95 to 11.43% in 1996-2008 (P < 0.01). Nephrotoxic AKI showed an increasing trend in recent years (P < 0.01) and mainly caused by rifampicin and NSAIDs. Liver disease-related AKI increased from 1.73% in 1983-95 to 3.17% in 1996-2008 (P < 0.01). Myeloma-associated acute renal failure (ARF) accounted for 1.25% of the total number of ARF cases in the period 1996-2008. HIV infection contributed to 1.65% of ARF of the total number of AKI cases in the second period (1996-2008). Incidence of renal cortical necrosis (RCN) decreased significantly from 5.8% in 1983-95 to 1.3% in 1996-2008 of the total number of ARF cases (P < 0.01). However, during the same period ARF due to acute tubular necrosis, acute glomerulonephritis and acute interstitial nephritis remained unchanged. The mortality rate from AKI decreased significantly from 20% in 1983-95 to 10.98% in 1996-2008 (P < 0.01).ConclusionsThe epidemiological characteristics of CAAKI have changed over the past three decades. There has been an increase in the overall incidence of ARF with the changing etiology of AKI in recent years. Incidences of obstetrical, surgical and diarrheal AKI have decreased significantly, whereas those of AKI associated with malaria, sepsis, nephrotoxic drugs and liver disease have increased. RCN has decreased significantly. In contrast to developed nations, community-acquired AKI is more common in developing countries. It often affects younger individuals and is caused by single and preventable diseases. © 2013 The Author.
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.
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.
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.
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]
The changing pattern of renal amyloidosis in indian subcontinent: Two decades of experience from a single center
(2012) Jai Prakash; Takhellambam Brojen; Surendra Singh Rathore; Tauhidul Alam Choudhury; Tribhuwan Gupta; Usha
Background: Renal amyloidosis is a major cause of morbidity and mortality among the patients of systemic amyloidosis. The causes of amyloidosis vary from country to country and from time to time at individual center. Aim: This study investigates the changes in epidemiological and clinical profile of renal amyloidosis in recent years. Method: Cases of biopsy-proven renal amyloidosis from January 1992 to December 2010 were studied retrospectively. They were divided into two groups: 1990s (between 1992 and 2002) and 2000s (between 2003 and 2010). The clinical characteristics of patients were studied and compared between the groups. Result: A total of 2498 (974 in 1990s and 1524 in 2000s) renal biopsies was done during the 19-year period. The incidence of amyloidosis in 1990s and 2000s was 1.74% (n = 17) and 1.9% (n = 29), respectively (p > 0.05). We noted that the incidence of renal amyloidosis increased significantly (p < 0.05) among the females in 2000s. The mean age of patients in 2000s and 1990s was 38 ± 17.9 and 39.2 ± 19 years, respectively (p = 0.83). Renal insufficiency in patients with renal amyloidosis significantly increased (p < 0.05) in 2000s (n = 14; 48.2%) in comparison to 1990s (n = 2; 12.8%). Subnephrotic proteinuria was observed in 12.8% (n = 2) and 48.82% (n = 14) of patients in 1990s and 2000s, respectively (p <0.05). Infection (n = 10; 58.8%) was the most common cause of secondary amyloidosis during the 1990s, whereas chronic inflammation (n = 14; 48.2%) was the most common cause in 2000s. In 1990s, the incidence of ankylosing spondylitis (AS) and rheumatoid arthritis (RA) was 11.7% (n = 2) and 5.8 (n = 1), respectively, but in 2000s, their respective incidence was 17.2% (n = 5) each. Multiple myeloma (MM) was the most common cause of amyloid light chain protein (AL) amyloidosis in both the groups. We observed systemic lupus erythromatosus (SLE)-related renal amyloidosis in two cases and Hodgkin lymphoma-associated amyloidosis in one case in 2000s. Conclusion: The overall incidence of renal amyloidosis showed little change from 1990s to 2000s. Chronic inflammatory diseases were the most common cause of renal amyloidosis in 2000s in contrast to infections in 1990s. Female gender was more affected in 2000s than in 1990s. Renal insufficiency and subnephrotic-range proteinuria were more frequent clinical manifestations of renal amyloidosis in recent years (2000s) in comparison to the earlier decade (1990s). © 2012 Informa Healthcare USA, Inc.