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   Table of Contents - Current issue
Coverpage
January-March 2021
Volume 7 | Issue 1
Page Nos. 1-29

Online since Thursday, October 21, 2021

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EDITORIAL  

Ethics, justice, and statement of principles: Paving the way to newer living p. 1
Anita Saxena
DOI:10.4103/jrnm.jrnm_16_21  
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REVIEW ARTICLE Top

Ethics in organ transplantation p. 5
Manjusha Yadla
DOI:10.4103/jrnm.jrnm_4_21  
Role of ethics in organ transplantation has been increasing with increasing number of organ transplants. Doing an ethical transplantation is of crucial importance. It is the liability of transplant team to follow the international and national ethical standards. Often, it is perceived that ethical and legal issues are the same. With the introduction of various ethical guidelines by international community, it is prudent that transplant team and the public abide by the existing regulations to avoid unanticipated outcomes of a successful transplant. Transplantation activity should be carried out with the premise that it is within the legal and ethical perspectives of that particular country. Transnational or transcontinental understanding of ethical perspectives by the nations actively involved in organ transplantation would definitely curb unethical and illegal elements.
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ORIGINAL ARTICLES Top

Micronutrients in hemodialysis patients: A single-center study p. 12
Anil Kumar Bhalla, Vaibhav Tiwari, Anurag Gupta, Vinant Bhargawa, Manish Malik, Ashwani Gupta, Devinder Singh Rana
DOI:10.4103/jrnm.jrnm_13_21  
Introduction: In end-stage chronic kidney disease, nephrologists must consider the homeostasis of the multiple water-soluble ions and vitamins that are influenced by renal replacement therapy. While certain ions such as potassium and calcium are closely monitored, little is known about the handling of trace elements and vitamins in the dialysis population. Material and Methods: This was a single-centered, observational, retrospective, cross-sectional study to analyze the serum levels of clinically relevant vitamins (Vitamin D, Vitamin B12, folate) and microelements (iron, zinc) among maintenance hemodialysis (MHD) patients during June 2020–June 2021. Results: Two hundred and twenty-five patients on MHD were included in the study. The mean age was 54 years. Diabetic kidney disease (32%) was the most common basic kidney disease. The majority of patients (76%) were undergoing twice-weekly MHD. Iron was the most deficient microelement among MHD patients (64%). Vitamin D was deficient in 85% of the population. Mean zinc levels were 90 ± 18 with 19% of the patients having low zinc levels. Vitamin B12 and folate were deficient in 3% and 5% of patients, respectively. However, 40% and 32% of the patients had levels of Vitamin B12 and folate above the measurable limit. There was no association of deficient micronutrients and age, sex, and dialysis frequency. Conclusion: Iron and zinc are mostly deficient among MHD patients. Vitamin supplements should be carefully prescribed as the majority of patients had an excess of Vitamin B12 and folate rather than deficiency.
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COVID-19 viral clearance patterns in patients with kidney disease: Study from tertiary care in South India p. 16
Manjusha Yadla, KV Anupama, Tauseef Ahmed
DOI:10.4103/jrnm.jrnm_2_21  
Aim: The aim of this study was to analyze the viral clearance patterns in COVID-positive patients with kidney disease. Patients and Methodology: This is a single-center observational study with demographic and clinical details of all the patients with renal insufficiency referred for COVID infection management. Results: Of total admissions of 250 patients with renal insufficiency, data were analyzed in those who were discharged from the hospital. Of 250 patients, 108 died and the data of 142 patients were analyzed. The mean duration of viral clearance was 27.5 days, with a range being <3 weeks to 45 days. The mean number of days for viral clearance in acute kidney injury (AKI) was 22.5 days, chronic kidney disease (CKD)-5D was 25.2 days and in transplant recipients 23.4 days. The maximum number of patients cleared the virus in the 4th week and near-complete viral was achieved by the end of the 6th week. Factors such as age, type of renal insufficiency such as AKI/CKD, presence of comorbidities like diabetes, severity of COVID disease, and presence of multiorgan involvement were not associated with viral clearance. Conclusion: In patients with kidney disease, weekly viral clearance was maximum in the 4th week. Moreover, cumulative viral clearance was 99% by the end of the 6th week.
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Epidemiology and outcomes of community-acquired-acute kidney injury in women: A study from tertiary care center in South India p. 21
Pradeep Khandavali, Manjusha Yadla
DOI:10.4103/jrnm.jrnm_3_21  
Introduction: Acute kidney injury (AKI) is sudden deterioration in kidney function for few days to weeks with or without kidney damage. Risk factors for AKI are diabetes, hypertension, pre-existing chronic kidney disease (CKD), and advanced age. Apart from the traditional risk factors, K-DOQI mentions the female gender as susceptibility factor for the development of AKI. Although it is well known that certain hospital-acquired causes of AKI such as contrast-induced nephropathy, aminoglycoside toxicity, care common in women, community acquired etiology is not well studied. Hence, we undertook this study to analyze community-acquired (CA)-AKI in women and their outcomes. Aim: The aim is to study the epidemiology and outcome of AKI in women. Material and Methods: A retrospective analysis of medical records of patients admitted with the diagnosis of AKI during the calendar year of 2018 was done. Data were collected from the computer system of the Aarogasree scheme, a flagship scheme of the Government providing cashless health services to the below poverty line patients. Under this, Code 6 is for Nephrology, 6.1 is for AKI. Demographic data, investigations, hospital stay, and treatment details are entered into the system. Patients with the final diagnosis of Acute on CKD and chronic dialysis were excluded. Age, gender, etiology, management, and the association between treatment and outcome were analyzed using descriptive statistics, and Chi-square test. The primary outcome analyzed was mortality. The secondary outcome in the form of geographical predisposition for the development of specific causes of AKI was also analyzed. Telangana State is divided into seven Zones geographically. We tried to analyze etiology and outcomes of AKI in these individual Zones. Results: A total of 390 patients were admitted with AKI as the presenting diagnosis to the female nephrology ward and intensive care unit (ICU) in our hospital. Out of 390 patients, 180 patients were excluded from the study. 210 patients were included in the study. The mean age of patients is 46.9 ± 16.2 years. Oliguria was presenting complaints in 33.8% and fever in 25.2% of patients with AKI. Febrile illness (22%) and acute gastroenteritis (15%) were major causes of AKI, followed by carcinoma cervix (14%) and PR-AKI (10%). Around one-third of patients belong to Zone 6 of Telangana state. The intrinsic renal cause was found to be the predominant cause of AKI in all zones except Zone 5 and Zone 7. Mortality was found to be highest (25%) in zone 4 followed by zone 2 (17.6%). The lowest mortality was found in Zone 1 and Zone NA (0%). No statistical significance was found for outcomes between those admitted to ICU and ward. The presence of diabetes (P = 0.53) or hypertension (P = 0.47) was not associated with increased mortality. Conclusion: Oliguria and fever are common clinical presentations of AKI in women. Febrile illness and acute gastroenteritis are the most common causes of AKI in women. Intrinsic renal cause for AKI was found to be common in all zones of Telangana state except Zone 5 and Zone 7 where post renal cause for AKI was predominant. Zone 4 and Zone 2 which are far from Zone 6 had the highest mortality. Neither diabetes mellitus nor hypertension was associated with increased mortality.
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CLASSROOM READING Top

Disentangling dysbiosis in chronic kidney disease p. 26
Anita Timmy Saxena
DOI:10.4103/jrnm.jrnm_14_21  
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