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1.
Nephron ; 145(5): 496-502, 2021.
Article in English | MEDLINE | ID: mdl-33965947

ABSTRACT

Podocytic infolding glomerulopathy (PIG) is a rare diagnosis based on characteristic histopathologic findings on renal biopsy and was proposed as a new entity about a decade ago. It is a type of podocytic injury, characterized by invagination of the podocyte cell membrane (cytoplasmic projections from podocytes) into the glomerular basement membrane. The presence of microspheres and/or microtubules on electron microscopy is the characteristic finding. PIG is most often associated with autoimmune conditions like systemic lupus erythematosus. We report pathologic findings typical of PIG in a patient with phospholipase A2 receptor antibody-positive membranous nephropathy. She was treated with rituximab and responded well with decrease in proteinuria to the sub-nephrotic range.


Subject(s)
Glomerulonephritis, Membranous/diagnosis , Podocytes/pathology , Receptors, Phospholipase A2/metabolism , Female , Glomerulonephritis, Membranous/drug therapy , Glomerulonephritis, Membranous/enzymology , Glomerulonephritis, Membranous/pathology , Humans , Kidney Glomerulus/pathology , Kidney Glomerulus/ultrastructure , Microscopy, Electron , Middle Aged , Rituximab/therapeutic use
2.
Kidney360 ; 2(1): 33-41, 2021 01 28.
Article in English | MEDLINE | ID: mdl-35368823

ABSTRACT

Background: AKI is a significant complication of coronavirus disease 2019 (COVID-19), with no effective therapy. Niacinamide, a vitamin B3 analogue, has some evidence of efficacy in non-COVID-19-related AKI. The objective of this study is to evaluate the association between niacinamide therapy and outcomes in patients with COVID-19-related AKI. Methods: We implemented a quasi-experimental design with nonrandom, prospective allocation of niacinamide in 201 hospitalized adult patients, excluding those with baseline eGFR <15 ml/min per 1.73 m2 on or off dialysis, with COVID-19-related AKI by Kidney Disease Improving Global Outcomes (KDIGO) criteria, in two hospitals with identical COVID-19 care algorithms, one of which additionally implemented treatment with niacinamide for COVID-19-related AKI. Patients on the niacinamide protocol (B3 patients) were compared against patients at the same institution before protocol commencement and contemporaneous patients at the non-niacinamide hospital (collectively, non-B3 patients). The primary outcome was a composite of death or RRT. Results: A total of 38 out of 90 B3 patients and 62 out of 111 non-B3 patients died or received RRT. Using multivariable Cox proportional hazard modeling, niacinamide was associated with a lower risk of RRT or death (HR, 0.64; 95% CI, 0.40 to 1.00; P=0.05), an association driven by patients with KDIGO stage-2/3 AKI (HR, 0.29; 95% CI, 0.13 to 0.65; P=0.03; P interaction with KDIGO stage=0.03). Total mortality also followed this pattern (HR, 0.17; 95% CI, 0.05 to 0.52; in patients with KDIGO stage-2/3 AKI, P=0.002). Serum creatinine after AKI increased by 0.20 (SEM, 0.08) mg/dl per day among non-B3 patients with KDIGO stage-2/3 AKI, but was stable among comparable B3 patients (+0.01 [SEM, 0.06] mg/dl per day; P interaction=0.03). Conclusions: Niacinamide was associated with lower risk of RRT/death and improved creatinine trajectory among patients with severe COVID-19-related AKI. Larger randomized studies are necessary to establish a causal relationship.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/drug therapy , Adult , COVID-19/complications , Humans , Niacinamide/therapeutic use , Prospective Studies , Renal Dialysis/adverse effects , Retrospective Studies , Risk Factors
3.
Kidney Int Rep ; 5(12): 2379-2382, 2020 Dec.
Article in English | MEDLINE | ID: mdl-33305136
5.
J Assoc Physicians India ; 62(8): 747-9, 2014 Aug.
Article in English | MEDLINE | ID: mdl-25856954

ABSTRACT

Leprosy is one of the most prevalent infections in India, with our country accounting for almost 60 percent of the world's patients. Hence unusual presentations of leprosy should be sought for and treated at the earliest. We report this rare case of polyneuritis cranialis secondary to leprosy. Affection ofa single cranial nerve has been described previously but there is only one report of leprosy presenting like orbital apex syndrome.


Subject(s)
Cranial Nerve Diseases/diagnosis , Cranial Nerve Diseases/genetics , Leprosy/complications , Neuritis/diagnosis , Neuritis/etiology , Humans , Male , Middle Aged
6.
J Assoc Physicians India ; 61(11): 836-8, 2013 Nov.
Article in English | MEDLINE | ID: mdl-24974502

ABSTRACT

We report a case of complete heart block in a patient with rheumatoid arthritis because of its rarity and unusual features like younger age, short duration and negative rheumatoid factor.


Subject(s)
Arthritis, Rheumatoid/complications , Heart Block/etiology , Adult , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Female , Heart Block/therapy , Humans , Hydroxychloroquine/therapeutic use , Methotrexate/therapeutic use , Pacemaker, Artificial
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