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Jaiswal J, Gupta SK, Dash SC, Tiwari SC, Mehta SN, Gupta YK, Velpandian T. Neoral monitoring by limited sampling area under the concentration time curve in stable indian renal transplant recipients. Transplant Proc 2003; 35:1298-9. [PMID: 12826142 DOI: 10.1016/s0041-1345(03)00507-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The optimization of cyclosporine (CsA) immunosuppression remains a challenge because of the narrow therapeutic window and highly variable pharmacokinetics (PK). The highly variable PK were improved by the introduction of the current microemulsion preparation Neoral. However, the best clinical benefit of this CsA microemulsion can only be obtained by regular PK monitoring. During the past decade, various PK strategies have been proposed, such as C(0), C(2), level monitoring, abbreviated or limited sampling approach, and various prediction algorithms to replace the conventional area under the curve (AUC). In this study we evaluated the Neoral PK in stable Indian renal transplant recipients using a limited sampling approach. The C(0) (mean +/- SE) was 175 +/- 15 ng. mL(-1); C(max) 970 +/- 101 ng. mL(-1), and the AUC (0-4) 2734 +/- 258 ng. h. mL(-1). The C(0) showed a poor relationship to AUC (0-4) (r =.65) but high correlations were obtained with C(2) (r = 0.93) and C(3) (r =.96). Our finding suggest that stable Indian renal transplant recipients should either be monitored using C(2) or C(3).
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Talwar R, Dash SC, Kucheria K. A case of chronic myeloid leukemia complicated with minimal change nephrotic syndrome. Acta Haematol 2003; 109:101-3. [PMID: 12624495 DOI: 10.1159/000068492] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2002] [Indexed: 11/19/2022]
Abstract
We present a 28-year-old patient with chronic myeloid leukemia (CML) in chronic phase complicated with nephrotic syndrome. The bone marrow cells revealed the presence of Philadelphia chromosome, the cytogenetic hallmark of CML, that results from a balanced, reciprocal translocation between the long arms of chromosomes 9 and 22, t(9;22)(q34;q11). This reciprocal translocation leads to the formation of the BCR/ABL fusion gene, the presence of which was confirmed using the highly sensitive fluorescence in situ hybridization technique. The renal biopsy was compatible with minimal change nephrotic syndrome. To the best of our knowledge, this is the first case of minimal change nephrotic syndrome associated with CML before the administration of any therapy.
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MESH Headings
- Adult
- Biopsy
- Chromosomes, Human, Pair 22
- Chromosomes, Human, Pair 9
- Fusion Proteins, bcr-abl/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Kidney/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Nephrosis, Lipoid/complications
- Nephrosis, Lipoid/diagnosis
- Proteinuria
- Translocation, Genetic
- Ultrasonography
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Guleria S, Aggarwal S, Mandal S, Singh P, Mehta SN, Aggarwal SK, Bhowmik D, Gupta S, Tiwari SK, Dash SC. The mini-donor nephrectomy: a viable option. Transplant Proc 2003; 35:39-40. [PMID: 12591297 DOI: 10.1016/s0041-1345(02)03786-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bhowmik D, Dash SC, Guleria S, Panigrahi A, Gupta S, Agarwal S, Tiwari SC, Mehta SN, Mehra NK. Spousal renal transplants: implications in developing countries. Transplant Proc 2003; 35:26-7. [PMID: 12591291 DOI: 10.1016/s0041-1345(02)03852-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Basak U, Mitra DK, Panigrahi A, Guleria S, Agarwal S, Mehta SN, Dash SC, Mehra NK. Clinical relevance of monitoring cytokine production following living donor renal transplantation. Transplant Proc 2003; 35:404-6. [PMID: 12591461 DOI: 10.1016/s0041-1345(02)03897-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kumar R, Dash SC, Thulkar S, Gupta NP. Repair of testicular artery injury during microsurgical varicocelectomy. J Urol 2003; 169:615-6. [PMID: 12544323 DOI: 10.1097/01.ju.0000043677.72859.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guleria S, Khazanchi RK, Dinda AK, Aggarwal S, Gupta S, Bhowmik D, Aggarwal SK, Tiwari SC, Dash SC, Mandal S. Spontaneous renal allograft rupture: is graft nephrectomy an option? Transplant Proc 2003; 35:339. [PMID: 12591430 DOI: 10.1016/s0041-1345(02)03781-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Deka R, Panigrahi A, Aggarwal SK, Guleria S, Dash SC, Mehta SN, Pandey RM, Mehra NK. Influence of pretransplant panel reactive antibodies on the posttransplant sensitization status. Transplant Proc 2002; 34:3082-3. [PMID: 12493381 DOI: 10.1016/s0041-1345(02)03676-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bhowmik D, Dinda AK, Khilnani GC, Mahajan S, Gupta S, Agarwal SK, Tiwari SC, Dash SC. Pulmonary mucormycosis in a diabetic renal transplant patient. THE INDIAN JOURNAL OF CHEST DISEASES & ALLIED SCIENCES 2002; 44:275-7. [PMID: 12437244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
A 50-year-old male, diabetic, post transplant patient had recurrent pneumonia. The first episode responded well to antibiotics, while on the second occasion he had a necrotising pneumonia, which developed into a thick-walled cavity. Despite antibiotics, his condition rapidly deteriorated precluding bronchoscopy or percutaneous biopsy. Post-mortem lung biopsy revealed typical hyphae of mucormycosis.
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Bhowmik D, Dash SC. Acute renal failure complicating intermittent rifampicin therapy. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2002; 50:856. [PMID: 12240867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Gupta S, Dash SC, Sharma S, Agarwal SK, Bhowmik D, Wani M, Ramasethu R, Tiwari SC, Guleria S, Mehta SN. Pneumocystis carinii pneumonia: role of high resolution computed tomography. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2002; 50:726-8. [PMID: 12186137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Pneumocystis carinii (PC) is a common opportunistic infection in renal transplant recipients and requires an early diagnosis for its successful treatment. For its definitive diagnosis PC needs to be demonstrated in bronchoalveolar lavage (BAL) fluid. At times BAL may not be possible or get delayed. In such conditions typical appearances seen on high resolution CT of the chest help in early diagnosis of PC pneumonia (PCP). This easily performed procedure helped in early diagnosis of PCP in two patients.
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Panigrahi A, Agarwal SK, Kanga U, Guleria S, Bhowmik D, Dash SC, Gupta S, Tiwari SC, Mehta SN, Mehra NK. Influence of HLA compatibility on renal graft survival using live unrelated & cadaver donors in India. Indian J Med Res 2002; 115:158-64. [PMID: 12239839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND & OBJECTIVES Living unrelated donor (LURD) renal transplantation has shown a rising trend over the last 5 yr at our center following the passing of The Transplantation of Human Organs Act by the Government of India in 1994. In this paper, the results of LURD and cadaver (CAD) donor renal transplantation are compared. We have also looked into factors that have a bearing on graft survival such as the extent of HLA mismatch (MM), infections, acute rejections (AR), donor age and sex. METHODS A total of 42 LURD and 25 CAD renal transplants performed between March 1994 and February 1999 has been included in the study. HLA typing, panel reactive antibody (PRA) screening and T and B cell cross match assay were performed by the complement dependent cytotoxicity (CDC) method for all patients. RESULTS The graft survival rates were generally higher in the LURD category as compared to the CAD group and were significant at 6 month period (90 vs 56%, P = 0.002). A follow up of the patients up to 60 months revealed a matching effect since the 3, 4 allele MM group had better survival rates as compared to the 5, 6 MM group. Twenty six of the 67 recipients (39%) experienced episodes of acute rejection (AR). Patients with 3, 4 MM had fewer such episodes than those with 5, 6 allele MM (P < 0.05). Of the 32 deaths, 20 were those with a functional kidney, of which 15 were caused by severe infections. INTERPRETATION & CONCLUSION Better HLA matching ensures fewer episodes of rejection and better long term graft survival in comparison to the poorly matched grafts. The graft survival for LURD recipients was appreciably higher than that of CAD recipients.
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Agarwal SK, Dash SC, Mehta SN, Gupta S, Bhowmik D, Tiwari SC, Guleria S. Results of renal transplantation on conventional immunosuppression in second decade in India: a single centre experience. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2002; 50:532-6. [PMID: 12164404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND In-spite of many renal transplant (RT) centres in the country, there is paucity of data on the survival results in India. Furthermore, there is hardly any data of results in second decade. In this study we present the results of RT in second decade at our centre. METHODS RT at our hospital is being done since 1972. First eight years saw occasional RT and complete data is not available in these patients. So, we have excluded these patients from the study. We have included rest all 144 patients who had RT between Jan. 1981 to Dec. 1989, so as to have at least 10 years of follow-up or more. All these patients were on conventional immunosuppression. RESULTS Of the 144 patients, 126 (87.5%) were males and the mean age was 29.5 +/- 8.5 years (range 14-54). Basic disease was presumed chronic glomenulonephritis (CGN) in 79.9%, vesicouretenic reflux (VUR) in 8% and diabetic nephropathy in 1.4% patients. Mean number of haemodialysis (HD) and blood transfusion before RT were 44 +/- 24.7 and 8.9 +/- 4.7 (range 0-25), respectively. Mean donor age was 40.9 +/- 10.1 year (range 18-62). HLA matching was haploidentical in 74.5% cases, HLA identical in 3% cases and 11.5% were less than two-antigen match. Of the 63% patients, who had at least one acute rejection (AR) during their follow-up, 78.8% cases had this AR within first three months after the renal transplant. During 10 years of follow up, 65 patients died (23 with normal graft function and 42 with chronic rejection) and 17 lost to follow-up. Eight patients lost their graft but were surviving at 10 years and 54 had functioning graft till the time of analysis. With mean follow-up of 83.9 +/- 61.2 (range 1-216) months, 10-year actuarial patients and graft survival was 53% and 47%, respectively. Graft half-life in these patients is 92 months. In multivariate analysis of the donor age, number of blood transfusion (BT), degree of HLA matching and AR, only AR was found to be statistically correlated with the graft outcome (p=0.004). CONCLUSION Our study concludes that in our set-up during eighties, on conventional immunosuppression, actuarial patient and graft survival at 10 year is 53% and 47%, respectively with graft half-life being 92 months. Only acute rejection has been found to affect the graft outcome in these patients.
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Bhowmik D, Padmanabhan S, Dinda A, Modi G, Gupta S, Agarwal SK, Tiwari SC, Dash SC. Hepatitis C virus related cryoglobulinemic glomerulonephritis. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2002; 50:275-7. [PMID: 12038665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
A 46 years male presented with skin rash and acute nephritic syndrome. He had history of jaundice four months back. Rheumatoid factor and cryoglobulins were present in the serum. Although anti-HCV antibodies were negative, HCV RNA was detected by polymerase chain reaction. Kidney biopsy showed membranoproliferative glomerulonephritis and thrombi in the lumen of the glomerular capillary loops. His renal functions improved with steroids.
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Bhowmik D, Jain PK, Masih JA, Saha D, Gupta S, Agarwal SK, Tiwari SC, Dash SC. Tandem plasmapheresis and hemodialysis. THERAPEUTIC APHERESIS : OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR APHERESIS AND THE JAPANESE SOCIETY FOR APHERESIS 2001; 5:439-41. [PMID: 11778931 DOI: 10.1046/j.1526-0968.2001.0303r.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Many patients requiring plasmapheresis (PE) have renal failure and also need hemodialysis. If done separately almost 6-7 h is required. Hence, we decided to perform the procedures simultaneously in those patients requiring both PE and hemodialysis. The plasmafilter was inserted into the extracorporeal circuit after the hemodialyzer. A total of 8 such sessions of tandem PE and hemodialysis were performed in 2 patients. This is called tandem PE/hemodialysis. The total procedure was completed in the same time as is required for routine hemodialysis. The total amount of priming fluid is also less when PE and hemodialysis are performed separately. Thus, it is economically beneficial to the hospital and also convenient to the patient. Apart from transient episodes of hypotension, which were corrected by saline infusion, no other complications were noted.
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Bhowmik D, Mathur R, Bhargava Y, Dinda AK, Agarwal SK, Tiwari SC, Dash SC. Chronic interstitial nephritis following parenteral copper sulfate poisoning. Ren Fail 2001; 23:731-5. [PMID: 11725921 DOI: 10.1081/jdi-100107371] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 21-year-old male patient was admitted with acute renal failure and intravascular hemolysis following suicidal parenteral copper sulfate poisoning. He developed metabolic acidosis and septicemia; and was treated with intensive hemodialysis, blood transfusions and antibiotics. After remaining anuric for 4 weeks, his urine output gradually increased. However his renal functions improved only partially. Renal biopsy done 8 weeks after the episode showed chronic tubulo-interstitial nephritis (CIN). This is the first reported case showing CIN following acute copper sulfate intoxication.
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Bhatla N, Bhowmik D, Kriplani A, Agarwal N, Gupta A, Dash SC. Successful pregnancy outcome in advanced chronic renal failure. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2001; 49:845-7. [PMID: 11837481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
A 24 years female of advanced chronic renal failure due to lupus nephritis presented with pregnancy of eight weeks duration she continued the pregnancy against medical advice. At 29 weeks gestation further deterioration of renal function prompted weekly dialysis and hospitalisation for intensive maternal and fetal monitoring. At 35 weeks she was safely delivered by elective caesarian section. This is the first case of dialysis during pregnancy to be reported from India.
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Dinda AK, Singh C, Aggarwal SK, Guleria S, Tiwari SC, Dash SC, Bagga A. Diagnosis of glomerular haematuria by imagecytometry of urinary red cells. Nephron Clin Pract 2001; 88:93-4. [PMID: 11340358 DOI: 10.1159/000045966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Gupta S, Dash SC, Bhowmik D, Mohanty NK, Agarwal SK, Tiwari SC. Losartan use in mild to moderate hypertension--adverse effects in moderate to severe renal failure. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2001; 49:591. [PMID: 11361289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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Agarwal SK, Dash SC, Irshad M, Gupta S, Bhowmik D, Tiwari SC, Guleria S, Mehta SN. Impact of hepatitis C virus infection on renal transplant outcome in India--a single centre study. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2000; 48:1155-9. [PMID: 11280219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is currently the main cause of hepatotropic viral infection in renal transplant (RT) recipient throughout the world. Contrary reports are available as regard graft and patient survival and liver disease outcome in these patients. From India, outcome of HCV positive patients following RT has not been documented. Herewith, we present results of RT in HCV positive patients at our centre. METHODS Study design was prospective case control with primary end point being graft and patient survival and the exposure being HCV infection. Between June 1995 till February 1998, 128 patients had RT at our hospital, of which, 37 (28.9%) were anti-HCV positive at the time of RT. All the patients were on triple immunosuppressive therapy. As a policy of unit, none of the donor had HBV and/or HCV infection. Anti-HCV positive patients formed the subjects (Gr. I), while anti-HCV negative patients severed as control (Gr. II). Anti HCV was done using 3rd generation ELISA tests kit. HCV-RNA could not be done due to non-availability. None of the positive patient was treated with anti-viral therapy. Acute rejection, serious infections, patient and graft survival and outcome of liver disease was compared in these patients. RESULTS Mean age of the patients, number of males, number of pre-RT haemodialysis and blood transfusion, donor age and HLA-mismatch were comparable in both the groups. Mean follow-up in Gr. I was 28 +/- 9.4 months and in Gr. II 31.4 +/- 7.6 months. At the end of this follow-up, acute rejection was seen in 43% and 33.3% patient in Gr. I and II respectively. In Gr. I, serious infections were seen in 30% while the same in Gr. II was 11.8% (p < 0.01). There was no difference in graft survival in Gr. I and II (72% and 66%) and the patient survival were also similar (72% and 66%). Of the deaths in Gr. I, 80% died of sepsis and 20% died of liver cell failure related to one each of hepatitis B and hepatitis E. Of the deaths in Gr. II, 65% died of sepsis and 17% died of hepatic cell failure. But, there was no difference in causes of deaths in these two groups. In both the groups, none of liver related death was due to isolated HCV infection. There was no effect of donor age, HLA mismatch, number of haemodialysis and pre-RT blood transfusion on the survival of graft as well as patient. CONCLUSION In conclusion, HCV infection is major problem in RT with us. In a short follow-up of nearly 30 months, graft and patient survival is same in HCV positive and negative patients. However, serious infections are significantly more common in HCV positive patients.
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Dinda AK, Singh C, Dash SC, Tiwari SC, Aggarwal SK, Bhowmik D, Bagga A. Role of supravital staining of urine sediment and bright field microscopy in diagnosis of acute renal failure in bedside medicine. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2000; 48:958-61. [PMID: 11200918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND An early accurate etiological categorization of acute renal failure (ARF) into acute glomerulonephritis (AGN), acute tubular necrosis (ATN) and acute interstitial nephritis (AIN) is very important in clinical medicine. METHODS To evaluate the efficacy of a simple, cheap supravital staining method developed in our laboratory, we examined urine of 32 cases of ARF at their initial presentation in oliguric phase, which were later biopsied. The stain consisted of 1% crystal violet and 0.5% safranin in normal saline. The coverslip preparations of coded and stained urine sediments were examined under ordinary bright field microscope (BFM) by two independent observers. RESULTS The renal biopsy showed 12 cases of AGN, 12 ATN and 8 AIN. The diagnosis could be predicted by supravital staining method in 75% cases with 95% uniformity among two observers with a sensitivity of 85.7% for AGN followed by AIN (80%) and ATN (75%). CONCLUSION Thus this simple supravital staining technique can be used with ordinary BFM for accurate urine sediment analysis in cases of ARF in bedside medicine.
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Agarwal SK, Irshad M, Dash SC. Prevalence of antibodies against hepatitis E virus in haemodialysis patients in India. Nephron Clin Pract 2000; 81:448. [PMID: 10095186 DOI: 10.1159/000045334] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Dash SC, Bhowmik D. Glomerulopathy with liver disease: patterns and management. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2000; 11:414-420. [PMID: 18209333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
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Agarwal SK, Dash SC. Spectrum of renal diseases in Indian adults. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2000; 48:594-600. [PMID: 11273537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Inspite of nephrology as a specialty since seventies, there is still paucity of data regarding the spectrum of renal diseases in India. Available literature from few hospitals shows data on specific clinical syndrome of renal diseases or specific renal diseases rather than the overall spectrum as a whole. This information will be useful for better resource management. MATERIAL AND METHODS We studied spectrum of renal diseases among 14,796 patients presenting for the first time to nephrology outpatients between January 1987 to Oct. 1998. Majority of patients in our clinic were adults. Patients 14 years or below who mostly attend pediatric renal unit of the hospital were excluded from the analysis. Till 1991, the study was retrospective but after 1991, patients were followed prospectively. Patients were grouped according to classical renal syndrome. After the initial presentation, patients were followed subsequently till their last follow-up in the clinic or till the time of reporting the present data. RESULTS Mean age of patients was 38.69 +/- 15.5 years with male predominance in majority of presentations. Chronic renal failure (CRF), nephrotic syndrome (NS), nephritic syndrome and hypertension were the four common presentations seen in 47.8%, 15.03%, 4.6% and 4.9% cases respectively. Other presentations were acute renal failure (1.9%), urinary tract infection (2.9%), stone disease (4.6%), obstructive uropathy (2.1%), isolated haematuria (1.2%) and asymptomatic urinary abnormalities (0.3%). Chronic glomerulonephritis was seen in 49.4% cases of CRF followed by diabetic nephropathy in 28.4% cases. Of the nephrotic syndrome cases, primary glomerulonephritis was seen 58.5% cases, of which minimal change disease was the commonest cause in 38% cases. Of the secondary glomerular diseases, diabetic nephropathy was commonest cause of NS (53%) followed by amyloidosis (16.4%) and lupus (8.3%). Tuberculosis was the commonest cause of renal amyloidosis seen in 50% cases. Of the nephritic syndrome, post-infective glomerulonephritis was commonest cause followed by rapidly progressive glomerulonephritis being the second commonest cause. In the hypertensive group, essential hypertension was the commonest cause followed by renovascular hypertension. CONCLUSION It is the first large study of its kind presenting the spectrum of renal diseases in the tertiary-care government hospital of the country and we expect the disease pattern to be reasonably similar in other similar government hospital of the country. Chronic renal failure, nephrotic syndrome and diabetes are three major diseases, with which we have to deal maximum. As CRF in young male patients is the largest load, with its wide social and economical implications in the Indian context, we must gear up to organise ourselves for providing the best possible care to these patients with the limited resources.
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