Indian TrANslational GlomerulonephrItis BioLogy nEtwork (I-TANGIBLE): Design and Methods

Background and Aim

Primary glomerular disease accounts for one-sixth of all chronic kidney diseases (CKDs) in India. We remain limited in our ability to effectively treat these conditions because of lack of understanding of the disease mechanisms and lack of predictors to identify the clinical course and therapeutic responsiveness. We propose to develop a network of investigators in glomerular diseases, collect information in a systematic fashion to understand the clinical outcomes, answer translational research questions better, and identify and recruit patients for clinical trials.

Materials and Methods

This is a prospective, observational study. The Indian TrANslational GlomerulonephrItis BioLogy nEtwork (I-TANGIBLE) cohort will enroll patients (>18 years) with biopsy-proven minimal change disease (MCD), focal segmental glomerulonephritis (FSGS), membranous nephropathy (MN), IgA nephropathy (IgAN), or membranoproliferative glomerulonephritis (MPGN) (immune complex- and complement-mediated), with first biopsy taken within 2 years of enrollment. Patients with estimated glomerular filtration (eGFR) rate <15 ml/min/1.73 m2 for >3 months at the time of screening, kidney transplant or bone marrow transplant recipients, patients with active malignancy, and patients with active hepatitis B/C replication or human immunodeficiency virus (HIV)-I/II will be excluded. Clinical details including history, medication history and details, and family history will be obtained. Consenting patient's blood and urine samples will be collected and stored, aligned to their clinical follow-up.

Expected Outcomes

The network will allow accurate ascertainment of disease burden of glomerular diseases across study sites, establishment of the treatment pattern of common glomerular diseases, investigation of medium- and long-term outcomes (remission, relapse, rate of eGFR decline), and building a suitable infrastructure to carry out clinical trials in primary glomerular disease.

Resilience as a protective factor on the quality of life (QoL) of Indian nursing students during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic negatively impacted the quality of life of individuals around the world, including health care professionals. There has been little research that examines the role of resilience concerning the impact of COVID-19 on the quality of life of nursing students. This study aimed to determine how resilience influenced the quality of life among nursing students during the COVID-19 pandemic.

METHODS

A cross-sectional research design was adopted for this study. A total of two hundred sixty-eight nursing students from three universities, South India responded in the web-based survey. Data was collected using self-reported questionnaires in June 2021.

RESULTS

Our findings revealed that the participants' resilience was normal, which had a moderate impact on the quality of life of nursing students during the COVID-19 pandemic. The COVID-19 impact on QoL significantly differed with year of education (F = 3.087; p < 0.02) and university (F = 6.697, p < 0.001). Bivariate analysis revealed significant inverse relationships between the impact of COVID-19 on quality of life with resilience (r = -0.259; p < 0.001) and perceived knowledge on COVID-19(r = -0.168; p < 0.006).

CONCLUSION

In our study, we found that resilience had a moderate impact on the quality of life of nursing students during the COVID-19 pandemic. Therefore, it is important to promote students' resilience and improve their quality of life during stressful situations.

Significance of Glomerular C1q deposits in IgA Nephropathy

Introduction: Immunoglobulin A (IgA) nephropathy is the most common form of glomerulonephritis in young men, often presenting as gross or microscopic haematuria and accounts for approximately 10% of the patients with End-Stage Renal Disease (ESRD). The contribution of the complement system to amplify tissue injury in IgA nephropathy has been suggested but the precise pathways of complement activation especially the involvement of classical pathway remain largely unknown. Aim: To determine the prevalence of glomerular C1q deposition in IgA nephropathy to delineate the relationship of glomerular C1q positivity and different histological variables indicating disease activity and disease progression and also to determine the relationship of glomerular C1q positivity and the Oxford scoring system in IgA nephropathy. Materials and Methods: This was a prospective study conducted over a period of three years {January 2014- December 2016} in the Department of Pathology with the cooperation of the Department of Nephrology at Government Medical College, Kozhikode , Kerala, India. A total of 44 cases which were both biopsy and immunofluorescence proven as IgA nephropathy were included in the study. For light microscopy, the tissue received in buffered formalin was processed into paraffin blocks, stained with Haematoxylin and Eosin (H&E) and histopathological changes analysed. For immunofluorescence, tissue received in normal saline was frozen in cryostat and 3 μm sections were stained using the Dako polyclonal Fluorescein Isothiocyanate (FITC) conjugated antibodies IgG, IgM, IgA, C3, C1q and studied for pattern of glomerular staining. Chi-square test was used for statistical analysis. Results: The prevalence of C1q deposits was 27.3%. Among histopathological variables, only fibrous crescent was found to have significant relationship with C1q positivity (p= 0.0472). On follow-up, 50% C1q positive patients and 11.76% C1q negative patients who were having normal renal functions at the start of the study went into renal insufficiency. Conclusion: The study revealed that there was a fairly high prevalence of C1q deposits in IgA nephropathy patients. Also, significant association was found between C1q deposits and fibrous crescent. Most significantly the study concluded that there is an increased tendency for the C1q positive patients to go into renal failure.

Withdrawal from Dialysis: Why and When?

Patients with end-stage kidney diseases may request for withdrawal of dialyses for many reasons. Healthcare practitioners frequently puzzled by ethical dilemma of respecting patient's wishes and beneficence of continuing dialysis. Shared decision-making and negotiating goal of care help in decision-making in patients' interests. Proactive identification guidelines that may be used for screening help in weighing options of dialysis and conservative care during progressive decline of clinical condition. Proactive identification guidelines may be used for screening. It helps in weighing options of dialysis versus conservative care during progressive decline of clinical condition. An individualized, patientcentred discussion, rather than disease-oriented, approach may be adapted.