An Uncommon Finding of Plasma Cell Invasion of the Kidney in a Patient with Plasma Cell Dyscrasia: Should It be Considered a Myeloma Defining Event?

Plasma cell invasion of the kidney in plasma cell dyscrasia is rare. We are reporting a case of plasma cell infiltration in the kidney presenting as rapidly progressing renal failure. The patient presented with generalized weakness, anemia, and advanced renal failure. The kidney biopsy revealed multifocal atypical CD138-positive plasma cell-rich interstitial inflammation and severe acute tubular injury. In the present situation of clinically unexplained renal failure with suspicion of plasma cell dyscrasia, a kidney biopsy proved to be key to the diagnosis. Hence, malignant plasma cell infiltration in the kidney could indicate underlying plasma cell dyscrasia and may serve as a future myeloma defining event (MDE).

A Case of Neuroleptic Malignant Syndrome-Prompted Myoglobin Cast Nephropathy

Myoglobin cast nephropathy is a sequel of rhabdomyolysis, and is characterized by the release of free myoglobin in the circulation, direct proximal convoluted tubule injury, and obstruction by myoglobin cast in distal tubules. We report an interesting case of myoglobin cast nephropathy in a patient who was on neuroleptic drugs and who presented with neuroleptic malignant syndrome and acute kidney injury.

A Series of Eight Cases of Pigment Nephropathy: An Obscured Aspect of Acute Kidney Injury

Pigment-induced acute kidney injury (AKI) is an important and preventable complication of rhabdomyolysis or hemolysis. It is characterized by the release of free heme pigment (myoglobin or hemoglobin) in the circulation, leading to direct injury of the proximal tubule and distal tubule obstruction by pigment cast. We are reporting eight cases of pigment-induced AKI, including six cases of myoglobin cast nephropathy and two cases of hemoglobin cast nephropathy. The causes of rhabdomyolysis were strenuous exercise, infection/febrile illness, and drug-induced neuroleptic malignant syndrome. Paroxysmal nocturnal hemoglobinuria and anti-tuberculosis treatment (rifampicin and isoniazid) had led to hemoglobin cast nephropathy each in one case. Seven cases had severe renal failure requiring dialysis. Short-term renal outcome was favorable. However, long-term follow-up is necessary to determine whether pigment-induced AKI has delayed sequelae. Therefore, clinicians should consider rhabdomyolysis or hemolysis as potential hidden causes of AKI in diverse clinical conditions, especially those of non-traumatic origin, to achieve an accurate diagnosis.

Epidemiology and Clinical Characteristics of Chronic Kidney Disease in Bihar: A Cross-Sectional Study From a Single Center

Background Chronic kidney disease (CKD) is a major public health concern globally, often co-occurring with type 2 diabetes (T2D), hypertension (HTN), and cardiovascular disorders (CVD), which complicate its management and exacerbate outcomes. This study aims to investigate the epidemiological and clinical characteristics of CKD in Bihar, a region often underrepresented in national data. Methods This cross-sectional observational study was conducted at the Department of Nephrology, Indira Gandhi Institute of Medical Sciences (IGIMS) in Patna, Bihar, India. A total of 2,534 adult patients of both sexes who consented to participate were included. We collected demographic and clinical data, calculated the estimated glomerular filtration rate using the CKD-Epidemiology (CKD-EPI) Collaboration creatinine equation, and classified CKD stages. Statistical analyses were performed using IBM SPSS Statistics for Windows, version 29.0.2.0 (IBM Corp., Armonk, NY). Result The majority of the study population was male (66.5%), with a significant number residing in rural areas (76.8%). The prevalent causes of CKD included HTN (41.2%), chronic tubulointerstitial nephritis (31.8%), and T2D (23.2%). Approximately one-third of patients were in the early stages (Stages 1 and 2) of CKD. A high prevalence of anemia was noted across all stages, increasing significantly with glomerular filtration rate (GFR) reduction. Treatment analysis showed suboptimal use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) and other standard treatments like diuretics and statins, especially among T2D patients. Conclusion Chronic kidney disease in Bihar affects predominantly young males and is associated with significant rural prevalence and comorbidities like T2D, HTN, and CVD. Our results highlight the need for improved management practices, especially in the use of ACEi/ARBs and erythropoiesis-stimulating agents, to slow GFR reduction. Further multicentric, community-based studies are recommended to provide a more comprehensive understanding of CKD in Bihar.

A Case of Dyke-Davidoff-Masson Syndrome with Hypoplasia of the Kidney: An Unusual Association

Dyke-Davidoff-Masson syndrome (DDMS) is a rare neuro-osteal syndrome of childhood and a constellation of cerebral hemiatrophy, facial asymmetry, seizures, osseous changes, and hemiplegia. It commonly presents with seizures and hemiplegia. The involvement of the kidney in DDMS is not known in the available literature, except in a case report that described ectopic kidney in DDMS. We present the case of a 15-year-old boy who presented with recurrent seizures, right facial palsy, left hemiparesis, and advanced renal failure. The neuroimaging revealed diffuse right cerebral atrophy, dilatation of the ipsilateral lateral ventricle, and ipsilateral thickening of the calvaria. The nephrological evaluation suggested the diagnosis of chronic kidney disease stage VD, probably secondary to congenital hypoplasia of the kidney.

Clinical Profile and Outcomes of Nephrotic Syndrome With Acute Kidney Injury in Adults: A Prospective Cohort Study

BACKGROUND

Nephrotic syndrome (NS) is characterized by various clinicopathological conditions like proteinuria, hypoalbuminemia, and anasarca. Patients with NS are prone to experience associated problems like acute kidney injury (AKI). The present study aimed to investigate the clinical profile and outcomes of NS with AKI in adults.

MATERIALS AND METHODS

This prospective, observational study was conducted over a period of one year. Adult patients with NS diagnosed with AKI were enrolled in the study. Data were collected at baseline and patients were followed up for at least three months.

RESULTS

A total of 60 patients were enrolled. The majority of the patients (78.3%) were aged between 18 and 30 years. Anemia was observed among 96.7% of the patients. A significant improvement was observed in the mean levels of proteinuria (5.80 vs. 1.70 gm/dL; P < 0.001), total cholesterol (270.00 mg/dL vs. 160.00 mg/dL), serum creatinine (2.18 mg/dL vs. 1.68 mg/dL; P < 0.001), and serum albumin (1.86 gm/dL vs. 3.29 gm/dL; P < 0.001) at baseline to three months. Pre-renal AKI was diagnosed in 95% of patients. According to histological classification, 19 patients had minimal change disease, whereas focal segmental glomerulosclerosis was observed in 23 patients. It was observed that 96.7% of the patients did not necessitate the need for renal replacement therapy.

CONCLUSION

The present study successfully examined the clinical profile and outcomes of adults with NS and AKI. The findings provide valuable insights into the characteristics and prognosis of this patient population, contributing to a better understanding of NS with AKI in adults.

Understanding the hydrochemical functioning of glacierized catchments of the Upper Indus Basin in Ladakh, Indian Himalayas

Recent studies have endorsed that surface water chemical composition in the Himalayas is impacted by climate change-induced accelerated melting of glaciers. Chemical weathering dynamics in the Ladakh region is poorly understood, due to unavailability of in situ dataset. The aim of the present study is to investigate how the two distinct catchments (Lato and Stok) drive the meltwater chemistry of the Indus River and its tributary, in the Western Himalayas. Water samples were collected from two glaciated catchments (Lato and Stok), Chabe Nama (tributary) and the Indus River in Ladakh. The mildly alkaline pH (range 7.3-8.5) and fluctuating ionic trend of the meltwater samples reflected the distinct geology and weathering patterns of the Upper Indus Basin (UIB). Gibbs plot and mixing diagram revealed rock weathering outweighed evaporation and precipitation. The strong associations between Ca²⁺-HCO₃^-, Mg²⁺-HCO₃^-, Ca²⁺-Mg²⁺, Na⁺-HCO₃^-, and Mg²⁺-Na⁺ demonstrated carbonate rock weathering contributed to the major ion influx. Principal component analysis (PCA) marked carbonate and silicates as the most abundant minerals respectively. Chemical weathering patterns were predominantly controlled by percentage of glacierized area and basin runoff. Thus, Lato with the larger glacierized area (~ 25%) and higher runoff contributed low TDS, HCO₃^-, Ca²⁺, and Na⁺ and exhibited higher chemical weathering, whereas lower chemical weathering was evinced at Stok with the smaller glacierized area (~ 5%). In contrast, the carbonate weathering rate (CWR) of larger glacierized catchments (Lato) exhibits higher average value of 15.7 t/km²/year as compared to smaller glacierized catchment (Stok) with lower average value 6.69 t/km²/year. However, CWR is high in both the catchments compared to silicate weathering rate (SWR). For the first time, in situ datasets for stream water chemical characteristics have been generated for Lato and Stok glaciated catchments in Ladakh, to facilitate healthy ecosystems and livelihoods in the UIB.

Outcome of COVID-19 in Kidney Transplant Patients from Eastern India: A Single Center Study

Introduction

COVID-19 in kidney transplant recipients (KTR) had been associated with high incidence of acute kidney injury and higher mortality. Management of these patients is still evolving.

Methods

A retrospective observational study was done that included all KTR aged ≥18 years and ≤65 years who had COVID-19 diagnosis via RTPCR test between 1 June 2020 and 30 May 2021. Severity of COVID-19 was determined as per the guidelines given by Government of India. Acute kidney injury was defined according to KDIGO guideline. Data was collected and analyzed using SPSS version 16.0 (Chicago, SPSS Inc.).

Results

Out of 34 patients, 29 were men. Median age of patients was 39.9 years and median time since transplantation was 34 months. Presenting symptoms were fever (100%), cough (79.4%), gastrointestinal symptoms (23.5%), and dysgeusia/anosmia (23.5%). COVID-19 was severe in 17.6%, moderately severe in 32.4%, and mild in 50% of patients. Time since transplantation, duration of symptoms, hospital stay and inflammatory markers like CRP, LDH, ferritin and d-dimer were significantly associated with disease severity (P < 0.05). Steroids were increased in 55%, antiproliferative agents stopped in 97%, and calcineurin inhibitors stopped in 26% of patients. 70.6% of the patients were managed in home isolation. Acute kidney injury occurred in 58.8% cases. 75% of the AKI patients recovered by 28 days after discharge.

Conclusion

Our study showed that outcome of COVID-19 in kidney transplant patients was reasonably good.

Deciphering the role of meteorological parameters controlling the sediment load and water discharge in the Sutlej basin, Western Himalaya

The Sutlej River basin of the western Himalaya (study area), owing to its unique geographical disposition, receives precipitation from both the Indian summer monsoon (ISM) and the Westerlies. The characteristic timing and intensity of the ISM and Westerlies, leaves a distinct footprint on the sediment load of the River. Analysis with the last forty years data, shows an increasing trend for temperature. While for precipitation during the same period, the Spiti watershed on the west has highest monthly accumulated precipitation with long term declining trend, in contrast to the other areas where an increasing trend has been observed. Thus, to probe the hydrological variability and the seasonal attributes, governed by the Westerlies and ISM in the study area, we analyzed precipitation, temperature, snow cover area (in %), discharge, suspended sediment concentration (SSC) and suspended sediment load (SSL) for the period 2004 - 2008. To accomplish the task, we used the available data of five hydrological stations located in the study area. Inter-annual shift in peak discharge during the monsoon period is controlled by the variation in precipitation, snow melt, glacier melt and temperature. Besides seasonal variability has been observed in generation of the sediments and its delivery to the river. Our analysis indicates, dominance of the Westerlies footprints in the hydrological parameters of the Spiti region, towards western part of the study area. While, it is observed that the hydrology of the Khab towards eastern part of the study area shows dominance of ISM. Further downstream, the hydrology of Nathpa station also shows dominance of ISM. It also emerged out that the snowmelt contribution to the River flow is mostly during the initial part, at the onset of the monsoon, while for rest and major part of the summer monsoon season, the River flow is augmented by the precipitation, glacial melt and some snow melt. We observed, that the SSC increases exponentially in response to increase in temperature and correlates positively with River discharge. The average daily SSL in the summer monsoon is many times more than that in the winter monsoon. The downstream decrease in steepness of the sediment rating curve is attributed to either a change in the River-sediment dynamics or on account of the anthropogenic forcing. The top 1% of the extreme summer monsoon events (only 4 events) in our study area contribute up to 45% of SSL to the total sediment load budget. It has also been observed that the River-sediment dynamics in the upstream catchments are more vulnerable and sensitive to the extreme events in comparison to the downstream catchments. The present study for the first time gives a holistic insight in to the complex dynamics of the hydrological processes operational in the study area. The research findings would be crucial for managing the water resources of the region and the linked water and food security.

Mega festivals like MahaKumbh, a largest mass congregation, facilitated the transmission of SARS-CoV-2 to humans and endangered animals via contaminated water

Our surrounding environment has been influenced by the COVID-19 pandemic situation. The second wave of COVID-19 in India has proven to be more devastating and aggressive than the first wave of the pandemic, which led to recognizing India as one of the world's topmost worst-hit nations considering >4000 fatalities reported in a single day in May 2021. Such "resurgence and acceleration" of COVID-19 transmission has been fuelled by the MahaKumbh festival and political mass gathering (elections rallies) events, where the COVID-19 protocols have been ignored by millions of pilgrims/followers. The present review discusses only the consequences of this year's MahaKumbh festivals, the largest religious mass gathering on earth, which was held during the COVID-19 pandemic in India, and its impact on both the spread of SARS-CoV-2 among participants and their families and its influence on the quality of the river Ganga. This article tries to give readers outside of India an overview of how much impact of any such single large gathering of any relgion in any part of the world can drive coronavirus infections and effectively commence the second/third wave outbreak with this case study. Furthermore, the religious large scale celebration are widely accepted through out the world that have played a significant role in the spread of the pandemic into remote villages and towns all over the subcontinent/world, thus affecting many areas with insufficient healthcare facilities that have been relatively spared. This review also highlights the potential risk of transmission from infected humans into the aquatic environment of the river Ganga. Besides the obvious relevance of SARS-CoV-2, a large variety of other water-related disease vectors (bacteria, viruses, and protozoa) stemming from visitors to the religious congregation were introduced into the upstream regions of the Ganga river. Their sheer number is assumed to have had a severe influence on its delicate ecosystem, including endangered mammals such as the river Dolphins. The detailed epidemiological and clinical study on transmission routes of SARS-CoV-2 is the need of the hour to understand the pathogenesis of RNA virus infection and prevent the massive spreading of such infectious respiratory diseases. An interdisciplinary approach, rooted in evidence-based efficient learning, contextual strategies, and a streamlined unified approach should be adopted to help in the development of a proactive prevention model during future MahaKumbh festival (and similar religious gatherings) instead of just "picking up the pieces" in a conventional post-event model.

Disentangling source of moisture driving glacier dynamics and identification of 8.2 ka event: evidence from pore water isotopes, Western Himalaya

Two atmospheric circulation patterns, the Indian Summer Monsoon (ISM) and mid-latitude Westerlies control precipitation and thus glacier variability in the Himalaya. However, the role of the ISM and westerlies in controlling climate and thus past glacier variability in the Himalaya is poorly understood because of the paucity of the ice core records. In this article, we present a new Holocene paleorecord disentangling the presence of the ISM and mid-latitude westerlies and their effect on glacier fluctuations during the Holocene. Our new record is based on high-resolution multi-proxy analyses (δ18Oporewater, deuterium-excess, grain size analysis, permeability, and environmental magnetism) of lake sediments retrieved from Chandratal Lake, Western Himalaya. Our study provides new evidence that improves the current understanding of the forcing factor behind glacier advances and retreat in the Western Himalaya and identifies the 8.2 ka cold event using the aforementioned proxies. The results indicate that the ISM dominated precipitation ~ 21% of the time, whereas the mid-latitude westerlies dominated precipitation ~ 79% of the time during the last 11 ka cal BP. This is the first study that portrays the moisture sources by using the above proxies from the Himalayan region as an alternative of ice core records.

Fibrillary glomerulonephritis presenting as crescentic glomerulonephritis in a young female: a case study

Fibrillary glomerulonephritis (FGN) is a rare disorder accounting for up to 1% of all glomerulonephritis (GN). FGN usually manifests as nephrotic or subnephrotic proteinuria, hematuria, and hypertension in patients after the sixth decade. The overall prognosis of FGN is very poor. Crescentic presentation of FGN is uncommon which may be diagnosed as rapidly progressive glomerulonephritis (RPGN) unless electron microscopy and/or special stains are done. We report a case of a young female who presented as RPGN but diagnosis was revised to crescentic FGN after electron microscopy and immunohistochemical staining with DNAJB9 stain. Patient remained dialysis-dependent after treatment with steroid and cyclophosphamide for 2 months and progressed to end-stage renal disease (ESRD). Crescentic FGN usually does not respond to treatment and invariably progresses to ESRD over few months. This case emphasizes the defining role of electron microscopy and special stains in diagnosing uncommon glomerular diseases.

Analysis of native kidney biopsy: Data from a single center from Bihar, India

This is a retrospective study of all native kidney biopsies performed at our center between October 1, 2012 and March 31, 2015. Relevant clinical and laboratory variables were recorded. Biopsy samples were processed for light microscopy and immunofluorescence in all cases. Histological classification was adapted from the World Health Organization recommendations. The indications for kidney biopsy were nephrotic syndrome in adults in 190 cases, rapidly progressive renal failure in 43, unexplained renal failure in 25, and steroid-resistant nephrotic syndrome in children in 12. The mean age of the patients was 31.48 ± 13.46 years. Male-to-female ratio was 1.87:1. Mean serum creatinine (SCr) of the patients was 2.36 ± 2.07 mg/dL. Primary glomerulonephritis accounted for 88.89% of cases (240) while secondary glomerulonephritis accounted for 7.40% of total cases (20). Interstitial disease accounted for 1.5% and vascular disease for 2.2%. The most common lesion among primary glomerulonephritis was focal segmental glomerulosclerosis (FSGS) (31.11%) followed by diffuse proliferative glomerulonephritis (DPGN) (13.33%) and membranous glomerulonephritis (MGN) (12.59%). Among secondary glomerulonephritis, lupus nephritis was the most common (5.56%). In patients with SCr 1.4 mg/dL or less (n = 131), FSGS was the most common histology (17.26%) followed by MGN (23.66%) and minimal change disease (7.63%). Whereas, in patients with SCr more than 1.4 mg/dL (n = 139), DPGN was the most common diagnosis (23.74%) followed by FSGS (17.26%) and IgAN (12.23%). Fourteen patients (5.2%) had one or more episode of gross hematuria, three of whom required blood transfusion. The overall FSGS was the most common lesion seen. When we consider only patients with deranged renal function, DPGN was the most common histopathological lesion. The reason for disproportionate high incidence for DPGN is not clear and requires further research.

Acute kidney injury with consumption of raw gall bladder of Indian carp fish (Labeo rohita): A single center study from India

AIM

This retrospective study examined the clinical presentation and outcome of all patients who presented with acute kidney injury (AKI) following consumption of uncooked fish gallbladder as folk medicine.

METHODS

We reviewed all cases admitted at our institute between 1 January 1997 and 31 December 2016 following ingestion of fish gallbladder (Indian carp/Labeo rohita).

RESULTS

A total 32 of patients were included, with a male: female ratio of 3:1 and mean age 44.34 ± 13.33 years. The mean number of gall bladder consumed was 4.59 ± 4.75. All 32 patients presented with hepatic and renal failure. The mean duration of onset of symptoms following ingestion was 6.47 ± 2.84 h. At the time of admission, urine output was 187.9 ± 141 mL/24 h, serum creatinine 11.66 ± 2.50 mg/dL, serum bilirubin 6.14 ± 3.91 mg/dL, serum glutamate-pyruvate transaminase (SGPT) 687 ± 458 IU/L and serum glutamic oxaloacetic transaminase (SGOT) 188 ± 181 IU/L. All but one patient required haemodialysis. Twenty-seven patients were discharged with recovering acute kidney injury while five patients died. Mean duration of hospital stay was 12.94 ± 8.31 days. Mean number of haemodialysis sessions received by patients was 4.59 ± 3.12. Interval between consumption and onset of symptoms, serum bilirubin and SGPT were found to be significantly different between those who survived and died.

CONCLUSION

Acute kidney injury associated with ingestion of raw fish gallbladder is associated with significant morbidity and mortality.

Methane production, oxidation and mitigation: A mechanistic understanding and comprehensive evaluation of influencing factors

Methane is one of the critical greenhouse gases, which absorb long wavelength radiation, affects the chemistry of atmosphere and contributes to global climate change. Rice ecosystem is one of the major anthropogenic sources of methane. The anaerobic waterlogged soil in rice field provides an ideal environment to methanogens for methanogenesis. However, the rate of methanogenesis differs according to rice cultivation regions due to a number of biological, environmental and physical factors like carbon sources, pH, Eh, temperature etc. The interplay between the different conditions and factors may also convert the rice fields into sink from source temporarily. Mechanistic understanding and comprehensive evaluation of these variations and responsible factors are urgently required for designing new mitigation options and evaluation of reported option in different climatic conditions. The objective of this review paper is to develop conclusive understanding on the methane production, oxidation, and emission and methane measurement techniques from rice field along with its mitigation/abatement mechanism to explore the possible reduction techniques from rice ecosystem.

Purification and dose-dependent toxicity study of abrin in swiss albino male mice

Abrin, a phytotoxin obtained from the seeds of the Abrus precatorius plant, is highly toxic with an estimated human fatal dose of 0.1—1 μg/kg. In this study, abrin was purified and characterized through SDS PAGE and mass spectrometry analysis; further study on toxicity was carried out to investigate the alteration in biochemical, and hematological variables through histopathological observations in mice. The intraperitoneal LD50 value of purified abrin for mice was found to be 0.91μg/kg of body weight. Mice were exposed to 0.4 and 1.0 LD50 abrin doses intraperitoneally and observed on days 1, 3, and 7. Plasma GOT and GPT levels increased significantly at both doses. At 1.0 LD50 dose, alkaline phosphatase, bilirubin, urea, uric acid, and creatinine levels increased, whereas albumin, total protein, glucose and cholesterol levels decreased significantly. Abrin intoxication also altered the hemoglobin, WBC, and RBC counts significantly at 1.0 LD50 dose. Liver GSH levels decreased while lipid peroxidation increased significantly in a dose—dependent manner. Biochemical changes were supported by the histological investigation, which also showed the degenerative changes in organs. In conclusion, abrin intoxication caused toxic effects and severe damages on studied organs mediated through alteration in biochemical and hematological variables, lipid peroxidation, and degeneration.

Comparative analysis of extractable proteins from Clostridium perfringens type A and type C strains showing varying degree of virulence

The prevailing scenario of bioterrorism warrants development of medical countermeasures with expanded coverage of select agents. Clostridium perfringens is a pathogen of medical, veterinary and military importance, and has been listed as Validated Biological Agent. We employed 2DE-MS approach to identify a total of 134 unique proteins (529 protein spot features) from the extractable proteome of four type A and type C strains. Proteins showing altered expression under host-simulated conditions from virulent type A strain (ATCC13124) were also elucidated. Significant among the differentially expressed proteins were elongation factor, molecular chaperones, ribosomal proteins, carbamoyl phosphate synthase, clpB protein, choloylglycine hydrolase, phosphopyruvate hydratase, and trigger factor. Predictive elucidation, of putative virulence associated proteins and sequence conservation pattern of selected candidates, was carried out using homologous proteins from other bacterial select agents to screen for the commonality of putative antigenic determinants. Pathogens (17 select agents) were observed to form three discrete clusters; composition of I and II being consistent in most of the phylogenetic reconstructions. This work provides a basis for further validation of putative candidate proteins as prophylactic agents and for their ability to provide protection against clusters of pathogenic select bacterial agents; aimed at mitigating the shadows of biothreat.