BackgroundPercutaneous renal biopsy (PRB) can result in serious complications. The study is aimed to compare the biopsy yield and complications rate of the real-time ultrasonagram (USG)-guided PRB and needle tracking with and without needle guide in two different study periods.MethodsWe compared the yield and complications of 2138 kidney biopsies performed in two different periods, 1510 biopsies during the first period from April 2004–December 2010 and 628 biopsies during second period from January 2011–March 2013. All biopsies in both periods were performed by nephrologists. Radiologists provided the real-time image without needle guide during the first period while nephrologists performed both imaging and biopsy with needle guide during the second period.ResultsOf all the 2138 patients, 226 (10.5%) patients developed 118 minor and 108 major complications. Only 13 (2.1%) major complications occurred in the second period and 95 (6.7%) in the first period (P < 0.001). The relative risk of developing a major complication without guide was 3.04 times greater than that of the biopsies performed with use of the guide. The mean number of glomeruli per biopsy obtained during the second period (17.98 ± 6.75) was significantly greater than that of the first period (14.14 ± 6.01) (P = 0.004). The number of passes to acquire adequate tissue (P = 0.001) and percentage of cortex on biopsy (P = 0.001) were also significantly better in the second period. The optimal observation period post biopsy is 24 h.ConclusionsReal-time USG imaging supported by needle guide device is associated with better biopsy yield and fewer complications.
♦ Objectives: We studied the effect of body mass index (BMI) at peritoneal dialysis (PD) initiation on patient and technique survival and on peritonitis during follow-up. ♦ Methods: We followed 328 incident patients on PD (176 with diabetes; 242 men; mean age: 52.6 ± 12.6 years; mean BMI: 21.9 ± 3.8 kg/m 2 ) for 20.0 ± 14.3 months. Patients were categorized into four BMI groups: obese, ≥25 kg/m 2 ; overweight, 23 -24.9 kg/m 2 ; normal, 18.5 -22.9 kg/m 2 (reference category); and underweight, <18.5 kg/m 2 . The outcomes of interest were compared between the groups. ♦ Results: Of the 328 patients, 47 (14.3%) were underweight, 171 (52.1%) were normal weight, 53 (16.2%) were overweight, and 57 (17.4%) were obese at commencement of PD therapy. The crude hazard ratio (HR) for mortality (p = 0.004) and the HR adjusted for age, subjective global assessment, comorbidities, albumin, diabetes, and residual glomerular filtration rate (p = 0.02) were both significantly greater in the underweight group than in the normal-weight group. In comparison with the reference category, the HR for mortality was significantly greater for underweight PD patients with diabetes [2.7; 95% confidence interval (CI): 1.5 to 5.0; p = 0.002], but similar for all BMI categories of nondiabetic PD patients. Median patient survival was statistically inferior in underweight patients than in patients having a normal BMI. Median patient survival in underweight, normal, overweight, and obese patients was, respectively, 26 patient-months (95% CI: 20.9 to 31.0 patient-months), 50 patient-months (95% CI: 33.6 to 66.4 patient-months), 57.7 patient-months (95% CI: 33.2 to 82.2 patient-months), and 49 patientmonths (95% CI: 18.4 to 79.6 patient-months; p = 0.015). Death-censored technique survival was statistically similar in all BMI categories. In comparison with the reference category, the odds ratio for peritonitis occurrence was 1.8 (95% CI: 0.9 to 3.4; p = 0.086) for underweight patients; 1.7 (95% CI: 0.9 to 3.2; p = 0.091) for overweight patients; and 3.4 (95% CI: 1.8 to 6.4; p < 0.001) for obese patients. ♦ Conclusions: In our PD patients, mean BMI was within the normal range. The HR for mortality was significantly greater for underweight diabetic PD patients than for patients in the reference category. Death-censored technique survival was similar in all BMI categories. Obese patients had a greater risk of peritonitis.
This study was carried out to look for diagnostic and prognostic role of neutrophil gelatinase-associated lipocalin (NGAL) in early diabetic nephropathy (DN) in type 2 diabetes individuals. NGAL was measured in both urinary and serum sample of 144 type 2 diabetes individuals stratified into three categories based on urinary albumin-creatinine ratio and 54 control populations with estimated glomerular filtration rate >60 mL/min/1.73 m2 and serum creatinine <1.2 mg/dl. The serum NGAL (sNGAL), urine NGAL (uNGAL), and uNGAL/urine creatinine were significantly higher in diabetic individuals than in the control populations with significant difference in between the groups (P < 0.05). Difference of above values between control value and normoalbuminuria was also statistically significant (P < 0.05). Again, sNGAL and uNGAL correlate positively with albuminuria (P < 0.05). Tubular injury may precede glomerular injury in diabetic individuals, and NGAL can be used as a biomarker to diagnose DN even earlier to incipient nephropathy. Both sNGAL and uNGAL can predict albuminuria and be used as a noninvasive tool for diagnosis, staging, and progression of DN.
Background Continuous ambulatory peritoneal dialysis (CAPD) has been an established modality of renal replacement therapy in India for a decade, but there is a paucity of published data on the outcome of CAPD patients in India. We analyzed our data to determine the overall predictors of survival and compared patient survival between diabetic and nondiabetic end-stage renal disease patients on CAPD. Methods Of 373 patients, 197 were diabetic (165 males, 32 females) and 176 nondiabetic (104 males, 72 females). Patients were followed for 22 ± 14 patient-months. Patients were prospectively followed until the study end point or death. Results Overall median survival was 48 patient-months. Median survival of diabetics (34.5 patient-months) was significantly inferior to nondiabetic patients (59 patient-months) p = 0.001. Overall patient survival at 1, 2, 3, 4, and 5 years was 90%, 72%, 60%, 49%, and 39%, respectively. Patient survival of diabetics versus nondiabetics at 1, 2, 3, 4, and 5 years was 85% versus 96%, 62% vs 82%, 48% vs 72%, 39% vs 62%, and 34% vs 42%, respectively. The relative risk of mortality in nondiabetics (34/176) was less than that in diabetic patients (71/197): odds ratio (OR) 0.43, 95% confidence interval (CI) 0.26 – 0.68; p = 0.001. On Cox regression analysis, diabetes (OR 1.95, 95% CI 1.23 – 3.07; p = 0.004), comorbidities (OR 0.39, 95% CI 0.25 – 0.61; p = 0.001), peritonitis (OR 1.79, 95% CI 1.19 – 2.68; p = 0.005), malnutrition (OR 0.52, 95% CI 0.29 – 0.94; p = 0.03), and residual glomerular filtration rate at initiation of CAPD (OR 0.87, 95% CI 0.81 – 0.93; p = 0.001) were significant predictors of overall mortality. Age (OR 0.68, 95% CI 0.45 – 1.03; p = 0.07), gender (OR 0.66, 95% CI 0.42 – 1.03; p = 0.06), and albumin level at initiation of CAPD (OR 0.92, 95% CI 0.64 – 1.33; p = 0.68) were not predictors of mortality. Age (56 ± 10 vs 46 ± 15 years, p = 0.001), comorbidities (51/197 vs 16/176, p = 0.001), peritonitis rate (0.68 vs 0.50 episodes/patient-year, p = 0.056), and severe malnutrition (27/197 vs 10/176, p = 0.002) were higher in diabetic than in nondiabetic patients. Conclusion In India the majority of CAPD patients are diabetic. Patient survival was inferior in diabetic compared to nondiabetic patients on CAPD, but survival was statistically similar after adjustment for comorbidities. Diabetes, comorbidities, residual glomerular filtration rate, peritonitis, and severe malnutrition are predictors of mortality in CAPD patients.
BackgroundGranulomatous tubulointerstitial nephritis (GIN) is common due to infections, drugs or sarcoidosis. However, the cause is often difficult to establish and the studies are limited. We studied the etiology of GIN and compared the clinical and histological features and outcome in different etiologies at a tertiary care center in North India.MethodsRenaö biopsies from GIN cases diagnosed from January 2004 to April 2014 were retrieved. Stain for acid fast bacilli was performed in all biopsies. Etiological diagnosis was based on clinical features, extra-renal manifestations, radiology, history of drug intake and demonstration of infective agent. Tissue PCR for tubercular DNA was performed in seven biopsies.ResultsSeventeen GIN patients [mean age 35 ± 15 years; males 11] were identified. Tuberculosis was the commonest etiology followed by idiopathic, sarcoidosis and fungal. Both tuberculosis and sarcoidosis patients presented with subnephrotic proteinuria and raised serum creatinine. Acid fast bacilli were demonstrated in 1/9 and necrosis was demonstrated in 3/9 granulomas in tuberculosis. Tissue PCR for tubercular DNA was positive in six TB patients and negative in one sarcoidosis patient. Patients responded well to appropriate therapy.ConclusionEtiological diagnosis of GIN is essential for timely and appropriate therapy. Tuberculosis is the commonest etiology (53%) in the tropics. Necrosis in granuloma, demonstration of acid fast bacilli, blood interferon gamma release assay and urine culture is not sensitive for the diagnosis of tuberculosis in GIN. Our findings suggest that tissue PCR for tuberculosis performed in an appropriate clinical setting is useful in the diagnostic evaluation of GIN.
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