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Context:In India, there are a large number of end-stage renal disease (ESRD) patients waiting for renal transplant. Deceased donor organ transplantation (DDOT) is the possible solution to bridge the disparity between organ supply and demand. The concept of expanded criteria donors (ECDs) was developed to combat the huge discrepancy between demand and organ availability. However, ECD kidneys have a higher propensity for delayed graft function (DGF), and therefore worse long-term survival. We present our experience of deceased donor renal transplantation.Aims:We report single centre experience on DDOT including ECDs vis-à-vis patient/graft survival, graft function in terms of serum creatinine (SCr), rejection episodes, and delayed graft function in 44 DDOTMaterials and Methods:Between August 1998 and April 2011, 44 renal transplants from 35 deceased donors were performed, of which 37.2% were expanded criteria donors. Results were analyzed in terms of age of donor, terminal SCr, graft ischemia time, graft function, post-transplant complications, and graft and patient survival. All recipients received sequential triple drug immunosuppression and induction with rabbit antithymocyte globulin (rATG). The induction is commenced by giving first dose of rATG intraoperatively (dose 1.5 mg/kg) and subsequent rATG infusions were administered daily for a minimum of 5 and maximum of 7 doses depending on initial graft function.Results:We have been able to achieve a mean cold ischemia time of 6.25 ± 2.55 h due to the coordinated team efforts. Delayed graft function occurred in 34% patients and 31.8% had prolonged drainage. There were no urinary leaks. Seven (16%) patients had biopsy-proven rejection episodes, all of which were reversed with treatment. Two patients underwent graft nephrectomy. One of these was due to hyperacute rejection and another due to anastomotic hemorrhage. One-year graft survival was 92.4% and the patient survival was 83.8%.Conclusion:Deceased donor renal transplants have satisfactory graft function and patient survival despite the high incidence of delayed graft function. Retrieving kidneys from marginal donors can add to the donor pool.

Encountering a foreign body (FB) in the kidney is uncommon. Most of the time a FB is introduced externally (violence or accident) or through endourological interventions. An ingested FB reaching the kidneys is extremely rare. This article includes an interesting case of FB, which apparently reached the kidney through the gastrointestinal tract as well as a brief review of the relevant literature. The case was successfully managed laparoscopically.

BACKGROUND In India, most of the anti-tuberculosis regimens under Revised National Tuberculosis Control Programme (RNTCP) are rifampicin based. Venous Thrombosis (VT) is a rare side effect of rifampicin and very few cases are reported worldwide. Studies have demonstrated possible association between VT and use of rifampicin, in patients treated with rifampicin containing regimens. MATERIALS AND METHODS This was an observational study done in New Medical College Hospital, Kota during the period June 2016 to July 2018. Careful watch was kept on patients who were admitted for any complications after initiation of ATT. RESULTS During this period, 4 patients, who were taking ATT, presented with thromboembolic events. Mean time of presentation was 71±22 days after starting ATT. 3 patients had lower limb DVT & 1 patient had pulmonary artery thrombus. CONCLUSION Though venous thrombosis is uncommon side effect of rifampicin, treating physicians should be cautious during treatment.

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Pericardial effusion is not so uncommon in hypothyroidism, but pericardial tamponade is very rare entity. Hypothyroidism complicated by pericardial tamponade is very rarely referenced in the medical literature. Here we report a rare case of a 70 year old female, who presented with breathlessness and was found to have hypothyroidism with large pericardial effusion complicating into pericardial tamponade. Management included urgent pericardiocentesis followed by l-thyroxine supplementation.

Emphysematous pyelonephritis (EP) is a rare, severe gas forming infection of renal parenchyma and its surrounding areas and potentially life threatening condition that requires prompt evaluation and treatment. Although it commonly present with a fulminant clinical picture of sepsis, relatively mild symptoms can also be encountered. To our knowledge, incidentally detected emphysematous pyelonephritis has not been reported so far. We report a case of EP that was incidentally detected during evaluation for diabetes.

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