ABSTRACT
Background: Immunoglobulin M nephropathy (IgMN) is an idiopathic glomerulonephritis (GN) usually presenting clinically as steroid resistant/dependent nephrotic syndrome (NS) with pathology of mesangial proliferative GN or focal and segmental glomerulosclerosis with diffuse predominant mesangial IgM deposits. Not much information is available about its natural history. This is the first Indian study to our knowledge on IgMN in adults and adolescents. Materials and Methods: We evaluated renal biopsies performed at our center between January,'04 to September,'09. Biopsies of all adolescents and adults were evaluated for IgMN and we studied their age, gender distribution, blood pressure (BP), disease duration, steroid/immunosuppressive management and serial serum creatinine (SCr), urinary proteins, and BP values. Patients with other systemic diseases/infections and children were excluded. Results: IgMN constituted 4.3% of 2702 adult renal biopsies. No significant gender predilection was noted. Males presented at average age of 23.1 years, females at 30 years. Steroid-dependent NS was the commonest presentation noted in 75% followed by steroid-resistant NS. Hypertension was noted in 10% patients. Mesangial proliferative GN (MePGN) was commonest histopathological finding noted in 74.4%, followed by focal segmental glomerulosclerosis (FSGS) in 16.2%, and minimal change disease (MCD) in 9.4% biopsies. Sole IgM deposits were noted in 88.5%. All MCD, 35.6% MePGN reached remission, FSGS progressed to renal failure by 1 year. Hypertension, proteinuria, interstitial fibrosis, and FSGS were bad prognosticators. Conclusions: This is the first Indian study of IgMN in adults and adolescents carried out over a period of 5.8 years, which has shown that hypertension, proteinuria, and interstitial fibrosis at presentation have bad prognosis.
Subject(s)
Adolescent , Adult , Aged , Biopsy , Female , Glomerulonephritis/chemically induced , Glomerulonephritis/epidemiology , Humans , Immunoglobulin M/toxicity , India/epidemiology , Kidney/pathology , Male , Middle Aged , Prevalence , Risk Factors , Young AdultABSTRACT
Neonatal morbidity and mortality in 573 singleton cesarean born infants was recorded. In 70% of women, it was a primary cesarean section. The neonatal mortality was 3.6% in babies born to primigravida mothers and 9.8% in infants of multigravida. Mortality in male and female infants was 5.73 and 9.65%, respectively. Preterm infants registered more than 7 times higher mortality than term infants. Birth weight below 2000 g and above 3500 g were associated with higher asphyxia rate and neonatal death. Neonatal morbidity frequently encountered was birth asphyxia (19.19%), septicemia (13.43%), jaundice (15.70%) and respiratory problems (23.0%).
Subject(s)
Birth Weight , Cause of Death , Cesarean Section/adverse effects , Female , Humans , India/epidemiology , Infant Mortality , Infant, Newborn , Male , Morbidity , Parity , Survival RateABSTRACT
Neonatal outcome of 178 low birth weight (LBW) babies in this study was associated with 26.4% neonatal mortality. A significantly higher mortality rate was noted in presence of adverse maternal factors, birth weight less than 1.5 kg, prematurity and respiratory distress at birth. Premature rupture of membranes and leaking (greater than 12 h) were recorded in 75 cases. Significant association was observed for septicemia. Maternal postpartum weight less than 40 kg was associated with higher incidence of neonatal infections than when mother's weight was greater than 45 kg.