Resumo A identificação precoce da doença renal pode proteger a saúde dos rins, prevenir a progressão da doença e complicações relacionadas, reduzir o risco de doenças cardiovasculares e diminuir a mortalidade. Devemos questionar “Seus rins estão saudáveis?” utilizando creatinina sérica para estimar a função renal e albumina urinária para avaliar lesões renais e endoteliais. A avaliação das causas e dos fatores de risco para a doença renal crônica (DRC) inclui testes para diabetes e medição da pressão arterial e do índice de massa corporal. Neste Dia Mundial do Rim, enfatizamos que a detecção de casos em populações de alto risco, ou mesmo a triagem em nível populacional, pode reduzir o ônus da doença renal globalmente. A DRC em estágio inicial é assintomática, facilmente diagnosticável e os recentes tratamentos, que representam uma mudança de paradigma, como inibidores do cotransportador de sódio-glicose tipo 2, promovem uma melhora significativa nos desfechos da doença e favorecem a análise custo-benefício para programas de triagem ou detecção de casos. Apesar disso, existem diversos obstáculos, incluindo a alocação de recursos, o financiamento da saúde, a infraestrutura dos serviços de saúde e a conscientização sobre a doença renal entre profissionais da saúde e a população em geral. Esforços coordenados pelas principais organizações não governamentais dedicadas a doenças renais, com o objetivo de priorizar a agenda de saúde renal junto aos governos e alinhar as iniciativas de detecção precoce com outros programas atuais, irão maximizar a eficiência.
Maharashtra is India’s third largest, second-most populous state, and its economic and financial hub. Nephrology is a progressive medical specialty in Maharashtra, continuing the legacy of early pioneering ventures from the country. Strong professional networks, state-of-the-art infrastructure, specialized diagnostics, affordable cost models for hemodialysis, easy access and consistent performance in kidney transplantation, state funding, and community involvement are the key strengths of nephrology in Maharashtra. The state has top-tier hospitals and medical colleges, making it a preferred destination for healthcare and medical education. This article describes the current state of nephrology services in Maharashtra.
IgAN is a major cause of end-stage kidney disease (ESKD) leading to kidney transplantation in a significant proportion of patients. However, its recurrence in transplanted kidneys can lead to graft loss. The rate of graft loss attributable to IgAN after transplantation is variably reported in different retrospective cohorts. Previous reports describe recurrence rates of 22-58% with a 1.3% to 16% rate of graft loss. Accurate diagnosis and prediction of graft loss are important for planning effective therapies to improve graft survival in IgAN post transplantation. The Oxford classification using MEST and MEST-C in native kidney disease IgAN has been established for well over a decade. We propose investigating if this classification system can be applied to kidney allografts to standardize the categorization of transplant IgAN. More importantly, successful use of this classification could assist in selecting patients for prospective interventional trials and defining better treatments. In this literature review, we explore the available literature on the Oxford classification and its utility in describing the disease and predicting graft loss in IgA nephropathy within the context of kidney transplantation.
Background: Low dose of pegylated erythropoietin (PegEPO) is better than conventional erythropoietin stimulating agents (ESAs) in improving hyporesponsiveness and maintaining stable haemoglobin (Hb) levels in renal anaemic patients undergoing hemodialysis. This real-world study aimed to assess effectiveness and safety of low-dose PegEPO (30 µg/0.3 mL), administered at different time-points in renal anaemia patients on dialysis. Methods: HEMEPEG (HEMoglobin outcomE with PegEPO) was a multicentre, retrospective, cross-sectional, observational study of renal anaemia patients receiving PegEPO up to 3 months. The study assessed an increase in Hb, patients achieving Hb 10-12 g/dl, and Hb increase by ≥1 and ≥2 g/dl. Results: Data from 223 out of 273 patients from 19 Indian centers were analyzed. PegEPO was administered weekly to 132 patients (59.19%), with 38.64% being diabetic and 77.27% previously treated with ESAs. Ten day dosing was given to 91 patients (40.81%), including 46.15% diabetic patients and 72.53% previously treated with ESAs. A Significant (p<0.0001) increase in mean Hb levels from baseline to day 30, 60 and 90 were observed for both studied groups, with a target Hb of 10-12 g/dl achieved in 51.08% and 52.85% of patients in the respective groups after 3 months. An increase in Hb by ≥1 and ≥2 g/dl were observed in weekly (68.67% and 45.78%) and 10-day group (77.14% and 50.00%) patients, respectively. Conclusions: PegEPO (30 µg/0.3 mL) was effective treatment of renal anaemia and diabetic chronic kidney disease (CKD) patients on dialysis when administered weekly or every 10 days over a 3-month treatment period.
Background. COVID-19-associated mucormycosis (CAM) is a recently emerging entity. There is a lack of reports of CAM in organ transplant recipients. Methods. We conducted a multicenter (n = 18) retrospective research in India during November 2020 to July 2021. The purpose of this study was to explore the clinical spectrum, outcome and risk factors for mortality of CAM in kidney transplant recipients (KTRs). Results. The incidence of CAM was 4.4% (61/1382 COVID-19-positive KTRs) with 26.2% mortality. The median age of the cohort was 45 (38–54) y. Twenty (32%) were not hospitalized and 14 (22.9%) were on room air during COVID-19. The proportion of postdischarge CAM was 59.1%, while concurrent CAM was reported in 40.9%. The presentation of CAM was 91.8% rhino-orbital-cerebral mucormycosis and 8.2% pulmonary with 19.6% and 100% mortality, respectively. In the univariable analysis, older age, obesity, difficulty of breathing, high-flow oxygen requirement, and delay in starting therapy were significantly associated with mortality. In the multivariable logistic regression analysis, patients requiring high-flow oxygen therapy [odds ratio (95% confidence interval) = 9.3 (1.6-51); P = 0.01] and obesity [odds ratio (95% confidence interval) = 5.2 (1-28); P = 0.05] was associated with mortality. The median follow-up of the study was 60 (35–60) d. Conclusions. We describe the largest case series of CAM in KTRs. Morality in pulmonary CAM is extremely high. Severe COVID-19 pose extra risk for the development of CAM and associated mortality. Our report will help in better understanding the conundrum and management of CAM.
