Role of narrow band ultra violet radiation as an add-on therapy in peritoneal dialysis patients with refractory uremic pruritus.

AIM: To assess the role of narrow band ultraviolet B (UVB) as a treatment option in peritoneal dialysis patients with refractory uremic pruritus. METHODS: In this retrospective study, 29 adult patients with end stage renal failure on peritoneal dialysis, and who had refractory uremic pruritus, were given narrow band UVB radiation as an add-on therapy to standard care for a duration of 12 wk. The response to the pruritus was assessed both weekly and at the end of the study period using a visual analogue score (VAS). RESULTS: The average VAS score at the end of the study was 3.14 ± 1.59, which was significant compared to the baseline value of 7.75 ± 1.02 (P < 0.05). Improvements in symptoms were noted in 19 out of 21 (90.4%) patients. However, relapse occurred in six out of the 19 patients who responded. The dropout rate was high during the study period (33.3%). CONCLUSION: Narrow band UVB is effective as an add-on therapy in peritoneal dialysis patients with refractory uremic pruritus. However, the present regime is cumbersome and patient compliance is poor.

Efficacy of Febuxostat for Slowing the GFR Decline in Patients With CKD and Asymptomatic Hyperuricemia: A 6-Month, Double-Blind, Randomized, Placebo-Controlled Trial.

BACKGROUND: Hyperuricemia is a putative risk factor for the progression of chronic kidney disease (CKD). We hypothesized that control of asymptomatic hyperuricemia may slow disease progression in CKD. STUDY DESIGN: This was a single-center, double-blind, randomized, parallel-group, placebo-controlled study. SETTING & PARTICIPANTS: Eligible participants were adults from Eastern India aged 18 to 65 years with CKD stages 3 and 4, with asymptomatic hyperuricemia. INTERVENTION: The intervention group received febuxostat, 40mg, once daily for 6 months, while the placebo group received placebo; both groups were followed up for 6 months. OUTCOMES: The primary outcome was the proportion of patients showing a >10% decline in estimated glomerular filtration rate (eGFR) from baseline in the febuxostat and placebo groups. Secondary outcomes included changes in eGFRs in the 2 groups from baseline and at the end of the study period. RESULTS: 45 patients in the febuxostat group and 48 in the placebo group were analyzed. Mean eGFR in the febuxostat group showed a nonsignificant increase from 31.5±13.6 (SD) to 34.7±18.1mL/min/1.73m(2) at 6 months. With placebo, mean eGFR decreased from a baseline of 32.6±11.6 to 28.2±11.5mL/min/1.73m(2) (P=0.003). The difference between groups was 6.5 (95% CI, 0.08-12.81) mL/min/1.73m(2) at 6 months (P=0.05). 17 of 45 (38%) participants in the febuxostat group had a >10% decline in eGFR over baseline compared with 26 of 48 (54%) from the placebo group (P<0.004). LIMITATIONS: Limitations of this study included small numbers of patients and short follow-up, and ∼10% of the randomly assigned population dropped out prior to completion. CONCLUSIONS: Febuxostat slowed the decline in eGFR in CKD stages 3 and 4 compared to placebo.

Rapidly progressive glomerulonephritis in tuberculosis.

Renal involvement in tuberculosis occurs due to lympho-hematogenous dissemination. However, glomerular involvement is an uncommon event. Crescentic nephritis complicating tuberculosis is a therapeutic dilemma and weighs the risk of worsening the infection after immunosuppressive therapy. We present here a case of miliary tuberculosis with immune complex crescentic nephritis with advanced renal injury requiring renal replacement therapy. A diagnosis of miliary tuberculosis was made on the basis of positive sputum AFB, lymph node biopsy showing caseating granulomas and urinary polymerase chain reaction being positive for mycobacterial antigens. The patient recovered renal function with anti-tuberculous therapy with-out requiring immunosuppressive therapy.

Acute kidney injury following Russell's viper bite in the pediatric population: a 6-year experience.

BACKGROUND: Snake bite continues to be an important public health problem in tropical countries, and Russell's viper is common in south-Asian countries such as India, Sri Lanka, and Myanmar. CASE-DIAGNOSIS/TREATMENT: Russell's viper envenomation can cause acute kidney injury (AKI) by various mechanisms. Few studies address AKI following Russell's viper bite in the pediatric population. CONCLUSIONS: In this study, we report our center's 6-year experience of such pediatric patients and identify the poor prognostic factors.

Long-term renal outcome of snake bite and acute kidney injury: a single-center experience.

BACKGROUND: Snake bite can cause acute kidney injury (AKI) through multiple mechanisms. Many of these patients have severe kidney injury requiring renal replacement therapy. The long-term outcome of survivors of such severe AKI is not known. METHODS: We prospectively followed up 60 patients who developed dialysis-requiring severe AKI following snake bite and had survived the hospital stay. RESULTS: A total of 25 (41%) patients showed persistent renal involvement in the form of renal dysfunction, proteinuria, or hypertension at a mean period of follow-up of 45 months. Totally 5% of the patients progressed to end-stage renal disease (ESRD) while 20% had glomerular filtration rate (GFR) <45 mL/min. CONCLUSIONS: Long-term outcome of snake bite and AKI is not benign with a significant percentage of patients continuing to have features of persistent renal damage.

Non-IgA mesangioproliferative glomerulonephritis: a benign entity?

BACKGROUND: Non-IgA mesangioproliferative glomerulonephritis is a well recognized but less studied entity. The clinical manifestations, treatment response and long-term outcome have not been clearly defined. METHODS: This single-centre study included patients with biopsy-proven non-IgA mesangioproliferative glomerulonephritis who had been on regular follow-up for >3 years. Their clinical features at presentation, response to therapy and long-term renal outcome are addressed in this study. RESULTS: Nephrotic syndrome developed in 51 of 57 patients (89.4%). The majority of them--34 of 51(80%)--were steroid sensitive and had either infrequent or no relapse. However, steroid-dependent nephrotic syndrome occurred in eight patients (15.6%), while steroid resistance occurred in nine patients (17.6 %). Thirteen patients developed chronic kidney disease (CKD) with three progressing to end-stage renal disease, three to CKD Stage 4 and seven to CKD Stage 3. CONCLUSIONS: Non-IgA mesangioproliferative glomerulonephritis is a disease, which is not benign, and is associated with significant treatment-related morbidity.

Herpes labialis in patients with Russell's viper bite and acute kidney injury: a single center experience.

Snake bite is an important health hazard in tropical countries and is associated with significant morbidity and mortality. Herpes labialis is a common ailment caused by the Herpes simplex virus. There is no published data showing any association between the snake bite and development of Herpes labialis. Here, we present a series of patients who developed Herpes labialis after Russell's viper bite and had acute kidney injury. We attempted to find whether snake bite is an immunosuppressed state and whether it could have pre-disposed the patients to the development of these lesions.

Nephrogenic systemic fibrosis: a brief review.

Nephrogenic systemic fibrosis is a fibrosing disorder of the skin that develops in patients with advanced renal failure. It mostly presents with progressive hardening or induration of the skin of the extremities. Systemic involvement is also known to occur in this entity. Exposure to gadolinium contrast for radiological evaluation has been identified as the offending agent. The condition is progressive and can be seriously disabling. Therapeutic options are limited and not rewarding in majority of the cases. Awareness of this entity is important so that proper precautionary measures can be taken at the earliest to ameliorate the condition.