Plasma exchange (PLEX) improves survival in acute liver failure (ALF); however, there is no study specifically analyzing its utility in hepatitis A virus-related ALF (HAV-ALF). A few reports suggest that ALF patients who are not on inotropes tolerate PLEX better. We aimed at comparing the efficacy of PLEX and of standard medical treatment (SMT) to treat HAV-ALF. We retrospectively compared consecutive HAV-ALF patients treated with PLEX (2018–2024) vs. SMT (2011–2024) at 13 centers across India. We compared in-hospital native liver survival in both groups. In the subset of patients not on inotropes, we compared survival and assessed predictors of poor outcome in PLEX and SMT groups. Eighty-four HAV-ALF patients in PLEX group (61 males; age = 23.5 [21–33] years, median [IQR]; King’s College Criteria [KCC] fulfilled = 22 patients, 26.2
Introduction: Chronic kidney disease (CKD) is a global health burden, often progressing to end-stage renal disease (ESRD). Identifying the underlying etiology is vital for implementing disease-specific therapy. Renal biopsy remains the gold standard for definitive diagnosis and prognosis in CKD. The aim of this study was to evaluate the clinicopathological spectrum and prognostic outcomes of kidney biopsy in CKD patients and assess its impact on diagnosis-driven treatment decisions. Materials and Methods: A prospective study was conducted at Jawaharlal Nehru Medical College, Aligarh, from July 2021 to December 2022, involving 102 CKD patients who met the clinical indications for renal biopsy. Patients were followed for 2 years after the biopsy. Baseline demographic, clinical, and laboratory parameters were recorded. Renal histopathology, postbiopsy treatment modifications, and clinical outcomes, including changes in estimated glomerular filtration rate (eGFR) and progression to ESRD, were analyzed. A nonbiopsy control group (n = 46) was also followed for comparison. Results: Among 102 biopsied patients, primary glomerular diseases were most common (53.9%), with immunoglobulin A nephropathy (IgAN; 20.6%) being the predominant diagnosis. Secondary causes (28.4%) included amyloidosis (9.8%) and lupus nephritis (4.9%). Biopsy results led to a change in treatment in a significant proportion, resulting in improved renal function over the next 2 years. The mean eGFR improved from 47.2 to 58.3 ml/min/1.73 m2 in the biopsy group, while it declined from 49.3 to 37.8 ml/min/1.73 m2 in the nonbiopsy group (P < 0.001). Multivariate analysis identified high baseline proteinuria, IgAN, and diffuse glomerulosclerosis as independent predictors of poor prognosis in the biopsy cohort. Postbiopsy complication rates were low and manageable. Conclusion: Kidney biopsy in CKD patients provides essential diagnostic and prognostic information, enabling tailored therapy that significantly improves renal outcomes. Routine consideration of biopsy in selected CKD patients may help slow disease progression and reduce the incidence of ESRD.
