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Mittal R, Agarwal SK, Dash SC, Saxena S, Tiwari SC, Mehta SN, Bhuyan UN, Mehra NK. Treatment of acute rejection in live related renal allograft recipients: a comparison of three different protocols. Nephron Clin Pract 1997; 77:186-9. [PMID: 9346385 DOI: 10.1159/000190271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We present our experience on the comparison of three different modes of steroid therapy, oral prednisolone (OP), intravenous dexamethasone (IVDX) and intravenous methylprednisolone (IVMP) in the treatment of acute rejection (AR) in renal allograft recipients. Between January 1980 and January 1992, 206 patients underwent live related renal transplantation. Before 1990, all received prednisolone (PRED) and azathioprine (AZA) only. After 1990, patients were given PRED, AZA and cyclosporine (CsA). After 1 year, CsA was stopped and patients were converted to a two-drug regimen only. Of the 206 patients, 180 (87.4%) were male and mean age was 30.3+/-8.7 years (range 14-63). During the mean follow-up of 43.5 months, 178 episodes of AR were seen in 121 patients. Each episode was considered as a separate entrant in the study. Conventional immunosuppression was given in 151 episodes and 27 episodes were on triple-drug therapy. Diagnosis of AR was made by clinical, sonography, nuclear scan with or without graft biopsy evidence. Of the 178 AR, 110 (61.8%) were within 3 months, 36 (20.2%) were between 3 months and 1 year and 32 (18%) were after 1 year. OP was given in 11 cases while IVDX and IVMP were given in 48 and 119 cases respectively. Overall, 154 (86%) showed either a complete or partial response to antirejection therapy. Response to therapy was 91, 90 and 85% in OP, IVDX and IVMP groups respectively. There was no statistical difference in response rate in different groups. There was also no difference in side effects in three different groups. Our data suggest that it is the high dose of steroid rather than mode of therapy which is responsible for therapeutic benefit in treatment of AR.
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Affiliation(s)
- R Mittal
- Department of Nephrology, All-India Institute of Medical Sciences, New Delhi
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Dash SC, Bhuyan UN, Dinda AK, Saxena S, Agarwal SK, Tiwari SC, Nundy S. Increased incidence of glomerulonephritis following spleno-renal shunt surgery in non-cirrhotic portal fibrosis. Kidney Int 1997; 52:482-5. [PMID: 9264006 DOI: 10.1038/ki.1997.357] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In a prospective study of 200 non-cirrhotic portal fibrosis (NCPF) patients, 7% had mild proteinuria and their renal biopsies showed mild mesangial proliferative glomerulonephritis (mes-PGN). The remaining 93% biopsies were normal. However, following the insertion of a spleno-renal shunt (SRS) for portal hypertension 32% of these patients developed nephrotic syndrome in five years. Renal histology revealed mesangiocapillary glomerulonephritis (MCGN) (18.5%), mes-PGN (9%), minimal change nephropathy (3%), and chronic sclerosing GN (1.5%). Immunofluorescence showed granular deposition of IgA and C3. IgA2 was the predominant form of Ig in the glomerular deposits, indicating that IgA in the immune complexes was derived from the gastrointestinal tract. Electron microscopy revealed electron dense deposits in the mesangium. In contrast to the NCPF patients who underwent a SRS for portal hypertension, the 200 patients in our study who underwent spleno-renal shunting because of extra hepatic portal obstruction did not have renal disease, nor did they develop renal disease during the five-year post-operative follow-up. Fifty percent of the glomerulonephritis (GN) in the NCPF group progressed to renal failure in five years; 46.6% continued to have proteinuria. Low serum complement, C3 (40%) and circulating immune complexes (14.8%) were detected in the glomerulonephritis group. Our study shows that: (i) there is a high rate of the occurrence of GN following SRS in NCPF patients, but not in those with normal livers; (ii) the type of GN is primarily IgA nephropathy; and (iii) the GN could be the result of defective hepatic reticuloendothelial function in the NCPF group that is worsened by the shunting procedure.
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Affiliation(s)
- S C Dash
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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Sharma MC, Bhuyan UN, Lal R. Renal cell carcinoma in a child: case report and brief review of literature. Indian J Cancer 1995; 32:85-8. [PMID: 9136464] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Renal cell carcinoma is common malignancy in the older age but extremely uncommon in childhood. Here in is reported a case of renal cell carcinoma in a eight year old female because of its rarity in children.
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Affiliation(s)
- M C Sharma
- Department of Pathology & Paediatric Surgery, All India Institute of Medical Sciences Ansari Nagar, New Delhi
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Mittal R, Agarwal SK, Dash SC, Saxena S, Tiwari SC, Mehta SN, Bhuyan UN, Mehra NK. Clinical profile and course and outcome of late acute rejection episodes in living-related-donor renal allograft recipients. Nephron Clin Pract 1995; 71:40-3. [PMID: 8538847 DOI: 10.1159/000188672] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We prospectively monitored clinical data and renal function at monthly intervals in 165 patients who had received living-related-donor renal allografts in our institution between January 1981 and December 1991 and had a functioning allograft for 1 year or longer. During a mean follow-up period of 47.2 (range 13-155) months, 32 patients (17.2%) developed late acute rejections, of which 14 (43.7%) were asymptomatic. Amongst the symptomatic late acute rejections, worsening of hypertension was the commonest finding, being present in 11 (61.1%) patients, followed by oliguria in 8 (44.4%) and weight gain in 7 (38.8%) patients. Of these 32 late acute rejections, as many as 28 (87.5%) showed a response to antirejection therapy with high-dose steroids: 5 (15.6%) a complete response and 23 (71.9%) a partial response. The response rate was 100% if it was the first acute rejection (20% complete and 80% partial), 78.6% if it was the second (14.3% complete and 64.3% partial), and no or only a partial response to treatment if it was the third acute rejection episode. On long-term follow-up, patients who had responded to to antirejection treatment had a significantly better graft survival as compared with nonresponding patients: 76 and 27%, respectively. Our observations suggest that routine monitoring of the renal function at frequent intervals is essential for early diagnosis and treatment of acute rejections, even during the late posttransplant period. The chances of a response to antirejection therapy are higher during the first episode of late acute transplant rejection as compared with second or a third late rejection event.
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Affiliation(s)
- R Mittal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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Bhuyan UN. Thrombotic microangiopathy with hypertension and acute renal failure in children (a typical hemolytic uremic syndrome). J Postgrad Med 1994; 40:120-2. [PMID: 8699375] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Thus I would like to conclude by saying that an idiopathic form of obliterative renal arteriopathy account for the rare presentation of severe hypertension and progressive renal failure with or without overt hemolytic anemia and thrombocytopenia in children. It can be labelled as primary malignant nephrosclerosis (NScl) or atypical HUS, based on primary thrombotic angiopathy. This, essentially intimal changes, is seen in diverse conditions and appears to result from primary endothelial injury followed by intimal exudation, thrombosis, and repair by fibrosis. Persistent or recurrence of this process form the basis of progressive obliterative arteriopathy. The result is renal ischemia and renin-angiotensin mediated hypertension. Establishment of a vicious circle would further accelerate HT and lead to end stage renal failure. Early recognition and prompt therapeutic intervention might prove beneficial.
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Affiliation(s)
- U N Bhuyan
- All India Institute of Medical Sciences, New Delhi
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Dash SC, Bhuyan UN, Gupta A, Sharma LC, Kumar A, Agarwal SK. Falciparum malaria complicating cholestatic jaundice and acute renal failure. J Assoc Physicians India 1994; 42:101-2. [PMID: 7860465] [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: 01/27/2023]
Abstract
Nine patients of acute falciparum malaria with severe hyperbilirubinemia developed acute renal failure (ARF). All of them had evidence of intrahepatic cholestasis and needed hemodialysis for several weeks; 7 survived and 2 died, one due to cerebral malaria, the other multiple organ failure. Interestingly, referal diagnosis did not include malaria as a cause of ARF in 8 out of 9 patients.
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Bhuyan UN, Bagga A, Srivastava RN. Acute renal failure and severe hypertension in children with renal thrombotic microangiopathy. Nephron Clin Pract 1994; 66:302-6. [PMID: 8190182 DOI: 10.1159/000187827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We observed 12 boys and 1 girl, 5-15 years old, presenting with acute renal failure (ARF) and severe hypertension. They constituted 4.9% of all patients with ARF. There was no preceding diarrheal or respiratory prodrome. Clinical and laboratory findings were indicative of hemolytic uremic syndrome (HUS) in 4, but obscure in 9 others. Renal biopsies revealed variably severe occlusive thrombotic microangiopathy (TMA) affecting predominantly interlobular arteries in 8 and both arteries and glomeruli in 5 cases. Glomerular crescents and cortical necrosis were not seen. Following supportive therapy, 8 progressed to or died of uremia; 2 showed persistent proteinuria, 1 moderate hypertension and 2 complete recovery. Our observations indicate that renal TMA without a prodromal illness and typical features of HUS may present with ARF, proteinuria and severe hypertension, and is associated with high mortality.
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Affiliation(s)
- U N Bhuyan
- Department of Pathology, All-India Institute of Medical Sciences, New Delhi
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Hemal AK, Gupta NP, Wadhwa SN, Songra MC, Batura D, Bhuyan UN. Primary repair of colorenocutaneous fistula in patients with genitourinary tuberculosis. Urol Int 1994; 52:41-4. [PMID: 8140680 DOI: 10.1159/000282568] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Two cases of colorenocutaneous fistula due to genitourinary tuberculosis are presented. They were successfully managed by single-stage surgery (nephroureterectomy, fistulectomy, and primary repair of the colon) and antitubercular treatment. The literature is briefly reviewed.
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Affiliation(s)
- A K Hemal
- Department of Urology, All India Institute of Medical Sciences, New Delhi
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Abstract
A 10-year-old girl with distal renal tubular acidosis (RTA) for 4 years (adequately treated for 3 years) developed clinical features suggesting systemic lupus erythematosus (SLE) with supportive laboratory evidence. She had heavy proteinuria and a decreased creatinine clearance (CCr). Renal biopsy showed diffuse proliferative and sclerosing glomerulonephritis with severe tubulointerstitial changes. Following treatment with corticosteroids and cyclophosphamide, she had a clinical remission, an increase in CCr and recovery from systemic acidosis. It is likely that distal RTA in this patient was a manifestation of SLE.
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Affiliation(s)
- A Bagga
- Department of Paediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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Bhuyan UN, Dash SC, Tiwari SC. Anti-neutrophil cytoplasmic antibody (ANCA) in necrotising vasculitides with renal involvement. J Assoc Physicians India 1993; 41:492-5. [PMID: 7904992] [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: 01/27/2023]
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA) was detected in sera of 20 out of 32 patients with necrotising vasculitides involving the kidneys and other organs. It was of high titre and cytoplasmic type in Wegener's granulomatosis (8/9); and of low titre and cytoplasmic or perinuclear type in systemic polyarteritis (6/12), renal limited polyarteritis (5/9) and pulmonary renal syndrome (1/2). It fell to low or undetectable levels on clinical improvement or remission with cyclophosphamide therapy. Its detection was helpful in diagnosis and management of vasculitides with renal and extrarenal manifestations.
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Affiliation(s)
- U N Bhuyan
- All India Institute of Medical Sciences, New Delhi
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Agarwal SK, Dash SC, Tiwari SC, Bhuyan UN. Idiopathic adult focal segmental glomerulosclerosis: a clinicopathological study and response to steroid. Nephron Clin Pract 1993; 63:168-71. [PMID: 8450907 DOI: 10.1159/000187177] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A total of 65 adult cases (53 males, 12 females) with biopsy-proven focal segmental glomerulosclerosis (FSGS) were studied. Hypertension, ascites and haematuria were seen in 13, 12 and 24 cases, respectively. Decreased creatinine clearance at presentation was found in 9 cases. Mean proteinuria per day, serum cholesterol and total protein were 7.5 +/- 4.3 g, 388.95 +/- 213.4 mg% (10.11 +/- 5.55 mmol/l) and 5.27 +/- 1.1 g% (0.527 +/- 0.11 milligram), respectively. Mesangial proliferation was seen in 13 cases and hilar sclerosis in 5. Fifty percent showed positive immunofluorescence; IgM in 10, C3 in 8, and IgG in 2. Forty-two cases could be followed (mean 32 months), out of which 38 had nephrotic syndrome and were treated with prednisolone; 58% showed response (31% complete remission and 27% partial remission). One patient in each group of responders and nonresponders had renal failure at the end of follow-up. Hypertension, degree of proteinuria, mesangial proliferation, degree of tubular atrophy and immunofluorescence findings did not significantly affect the response to steroids. We conclude that a group of patients with idiopathic adult FSGS has a favourable response to steroids, which cannot be predicted clinically.
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Affiliation(s)
- S K Agarwal
- Department of Nephrology and Pathology, All India Institute of Medical Sciences, New Delhi
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Saxena S, Hotchandani RK, Bhuyan UN, Agarwal SK, Tiwari SC, Dash SC. Membranous glomerulonephritis associated with autosomal dominant polycystic kidney disease. Nephron Clin Pract 1993; 65:316-7. [PMID: 8247200 DOI: 10.1159/000187497] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Malhotra KK, Dash SC, Sharma RK, Dhawan IK, Mehta SN, Tiwari SC, Agarwal SK, Bhuyan UN. Outcome of patients with pre-existing hepatitis B virus infection following renal transplant. Trop Gastroenterol 1993; 14:16-20. [PMID: 8342244] [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: 01/30/2023]
Abstract
Twenty four patients who were HBsAg positive prior to renal transplantation were studied with respect to their hepatic and renal outcome. The kidneys in all patients were obtained from living related donors. The standard immunosuppressive therapy consisted of azathioprine and prednisolone. Post-renal transplant follow-up varied from 32-86 months (mean 55 +/- 9). Renal functions, liver functions, HBsAg and HBsAb status was closely monitored during follow-up. One patient developed acute hepatitis four months after transplantation; this resolved in 10 weeks. Four patients showed transient elevations of liver enzymes. The results of liver biopsy in 16 cases revealed, normal histology (8), virus in hepatocytes (5), and acute hepatitis (3). None of the patients had evidence of chronic liver disease. Two patients died due to chronic rejection/chronic renal failure and two patients died due to septicaemia. Five living patients have mild to moderate chronic rejection. It was concluded that pre-existing HBsAg carrier state in transplant patients had no deteriorating effect on the liver. The mortality was related to chronic rejection and septicaemia.
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Affiliation(s)
- K K Malhotra
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi
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Singh YN, Malaviya AN, Sharma SK, Kumar A, Wali JP, Dash SC, Bhuyan UN. Wegener's granulomatosis in northern India. J Assoc Physicians India 1992; 40:594-6. [PMID: 1308014] [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: 12/26/2022]
Abstract
Till recently, Wegener's granulomatosis (WG) was considered a rare disease in India. Over the last 5 years we studied 13 proven cases of WG. This paper describes the details of the disease as seen in these patients, and response to corticosteroid and cyclophosphamide therapy, and compares these observations with a Western and an Indian study.
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Affiliation(s)
- Y N Singh
- Department of Medicine, All-India Institute of Medical Sciences, New Delhi
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Saxena S, Verma K, Bhuyan UN, Singh OP, Dash SC. Amyloidosis complicating psoriatic arthropathy. J Assoc Physicians India 1992; 40:609-10. [PMID: 1308018] [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: 12/26/2022]
Affiliation(s)
- S Saxena
- Dept. of Nephrology, AIIMS, New Delhi
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Bhuyan UN, Dash SC, Srivastava RN, Tiwari SC, Malhotra KK. IgA associated glomerulonephritis. J Assoc Physicians India 1992; 40:310-3. [PMID: 1483990] [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: 12/27/2022]
Abstract
Immunohistological analysis of 1146 renal biopsies revealed IgA associated glomerulonephritis (IgAGN) in 83 (7.24%) patients (33 children, 50 adults). Clinical features were unusually severe in a high proportion. Nephrotic syndrome (NS) responding poorly to prednisolone was found in 24%, hypertension (HT) in 39%, and azotemia in 34% of patients. NS was slightly more frequent in children than in adults, but HT and azotemia occurred twice as often in adults as in children. Histologically, extensive glomerular crescents and sclerosis were prominent. In addition, moderate arteriolitis and arteriolosclerosis and marked tubulointerstitial nephropathy were notable features. Thus, a low incidence and marked severity characterized IgAGN in this study.
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Affiliation(s)
- U N Bhuyan
- Department of Pathology, All-India Institute of Medical Sciences, New Delhi
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Malaviya AN, Singh RR, Sindhwani R, Singh YN, Ahujà RK, Bhuyan UN, Khare SD, Kumar A, Malaviya R, Negi PC. Intermittent intravenous pulse cyclophosphamide treatment in systemic lupus erythematosus. Indian J Med Res 1992; 96:101-8. [PMID: 1428048] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
To determine the efficacy and safety of intermittent intravenous pulse cyclophosphamide in patients of severe systemic lupus erythematosus (SLE), 50 patients having severe/refractory lupus nephritis, vasculitis or neuropsychiatric manifestations were treated with 3 weekly pulses of cyclophosphamide for 6 such pulses. This treatment was found to be associated with significant and sustained improvement during a 2 yr follow up with respect to the mean renal activity score, individual renal parameters (proteinuria, erythrocyturia, and serum creatinine levels), focal neurological manifestations, vasculitic lesions, antinuclear antibody titers, complement component C3, anti-dsDNA antibodies levels and ESR. There was a sustained decrease in the overall mean disease activity score, and the mean daily dose of prednisolone (pretreatment 32.62 mg daily to 3.75 mg daily after 24 months). There was a significant decline in the percentage and absolute B cell count after 7, 14 and 21 days of this treatment. Effect on other lymphocyte subsets (CD3+, CD4+ and CD8+) was not marked. Pulse cyclophosphamide could therefore be an effective and less toxic form of treatment in patients with SLE having severe lupus nephritis, focal neurological lesions or vasculitis.
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Affiliation(s)
- A N Malaviya
- Department of Medicine, All India Institute of Medical Sciences, New Delhi
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Abstract
Forty-three children with crescentic glomerulonephritis (GN), having large crescents in more than 50% of the glomeruli, were observed during a period of 22 years. There were 17 boys and 26 girls between the ages of 3.5 and 14 years (mean 8.7 +/- 2.6). Thirty-one patients (72%) presented with acute nephritic features and increasing renal insufficiency (rapidly progressive GN) whereas 12 had an insidious onset with nephrotic syndrome, or rarely with nonspecific symptoms. Eleven patients had evidence of poststreptococcal GN and 6 an underlying systemic disorder. Renal biopsy showed large crescents in greater than 80% of the glomeruli in 38 cases (100% in 28) which were predominantly fibrocellular or fibrous in 80% of the patients. Nineteen patients (44%) were treated with prednisolone, cyclophosphamide and dipyridamole; in addition, 8 were also given anticoagulants. Six patients received pulse doses of corticosteroids. In 23 patients, there was inexorable progression of renal failure, 14 showed partial improvement but subsequently had varying degrees of renal insufficiency and in 6, there was recovery of renal function with normal levels of serum creatinine. Of the latter, 4 had received immunosuppressive anticoagulant therapy and 2 only supportive care. Of 11 patients with poststreptococcal crescentic GN, 7 progressed to end-stage renal disease and 2 developed chronic renal insufficiency. Our findings confirm the poor outcome of crescentic GN in children, irrespective of the underlying etiology. In a small proportion of cases, the disorder may have an insidious onset and a slowly progressive course, but an equally grave prognosis.
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Affiliation(s)
- R N Srivastava
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
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Saxena S, Bhuyan UN, Dash SC. Thin membrane nephropathy. J Assoc Physicians India 1992; 40:49-50. [PMID: 1634467] [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]
Affiliation(s)
- S Saxena
- Department of Nephrology, AIIMS, New Delhi
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Agarwal SK, Dash SC, Mehta SN, Bhuyan UN. Recurrence of idiopathic membranous nephropathy in HLA-identical allograft. Nephron Clin Pract 1992; 60:366. [PMID: 1565192 DOI: 10.1159/000186781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Bagga A, Kabra SK, Srivastava RN, Bhuyan UN. Henoch-Schonlein syndrome in northern Indian children. Indian Pediatr 1991; 28:1153-7. [PMID: 1797667] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In order to evaluate clinical features and renal pathological findings of Henoch-Schonlein syndrome (HSS) in northern Indian Children, we studied 47 such cases. The mean age at onset was 8.5 yr; sex ratio (M:F) 2.6:1. The clinical features were purpuric rash (96%), abdominal pain (64%), Henoch-Schonlein nephritis (51%) and arthralgias (47%). Patients younger than 6 yr also showed urticarial rash or edema of scalp and extremities. Henoch-Schonlein nephritis (HSN) and abdominal symptoms were more common in older cases. The manifestations of HSN were asymptomatic hematuria and/or proteinuria (n = 15), acute nephritic syndrome (n = 6), and nephrotic syndrome (n = 3). The severity of clinical manifestations correlated with the renal pathologic findings. On follow up, 29% cases showed renal impairment. The prognosis was poor in patients with the acute nephritic or nephrotic syndrome and crescents in more than 50% glomeruli. Combination of clinical data and renal biopsy findings are important in assessing the long-term outcome in cases with HSN.
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Affiliation(s)
- A Bagga
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
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Tiwari SC, Agarwal SK, Saxena S, Bajpai V, Bhuyan UN, Dash SC, Malhotra KK. Idiopathic adult minimal change disease. A clinicopathological study and response to therapy. J Assoc Physicians India 1987; 35:756-9. [PMID: 3449510] [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: 01/05/2023]
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Bhuyan UN, Srivastava RN. Incidence & significance of IgM mesangial deposits in relapsing idiopathic nephrotic syndrome of childhood. Indian J Med Res 1987; 86:53-60. [PMID: 3692560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Kaushal R, Dash SC, Kapur S, Bhuyan UN. Wegener's granulomatosis with rapidly progressive glomerulonephritis. J Assoc Physicians India 1987; 35:382-4. [PMID: 3693295] [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: 01/07/2023]
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Chetty A, Bhuyan UN, Mitra DK, Roy S, Deorari A. Cryptogenic fibrosing alveolitis in children. Ann Allergy 1987; 58:336-40. [PMID: 3578926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cryptogenic fibrosing alveolitis (CFA) in children is supposedly a rare diffuse lung disease characterized clinically by tachypnoea, cough, poor weight gain, and cyanosis. Histologically, it is characterized by thickening of alveolar walls and infiltration of the alveolar septae with mononuclear cells and fibrous tissue. The condition is more acute in children, with fulminant course. Ten children were diagnosed as having CFA out of three hundred children seen over a period of 3 years. Diagnosis was established by characteristic clinical findings and laboratory evaluation. All the children had tachypnoea at rest and bilateral crepitations in the absence of fever. Diffuse bilateral persistent irregular shadows were noted on the chest X-ray of these children. Pulmonary function studies revealed a restrictive type of abnormality with low transfer factor for carbon monoxide in six children. Open lung biopsy was done in eight children. The biopsy material was graded according to nine morphologic variables. Administration of steroids early in the course of illness resulted in amelioration of symptoms in 60% of the patients.
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Bhuyan UN, Tiwari SC, Malaviya AN, Kumar A, Dash SC, Malhotra KK, Guleria JS. Clinical and morphological severity of renal involvement in systemic necrotising vasculitides. J Assoc Physicians India 1987; 35:213-7. [PMID: 2886489] [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: 01/03/2023]
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Kothari SS, Tiwari SC, Aggarwal SK, Kumar A, Bhuyan UN, Kumar R. Immunohistology and clinical presentation of mesangioproliferative glomerulonephritis. J Assoc Physicians India 1987; 35:191-4. [PMID: 2956249] [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: 01/03/2023]
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Bhuyan UN, Dash SC, Srivastava RN, Tiwari SC, Malhotra KK. Clinical & morphologic indicators of prognosis in primary IgA nephropathy of children & adults. Indian J Med Res 1986; 84:178-86. [PMID: 3759171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Malaviya AN, Misra R, Banerjee S, Kumar A, Tiwari SC, Bhuyan UN, Malhotra KK, Guleria JS. Systemic lupus erythematosus in North Indian Asians. A prospective analysis of clinical and immunological features. Rheumatol Int 1986; 6:97-101. [PMID: 3489275 DOI: 10.1007/bf00270344] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
One hundred and one patients with systemic lupus erythematosus (SLE) from North Indian stock are presented. The clinical manifestations, laboratory parameters, causes of death, and survival are compared and contrasted with the other major reported series. SLE of North Indian Asians has several features comparable to those reported from the West, but other features are more similar to the SLE seen in Mongoloid races.
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Jain RK, Malaviya AN, Bansal R, Kumar A, Tiwari SC, Bhuyan UN. Cryoglobulins in infective endocarditis: correlation with organ involvement. J Assoc Physicians India 1986; 34:491-3. [PMID: 3759873] [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: 01/07/2023]
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31
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Singh K, Seerharam KA, Pasricha JS, Bhuyan UN. Eosinophilic spongiosis preced by a phase of classical pepmphigus vulgaris. Indian J Dermatol Venereol Leprol 1986; 52:236-238. [PMID: 28150653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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32
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Malhotra KK, Dash SC, Dhawan IK, Bhuyan UN, Gupta A. Tuberculosis and renal transplantation--observations from an endemic area of tuberculosis. Postgrad Med J 1986; 62:359-62. [PMID: 3532083 PMCID: PMC2418707 DOI: 10.1136/pgmj.62.727.359] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Ninety-five renal transplant recipients from an endemic area of tuberculosis were investigated to find out the prevalence and course of tuberculosis in pre- and post-transplant periods. Eleven patients had tuberculosis in the pre-transplant period - pulmonary (2), pleural (2), miliary (1), abdominal (2), lymph node (5) and pericardial (1). They were transplanted after antituberculous therapy of 3 to 6 months with satisfactory results. The anti-tuberculous treatment was usually continued for 2 years. Only one of the above 11 patients had evidence of tuberculosis in the post-transplant period. Nine patients developed tuberculosis for the first time in the post-transplant period - pulmonary (4), pleural (1), miliary (1), lymph node (4) and pericardial (1). There was no mortality due to tuberculosis. Thorough search for tuberculosis is mandatory both during pre-transplant assessment and post-transplant follow-up in areas of endemic tuberculosis.
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Abstract
Corticosteroid resistance appeared late in the course of relapsing nephrotic syndrome in 12 patients who previously had steroid-sensitive relapses for 0.8 to 13 years. In 11 patients, renal histology performed earlier in the course of the disease showed minimal change in eight, mesangial proliferative glomerulonephritis (MesPGN) in two, and focal segmental glomerulosclerosis (FSGS) in one. Renal biopsy in another patient and a repeat procedure in four of eight patients who initially showed minimal change was done after they had developed steroid resistance, and showed FSGS. Cyclophosphamide was given to 11 patients after they became steroid resistant, and induced remission in eight that continued for 1 to 2 years in two patients. The other six had relapses that were steroid sensitive, but three of them (two with FSGS and one with MesPGN) later became resistant to steroids as well as to cyclophosphamide. Of six patients with FSGS, four with initial or subsequent resistance to cyclophosphamide eventually developed renal insufficiency. The other two have remained in remission for 12 to 16 years; one of these did not receive cyclophosphamide. Our observations suggest that patients with late steroid resistance comprise a heterogeneous group; those with FSGS and resistance to cyclophosphamide therapy may have a poor outcome.
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Bhuyan UN, Tiwari SC, Malaviya AN, Srivastava RN, Dash SC, Malhotra KK. Immunopathology & prognosis in Henoch-Schonlein glomerulonephritis. Indian J Med Res 1986; 83:33-40. [PMID: 3699866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Sundar AS, Malhotra KK, Bhuyan UN, Tiwari SC, Malaviya AN. Kidney in progressive systemic sclerosis. Indian J Med Res 1985; 82:534-9. [PMID: 3833705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Sharma RK, Malhotra KK, Bhuyan UN, Dash SC, Kumar R, Dhawan IK. Infections in renal transplant recipients. J Assoc Physicians India 1985; 33:757, 759, 761. [PMID: 3915498] [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: 01/08/2023]
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Kumar A, Malaviya AN, Bhat A, Misra R, Banerjee S, Sindhwani R, Tiwari SC, Bhuyan UN, Guleria JS. Clinicopathological profile of vasculitides in India. J Assoc Physicians India 1985; 33:694-8. [PMID: 4093380] [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: 01/08/2023]
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Srivastava RN, Agarwal RK, Choudhry VP, Moudgil A, Bhuyan UN, Sunderam KR. Cyclophosphamide therapy in frequently relapsing nephrotic syndrome with and without steroid dependence. Int J Pediatr Nephrol 1985; 6:245-50. [PMID: 4093243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
An 8-week therapy with cyclophosphamide (CP) and alternate-day prednisone was given to 65 patients having steroid-sensitive, frequently relapsing nephrotic syndrome, including 17 with steroid dependence. It induced remissions of less than 6 months in 18 patients, 6 to 36 months in 21 and over 3 years in 26. Considering a remission of 6 months as significant, certain clinical variables were compared in patients without such a response with those getting longer remissions. In the group with frequent relapses a higher proportion of patients aged above 8 years had remissions of over 6 months as well as over 3 years, than those who were younger at CP therapy. Among patients with frequent relapses as well as those with steroid dependence, a post-CP remission of more than 6 months was associated with a better long-term course. The response to CP in both groups was similar regarding the duration of remissions, but a greater proportion of steroid-dependent patients subsequently again showed steroid dependence or frequent relapses. Our findings suggest that a higher age at CP therapy and an ensuing remission of over 6 months are predictors of a better response, and steroid dependence of a less favorable outcome.
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Seth V, Rohatagi M, Bhuyan UN, Sundaram KR, Nath N. Tuberculous cervical lymphadenitis in children as a relatively immune competent state. Indian J Med Res 1985; 81:364-71. [PMID: 3874827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Bhuyan UN, Srivastava RN, Choudhry VP. Pathology of acute renal failure & haemolytic uraemic syndrome in acute dysentery in children. Indian J Med Res 1985; 81:402-8. [PMID: 4018868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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41
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Malaviya AN, Banerjee S, Misra RN, Kaul R, Bhuyan UN. Antinuclear antibody and rheumatoid factor estimations in the diagnosis of rheumatic diseases in northern India. Asian Pac J Allergy Immunol 1984; 2:232-6. [PMID: 6335834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Malhotra KK, Saraswat VA, Basu AK, Bhuyan UN, Bhargava S. Renal osteodystrophy in renal transplant recipients. J Assoc Physicians India 1984; 32:867-71. [PMID: 6394582] [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: 01/20/2023]
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Abstract
Two patients presented with the nephrotic syndrome complicating non-specific aorto-arteritis (Takayasu's arteritis). Histologically both had renal amyloidosis. On investigation there was no evidence of chronic infection or any immuno-inflammatory disease known to be associated with amyloidosis. These cases raise the possibility of a significant association between aorto-arteritis of the Takayasu type and systemic amyloidosis.
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Bhuyan UN, Srivastava RN, Dash SC, Malhotra KK. Severity of nephropathy & steroid resistance in focal segmental glomerulosclerosis. Indian J Med Res 1984; 79:657-65. [PMID: 6511002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Malaviya AN, Khan KM, Tiwari SC, Bhuyan UN. Systemic connective disease in India. VII. Deaths in systemic lupus erythematosus. J Assoc Physicians India 1984; 32:313-6. [PMID: 6746537] [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: 01/21/2023]
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46
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Bhuyan UN, Dash SC, Srikanta S, Malaviya AN, Malhotra KK. Occurrence of glomerulonephritis and autoantibodies in diabetes mellitus. J Assoc Physicians India 1984; 32:171-5. [PMID: 6235208] [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: 01/19/2023]
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47
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Mittal VK, Malhotra KK, Bhuyan UN, Malaviya AN. Kidney involvement in seronegative spondarthritides. Indian J Med Res 1983; 78:670-5. [PMID: 6231247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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48
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Bhuyan UN, Malaviya AN, Dash SC, Malhotra KK. Prognostic significance of renal angiitis in systemic lupus erythematosus (SLE). Clin Nephrol 1983; 20:109-13. [PMID: 6354537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Analysis of 80 cases of SLE with renal involvement revealed the following. Angiitis involving arterioles and interlobular arteries was observed in 17 out of 42 cases with diffuse proliferative lupus GN. This was not observed in other types of lupus GN. Out of 17 cases of angiitis, 7 were complicated by thrombosis. Irregular deposits of immunoglobulins and complement were demonstrated in the vessel walls and in luminal thrombi and suggested an immune-complex origin. Fibrinogen was also demonstrable frequently. The vascular lesions were associated with severe glomerular and tubulointerstitial injury and a poor prognosis. A relatively favorable outcome was observed in SLE without renal angiitis.
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Malhotra KK, Sharma RK, Prabhakar S, Bhargava S, Bhuyan UN, Dhawan IK, Kumar R, Dash SC. Aortoarteritis as a major cause of renovascular hypertension in the young. Indian J Med Res 1983; 77:487-94. [PMID: 6874039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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50
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Srikanta S, Malaviya AN, Rajagopalan P, Bhuyan UN, Ahuja MM. Association of type I (insulin-dependent) diabetes mellitus, autoimmunity, antinuclear antibody, and membranoproliferative glomerulonephritis. Diabetes Care 1983; 6:71-4. [PMID: 6220878 DOI: 10.2337/diacare.6.1.71] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In a large series of patients with insulin-dependent diabetes mellitus who were screened for autoantibodies, two patients were positive for antinuclear antibodies. Both of these patients developed severe renal disease with the renal biopsy findings of membranoproliferative glomerulonephritis. Multiple autoantibodies and circulating immune complexes were demonstrated in their sera. There was evidence suggesting complement consumption. This article illustrates that immune complex glomerulonephritis can occur in some patients with IDDM, particularly in those with antinuclear antibody and polyendocrine involvement, and that renal biopsy in such cases may have prognostic and therapeutic importance.
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