Open Access Case Study

IgA Vasculitis in a Patient on Dialysis

Deepak Kumar Chitralli, Brian Mark Churchill, Pallavi Patri, Divya Puttegowda

Asian Journal of Research in Nephrology, Page 17-23

Immunoglobulin A vasculitis (IgA Vasculitis), formerly called Henoch Schonlein Purpura (HSP) is a common systemic vasculitis in children. It is 33 times less common in adults than in children. Besides having dermatology manifestations in form of rash, it may affect other organs including kidney (nephritis that can lead to chronic kidney disease), arthritis, arthralgia, abdominal pain, bowel angina and gastrointestinal bleeding.

IgA vasculitis may result in IgA vasculitis nephritis (formerly called HSP nephritis). It shares a lot of similarities with IgA nephropathy, but has some notable differences as discussed later.

IgA vasculitis is rare in chronic kidney disease (CKD) patients on dialysis. We present a case of IgA vasculitis in an elderly male with end stage renal disease (ESRD) presumed to be due to diabetic nephropathy (kidney biopsy not available). He developed skin manifestations (rash). Skin biopsy confirmed the presence of IgA vasculitis.

Open Access Original Research Article

Hepatotoxicity in the Liver of Wistar Rats Administered with a Combination of Tramadol and Rophynol

E. U. Eric, E. F. Eruvwahwe, V. E. Ohwodo, S. B. Izein

Asian Journal of Research in Nephrology, Page 1-8

Objectives: The objective of this research was to investigate the histopathological effects of combined oral administration of Tramadol and Rohypnol on the liver and kidney of adult Wistar rats.

Materials: Thirty two (32) adult Wister rats weighing 120 ± 20 g - 180 ±30 g comprising sixteen (16) males and sixteen (16) females were procured from the animal house of the Department of Pharmacology, College of Health Sciences Niger Delta University, Bayelsa state. Nigeria, assigned into four (4) major groups with four male, 4 females animals in each group after the period of acclimatization: a control group "A" and three test groups (B, C and D), Group A (control), test Groups B:Tramadol only. Group C: Rohypnol only. Group D received a combined oral dose of Tramadol and Rohypnol. At the end of the treatment, the liver and the kidney of each sacrificed rat were processed for paraffin sectioning and stained with Harris hematoxylin and eosin.

Results: Photomicrograph of Groups B, C and D show moderate inflammatory cells and obliteration of the central vein which are features of hepatic injury.

Conclusion: The present study concluded that oral combination of Tramadol and Rohypnol induces hepatoxicity and inflammation of the liver but produces no effect on the kidney at the dose and time.

Open Access Original Research Article

Ascorbic Acid: A Prophylaxis Drug Therapy for Depression in Female Dam Rats

Himesh Soni, Richa Swarnkar, Jitender K. Malik

Asian Journal of Research in Nephrology, Page 9-16

Ascorbic acid is extremely concentrated in the brain, being considered as a neuro-modulator. This vitamin possesses antioxidant properties due to its action either as an electron donor or as broad-spectrum radical scavenge. Maternal separation is used in a large number of studies on anti-depression. The present study demonstrates the long-term effect of ascorbic acid (10 mg/kg p.o) on maternal separation (MS) by isolation stress on the emotionality behaviour of female dam rats. The assessment of the 5-HT level in brain was analysed by HPLC, which revealed increased level of 5-HT when compared with control. Locomotor activity and FST showed that there were increased in % swimming & % climbing. Therefore, present finding relevance of ascorbic acid for the treatment of depression and as a co-adjuvant treatment with antidepressants.

Open Access Original Research Article

Feasibility and Hemodynamic Tolerability of Sustained Low- Efficiency Dialysis in Critically Ill Patients with Acute Kidney Injury

Midhun Ramesh, Satish Balan, Praveen Murlidharan

Asian Journal of Research in Nephrology, Page 24-32

Introduction: AKI is a common complication of critical illness. Management of AKI may require the initiation of RRT to correct metabolic and fluid derangements. CRRT does have some advantages over conventional intermittent dialysis in critical care settings. The main disadvantage of CRRT is its exorbitant cost. SLED is a hybrid technique between CRRT and IHD, done using conventional HD machines and dialyzers.

Materials and Methods: The primary objective of the study was to determine the hemodynamic tolerability & feasibility of SLED in critically ill patients with AKI. All patients admitted to the ICU; who was started on SLED was included in this study. Data on demographic information, pre-dialysis Biochemical & Hematological parameters were collected. BP and vasopressor requirements during the SLED sessions were recorded. Survival predictors were described using a SOFA score at the time of initiation of the first SLED session.

Results: 427 SLED sessions were conducted in 148 patients. Two patients suffered from cardiac arrest during the SLED session. There was an increased requirement of inotropic support in 56 sessions which was labeled as a hemodynamically unstable session. Hypotension refractory to inotropic medication, requiring SLED discontinuation occurred in 14 sessions. 97.7% of the prescribed duration of treatment and 89.07% of the ultrafiltration goal was achieved with SLED in this study.

Conclusion: SLED is a well-tolerated, feasible, cost-effective RRT modality in resource-limited settings for critically ill patients with AKI.

Open Access Original Research Article

Vascular and Valvular Calcification in Diabetic Patients with or without CKD

Deepak Kumar Chitralli, Brian Mark Churchill

Asian Journal of Research in Nephrology, Page 33-41

Introduction: Chronic kidney disease (CKD) is associated with atherosclerosis, heart failure, valvular heart disease, arrhythmia, cardiovascular calcification, and sudden cardiac death. The calcification of the cardiovascular system increases as CKD progresses and is associated with increased morbidity and mortality.

This study was undertaken to assess vascular calcification and its risk factors in diabetics with early CKD.

Methods: This is a prospective, observational study. Data analysis of the outcomes was done by SPSS-17 version. Patients were enrolled from the nephrology out-patient/ in-patient department at St Johns Medical College hospital, Bangalore. Patients were studied between July 2010 to July 2012 for a period of 2 years.

Study Population: The study population included 60 diabetic patientswere divided into 2 groups (Group A- diabetic patients with normal renal functions; Group B- diabetic patients with CKD) in 1:1 ratio after matching the age, duration of diabetes and history of smoking.

Results: In this study we observed that vascular and valvular calcification were significantly higher in the Group B (diabetics with CKD) as compared to Group A (diabetics with normal renal functions).

Higher serum phosphorous levels and lower mean eGFR levels showed significant correlation with vascular calcification in Group B.

A significant correlation was found between lower mean eGFR levels and vascular calcification in Group B. Also, correlation was found to be significant between vascular calcification and valvular calcification in Group B.