Journal of Renal and Hepatic Disorders
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The Interplay of Iron and Lipid Homeostasis in Non-Alcoholic Fatty Liver Disease
Get PDFThe liver is essential for numerous metabolic functions and is the primary site of iron storage and regulation in addition to maintaining critical functions in lipid metabolism. Both iron deficiency and overload have been demonstrated as being involved with metabolic dysfunction; hence, tight regulation of iron absorption is essential to maintain health. Approximately one-third of individuals suffering from non-alcoholic fatty liver disease have elevated hepatic iron concentrations, with increased iron associated with increased disease severity, suggesting a convergence in dysregulation between lipid and iron metabolism. Increasingly, the literature is demonstrating, using a myriad of model organisms and iron-loading methods, that iron loading induces dysregulation in multiple aspects of hepatic lipid metabolism. However, the molecular mechanisms involved, and their subsequent effects on human diseases, are unclear. As iron is a fundamental component of many enzymes and proteins involved in lipid metabolism and is involved in the production of free radicals and oxidative stress, the mechanisms are numerous. In this review, we examine and summarise the dysregulation that iron loading elicits on hepatic lipid availability, de novo synthesis, catabolism, and export. We propose that understanding the interplay between iron and lipid metabolism holds the key to unlocking the complexities of disease development and progression, ultimately leading to improved therapeutic avenues
Prevalence of dysmagnesemia among CKD patients in North India
Get PDFMagnesium is the second-most common intracellular cation after calcium with 99% of total body magnesium distributed intracellularly in bones, muscles, and soft tissues. Only 1% of total body magnesium is present extracellularly that contributes to the normal serum magnesium concentration of 1.8–2.6 mg/dL. Recently, many studies have focused on the role of magnesium homeostasis and human health. Diabetes and hypertension are the leading causes of chronic kidney disease (CKD), and the significance of magnesium in CKD has been astonishing in medical practice. In this study, we investigated the serum levels of magnesium and its prevalence at different stages of CKD. This cross-sectional descriptive study was conducted over a period of 2 months. Serum magnesium levels were analysed in 224 patients with CKD and were grouped into five stages of CKD according to the guidelines of the Kidney Disease: Improving Global Outcomes (KDIGO) based on glomerular filtration rate. Laboratory data of patients was analysed using the IBM SPSS V23 software (Chicago, USA) for statistical relationship between serum magnesium levels and stages of CKD in patients with CKD. Mean serum magnesium level of the study population was 2.21 ± 0.75 mg/dL; 50.9% of the patients were normomagnesemic (normal level of magnesium ions in the blood), followed by 30.4% hypomagnesemic and 20.5%, hypermagnesemic. CKD was more common in males (63.4%), compared to females (36.6%). Mean age of patients in G5 stage was significantly higher than in G3a, G3b, and G4 stages (P = 0.001). A progressive decline in renal function and retention of uraemic solutes was observed with progression of CKD. Multiple factors, both inherited or acquired, such as diuretics and alcohol, are implicated in controlling serum magnesium levels. Magnesium deficiency leads to 2.12-fold higher risk of progression to end-stage renal disease (ESRD)
A Prospective Non-Randomised Interventional Study of Goal-Directed Ultrafiltration Compared With Clinical Dry-Weight Assessment in Achieving Euvolemic Status of Patients on Maintenance Hemodialysis
Get PDFAn accurate assessment of intravascular volume status in hemodialysis (HD) patients presents a significant challenge. Current clinical practices to determine dry weight is flawed due to interobserver variability and nonreproducibility. This miscalculation results in either chronic hypervolemia or hypovolemia with intra or interdialytic hypotension. The quest for noninvasive volume assessment tools to aid in the estimation of dry weight still continues. This study aims at goal-directed ultrafiltration removal compared with clinical dry-weight assessment in achieving euvolemic status of patients on chronic HD. It is a prospective, single-centered, nonrandomized, noninvasive interventional study on HD patients, for 12 months. Fifty two patients participated out of which 46 completed the study. Ultrasound-guided inferior vena cava collapsing index (IVCCI) and B lines were measured at intervals along with cardiac parameters. Dry weight was first estimated clinically by trial and error method. New dry weight target was set when B-lines were less than four in the eight site lung ultrasound and IVCCI between 50 and 75%, after 30 min post dialysis. Approximately 23.9% of the patients did not require dry-weight modification throughout the study. About 19% patients did not achieve dry weight in spite of all interventions. Overall, 56.5% of the patients achieved dry weight during the study period. A total of 46.3% of patients with NYHA Grade 3 dyspnoea observed at the start of study was reduced to 2.2%, showing statistical significance. Clinical assessment when bundled with noninvasive technology of assessment of dry weight showed encouraging results. B-lines and IVCCI estimation could be additional tools to achieve target weight goals, reducing complications and increasing compliance
Pulmonary Hypertension in Patients of Chronic Kidney Disease on Maintenance Hemodialysis: Study from a Tertiary Care Center in Central India
Get PDFTo study the incidence of pulmonary hypertension (PH) in chronic kidney disease (CKD) stage V patients on maintenance hemodialysis (HD) at our center. To compare clinical and metabolic variables among CKD patients with and without PH to search for possible etiologic factors. Comparison of PH in CKD patients at baseline and after 3 months of sildenafil therapy. The study was conducted in the Department of Nephrology, Sri Aurob-indo Institute of Medical Sciences, Indore, for a period of 1 year from December 2021 to November 2022. All CKD patients on maintenance HD at our center were included in the study. A pre-structured proforma was used to record patient data. Detailed clinical examination, 2DECHO, and Biochemical tests were done. All patients with mean pulmonary artery pressure (mPAP) > 25 mmHg on 2D echocardiography were considered to have PH and were started on sildenafil therapy 20 mg three times a day for 3 months. PH was classified as mild PH (mPAP > 25 up to 40 mmHg), moderate PH (mPAP > 40 mmHg to 60 mmHg), and severe PH (mPAP > 60 mmHg). Patients were then followed for 3 months to look for episodes of dyspnea and emergency admissions and reassessed after 3 months by repeat 2D echocardiography to find improvement in PH. A total of 102 patients were analyzed during the study period; among them, 40 patients (39.2%) had PH. Out of them, 18 patients (45%) had mild PH, 14 patients (35%) had moderate PH, and 8 patients (20%) patients had severe PH. Average age of our patients was 48.8 ± 9.4 years, the majority being men. On comparing the clinical features between patients with and without PH, none of the clinical parameters had any statistically significant impact on PH. Also, none of the laboratory parameters had statistical significance among PH and non-PH groups. Among the patients with PH, 25 patients (62.5%) had Arteriovenous (AV) fistula, 10 patients (25%) had temporary dialysis catheters. Eight patients (20%) had jugular catheters, two patients (5%) had femoral catheters, and 5 (12.5%) patients had tunneled jugular catheters. Initially, 102 patients were enrolled in the study. Of these, 40 (39.2%) had PH and 62 (60.7%) did not. Patients who had PH started sildenafil 20 mg three times a day. Of these 40 patients, at 3 months, eight patients were lost to follow-up, and 32 patients with PH remained in the study. Emergency admissions in each group of PH declined after 3 months, and the result was statistically significant. Echocardiographic findings were compared in patients with PH and without PH, but the difference in patients on HD with PH and without PH was not statistically significant. PH is a significant problem in CKD patients on HD. This issue needs to be evaluated in a timely manner to avoid the risk of morbidity and mortality. It is vital to treat them at the earliest to prevent life-threatening complications
Acute Hepatitis by Bartonella henselae Infection in an Adult Patient with Decompensated Liver Cirrhosis
Get PDFHepatitis caused by Bartonella henselae in adults is a condition that is seldom reported in the literature, as well as its current incidence and prevalence. While there is a broad spectrum of well-defined and established clinical entities, hepatic involvement represents the third most frequent clinical manifestation of infection by this genus of bacteria. It may or may not be characterized by the presence of hepatosplenic granulomas. Diagnosis requires a high level of clinical suspicion, exclusion of additional etiologies, and a causal relationship with risk factors. Polymerase chain reaction is the diagnostic test with the highest diagnostic yield, and treatment varies depending on the clinical expression. We describe the case of an adult patient with hepatitis secondary to Bartonella henselae infection
Quality of Life of Patients on Peritoneal Dialysis and Contributing Factors: A Cross-Sectional Study
Get PDFIn recent years, interest in Health-Related Quality of Life (HRQoL) as a major indicator of clinical efficacy and treatment outcome in patients of End-Stage Renal Disease (ESRD) has grown significantly. This study aimed to determine the contributing factors affecting the quality of life (QoL) of ESRD patients undergoing peritoneal dialysis (PD). A cross-sectional study was conducted on PD patients presented at PD centres of Al-Zahra and Noor hospitals in Isfahan, Iran, from May to August 2019. A total of 173 patients having peritoneal dialysis for more than 3 months filled the validated 36-item short-form health survey questionnaire (SF-36). Baseline demographic details and dialysis-related factors were collected from patients’ medical records. The overall QoL score of patients was 50.28 ± 20.87. Male patients had a higher QoL score than female patients (58.18 in males, compared to 48.18 in females; P = 0.04). A significant association between frequency of dialysis and quality of life was observed, where three sessions of dialysis per day yielded the highest quality of life (QoL score = 59.62; P = 0.047). A significant positive correlation was discovered between QoL score and residual renal function (P = 0.013). In addition, a higher QoL score was observed in self-employed patients (60.95), compared to housewives (46.49) (P = 0.001). QoL assessment should be included as an integral part of patient follow-up to evaluate treatment outcomes and implement possible interventions to improve patient’s quality of life
IgA Nephropathy Associated with IgA Vasculitis Coexisting with Focal Segmental Glomerulosclerosis Tip Variant: A Case Report
Get PDFIgA vasculitis (IgAV), previously known as Henoch–Schönlein purpura, is a form of small vessel vasculitis that affects the skin, joints, intestines, and kidneys. The clinical presentation in adults is usually infrequent, more severe, with a worse prognosis and a higher recurrence rate. Due to limited scientific evidence, IgAV is viewed similarly to IgA nephropathy (IgAN), and the renal histopathological lesions are indistinguishable between the two. IgAN is the most prevalent glomerular diseases worldwide. The diagnosis of IgAN is confirmed through a renal biopsy. The most frequently found histopathological lesions are mesangial proliferation and concurrent IgA deposition confirmed by direct immunofluorescence. Focal segmental glomerulosclerosis (FSGS) appears as a glomerular pattern of injury in up to 40% of renal biopsies with IgAN, although there are few reported cases in the international literature where both diseases coexist as primary etiologies. We report a case of a female patient presenting with vasculitic lesions, abdominal pain, and nephrotic syndrome, whose cause is confirmed by a renal biopsy with a diagnosis of IgAN secondary to IgAV and coexistence of FSGS, an unusual presentation with few case reports
Differences in Urinary Calculi Characteristics among the Three Main Racial Groups in KwaZulu-Natal, South Africa
Get PDFRacial differences in the characteristics of urinary calculi are poorly described in the South African context, limiting our local understanding of urolithiasis pathology and thwarting our efforts in designing appropriate preventative interventions. We sought to investigate differences in urinary calculi characteristics among the main racial groups in KwaZulu-Natal, South Africa. We conducted a retrospective chart review of patients with urinary calculi at a quaternary hospital in KwaZulu-Natal, South Africa, during 2018–2019. We collected data on the patient’s age, sex, race (Caucasian, Asian, Black African), residence, and pre-stenting. Five study outcomes were investigated across racial groups: number of calculi, location of the calculi, size of the calculi, density of the calculi (Hounsfield Unit measurement >600), and the number of operative interventions performed. Data were analyzed with descriptive statistics, the chi-squared test, and unadjusted/adjusted logistic regression. Our study sample consisted of 147 patients (10.9% Caucasian, 55.8% Asian, and 33.3% Black African). Most patients (86.4%) were from urban areas. A higher proportion of Black Africans had urinary calculi with Hounsfield Unit measurements >600 (P = 0.002). In the logistic regression models, Black Africans had a higher probability of having urinary calculi with Hounsfield Unit measurements >600 (Unadjusted Odds Ratio: 7.17, 95% Confidence Interval: 2.00–27.80; Adjusted Odds Ratio: 18.75, 95% Confidence Interval: 3.37–157.57). Our analysis suggests that Black Africans are at higher risk of having harder urinary calculi than other race groups. This has implications for urolithiasis management and highlights the importance of primary prevention in this group. We recommend additional research to confirm our findings
A Comprehensive Overview of In-patients Treated for Hepatocellular Carcinoma at a Tertiary Care Facility in Tanzania
Get PDFHepatocellular carcinoma (HCC) is one of the commonest causes of cancer-related morbidity and mortality worldwide. However, only a limited number of studies on HCC have been conducted in Tanzania. We therefore conducted a cross-sectional study among in-patients treated for HCC in a tertiary referral hospital located in Dar es Salaam, Tanzania, in order to provide a concise description of the clinical characteristics and treatment options offered in the study setting. We identified 36 in-patients treated for HCC over a 6-month data collection period. Seventy-seven percent (n = 28) of the participants were males and about two-thirds (61.2%) were aged between 40 and 60 years. Majority (44.4% [n = 16]) of the patients had Child-Pugh class B and an Eastern Cooperative Oncology Group (ECOG) performance status of 2 (33.3% [n = 12]). Patients with tumors >6.5 cm and multinodular tumors (>3 nodules) accounted for 69.4% (n = 25) and 55.6% (n = 20), respectively. Portal vascular invasion and extrahepatic metastasis were respectively present in 27.8% (n = 10) and 25% (n = 9) of the patients. Of the study participants, only two had early-stage disease as per the Barcelona Clinic Liver Cancer (BCLC) staging system, corresponding to the observed tumor resection rate of 5.6%. The most frequently reported inoperable factor among the study participants was an ECOG performance status > 0 (n = 30 [83.3%]). Findings thus reveal a high proportion of late-stage diseases among participants that could have resulted in the observed low tumor resection rate. Initiatives to facilitate identification of the disease at an early stage are therefore paramount in optimizing care
L-Ornithine-L-Aspartate and Intermittent Renal Replacement Therapy in Fulminant Hepatitis A: A Case Report
Get PDFHepatitis A is a common viral infection worldwide that is transmitted via the fecal-oral route. Since the introduction of an efficient vaccine, the incidence of infection has decreased but the number of cases has risen due to widespread community outbreaks among unimmunized individuals. Classic symptoms include fever, malaise, dark urine, and jaundice, and are more common in older children and adults. People are often most infectious 14 days prior to and 7 days following the onset of jaundice. We will discuss the case of a young male patient, diagnosed with acute hepatitis A, leading to fulminant hepatitis refractory to conventional therapy and the development of subsequent kidney injury. The medical treatment through the course of hospitalization was challenging and included the use of L-ornithine-L-aspartate and prolonged intermittent hemodialysis, leading to a remarkable outcome. Hepatitis A is usually self-limited and vaccine-preventable; supportive care is often sufficient for treatment, and chronic infection or chronic liver disease rarely develops. However, fulminant hepatitis, although rare, can be very challenging to manage as in the case of our patient