Renal Effects of Hyperbaric Oxygen Therapy in Patients with Diabetes Mellitus: A Retrospective StudyRead the full article
International Journal of Nephrology publishes original research articles, review articles, and clinical studies on the prevention, diagnosis, and management of kidney diseases and associated disorders.
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Retrospective Study on Acute Kidney Injury among Cholera Patients in an Outbreak in Whitefield, Bengaluru
Introduction. Cholera is gastroenteritis caused by Vibrio cholerae. It presents with vomiting, severe secretory diarrhoea, and dehydration. It can cause severe complications with severe electrolyte imbalances and oligoanuric acute kidney injury due to acute tubular necrosis secondary to dehydration or infection itself. However, cholera presenting with significant proteinuria and acute kidney injury has not been reported. Hence, this study was conducted. Aims and Objectives. This aim of this study was to assess clinical features, treatment, and prognosis of AKI in cholera patients; to correlate proteinuria with AKI in cholera patients; and to compare cholera patients with normal kidney function and those with AKI. Material and Methods. It was a retrospective observational study involving patients with cholera. Information regarding cholera patients with acute kidney injury, proteinuria, and prognosis were collected. Results. Most of the patients had significant vomiting, moderate-to-severe diarrhoea, dehydration, and hypovolaemic shock. Cholera caused severe complications such as severe electrolyte imbalances including hyponatraemia and hypokalaemia, acute kidney injury, and proteinuria secondary to dehydration or infection. A surprising finding noted was the lack of significant association between the onset of acute kidney injury and usual risk factors such as hypovolaemic shock and dehydration. It was found that proteinuria had influenced the onset of acute kidney injury, but it did not influence recovery. As there was complete recovery in kidney function, none of the cases required kidney biopsy. There was no mortality noted. Conclusions. This study points towards the rare occurrence of proteinuria and acute kidney injury in Vibrio cholerae infection with spontaneous remission of kidney disease with appropriate therapy.
Prevalence of Depression and Sleep Disorders in Patients on Dialysis: A Cross-Sectional Study in Qatar
Patients with end-stage renal disease treated with dialysis have poor quality of life (QOL). Improving QOL in these patients with multiple comorbidities is a large challenge. We performed a cross-sectional study to evaluate the prevalence and associated factors of depression and sleep disorders in this population. Our primary aim was to evaluate QOL measures in dialysis patients in Qatar through a series of validated questionnaires mainly concerning depression and sleep disorders. Our secondary aim was to study the associations of age, sex, and comorbid conditions with the QOL measures. We hypothesized that end-stage renal disease (ESRD) patients on dialysis would have disturbed QOL due to both ESRD and dialysis and comorbidities. This prospective cross-sectional study included adult ESRD patients receiving either hemodialysis (HD) or peritoneal dialysis (PD) in the main tertiary dialysis unit in Qatar. We administered two surveys to evaluate depression (the Center for Epidemiologic Studies Depression Scale, http://www.bmedreport.com/archives/7139) and sleep disorders (the Pittsburgh Sleep Quality Index, https://www.sleep.pitt.edu/instruments/). We also reviewed patient demographics, comorbidities, and laboratory test results to evaluate any associated factors. We randomly studied 253 patients (62% on HD and 38% on PD). Overall, 48% of patients had depression, while 83.8% had sleep disorders. The PD had more poor sleepers than the HD group (89.1% versus (vs.) 75%, ). Most of our dialysis patients had poor sleep, but it was more significant in the elderly group 109 (90%) than in the young group 103 (78%) (). Patients with diabetes mellitus (DM) had significantly more prevalence of poor sleep (131 (88.5%)) than those without DM (81 (77.1%), ). More female patients had depression than male patients (52% vs. 25%, ; odds ratio: 3.27 (95% confidence interval: 1.9–5.6), ). This is the first study in Qatar to evaluate depression and sleep disorders in patients on dialysis therapy.
Mitochondrial Complex I Deficiency among Egyptian Pediatric Patients with Steroid-Resistant Nephrotic Syndrome
Background and objectives. Nephrotic Syndrome (NS) is one of the most common glomerular diseases among children. Up to 20% of patients are steroid resistant (SRNS) representing a challenging subset at high risk of developing end-stage renal disease. Renal manifestations of mitochondrial diseases (MIDs) include nephrotic syndrome, renal insufficiency, nephrolithiasis, Bartter-like syndrome, focal segmental glomerulosclerosis, and nephrocalcinosis. The objective of the current study is to measure the activity of mitochondrial complex I in renal biopsies obtained from pediatric patients diagnosed with SRNS compared to steroid-sensitive nephrotic syndrome (SSNS) patients in order to elucidate its role in pathogenesis and the prognosis for further genetic work. Subjects and Method. Renal biopsies of 120 patients diagnosed with nephrotic syndrome based on clinical and laboratory findings, divided into two groups, SRNS (60 patients) and SSNS (60 patients). Pathological study and spectrophotometric measurement of mitochondrial complex I in renal biopsy and muscle homogenates were performed for both groups. Results. Positive consanguinity was a remarkable finding in 44 patients among the SRNS group (73%), compared with 33 patients among the SSNS group (55%). Complex I activity was significantly lower in the SRNS group (0.2657 ± 0.1831 nmol/ml/min), than in the SSNS group (0.4773 ± 0.1290 nmol/ml/min) (). There was a significant positive correlation between complex I activity and the heaviness of proteinuria among the SRNS group (r 0.344, ). There were statistically significant differences in serum C3 and C4 levels between both groups (, 0.053, respectively). Conclusion. Mitochondrial complex I deficiency in patients who have a nephrotic syndrome complaint may play a role in their responsiveness to steroid therapy and the development of SRNS and even the prognosis of their illness.
A Cross-Sectional Analysis of Dietary Intake and Nutritional Status of Patients on Haemodialysis Maintenance Therapy in a Country of Sub-Saharan Africa
Malnutrition is common among dialysis patients, but there is insufficient literature on the problem from resource-poor settings of the sub-Saharan region. We conducted a cross-sectional investigation of dietary intake and nutritional status of haemodialysis (HD) patients to inform the current status of this population group in the region. HD patients aged ≥18 years, with dialysis vintage of ≥3 months, at one nephrology unit in Tanzania were assessed for their habitual diet and nutrient intake. Anthropometric measures and biochemistry tests were also performed. The diet was predominantly starchy food based, accompanied by a limited selection of vegetables. Fruits and animal protein were also minimally consumed (1 portion/day each). Fruit consumption was higher in females than males (median (25th, 75th) = 2 (1, 2.3) versus 0.5 (0, 1.7) portions, = 0.008). More than 70% of participants had suboptimal measures for protein and energy intake, dietary iron, serum albumin, muscle mass, and hand grip strength (HGS). Inadequacies in protein and energy intake and dialysis clearance (URR) increased with the increase in body weight/BMI and other specific components (MAMC and FMI). Consumption of red meats correlated significantly and positively with serum creatinine (r = 0.46, = 0.01), potassium (r = 0.39, = 0.03), and HGS (r = 0.43, = 0.02) and was approaching significance for a correlation with serum iron (r = 0.32, = 0.07). C-RP correlated negatively with albumin concentration (r = −0.32, = 0.02), and participants with C-RP within acceptable ranges had significantly higher levels of haemoglobin ( = 0.03, effect size = −0.28). URR correlated negatively with haemoglobin concentration (r = −0.36, = 0.02). Patients will benefit from improved nutritional services that deliver individually tailored and culturally practical dietary advice to enable them to make informed food choices whilst optimizing disease management.
Clinical Presentation, Renal Histopathological Findings, and Outcome in Patients with Monoclonal Gammopathy and Kidney Disease
Monoclonal gammopathies are associated with acute and chronic kidney injury. Nephrotoxicity of the secreted monoclonal (M)-protein is related to its biological properties and blood concentration. Little is known about epidemiology, clinical manifestations, and outcome of monoclonal gammopathies in patients with kidney disease. We retrospectively collected data about demographics, clinical manifestations, and renal histological lesions of all patients (n = 1334) who underwent kidney biopsy between January 2000 and March 2017. Monoclonal gammopathy was detected in 174 (13%) patients with a mean age of 66.4 ± 13.1 years. The spectrum of monoclonal gammopathies comprised monoclonal gammopathy of undetermined significate (MGUS) (52.8%), multiple myeloma (MM) (25.2%), primary amyloidosis (AL) (9.1%), smoldering MM (SMM) (4%), non-Hodgkin lymphoma (NHL) (6.8%), and Hodgkin lymphoma (HL) (1.7%). Monoclonal gammopathy of renal significance (MGRS) accounted for 6.5% in patients with MGUS and 14.2% in patients with SMM. Evaluation of kidney biopsy revealed that M-protein was directly involved in causing kidney injury in MM (93.1%). MM was the only gammopathy significantly associated with an increased risk of kidney injury (odds ratio [OR] = 47.5, CI 95%, 13.7–164.9; ). While there were no significant differences in the progression toward end-stage renal disease or dialysis , monoclonal gammopathies were associated with a different risk of death at the end of the follow-up. In conclusion, monoclonal gammopathy was a frequent finding (13%) in patients who underwent kidney biopsy. M-protein was secreted by both premalignant (56.8%) and malignant (43.2%) lymphoproliferative clones. Kidney biopsy had a key role in identifying MGRS in patients with MGUS (6.5%) and SMM (14.2%). Among monoclonal gammopathies, only MM was significantly associated with biopsy-proven kidney injury. The rate of end-stage renal disease or dialysis was similar among monoclonal gammopathies, whereas NHL, MM, and SMM showed a higher rate of deaths.
Impact of National Economy and Policies on End-Stage Kidney Care in South Asia and Southeast Asia
Background. The association between economic status and kidney disease is incompletely explored even in countries with higher economy (HE); the situation is complex in lower economies (LE) of South Asia and Southeast Asia (SA and SEA). Methods. Fifteen countries of SA and SEA categorized as HE and LE, represented by the representatives of the national nephrology societies, participated in this questionnaire and interview-based assessment of the impact of economic status on renal care. Results. Average incidence and prevalence of end-stage kidney disease (ESKD) per million population (pmp) are 1.8 times and 3.3 times higher in HE. Hemodialysis is the main renal replacement therapy (RRT) (HE-68%, LE-63%). Funding of dialysis in HE is mainly by state (65%) or insurance bodies (30%); out of pocket expenses (OOPE) are high in LE (41%). Highest cost for hemodialysis is in Brunei and Singapore, and lowest in Myanmar and Nepal. Median number of dialysis machines/1000 ESKD population is 110 in HE and 53 in LE. Average number of machines/dialysis units in HE is 2.7 times higher than LE. The HE countries have 9 times more dialysis centers pmp (median HE-17, LE-02) and 16 times more nephrologist density (median HE-14.8 ppm, LE-0.94 ppm). Dialysis sessions >2/week is frequently followed in HE (84%) and <2/week in LE (64%). “On-demand” hemodialysis (<2 sessions/week) is prevalent in LE. Hemodialysis dropout rates at one year are lower in HE (12.3%; LE 53.4%), death being the major cause (HE-93.6%; LE-43.8%); renal transplants constitute 4% (Brunei) to 39% (Hong Kong) of the RRT in HE. ESKD burden is expected to increase >10% in all the HE countries except Taiwan, 10%–20% in the majority of LE countries. Conclusion. Economic disparity in SA and SEA is reflected by poor dialysis infrastructure and penetration, inadequate manpower, higher OOPE, higher dialysis dropout rates, and lesser renal transplantations in LE countries. Utility of RRT can be improved by state funding and better insurance coverage.