Long-term Outcome of Lupus Nephritis: A Single Center Study.

INTRODUCTION: There is paucity of data on long-term outcome of lupus nephritis (LN) from south India. Our study looks at long term outcomes in patients with biopsy proven LN with terms of response to therapy, flare, mortality, treatment-related complications, outcome and post flare analysis. We also analyzed the factors which predicted the outcome. METHODS: A retrospective observational study was conducted from 2005 to 2012 at St. John's Medical college and hospital, Bangalore. Patients received treatment as per NIH protocol. Patients of LN who regularly visited OPD were included. Statistical analysis was done by using SPSS 19 software. RESULTS: At end of 84 ± 6 months (N = 59), 38 subjects showed complete remission (CR), 6 partial remission (PR), 3 developed chronic kidney disease, 2 developed end-stage kidney disease (ESKD), and 10 died. In outcome of flare (N = 15), 7 had nephrotic flare, 3 had refractory flare, 3 showed nephritic flare with 2 developing ESKD. Change of LN class was 3 subjects had changed to class II from class IV, 1 to class II from class V, 7 to class III from class IV, 2 to class IV from class V, and 2 to class IV from class VI. Factors predicting poor outcomes were serum creatinine, hypertension at presentation, and failure to achieve remission in 1 year. 7 subjects conceived, of which 4 of them were treated with azathioprine (AZA) and 3 of them who were on mycophenolate mofetil and was changed to AZA. 4 subjects had successful pregnancy outcome, 2 had preeclampsia, and 1 subject had missed abortion. CONCLUSION: At end of 84 ± 6 months, patient survival rate was 84%.

Recurrent episodic myoglobinuric acute kidney injury as presenting manifestation of idiopathic polymyositis.

Polymyositis (PM) is a rare heterogeneous group of disorders with frequent multisystem involvement including uncommon renal manifestations. Acute kidney injury (AKI) as the primary manifestation of PM is extremely rare. Herein, we report a case of recurrent episodic AKI in an adult female who was subsequently diagnosed to have PM.

Organ donation, awareness, attitudes and beliefs among post graduate medical students.

Organ transplantation is the most preferred treatment modality for patients with end-stage organ disease. There is an inadequate supply of cadaver organs commensurate with need. Health-care professionals are the critical link in augmenting public awareness about organ donation. Their attitudes and beliefs can influence the public opinion. This study aims at understanding the awareness, attitudes, and beliefs among the medical postgraduate students. A total of 123 post-graduates of a medical college hospital in South India participated in the study. A specially de-signed questionnaire was used in assessment. Data were statistically analyzed using SPSS Windows version 10.0. The mean age of the postgraduate students was 28.32 + or - 3.5 years, 54% were males, 62% belonged to Christian religion, 69% were single, 77% were from nuclear families, 87% had urban background, and 54% were from upper socioeconomic strata. About 97% said they were aware of organ donation through media, 23 understood the concept of "cadaver" as "brain-death" and 93% were able to distinguish between brain-death and persistent vegetative state. Eighty-nine percent wished to donate their organs, 77% did not believe in body disfigurement and 87% did not believe in rebirth without the donated organs, if they pledged their organs. Sixty-nine percent were willing to donate the organs of their family members. Eighty percent were willing to receive organs from family and cadaver, 40% were willing to donate a child's organs, 95% did not believe that organ donation is against their religion, 87% disagreed with the notion that doctors would not impart adequate care if they were pledged organ donors and 79% agreed that doctors would not declare death prematurely, if they had pledged their organs during life. There was a statistically significant correlation between attitudes, beliefs and demographics. In conclusion, the concept of brain-death was clearly understood by only a small number of medical postgraduate students. They however, had positive attitudes and beliefs towards organ donation.

Perceived illness intrusion among patients on hemodialysis.

Dialysis therapy is extremely stressful as it interferes with all spheres of daily activities of the patients. This study is aimed at understanding the perceived illness intrusion among pa-tients on hemodialysis (HD) and to find the association between illness intrusion and patient demographics as well as duration of dialysis. A cross sectional study involving 90 patients with chronic kidney disease (CKD) stage V, on HD was performed during the period from 2005 to 2006. The subjects included were above 18 years of age, willing, stable and on dialysis for at least two months. Patients with psychiatric co-morbidity were excluded. A semi-structured interview schedule covering socio-demographics and a 13 item illness intrusion checklist covering the various aspects of life was carried out. The study patients were asked to rate the illness intrusion and the extent. The data were analyzed statistically. The mean age of the subjects was 50.28 +/- 13.69 years, males were predominant (85%), 73% were married, 50% belonged to Hindu religion, 25% had pre-degree education, 25% were employed and 22% were housewives. About 40% and 38% of the study patients belonged to middle and upper socio-economic strata respectively; 86% had urban background and lived in nuclear families. The mean duration on dialysis was 24 +/- 29.6 months. All the subjects reported illness intrusion to a lesser or greater extent in various areas including: health (44%), work (70%) finance (55%), diet (50%) sexual life (38%) and psychological status (25%). Illness had not intruded in areas of relationship with spouse (67%), friends (76%), family (79%), social (40%) and religious functions (72%). Statistically significant association was noted between illness intrusion and occupation (P= 0.02).