Browsing by Author "Usha"

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A preliminary study on the significant value of beta-2-microglobulin over serum creatinine in renal transplant rejection and renal failure
(2008) G.K. Sonkar; Usha; R.G. Singh
Introduction: Beta-2-microglobulin (β2M) is a light chain of HLA class I molecule, which is filtered by glomerulus, reabsorbed and catabolised by proximal tubule. It is one of the markers of transplant rejection. The aim of the present study was to find out the level of β2M in acute renal failure (ARF), chronic renal failure (CRF), renal transplant rejection (TR) and renal transplantation stable (TS) cases, and correlation of β2M with serum creatinine (SCr) in assessing renal failure. Methods: 23 patients with ARF, 22 patients with CRF, six cases of TR, seven patients with TS, and 28 normal healthy controls were studied within a one-year period. Results: Highest mean value of β2M was noted (12.97 +/- 3.83 μg/ml) in CRF, and all cases had elevated β2M of which 81.8 percent of cases had β2M above 10 μg/ml. In ARF, all cases had elevated β2M and 78.3 percent patients had a value more than 10 μg/ml with a mean value of 11.75 +/- 2.09 μg/ml. TR cases also had elevated β2M but 50 percent had mild elevation (less than 10 μg/ml) and 50 percent had marked elevation (more than 10 μg/ml). 42.8 percent of TS patients also had mild elevation of β2M in the range 2.10-3.70 μg/ml. Interestingly, in normal healthy controls, 21.4 percent of patients had mild elevation of β2M of 2.1-2.75 μg/ml, while 78.6 percent of cases had a normal range of β2M (less than 2 μg/ml). All normal healthy controls and 71.4 percent of TS cases had normal SCr (less than 1.4 mg/dL). All cases of CRF and TR cases, and 28.6 percent of TS cases had elevated SCr. 81.8 percent of cases with CRF and 60.9 percent of cases with ARF had a marked rise of serum creatinine above 5 mg/dL. Conclusion: Our study showed that β2M is not superior over SCr for renal failure and TR cases, because it is also elevated in 21.4 percent of normal controls and 42.8 percent of TS cases. SCr is a cheaper, simpler and comparatively good test to assess renal failure and TR.
A Probable Explanation for Mild Extra-articular Manifestations in Indian Patients of Rheumatoid Arthritis: A Preliminary Study
(1998) Vibha Agrawal; Usha; S.C. Goel; Ratah Mala Gupta
One hundred four Rheumatoid factor (RF) positive Rheumatoid Arthritis (RA) patients fulfilling ARA criteria were screened for extraarticular manifestations. Rheumatoid nodules were present in 2.8% cases. Other extraarticular manifestations such as pulmonary, cardiac, occular, renal or GI involvement were absent in these cases. However, circulating immune complexes (CICs) were highly significantly raised in all the RA patients (P<0.001). From amongst these cases a limited number (8 cases) have been subjected to qualitative and quantitative analysis of CICs to look for whether there could be any relationship between these and mild extraarticular manifestations that were being noticed in our groups of patients. Finding showed IgG-IgG CICs in. five, IgG-IgM in two and IgG-IgA in one case. Quantitative analysis revealed mean IgG 4.97±1.7 IU/ml, IgM 14.58±5.53 IU/ml and IgA 5.08±1.53 IU/ml on LD Solugen plates. Serum concentration of C3 was not reduced (94.1±8.9 mg/dl). Low IgM contents of CICs and no reduction in complement level is the likely explanation for less severe inflammatory manifestations seen in our study. The conclusion and findings have been discussed in the light of observation reported by the Western, workers.
Acute kidney injury in patients with human immunodeficiency virus infection
(Wolters Kluwer Medknow Publications, 2015) J. Prakash; T. Gupta; S. Prakash; S.S. Rathore; Usha; S. Sunder
Acute kidney injury (AKI) is an important cause of hospitalization and morbidity in human immunodeficiency virus (HIV)-positive patients. However, the data on AKI in such patients is limited. The aim of the present study was to analyze the incidence, causes and outcome of AKI in HIV-positive patients from our antiretroviral therapy centre. All HIV-positive patients were evaluated for evidence of clinical AKI. AKI was noted in 138/3540 (3.9%) patients. Of 138 AKI patients, 96 (69.6%) had acquired immuno deficiency syndrome and 42 (30.4%) were HIV seropositive. Majority of AKI patients belonged to AKI network (AKIN) Stage II (42%) or III (48.5%) at presentation. Prerenal, intrinsic and postrenal AKI were noted in 53.6%, 44.2% and 2.2% of cases, respectively. Hypovolemia (44.2%) and sepsis (14.5%) contributed to AKI in vast majority of cases. AKI was multifactorial (volume depletion, sepsis and drugs) in 39% of patients. Acute tubular necrosis (ATN) was the most common intrinsic lesion. Acute interstitial nephritis and diffuse endocapillary proliferative glomerulonephritis were noted in five and two cases, respectively. In-hospital mortality was 24.64%. Lower CD4 count, decreased serum albumin level and Stage 4 WHO disease were associated with higher mortality. At 3 months or more follow-up complete recovery of renal function, chronic kidney disease Stage 3-5 and progression to end stage renal disease were noted in 58.69%, 14.5% and 2.2% of cases, respectively. Thus, prerenal factors and ischemic ATN were the most common cause of AKI in HIV-infected patients. Recovery of renal function was seen in 59% of cases, but AKI had high in-hospital mortality.
Acute renal failure in pregnancy in a developing country: Twenty years of experience
(2006) Jai Prakash; Hemant Kumar; D.K. Sinha; P.G. Kedalaya; L.K. Pandey; P.K. Srivastava; R. Raja; Usha
Acute renal failure (ARF) has become a rare complication of pregnancy in developed countries. The aim of this study was to describe changing trends in pregnancy-related acute renal failure (PR-ARF) in two successive periods; 1982-1991 and 1992-2002. From July1982 to December 2002, 190 cases of PR-ARF were observed in Eastern India (11.6% of total number of ARF needing dialysis). Obstetrical complications were causative factors for ARF in 15% (65/426) and 10% (125/1201) of patients in the two periods, respectively. The incidence of PR-ARF fell from 15% in 1982-1991 to 10% in 1992-2002, with respect to the total number of acute renal failure cases. Post-abortal ARF showed a declining trend, 9% in the 1980s to 7% in the 2000s, of the total number of ARF cases. Preeclampsia-eclampsia was the cause of obstetrical ARF in 23% (1982-1991) and 14.4% (1992-2002) of cases in these two periods. The percentage of total ARF due to eclampsia declined from 3.5% during the period 1982-1991 to 1.4% in 1992-2002. Puerperal sepsis contributed to 0.8% of total ARF in recent years, compared to 2.4% in the earlier period. The incidence of cortical necrosis decreased significantly (p < 0.001) from 17% in 1982-1991 to 2.4% in the 2000s. The maternal mortality reduced to 6.4% in 1992-2002 from initial high mortality of 20% in the period of 1982-1991. Conclusion. PR-ARF which remained high in the initial period has decreased in recent years. This is associated with a declining trend in post-abortal ARF and a reduction in maternal mortality as well. We noted a significant decrease (p < 0.001) in the incidence of cortical necrosis in PR-ARF. The reasons for this favorable outcome in obstetrical ARF seem to be due to improved medical care, decrease in the number of septic abortions, effective care of obstetrical complications, and legalization of abortion. Copyright © Taylor & Francis Group, LLC.
Adenosine deaminase activity in nephrotic syndrome
(Oxford University Press, 1997) O.P. Mishra; Rajiv Garg; Z. Ali; Usha
Cell-mediated immunity (CMI) was evaluated in 40 children with idiopathic nephrotic syndrome and 20 healthy controls. The significantly decreased response to purified protein derivative (PPD) (P < 0.001), absolute lymophocyte count (ALC) (P < 0.02), T-lymphocytes percentage (P < 0.001) and elevated serum adenosine deaminase (ADA) activity (P < 0.001) were observed in patients with active nephrotic syndrome (ANS) in comparison to controls. The overall mean values of T-lymphocytes percentage and ADA activity in ANS patients were 73.7 and 213.7 per cent of normal mean, respectively. A significant negative correlation was observed between the two parameters (r = -0.5649, P < 0.001). In remission, the ALC and T-lymphocytes percentage showed significant increase in levels in comparison to their corresponding ANS values (P < 0.05 and P < 0.001, respectively), but the latter remained significantly lower when compared with controls (P < 0.001). The ADA activity did not differ significantly in comparison to corresponding ANS level. Thus, impaired CMI was observed both in active, as well as in remission stage of the disease and ADA activity demonstrated a more pronounced change than other parameters.
Adenosine deaminase activity in protein-energy malnutrition
(Scandinavian University Press, 1998) O.P. Mishra; S. Agrawal; Z. Ah; Usha
Cell-mediated immunity (CMI) was evaluated in 69 children with protein- energy malnutrition (PEM) and 20 healthy controls. Significantly decreased responses to purified protein derivative (PPD) (p < 0.02) and absolute lymphocyte count (ALC) (p < 0.01) and increased serum adenosine deaminase (ADA) activity (p < 0.001) were observed in PEM cases compared with the controls. The mean values of ALC and ADA activity in PEM patients were 85.9% and 158.7% of the normal mean, respectively. A significant negative correlation was observed between the two parameters (r = -0.2765, p < 0.01). The CMI tests were abnormal in all three grades of PEM, except for the response to PPD in grade I, when compared with the controls. No significant differences were found between infected and uninfected PEM cases. Thus, impaired CMI was observed not only in grades II and III but also in grade I PEM patients and the concomitant infection did not affect its status. However, ADA activity demonstrated a more pronounced change than the other tests.
Advances in nephrology
(1999) R.G. Singh; G. Prasad; Usha
[No abstract available]
Amyloid nephropathy in ankylosing spondylitis
(1988) J. Prakash; K. Tripathi; O.P. Sharma; Usha; P.K. Srivastava
[No abstract available]
Ascorbic acid status in uremics.
(1992) R.G. Singh; A.K. Gupta; S.S. Dubey; Usha; M.R. Sharma
Plasma levels of ascorbic acid (AA) and dehydroascorbic acid (DHA) were estimated in 27 patients of end stage renal failure (ESRF) on standard conservative therapy (group A) and 9 patients of ESRF on maintenance haemodialysis (MHD; group B). Fourteen healthy subjects matched for age and sex served as control (group C). The dietary intake of vitamin C was significantly decreased in group A than in group B compared to control. Similarly, plasma AA was significantly lowered to 0.801 +/- 0.283 mg per cent in group A compared to 1.421 +/- 0.47 mg per cent in control. While it was just lowered to 1.058 +/- 0.272 mg per cent in group B. Although plasma level of DHA was raised to 0.243 +/- 0.486 mg per cent and 0.166 +/- 0.54 mg per cent in groups A and B respectively, the increase was not statistically significant. In our present study, the DHA/AA ratio was found to be inversely proportional to the plasma AA. Further, this ratio has been claimed to be a better indicator of overall reducing atmosphere (i.e., profile of vitamin C) of the body.
Celiac disease-associated antibodies in patients with psoriasis and correlation with HLA Cw6
(2010) Sangeeta Singh; Gyanendra Kumar Sonkar; Usha; Sanjay Singh
Etiopathology of psoriasis is not completely understood. Patients with psoriasis show elevated sensitivity to gluten. The aim of this study was to see the expression of celiac disease (CD)-associated antibodies gliadin IgA, gliadin IgG, and tissue transglutaminase IgA, and their correlation with HLA Cw6 in patients with psoriasis. The study comprised 56 patients with psoriasis and 60 healthy controls (HC). The levels of antibodies were detected by using ELISA technique and HLA Cw6 typing was carried out by microcytotoxicity method. HLA Cw6 was significantly expressed in psoriasis cases when compared with HC (P<0.05). CD-associated antibodies gliadin IgA/IgG and tissue transglutaminase IgA were significantly higher in the serum of patient with psoriasis when compared with HC (P<0.05, <0.05, and 0.01, respectively). Serum anti tissue transglutaminase IgA (anti tTG IgA) was significantly higher in females when compared with males and expressed more in elderly patients. There was a significant positive correlation among the antibodies (anti gliadin IgA with anti gliadin IgG: r=0.67, P<0.05; anti gliadin IgA with anti tTG IgA: r=0.45, P<0.05, anti gliadin IgG with anti tTG IgA: r=0.26, P<0.05, respectively), whereas insignificant with HLA Cw6. Our study concludes that latent CD or CD-associated antibodies were present in patients with psoriasis and also concludes that HLA Cw6 has no association with expression of these antibodies in patients with psoriasis. © 2010 Wiley-Liss, Inc.
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.
Chronic lymphocytic leukaemia terminating into plasma cell leukaemia
(2002) V.P. Singh; M. Rai; Jyoti Shukla; S. Sunder; Usha
Transformation of chronic lymphocytic lymphoma into plasma cell leukaemia is extremely rare. The diagnosis is made on if the circulating plasma cells in peripheral blood is in excess of 2000 cells/mm3.
Clinical usefulness of a modified imunoelectrophoresis method for detection of myeloma immunoglobulins
(Nova Science Publishers, Inc., 2011) Nadeem A. Ansari; M. Owais; Usha
Immunoelectrophoresis is a clinically prevalent and sensitive technique used for isotyping of multiple myeloma. Immunoglobulin heavy and light chain types are known as potential biomarkers for the disease. In the present study, we used a modified immunoelectrophoresis method to detect the immunoglobulins of myeloma patients. Immunoglobulins of myeloma patients showed sharp precipitin bands while that of normal healthy subjects showed no characteristic bands of myeloma. The method proved to be rapid and cost effectivewith no loss of sensitivity for detection of precipitin bands corresponding to immunoglobulin heavy and light chains of myeloma patients. © 2011 Nova Science Publishers, Inc. All rights reserved.
Clinico radiological evaluation of non-obstructive renal tuberculosis
(1989) R.G. Singhi; I.S. Gambhir; J. Mathur; Usha; K.V. Johny
Twenty cases of A.F.B. culture positive renal tuberculosis without any obstructive feature as demonstrated by I.V.P. were studied. Gross hematuria, dysuria were common presenting symptoms. Proteinuria was present in 14 cases and in 7 cases it was in the nephrotic range. Urine culture was sterile for secondary micro-organism in 6 cases. Hypertension was a presenting feature in 3 cases. Chronic renal failure and acute renal failure were only observed in one case. Pyelographic findings suggestive of renal tuberculosis were present in half of the cases. Associated extragenital tuberculosis was seen in one fourth of cases.
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.
Comparative evaluation of fosinopril and herbal drug Dioscorea bulbifera in patients of diabetic nephropathy.
(2013) R.G. Singh; M. Rajak; B. Ghosh; Usha; A. Agrawal; G.P. Dubey
Worldwide, diabetic nephropathy is one of the leading causes of end-stage renal failure. This hospital-based single-center prospective open-label randomized case-control interventional study was performed to evaluate and compare the native drug Dioscorea bulbifera with fosinopril in the management of diabetic nephropathy. Patients with diabetic nephropathy with proteinuria >500 mg/day or albuminuria >300 mg/ day, S Cr ≤2.5 mg/dL and hypertension controlled with a single drug were included into the study and were divided into three groups according to the interventional drugs that they were given; group A (n = 46) on fosinopril (5-40 mg/day), group B (n = 45) on Dioscorea bulbifera (500 mg BD) and group C (n = 46) on neither of these drugs. All necessary laboratory investigations needed to assess the effect of both the drugs were carried out. Patients were followed-up for six months. The study included 137 patients (M:F 2.61:1) with an age range of 19-76 years. At the sixth-month follow-up, a significant decrease in the systolic blood pressure was noted in all three groups whereas the diastolic blood pressure decreased significantly only in group B. There was significantly better control of both systolic and diastolic blood pressures in group B than in the other groups. Although fasting blood sugar was poorly controlled in the initial visit in all three groups, there was a significant decrease at the sixth-month follow-up in all three groups. Moreover, the decrease was significantly more pronounced in group B than in the other two groups. Low-density lipoprotein decreased significantly only in group B. Proteinuria, serum transforming growth factor-β, interleukin-6 (IL-6) and C-reactive protein decreased in both group A and group B, more so in the latter, but the differences between the groups were not statistically significant. Importantly, proteinuria and serum IL-6 showed an increasing trend in group C. It can be concluded that Dioscorea bulbifera was more effective than fosinopril in controlling blood pressure, glycemia, cholesterolemia and inflammatory state in diabetic nephropathy. Both agents decreased proteinuria. However, creatinine clearance significantly decreased with both the drugs, more so with Dioscera, and thus further evaluation with a larger trial is needed.
Crescentic glomerulonephritis in association with traumatic arteriovenous fistula following gun shot injury
(1998) H. Kumar; R.G. Singh; Jai Prakash; Usha; C.R. Kar; K.S. Basavaraj
[No abstract available]
Decreasing incidence of renal cortical necrosis in patients with acute renal failure in developing countries: A single-centre experience of 22 years from Eastern India
(2007) Jai Prakash; Rubina Vohra; I.A. Wani; A.S. Murthy; P.K. Srivastva; K. Tripathi; L.K. Pandey; Usha; R. Raja
Background. Renal cortical necrosis (RCN) accounts for 2% of all cases of acute renal failure (ARF) in adults and 15-20% of ARF during the third trimester of pregnancy in developed nations. However, RCN incidence is higher in developing countries ranging from 6-7% of all cases of acute renal failure. The present study describes changing trends in the clinical spectrum of RCN in patients with ARF in Eastern India. Methods. Patients with ARF suspected to have RCN on clinical grounds underwent percutaneous renal biopsy. Patients showing cortical necrosis on histology were included in the present study. Diffuse and patchy cortical necrosis was classified based on standard histological criteria. The patients with cortical necrosis were studied over a period of 22 years; from July 1984 to December 2005. The results of our observation were compared with respect to etiology, incidence, prognosis and outcome of renal cortical necrosis in two study periods; namely, 1984-1994 and 1995-2005. Results. The incidence of RCN was 3.12% of allcases of ARF of diverse etiology. RCN was observed in 57 patients; obstetric 32 (56.2%); non-obstetric 25 (43.8%). Diffuse cortical necrosis was the dominant lesion in 41 (71.9%) patients and the remaining 16 (28%) patients had patchy cortical necrosis. The overall incidence of RCN in obstetric ARF was 15.2%; the incidence being higher (11.9%) in the post-abortal group in comparison to 3.3% in late pregnancy. RCN had occurred complicating abruptio placentae, puerperal sepsis and postpartum haemorrhage (PPH) in late pregnancy, while septic abortion was the sole cause of RCN in early pregnancy. Haemolytic uraemic syndrome (HUS) was the major (31.5%) cause of RCN in the non-obstetric group and miscellaneous factors were responsible in seven (12.3%) patients. Partial recovery of renal function was observed in 11 (19.2%), and 16 (28%) patients had progressed to ESRD. The incidence of RCN decreased from 6.7% in 1984-1994 to 1.6% in 1995-2005 of total ARF cases. RCN following obstetrical complication decreased significantly; 4.7% in the 1990s to 0.5% of the total ARF cases, in the 2000s. The mortality decreased to 19% in 1995-2005 from the initial high mortality of 72% in 1984-1994. The renal prognosis improved as a result of the decreased mortality of patients. Conclusion. We observed a decreasing trend in the incidence of RCN in patients with ARF in recent years, which is associated with increased patient survival and better renal prognosis. This improvement was mainly due to declining incidence and severity of RCN in obstetrical ARF. © 2007 Oxford University Press.
Diabetic retinopathy is a poor predictor of type of nephropathy in proteinuric type 2 diabetic patients
(2007) J. Prakash; M. Lodha; S.K. Singh; Rubina Vohra; R. Raja; Usha
Background : Both diabetic nephropathy (DN) and nondiabetic nephropathy (NDN) are reported to occur in patients with type 2 diabetes mellitus (DM). The precise diagnosis of the type of nephropathy has obvious clinical and prognostic implication. The aim of the study was to evaluate the histologic spectrum of nephropathy in proteinuric type 2 diabetic patients and to find the correlation between type of nephropathy and diabetic retinopathy (DR). Methods : Twenty eight proteinuric type 2 diabetic patients were included in the study. Five patients (ADPKD 3 and chronic pyelonephritis 2) were excluded from biopsy. Percutaneous renal biopsy was carried in remaining 23 patients. Results : There was a preponderance of male (75%) and majority of the patients were in the age group of 30-78 years. Duration of diabetes ranged between 4 months to 25 years with mean ± SD of 10.53±7.62 years. The presenting features were nephrotic syndrome 14 (60.9%), non-nephrotic proteinuria 9 (39.1%) and impaired renal function in 19 (82.6%) patients. Renal biopsy in 23 cases revealed; isolated diabetic nephropathy 13 (56.2%), NDN 7 (13.43%) and 3 (13%) patients had NDN superimposed on diabetic nephropathy. Membranous nephropathy (2), focal segmental glomerulosclerosis (2), mesangiocapillary glomerulonephritis (1) were the nondiabetic glomerular disease in our type 2 diabetic patients. Chronic pyelonephritis and ischemic interstial nephropathy was the predominant tubulointerstial lesion in this study. Diabetic retinopathy (DR) observed in 12 (75%) patients with biopsy proven DN and absent in 4 (25%) patients with DN. The distribution of renal lesions in patients with DR (n=15) showed DN in 9 (60%), NDN 3 (20%) and remaining 3 patients had combined lesions. Renal biopsy in 8 patients without DR showed typical DN in 4 (50%) and NDN in 4 (50%) patients. Conclusion : This study demonstrates presence of both glomerular and tubulointerstitial lesions unrelated to diabetes (NDN) in proteinuric type 2 diabetic patients. Further presence or absence of DR was a poor predictor of diabetic nephropathy because DN was noted in 50% of patients without DR and 40% of patients with DR had non-diabetic nephropathy either alone or in combination with DN. © JAPI 2007.