Paint-thinner-induced Acute Kidney Injury: A Case Series and Review.

Occupational health hazards contribute significantly to the morbidity and mortality of workers in factories. Toluene has become a widely abused inhaled volatile drug. The spectrum of toluene-induced renal injury includes rhabdomyolysis, myoglobinemia, distal renal tubular acidosis (RTA), acute tubular necrosis, glomerulonephritis, and interstitial nephritis. We describe two patients with paint-thinner-induced kidney injury who were affected through different routes of exposure and recovered well, with one requiring dialysis support; the second patient, who had developed Type 1 distal RTA and mild kidney injury, was managed with conservative measures. Toluene can cause acute neurological symptoms, accompanied by severe metabolic alterations, as well as organ injury and dysfunction. A common association of the development of hypokalemic paralysis and metabolic acidosis with toluene intoxication was observed. Liver injury and rhabdomyolysis are also common. Vomiting, dehydration, tubular injury, and rhabdomyolysis are all possible additional causes of acute renal failure in toluene intoxication. Type 1 distal RTA, which is characterized by an inability to lower urine pH despite acidemia, results in hyperchloremic metabolic acidosis with hypokalemia. The management of acute toluene toxicity is largely conservative, consisting of correcting the electrolytes and the acid-base balance, fluid alterations, and renal replacement therapy in severe acute kidney injury. A clinical suspicion of organ failure and prompt supportive care leads to encouraging results. Adequate protective steps for workplaces involved in the use of such substances in confined spaces include prior risk assessment, using low-toxicity chemical products, ensuring adequate ventilation, safety training, and using appropriate personal protective equipment.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in Kidney transplant patients: A case series and literature review.

COVID-19 is a novel highly contagious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Immunosuppressed people are at a higher risk for unfavourable outcomes if infected with SARS-CoV-2, as cellular immunity plays a key role in determining the course and outcome in COVID-19. Kidney transplant recipients (KTRs) are thus a distinct subset of the population. We describe our early experience with 2 KTRs requiring hospital admission due to COVID-19 and who recovered well. We conclude that timely intervention in the form of modifying immunosuppression and close monitoring and institution of further measures based on clinical severity is needed in KTRs with COVID-19.

Incidence and Risk Factors of Acute Kidney Injury in Patients Hospitalized with Pneumonia: A Prospective Observational Study.

Background: Acute kidney injury (AKI) is frequent in hospitalized patients with critical illness and presents in up to one-quarter of patients with non-severe community-acquired pneumonia (CAP), resulting in increased short and long-term mortality. There is a paucity of literature from resource-limited settings regarding the incidence and risk factors for AKI in patients with CAP. In this study, we looked at the incidence and risk factors for AKI in patients hospitalized with CAP in a resource-limited setting Methods: This prospective observational study conducted over 1 year period included patients ≥ 18 years of age diagnosed with CAP admitted to a tertiary care center. The differences in baseline characteristics between hospitalized CAP patients with and without AKI; and risk factors for AKI and the need for renal replacement therapy (RRT) were analyzed using Chi-square test, t-test, Mann-Whitney U test, and logistic regression with p-value <0.05 considered statistically significant. Results: We observed 27.6 % (58/210) of patients had AKI in our study. Patients with AKI had significantly higher baseline comorbidities of chronic kidney disease (p=0.005) and coronary artery disease (p=0.032), and significantly higher uric acid (p=0.002), lower albumin (p=0.005), lower total protein (p=0.015), higher bilirubin (p=0.001), higher LDH (p=0.041), and higher CURB-65 score (p<0.001) in addition to elevated creatinine, BUN (p<0.001) compared to the no-AKI group. The patient group requiring RRT had significantly more males (p=0.019), with significantly higher phosphorus (p=0.038), lower ALT (p=0.022), and expectedly higher creatinine (p<0.001) and blood urea nitrogen (p=0.016). The adjusted logistic regression analysis revealed that patients with higher CURB-65 scores were at increased odds of undergoing RRT (OR 8.74, 95% CI 5.27 to 12.21, p=0.039). Conclusion: There is a high incidence of AKI in patients hospitalized for CAP in developing countries. Clinicians should be alert for the prevention and early detection of AKI in CAP patients.

Clinicopathological profile of gastrointestinal lymphomas in Kashmir.

BACKGROUND: The histological categorization of lymphoma has been a source of controversy for many years for both clinicians and pathologists. Clinicopathologic information of gastrointestinal lymphomas in Indian subcontinent is lacking. We studied histopathological spectrum of Primary Gastrointestinal Lymphomas (PGIL) and attempted to classify the G.I. lymphomas based on the recent WHO classification in to major histological types and immunological categories. MATERIAL AND METHODS: This study was done to evaluate the clinicopathological pattern of 100 cases with a histopathological diagnosis of primary gastrointestinal lymphoma at a tertiary care hospital. All patients of primary gastrointestinal lymphomas were included with the help of medical records over a 11-years period that is, January 2005 to December 2015. RESULTS: The study included 100 cases (60 males, 40 females; mean age 51.43 years; age range 4.5-90 years). The disease involved stomach in 82 (82%), small intestine in 8 (8%), large bowel and rectum in 8 (8%), gall bladder in 1 (1%) and oesophagus in 1 (1%). 82 (82%) of the 100 cases were Diffuse Large B cell lymphomas; 12 (12%) were Extra Nodal Marginal Zone Lymphomas (ENMZL of MALT type) 2 (2%) IPSID 2 (2%) of Mantle cell lymphoma morphology, 1 (1%) Burkitt's and 1(1%) enteropathy associated T cell lymphoma. The commonest presenting symptom was abdominal pain. 99 (99%) of 100 tumours were classified as B-cell lymphomas immunohistochemically and majority exhibited monoclonal light chain restriction on kappa/lambda staining. In addition; Burkitt's lymphoma showed positivity for CD 10. One tumour (1%) showed positivity for T-cell markers. The data demonstrated that primary GI NHL is more common among males, mainly in their fifth decade. Abdominal pain is the most common presenting symptom, with stomach being the most commonly involved site. Diffuse large cell lymphoma is the most frequent histologic subtype, followed by extranodal marginal-zone B cell lymphoma (MALT type). H. Pylori infection was observed in cases with low grade MALT lymphomas. Striking was the observation of two cases of IPSID (a disease commonly found in Mediterranean countries) and one case of enteropathy associated T cell lymphoma. CONCLUSION: EGD, imaging, light microscopic examination and immunohistochemical workup for B and T cell markers and staining for light chains to assist documentation of monoclonality are of precise diagnostic value in gastrointestinal lymphomas and form a part of the diagnostic workup.