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.

Knowledge about COVID-19 and Practices among Hemodialysis Technicians in the COVID-19 Pandemic Era.

INTRODUCTION: Hemodialysis technicians play a crucial role in infection control practices in hemodialysis units. Thus, it is important to assess the knowledge and attitude towards COVID-19 among hemodialysis technicians in this pandemic situation. MATERIALS AND METHODS: An online survey composed of 22 closed-ended questions using Google Forms was conducted in the month of April (13th to 19th) 2020. The survey consisted of questions regarding the knowledge of COVID-19 and current hemodialysis practice among hemodialysis technicians. The study was approved by the institutional ethics board. The survey was administered online through a mobile phone invitation. Basic statistics (mean and standard deviation or total number and percent) were computed for all covariates. RESULTS: Out of 150, 115 technicians participated in the survey. 80.9% of the participants were males. The mean age of respondents was 28.22 + 6.97 years. Most of the respondents could correctly identify fever (87.8%), breathlessness (86.08%), and dry cough (81.7%) as the symptoms of COVID-19 infection. 75.7% of the technicians were aware that it can be transmitted by asymptomatic persons. 61.1% of the technicians were segregating patients who had symptoms such as fever and cough to the last shift of the day. 81.1% of the technicians read the guidelines issued by the Indian Society of Nephrology-COVID-19 working group. But, only 25.5% of the respondents could rightly identify to keep a minimum distance of two meters between two beds while dialyzing a suspected patient of COVID-19 along with other patients to minimise risk of COVID-19 transmission. 60% of the technicians have received hydroxychloroquine as prophylaxis against coronavirus infection. CONCLUSION: Our study shows a significant knowledge gap among hemodialysis technicians about COVID-19. Effective COVID-19 education campaigns should be carried out intensively with relevant information among hemodialysis technicians to address the knowledge gap. A well-informed hemodialysis technician can prove to be a great tool to spread the right infection control practices among dialysis-dependent patients.

Hepatitis C virus, directly acting antivirals and Guillain-Barré syndrome.

Guillain-Barré syndrome (GBS) has been associated with both infective and noninfective etiologies. It is usually preceded by acute gastrointestinal or respiratory infections. We report an unusual case of GBS in a hepatitis C virus-positive hemodialysis (HD)-dependent patient who was being treated with sofosbuvir and daclatasvir along with antitubercular drugs for pulmonary tuberculosis. One should keep GBS in the differential diagnosis in HD patients whenever patient presents with lower limb weakness. Early diagnosis will help in timely initiation of treatment which is crucial to treat GBS.

An uncommon cause of rapidly progressive renal failure in a lupus patient: Pauci-immune crescentic glomerulonephritis.

We report a case of systemic lupus erythematosus (SLE) who presented with rapidly progressive renal failure (RPRF) with positive antinuclear antibody (ANA) and anti-double-stranded DNA (dsDNA) antibody and active urinary sediment in the form of microscopic hematuria and proteinuria. Provisional clinical diagnosis of lupus nephritis was made. Renal biopsy showed pauci-immune crescentic glomerulonephritis, the diagnosis of which was supported by positive serum anti-MPO antibody. Renal biopsy in SLE patients can sometimes reveal varied pathological entities such as antinuclear cytoplasmic antibodies (ANCAs) positive vasculitis, as in our case, which modified our treatment protocol. Thus, in a patient with SLE presenting with RPRF with active urinary sediments, ANCA serology, and renal biopsy with immunofluorescence examination should be performed always.

Primary Renal Echinococcosis.

Echinococcosis is a parasitic infection caused by the larval stage of a cestode Echinococcus granulosus and is endemic in sheep farming regions of developing countries. It manifests as hydatid cyst and most commonly is found in liver followed by lungs. Renal hydatid cyst is rare and amounts for 2% of all cases. There are no specific clinical manifestations, and hence diagnosis of renal hydatid disease is missed out easily without imaging. We report a case of 50-year-old female who had 6 months history of lower abdominal pain with hematuria, found to have right renal hydatid cyst on imaging which was treated with right nephrectomy with pre- and post-operative albendazole treatment.

Hypokalemic paralysis secondary to tenofovir induced fanconi syndrome.

Tenofovir induced fanconi syndrome (FS) presenting as hypokalemic paralysis is an extremely rare complication in patients on anti-retroviral therapy. We report a 50-year-old male with acquired immunodeficiency syndrome on tenofovir-based anti-retroviral therapy who presented with acute onset quadriparesis. On evaluation, he was found to have hypokalemia with hypophosphatemia, glucosuria and proteinuria suggesting FS. He regained normal power in limbs over next 12 h following correction of hypokalemia. Ours would be the second reported case in India.

Pancreatic ascites in the setting of portal hypertension.

Pancreatic ascites is a rare cause of ascites and develops largely as a complication of chronic pancreatitis or sometimes due to duct injury during surgical procedures. The entity may mimic spontaneous bacterial peritonitis or ascites due to portal hypertension. Here, the authors discuss a case of pancreatic ascites developing in the setting of alcoholic liver disease with portal hypertension. The patient had features of chronic pancreatitis with pancreatic duct fistula and was managed with stenting of the pancreatic duct.

Acrocallosal syndrome in a young hypertensive male.

Acrocallosal syndrome is an extremely rare genetic disorder with autosomal recessive inheritance. It is characterised by moderate to severe mental retardation, hypotonia, agenesis of the corpus callosum and preaxial polydactyly involving both feet and the facial features like broad forehead and hypertelorism. The authors report a case of a young hypertensive male who presented with unprovoked seizures for the first time who had multiple craniofacial, digital dysmorphic features with moderate mental retardation. The diagnosis of acrocallosal syndrome was arrived at after neuroimaging showed agenesis of corpus callosum with interhemispheric cysts.

Sudden mono-ocular blindness with recurrent transient diplopia and ptosis in a middle-aged woman.

Sudden painless loss of vision is an ophthalmologic and a medical emergency resulting from various causes such as occlusion of retinal artery or vein, macular or vitreous haemorrhages, retinal detachment, and anterior and posterior ischaemic optic neuropathy. We report a 48-year-old woman presenting with right monocular blindness due to branch retinal artery occlusion whose vision recovered due to timely paracentesis coupled with treatment with adequate antiplatelet agents and anticoagulants. The patient had transient diplopia and ptosis despite adequate antiplatelet agents and anticoagulants. Thorough search for aetiology revealed the underlying cause to be aortoarteritis. Aortoarteritis is a rare disease, and ocular involvement occurs late in the disease. We review ophthalmologic manifestation of aortoarteritis and diagnostic utilities of various modalities for aortoarteritis.

Xanthogranulomatous pyelonephritis in a young postpartal female.

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic inflammatory disorder of the kidney characterised by an infectious phlegmon arising in the renal parenchyma. It is seen in patients who have urolithiasis, urinary tract infection and immunocompromised status. The clinical presentation is variable and renal neoplasm is considered as a differential due to its characteristic extrarenal visceral invasion. The treatment is almost universally extirpative and can pose a formidable challenge to the treating physician and surgeon. The authors report a rare case of XGP in a postpartal woman who presented with multiple visceral abscesses whose diagnosis was arrived on histopathological examination.

Rare variety of T-cell lymphoma.

We report a case of 18 year old male who presented with hepatosplenomegaly, anemia and thrombocytopenia. His complete hemogram, peripheral smear, bone marrow studies were inconclusive. On immunophenotyping he was diagnosed as "Hepatosplenic gamma delta (gammadelta) T cell lymphoma" which is a very rare variety of T cell lymphoma. Less than 100 cases have been described in the literature since the entity was first described in 1990.

Suprasellar tuberculoma presenting as panhypopituitarism.

Suprasellar tuberculomas are exceptionally rare. We present the case of a middle aged male who presented with generalised apathy and meningism of two weeks duration. Neuroimaging was suggestive of tuberculomas in suprasellar cistern, while endocrinological investigation showed panhypopituitarism manifesting as pituitary hypothyroidism, hypocortisolism, and hyperprolactinemia. Cerebrospinal fluid examination showed lymphocytic reaction with raised proteins. A diagnosis of suprasellar tuberculoma with panhypopituitarism was made. The patient was started on antituberculous treatment and hormone replacement which led to remarkable improvement in condition of patient and resolution of tuberculous granuloma in follow up imaging.