Journal of Renal and Hepatic Disorders
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Clinicopathological Spectrum and Outcome of Crescentic Glomerulonephritis: A Retrospective Study from North-East India
Get PDFCrescentic glomerulonephritis (CrGN) is characterized by the presence of crescents in more than 50% of glomeruli. This study aims to identify the etiology and clinicopathological features and outcomes of CrGN. In this observational study, 80 biopsy-proven CrGN were included. Patients’ demographic profile, clinical parameters, treatments, and outcomes were collected and analyzed. The mean age in our study population was 40.86 ± 16.5 years. Type II CrGN was the most common type of CrGN. Female predominance was observed in type I and type II CrGN. The highest percentage of glomeruli with crescents was seen in type I (87 ± 15.2%, P = 0.04), followed by type III and type II. At the last follow-up, mean estimated glomerular filtration rate was 25.8 ± 11.41 mL/min/1.73 m2 and was significantly lower in type I CrGN (11.6 ± 4.8 mL/min/1.73 m2 P = 0.001). The overall 5-year renal survival rate was 55% and was highest in type II (69.4%), followed by type III and type I (27.3%) CrGN (P = 0.0299). In our study, oliguria at the time of presentation, percentage of crescents, glomerular sclerosis, and moderate/severe IFTA were associated with poor renal outcomes. In conclusion, CrGN was seen in 5.7% of kidney biopsies in our study. Type II CrGN was the most common type of CrGN followed by type III CrGN. Renal survival was poor in type I CrGN patients compared to type II and type III CrGN. Also, oliguria, crescents, glomerular sclerosis, and moderate/severe IFTA were associated with poor renal outcomes
Clinicopathologic Spectrum of Xanthogranulomatous Pyelonephritis: A Single Center Experience over 8 Years
Get PDFXanthogranulomatous pyelonephritis (XGP) is a chronic pyelonephritis subtype in which destruction of the renal parenchymal occurs, resulting in progressive loss of kidney functions. Although middle age is the predominant age group affected, but it can be spotted at any age. There is accumulation of macrophages (lipid-laden), leading to renal parenchymal destruction and fibrosis. In this study, we present our data of 15 patients who had undergone nephrectomy and had biopsy-proven XGP. XGP constituted 4.53% of the 331 nephrectomies performed for infective causes over a period of 8 years. All our patients had undergone unilateral total nephrectomy. Demographic and clinical data were analyzed after taking consent from all the patients. The age range of patients in our study was 18–65 years with a mean age of 43.93 ± 13.86 years. Ten (66.6%) of our patients were females. Diabetes was present in 40% of the patients. Three patients had imaging, suggestive of pyonephrosis, 3 had perinephric collection and 9 patients (60%) had concomitant nephrolithiasis. All the kidneys were grossly enlarged and were nonfunctional on renal scintigraphy. XGP is a form of chronic pyelonephritis, which, although less common, is devastating because of destruction of the renal parenchyma and associated morbidity. Clinicoradiologic correlation cannot be overemphasized. Definitive diagnosis is established through histopathologic examination
Epidemiological, Clinical, and Diagnostic Aspects of Urinary Tract Infection in Newborns at the Departmental Teaching Hospital of Borgou-Alibori (DTH-B/A) in Benin
Get PDFTo study epidemiological and diagnostic aspects of urinary tract infection (UTI) in newborns at the Departmental Teaching Hospital of Borgou-Alibori (DTH-B/A). This was a cross-sectional study conducted from April 1, 2019 to September 30, 2019 and concerned all newborns admitted to the neonatal unit of DTH-B/A. According to the National Agency for Health Accreditation and Evaluation (NAHAE)recommendations of 2002, all symptomatic newborns who did not have a visible malformation outside the genitourinary system and whose parents gave their consent were included in the study. The census was exhaustive despite the calculated minimum size of 109 newborns. Urine sedimentation and cytobacteriological examination of urine samples, taken in adhesive bags after local disinfection, demonstrated presence of pathogenic microbes. Sensitivity of detected microbes was studied to different antibiotics. Interpretive reading of antibiograms was established according to the Standards of the French Society of Microbiology (FEMS), edition 2012. If UTI was confirmed, an abdominopelvic ultrasound was performed in search for a malformative uropathy as a contributing factor in newborns. A standardized survey was developed for data collection. The data entered were analyzed using the Epi info software, version 3.5.4. In all, 124 newborns were included in the study. UTI accounted for 8.06% of all neonatal infections and 2.15% of admissions. The average age of onset was 7.8 days, with a gender ratio of 1:1. The main clinical manifestations were jaundice and respiratory distress. Microbes involved were Staphylococcus aureus (6/10), Escherichia coli (2/10), and Klebsiella oxytoca (2/10). The resistance of microbes to antibiotics was generally high. No abnormalities were revealed in the ultrasound. Although neonatal UTI is not a rare infection, bacterial resistance is of concern
Indications for Percutaneous Ultrasound-Guided Renal Biopsy and Complications Associated with it: An Observational Study
Get PDFRenal biopsy is performed for various reasons depending on the clinical manifestations presented. Although percutaneous kidney biopsy is a safe procedure, major or minor complications could occur. Our study aimed to assess the indications for percutaneous renal biopsy and complications associated with the procedure. This was a prospective observational study conducted in the Department of Nephrology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India. Patients who underwent percutaneous ultrasound-guided renal biopsy at the institute between October 2017 and June 2019 were enrolled in the study. Data regarding indications for performing a percutaneous renal biopsy and incidence of minor and major post-biopsy complications were collected. A total of 229 patients who underwent ultrasound-guided percutaneous renal biopsy were enrolled in the study. The most common indications for ultrasound-guided percutaneous renal biopsy were nephrotic syndrome (33.3%), subnephrotic proteinuria with azotemia (14%), and unexplained azotemia with proteinuria and hematuria (13.5%). Post-biopsy complications were observed in 89 (37.55%) patients. Minor complications developed in 83 (36.22%) patients and major complications in six (2.62%) patients. Among patients with major complications, two (0.87%) patients underwent invasive procedures (embolization and cystoscopic removal of bladder clot) and four patients developed hemodynamic instability. No procedure-related mortality was reported in the study. The most common indications for renal biopsy were nephrotic syndrome, subnephrotic proteinuria with azotemia, unexplained azotemia with proteinuria, and hematuria. The incidence of major complications was low
Comparison of Transient Elastography and Liver Biopsy in Assessing Fibrosis in Patients with Nonalcoholic Fatty Liver Disease
Get PDFNonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. Ultrasound-based transient elastography (TE) or TE of the liver is a noninvasive tool for effectively evaluating liver stiffness and fibrosis. The study aimed to compare the accuracy of TE as assessed by Fibroscan with liver biopsy in staging fibrosis in patients with NAFLD. Consecutive NAFLD patients (N = 72) were prospectively enrolled. TE evaluation was performed with Fibroscan and compared with liver biopsy, which is a reference standard. Fibrosis was staged according to the METAVIR scoring system (Meta-analysis of Histological Data in Viral Hepatitis). TE scores and biopsy-related fibrosis stages were correlated. Diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) of TE was evaluated. Data were analyzed using software R v3.6.3. Liver biopsy showed that 36.11% of patients did not exhibit fibrosis, whereas 25, 16.67, 15.28, and 6.94% of patients had stage F1 (portal/mild fibrosis), F2 (periportal/moderate fibrosis), F3 (bridging/severe fibrosis), and F4 (cirrhosis/advanced fibrosis), respectively. TE showed that 50% of patients had cirrhosis, whereas 20.83,15.28, and 13.86% of patients had mild, moderate, and severe fibrosis, respectively. TE had 71% accuracy, 89% sensitivity, and 38% specificity in diagnosing the severity of fibrosis. Hence, it can be implemented as a noninvasive alternative diagnostic tool for understanding the severity of fibrosis in patients with NAFLD. Moreover, it can also be used for quick early diagnosis of NAFLD, reliable staging of fibrosis, and understanding the need for liver transplantation in patients with NAFLD
Body Composition of Chronic Kidney Disease Patients: A Multi-Stage Analysis
Get PDFWith accelerated muscle proteolysis, a decrease in muscle mass is evident in chronic kidney disease (CKD) patients. This eventually leads to nutritional disturbance that for a long has been mostly attributed to malnutrition. This predisposes patients to premature morbidity and mortality. Assessing body composition, thus, becomes vital. In this cross-sectional study, CKD patients (n = 47) of stages 2, 3a, 3b and 4 were assessed for their lean tissue mass, adipose tissue mass and overhydration by body composition monitor. Lean tissue index and fat tissue index were calculated as lean tissue mass and adipose tissue mass in kilogram divided by patients’ height in square meters. Patients were assessed for their handgrip strength (HGS) by Jamar hydraulic hand dynamometer, and also for their 7-day diet history. Mean lean tissue index of CKD patients was 11.73 ± 2.49 kg/m2. About 34 (72.3%) out of 47 patients were below the reference value of lean tissue index. A significant difference in lean tissue index (P = 0.03) was observed at various stages. Patients at stage 4 had the lowest lean tissue index. Lean tissue was significantly (P = 0.03) low in patients consuming protein <0.6 gm/kg/day. All 47 patients had less than normal HGS values. Patients’ mean fat tissue index was 14.86 ± 6.18 kg/m2 and had water retention with a mean overhydration of 1.47 ± 2.12 L. CKD patients were malnourished with a significant low lean tissue index. Dietary protein intake and HGS of these patients were positively associated with lean tissue index
A Case Presentation of Gastrointestinal Stromal Tumor of Duodenum
Get PDFA gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. It is caused by the mutation in KIT and PDGFRα genes. It constitutes <1% of all gastrointestinal tumors. Duodenal GISTs constitute 4.5% of all GISTs. We report a 61-year-old lady, presented with generalized abdominal pain, vomiting, abdominal distension, and nausea for the last 3 years. Physical examination showed a pallor and on abdominal examination, a large palpable mass was extending from the pelvis to the right upper quadrant of the abdomen. The CT scan showed a large heterogeneously echogenic mass in the abdomen and pelvis with no lymphadenopathy and distant metastasis in this region. Laparotomy showed a large globular mass extending from the pelvis to the right upper quadrant of the abdomen adherent to the wall of a third part of the duodenum. Complete surgical resection of tumor done with an intact capsule. Microscopic examination showed neoplastic spindle cells with tumor necrosis. An immunohistochemical study confirmed GIST
Acute Alcohol Tissue Damage: Protective Properties of Betaine
Get PDFTeenage binge drinking is a major health issue; however, there is a paucity of data on liver injury. Herein, we investigated how acute ethanol affects juvenile hepatic cells through changes in oxidative stress, apoptosis, and liver function, as well as the ability of betaine, which can replenish the antioxidant glutathione and mitigate oxidative injury. Juvenile male Wistar rats were given either water or betaine (2% w/v) for 6 days and treated with either saline 0.15 mol/L NaCl or ethanol (75 mmol/kg body weight). After 24 h, liver enzymes, oxidative damage, apoptosis, and parameters of antioxidant enzyme activity were examined. Acute ethanol increased hepatic enzymes (99%, P < 0.05). Total protein and albumin levels were reduced by 14 and 18% (P < 0.001), respectively, which was prevented by betaine treatment. Cytosolic cytochrome c increased by 59% (P < 0.05), corresponding to a decrease in mitochondrial cytochrome c content, which was ameliorated with betaine. Cytosolic glutathione peroxidase was reduced with alcohol (P < 0.05) and was prevented with betaine. Subtle changes were observed in catalase, superoxide dismutase, glutathione reductase, and complex I activity after ethanol treatment. In summary, whilst juvenile animals appear to have higher basal levels of antioxidant enzymes, betaine conferred some protection against alcohol-induced oxidative stress
Kidney Injury in Children Infected with HIV, Followed at the Teaching Hospital of Borgou (Benin): Epidemiological and Clinical Aspects
Get PDFThe history of kidney disease associated with HIV infection dates back to the years of HIV breakthrough. The objective was to study kidney damage in children infected with HIV at the Teaching Hospital of Borgou (Benin) in 2019. This was a cross-sectional, descriptive, analytical, matching-type study carried out from June 1, 2019 to September 30, 2019 at the pediatrics department of Teaching Hospital of Borgou (Benin). The study included HIV-positive children, followed in consultations, and whose parents gave their consent. The biological markers were demonstrated with urine dipstick. Glomerular filtration rate was calculated using the Schwartz test and classified according to stages. The dependent variable was the presence of at least one impairment (biological or functional). Sample size was determined by Schwartz’s method on the basis of one case for two controls. Sociodemographic, clinical, biological, and therapeutic data were collected. Comparisons were made using the Chi- square test or Fisher’s exact test. The identification of associated factors was possible using a multiple logistic regression model at 5% threshold. In total, we included 117 children, including 39 HIV-positive children. The average age was 8 ± 4.81 years and the gender ratio was 1:17. The frequency of kidney damage was 76.5%. Permanent proteinuria and at least two crosses on urine dipstick were present in 20.5%, leukocyturia in 2.6%, and proximal tubular dysfunction in 5.1%. Glomerular hyperfiltration was found in 38.5%, acute kidney injury in 38.5%, and chronic kidney injury in 5.1%. Associated factors were age (P = 0.004), presence of opportunistic infections (P = 0.00), and treatment adherence (P = 0.004). Kidney damage is common in HIV-positive children. Careful follow-up is necessary to avoid complications
The Role of the Liver in Iron Homeostasis and What Goes Wrong?
Get PDFIron is an essential mineral that is vital for growth development, normal cellular function, synthesis of hormones and connective tissue, and most importantly, serves as a component of hemoglobin to carry oxygen to body tissues. The body finely regulates the amount of circulating and stored iron within the body to maintain concentration levels within range for optimal physiologic function. Without iron, the ability for cells to participate in electron transport and energy metabolism decreases. Furthermore, hemoglobin synthesis is altered, which leads to anemia and decreased oxygen delivery to tissue. Problems arise when there is too little or too much iron. This review explores the role of the liver in iron physiology, iron overload and discusses the most common causes of primary and secondary hepatic iron overload