Ravindra Prabhu Attur

Acute kidney injury in scrub typhus

BackgroundWe studied the urinary abnormalities and acute kidney injury (AKI) as per RIFLE criteria in scrub typhus.MethodsA prospective case record-based study of scrub typhus was carried out from January 2009 to December 2010 in a tertiary hospital in South India. Patients were followed up until renal recovery or for at least 3xa0months after discharge. Univariate, chi-squared tests and multivariate logistic regression analyses were performed to identify the predictors of AKI.ResultsScrub typhus was diagnosed in 259 patients. Urinary abnormalities were seen in 147 patients (56.7xa0%) with 60 patients (23.2xa0%) having AKI. All AKI patients had urinary abnormalities and 17 (28.3xa0%) were oliguric. Applying RIFLE (risk, injury, failure, loss, end-stage kidney disease) criteria, R, I, F were present in 23 (38.33xa0%), 13 (21.67xa0%), and 24 patients (40xa0%), respectively. Creatine phosphokinase (CPK) was raised in 33 patients (55xa0%) and hemodialysis was required in 6 patients (10xa0%). The case fatality rate in this study was 2 out of 259 (0.77xa0%), both having AKI and others recovering clinically. Significant predictors of AKI were tachycardia [odds ratio (OR) 2.28], breathlessness (OR 2.281), intensive care requirement (OR 2.43), mechanical ventilation (OR 3.33), thrombocytopenia (OR 2.90) and CPKxa0>80xa0U/L (OR 1.76) by univariate analysis and intensive care requirement (adjusted OR 2.89) and thrombocytopenia (AOR 2.28) by multivariable logistic regression.ConclusionScrub typhus should be part of the differential diagnosis of acute febrile illness with AKI. AKI in scrub typhus is usually mild, non-oliguric, and renal recovery occurs in most patients. Rhabdomyolysis may be contributory to AKI. Thrombocytopenia and intensive care requirement are significant predictors of AKI in scrub typhus.

Pharmaceutical Care for Dialysis Patients

The incidence of end stage renal disease (ESRD) is increasing worldwide. Dialysis centers are overwhelmed by the increased number of patients. When a patient becomes aware that his/her kidneys are nonfunctional, he/she is likely to be confused and depressed. The counseling of the patient in the matter of drugs, disease, and lifestyle forms an important necessity, which can help the patient′s confidence and motivate the patient for self-care of his/her condition. The counseling of the patient and dispelling the myths regarding ESRD and dialysis is vital for all patients on a continuous basis. This can be achieved by practicing the pharmaceutical care in ESRD patients on dialysis. In this article, the knowhow and the significance of self-management of ESRD patients on dialysis is discussed.

Pharmacoeconomic evaluation of hospitalised pre-dialysis and dialysis patients: A comparative study.

BACKGROUNDnThe progression of chronic kidney disease (CKD) can be attributed to various factors, including lack of medical services, delayed referral, lack of awareness about the disease, drugs, and financial support.nnnAIMSnTo compare the pharmacoeconomic-related direct medical and non-medical costs among hospitalised pre-dialysis and dialysis patients.nnnMETHODSnA prospective observational study was conducted on the inpatients admitted to the Department of Nephrology. Patients undergoing maintenance dialysis or initiated on renal replacement therapy were included in the dialysis patients group and other CKD patients in the pre-dialysis group. The data pertaining to the pharmacoeconomic-related direct medical and non-medical costs were collected from the patient records, medical bills, and other relevant sources.nnnRESULTSnOut of 100 patients, 43 were in the pre-dialysis group and 57 were in the dialysis group. The median direct medical costs (INR 4,731.62, USD

Acute kidney injury in patients with cirrhosis of liver: Clinical profile and predictors of outcome

76.47) for dialysis group patients were significantly higher than for the pre-dialysis group (INR 1,820.95, USD

Paraneoplastic glomerulopathy in a case of collecting duct renal cell carcinoma

29.43). The median direct non-medical costs (INR 550, USD

Immune mediated crescentic MPGN secondary to HBV infection: A rare presentation for a common infection.

8.88) for pre-dialysis group patients were not significantly higher than for the dialysis group (INR 480, USD

Acute Kidney Injury: Prevalence and Outcomes in Southern Indian Population

7.75).nnnCONCLUSIONnThere was a significant difference in the median direct total costs between pre-dialysis and dialysis patients. The number of medications per prescription and length of hospital stay are the factors that influence the median direct total costs.

SP296EFFECT OF FEBUXOSTAT VERSUS ALLOPURINOL ON HYPERURICEMIA AND PROGRESSION OF CHRONIC KIDNEY DISEASE

BackgroundAcute kidney injury (AKI) is a common complication of liver cirrhosis and is associated with poor survival. We studied the clinical profile and predictors of in-hospital mortality in patients with cirrhosis of the liver with AKI.MethodsThis retrospective cohort study examined patients at a tertiary care hospital. AKI staging was done based on the new 2015 Ascites Club Criteria. Patients were grouped into three types of AKI: pre-renal azotemia (PRA), hepatorenal syndrome (HRS), and acute tubular necrosis (ATN).ResultsData of 123 patients with cirrhosis and AKI were analyzed. Most patients had AKI stage 3 (57.7%). ATN (42.3%) and HRS (43.9) were the predominant types of AKI followed by PRA (13.8%). The overall in-hospital mortality in our study was 44.7%. The mortality increased with increasing severity of AKI (pu2009=u20090.0001) and was the highest in AKI stage 3 (pu2009=u20090.001) and those who required hemodialysis (pu2009=u20090.001). There was a significant in-hospital mortality in patients with ATN and HRS in comparison to PRA (pu2009=u20090.001). On multivariate analysis, the factors predicting in-hospital mortality were AKI stage 3, and oliguria (pu2009=u20090.0001).ConclusionsAcute kidney injury in cirrhosis of liver carries high in-hospital mortality. Pre-renal AKI has a better survival compared to ATN and HRS. The higher stage of AKI at presentation and the presence of oliguria are two important predictors of in-hospital mortality.

MP158LUPUS NEPHRITIS - EXPERIENCE FROM SOUTHERN INDIA

Paraneoplastic glomerulopathy has been described in established cases of the solid tumors of lung, gastrointestinal system, breast, etc., and rarely in patients with Renal Cell Carcinoma (RCC). Studies on secondary glomerular diseases have described a higher incidence of IgA nephropathy in patients with RCC compared to membranous glomerulopathy, which are commonly reported in malignancies of the lung and gastrointestinal tract. Collecting Duct Carcinoma (CDC), a rare high grade adenocarcinoma accounts for <1% of all renal malignancies. It arises from the cells of the collecting ducts of Bellini. We report a case of an elderly male who was diagnosed to have a disseminated CDC during his evaluation for nephrotic syndrome. Renal biopsy was suggestive of a secondary membranous glomerulonephropathy.

MP140CLINICAL PROFILE OF NEPHROTIC SYNDROME IN ADULTS

Hepatitis B virus (HBV) infection presenting as crescentic glomerulonephritis in the absence of cryoglobulinemia is an extremely rare phenomenon. We report a case of a 44-year-old male with HBV infection, who underwent kidney biopsy for rapidly progressive renal failure and nephrotic range proteinuria. Histopathological evaluation of the kidney biopsy was consistent with immune complex mediated crescentic membranoproliferative glomerulonephritis (MPGN). The patient achieved complete renal and virological remission with steroids, plasmapheresis and antiviral therapy. This case report summarises the importance of early initiation of immunosuppression and plasmapheresis under antiviral coverage for improved clinical outcomes.