Kidney Disease Patterns diagnosed by Kidney Biopsy: A Single-center Experience from Central India.

The incidence of kidney disease patterns diagnosed by kidney biopsy depends on age, gender, race, socioeconomic, nutritional, and environmental factors. The present study was performed at a tertiary care teaching hospital in central India to show the current frequency of different types of kidney diseases through histopathological findings. MATERIALS AND METHODS: We carried out a retrospective analysis of kidney biopsies done in our institute between January 2016 and June 2021, and clinical and histopathological correlation was done from the available medical records. RESULTS: Of the 411 kidney biopsies evaluated, 56.7% were females and the mean age of patients was 31.65 years. The elderly population (age ≥60 years) constituted 5% of patients. The most common indication for kidney biopsy was nephrotic syndrome (NS) (49.9%). On analysis of histological patterns, 59.3% of patients had primary glomerular disease (PGD), 28% had secondary glomerular disease (SGD), 5.2% had tubulointerstitial disease (TID), and 6.7% had vascular disease. In our study, focal segmental glomerulosclerosis (FSGS) was the most common PGD (28.9% of all PGD) followed by membranous nephropathy (MN) (19.7%), minimal change disease (MCD) (16.5%), and IgA nephropathy (IgAN) (15.4%). The most common SGD was lupus nephritis (LN) (23%) followed by diabetic nephropathy (DN) (1.99%). In patients aged ≤18 years, MCD was the most common PGD (26.5%) and FSGS was the most common PGD (30%) in patients aged between 19 and 59 years. In the elderly population (age ≥60 years), MN was the most common (38%) PGD. CONCLUSION: This is the largest study of kidney biopsies patterns from the central part of India, and it presents the combined analysis of the clinical, histopathological, and immunofluorescent features of biopsy-proven kidney diseases in our population.

Analysis of Clinical and Histopathological Pattern of Biopsy Proven Glomerular Diseases from Central India.

The pattern of glomerular disease differs in incidence among the different geographical areas because of ethnicity, genetic variability, environmental factors, and socioeconomic conditions. The prevalence of pattern glomerular diseases varies from different parts of the world and from within the same country, the current study was performed to show the frequency of occurrence of primary and secondary glomerular disease (SGD) observed in a tertiary care hospital catering to patients from central India. In a retrospective study, we analyzed the clinical and pathological data of 176 kidney biopsies that were performed from 2016 to 2019 at the Department of Nephrology Super Speciality Hospital in Nagpur. Ultrasound-guided kidney biopsies were performed percutaneously using an automated gun. The biopsy samples were examined for light microscopy and immunofluorescence. Patient age, gender, blood urea, serum creatinine, urine microscopy, 24-h urinary protein, virology, immunology profiles, indication for kidney biopsy, and histopathological findings were recorded for analysis. In our study, the most common indication for kidney biopsy was nephrotic syndrome (63.6%) followed by systemic lupus erythematosus with lupus nephritis (LN) (25.5%). Primary glomerular disease (PGD) was reported in 70%, SGD was reported in 30% of the 176 kidney biopsies studied. Among the 124 patients with PGD focal and segmental glomerulosclerosis (FSGS) was most common (30.6%) followed by primary membranous glomerulopathy (18.5%), minimum change disease (17.7%), immunoglobulin A nephropathy (10.4%), C3 glomerulopathy (5.6%), and diffuse proliferative glomerulonephritis (4.8%). Among the patients with SGD, LN was the most common (86.5%) followed by AL amyloidosis (3.4%) and AA amyloidosis (3.4%). In our study, among the PGD, FSGS was the most frequent while LN was the most common SGD.

Leukocyte esterase reagent strip as a bedside tool to detect peritonitis in patients undergoing acute peritoneal dialysis.

Peritonitis is a common and life-threatening complication of acute peritoneal dialysis (PD). Diagnosis requires the presence of clinical signs of peritonitis which are nonspecific and laboratory investigations [total leukocyte count (TLC), Gram-stain, and culture of PD effluent fluid] which are time-consuming and not available at the bedside. In this study, we evaluated the use of leukocyte esterase reagent strip (LERS) as a bedside test to diagnose peritonitis in patients undergoing acute PD. Patients who underwent acute PD were monitored for signs and symptoms of peritonitis. PD effluent fluid analysis included TLC, absolute neutrophil count, Gram-stain, and culture for the diagnosis of peritonitis. LERS (Multistix 10SG) was simultaneously dipped in PD effluent fluid and read at two minutes. Reading of + was considered as indicative of peritonitis. Twenty-one out of 166 (12.6%) patients undergoing acute PD developed peritonitis. LERS detected peritonitis in 20 patients. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of LERS were 95.2%, 95.2%, 74.1%, and 99.3%, respectively. LERS has very high sensitivity and NPV and can be used as a rapid bedside tool to exclude peritonitis in patients undergoing acute PD.

Acute Stylet Peritoneal Dialysis in Acute Kidney Injury: The Soul Never Dies.

BACKGROUND: Acute Kidney Injury (AKI) has a significant mortality rate. In developing countries, mortality due to AKI is high due to lack of access to dialysis facilities and related cost. The main goal of International Society of Nephrology (ISN) 0 by 25 initiative is to eliminate deaths due to AKI. Peritoneal dialysis is an underutilized modality in such a scenario. The aim of this study was to look into effectiveness of starting Acute stylet Peritoneal Dialysis (PD) in a resource constraint settings. METHODS: In this prospective study conducted over a year, patients with AKI due to various aetiologies were subjected to Acute stylet PD. The clinical Outcome, demographic, biochemical and treatment data was assessed. Descriptive statistics was used to analyze the data. RESULTS: A total of 79 (41 anuric, 33 oliguric and 5 nonoliguric) patients were included in the study. Sepsis was the predominant cause of AKI. Recovery was seen in 34% of patients. Patients with relatively preserved urine output recovered with PD in comparison to the anuric patients (p value <0.01). 58% of patients, majority of whom were anuric needed Hemodialysis (HD) in due course (7 ± 3 days) of time. The mortality in our study was 7.5%. CONCLUSIONS: Acute stylet PD can be considered as a modality of Renal Replacement Therapy (RRT) to treat a selected (oliguric, nonoliguric) group of AKI patients and as a bridge therapy for HD in those AKI patients in anuria.

Profile of glomerular diseases associated with hepatitis B and C: A single-center experience from India.

Hepatitis B and C are known to affect kidneys in a number of ways. Glomerular diseases associated with hepatitis B and C include membranous nephropathy (MN), membranoproliferative glomerulonephritis (MPGN), focal segmental glomerulosclerosis, immunoglobulin A nephropathy, rarely amyloidosis, and fibrillary and immunotactoid glomerulopathy. In a retrospective analysis of kidney biopsy of 534 patients, we found 16 (2.9%) patients of hepatitis B and 11 (2.05%) patients of hepatitis C with glomerular disease. The most common form of glomerulonephritis in hepatitis B patient was MN and in hepatitis C patient was MPGN.