Lata Nayak - Academia.edu (original) (raw)

Papers by Lata Nayak

The Journal of the Association of Physicians of India, 2019

Purpose of the Study Thromboelastography provides a holistic picture of blood coagulation includi... more Purpose of the Study Thromboelastography provides a holistic picture of blood coagulation including fibrin formation, cross, linking and fibrinolysis. Coagulaopathy in end stage renal disease (ESRD) is multifactorial. The present evaluated the thromboelastographic profile of ESRD patients and compared it to conventional tests of coagulation. Study Design In this observational case control study, fifty ESRD patients and 50 controls were recruited. Venous samples were withdrawn and platelet count, International Normalization Ratio and fibrinogen levels were measure. Simultaneously a thromboelastography (TEG) was performed. All samples were drawn prior to initiation of dialysis. Results The fibrinogen concentration was higher in the ESRD group compared to control (455.51±83.39 vs. 233.84±71.71 mg/dl, P<0.05). The maximum amplitude in ESRD group was 76.94 ± 15.11 mm, which was significantly higher than control group 65.10±10.31 mm (P<0.05).Out of 50 ESRD patients,39 had maximum am...

Indian Journal of Urology : IJU : Journal of the Urological Society of India, 2018

Infection and Drug Resistance, Nov 1, 2019

PurposeBaseline viral load and existence of resistance-associated substitutions (RASs) are associ... more PurposeBaseline viral load and existence of resistance-associated substitutions (RASs) are associated with direct-acting antiviral agent (DAA) treatment failure in patients with chronic hepatitis C virus (HCV) infection.Patients and methodsThis study was done on HCV-infected patients with different clinical conditions, group 1 included HCV-infected patients with only liver disease (n= 24) and group 2 had HCV-infected patients with coexisting chronic kidney disease (CKD) (n =26). Baseline RAS in the viral genome, before treatment initiation, was examined in both the groups to understand the host disease status on their occurrence.ResultsPredominant genotype (gt) differed in both the groups, in group 1 it was gt3 while it was gt1 in group 2. Overall, the occurrence of RASs at baseline was seen in 10 patients (20%); in group 1 it was seen in 8 (33.3%) as compared to only 2 (7.6%) in group 2; p < 0.001. RAS in both NS5a and NS5b regions of the virus was seen in group 1 while in group 2, RASs were seen only in the NS5a region of the virus at 30K position. In group 1, multiple RASs were also seen. The existence of RAS at baseline in both the groups did not affect the attainment of post-treatment cure for the virus in terms of sustained virological response (SVR).ConclusionHost disease status influences the occurrence of baseline RAS in the virus.

Journal of vascular and interventional radiology : JVIR, May 1, 2018

To evaluate the safety and diagnostic yield of combined fluoroscopy and ultrasound-guided transju... more To evaluate the safety and diagnostic yield of combined fluoroscopy and ultrasound-guided transjugular kidney biopsy (TJKB) in cirrhotic patients with suspected renal parenchymal disease. A retrospective review was made of 27 patients (21 men; overall mean age 44.7 y) who underwent TJKB from June 2013 to June 2016; 21 patients had coagulopathy and/or thrombocytopenia, 4 underwent simultaneous TJKB with transjugular liver biopsy, and 1 patient each had severe obesity and gross ascites. All procedures were performed with the use of fluoroscopy and simultaneous transabdominal ultrasound guidance. The data were analyzed for number of passes taken, number of glomeruli in the tissue cores, adequacy of tissue core for histopathologic diagnosis, and incidence and severity of complications. The average number of passes per case was 3.6 (range 2-6). The total length of tissue cores ranged from 0.4 cm to 2.5 cm. The mean numbers of glomeruli per procedure on light microscopy were 6.7 (range 0-...

Liver international : official journal of the International Association for the Study of the Liver, Jan 20, 2018

There is scant data on use of sofosbuvir containing directly acting anti-viral (DAA) regimens in ... more There is scant data on use of sofosbuvir containing directly acting anti-viral (DAA) regimens in chronic kidney disease (CKD) patients. Recently generic versions of DAAs have become available in low income countries including India. The aim of this study was to study the efficacy and safety of generic sofosbuvir in combination with generic ribavirin, ledipasvir, or daclatasvir in HCV infected patients with CKD including patients with advanced CKD (CKD stage 4 or 5 with an estimated glomerular filtration rate (GFR) <30 mL/min or those on dialysis). Seventy one CKD patients (76% male, 84.5% on maintenance hemodialysis, 23.9% cirrhosis) with HCV infection were included in the study. Full dose sofosbuvir was used in combination with ribavirin (N= 26, for 24 weeks, 69.2% genotype 1, 30.8% genotype 3), ledipasvir (N=26, for 12 weeks, all genotype 1) and daclatasvir (N=19, for 12 weeks, all genotype 3). Sustained virological response (SVR) (HCV RNA <12 IU/mL) at 12 weeks after stoppi...

Journal of Hepatology, 2015

Background and Aims: Increased adrenergic function causes proximal tubular fluid retention and re... more Background and Aims: Increased adrenergic function causes proximal tubular fluid retention and reduces renal excretion of solute-free water, but, in advanced cirrhosis, non-osmotic hypersecretion of vasopressin (ADH) is considered the cause of water retention and hyponatremia. Aim. Since ADH V2 receptor

Journal of clinical and translational hepatology, Jan 28, 2017

Background and Aims: The role of bile cast nephropathy (BCN) in pathogenesis of hepatorenal syndr... more Background and Aims: The role of bile cast nephropathy (BCN) in pathogenesis of hepatorenal syndrome (HRS) in decompensated cirrhosis and acute on chronic liver failure (ACLF) is unknown. This study aimed to determine the frequency of BCN detected on postmortem renal biopsy among patients with decompensated cirrhosis and ACLF who had been admitted with acute kidney injury due to HRS (HRA-AKI) and expired during that hospitalization. Methods: One-hundred-twenty-seven postmortem renal biopsies with adequate size (>1 cm in length) were included for analysis. These were obtained from 84 patients with decompensated cirrhosis and 43 patients with ACLF. Results: BCN was detected in 57 of the total 127 (44.8%) renal biopsy specimens. Patients with BCN had significantly higher levels of serum total bilirubin, total leukocyte count and model for end-stage liver disease score, as compared to those without BCN. BCN was detected in 32/43 (74.4%) of the patients with ACLF, as compared to 25/84...

Liver international : official journal of the International Association for the Study of the Liver, Oct 10, 2017

There is limited data on predictors of acute kidney injury(AKI) in ACLF. We developed a PIRO mode... more There is limited data on predictors of acute kidney injury(AKI) in ACLF. We developed a PIRO model (Predisposition, Injury, Response, Organ failure) for predicting AKI in a multi-centric cohort of ACLF patients. Data of 2360 patients from APASL-ACLF Research Consortium (AARC) was analysed. Multivariate logistic regression model (PIRO score) was developed from a derivation cohort (n=1363) which was validated in another prospective multicentric cohort of ACLF patients (n=997) RESULTS: Factors significant for P component were serum creatinine[(≥2mg/dl)OR 4.52, 95% CI (3.67-5.30)], bilirubin [(<12 mg/dL,OR 1) versus (12-30 mg/dL,OR 1.45, 95% 1.1-2.63) versus (≥30 mg/dL,OR 2.6, 95% CI 1.3-5.2)], serum potassium [(<3 mmol/LOR-1)versus (3-4.9 mmol/L,OR 2.7, 95% CI 1.05-1.97) versus (≥5 mmol/L,OR 4.34, 95% CI 1.67-11.3)] and blood urea (OR 3.73, 95% CI 2.5-5.5); for I component nephrotoxic medications (OR-9.86, 95% CI 3.2-30.8); for R component,Systemic Inflammatory Response Syndrome,...

Journal of Clinical and Experimental Hepatology, 2017

Indian Journal of Urology, 2016

We describe the surgical steps of a successful en-bloc kidney transplant from a 16-month old pedi... more We describe the surgical steps of a successful en-bloc kidney transplant from a 16-month old pediatric donor to an adult recipient.

Journal of Hepatology, 2015

Background and Aims: Contrast induced nephropathy (CIN) is described in patients undergoing inter... more Background and Aims: Contrast induced nephropathy (CIN) is described in patients undergoing interventional cardiac procedures and a grading system for the same has been in use. The predictors of development of CIN in cirrhotics (CP) has not been studied adequately. It is well known that CP have low creatinine (Cr) clearance and renal reserve and maybe at risk, to develop CIN. We devised a novel scoring system (Contrast Induced Nephropathy In Cirrhosis, CINIC score) to predict CIN in CP using a derivative group (DG) which was validated in a separate cohort (VG). Methods: DG of 350 CP [M=281, F = 69; alcohol = 86, HBV=190, others = 74] with or without decompensation undergoing contrast enhanced computed tomography [CECT, Omnipaque 300 (Iohexol, 1ml/kg; 300mg/ml Iodine)], of abdomen were prospectively studied for development of CIN. CIN was defined as an absolute increase of 0.5mg/dL Cr from baseline or increase in Cr >25% within 48 to 72hrs. Independent risk factors were identified on multivariate analysis, a score derived, based on regression coefficient values rounded for each variable, providing a total score. This was validated in independent VG of 150 CP undergoing CECT. Results: 39 (11.1%) patients developed CIN. On univariate analysis severity of ascites (p 6.2mg/dL, Sen 60%), DM & HTN, 2 each, and CTP 4 (>11, Sen 93%), for a total score of 9. Prediction of CIN was made at a total score of ≥4.5, rounded off to 5 [sensitivity 84%, specificity 76%, AUROC 0.889 (95%CI 0.845–0.933), p < 0.001]. Patients in DG and VG were comparable. In VG, CINIC score predicted CIN with AUROC 96.3 (Sen 80%, Spe 90.4%, PPV 48%, NPV 97.6%). Coordinates of the ROC curve

Hepatology International, 2014

Patients with acute-on-chronic liver failure (ACLF) are known to have a very high mortality rate ... more Patients with acute-on-chronic liver failure (ACLF) are known to have a very high mortality rate as the majority of these patients succumb to multiorgan failure. Liver transplant remains the only option for these patients; however, there are problems with its availability, cost and also the complications and side effects associated with immunosuppression. Unlike advanced decompensated liver disease, there is a potential for hepatic regeneration and recovery in patients with ACLF. A liver support system, cell or non-cell based, logically is likely to provide temporary functional support until the donor liver becomes available or the failing liver survives the onslaught of the acute insult and spontaneously regenerates. Understanding the pathogenesis of liver failure and regeneration is essential to define the needs for a support system. Removal of hepatotoxic metabolites and inhibitors of hepatic regeneration by liver dialysis, a non-cell-based hepatic support, could help to provide a suitable microenvironment and support the failing liver. The current systems, i.e., MARS and Prometheus, have failed to show survival benefits in patients with ACLF based on which newer devices with improved functionality are currently under development. However, larger randomized trials are needed to prove whether these devices can enable restoration of the complex dysregulated immune system and impact organ failure and mortality in these patients.

Hepatology International, 2013

Acute kidney injury (AKI) is a relatively frequent problem, occurring in approximately 20 % of ho... more Acute kidney injury (AKI) is a relatively frequent problem, occurring in approximately 20 % of hospitalized patients with cirrhosis. Although serum creatinine (S Cr) is the most commonly used method to determine AKI because of easy availability and low cost, practically it underestimates the extent of kidney injury in patients with chronic liver disease. AKI is defined as an abrupt rise in S Cr of 0.3 mg/dl or more ([26.4 mmol/l) or an increase of 150 % or more (1.5-fold) from baseline. The cause of AKI in cirrhosis is multifactorial and is unique in terms of pathogenesis. The most common causes of AKI in cirrhosis can be subdivided into either functional or structural. The functional group includes volume-responsive (prerenal azotemia) and volume-unresponsive states (hepatorenal syndrome). Volume responsive is the most common type of AKI due to frequent use of diuretics, large volume abdominal paracentesis and gastrointestinal bleeding in patients with liver disease. The structural causes include acute tubular necrosis, tubulointerstitial and glomerular diseases. Patients with decompensated cirrhosis are in a vasodilatory state leading to a decrease in effective arterial blood volume, predisposing to AKI. Therefore, management of AKI depends on the underlying cause, and therapy should be directed toward removal of the cause. The outcome in cirrhosis when patients are on dialysis is very dismal. Every effort should be made to prevent AKI.

Journal of Hepatology, 2014

Journal of Hepatology, 2014

The Journal of the Association of Physicians of India, 2019

Purpose of the Study Thromboelastography provides a holistic picture of blood coagulation includi... more Purpose of the Study Thromboelastography provides a holistic picture of blood coagulation including fibrin formation, cross, linking and fibrinolysis. Coagulaopathy in end stage renal disease (ESRD) is multifactorial. The present evaluated the thromboelastographic profile of ESRD patients and compared it to conventional tests of coagulation. Study Design In this observational case control study, fifty ESRD patients and 50 controls were recruited. Venous samples were withdrawn and platelet count, International Normalization Ratio and fibrinogen levels were measure. Simultaneously a thromboelastography (TEG) was performed. All samples were drawn prior to initiation of dialysis. Results The fibrinogen concentration was higher in the ESRD group compared to control (455.51±83.39 vs. 233.84±71.71 mg/dl, P<0.05). The maximum amplitude in ESRD group was 76.94 ± 15.11 mm, which was significantly higher than control group 65.10±10.31 mm (P<0.05).Out of 50 ESRD patients,39 had maximum am...

Indian Journal of Urology : IJU : Journal of the Urological Society of India, 2018

Infection and Drug Resistance, Nov 1, 2019

PurposeBaseline viral load and existence of resistance-associated substitutions (RASs) are associ... more PurposeBaseline viral load and existence of resistance-associated substitutions (RASs) are associated with direct-acting antiviral agent (DAA) treatment failure in patients with chronic hepatitis C virus (HCV) infection.Patients and methodsThis study was done on HCV-infected patients with different clinical conditions, group 1 included HCV-infected patients with only liver disease (n= 24) and group 2 had HCV-infected patients with coexisting chronic kidney disease (CKD) (n =26). Baseline RAS in the viral genome, before treatment initiation, was examined in both the groups to understand the host disease status on their occurrence.ResultsPredominant genotype (gt) differed in both the groups, in group 1 it was gt3 while it was gt1 in group 2. Overall, the occurrence of RASs at baseline was seen in 10 patients (20%); in group 1 it was seen in 8 (33.3%) as compared to only 2 (7.6%) in group 2; p < 0.001. RAS in both NS5a and NS5b regions of the virus was seen in group 1 while in group 2, RASs were seen only in the NS5a region of the virus at 30K position. In group 1, multiple RASs were also seen. The existence of RAS at baseline in both the groups did not affect the attainment of post-treatment cure for the virus in terms of sustained virological response (SVR).ConclusionHost disease status influences the occurrence of baseline RAS in the virus.

Journal of vascular and interventional radiology : JVIR, May 1, 2018

To evaluate the safety and diagnostic yield of combined fluoroscopy and ultrasound-guided transju... more To evaluate the safety and diagnostic yield of combined fluoroscopy and ultrasound-guided transjugular kidney biopsy (TJKB) in cirrhotic patients with suspected renal parenchymal disease. A retrospective review was made of 27 patients (21 men; overall mean age 44.7 y) who underwent TJKB from June 2013 to June 2016; 21 patients had coagulopathy and/or thrombocytopenia, 4 underwent simultaneous TJKB with transjugular liver biopsy, and 1 patient each had severe obesity and gross ascites. All procedures were performed with the use of fluoroscopy and simultaneous transabdominal ultrasound guidance. The data were analyzed for number of passes taken, number of glomeruli in the tissue cores, adequacy of tissue core for histopathologic diagnosis, and incidence and severity of complications. The average number of passes per case was 3.6 (range 2-6). The total length of tissue cores ranged from 0.4 cm to 2.5 cm. The mean numbers of glomeruli per procedure on light microscopy were 6.7 (range 0-...

Liver international : official journal of the International Association for the Study of the Liver, Jan 20, 2018

There is scant data on use of sofosbuvir containing directly acting anti-viral (DAA) regimens in ... more There is scant data on use of sofosbuvir containing directly acting anti-viral (DAA) regimens in chronic kidney disease (CKD) patients. Recently generic versions of DAAs have become available in low income countries including India. The aim of this study was to study the efficacy and safety of generic sofosbuvir in combination with generic ribavirin, ledipasvir, or daclatasvir in HCV infected patients with CKD including patients with advanced CKD (CKD stage 4 or 5 with an estimated glomerular filtration rate (GFR) <30 mL/min or those on dialysis). Seventy one CKD patients (76% male, 84.5% on maintenance hemodialysis, 23.9% cirrhosis) with HCV infection were included in the study. Full dose sofosbuvir was used in combination with ribavirin (N= 26, for 24 weeks, 69.2% genotype 1, 30.8% genotype 3), ledipasvir (N=26, for 12 weeks, all genotype 1) and daclatasvir (N=19, for 12 weeks, all genotype 3). Sustained virological response (SVR) (HCV RNA <12 IU/mL) at 12 weeks after stoppi...

Journal of Hepatology, 2015

Background and Aims: Increased adrenergic function causes proximal tubular fluid retention and re... more Background and Aims: Increased adrenergic function causes proximal tubular fluid retention and reduces renal excretion of solute-free water, but, in advanced cirrhosis, non-osmotic hypersecretion of vasopressin (ADH) is considered the cause of water retention and hyponatremia. Aim. Since ADH V2 receptor

Journal of clinical and translational hepatology, Jan 28, 2017

Background and Aims: The role of bile cast nephropathy (BCN) in pathogenesis of hepatorenal syndr... more Background and Aims: The role of bile cast nephropathy (BCN) in pathogenesis of hepatorenal syndrome (HRS) in decompensated cirrhosis and acute on chronic liver failure (ACLF) is unknown. This study aimed to determine the frequency of BCN detected on postmortem renal biopsy among patients with decompensated cirrhosis and ACLF who had been admitted with acute kidney injury due to HRS (HRA-AKI) and expired during that hospitalization. Methods: One-hundred-twenty-seven postmortem renal biopsies with adequate size (>1 cm in length) were included for analysis. These were obtained from 84 patients with decompensated cirrhosis and 43 patients with ACLF. Results: BCN was detected in 57 of the total 127 (44.8%) renal biopsy specimens. Patients with BCN had significantly higher levels of serum total bilirubin, total leukocyte count and model for end-stage liver disease score, as compared to those without BCN. BCN was detected in 32/43 (74.4%) of the patients with ACLF, as compared to 25/84...

Liver international : official journal of the International Association for the Study of the Liver, Oct 10, 2017

There is limited data on predictors of acute kidney injury(AKI) in ACLF. We developed a PIRO mode... more There is limited data on predictors of acute kidney injury(AKI) in ACLF. We developed a PIRO model (Predisposition, Injury, Response, Organ failure) for predicting AKI in a multi-centric cohort of ACLF patients. Data of 2360 patients from APASL-ACLF Research Consortium (AARC) was analysed. Multivariate logistic regression model (PIRO score) was developed from a derivation cohort (n=1363) which was validated in another prospective multicentric cohort of ACLF patients (n=997) RESULTS: Factors significant for P component were serum creatinine[(≥2mg/dl)OR 4.52, 95% CI (3.67-5.30)], bilirubin [(<12 mg/dL,OR 1) versus (12-30 mg/dL,OR 1.45, 95% 1.1-2.63) versus (≥30 mg/dL,OR 2.6, 95% CI 1.3-5.2)], serum potassium [(<3 mmol/LOR-1)versus (3-4.9 mmol/L,OR 2.7, 95% CI 1.05-1.97) versus (≥5 mmol/L,OR 4.34, 95% CI 1.67-11.3)] and blood urea (OR 3.73, 95% CI 2.5-5.5); for I component nephrotoxic medications (OR-9.86, 95% CI 3.2-30.8); for R component,Systemic Inflammatory Response Syndrome,...

Journal of Clinical and Experimental Hepatology, 2017

Indian Journal of Urology, 2016

We describe the surgical steps of a successful en-bloc kidney transplant from a 16-month old pedi... more We describe the surgical steps of a successful en-bloc kidney transplant from a 16-month old pediatric donor to an adult recipient.

Journal of Hepatology, 2015

Background and Aims: Contrast induced nephropathy (CIN) is described in patients undergoing inter... more Background and Aims: Contrast induced nephropathy (CIN) is described in patients undergoing interventional cardiac procedures and a grading system for the same has been in use. The predictors of development of CIN in cirrhotics (CP) has not been studied adequately. It is well known that CP have low creatinine (Cr) clearance and renal reserve and maybe at risk, to develop CIN. We devised a novel scoring system (Contrast Induced Nephropathy In Cirrhosis, CINIC score) to predict CIN in CP using a derivative group (DG) which was validated in a separate cohort (VG). Methods: DG of 350 CP [M=281, F = 69; alcohol = 86, HBV=190, others = 74] with or without decompensation undergoing contrast enhanced computed tomography [CECT, Omnipaque 300 (Iohexol, 1ml/kg; 300mg/ml Iodine)], of abdomen were prospectively studied for development of CIN. CIN was defined as an absolute increase of 0.5mg/dL Cr from baseline or increase in Cr >25% within 48 to 72hrs. Independent risk factors were identified on multivariate analysis, a score derived, based on regression coefficient values rounded for each variable, providing a total score. This was validated in independent VG of 150 CP undergoing CECT. Results: 39 (11.1%) patients developed CIN. On univariate analysis severity of ascites (p 6.2mg/dL, Sen 60%), DM & HTN, 2 each, and CTP 4 (>11, Sen 93%), for a total score of 9. Prediction of CIN was made at a total score of ≥4.5, rounded off to 5 [sensitivity 84%, specificity 76%, AUROC 0.889 (95%CI 0.845–0.933), p < 0.001]. Patients in DG and VG were comparable. In VG, CINIC score predicted CIN with AUROC 96.3 (Sen 80%, Spe 90.4%, PPV 48%, NPV 97.6%). Coordinates of the ROC curve

Hepatology International, 2014

Patients with acute-on-chronic liver failure (ACLF) are known to have a very high mortality rate ... more Patients with acute-on-chronic liver failure (ACLF) are known to have a very high mortality rate as the majority of these patients succumb to multiorgan failure. Liver transplant remains the only option for these patients; however, there are problems with its availability, cost and also the complications and side effects associated with immunosuppression. Unlike advanced decompensated liver disease, there is a potential for hepatic regeneration and recovery in patients with ACLF. A liver support system, cell or non-cell based, logically is likely to provide temporary functional support until the donor liver becomes available or the failing liver survives the onslaught of the acute insult and spontaneously regenerates. Understanding the pathogenesis of liver failure and regeneration is essential to define the needs for a support system. Removal of hepatotoxic metabolites and inhibitors of hepatic regeneration by liver dialysis, a non-cell-based hepatic support, could help to provide a suitable microenvironment and support the failing liver. The current systems, i.e., MARS and Prometheus, have failed to show survival benefits in patients with ACLF based on which newer devices with improved functionality are currently under development. However, larger randomized trials are needed to prove whether these devices can enable restoration of the complex dysregulated immune system and impact organ failure and mortality in these patients.

Hepatology International, 2013

Acute kidney injury (AKI) is a relatively frequent problem, occurring in approximately 20 % of ho... more Acute kidney injury (AKI) is a relatively frequent problem, occurring in approximately 20 % of hospitalized patients with cirrhosis. Although serum creatinine (S Cr) is the most commonly used method to determine AKI because of easy availability and low cost, practically it underestimates the extent of kidney injury in patients with chronic liver disease. AKI is defined as an abrupt rise in S Cr of 0.3 mg/dl or more ([26.4 mmol/l) or an increase of 150 % or more (1.5-fold) from baseline. The cause of AKI in cirrhosis is multifactorial and is unique in terms of pathogenesis. The most common causes of AKI in cirrhosis can be subdivided into either functional or structural. The functional group includes volume-responsive (prerenal azotemia) and volume-unresponsive states (hepatorenal syndrome). Volume responsive is the most common type of AKI due to frequent use of diuretics, large volume abdominal paracentesis and gastrointestinal bleeding in patients with liver disease. The structural causes include acute tubular necrosis, tubulointerstitial and glomerular diseases. Patients with decompensated cirrhosis are in a vasodilatory state leading to a decrease in effective arterial blood volume, predisposing to AKI. Therefore, management of AKI depends on the underlying cause, and therapy should be directed toward removal of the cause. The outcome in cirrhosis when patients are on dialysis is very dismal. Every effort should be made to prevent AKI.

Journal of Hepatology, 2014

Journal of Hepatology, 2014