ABSTRACT
Introduction: Infection-related glomerulonephritis (IRGN) is associated with glomerular immune complex deposition along with complement activation. Steroids may attenuate glomerular injury and thereby improve renal outcomes. Methods: We randomly assigned patients who had biopsy-proven IRGN and serum creatinine greater than 1.5 mg/dl to receive corticosteroids plus supportive care (intervention arm), or supportive care alone (control arm). Patients were followed up for 6 months. The primary outcome was complete renal recovery at 6 months. Safety of steroid therapy was also assessed. Results: A total of 52 patients underwent randomization. At 6 months, 17 of 26 patients (65.4%) in the intervention arm and 14 of 26 patients (53.8%) in the control arm had complete renal recovery (odds ratio 1.6; 95% confidence interval, 0.5-4.9; P = 0.397). There was no statistically significant difference in any of the secondary outcomes. Adverse events occurred in 12 patients (46.2%) in the intervention arm and 2 patients (7.7%) in the control arm (P = 0.002). Conclusion: In this single-center trial, corticosteroids did not result in a statistically significant increase in rates of complete renal recovery at 6 months. There was a significantly increased risk of adverse events associated with the use of corticosteroids.
ABSTRACT
Introduction: Several months into the coronavirus disease 2019 (COVID-19) pandemic, there remains a paucity of data on the behavior of the disease in patients with end-stage kidney disease (ESKD) on maintenance hemodialysis (MHD). Here, we describe the clinical presentations, biochemical profile, and outcomes of 183 such patients from a large tertiary-care center in South India. Materials and Methods: This prospective, observational study, included all patients with COVID-19 and ESKD who received at least one session of hemodialysis at our center, from the start of the outbreak to July 9, 2020. Clinical features at presentation, laboratory and radiological data, and outcomes were analyzed. Results: A total of 183 patients were included in the analysis. Patients who had symptoms at presentation accounted for 49.18% of the cohort, with the most common symptoms being fever (87.1%), cough (67.7%), and breathlessness (63.4%). Factors independently associated with mortality on univariate analysis included age ≥60 years, having symptoms at presentation, neutrophil-lymphocyte ratio >6, C-reactive protein >20 mg/L, serum lactate dehydrogenase >250 IU/L, CT (computed tomography) Grades 3 and 4, and the need for respiratory support. However, on multivariate logistic regression analysis, the only factor that retained significance was an age >60 years. Conclusions: This analysis confirms the previous reports of higher COVID-19-related mortality in the dialysis population and identifies older age, higher inflammatory markers, and greater degrees of radiological lung involvement to correlate with increased mortality.
ABSTRACT
Cytomegalovirus (CMV) is the most common cause of congenital infections in humans occurring in 1% of all liveborns. Symptomatic congenital CMV infection involves multiple systems and causes significant morbidity and mortality in newborns. Isolated CMV infection of the kidneys in a living infant has not been reported in literature. Here, we report an infant who presented only with renomegaly and renal biopsy showed extensive CMV inclusions. Serum and urine polymerase chain reaction for CMV were positive, and CMV involvement of other organs was ruled out. The child for treated with intravenous ganciclovir and is currently on follow-up. Cytomegalic inclusion disease involving only kidneys without other systems involvement can occur. The treatment protocol is unclear and long-term follow-up is needed.
