Dhananjai Agrawal

Sawai ManSingh Medical College and Hospital

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Vinay Malhotra

Sawai ManSingh Medical College and Hospital

Kunal Gandhi

Amrita Institute of Medical Sciences and Research Centre

Pankaj Beniwal

Sawai ManSingh Medical College and Hospital

Dharmendra Prasad

Babasaheb Bhimrao Ambedkar Bihar University

Rajesh Jhorawat

All India Institute of Medical Sciences Jodhpur

Arjun Agarwal

Sawai ManSingh Medical College and Hospital

Piyush Kimmatkar

Pediatric Nephrology of Alabama

Amith Dsouza

Father Muller Medical College Hospital

Parvati Joshi

Sickle Cell Institute Chhattisgarh, Raipur

Sanjeev Sharma

Icahn School of Medicine at Mount Sinai

Cooperative Institutions

Sawai ManSingh Medical College and Hospital

Institute of Transplantation Sciences

Sawai Man Singh Hospital

Post Graduate Institute of Medical Education and Research

Creative Commons

All India Institute of Medical Sciences

All India Institute of Medical Sciences Raipur

Institute of Medical Sciences

Banaras Hindu University

All India Institute of Medical Sciences Bhopal

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Clinicopathologic profile of glomerular diseases associated with autoimmune thyroiditis

Thyroid Research and Practice (2017)

Kunal Gandhi Karamvir Godara Dhananjai Agrawal Vinay Malhotra Pankaj Beniwal

Introduction: Thyroid hormones are known to influence renal function, development, and renal hemodynamics. In this study, we aimed to de ne the frequency and characteristics of various glomerular diseases associated with autoimmune thyroiditis. Methods: We reviewed retrospectively 36 patients with autoimmune thyroiditis referred for evaluation of proteinuria, hematuria, and/or renal impairment. Renal biopsy was performed in 32 patients and was examined with light microscopy and immunofluorescence. Six months follow-up data of 22 patients was reviewed. Results: The mean age of study population was 43.6 years. Most of them were females (n = 28). Mean duration of hypothyroidism (HT) was 1.5 years. Hypertension was seen in 16 patients and deranged renal function (estimated glomerular filtration rate <60 ml/min/1.73 m2) in 18 with a mean serum creatinine of 1.28 mg/dl at time of biopsy. 10 patients presented with nephrotic syndrome, 33 presented with isolated proteinuria and 22 presented with hematuria with or without significant proteinuria The most common histopathologic finding was membranous nephropathy (MGN) (n = 16), followed by minimal-change nephropathy (n = 5), focal segmental glomerulosclerosis (n = 5), immunoglobulin A nephropathy (n = 3), amyloidosis (n = 2), and membranoproliferative glomerulonephritis (n = 1). Membranous nephropathy was the most common finding inn patients with the nephrotic syndrome. Conclusion: Glomerular pathologies associated with HT are diverse and similar to those found in the general population; therefore, renal biopsy should be performed in cases with progressive renal failure or urinary abnormalities.

Autoimmune thyroiditis

10.4103/0973-0354.207133

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Citations (1)

SP202ACUTE KIDNEY INJURY IN PATIENTS WITH PLASMODIUM VIVAX MALARIA: CLINICOHISTOPATHOLOGIC PROFILE

Nephrology Dialysis Transplantation (2015)

Kunal Gandhi Vinay Malhotra Rajesh Jhorawat Dhananjai Agrawal Pankaj Beniwal

Vivax malaria

10.1093/ndt/gfv190.14

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Significance and safety of renal allograft biopsies: Experience from a tertiary care center in India

Indian Journal of Transplantation (2019)

Pankaj Beniwal Nisha Gaur Vinay Malhotra Dhananjai Agrawal ShailendraK Singh

Introduction: Renal allograft biopsy is a useful tool in the presence of allograft dysfunction. There are many published studies regarding utility and safety of native kidney biopsies, whereas for allograft biopsies, data are scarce. Methodology: This retrospective analysis included all patients who underwent renal allograft biopsies from January 1, 2012, to December 31, 2017. Data were collected from patient records and interviews. Details regarding clinical indications, preprocedure rise in creatinine, urine analysis, periprocedure fall in hemoglobin, postprocedure hematoma in ultrasonography, and other complications were noted. Details of biopsy findings were analyzed. We noted the changes made in treatment after renal biopsies. Results: One hundred and seventeen (n = 117) patients underwent 150 renal biopsy procedures, with a mean age of 38.3 ± 11.6 years. Ninety-two (78.6%) were male. The majority (89.74%) of the patients received kidney from live donors. The most common indication for biopsy was acute allograft dysfunction (54%) with asymptomatic rise in creatinine (32.7%). In the first 15 days posttransplantation, the most common indication was delayed graft function (15.33%). Ninety percent of biopsies were adequate. For clinical diagnosis of acute allograft dysfunction, the most common pathological finding was active antibody-mediated rejection (AMR) in 14.49% patients. In the presence of chronic allograft dysfunction, the most common histopathological finding was chronic AMR in 18 (13.04%) biopsies. Major complications occurred in 4.0% of patients. Conclusion: Renal allograft biopsy is a useful tool in the evaluation of allograft dysfunction, and with current biopsy technique under real-time sonography, the major complication rate is less. It can be regarded as a safe procedure with excellent diagnostic yield.

Single Center

10.4103/ijot.ijot_10_19

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Clinicoepidemiological profile of peritonitis complicating acute peritoneal dialysis: A single-center experience

Saudi Journal of Kidney Diseases and Transplantation (2017)

Kunal Gandhi Dharmendra Prasad Vinay Malhotra Dhananjai Agrawal Pankaj Beniwal

A prospective observational study examining the incidence and microbiological aspects of peritonitis complicating acute intermittent peritoneal dialysis (IPD) was performed. A total of 145 acute IPD treatments were included involving 112 patients. The majority of patients suffered from acute kidney injury (72.3%) secondary to sepsis. Peritonitis occurred in 31 treatment sessions, giving a frequency of 21.4% of procedures performed. The mean interval between starting dialysis and the first sign of peritonitis was 2.9 days, with 58% of cases occurring in the Intensive Care Unit. Frequent catheter manipulation/repositioning and leakages were identified as significant predisposing factors for peritonitis, and the risk of peritonitis was increased with longer duration of IPD. Gram-negative infections were more common than Grampositive infections. The use of systemic antibiotics did not prevent the development of peritonitis.

Single Center

10.4103/1319-2442.215125

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Citations (4)

Sofosbuvir–Velpatasvir Fixed Drug Combination for the Treatment of Chronic Hepatitis C Infection in Patients With End-Stage Renal Disease and Kidney Transplantation

Journal of Clinical and Experimental Hepatology (2019)

Nisha Gaur Vinay Malhotra Dhananjai Agrawal Singh Sk Pankaj Beniwal

Sofosbuvir

Hepatitis C

10.1016/j.jceh.2019.10.004

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Citations (24)

Spectrum of Non diabetic kidney disease in patients with type 2 diabetes and its clinicopathological correlation.

PubMed (2022)

Megha Agarwal Geeta Dabas Dhananjai Agrawal Rakesh Gupta Vinay Malhotra

Diabetes mellitus (DM) is the leading cause of chronic kidney disease worldwide chiefly attributable to diabetic nephropathy (DN). In these patients, non diabetic kidney disease (NDKD) can also occur either alone or superimposed on diabetic nephropathy. This study aimed to identify the prevalence and the etiology of NDKD in our center and also the clinical and laboratory parameters to help distinguish these two entities.This was a cross sectional observational study. A total of 47 patients were enrolled in the study during the study period. In all the patients, kidney biopsy was done because of atypical presentations and was examined by light and immunofluorescence microscopy. The clinical & laboratory parameters and the biopsy findings were recorded in a standard proforma.A total of 47 patients (male/female: 34/13 and mean age 52.11±9.36) were included in the study. The chief co morbidity was hypertension which was present in 61.7% of patients. The most common indication of biopsy was nephrotic presentation (38.3%) followed by nephritic illness (25.5%). The prevalence of NDKD in our study cohort was 85.1% of which isolated NDKD was 57.4% and NDKD + DN was 27.7%. The most common histological lesion were membranous glomerulopathy and focal segmental glomerulosclerosis (FSGS) each with a frequency of 15% followed by chronic tubulointerstitial nephritis (CTIN), IgA nephropathy and others. There was significant difference in the median duration of diabetes in these groups and it was around 5 years less in the NDKD group. There was no difference among three groups in term of eGFR, HbA1C and proteinuria.Our study demonstrated a high prevalence of NDKD in the patients with type 2 diabetes. The duration of diabetes was the strongest predictor of NDKD. Kidney biopsy should be undertaken liberally whenever there is strong clinical suspicion especially in the presence of atypical features. The exact histological diagnosis can clarify the further treatment planning as well as the prognosis.

Glomerulopathy

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Gitelman′s syndrome presenting with hypocalcemic tetany and hypokalemic periodic paralysis

Saudi Journal of Kidney Diseases and Transplantation (2016)

Kunal Gandhi Dharmendra Prasad Vinay Malhotra Dhananjai Agrawal

Gitelman's syndrome is an autosomal recessive renal tubular disorder characterized by hypomagnesemia, hypokalemia, hypocalciuria, and metabolic alkalosis. Hypocalcemic tetany as a presentation of Gitelman's syndrome has rarely been reported in literature. We report a rare case of Gitelman's syndrome presenting with hypocalcemic tetany along with hypokalemic periodic paralysis. A 17-year-old female was admitted to our hospital with a history of perioral numbness and carpal spasms of five days duration with progressive quadriparesis developing over a period of few hours. Past history was significant for three episodes of transient lower limb weakness. On examination, blood pressure was 110/70 mm Hg. Chvostek's sign and Trousseau's sign were positive. Neurologically, she was fully oriented. She had Grade 3 power in all the four limbs with intact sensation. Laboratory tests showed hypocalcemia (7.8 mg/dL), hypokalemia (2.2 mEq/L), hypomagnesemia (0.9 mEq/L), and hypocalciuria (104 mg/day). Arterial blood gas showed mild metabolic alkalosis with respiratory compensation. Thus, a clinical diagnosis of GS was made. The patient made a remarkable recovery after the correction of electrolyte imbalance. The aim of this case report is to re-emphasize the fact that hypocalcemia can rarely occur in Gitelman's syndrome.

Hypocalciuria

Tetany

Gitelman syndrome

Hypophosphatemia

Respiratory alkalosis

10.4103/1319-2442.190881

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Citations (9)

Images in transplantation

Indian Journal of Transplantation (2014)

Kunal Gandhi Dharmendra Prasad Dhananjai Agrawal Pankaj Beniwal Vinay Malhotra

10.1016/j.ijt.2015.01.002

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An interesting case of renal allograft dysfunction with multiple renal arteries of the transplanted kidney

Indian Journal of Transplantation (2015)

Kunal Gandhi Piyush Kimmatkar Amith Dsouza Pankaj Beniwal Vinay Malhotra

Transplanted kidney

10.1016/j.ijt.2015.07.001

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Usefulness of real-time sonoelastography for assessment of renal allograft fibrosis

Indian Journal of Transplantation (2020)

Shubham Agrawal Ramdayal Sahu DharmendraKumar Jangid DevendraSingh Dhaker Vinay Rathore

Background: Currently, allograft renal biopsy is the only reliable tool available to detect fibrosis in the transplanted kidney. However, it is an invasive procedure and is associated with complications. Therefore, a noninvasive tool to detect renal allograft fibrosis is needed. Aims: The aim of the study was to evaluate the usefulness of real-time sonoelastography (RTS) in the diagnosis of renal allograft fibrosis. Subjects and Methods: We studied 15 renal allograft recipients who had chronic allograft nephropathy. RTS was performed by an experienced radiologist to semi-quantitatively determine cortical and medullary stain ratio. These parameters were compared with the degree of fibrosis as assessed by allograft renal biopsy. For comparison, patients were divided into two groups based on the degree of fibrosis: those with mild fibrosis (interstitial fibrosis and tubular atrophy [IFTA] <25%) and those with moderate-to-severe fibrosis (IFTA >25%). A receiver operating characteristic (ROC) curve analysis was performed to evaluate the accuracy of cortical strain ratio to discriminate between patients with mild fibrosis versus patients with moderate-to-severe fibrosis. Results: The mean cortical strain ratio was significantly higher in those who had mild fibrosis as compared to those who had moderate-to-severe fibrosis (2.46 ± 0.55 vs. 1.78 ± 0.15, P = 0.01), while the medullary strain ratio was comparable between the two groups. The diagnostic accuracy of cortical strain ratio, as evaluated by area under the curve of ROC analysis, was 0.96. Conclusion: RTS can differentiate between mild fibrosis and moderate-to-severe fibrosis with high accuracy.

10.4103/ijot.ijot_53_19

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