Background The ISKDC classification for IgA vasculitis and nephritis (IgAVN) does not include markers of chronicity, and crescents—a key feature—do not reliably predict renal outcomes. Recent evidence suggests the updated Oxford classification for IgA nephropathy may offer improved prognostic value. This study aimed to compare clinical, laboratory, and histological features between adult and pediatric patients with IgAVN, categorize IgAVN renal biopsies using the updated Oxford classification and correlate clinical/laboratory data with both ISKDC and Oxford classification systems. Materials and Methods This retrospective study spanned 11 years and included IgAVN cases with at least 8 glomeruli per biopsy. Clinical and histopathological records were retrieved and analyzed. Cases were scored according to the updated Oxford classification of IgA nephropathy and the ISKDC classification for IgAVN. Results The study included 59 adults and children with IgAVN. ISKDC grade distribution was: I (3%), II (47%), III (38.9%), IV (8.4%), VI (1.6%). Biopsy MEST-C scores were: M1 (44%), E1 (61%), S1 (18.6%), T1 (8.4%), T2 (1.6%), C1 (35.5%), C2 (11.8%). Markers of chronicity (glomerulosclerosis, tubular atrophy, interstitial fibrosis), mean creatinine, and eGFR were significantly more altered in adults. In the Oxford system, creatinine at presentation correlated with the T score, and active sediments with the M score. No clinical or laboratory parameters correlated with ISKDC grade. At final follow-up, 97.3% of patients achieved remission. Conclusion The updated Oxford classification correlates more strongly with laboratory findings at presentation across age groups than the ISKDC classification. Long-term follow-up is necessary to evaluate its clinical utility.
Background Chronic kidney disease (CKD) is a major healthcare challenge in India. Expansion of dialysis services without a functional registry leaves a critical gap in patient outcome data. Material and Methods This study evaluated the outcomes of a diverse cohort of patients undergoing maintenance hemodialysis (HD) treated at Apex Kidney Care (AKC), a major Indian dialysis service provider. A cohort of 24,775 patients receiving HD for >90 days between August 2008 and April 2025, at 288 centers across 16 states, was included. HD vintage was calculated from Day 0 and excluded patients who died or exited before Day 90. The primary outcome was patient survival, and factors affecting this were evaluated. Results Patient survival was 87.7% (95% CI, 87–88%) at 1 year and 58.2% (95% CI, 57–59%) at 5 years. The 5-year survival declined with advancing age: <45 years, 73% (95% CI, 72–75); 45–65 years, 61% (95% CI, 59–62); >65 years, 45% (95% CI, 42–49) ( p <0.001). Patients with diabetes formed 39.2% of the cohort and had lower age-adjusted 5-year survival (65% [95% CI 62–67]) compared to the rest (74% [95% CI 73-75], p <0.001). A multivariable Cox proportional hazards (PH) model indicated a 15% higher mortality for females ( p <0.001). Five-year survival was significantly higher for patients receiving >3 dialysis sessions weekly (81%) compared to those receiving <2 sessions (65%). Survival varied by center type (private 79%, public 72%), but center category was not a significant predictor in multivariable analysis ( p = 0.6 ). Conclusion This study establishes long-term survival outcomes for patients on HD in India, Frequency of dialysis emerged as the main dialysis-related factor associated with survival.
Background Chronic kidney disease (CKD) is related to the development and progression of diabetic foot ulcers (DFU). The aim was to assess the relationship between the International Working Group on Diabetic Foot (IWGDF) podiatric risk (PR) score and kidney function based on KDIGO among people with type 2 diabetes (T2D) in the Indian context. Materials and Methods In this cross-sectional observational study, data from 5,972 participants from 2022–2025 were included and categorized based on IWGDF PR and KDIGO categories. Demographic, anthropometric, hemodynamic, biochemical details and comorbidities were recorded. Results Proportion of participants in PR stages 0 and 1 across CKD risk categories decreased significantly (56.1%, 30.3% to 13.6% and 51.1%, 32.5% to 16.4%) and in PR stages 2 and 3 increased significantly (27.2%, 28.6% to 44.2% and 18.8%, 19.7% to 61.5% respectively) ( p <0.001). Median eGFR decreased significantly across PR (80 vs. 73 vs. 70 vs. 59; p <0.001). Multivariate logistic regression revealed that age: 50–59 OR (95% CI); [2 (1.7–2.3)], ≥60 [3.7 (3.1–4.4)], longer duration of diabetes: 10-20 [2.1 (1.8–2.4)], >20 [3.2 (2.7–3.9)], smoking [1.4 (1.1–1.7), HbA1c [1.1 (1.1–1.2)], eGFR categories: 60–89 [1.3 (1.1–1.6)], 45–59 [3 (2.3–3.8)], 15–44 [5.5 (3.7–8.3)], albuminuria [1.5 (1.3–1.7)] and insulin usage [1.9 (1.6–2.2]; p <0.001 for all were independently associated with high PR. Conclusion Declining kidney function was associated with PR stages of IWGDF.
Background Renal transplantation is the treatment of choice for children with end-stage renal disease, offering better growth, development, and quality of life when compared to dialysis, but long-term data from India are limited. Materials and Methods We retrospectively reviewed 53 pediatric recipients (<18 years) who underwent kidney transplantation at a South Indian tertiary center between January 2005–2025. Demographics, donor characteristics, immunosuppression, complications, rejection, infections, and survival were analyzed. Survival was estimated by Kaplan-Meier methods. Results The mean age at transplant was 14.9 ± 2.7 years; 62.3% were male. Live-related donor transplants comprised 94.3%. Etiologies included primary glomerular diseases (37.7%) and congenital anomalies of the kidney and urinary tract (26.4%). Anti-thymocyte globulin was the most common induction agent (41.5%), and tacrolimus-based regimens were used in 64.2%. Delayed graft function occurred in 15.1%. Acute rejection was documented in 34%, Antibody-mediated rejection (ABMR) in 60%, T-cell-mediated rejection (TCMR) in 32%, and combined ABMR and TCMR in 8%. Infections occurred in 58.5%, mainly urinary tract and respiratory infections. Graft survival rates at 1, 5, and 10 years were 96.2, 75, and 56%, respectively; patient survival at last follow-up was 73.6%. Conclusion Early graft survival in our setting is comparable to the other series. Long-term outcomes are impacted by infectious complications and chronic rejection.
Background Hemodialysis (HD) may be associated with cerebral hypoperfusion and neuronal stress in patients with end-stage renal disease (ESRD). This exploratory study assessed changes in serum concentrations of neuronal injury biomarkers, including Tau protein (Tau), during a single HD session and examined their associations with selected cardiovascular and inflammatory biomarkers. Materials and Methods Forty-four patients with ESRD undergoing maintenance HD were analyzed. Blood samples were collected immediately before and after one HD session to assess serum concentrations of selected biomarkers. Correlation and exploratory regression analyses were used to identify variables associated with change in Tau concentration (ΔTau) and post-HD ΔTau. Results Serum ΔTau increased after HD (394.36 ± 161.13 vs 469.78 ± 155.45 pg/mL, p = 0.0042), whereas GFAP, MBP, and S100B did not change significantly. Exploratory regression suggested that ΔTau was associated with ΔET-1, pre-HD parathormone, and pre-HD oxidized LDL (oxLDL). Post-HD Tau was mainly associated with post-HD ET-1, pre-HD ferritin, and QTc change; an alternative model including post-HD IL-6 instead of ferritin was also considered. Conclusion A single HD session was associated with increased serum ΔTau in patients with ESRD. The observed associations with ET-1, oxLDL, inflammatory markers, and QTc changes should be interpreted as exploratory and require validation in larger, independent cohorts.
Hypertension affects >1 billion individuals worldwide. Despite the availability of effective antihypertensive therapy, the prevalence of treatment-resistant hypertension (TRH), defined as uncontrolled hypertension despite the use of ≥3 antihypertensive agents at optimum doses, is reported to be 5 to 30% of the hypertensive population. Uncontrolled hypertension contributes to an elevated risk of stroke, myocardial infarction, heart failure, and kidney failure. TRH is associated with a 50% higher risk of cardiovascular disease than controlled hypertension. Several factors contribute to apparent treatment resistance, including poor medication adherence, physician inertia, inadequate doses or inappropriate combinations of antihypertensive drugs, excess salt and alcohol intake. The pathophysiology underlying true TRH remains unclear. In this article, we discuss the factors responsible for apparent treatment resistance in hypertension and the management strategies, including device therapy and newer antihypertensive agents that are likely to be available in the near future.
Background Arsenic trioxide (ATO) is used to treat acute promyelocytic leukemia (APL). It can cause nephrotoxicity in patients with APL, possibly through oxidative stress. Resveratrol (Res), a phytoalexin, has proven antioxidant properties. We investigated the effect of Res on ATO-induced nephrotoxicity in adult male Swiss albino mice ( Mus musculus ). Materials and Methods The mice (N = 40) were treated by gavage for 45 days as follows: control (Group I), 5% gum acacia (vehicle, Group II), 2 mg/Kg body weight ATO (Group III), 40 mg/Kg body weight Res (Group IV), ATO followed by Res 1 h later (Group V). Subsequently, the mice were sacrificed, and their kidneys were histologically examined on Hematoxylin & Eosin (H&E) and Periodic acid Schiff (PAS) stained sections for interstitial edema, inflammation, acute tubular injury (ATI), and total cortical injury (TCI). Pathological scoring was done after blinding using a standard scoring protocol. Results Group III mice showed significantly higher ATI and TCI scores as compared to Group V mice ( p = 0.017 and 0.028, respectively). There was no significant difference in interstitial inflammation scores among the groups. However, interstitial edema scores were significantly higher in Group-III when compared with Group-II and Group-IV ( p = 0.025 and 0.016). Conclusion Sequentially administered Res reduced ATO-induced nephrotoxicity, as evidenced by preservation of renal histology.
Background Acanthosis nigricans (AN) has been proposed as a vascular risk indicator, but evidence linking it to specific diabetes-related complications is minimal and weak. This study evaluated the utility of AN as a novel clinical predictor and an unexplored marker of vascular complications in type 2 diabetes (T2D). Materials and Methods In this prospective, observational, cross-sectional comparative study, 300 adults with T2D were enrolled: 150 with moderate-to-severe AN and 150 age-matched individuals without non-AN (NAN). Microvascular (nephropathy, retinopathy, neuropathy) and macrovascular complications were systematically assessed using standardized protocols. Multivariable logistic regression models were adjusted for age, sex, diabetes duration, body mass index (BMI), and lifestyle factors. Results Nephropathy was nearly three times more prevalent in participants with AN than without (50.0% vs. 17.3%). After comprehensive adjustment for potential confounders, AN independently predicted nephropathy (adjusted OR, 4.21, 95% CI 2.35–7.53; p <0.001). On further analysis, prevalence of AN was 75.0% among those with nephropathy versus 37.5% among those without nephropathy ( p <0.001), yielding an odds ratio for AN in the nephropathy group of 4.93 (95% CI 2.78–8.74). No significant associations were observed between AN and retinopathy, neuropathy, or macrovascular disease. Individuals with AN exhibited higher BMI, greater abdominal adiposity, elevated triglycerides, reduced HDL cholesterol, and significantly increased microalbuminuria, despite comparable glycemic control. Conclusions AN is an easily identifiable novel clinical marker independently associated with diabetic nephropathy in Asian Indians. To our knowledge, this is the first study offering a cost-free bedside tool and providing a new viewpoint to stratify nephropathy risk in diabetes care and needs to be validated in other populations
Background Hemodialysis generates a warm effluent stream (25°C) that is discarded, representing a continuous loss of low-grade thermal energy while clinics expend significant energy for water heating, contributing to operational costs and carbon emissions. Methods A transient mathematical model was developed to simulate a passive shell-and-tube heat exchanger for integration into a dialysis drain line. The model was validated experimentally (normalized root mean square error (NRMSE) = 3.4%). A techno-economic assessment for a 4-station clinic was performed, evaluating recoverable energy, effectiveness, and payback period based on key parameters including a 4 h 30 total machine operating cycle (4 h treatment at 25°C + 30 min thermal disinfection at 90°C) and an effluent flow rate of 0.05 kg/s (design value for 4 machines). Results The optimal 8-tube heat exchanger design recovers over 15 kWh/ session with >80% effectiveness. For a modeled 4-station clinic, this yields annual savings of ∼63,200 kWh (15,800 kWh per-machine), a payback period of 1.95 years, and an annual CO₂ reduction of ∼45 metric tons (11.3 tons per-machine). Conclusion Recovering thermal energy from dialysis effluent using the exchanger design described here is technically feasible and economically viable.
