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Raj Sharma

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Saint Louis University

Abdulla Al Khader Al Sayyari

King Saud Bin Abdulaziz University for Health Sciences

Elmukhtar Habas

Melvin T M Chin

UNSW

The University of Queensland, Australia

Akinfenwa Atanda

Patiencen Obiagwu

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Papers by Raj Sharma

Real-time ultrasound-guided percutaneous renal biopsy with needle guide by nephrologists decreases post-biopsy complications

Clinical kidney journal, 2015

Percutaneous renal biopsy (PRB) can result in serious complications. The study is aimed to compar... more Percutaneous 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. We 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. Of 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 ...

Emergency surgery for Meckel's diverticulum

World journal of emergency surgery : WJES, 2008

The current work attempts to highlight the various life threatening complications of Meckel's... more The current work attempts to highlight the various life threatening complications of Meckel's diverticulum and to present the surgical strategies used in the emergency conditions so far in the form of a review of the works presented in the literature. Our aim behind this presentation is to cover the possible indications, methods, their complications and the outcome of these surgical techniques. For this, we made an extensive literature search using Google and Pubmed with the words-"Meckel's diverticulum", "Complications", "Management" and "Emergency surgery". All the relevant articles containing the surgical aspects of symptomatic Meckel's diverticulum till May 2008 were collected and analyzed. Meckel's diverticulum is the remains of the prenatal yolkstalk (Vitellointestinal duct). Although it generally remains silent but life threatening complications may arise making it an important structure for having a detailed knowledge o...

The many faces of infection in a hemodialysis patient

Kidney international, 2014

A 53-year-old diabetic man, with end-stage renal disease and on maintenance hemodialysis through ... more A 53-year-old diabetic man, with end-stage renal disease and on maintenance hemodialysis through arteriovenous fistula since 6 months, presented with a 6-week history of fever, multiple swellings over chest and lower limbs, cough, and dyspnea. On examination, multiple fluctuant swellings with palpable crepitus were noted over anterior chest wall and lower limbs ( ). Chest X-ray showed massive left pleural effusion. On thoracocentesis, empyema was noted; cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Aspiration of the swellings over his chest and foot also showed MRSA infection. Blood cultures and sputum cultures were also positive for MRSA. Computed tomography (CT) of the chest was suggestive of large loculated left pleural effusion and thick-walled collections involving right sternoclavicular and manubriosternal joints, which were subluxated with air pockets within the collections and extended retrosternally abutting major vessels ( ). In view of disseminated MRSA infection with bacteremia, an echocardiogram was performed, which was suggestive of endocarditis with vegetations over posterior leaflet of aortic valve. The patient was treated with vancomycin and amikacin, left-sided pleural drain, and drainage of abscesses with subsequent improvement that was confirmed on repeat echocardiogram and chest CT. This patient illustrates the high infectious risk associated with hemodialysis, which is a common cause of mortality in these patients. Early diagnosis and aggressive treatment are required. n e p h r o l o g y i m a g e Figure 1 | Multiple inflammatory swellings over chest (black arrows). A P A P L R F R L Figure 2 | Computed tomography of chest-air pockets within the abscesses over chest (white arrow), massive left pleural effusion (white arrow heads).

Inflammatory Pseudotumor of the Urachus

UroToday International Journal, 2012

Prognostic significance of distal renal tubular acidosis in posterior urethral valve

Pediatric Nephrology, 2001

The prognostic significance of distal renal tubular acidosis (DRTA) in the development of overt n... more The prognostic significance of distal renal tubular acidosis (DRTA) in the development of overt nephropathy (ON) in children with posterior urethral valves (PUV) is not clear. This condition was studied prospectively in 22 children with posterior urethral valve (PUV), with normal renal function. Prior to surgery, the children with ON had a higher incidence of bilateral reflux (P=0.006), but the difference was not significant for age at surgery (P=0.31), duration of voiding symptoms prior to surgery (P=0.30), presence of DRTA (P=0.35) and bladder abnormalities (P=0.27), with none of these factors being significant on logistic regression analysis. At the end of the follow-up, after surgery, age at surgery (P≤0.0001), duration of voiding symptoms prior to surgery (P≤0.0003), persistent DRTA (P=0.0001) and persistent bladder dysfunction (P=0.02) after surgery were significantly higher in children with ON. On univariate logistic regression analysis, age at surgery (P=0.009), duration of voiding symptoms prior to surgery (P=0.01), persistent DRTA (P=0.002) and persistent bladder abnormalities (P=0.03) after surgery were significant for ON after surgery, but on stepwise multivariate logistic regression analysis only persistent DRTA (P=0.002) turned out to be significant. We conclude that persistent DRTA after surgery can predict overt nephropathy in children with PUV after surgery.

Incomplete distal renal tubular acidosis affects growth in children

Nephrology Dialysis Transplantation, 2007

Background. Incomplete distal renal tubular acidosis (idRTA) is recognized as an underlying aetio... more Background. Incomplete distal renal tubular acidosis (idRTA) is recognized as an underlying aetiology in recurrent nephrolithiasis. Until the recently reported high prevalence of idRTA in adults with osteoporosis, the effect of idRTA on skeletal parameters was not known. We hypothesize that idRTA has a potential to affect height in the paediatric population. Methods. In a cross-sectional study, the children with posterior urethral valves (PUV), with normal estimated glomerular filtration rates, were evaluated for idRTA and complete dRTA. The idRTA evaluation was done by short ammonium chloride acidification test. The height standard deviation scores (SDS) in the idRTA group were compared with PUV children without dRTA, with complete dRTA, and to age and gender matched controls with no renal issue (n ¼ 50). Results. The idRTA group (n ¼ 17) manifested a significantly lower mean height SDS (À1.94 AE 0.41 vs À0.46 AE 0.28; P < 0.001) and a higher short stature prevalence (height SDS below 2) (18% vs 0; P ¼ 0.06) as compared with those without dRTA (n ¼ 23). The matched controls showed a significantly higher height SDS as compared with the idRTA group (À0.39 AE 0.25 vs À1.94 AE 0.41; P < 0.001). As compared with the complete dRTA group (n ¼ 9), the children with idRTA did have significantly higher height SDS (À1.94 AE 0.41 vs À5.31 AE 1.95; P ¼ 0.002), and a lower short stature prevalence (18% vs 78%; P ¼ 0.001). On multivariate analysis, dRTA was significantly associated with the height SDS ( ¼ À0.88; P < 0.001).

Longitudinal follow-up of bone mineral density in children with nephrotic syndrome and the role of calcium and vitamin D supplements

Nephrology Dialysis Transplantation, 2005

Background. We previously have demonstrated that children with idiopathic nephrotic syndrome (INS... more Background. We previously have demonstrated that children with idiopathic nephrotic syndrome (INS) are at risk of metabolic bone disease (MBD). In this study, we report the longitudinal follow-up of these children and the role of calcium and vitamin D supplements. Methods. We prospectively studied 100 consecutive children with INS. They were treated with prednisone. All were subjected to a baseline clinical, biochemical and radiological evaluation. They were initiated on calcium (500 mg/day) and vitamin D 3 (200 IU/day) supplements, followed by a repeat assessment. The primary outcome measure was the Áz score (difference between the initial and final z scores) on dual energy X-linked absorptiometry (DEXA). A univariate and multivariate analysis using stepwise linear regression was performed for factors predictive of an improved Áz score. Results. Of the 88 children that completed the study, the majority (n ¼ 54) had improved bone mineral density (BMD) at the spine, and another 25 children had stable BMD on calcium and vitamin D 3 supplements. The mean spinal BMD values were significantly better on follow-up (0.607±0.013 g/cm 2 ) as compared with baseline values (0.561±0.010 g/cm 2 ) (P<0.0001). The interval between initial and follow-up assessment was 1.5±0.07 years. Children who were on these supplements (n ¼ 73) had a significantly improved z score as compared with those who did not receive them (n ¼ 15) (P ¼ 0.008). On multivariate analysis, the factors predictive of an improved z score were: younger age (P<0.0001), calcium and vitamin D 3 supplement (P<0.0001), greater dietary calcium intake (P ¼ 0.022) and lower interval steroid dose (P ¼ 0.001).

$Research paper thumbnail of A rare clinical syndrome of refractory secondary hypertension, renal artery stenosis and erythrocytosis$

A rare clinical syndrome of refractory secondary hypertension, renal artery stenosis and erythrocytosis

NDT Plus, 2011

Clinical syndrome of refractory secondary hypertension, renal artery stenosis and secondary eryth... more Clinical syndrome of refractory secondary hypertension, renal artery stenosis and secondary erythrocytosis could occur in the same patient. We report a rare case of refractory secondary hypertension, renal artery stenosis and primary erythrocytosis as an expression of polycythaemia rubra vera (PV) and suggest that erythrocytosis in a hypertensive renovascular occlusive disease may be primary due to underlying PV. This clinical syndrome should be excluded in such patients with refractory hypertension.

Does Mycophenolate Mofetil Decrease the Recurrent Acute Rejection in Renal Transplant Recipients

International Urology and Nephrology, 2005

Purpose: Mycophenolate mofetil (MMF) has emerged as a valuable immunosuppression in renal transpl... more Purpose: Mycophenolate mofetil (MMF) has emerged as a valuable immunosuppression in renal transplant patients. However, it is expensive and cannot be used routinely in our population. Material and methods: In a retrospective study, 60 renal transplant patients on MMF based triple immunosuppression were analysed. The indication for MMF was as rescue therapy after treatment of acute vascular rejection (Banff type-4, grade IIA, IIB and III) in all patients. However, 20 such patients also had associated chronic liver diseases. The patients were given 1.5-2.0 g MMF in two divided doses at least for 6 months, depending upon the tolerability, adverse effects and affordability, and followed-up at least for 1 year. The control group consisted of 60 cases of acute vascular rejection (Banff type-4, grade IIA, IIB and III) who were placed on cyclosporine, azathioprine and steroid based maintenance immunosuppressive regimen in same time frame. Results: The incidence recurrent acute rejections in MMF group was 18% and 42% in control group (P < 0.005). The serum transaminases in all patients of the liver diseases became normal in 3-6 months. The incidence of opportunistic infections in MMF and control group were 22% and 11% respectively (P < 0.05). The MMF based regimen was two times more expensive. The 1 year patient and graft survivals between two groups were not statistically significantly different. Conclusion: The MMF based regimen significantly decreases the recurrent acute rejections. However, it is expensive and cannot be used routinely in all patients in Indian scenario.

Cyclosporin A withdrawal in live related renal transplantation: long-term results

Clinical Transplantation, 2001

Cyclosporin A (CsA) withdrawal after 1 yr of stable graft function has been shown to be beneficia... more Cyclosporin A (CsA) withdrawal after 1 yr of stable graft function has been shown to be beneficial in cadaveric renal transplantation. This strategy could be even more suitable for &#39;immunologically advantaged&#39; grafts as in live related renal transplantation. We report the long-term outcome of patients in a live related transplantation programme undergoing early (between 1989 and 1992) and late (1993 onwards) CsA withdrawal as compared with those on long-term low dose CsA (1993 onwards). Two-hundred and fifty-two patients were divided into three groups based on the following immunosuppressive protocol: group ECyW (n=99), early CsA withdrawal (9 months after transplantation); group LCyW (n=44), late CsA withdrawal (median 16 months, range 13--22 months after transplantation); and group LDCy (n=109), long-term low dose CsA. The median period of follow-up was 66 months after transplantation (range 43--84 months). There was no difference in the actuarial 6-yr patient or graft survival among the three groups. Acute rejection episodes were more frequent in ECyW (54.4%) than in LDCy (31.8%) and LCyW (23.8%) (p=0.001). The risk of developing late (&gt; or =9 months) acute rejection was highest in ECyW 32/99 (32.3%) as compared with LCyW 8/44 (18.4%; p=0.08) and LDCy 8/109 (7.3%; p=0.0001). Of the 32 ECyW patients who developed acute rejection episodes after CsA withdrawal, 13 (40.6%) lost their grafts either due to uncontrolled acute rejection or to chronic rejection. Chronic rejection was higher in ECyW (24%) than in LCyW (11%; p=0.04) and LDCy (17%; p=0.17). Antihypertensive requirement was highest in patients maintained on low dose CsA. Graft function, as measured by serum creatinine levels, was significantly better in LCyW (1.24+/-0.4 mg%) as compared with ECyW (1.49+/-0.5 mg%) and LDCy (1.48+/-0.6 mg%). Early CsA withdrawal after live related renal transplantation is associated with a significant risk of acute rejection and subsequent chronic rejection. Slow withdrawal after 1 yr is safe and more economical than the long-term administration of low dose CsA.

Gangrenous Meckel’s diverticulum causing acute intestinal obstruction in an adult

ANZ Journal of Surgery, 2008

Clinical Evaluation of the Efficacy and Safety of Calcium Dobesilate in Patients with Chronic Venous Insufficiency of the Lower Limbs

Angiology, 2002

Objective To compare postoperative analgesia provided by a constant rate infusion (CRI) of dexmed... more Objective To compare postoperative analgesia provided by a constant rate infusion (CRI) of dexmedetomidine (DMED) to that of a well-established positive control [morphine (MOR)] in critically ill dogs. The sedative, cardiorespiratory effects and clinical safety of a 24-hour DMED CRI were also evaluated.

High Prevalence of ACE DD Genotype Among North Indian End Stage Renal Disease Patients

BMC …, 2006

The Renin-Angiotensin system (RAS) is a key regulator of both blood pressure and kidney functions... more The Renin-Angiotensin system (RAS) is a key regulator of both blood pressure and kidney functions and their interaction. In such a situation, genetic variability in the genes of different components of RAS is likely to contribute for its heterogeneous association in the renal disease patients. Angiotensin converting enzyme-1 (ACE-1) is an important component of RAS which determines the vasoactive peptide Angiotensin-II.

Hemoglobin—E β thalassemia presenting with recurrent priapism—A rare complication

American Journal of Hematology, 2008

E b thalassemia is a pathological double heterozygous state in which a patient inherits thalassem... more E b thalassemia is a pathological double heterozygous state in which a patient inherits thalassemia gene from one parent and the hemoglobin E gene from the other parent. Clinical severity of Hemoglobin E-b thalassemia is variable, ranging from mild to severe, simulating homozygous b thalassemia [1]. Inspite of its occasional resemblance with thalassemia major, thromboembolic manifestations have been rarely reported in this disease [2]. Priapism represents a rare variety of thromboembolic manifestation, which has been reported in other hemoglobinopathies such as in sickle cell disease and thalassemia intermedia [3]. It has not been reported in literature of hemoglobin E-b thalassemia to the best of our knowledge. It was unavailability of such information, which prompted us to submit the present communication.

Steroid response pattern in Indian children with nephrotic syndrome

Acta Paediatrica, 1994

The steroid response pattern to standard prednisolone therapy is of immense diagnostic, therapeut... more The steroid response pattern to standard prednisolone therapy is of immense diagnostic, therapeutic and prognostic value for the treating physician in managing children with nephrotic syndrome. None of the studies from our country has analysed the clinical, biochemical and histopathological profile in different steroid response categories. To address this problem we conducted a study comprising 127 children with nephrotic syndrome referred to our institute. They were treated with oral prednisolone according to the APN protocol. Based on the subsequent response these children were classified into different steroid response categories on follow-up. Of the 116 children with follow-up of more than six months, infrequent relapsers constituted the majority (37.9%). The frequency of other steroid response categories was as follows: frequent relapsers (21.6%), steroid-dependent (18.1%), initial non-responders (17.3%) and subsequent non-responders (5.1%). The factors predicting a poor response to standard prednisolone therapy in our study were age of onset more than eight years, male sex, hypertension, microscopic haematuria and presence of non-minimal change nephrotic syndrome lesions on histopathology.

Real-time ultrasound-guided percutaneous renal biopsy with needle guide by nephrologists decreases post-biopsy complications

Clinical kidney journal, 2015

Percutaneous renal biopsy (PRB) can result in serious complications. The study is aimed to compar... more Percutaneous 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. We 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. Of 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 ...

Emergency surgery for Meckel's diverticulum

World journal of emergency surgery : WJES, 2008

The current work attempts to highlight the various life threatening complications of Meckel's... more The current work attempts to highlight the various life threatening complications of Meckel's diverticulum and to present the surgical strategies used in the emergency conditions so far in the form of a review of the works presented in the literature. Our aim behind this presentation is to cover the possible indications, methods, their complications and the outcome of these surgical techniques. For this, we made an extensive literature search using Google and Pubmed with the words-"Meckel's diverticulum", "Complications", "Management" and "Emergency surgery". All the relevant articles containing the surgical aspects of symptomatic Meckel's diverticulum till May 2008 were collected and analyzed. Meckel's diverticulum is the remains of the prenatal yolkstalk (Vitellointestinal duct). Although it generally remains silent but life threatening complications may arise making it an important structure for having a detailed knowledge o...

The many faces of infection in a hemodialysis patient

Kidney international, 2014

A 53-year-old diabetic man, with end-stage renal disease and on maintenance hemodialysis through ... more A 53-year-old diabetic man, with end-stage renal disease and on maintenance hemodialysis through arteriovenous fistula since 6 months, presented with a 6-week history of fever, multiple swellings over chest and lower limbs, cough, and dyspnea. On examination, multiple fluctuant swellings with palpable crepitus were noted over anterior chest wall and lower limbs ( ). Chest X-ray showed massive left pleural effusion. On thoracocentesis, empyema was noted; cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Aspiration of the swellings over his chest and foot also showed MRSA infection. Blood cultures and sputum cultures were also positive for MRSA. Computed tomography (CT) of the chest was suggestive of large loculated left pleural effusion and thick-walled collections involving right sternoclavicular and manubriosternal joints, which were subluxated with air pockets within the collections and extended retrosternally abutting major vessels ( ). In view of disseminated MRSA infection with bacteremia, an echocardiogram was performed, which was suggestive of endocarditis with vegetations over posterior leaflet of aortic valve. The patient was treated with vancomycin and amikacin, left-sided pleural drain, and drainage of abscesses with subsequent improvement that was confirmed on repeat echocardiogram and chest CT. This patient illustrates the high infectious risk associated with hemodialysis, which is a common cause of mortality in these patients. Early diagnosis and aggressive treatment are required. n e p h r o l o g y i m a g e Figure 1 | Multiple inflammatory swellings over chest (black arrows). A P A P L R F R L Figure 2 | Computed tomography of chest-air pockets within the abscesses over chest (white arrow), massive left pleural effusion (white arrow heads).

Inflammatory Pseudotumor of the Urachus

UroToday International Journal, 2012

Prognostic significance of distal renal tubular acidosis in posterior urethral valve

Pediatric Nephrology, 2001

The prognostic significance of distal renal tubular acidosis (DRTA) in the development of overt n... more The prognostic significance of distal renal tubular acidosis (DRTA) in the development of overt nephropathy (ON) in children with posterior urethral valves (PUV) is not clear. This condition was studied prospectively in 22 children with posterior urethral valve (PUV), with normal renal function. Prior to surgery, the children with ON had a higher incidence of bilateral reflux (P=0.006), but the difference was not significant for age at surgery (P=0.31), duration of voiding symptoms prior to surgery (P=0.30), presence of DRTA (P=0.35) and bladder abnormalities (P=0.27), with none of these factors being significant on logistic regression analysis. At the end of the follow-up, after surgery, age at surgery (P≤0.0001), duration of voiding symptoms prior to surgery (P≤0.0003), persistent DRTA (P=0.0001) and persistent bladder dysfunction (P=0.02) after surgery were significantly higher in children with ON. On univariate logistic regression analysis, age at surgery (P=0.009), duration of voiding symptoms prior to surgery (P=0.01), persistent DRTA (P=0.002) and persistent bladder abnormalities (P=0.03) after surgery were significant for ON after surgery, but on stepwise multivariate logistic regression analysis only persistent DRTA (P=0.002) turned out to be significant. We conclude that persistent DRTA after surgery can predict overt nephropathy in children with PUV after surgery.

Incomplete distal renal tubular acidosis affects growth in children

Nephrology Dialysis Transplantation, 2007

Background. Incomplete distal renal tubular acidosis (idRTA) is recognized as an underlying aetio... more Background. Incomplete distal renal tubular acidosis (idRTA) is recognized as an underlying aetiology in recurrent nephrolithiasis. Until the recently reported high prevalence of idRTA in adults with osteoporosis, the effect of idRTA on skeletal parameters was not known. We hypothesize that idRTA has a potential to affect height in the paediatric population. Methods. In a cross-sectional study, the children with posterior urethral valves (PUV), with normal estimated glomerular filtration rates, were evaluated for idRTA and complete dRTA. The idRTA evaluation was done by short ammonium chloride acidification test. The height standard deviation scores (SDS) in the idRTA group were compared with PUV children without dRTA, with complete dRTA, and to age and gender matched controls with no renal issue (n ¼ 50). Results. The idRTA group (n ¼ 17) manifested a significantly lower mean height SDS (À1.94 AE 0.41 vs À0.46 AE 0.28; P < 0.001) and a higher short stature prevalence (height SDS below 2) (18% vs 0; P ¼ 0.06) as compared with those without dRTA (n ¼ 23). The matched controls showed a significantly higher height SDS as compared with the idRTA group (À0.39 AE 0.25 vs À1.94 AE 0.41; P < 0.001). As compared with the complete dRTA group (n ¼ 9), the children with idRTA did have significantly higher height SDS (À1.94 AE 0.41 vs À5.31 AE 1.95; P ¼ 0.002), and a lower short stature prevalence (18% vs 78%; P ¼ 0.001). On multivariate analysis, dRTA was significantly associated with the height SDS ( ¼ À0.88; P < 0.001).

Longitudinal follow-up of bone mineral density in children with nephrotic syndrome and the role of calcium and vitamin D supplements

Nephrology Dialysis Transplantation, 2005

Background. We previously have demonstrated that children with idiopathic nephrotic syndrome (INS... more Background. We previously have demonstrated that children with idiopathic nephrotic syndrome (INS) are at risk of metabolic bone disease (MBD). In this study, we report the longitudinal follow-up of these children and the role of calcium and vitamin D supplements. Methods. We prospectively studied 100 consecutive children with INS. They were treated with prednisone. All were subjected to a baseline clinical, biochemical and radiological evaluation. They were initiated on calcium (500 mg/day) and vitamin D 3 (200 IU/day) supplements, followed by a repeat assessment. The primary outcome measure was the Áz score (difference between the initial and final z scores) on dual energy X-linked absorptiometry (DEXA). A univariate and multivariate analysis using stepwise linear regression was performed for factors predictive of an improved Áz score. Results. Of the 88 children that completed the study, the majority (n ¼ 54) had improved bone mineral density (BMD) at the spine, and another 25 children had stable BMD on calcium and vitamin D 3 supplements. The mean spinal BMD values were significantly better on follow-up (0.607±0.013 g/cm 2 ) as compared with baseline values (0.561±0.010 g/cm 2 ) (P<0.0001). The interval between initial and follow-up assessment was 1.5±0.07 years. Children who were on these supplements (n ¼ 73) had a significantly improved z score as compared with those who did not receive them (n ¼ 15) (P ¼ 0.008). On multivariate analysis, the factors predictive of an improved z score were: younger age (P<0.0001), calcium and vitamin D 3 supplement (P<0.0001), greater dietary calcium intake (P ¼ 0.022) and lower interval steroid dose (P ¼ 0.001).

$Research paper thumbnail of A rare clinical syndrome of refractory secondary hypertension, renal artery stenosis and erythrocytosis$

A rare clinical syndrome of refractory secondary hypertension, renal artery stenosis and erythrocytosis

NDT Plus, 2011

Clinical syndrome of refractory secondary hypertension, renal artery stenosis and secondary eryth... more Clinical syndrome of refractory secondary hypertension, renal artery stenosis and secondary erythrocytosis could occur in the same patient. We report a rare case of refractory secondary hypertension, renal artery stenosis and primary erythrocytosis as an expression of polycythaemia rubra vera (PV) and suggest that erythrocytosis in a hypertensive renovascular occlusive disease may be primary due to underlying PV. This clinical syndrome should be excluded in such patients with refractory hypertension.

Does Mycophenolate Mofetil Decrease the Recurrent Acute Rejection in Renal Transplant Recipients

International Urology and Nephrology, 2005

Purpose: Mycophenolate mofetil (MMF) has emerged as a valuable immunosuppression in renal transpl... more Purpose: Mycophenolate mofetil (MMF) has emerged as a valuable immunosuppression in renal transplant patients. However, it is expensive and cannot be used routinely in our population. Material and methods: In a retrospective study, 60 renal transplant patients on MMF based triple immunosuppression were analysed. The indication for MMF was as rescue therapy after treatment of acute vascular rejection (Banff type-4, grade IIA, IIB and III) in all patients. However, 20 such patients also had associated chronic liver diseases. The patients were given 1.5-2.0 g MMF in two divided doses at least for 6 months, depending upon the tolerability, adverse effects and affordability, and followed-up at least for 1 year. The control group consisted of 60 cases of acute vascular rejection (Banff type-4, grade IIA, IIB and III) who were placed on cyclosporine, azathioprine and steroid based maintenance immunosuppressive regimen in same time frame. Results: The incidence recurrent acute rejections in MMF group was 18% and 42% in control group (P < 0.005). The serum transaminases in all patients of the liver diseases became normal in 3-6 months. The incidence of opportunistic infections in MMF and control group were 22% and 11% respectively (P < 0.05). The MMF based regimen was two times more expensive. The 1 year patient and graft survivals between two groups were not statistically significantly different. Conclusion: The MMF based regimen significantly decreases the recurrent acute rejections. However, it is expensive and cannot be used routinely in all patients in Indian scenario.

Cyclosporin A withdrawal in live related renal transplantation: long-term results

Clinical Transplantation, 2001

Cyclosporin A (CsA) withdrawal after 1 yr of stable graft function has been shown to be beneficia... more Cyclosporin A (CsA) withdrawal after 1 yr of stable graft function has been shown to be beneficial in cadaveric renal transplantation. This strategy could be even more suitable for &#39;immunologically advantaged&#39; grafts as in live related renal transplantation. We report the long-term outcome of patients in a live related transplantation programme undergoing early (between 1989 and 1992) and late (1993 onwards) CsA withdrawal as compared with those on long-term low dose CsA (1993 onwards). Two-hundred and fifty-two patients were divided into three groups based on the following immunosuppressive protocol: group ECyW (n=99), early CsA withdrawal (9 months after transplantation); group LCyW (n=44), late CsA withdrawal (median 16 months, range 13--22 months after transplantation); and group LDCy (n=109), long-term low dose CsA. The median period of follow-up was 66 months after transplantation (range 43--84 months). There was no difference in the actuarial 6-yr patient or graft survival among the three groups. Acute rejection episodes were more frequent in ECyW (54.4%) than in LDCy (31.8%) and LCyW (23.8%) (p=0.001). The risk of developing late (&gt; or =9 months) acute rejection was highest in ECyW 32/99 (32.3%) as compared with LCyW 8/44 (18.4%; p=0.08) and LDCy 8/109 (7.3%; p=0.0001). Of the 32 ECyW patients who developed acute rejection episodes after CsA withdrawal, 13 (40.6%) lost their grafts either due to uncontrolled acute rejection or to chronic rejection. Chronic rejection was higher in ECyW (24%) than in LCyW (11%; p=0.04) and LDCy (17%; p=0.17). Antihypertensive requirement was highest in patients maintained on low dose CsA. Graft function, as measured by serum creatinine levels, was significantly better in LCyW (1.24+/-0.4 mg%) as compared with ECyW (1.49+/-0.5 mg%) and LDCy (1.48+/-0.6 mg%). Early CsA withdrawal after live related renal transplantation is associated with a significant risk of acute rejection and subsequent chronic rejection. Slow withdrawal after 1 yr is safe and more economical than the long-term administration of low dose CsA.

Gangrenous Meckel’s diverticulum causing acute intestinal obstruction in an adult

ANZ Journal of Surgery, 2008

Clinical Evaluation of the Efficacy and Safety of Calcium Dobesilate in Patients with Chronic Venous Insufficiency of the Lower Limbs

Angiology, 2002

Objective To compare postoperative analgesia provided by a constant rate infusion (CRI) of dexmed... more Objective To compare postoperative analgesia provided by a constant rate infusion (CRI) of dexmedetomidine (DMED) to that of a well-established positive control [morphine (MOR)] in critically ill dogs. The sedative, cardiorespiratory effects and clinical safety of a 24-hour DMED CRI were also evaluated.

High Prevalence of ACE DD Genotype Among North Indian End Stage Renal Disease Patients

BMC …, 2006

The Renin-Angiotensin system (RAS) is a key regulator of both blood pressure and kidney functions... more The Renin-Angiotensin system (RAS) is a key regulator of both blood pressure and kidney functions and their interaction. In such a situation, genetic variability in the genes of different components of RAS is likely to contribute for its heterogeneous association in the renal disease patients. Angiotensin converting enzyme-1 (ACE-1) is an important component of RAS which determines the vasoactive peptide Angiotensin-II.

Hemoglobin—E β thalassemia presenting with recurrent priapism—A rare complication

American Journal of Hematology, 2008

E b thalassemia is a pathological double heterozygous state in which a patient inherits thalassem... more E b thalassemia is a pathological double heterozygous state in which a patient inherits thalassemia gene from one parent and the hemoglobin E gene from the other parent. Clinical severity of Hemoglobin E-b thalassemia is variable, ranging from mild to severe, simulating homozygous b thalassemia [1]. Inspite of its occasional resemblance with thalassemia major, thromboembolic manifestations have been rarely reported in this disease [2]. Priapism represents a rare variety of thromboembolic manifestation, which has been reported in other hemoglobinopathies such as in sickle cell disease and thalassemia intermedia [3]. It has not been reported in literature of hemoglobin E-b thalassemia to the best of our knowledge. It was unavailability of such information, which prompted us to submit the present communication.

Steroid response pattern in Indian children with nephrotic syndrome

Acta Paediatrica, 1994

The steroid response pattern to standard prednisolone therapy is of immense diagnostic, therapeut... more The steroid response pattern to standard prednisolone therapy is of immense diagnostic, therapeutic and prognostic value for the treating physician in managing children with nephrotic syndrome. None of the studies from our country has analysed the clinical, biochemical and histopathological profile in different steroid response categories. To address this problem we conducted a study comprising 127 children with nephrotic syndrome referred to our institute. They were treated with oral prednisolone according to the APN protocol. Based on the subsequent response these children were classified into different steroid response categories on follow-up. Of the 116 children with follow-up of more than six months, infrequent relapsers constituted the majority (37.9%). The frequency of other steroid response categories was as follows: frequent relapsers (21.6%), steroid-dependent (18.1%), initial non-responders (17.3%) and subsequent non-responders (5.1%). The factors predicting a poor response to standard prednisolone therapy in our study were age of onset more than eight years, male sex, hypertension, microscopic haematuria and presence of non-minimal change nephrotic syndrome lesions on histopathology.