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Rathi M, Kohli HS, Jha V, Gupta KL, Sakhuja V, Mukhopadhyay P. Polyarteritis nodosa presenting with spontaneous perirenal hematoma. Indian J Nephrol 2012; 22:295-7. [PMID: 23162275 PMCID: PMC3495353 DOI: 10.4103/0971-4065.101254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Parameswaran S, Mittal N, Joshi K, Rathi M, Kohli HS, Jha V, Gupta KL, Sakhuja V. Tubulointerstitial nephritis with uveitis syndrome: A case report and review of literature. Indian J Nephrol 2011; 20:103-5. [PMID: 20835328 PMCID: PMC2931125 DOI: 10.4103/0971-4065.65307] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tubulointerstitial nephritis with uveitis (TINU) syndrome is an unusual and under diagnosed cause of acute interstitial nephritis. The interstitial nephritis may precede, follow or develop concurrent to the uveitis. About 200 cases have been reported worldwide with only a single case reported from India. We report a 16-year-old male with TINU syndrome.
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Sreejith P, Jha V, Kohli HS, Rathi M, Gupta KL, Sakhuja V. Allograft and prostatic involvement in a renal transplant recipient with disseminated tuberculosis. Indian J Nephrol 2011; 20:40-2. [PMID: 20535270 PMCID: PMC2878410 DOI: 10.4103/0971-4065.62097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Tuberculosis is a serious opportunistic infection in renal transplant recipients and is disseminated in nature in one-third of patients. Genito urinary tuberculosis is rare in renal transplant recipients. We report a patient presenting 5 years after renal transplantation with disseminated tuberculosis and allograft and prostatic involvement.
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Sreejith P, Kuthe S, Jha V, Kohli HS, Rathi M, Gupta KL, Sakhuja V. Constrictive pericarditis in a renal transplant recipient with tuberculosis. Indian J Nephrol 2010; 20:156-8. [PMID: 21072157 PMCID: PMC2966983 DOI: 10.4103/0971-4065.70849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Tuberculosis is a common cause of pericarditis in the developing countries and constrictive pericarditis is a serious sequel. There are only three cases of constrictive pericarditis in kidney transplant recipients previously reported in literature. Here, we report a case of constrictive pericarditis developing in a renal transplant recipient while on antituberculous therapy for tuberculous pleural effusion.
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Sreejith P, Jha V, Kohli HS, Rathi M, Gupta KL, Sakhuja V. Authors' reply. Indian J Nephrol 2010; 20:224-5. [PMID: 21206693 PMCID: PMC3008961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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56
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Jairam A, Das R, Aggarwal PK, Kohli HS, Gupta KL, Sakhuja V, Jha V. Iron status, inflammation and hepcidin in ESRD patients: The confounding role of intravenous iron therapy. Indian J Nephrol 2010; 20:125-31. [PMID: 21072151 PMCID: PMC2966977 DOI: 10.4103/0971-4065.70840] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Uremia is a state of heightened inflammatory activation. This might have an impact on several parameters including anemia management. Inflammation interferes with iron utilization in chronic kidney disease through hepcidin. We studied the body iron stores, degree of inflammatory activation, and pro-hepcidin levels in newly diagnosed patients with end-stage renal disease (ESRD), and compared them with normal population. In addition to clinical examination and anthropometry, the levels of iron, ferritin, C-reactive protein, tumor necrosis factor alfa, interleukin-6, and prohepcidin were estimated. A total of 74 ESRD patients and 52 healthy controls were studied. The ESRD patients had a significantly lower estimated body fat percentage, muscle mass, and albumin; and higher transferrin saturation (TSAT) and raised serum ferritin. Inflammatory activation was evident in the ESRD group as shown by the significantly higher CRP, IL-6, and TNF-α levels. The pro-hepcidin levels were also increased in this group. Half of the ESRD patients had received parenteral iron before referral. Patients who had received intravenous iron showed higher iron, ferritin, and TSAT levels. These patients also showed more marked inflammatory activation, as shown by the significantly higher CRP, TNF-α, and IL-6 levels. We conclude that our ESRD patients showed marked inflammatory activation, which was more pronounced in patients who had received IV iron. High hepcidin levels could explain the functional iron deficiency. The cause of the relatively greater degree of inflammatory activation as well as the relationship with IV iron administration needs further studies.
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Kohli HS. Mental health and well-being. THE NATIONAL MEDICAL JOURNAL OF INDIA 2010; 23:35-36. [PMID: 20839593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Anirban G, Kohli HS, Jha V, Gupta KL, Sakhuja V. The comparative safety of various intravenous iron preparations in chronic kidney disease patients. Ren Fail 2008; 30:629-38. [PMID: 18661414 DOI: 10.1080/08860220802134631] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The relative safety of parenteral iron preparations is a controversial issue in the management of anemia in chronic kidney disease (CKD), as direct head-to-head comparative trials are lacking. In this study, patients of CKD were randomized to receive intravenous low molecular weight iron dextran (ID), sodium ferrigluconate complex (SFGC), and iron sucrose (IS) at doses and infusion rates recommended by the product manufacturer. One time test dose was used only for ID and SFGC. A total of 2,980 injections (n = 339) of i.v. iron was given, and 49 patients (14.45% per patient) and a total of 56 adverse events (1.88% per infusion) were noted. Odds ratios (OR) of serious adverse drug events (ADE; i.e., death, anaphylaxis, or suspected immuno-allergic events) per patient was not significant between ID vs. SFGC (3.566) and SFGC vs. IS (2.129), whereas that between ID vs. IS (7.594) was highly significant (p = 0.034). OR of serious ADE exposure was significantly higher in ID vs. SFGC (OR = 5.670, p = 0.0147) and ID vs. IS (OR = 7.799, p < 0.001). No significant difference was seen between the three groups in terms of non-serious ADEs. Drug discontinuation occurred significantly more often with ID. One patient who developed anaphylactoid reaction with SFGC and ID tolerated iron sucrose well.
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Chopra S, Suri V, Aggarwal N, Rohilla M, Keepanasseril A, Kohli HS. Pregnancy in chronic renal insufficiency: single centre experience from North India. Arch Gynecol Obstet 2008; 279:691-5. [DOI: 10.1007/s00404-008-0797-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 09/01/2008] [Indexed: 10/21/2022]
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Aggarwal N, Suri V, Soni S, Chopra V, Kohli HS. A prospective comparison of random urine protein-creatinine ratio vs 24-hour urine protein in women with preeclampsia. MEDSCAPE JOURNAL OF MEDICINE 2008; 10:98. [PMID: 18504482 PMCID: PMC2390693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To assess the diagnostic accuracy of random urine protein-creatinine ratio for the prediction of significant proteinuria in patients with preeclampsia. STUDY DESIGN 155 pregnant patients diagnosed to have hypertension in late pregnancy were instructed to collect urine during a 24-hour period. Protein-creatinine ratio was evaluated in a random urinary specimen. Out of these, 120 patients fulfilled the inclusion criteria. The predictive value of the random urinary protein-creatinine ratio for the diagnosis of significant proteinuria was estimated by using a 300-mg protein level within the collected 24-hour urine as the gold standard. RESULTS 104 patients (86.67%) had significant proteinuria. There was significant association between 24-hour protein excretion and the random urine protein-creatinine ratio (r(s)=0.596, P < .01). With a cut-off protein-creatinine ratio greater than 1.14 as a predictor of significant proteinuria, sensitivity and specificity were 72% and 75%, respectively. The positive predictive value was 94.9% and negative predictive value was 29.2%. CONCLUSION The random urine protein-creatinine ratio was not a good predictor of significant proteinuria in patients with preeclampsia.
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Kurtkoti J, Sakhuja V, Sud K, Minz M, Nada R, Kohli HS, Gupta KL, Joshi K, Jha V. The utility of 1- and 3-month protocol biopsies on renal allograft function: a randomized controlled study. Am J Transplant 2008; 8:317-23. [PMID: 18093273 DOI: 10.1111/j.1600-6143.2007.02049.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Identification of pathological events in the renal allograft using protocol biopsies at predetermined time intervals may yield useful information and improve outcomes. We examined the influence of decisions taken on the basis of 1- and 3-month protocol biopsies findings on 1-year renal allograft function in a prospective randomized study. Out of 102 living-donor allograft recipients, 52 were randomized to undergo protocol biopsies and 50 controls had only indicated biopsies. All acute rejection (AR) episodes (clinical and subclinical) were treated. Calcineurin inhibitor (CNI) dose adjustments were made on clinical judgment. Baseline recipient and donor characteristics, immunosuppressive drug usage, HLA matches and 2-h cyclosporine levels were similar in both groups. At 1 and 3 months, protocol biopsies revealed borderline (BL) changes in 11.5% and 14% patients, AR in 17.3% and 12% and chronic allograft nephropathy (CAN) in 3.8% and 10%. The incidence of clinically evident AR episodes was similar in the two groups, but biopsy group had lower serum creatinine at 6 months (p = 0.0003) and 1 year (p < 0.0001). The renal functions were similar in those with normal histology and BL changes. Protocol biopsies are helpful in detecting subclinical histological changes in the graft and improving short-term renal allograft function.
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Jain AK, Sukhija J, Sakhuja V, Kohli HS, Sud K. Tear flow study in renal transplant patients receiving cyclosporine A. ANNALS OF OPHTHALMOLOGY (SKOKIE, ILL.) 2008; 40:31-34. [PMID: 18556979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We studied tear flow in 23 renal transplant patients receiving cyclosporine A. Four minute Schirmer test was done once before and three times after starting cyclosporine A. Average tear flow was 9.7+/-0.9 before treatment and 15.9+/-1.1 at 1-2 months after renal transplant, 16.5+/-1.3 at 3-5 months and 17.6+/-1.4 at 8-10 months. Tear flow was significantly increased following oral cyclosporine treatment.
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Kohli HS. Don't forget public health! THE NATIONAL MEDICAL JOURNAL OF INDIA 2007; 20:153-4. [PMID: 17867623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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64
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Vaiphei K, Bhalla A, Kohli HS. Ischemic colitis with superadded infection by unusual organisms. Indian J Gastroenterol 2007; 25:298-301. [PMID: 17264430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Jha V, Rathi M, Ganguli A, Singh SK, Kohli HS, Gupta KL, Sakhuja V. Bardet-Biedl syndrome with end-stage kidney disease: A case report and review of literature. Indian J Nephrol 2007. [DOI: 10.4103/0971-4065.35014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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66
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Kohli HS. Dementia, drugs and doing the right thing. THE NATIONAL MEDICAL JOURNAL OF INDIA 2007; 20:36-7. [PMID: 17557524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Singh SK, Gupta AK, Jha V, Kohli HS, Gupta KL, Minz M, Sakhuja V. Treatment of Oropharyngeal Cancer in Renal Transplant Recipients Without Cessation of Immunosuppressive Therapy. Transplant Proc 2006; 38:2088-9. [PMID: 16980008 DOI: 10.1016/j.transproceed.2006.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Renal transplantation and immunosuppression are associated with an increased incidence of malignancy. Reduction or cessation of immunosuppressive therapy has been advocated in these cases to prevent tumor progression and recurrence. We evaluated the outcome of treatment of oropharyngeal cancer (OC) after renal transplantation without cessation of immunosuppressive therapy. METHODS The database of patients with OC after renal transplantation was analyzed with respect to age, sex, type of immunosuppression, interval between transplantation and diagnosis of cancer, as well as method of treatment and survival. RESULTS Thirty one (2.06%) renal transplant recipients developed malignancy including 6 (20%) with OC. Lingual cancer was seen in three, and one each showed an isolated tonsillar lymphoma, a parotid carcinoma, or a carcinoma of the larynx with only the last having had two other malignancies in the past. Three subjects were on immunosuppression with azathioprine and prednisolone, and the others were prescribed cyclosporine and prednisolone. Average time from transplantation to diagnosis of OC was 106 months. The interval was the shortest (2 years) for tonsillar lymphoma in an 18-year-old patient who received cyclosporine and showed features of left follicular tonsillitis. The patient with advanced carcinoma of the larynx did not receive any treatment and succumbed within 3 months. The dose of cyclosporine was reduced in the lymphoma case but immunosuppression was not altered in the other patients. All subjects were treated with a standard protocol. During a mean follow-up of 33 months, one had local recurrence of parotid carcinoma and the others showed well functioning renal grafts. CONCLUSION Comprehensive treatment of OC after renal transplantation without withdrawing the immunosuppression prolonged the life of these patients with functioning grafts.
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Kohli HS. Re-organizing the health services in Scotland. THE NATIONAL MEDICAL JOURNAL OF INDIA 2004; 17:333-4. [PMID: 15736559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Kohli HS. Young people's health behaviour. THE NATIONAL MEDICAL JOURNAL OF INDIA 2004; 17:212. [PMID: 15372768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Kohli HS. Sexual health. THE NATIONAL MEDICAL JOURNAL OF INDIA 2004; 17:109. [PMID: 15141610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Kohli HS, Sakhuja V. Snake bites and acute renal failure. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2003; 14:165-176. [PMID: 18209442] [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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Singh V, Sud K, Kohli HS, Gupta KL, Sakhuja V. Acute intermittent porphyria: an unusual cause of malignant hypertension. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2003; 51:225-6. [PMID: 12725276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Hypertension is a rare complication of acute intermittent porphyria (AIP) and is related to the sympathetic over-activity seen in this condition. We report a patient with AIP with malignant hypertension that recurred with a subsequent episode. Mechanisms of hypertension and renal damage are discussed.
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Singh SK, Sakhuja V, Sharma SK, Mandal AK, Gupta KL, Kohli HS, Sud K, Jha V. Unusual causes of ureteral obstruction in renal allografts: case reports. Transplant Proc 2003; 35:337-8. [PMID: 12591429 DOI: 10.1016/s0041-1345(02)03937-4] [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: 10/27/2022]
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Sud K, Singh B, Kohli HS, Jha V, Gupta KL, Sakhuja V. Evaluation of different sampling times for best prediction of cyclosporine area under the curve in renal transplant recipients. Transplant Proc 2002; 34:3168-70. [PMID: 12493408 DOI: 10.1016/s0041-1345(02)03587-x] [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: 10/27/2022]
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Singh V, Sud K, Mittal BR, Kohli HS, Gupta KL, Sakhuja V. Postrenal transplant erythrocytosis: risk factors and effectiveness of angiotensin receptor antagonists. Transplant Proc 2002; 34:3191-2. [PMID: 12493416 DOI: 10.1016/s0041-1345(02)03673-4] [Citation(s) in RCA: 5] [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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