RESUMEN

An elderly male renal allograft recipient presented with thrombocytopenia. He had a kidney transplant for diabetic kidney disease and was on azathioprine and prednisolone. He had taken Cissus quadrangularis capsules for backache. A bone marrow aspiration to evaluate the cause of thrombocytopenia showed megakaryocyte hyperplasia, suggesting peripheral destruction. Repeat platelet counts after stopping Cissus quadrangularis showed normal levels.

Asunto(s)

Cissus/efectos adversos , Trasplante de Riñón , Megacariocitos/efectos de los fármacos , Extractos Vegetales/efectos adversos , Trombocitopenia/inducido químicamente , Anciano , Humanos , Hiperplasia , Masculino , Megacariocitos/patología , Recuento de Plaquetas , Trombocitopenia/sangre , Trombocitopenia/diagnóstico , Resultado del Tratamiento

RESUMEN

We studied the dialysis practice-patterns with regard to various aspects of chronic kidney disease (CKD) stage 5D, like anemia, mineral bone disease, vaccination, hospitalization, hypertension and cost of therapy. Four hundred and sixty-four adult hemodialysis (HD) patients from various dialysis centers of Mumbai were included in the study. The mean age of the study patients was 47.2 years. Temporary dialysis catheters were the most common initial vascular access. Thirteen percent of prevalent HD patients were on temporary catheters; 33% of patients had history of failure of arterio-venous fistula. The most common cause of failure was access thrombosis. About 75% of the patients had hemoglobin <11 g/dL and 35% had uncontrolled blood pressure. The prevalence of positive hepatitis B surface antigen and anti-hepatitis C virus antibody was 6% and 2%, respectively. The average cost of HD treatment was approximately 6100 Indian rupees (about US $100). HD is helpful in treating many of the clinical manifestations of CKD and postpones otherwise imminent death. However, dialysis treatment is no panacea to renal failure; HD patients have higher hospitalization rates and lower quality of life than the general population. The therapy itself brings with it a unique set of problems, such as vascular access-related complications, which cause significant mortality and morbidity. This study was a study of the current HD practices. The primary goal of this cross-sectional observational study is to understand dialysis practices and obtain data that can be used to improve care in the future.

Asunto(s)

Pautas de la Práctica en Medicina/tendencias , Diálisis Renal/tendencias , Insuficiencia Renal Crónica/terapia , Derivación Arteriovenosa Quirúrgica/tendencias , Cateterismo Venoso Central/tendencias , Comorbilidad , Estudios Transversales , Femenino , Costos de Hospital/tendencias , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/economía , Prevalencia , Diálisis Renal/efectos adversos , Diálisis Renal/economía , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/economía , Insuficiencia Renal Crónica/epidemiología , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

BACKGROUND: Epidemiology of minimal-change disease (MCD) in adults differs from that in children and is not studied well in Indian population. METHODS: We retrospectively studied the records of 61 adult patients with MCD to assess clinical, laboratory and histopathological features, and to evaluate the response to treatment, course and complications of the disease and therapy. RESULTS: The male to female ratio was 1.17:1. Mean age was 30.46 years. Of the total, 6.55% had hypertension; 13.11% had microhaematuria. After initial treatment with steroids, 68.85% had complete remission (CR) and 13.1% had partial remission (PR). Twelve of 14 (85.71%) steroid-resistant cases had CR or PR after alternative immunosuppression with cyclophosphamide, or mycophenolate mofetil. Of all patients, 44.2% had at least one relapse; 8.19% were frequently relapsing and 26.22% were steroid dependent. After a mean follow-up of 149.9 weeks, 38 (61.29%) patients were in CR and 16 (26.22%) in PR with a mean proteinuria of 1.28 g/day, 3 being treated for relapse. Mean serum creatinine was 89.28 µmol/L (1.01 mg/dL). Fourteen (22.95%) had acute kidney injury (AKI). All but two recovered completely. CONCLUSIONS: This single-centre study with a medium-term follow-up shows that majority of patients respond to steroids or alternative immunosuppressants. AKI is common and may not be completely reversible in some cases.