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   2017| January-March  | Volume 4 | Issue 1  
    Online since March 1, 2017

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Ultrasound spectrum of tubular ectasia of rete testis and epididymis: Emphasis on early detection
Aniruddha R Kulkarni, Mohammed Ashfaque Tinmaswala, Shubhangi V Shetkar
January-March 2017, 4(1):14-20
Background and Objectives: Tubular ectasia is a rare, pathologically benign condition which initially may present as tiny cyst. Knowledge of typical ultrasound features of this condition helps to differentiate it from other malignant lesions of testis. This study was conducted to find out ultrasound spectrum of tubular ectasia of rete testis and epididymis. Methods: Patients undergoing scrotal ultrasound and doppler for various indications including scrotal pain, infertility, postvasectomy and prior to recanalisation of vas were studied. The history, clinical examination, semen analysis and ultrasound features were analyzed. Our emphasis was on early detection of this rare but benign entity involving testis and epididymis. Results: Scrotal ultrasound with colour doppler in these patients revealed the abnormalities ranging from early changes like specked appearance and tiny cysts to more severe forms involving rete testis and epididymis. Associated abnormalities like epididymal cyst, hydrocele and spermatocele were also found in addition to tubular ectasia in some cases. Conclusion: Tubular ectasia is a pathologically benign condition which can be reliably diagnosed on ultrasound and colour doppler. Familiarity with the ultrasound and doppler features of tubular ectasia will definitely help in early diagnosis which in turn will help in reducing patients' anxiety and prevent unnecessary interventions.
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Association of lipid abnormalities and oxidative stress with diabetic nephropathy
Kamal Kachhawa, Divya Agrawal, Bandana Rath, Sanjay Kumar
January-March 2017, 4(1):3-9
Chronic kidney disease (CKD) is characterized by progressive loss of renal function. Although the burden of CKD in India cannot be assessed accurately, its approximate prevalence is believed to be 800 per million populations (pmp), and the incidence of end-stage renal disease (ESRD) is 150–200 pmp. Diabetic nephropathy is a leading cause of ESRD worldwide. Another cause of ESRD is dyslipidemia, which is one of the most common quantitative lipid abnormalities in patients with CKD. In diabetes, the total cholesterol and triglyceride levels rise as the albumin excretion rate increases, leading to renal injury. Oxidative stress generated by hyperglycemia increases reactive oxygen species production, which causes cellular dysfunction and damage, and ultimately results in diabetic micro- and macro-vascular complications. Therefore, lipids may represent a useful clinical tool for not only identifying patients at a high risk of developing CVD but also assessing the development and progression of renal disease. In this review, we summarize the effects of lipid abnormalities and oxidative stress in patients with diabetes and nephropathy.
  12,902 1,166 6
Level change of prostate-specific antigen in patients with benign prostatic hyperplasia after transurethral prostatic resection
Jiao Liu, Jilei Tang, Daxin Gong, Chuize Kong
January-March 2017, 4(1):10-13
Objectives: The objective of this study was to explore the values of prostate-specific antigen (PSA) before and after transurethral prostatic resection (TURP) surgery and the corresponding correlation with the resection extent through short and long-term changes of benign prostatic hyperplasia (BPH) of patient's serum PSA after TURP. Materials and Methods: Data were abstracted from a retrospective sampling study of 209 cases of BPH patients. The values of serum PSA level were measured preoperatively and at specified periods after TURP surgery; 5 days, 1 month, 3 months, and 6 months. These periods were correlated with the resection extent. Results: Quantitative PSA values were collected before and after the surgical procedure at the time periods. The decrease of PSA value was observed 5 days after surgery when compared with preoperative PSA value, which is about 4.42 ± 8.78 ng/mL while 35% decrease was reported following a month after surgery. Moreover, PSA levels in these five periods were significantly different (P < 0.01), and the value of PSA >4 ng/mL group is still higher than the group of PSA ≤4 ng/mL after the decrease. Resection extent of TURP: The mean differences between real removal quality and the quality, according to the prostate ultrasonography, should be removed, which is expressed in ± standard deviations. The value of the total sample is −0.941 ± 9.56 ng/mL. Values in the group of PSA ≤4 ng/mL and PSA >4 ng/mL are 0.13 ± 10.53 and −3.83 ± 5.41, respectively. There appears to be a positive correlation between the variations of PSA and the resection extent (P < 0.01, R = 0.91). In addition, a positive correlation was confirmed between the variations of PSA and the resection extent in the group of PSA ≤4 ng/mL and PSA >4 ng/mL (P < 0.01, R 1 = 0.986, R 2 = 0.924). Conclusion: A downward trend is demonstrated here in PSA after TURP. The PSA value lowered to a normal level in about 1 month. The interesting point is that there is an inverse relationship between the larger size of the resection and the decrease in PSA values. Thus, missed and misdiagnoses of prostate cancer could be reduced with the long-term follow-up of BPH patients' postoperative levels of serum after TURP. In regards to patients whose preoperative PSA >4 ng/mL, monitoring standards should be taken according to their postoperative PSA baseline when measuring their results of prostate needle biopsies and the diagnosis of prostatic cancer.
  12,770 784 2
Nonsteroidal anti-inflammatory drugs: Is there a link between cardiovascular and renal adverse effects?
Regan E Sevinsky, David W Stewart, Sam Harirforoosh
January-March 2017, 4(1):1-2
  10,596 997 7
Atypical anti-glomerular basement membrane disease superimposed on IgA nephropathy
T Balasubramaniyan, Jeyachandran Dhanapriya, Thanigachalam Dineshkumar, Arcot Thanjan Maasila, Srinivasan Arivazhagan, Dhanasekaran Rajasekar, Ramanathan Sakthirajan, Natarajan Gopalakrishnan
January-March 2017, 4(1):26-28
Anti-glomerular basement membrane (anti-GBM) disease is an autoimmune disorder characterized by crescentic glomerulonephritis, pulmonary hemorrhage, and the presence of circulating anti-GBM antibodies which bind to the α3 chain of Type IV collagen found in the GBM. IgA nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide. The simultaneous occurrence of atypical anti-GBM disease and IgAN has not been reported previously. We report here two female patients who presented with oliguria, hypertension, and renal failure. Renal biopsy revealed crescentic glomerulonephritis and bright linear IgG staining along glomerular capillary walls and mesangial IgA (3+) deposits in immunofluorescence. Serology was negative for anti-GBM antibodies both by ELISA and immunoblot assays. Hence, a diagnosis of atypical anti-GBM disease with superimposed IgAN was made. Both patients were treated with hemodialysis, intravenous steroids, and cyclophosphamide with the improvement of renal function in one patient and the other progressed to end-stage renal disease.
  9,163 712 1
Anaphylactic reaction during hemodialysis on polysulfone membrane in a patient receiving angiotensin II receptor antagonist
Ji Fang, Lin Feng, Hao Wang
January-March 2017, 4(1):29-31
Allergic reactions happened during hemodialysis (HD) on polysulfone membrane in a 59-year-old female patient who was being treated with an angiotensin II receptor antagonist, olmesartan, for aggravated hypertension. Anaphylactic reactions including itching, hypoxemia, and facial swelling appeared 1 h after starting the 6th session of HD and lasted for 30 min. When we changed dialyzer and stopped olmesartan for 4 days, the reactions disappeared.
  9,041 769 -
Nondiabetic renal disease in type 2 diabetes mellitus
Lakshminarayana R Gopaliah, Sheetal G Lakshminarayana, Seethalekshmy Vijayan Nalumakkal
January-March 2017, 4(1):21-25
Background and Objectives: The prevalence of nondiabetic renal disease (NDRD) in those with type 2 diabetes mellitus (T2DM) is common worldwide; however, data from India are limited. Materials and Methods: This study included participants with T2DM who underwent renal biopsy with suspicion of NDRD from September 2009 to August 2016. Results: Seventy-one participants (males: 47 [66.2%] and females: 24 [33.8%]) of T2DM with mean age and standard deviation of 52.93 ± 12.56 years were included in the study. The indications for renal biopsy included acute on chronic renal failure in 35.2% (25), nephrotic syndrome in 31% (22), acute renal failure in 14.1% (10), nephritic syndrome in 14.1% (10), and others in 5.6% (4) of participants. The prevalence rates of NDRD, diabetic nephropathy (DN), and DN with NDRD were 50.71% (36), 28.16% (20), and 21.13% (15), respectively. Among the participants with NDRD, 69.44% (25) had primary glomerular diseases (PGDs), 16.67% (6) had tubulointerstitial diseases (TIDs), and 13.89% (5) had secondary glomerular diseases (SGDs). IgA nephropathy was the most common of PGDs affecting 28% (7), followed by postinfective glomerulonephritis (PIGN) in 20% (5), membranous nephropathy in 16% (4), focal segmental glomerulosclerosis in 12% (3), and miscellaneous lesions in 24% (10). Acute interstitial nephritis and primary amyloidosis were the most common of TIDs and SGDs, respectively. Among the patients with combination of DN with NDRD, 53.33% (8) were TIDs and 46.67% (7) had glomerular diseases. Acute tubular injury/necrosis and PIGN were the most common of TIDs and glomerular disease, respectively. The figures in brackets representing number of patients. Conclusions: The majority of the participants with T2DM had NDRD either alone or in combination with DN in the study, underlining the utility of renal biopsy for their diagnoses in those with appropriate indication. Wide spectrum of PGDs, TIDs, and SGDs was found in the study.
  9,008 759 1