Chennu Krishna Kishore

Cutaneous fungal infection in a renal transplantation patient due to a rare fungus belonging to order Pleosporales.

Fungal infections are being increasingly reported from immuno-compromised as well as immuno-competent patients. Transplant patients are on long term immunosuppressive therapy which makes them highly vulnerable to opportunistic fungal infections .These infections can be cutaneous or systemic. Several fungi have been reported to be the culprits such as Candida spp., Aspergillus spp., C. neoformans, P. carinii, and zygomycetes group of fungi. Cutaneous infections are most commonly caused by Pityriasis (tinea) versicolor, dermatophytes, and candida sp but these days the demtiaceous fungi are becoming more frequently reported .Here we report a case of post renal transplant cutaneous infection caused by dematiaceous fungus belonging to the order Pleosporales

Emphysematous pyelonephritis: disappearing kidneys.

A 51-year-old man with type 2 diabetes mellitus for 10 years and hypertension for 8 years, who was a smoker and an alcoholic, presented with a history of fever, chills, and rigor of 4 days; abdominal pain and distension of 3 days; jaundice and anuria of 1 day duration. He had been binge drinking for 2 days before admission and had not taken insulin for several days. Examination revealed jaundice, tachypnea, tachycardia, a blood pressure of 90/70 mm Hg, and diffuse abdominal tenderness, with no guarding or rigidity. Investigations showed the following results: random blood glucose, 385 mg/dl; serum creatinine, 8.5 mg/dl; blood urea, 185 mg/dl; serum sodium, 142 mEq/l; serum potassium, 5.5 mEq/l; serum bilirubin, 8.0 mg/dl; hemoglobin, 13.5 g/dl; total leukocyte count, 30,800/μL; platelet count, 85,000/μL; and urine and blood cultures, sterile. Ultrasound abdomen showed multiple gas shadows in both the kidneys. Computerized tomography scan of the abdomen (Figure 1 and Supplementary Figure S1 online) revealed that the major parts of kidneys were replaced by gas, with only shreds of renal tissue visible. On the same day, bilateral ultrasound-guided percutaneous drainages were placed (Supplementary Figure S2 online). The pus revealed the growth of Escherichia coli. He was treated with pipercillin–tazobactum and aztreonam for 3 weeks. There was improvement in fever and hypotension. However, he remained dialysis dependent.

Hair Dye Related Acute Kidney Injury - A Clinical and Experimental Study

We studied paraphenylenediamine (PPD)-related acute kidney injury (AKI) in 81 patients and also in albino rats experimentally. In the patients’ group AKI was found in 32.7%. Of them, 81.4% needed dialysis support. The overall mortality was 25.9%. In experimental rats the renal lesions were noted in all and they were glomerular congestion, intertubular (interstitial) hemorrhages, acute tubular necrosis, mesangial proliferation, and intratubular casts. The severity of renal injury appears to be dose dependent.

Sternoclavicular Joint Arthritis with Acute Kidney Injury

Septic arthritis of sternoclavicular joint comprises approximately <1% of all joint infections. Common in elderly, but in intravenous drug abusers, it often occurs in the young. The development of acute kidney injury (AKI) in association with this entity is very rare. We present herein the management of one such patient. A 51 year-old male presented to the emergency department with high-grade fever and progressive tender swelling at the base of the neck extending to the right of the chest wall. He was toxic, hypotensive, oliguric, and dyspneic at the time of presentation. Laboratory evaluation revealed anemia [hemoglobin (Hb)—8.6 g%], polymorphonuclear leukocytosis [total counts (TC)— 17,800/mm], thrombocytopenia (5700/mm), and severe renal failure [blood urea (B.urea)—215 mg%, serum creatinine (s.cr)—6.4 mg%] with bland urinary sediment. Ultrasound of the abdomen revealed normal-sized kidneys with no obstruction. In view of sudden onset renal failure with rapid progression to severity [risk injury failure loss end-stage (RIFLE)3/ acute kidney injury network (AKIN)-3] despite fluid resuscitation, bland urinary sediment, and normal-toenlarged echogenic kidneys with no obstruction on ultrasound, the possibility of intrinsic renal failure secondary to acute tubular necrosis was considered. Plain chest X-ray showed chest wall abscess with air pockets. Plain computed tomography of the chest was suggestive of chest wall abscess extending to mediastinum with air pockets. Incision and drainage of pus was performed. Pus and blood cultures grew Escherichia coli and were treated with piperacillin/tazobactam as per the sensitivity. Follow-up contrast computed tomography done 2 weeks later revealed bony destruction of clavicle and sternoclavicular joint involvement (Figure 1). The patient was supported by hemodialysis (HD) for AKI. After seven sessions of HD, he improved from AKI (s.cr—1.9 mg%). In view of sternoclavicular joint and medial end of clavicular bone destruction, bone resection surgery was suggested; however, he got discharged on request and was lost to follow-up subsequently. The sternoclavicular joint is a synovium-lined joint composed of inferior medial clavicular head, superiorly lateral notch of the manubrium, and the

Malignant hypertension with protracted but not definitive oligoanuric acute kidney failure.

Malignant hypertension (MHTN) is diagnosed when a patient presents with accelerated hypertension and multiorgan compromise including severe retinopathy. The renal manifestations may be oliguric renal failure or rapidly progressive renal failure. Oliguria in MHTN occurs as a consequence of malignant nephrosclerosis, microangiopathic haemolytic anemia, polyarteritis nodosa, lupus, acute cortical necrosis and scleroderma. However, acute kidney insufficiency (AKI) may be seen in the absence of systemic disease or of nephropathy. The clinical presentation of anuria with MHTN is rare, and in such situations renal recovery is unlikely. There are few case studies reporting reversible renal failure in MHTN [1–16]. A literature search supports the view that the entity of reversible anuric renal failure in MHTN is recognized by early clinical presentation (with anuria/oliguria), the presence of normal sized kidneys, normal main renal arteries and kidney biopsy without significant vascular changes. Herein, we report two such cases with anuria due to MHTN who recovered after remaining on haemodialysis for an average 2 months.

Sternal tuberculosis in a patient with chronic kidney disease

Sternum is generally regarded as resistant to infections and thus is an infrequent site of osteomyelitis. Involvement of sternum by Mycobacterium tuberculosis is rare. Sternal tuberculosis in chronic kidney disease (CKD) was not reported till date. We report a 40-year-old patient with stage IV CKD, who presented with sternal and cervical lymphnodal tuberculosis.

Spontaneous Cure of Migrated Peritoneal Catheter

“Catheter migration” refers to displacement of the peritoneal dialysis (PD) catheter from the pelvis to the upper abdomen; migration typically results in PD failure and may require catheter removal (1). Currently, the common management technique is to reposition the catheter—either manually, by laparoscopy, by using a Fogarty balloon catheter, or by a surgical procedure. Spontaneous cure of a migrated catheter is rare. We report one such observation in a patient with diabetic end-stage renal disease on PD.

Plasma exchange for steroid unresponsive Devic's disease

1. Modi G, Jha V. Incidence of ESRD in India. Kidney Int 2011;79:573. 2. Modi GK, Jha V. The incidence of end‐stage renal disease in India: A population‐based study. Kidney Int 2006;70:2131‐3. 3. Raman R, Gupta A, Pal SS, Ganesan S, Venkatesh K, Kulothungan V, Sharma T. Prevalence of Metabolic Syndrome and its influence on microvascular complications in the Indian population with type 2 diabetes mellitus. Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN‐DREAMS, report 14). Diabetol Metab Syndr 2010;2:67.