A multicenter study of malnutrition status in chronic kidney disease stages I-V-D from different socioeconomic groups.

There is a paucity of data on malnutrition in different socioeconomic status in chronic kidney disease (CKD) patients. Hence, this cross-sectional study was undertaken in CKD-ND and CKD-D. The aim of the study was to assess the prevalence of malnutrition in the various stages of CKD among the various socioeconomic groups, namely the low-income groups and the upper-middle-income groups. This is a cross-sectional study conducted among 394 patients. The patient data were obtained from three institutions: Institution 1, Institution 2, and Institution 3. Patients were predominantly from the South Indian population and were between the age groups of 18 and 80 years. Measurements: malnutrition was assessed using anthropometry, body composition monitor, biochemical parameters, and dietary recall. Subjective Global Assessment Scale for nondialyzed patients and Malnutrition-Inflammation Score for dialyzed patients were also collected . As per the CKD stages, we found the percentage of malnutrition to be 7% in Stage III, 14% in Stage IV, 18% in Stage V, and 68% in Stage V-D in the upper-middle-income group, whereas it was 10% in Stage III, 26% in Stage IV, 40% in Stage V, and 93% in Stage V-D in the low-income group. The severity of malnutrition was stratified according to the stages of CKD, and it was found to be higher in progressive stages of CKD among the low-income groups as compared to the high-income groups.

A rare case of autosomal recessive ATP6V0A4 variant of distal renal tubular acidosis in a young female with recurrent nephrolithiasis.

Homozygous autosomal recessive distal renal tubular acidosis (dRTA) is a rare entity. The intercalated cells in the collecting ducts are defective in apical proton secretion or basolateral bicarbonate reabsorption, due to mutations in genes encoding for proteins in a4 and B1 subunits of the V-ATPase and the anion exchanger Cl-/HCO- (kAE1). This results in decreased ammonium (NH4+) excretion and defective urine acidification. dRTA is characterized by hyperchloremic metabolic acidosis with normal anion gap, hypokalemia, hypercalciuria, hypocitranuria, and nephrocalcinosis. Autosomal recessive dRTA is associated with mutation in ATP6V1B1 (2p13) or ATP6V0A4 (7q34) genes. ATP6V1B1 mutation is associated with early - onset sensory neural hearing loss (SNHL), whereas ATP6V0A4 gene mutation may be associated with early-to late-onset SNHL. We report the case of a 30-year-old married woman diagnosed with dRTA at three months of age with mild SNHL, showing homogygous nonsense mutation in exon 3 of the ATP6V0A4 gene that resulted in a stop codon and premature truncation of the protein at codon 6.

A rare association of Mycobacterium tuberculosis infection of kidney and urinary tract with immunoglobulin A nephropathy.

Mycobacterium tuberculosis(MTB)-related secondary immunoglobulin A (IgA) nephropathy is reported in a 72-year-old male patient. The patient was diagnosed to have MTB infection of the kidney and genitourinary tract which was diagnosed by the demonstration of the organism by GeneXpert Ultra and culture. Concurrent kidney biopsy showed IgA nephropathy. The patient responded to urethral double-J stenting and four-drug antituberculous therapy with improvement of kidney function and resolution of MTB. IgA nephropathy can present as primary glomerulonephritis or secondary to MTB infection.