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Gupta A, Puri S, Aggarwal NP, Randhwa GS, Jha PM. Intravascular Hemolysis, Methemogolbinemia and Acute Renal Failure in a Young Female. Indian J Nephrol 2023; 33:136-139. [PMID: 37234441 PMCID: PMC10208537 DOI: 10.4103/ijn.ijn_410_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/20/2021] [Accepted: 12/03/2021] [Indexed: 11/04/2022] Open
Abstract
Copper sulfate occurs as large blue crystals in nature, commonly known as "blue vitriol" or "blue stone." It is a potentially lethal poison with significant mortality. Copper sulfate is a powerful oxidizing agent and causes corrosive injury to the mucous membrane. The clinical course involves intravascular hemolysis resulting in anemia, jaundice, and renal failure. Laboratory diagnosis of the condition is not an issue; the difficulty is suspecting it, promptly initiating chelation therapy, and other supportive symptomatic treatment. We present a case of copper sulfate poisoning in a young female with suicidal intent resulting in severe acute toxicity, which was successfully managed by copper chelator (d-Penicillamine) and other supportive measures.
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Affiliation(s)
- Ashish Gupta
- Senior Consultant, Max Super Specialty Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India
| | - Saurabh Puri
- Medicine, Max Super Specialty Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India
| | - Neeru P. Aggarwal
- Nephrology, Max Super Specialty Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India
| | - Gulshan S. Randhwa
- Medicine, Max Super Specialty Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India
| | - Prem Mohan Jha
- Nephrology, Max Super Specialty Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India
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Gupta A, Puri S, Aggarwal NP, Randhawa G, Jha PM. Typhoid Fever Complicated by Rhabdomyolysis with Acute Hepatitis, Splenic Infarct, Pancreatitis, and Acute Kidney Injury. Indian J Nephrol 2023; 33:147-149. [PMID: 37234442 PMCID: PMC10208540 DOI: 10.4103/ijn.ijn_497_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/17/2022] [Accepted: 05/06/2022] [Indexed: 11/23/2022] Open
Abstract
Typhoid fever is a potentially life-threatening infectious disease that presents itself with a wide array of symptoms ranging from uncomplicated fever to sepsis with multiorgan dysfunction syndrome. An 18-year-old male college student presented with progressively increasing fever with abdominal discomfort, anorexia, and persistent vomiting. Typhoid fever was suspected in view of clinical findings along with leukopenia, grossly elevated transaminases, and acute kidney injury. He was managed with intravenous (IV) antibiotics, which resulted in the resolution of fever and other symptoms. Rhabdomyolysis is an extremely rare complication in typhoid fever, which is a very common cause of fever in tropical countries, leading to acute renal failure, causing very high morbidity and mortality.
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Affiliation(s)
- Ashish Gupta
- Department of Internal Medicine, Max Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India
| | - Saurabh Puri
- Department of Internal Medicine, Max Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India
| | - Neeru P. Aggarwal
- Department of Nephrology, Max Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India
| | - Gulshan Randhawa
- Department of Internal Medicine, Max Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India
| | - Prem Mohan Jha
- Department of Nephrology, Max Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India
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Gupta AK, Singh NP, Khanna T, Aggarwal NP, Gandhi P, Kaul S, Sarkar T, Khullar D. PS-C27-11: HYPERTENSION AND LOW EGFR AMONG MALE OCCUPATIONAL AUTO-RICKSHAW DRIVERS FROM NORTH INDIA- SCREENING FOR CHRONIC KIDNEY DISEASE RISK FACTORS. J Hypertens 2023. [DOI: 10.1097/01.hjh.0000917152.03493.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Singh NP, Panwar V, Aggarwal NP, Chhabra SK, Gupta AK, Ganguli A. Regulation of Calcium Homeostasis in Acute Kidney Injury: A Prospective Observational Study. Indian J Crit Care Med 2022; 26:302-306. [PMID: 35519919 PMCID: PMC9015928 DOI: 10.5005/jp-journals-10071-24124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Maintaining homeostasis is an integral part of all physiological processes both in health and disease including critically ill patients and may impact clinical outcomes. The present study was designed to assess prevalence of serum calcium, phosphate, vitamin-D3, FGF-23, and PTH levels abnormalities in AKI. Patients and methods Single-center, prospective, observational study in a tertiary care hospital. Patients meeting KDIGO criteria for AKI were included. Paired blood samples were drawn from eligible patients—first sample within 24 hours of AKI diagnosis and second after 5 days or at time of hospital discharge, whichever was earlier for measuring serum calcium (albumin corrected), phosphate, PTH, 25(OH)Vit-D, and FGF-23 levels. Clinical outcomes analyzed included survival status, utilization of RRT, and hospital stay. Results Of the 50 patients with AKI, about three-fourths were males. Mean age of the participants was 57.32 ± 11.47 years. Around half of patients had hypocalcemia and four-fifths had low serum phosphate. Nearly 82% had low 25(OH)Vit-D and 52% cases had high PTH level. Patients who underwent RRT had numerically higher but not significant serum calcium and PTH levels. FGF-23 levels (pg/mL) were significantly higher in patients on RRT (81.70 ± 17.30 vs non-RRT, 72.43 ± 20.27, p = 0.049), nonsurvivors (87.96 ± 18.82 vs survivors 57.11 ± 15.19, p = 0.045), and those hospitalized for time of stay above median (109.67 ± 26.97 vs below median 70.27 ± 20.43, p = 0.046). Among all the bone and mineral parameters analyzed high FGF23 levels were consistently linked with poor clinical outcomes in AKI. Conclusion The present study found high prevalence of calcium and phosphate disorders in AKI with dysregulated phosphate homeostasis as evidenced from elevated FGF-23 levels linked with morbidity and mortality in AKI. How to cite this article Singh NP, Panwar V, Aggarwal NP, Chhabra SK, Gupta AK, Ganguli A. Regulation of Calcium Homeostasis in Acute Kidney Injury: A Prospective Observational Study. Indian J Crit Care Med 2022;26(3):302–306.
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Affiliation(s)
- Narinder Pal Singh
- Faculty of Medicine and Health Sciences, SGT Medical College Hospital and Research Institute, Gurugram, Haryana, India
- Narinder Pal Singh, Faculty of Medicine and Health Sciences, SGT Medical College Hospital and Research Institute, Gurugram, Haryana, India, Phone: +91 9868446621, e-mail:
| | - Vikrant Panwar
- Department of Gastroenterology, Artemis Institute of Health Sciences, Gurugram, Haryana, India
| | - Neeru P Aggarwal
- Department of Nephrology, Max Super Speciality Hospital, Ghaziabad, Uttar Pradesh, India
| | - Satish K Chhabra
- Department of Nephrology, Max Super Speciality Hospital, Patparganj, New Delhi, India
| | - Anish K Gupta
- Faculty of Medicine and Health Sciences, SGT Medical College Hospital and Research Institute, Gurugram, Haryana, India
| | - Anirban Ganguli
- Department of Nephrology, Georgetown University, Washington, DC, United States of America
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Singh NP, Nautiyal A, Karol A, Aggarwal NP, Minocha G, Gupta AK. Pulmonary Hypertension in Patients with End Stage Renal Disease on Maintenance Hemodialysis-A Cross-sectional Study. J Assoc Physicians India 2018; 66:26-29. [PMID: 31313546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Pulmonary Hypertension (PH) in End Stage Renal Disease (ESRD) on Maintenance Hemodialysis (HD) portends a poor outcome in patients undergoing dialysis. METHODS 50 patients with ESRD undergoing regular hemodialysis for at least 3 months were included. Biochemical parameters- hemoglobin, urea, creatinine, albumin, calcium, phosphorus and PTH assessed post dialysis. All patients underwent 2D echocardiography one hour after dialysis to avoid overestimation of pulmonary artery pressures. Measurement of various parameters was carried out including right atrial and ventricular dimensions, tricuspid annular plane systolic excursion, flow across tricuspid and pulmonary valves and tissue doppler imaging of the annular plane. PH was defined as mean right ventricular systolic pressure ≥25 mmHg. Variables were compared between two groups- subjects with PH and Non-PH. RESULTS Seventeen patients were detected to have PH. All baseline biochemical parameters did not show significant difference between two groups. On ECHO, right atrial and ventricular enlargement and pulmonary vascular resistance were significantly higher in PH group. LA vol index greater than 34ml/m2 was detected in 94.1% patients with PH as opposed to 51.5% in non PH. LVEDP was detected to be significantly higher in PH compared to Non PH (p=0.001; 94.1% vs 39.4%). Mean values of ejection fractions were also significantly different. CONCLUSION This study suggests that up to one third of ESRD patients on HD develop PH. Echocardiography findings reveal a significant association between raised LVEDP and increased pulmonary artery pressures. Thus, volume overload and diastolic dysfunction (heart failure with preserved ejection fraction) appear to be the main contributors to development of PH.
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Affiliation(s)
- Narinder Pal Singh
- Senior Director, Internal Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh;*Corresponding Author
| | - Arushi Nautiyal
- Resident, Medicine, Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh
| | - Ajay Karol
- Consultant, Department of Cardiology, Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh
| | - Neeru P Aggarwal
- Associate Director, Department of Nephrology, Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh
| | - Gaurav Minocha
- Principal Consultant, Department of Cardiology, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh
| | - Anish Kumar Gupta
- Research Associate, Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh
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Abstract
Hemolytic-uremic syndrome (HUS) is characterized by acute kidney injury with hemolytic anemia and thrombocytopenia. It has diverse etiologies, clinical manifestations, and risk factors. Acute pancreatitis as a cause of HUS is rare in adults. We report a case of 32-year-old male who presented with ethanol-induced acute pancreatitis complicated with hemolytic-uremic syndrome managed with hemodialysis and plasmapheresis.
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Affiliation(s)
- Narinder Pal Singh
- Department of Internal Medicine and Nephrology, Max Super Speciality Hospital, Ghaziabad, Uttar Pradesh, India
| | - Neeru P Aggarwal
- Department of Internal Medicine and Nephrology, Max Super Speciality Hospital, Ghaziabad, Uttar Pradesh, India
| | - Hardik R Shah
- Department of Internal Medicine and Nephrology, Max Super Speciality Hospital, Ghaziabad, Uttar Pradesh, India
| | - Laxmi Kant Jha
- Department of Internal Medicine and Nephrology, Max Super Speciality Hospital, Ghaziabad, Uttar Pradesh, India
| | - Anish Kumar
- Department of Internal Medicine and Nephrology, Max Super Speciality Hospital, Ghaziabad, Uttar Pradesh, India
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Shah HR, Singh NP, Aggarwal NP, Singhania D, Kumar A. Cardiorenal Syndrome: Clinical Outcome Study. J Assoc Physicians India 2016; 64:41-46. [PMID: 28405987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Over recent years, the field of medicine has been challenged by the twin epidemic of heart failure and renal insufficiency. The coexistence of the two problems in the same patient, referred to as cardiorenal syndrome (CRS), is defined as 'disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. The mechanisms underlying this interaction are complex and multifactorial in nature. OBJECTIVE OF STUDY Identify and classify patients admitted with cardiorenal syndrome into various subtypes and assess clinical outcome at discharge and at three months. METHODS Ours was a longitudinal study of 50 patients admitted in ICU with CRS. They were classified as per RONCO classification (2008) into various subtypes. Outcomes was addressed as favourable for patients stable at discharge and at 3 months follow up, whereas outcome was termed non-favourable for patients who expired or initiated on hemodialysis. RESULTS Of 50 patients, two-third patients were males (66%), with mean age of males and females being 64.18 years and 64.64 years respectively. Majority of the patients had Type-1 CRS (46%) followed by twenty two percent Type-2, twenty six percent type-4 and six percent Type-5. There were no patients with type-3 CRS. At the end of the study, 24 (48%) patients were stable, 12 (24%) required dialysis and 14 (28%) patients had expired. The total non-favourable outcomes (dialysis / death) were higher with subtypes CRS-4 (n-11, 22%) and CRS-1 (n-8, 16%). Anemia, raised serum creatinine, low eGFR values, low ejection fraction were significant predictors of non-favourable outcome in our study. CONCLUSIONS CRS occurs in all age groups, more commonly in elderlies with a male preponderance. Prevalence of CRS-1 was higher followed by CRS-4. Prognosis was unfavourable in CRS-1, CRS-4 and CRS-5. Sepsis was predominant cause of death in patients with CRS-5 with hundred percent mortality during hospital stay. Risk factors like pre-existing renal impairment, anemia, reduced e GFR and low ejection fraction were significantly associated with worse outcomes. There is need for large scale population / community based studies to chart the prevalence of cardiorenal subtypes and prognosticate each individually.
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Affiliation(s)
| | - N P Singh
- Director, Meedicine Allied Specialities
| | | | | | - A Kumar
- Research Associate, Dept. of Medicine, Max Super Specialitiy Hospital, Ghaziabad, Uttar Pradesh
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Aggarwal NP. Hepatitis due to anti-tuberculous drugs. Indian J Chest Dis Allied Sci 1992; 34:231-2. [PMID: 1302758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Aggarwal NP, Kallan BM, Aggarwal M, Joshi R. Effects of age, sex and alcoholic habit of patients on liver enzymes during antituberculosis chemotherapy. J Indian Med Assoc 1991; 89:311-2. [PMID: 1787318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Affiliation(s)
- N P Aggarwal
- Department of T.B. and Chest Diseases, Medical College, Amritsar
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