Journal of Renal and Hepatic Disorders
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Clinicopathologic Spectrum of Nephrotic Syndrome in the Elderly
Get PDFThe elderly population is affected by a wide range of kidney diseases like young adult patients. However, their clinical course and morphological manifestations are affected by aging. Recognition, diagnosis, and management of glomerular disease in elderly persons have several unique challenges. We aimed to study the clinicopathologic spectrum of elderly patients with nephrotic syndrome (NS). In this retrospective study, we looked at 234 patients of adult NS who were biopsied during the last 5 years. Among them, 31 patients were above the age of 60 years (Elderly). Mean age in elderly patients was 67.48 ± 6.11 years, with age range from 60 to 86 years. Elderly NS patients constituted 13.2% of total adult NS patients. Nineteen patients (61.2%) were males and 12 (38.7%) were females. Hematuria was observed in 19% and hypertension in 48% patients. Mean serum albumin was 2.79 ± 0.39 g/dl and mean 24 h urinary protein was 3.77 ± 0.8 grams. Membranous nephropathy (MN) followed by minimal change disease (MCD) was the most common diagnosis. No major complication with biopsy was reported in our study as has been the case with most studies
Incidence, Histopathological Pattern, and Predictors of Non-Diabetic Renal Disease in Type 2 Diabetes Mellitus: A Single-Center Prospective Observational Study
Get PDFPatients with type 2 diabetes mellitus (T2DM) may have renal involvement because of isolated diabetic nephropathy (DN), isolated non-diabetic renal disease (NDRD), or mixed lesions (DN combined with NDRD). This study was conducted to find out incidence, histopathological pattern, and clinical predictors of NDRD in the Kashmiri population. This is a single-center prospective observational study conducted from August 2015 to July 2017. Patients with T2DM presenting with atypical clinical features of renal involvement underwent kidney biopsy. A total of 33 patients were included. Isolated NDRD was found in 16/33 (48.5%) patients, isolated DN was discovered in 10/33 (30.3%), and mixed lesions in 7/33 (21.2%) patients. NDRD with or without DN was present in 23/33 (69.7%) patients. Overall, the most common renal histopathological lesion in NDRD was immunoglobulin A (IgA) nephropathy present in 7/23 (30.4%) patients. In mixed lesions, FSGS and TMA were the most common renal lesions present in 2/7 (28.57%) patients. The mean duration of diabetes in NDRD and isolated DN groups was 4.4±3.6 and 7.0±2.9 years, respectively (P = 0.04). NDRD was present in 21/23 (91.3%) patients without diabetic retinopathy (P = 0.016). Our data demonstrated that more than half of the patients with T2DM with atypical features had NDRD upon renal biopsy. The absence of diabetic retinopathy and a shorter duration of diabetes were indicators of NDRD. IgA nephropathy was the most prevalent renal pathology. Clinicians must consider kidney biopsy liberally, especially in patients with unclear etiology of a kidney disease. Patients with type 2 diabetes mellitus (T2DM) may have renal involvement because of isolated diabetic nephropathy (DN), isolated non-diabetic renal disease (NDRD), or mixed lesions (DN combined with NDRD). This study was conducted to find out incidence, histopathological pattern, and clinical predictors of NDRD in the Kashmiri population. This is a single-center prospective observational study conducted from August 2015 to July 2017. Patients with T2DM presenting with atypical clinical features of renal involvement underwent kidney biopsy. A total of 33 patients were included. Isolated NDRD was found in 16/33 (48.5%) patients, isolated DN was discovered in 10/33 (30.3%), and mixed lesions in 7/33 (21.2%) patients. NDRD with or without DN was present in 23/33 (69.7%) patients. Overall, the most common renal histopathological lesion in NDRD was immunoglobulin A (IgA) nephropathy present in 7/23 (30.4%) patients. In mixed lesions, FSGS and TMA were the most common renal lesions present in 2/7 (28.57%) patients. The mean duration of diabetes in NDRD and isolated DN groups was 4.4±3.6 and 7.0±2.9 years, respectively (P = 0.04). NDRD was present in 21/23 (91.3%) patients without diabetic retinopathy (P = 0.016). Our data demonstrated that more than half of the patients with T2DM with atypical features had NDRD upon renal biopsy. The absence of diabetic retinopathy and a shorter duration of diabetes were indicators of NDRD. IgA nephropathy was the most prevalent renal pathology. Clinicians must consider kidney biopsy liberally, especially in patients with unclear etiology of a kidney disease
Mitochondrial Impairment and Oxidative Stress Are Essential Mechanisms Involved in the Pathogenesis of Acute Kidney Injury
Get PDFAcute kidney injury (AKI) is an emergency condition that requires restrictive and appropriate clinical interventions. Identifying mechanisms of organ injury is a critical step in developing clinical interventions. Unilateral ureter obstruction (UUO) is widely used as an animal model for investigating AKI. The current study was designed to evaluate the role of mitochondrial impairment and oxidative stress in the pathogenesis of renal injury in UUO model. Mice underwent UUO surgery. Then, kidney tissue histopathological changes, plasma biomarkers of renal injury, oxidative stress, and different renal mitochondrial indices were evaluated at scheduled time intervals (3, 7, 14, and 21 days after UUO surgical procedure). Significant increase in plasma creatinine and blood urea nitrogen levels was evident in UUO mice. The UUO surgery induced severe kidney tissue histopathological alterations, including necrosis, severe tubular atrophy, and interstitial inflammation. Moreover, kidney biomarkers of oxidative stress included reactive oxygen species formation, lipid peroxidation, protein carbonylation, decreased glutathione reservoirs (GSH), and increased oxidized glutathione (GSSG) observed in UUO mice. On the other hand, significant mitochondrial depolarization, decreased mitochondrial dehydrogenases activity, mitochondrial permeabilization, and decreased adenosine triphosphate and GSH/GSSG levels were discovered in mitochondria isolated from the kidneys of UUO mice. The data obtained from the current study demonstrated a pivotal and interconnected role for oxidative stress and mitochondrial dysfunction in the pathogenesis of renal injury in UUO model. Therefore, these directions could serve as therapeutic targets in animal models or patients of acute renal failure
Impact of Induction Therapy on Clinical Outcomes of Kidney Transplant Recipients: A Single-Centre Cohort Study
Get PDFThe purpose of this study was to evaluate long-term efficacy of immunosuppressive drugs based on the type of induction therapy given to kidney transplant recipients, and determine the occurrence of graft dysfunctions or rejections. We compared the safety and efficacy of anti-thymocyte globulin (ATG) and basiliximab (BAS) in high-risk patients and analyzed the cumulative incidence of immediate, slow, and delayed graft function in kidney transplant recipients to determine their initial short-term graft function. Evaluation of the long-term efficacy after 3 years post-transplantation by assessment of patients and graft survival, incidence of infections, and risks of rejection were the primary endpoints. Patients with stable graft survival were observed more with ATG (85%) than BAS (70%); in contrast, graft dysfunctions, graft nephrectomy, rejection episodes, and patient deaths were more prevalent with BAS than ATG, with statistically significant differences in long-term graft functioning. Patient survival at 3 years in ATG group was 90.4%, compared to 88% in BAS group, and graft survival was 90.4% in the ATG group and 81.3% in the BAS group (P < 0.001). The use of both induction therapies resulted in good patient and graft survival outcomes than placebo, and the results showed that there was a significant difference in both patient and graft survival after 3 years between induction of ATG and BAS, suggesting that ATG can be safer, effective, and preferable drug over BAS for high-risk recipients
Time-Dependent Alterations in Liver Oxidative Stress due to Ethanol and Acetaldehyde
Get PDFBinge drinking is a major public health issue and ethanol-related liver insult may play a major role in the pathology of alcoholic liver disease. However, the degree of oxidative stress, cell death and contribution of acetaldehyde to liver damage over a 24-h period has yet to be determined. Herein, we aimed to investigate the effect of acute alcohol and elevated acetaldehyde levels on hepatic oxidative damage, apoptosis, and antioxidant enzyme activity over a 24-h period. Male Wistar rats were divided into four groups and animals were pre-injected (intraperitonially [i.p.]) with either saline (0.15 mol/L) or cyanamide (5-mmol/kg body weight), followed by either saline (0.15 mol/L) or ethanol (75-mmol/kg bodyweight). After 2.5, 6 and 24 h, hepatic cytosolic and mitochondrial fractions were analysed for indices of oxidative stress. At 2.5 h, cytosolic glutathione and malondialdehyde levels were significantly reduced and increased, respectively, with alcohol treatment. Caspase-3 activity and cytochrome c levels were increased with alcohol treatment at 24 h. The combination of cyanamide and alcohol treatment at 24 h led to a significant increase in serum alanine aminotransferase levels, and reduced albumin and total protein levels. Furthermore, glutathione peroxidase activity and glutathione reductase activity were significantly decreased and increased, respectively. Finally, superoxide dismutase activity was decreased in cytosol and increased in the mitochondria after cyanamide and ethanol treatment, respectively. This study indicates a complex differential effect of alcohol and acetaldehyde, whereby alcohol toxicity in the mitochondria takes place throughout the 24-h period, but raised acetaldehyde has a further detrimental effect on liver function
Fibrolamellar Carcinoma with DNAJB1-PRKACA Fusion in a 16-Year-Old: Case Report and Review of Literature
Get PDFFibrolamellar hepatocellular carcinoma (FLC) is a unique primary liver malignancy arising in noncirrhotic livers of young adults with an incidence of 0.02 per 100,000 in the USA (1). In the 5th edition of the WHO classification of the digestive system tumors published in 2019, fibrolamellar carcinoma is categorized as a subset of hepatocellular carcinoma (HCC). In 2014, the unique DNAJB1-PRKACA chimeric fusion protein was identified. Later studies proved this chimeric fusion protein as the main pathological driver in the disease manifestation of fibrolamellar carcinoma. Despite the invention of specific molecular genetic alteration in FLC, its oncogenic role and implication in FLC treatment remain an enigma. Surgical resection remains the primary therapeutic option, and the recurrence rate is extremely high (1). We present a case of fibrolamellar carcinoma in a pediatric patient with the PRKACA rearrangement resulting in DNAJB1-PRKACA fusion
Outcome of Hospitalized Pneumonia Patients with and without COVID-19: A Retrospective Cohort Study
Get PDFCOVID-19 pneumonia and community-acquired pneumonia (CAP) have been associated with morbidity and mortality. The aim of this study was to evaluate the outcome of hospitalized patients with COVID-19 pneumonia versus CAP in terms of mortality. This was a retrospective cohort study conducted between pre-COVID-19 era (May 2019–November 2019) and COVID-19 era (May 2020–November 2020). The study included all adult patients with COVID-19 pneumonia (Group 1) and adult patients with CAP but are COVID-19 negative (Group 2). A total of 106 patients were included in the study, of which 56 were in the COVID-19 pneumonia group and 50 in the CAP group. Patients who developed acute kidney injury (AKI) were 60.7% (n = 34) in Group 1 and 48% (n = 24) in Group 2. Mortality occurred in 37.5% (n = 21) patients in Group 1 and 12.0% (n = 6) in Group 2 (P = 0.003). A total of 52 patients required admission to intensive care unit (ICU), of which 44.6% (n = 25) were in Group 1 and 54.0% (n = 27) in Group 2. Of the 58 patients who developed AKI, 3 (8.8%) patients in Group 1 passed away compared to none in Group 2. Moreover, 58.8% patients (n = 20) in Group 1 and 70.8% patients (n = 17) in Group 2 required ICU admission. Mortality rate in the ICU was 80.0% (n = 16) and 35.3% (n = 6) in Groups 1 and 2, respectively (P = 0.006). The overall mortality rate was higher in case of COVID-19 patients than those with CAP. In case of patients with AKI, mortality rate in the ICU was significantly higher in COVID-19 pneumonia patients compared to CAP patients
Paraquat-associated Severe Acute Kidney Injury—Study from India
Get PDFTo analyze the outcomes of severe acute kidney injury in patients with paraquat ingestion. This retrospective analysis of case records was done in our institute, a tertiary care government teaching hospital, over a period of 4 years. Of the total 1310 acute paraquat poisonings during this period, severe acute kidney injury (AKI), referred for nephrology management was observed in 60 patients. Common symptoms at presentation include vomiting, oral ulcers, and abdominal pain. Oliguric AKI was present in 26%. Need for renal replacement therapy was observed in 95% of the cases. Mortality was observed in 38 of the 60 patients (68%). Factors associated with mortality on Cox regression analysis include amount of consumption. Estimated duration of survival on analysis curves was 8 days in 50% after admission and 15 days after consumption in 50%. Paraquat poisoning is associated with grave outcomes of morbidity and mortality. Severity of AKI is significant in this poisoning. Amount of consumption, latency of referral play a major role in outcomes
Epidemiological, Clinical, Therapeutic, and Evolutionary Aspects of Acute Kidney Damage during Severe Malaria in Children at the Borgou Departmental Teaching Hospital (Benin)
Get PDFMalaria is an endemic pathology with several complications, including kidney damage. The objective of this work was to study kidney damage during severe malaria in children at the pediatrics department of the Borgou Departmental Teaching Hospital (Borgou DTH), Benin in 2021. This was a longitudinal study carried out over 4 months from June 1, 2021 to September 30, 2021 (with 1 month of recruitment from June 1 to July 1, 2021) at the pediatric department of the Borgou DTH. The study included children aged 1 month–15 years, hospitalized for Plasmodium falciparum malaria with at least one clinical manifestation of malaria severity established by the World Health Organization in 2000 and whose parents had given their informed consent. The damage was established by urinary sedimentation using urine dipstick and urinary cap and serum creatinine. Acute kidney injury (AKI) was intended and classified according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The dependent variable was the presence of at least one clinical, biological, and functional impairment. Follow-up was regular for up to 3 months. Lost to follow-up were excluded. Predictors of occurrence were identified. Statistical difference was considered significant at P < 0.05. Of the 164 children hospitalized for severe malaria during the study period, 72 had at least one renal impairment, with a frequency of 43.90%. The average age of the children was 44.93 months. On urine dipstick, 76.39% of the patients had hemoglobinuria and 55.56% had albuminuria. Urinary cap revealed 44% granular cylindruria and 32% crystalluria. AKI was detected in 4.54% patients. Recovery was complete in all follow-up cases. The predictors of kidney damage were coma ( P = 0.017), jaundice ( P = 0.007), thrombocytopenia ( P = 0.021), and long hospital stay ( P = 0.008). Kidney damage in severe malaria is frequent. Early diagnosis and prompt treatment are fundamentals of rapid and complete recovery of kidney functions
Histopathological Spectrum of Nephrectomies; a Single Centre Experience of over 14 Years
Get PDFNephrectomy is conducted either as an open or a laparoscopic procedure for a variety of clinical indications. These include both neoplastic and non-neoplastic conditions, such as the non-functioning kidney. In many patients the final diagnosis is established on the histopathology of the retrieved kidney. In this study, retrospective analysis of data of last 14 years was studied pertaining to the number and indications of nephrectomy at the present study centre. Demographic and clinical details were assessed. Gross and microscopic histopathological details were recorded. Diagnosis was established on the basis of clinical features and histopathology. A total of 638 total nephrectomy specimens were received. Of these, 280 cases were of neoplastic and 358 of non-neoplastic lesions, with a male-to-female ratio of 1.21:1. The age range varied widely according to clinical manifestations. The age range in the present study was 5–84 years. Patients operated for non-neoplastic disorders were younger (mean age: 38.1 years) than those operated for neoplastic disorders (mean age: 54.4 years). Clear renal cell carcinoma (RCC) was the commonest RCC type (150 patients) followed by papillary RCC (51 cases). Nephrectomy is done due to both benign and malignant clinical indications as observed in this study. The most common indication was chronic pyelonephritis with the non-functioning kidney