ratan jha - Academia.edu (original) (raw)

Papers by ratan jha

Endocrine Practice, 2010

Case Presentation: A 19-year-old white man with uncontrolled type 1 diabetes mellitus (hemoglobin... more Case Presentation: A 19-year-old white man with uncontrolled type 1 diabetes mellitus (hemoglobin A1c, 12.7%) was admitted to the intensive care unit and treated for diabetic ketoacidosis. He underwent computed tomography of the abdomen and pelvis because of persistent abdominal pain. Computed tomography revealed hepatomegaly with liver span of 15 cm (Fig. 1). The patient had intermittent transaminitis over the past year with negative workup for autoimmune and infectious etiologies. He had been diagnosed with nonalcoholic steatohepatitis. He reported no alcohol or drug use; acetaminophen level was undetectable. Coagulation studies and total protein and albumin were normal. His hepatic enzyme concentrations had risen from before hospitalization: aspartate aminotransferase, from 44 IU/L to 262 IU/L; alanine aminotransferase, from 125 IU/L to 519 IU/L; alkaline phosphatase, from 113 IU/L to 161 IU/L. There were no elevations in bilirubin or creatinine kinase, nor was there a decrease in renal function. By the day of discharge, his hepatic transaminases had trended back to baseline. Ultrasonography-guided liver biopsy was performed, and diffusely pale-staining hepatocytes with excessive glycogen accumulation on periodic acid–Schiff stain were seen (Fig. 2). Glycogenated nuclei were scattered throughout the parenchyma, and rare macrovesicular fat droplets were present. What is the diagnosis?

Journal of Renal Nutrition and Metabolism, 2020

International Journal of Diabetes in Developing Countries, 2007

ABSTRACT

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2010

Increased predilection for hypokalemia-induced rhabdomyolysis has been noted in pregnant women. W... more Increased predilection for hypokalemia-induced rhabdomyolysis has been noted in pregnant women. We managed a woman with distal renal tubular acidosis (RTA) with persistent hypokalemia who presented with recurrent rhabdomyolysis in her consecutive pregnancies despite adequate potassium citrate therapy.

Journal of the Scientific Society, 2014

Elevation of cardiac enzymes and troponins particularly in settings of sepsis and renal failure m... more Elevation of cardiac enzymes and troponins particularly in settings of sepsis and renal failure may cloud the diagnostic picture of acute coronary syndrome in many cases. Interpretation of such elevated enzymes thus warrants caution. It necessitates adequate awareness amongst clinicians, of conditions with such elevation in the absence of myocardial ischemia/infarction as well as those that harbinger false positives. We discuss one such case that posed a diagnostic dilemma and review the pertinent literature.

Endocrine Practice, 2008

Objective: To present 4 cases of distal renal tubular acidosis (RTA) in patients with primary hyp... more Objective: To present 4 cases of distal renal tubular acidosis (RTA) in patients with primary hyperparathyroidism (PHPT) and discuss their possible etiopathogenetic correlation. Methods: We diagnosed distal RTA in 4 patients with symptomatic primary PHPT on the basis of the baseline biochemical variables and the results of the ammonium chloride loading test. Complete resolution of distal RTA was documented after surgical cure of PHPT by removal of a parathyroid adenoma. Results: All our patients presented with symptomatic bone disease and metabolic myopathy. One patient presented with recurrent renal stones. Inappropriately alkaline fasting urine (pH >5.5) in association with a normal anion gap metabolic acidosis suggested the diagnosis of distal RTA. All cases were confirmed by an ammonium chloride loading test. Three patients responded to surgical cure of PHPT by normalization of the acid-base status. Conclusion: Hypercalciuria in PHPT can lead to nephrocalcinosis and renal tubular dysfunction, which manifests as distal RTA. Cure of distal RTA after surgical treatment of PHPT establishes PHPT as the primary cause of distal RTA in these cases.

The Journal of the Association of Physicians of India, 2008

Widely prevalent vitamin D deficiency and delayed diagnosis contributes to severe symptomatic pri... more Widely prevalent vitamin D deficiency and delayed diagnosis contributes to severe symptomatic primary hyperparathyroidism in India. We analysed fifty one consecutive patients of primary hyperparathyroidism managed at our centre. All of them were symptomatic. Retrospective analysis. Fifty one consecutive cases of symptomatic primary hyperparathyroidism, presenting to our centre from January 1994 to May 2007 were retrospectively analyzed. Clinical presentation, biochemical, radiological and details of underlying parathyroid lesion were noted. A total of 51 cases of primary hyperparathyroidism were studied. Mean age was 39.5 +/- 11.5 yrs (Range 13 to 70 years, Female: Male 2:1). Mean duration of symptoms was 35.8 + 29.1 months. Bone pains and painful proximal myopathy were the commonest presentation (24/51), followed by pathological fractures in 12 cases. Distal Renal tubular acidosis was diagnosed in 4 cases, 3 of whom normalized after surgery. At initial evaluation, twenty one patien...

Indian Journal of Nephrology, 2001

... Mortality due to HBV in hemodialysis: Effect of vaccination. J Nephrol 1993; 6: 98-102. 3. Th... more ... Mortality due to HBV in hemodialysis: Effect of vaccination. J Nephrol 1993; 6: 98-102. 3. Thomas PP, Kirubhakaran MG, Jacob CK, Srinivas NS, Hariharan S, John TJ, Shastry JCM. Hepatitis B infection in dialysis unit in South India. JAPI 1987; 35: 284-85. ...

Unilateral renal agenesis (URA) is a developmental defect associated with ano-malies of the genit... more Unilateral renal agenesis (URA) is a developmental defect associated with ano-malies of the genitourinary system. The associations vary from absence of testis alone to high anorectal anomalies in other patients. We present two interesting patients with URA, encountered recently. Our first case was diagnosed with URA at the age of 11 years, which was detected on sonography, when he presented with pain abdomen. The presence of an epididymal cyst masked the absence of ipsilateral testes leading to delay in the diagnosis. Our second case was diagnosed with URA during the neonatal period when he presented with anorectal agenesis. He underwent abdomino-anal pull-through operation and later clinical course was complicated by recurrent cystitis, secondary vesicoureteral reflux and hydroureteronephrosis of solitary kidney, progressing to chronic kidney disease.

Indian Journal of Nephrology

Journal of Renal Nutrition and Metabolism

Chronic kidney disease (CKD) is a state of exaggerated oxidative stress and chronic inflammation.... more Chronic kidney disease (CKD) is a state of exaggerated oxidative stress and chronic inflammation. The syndrome of CKD culminates in three spheres of dysfunction namely: accumulation of uremic toxins, oxidative stress and progressive systemic inflammation. It is postulated that uremic as well as non-uremic solutes may play an important role in worsening oxidative stress and activating many other inimical pathways which results in endothelial dysfunction and cytokine driven inflammatory process. This article briefly touches upon biomarkers and treatment strategies targeting uremia, oxidative stress and inflammation.

Manual of Nephrology, 2016

Indian Journal of Endocrinology and Metabolism, 2016

Primary hyperparathyroidism (PHPT) in India, unlike in the Western world, is largely asymptomatic... more Primary hyperparathyroidism (PHPT) in India, unlike in the Western world, is largely asymptomatic disease. Due to lack of awareness and routine calcium estimation, delayed presentation and co-existing calcium and Vitamin D (Vit D) deficiency, bone and other systemic involvement are more commonly seen. [1] With greater awareness among physicians, widespread use of AutoAnalyzers, and increasing trend of

Clinical Kidney Journal, 2012

Journal of the Indian Medical Association, 2013

Acute transverse myelitis is a well known neurological complication occurring in systemic lupus e... more Acute transverse myelitis is a well known neurological complication occurring in systemic lupus erythematosus. Many prior studies have shown a link between transverse myelitis and the presence of antiphospholipid antibodies. Earlier theories have linked thrombotic tendency to be the culprit in such manifestations but currently there is evidence to support other causative mechanisms. A case of a young female diagnosed as systemic lupus erythematosus has been reported who presented with acute transverse myelitis and was found to be seronegative for antiphospholipid antibody. It is important to pay heed to and accordingly treat complications like acute transverse myelitis that occur regardless of antiphospholipid antibody positivity in a systemic lupus erythematosus setting.

Endocrine Practice, 2010

Case Presentation: A 19-year-old white man with uncontrolled type 1 diabetes mellitus (hemoglobin... more Case Presentation: A 19-year-old white man with uncontrolled type 1 diabetes mellitus (hemoglobin A1c, 12.7%) was admitted to the intensive care unit and treated for diabetic ketoacidosis. He underwent computed tomography of the abdomen and pelvis because of persistent abdominal pain. Computed tomography revealed hepatomegaly with liver span of 15 cm (Fig. 1). The patient had intermittent transaminitis over the past year with negative workup for autoimmune and infectious etiologies. He had been diagnosed with nonalcoholic steatohepatitis. He reported no alcohol or drug use; acetaminophen level was undetectable. Coagulation studies and total protein and albumin were normal. His hepatic enzyme concentrations had risen from before hospitalization: aspartate aminotransferase, from 44 IU/L to 262 IU/L; alanine aminotransferase, from 125 IU/L to 519 IU/L; alkaline phosphatase, from 113 IU/L to 161 IU/L. There were no elevations in bilirubin or creatinine kinase, nor was there a decrease in renal function. By the day of discharge, his hepatic transaminases had trended back to baseline. Ultrasonography-guided liver biopsy was performed, and diffusely pale-staining hepatocytes with excessive glycogen accumulation on periodic acid–Schiff stain were seen (Fig. 2). Glycogenated nuclei were scattered throughout the parenchyma, and rare macrovesicular fat droplets were present. What is the diagnosis?

Journal of Renal Nutrition and Metabolism, 2020

International Journal of Diabetes in Developing Countries, 2007

ABSTRACT

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2010

Increased predilection for hypokalemia-induced rhabdomyolysis has been noted in pregnant women. W... more Increased predilection for hypokalemia-induced rhabdomyolysis has been noted in pregnant women. We managed a woman with distal renal tubular acidosis (RTA) with persistent hypokalemia who presented with recurrent rhabdomyolysis in her consecutive pregnancies despite adequate potassium citrate therapy.

Journal of the Scientific Society, 2014

Elevation of cardiac enzymes and troponins particularly in settings of sepsis and renal failure m... more Elevation of cardiac enzymes and troponins particularly in settings of sepsis and renal failure may cloud the diagnostic picture of acute coronary syndrome in many cases. Interpretation of such elevated enzymes thus warrants caution. It necessitates adequate awareness amongst clinicians, of conditions with such elevation in the absence of myocardial ischemia/infarction as well as those that harbinger false positives. We discuss one such case that posed a diagnostic dilemma and review the pertinent literature.

Endocrine Practice, 2008

Objective: To present 4 cases of distal renal tubular acidosis (RTA) in patients with primary hyp... more Objective: To present 4 cases of distal renal tubular acidosis (RTA) in patients with primary hyperparathyroidism (PHPT) and discuss their possible etiopathogenetic correlation. Methods: We diagnosed distal RTA in 4 patients with symptomatic primary PHPT on the basis of the baseline biochemical variables and the results of the ammonium chloride loading test. Complete resolution of distal RTA was documented after surgical cure of PHPT by removal of a parathyroid adenoma. Results: All our patients presented with symptomatic bone disease and metabolic myopathy. One patient presented with recurrent renal stones. Inappropriately alkaline fasting urine (pH >5.5) in association with a normal anion gap metabolic acidosis suggested the diagnosis of distal RTA. All cases were confirmed by an ammonium chloride loading test. Three patients responded to surgical cure of PHPT by normalization of the acid-base status. Conclusion: Hypercalciuria in PHPT can lead to nephrocalcinosis and renal tubular dysfunction, which manifests as distal RTA. Cure of distal RTA after surgical treatment of PHPT establishes PHPT as the primary cause of distal RTA in these cases.

The Journal of the Association of Physicians of India, 2008

Widely prevalent vitamin D deficiency and delayed diagnosis contributes to severe symptomatic pri... more Widely prevalent vitamin D deficiency and delayed diagnosis contributes to severe symptomatic primary hyperparathyroidism in India. We analysed fifty one consecutive patients of primary hyperparathyroidism managed at our centre. All of them were symptomatic. Retrospective analysis. Fifty one consecutive cases of symptomatic primary hyperparathyroidism, presenting to our centre from January 1994 to May 2007 were retrospectively analyzed. Clinical presentation, biochemical, radiological and details of underlying parathyroid lesion were noted. A total of 51 cases of primary hyperparathyroidism were studied. Mean age was 39.5 +/- 11.5 yrs (Range 13 to 70 years, Female: Male 2:1). Mean duration of symptoms was 35.8 + 29.1 months. Bone pains and painful proximal myopathy were the commonest presentation (24/51), followed by pathological fractures in 12 cases. Distal Renal tubular acidosis was diagnosed in 4 cases, 3 of whom normalized after surgery. At initial evaluation, twenty one patien...

Indian Journal of Nephrology, 2001

... Mortality due to HBV in hemodialysis: Effect of vaccination. J Nephrol 1993; 6: 98-102. 3. Th... more ... Mortality due to HBV in hemodialysis: Effect of vaccination. J Nephrol 1993; 6: 98-102. 3. Thomas PP, Kirubhakaran MG, Jacob CK, Srinivas NS, Hariharan S, John TJ, Shastry JCM. Hepatitis B infection in dialysis unit in South India. JAPI 1987; 35: 284-85. ...

Unilateral renal agenesis (URA) is a developmental defect associated with ano-malies of the genit... more Unilateral renal agenesis (URA) is a developmental defect associated with ano-malies of the genitourinary system. The associations vary from absence of testis alone to high anorectal anomalies in other patients. We present two interesting patients with URA, encountered recently. Our first case was diagnosed with URA at the age of 11 years, which was detected on sonography, when he presented with pain abdomen. The presence of an epididymal cyst masked the absence of ipsilateral testes leading to delay in the diagnosis. Our second case was diagnosed with URA during the neonatal period when he presented with anorectal agenesis. He underwent abdomino-anal pull-through operation and later clinical course was complicated by recurrent cystitis, secondary vesicoureteral reflux and hydroureteronephrosis of solitary kidney, progressing to chronic kidney disease.

Indian Journal of Nephrology

Journal of Renal Nutrition and Metabolism

Chronic kidney disease (CKD) is a state of exaggerated oxidative stress and chronic inflammation.... more Chronic kidney disease (CKD) is a state of exaggerated oxidative stress and chronic inflammation. The syndrome of CKD culminates in three spheres of dysfunction namely: accumulation of uremic toxins, oxidative stress and progressive systemic inflammation. It is postulated that uremic as well as non-uremic solutes may play an important role in worsening oxidative stress and activating many other inimical pathways which results in endothelial dysfunction and cytokine driven inflammatory process. This article briefly touches upon biomarkers and treatment strategies targeting uremia, oxidative stress and inflammation.

Manual of Nephrology, 2016

Indian Journal of Endocrinology and Metabolism, 2016

Primary hyperparathyroidism (PHPT) in India, unlike in the Western world, is largely asymptomatic... more Primary hyperparathyroidism (PHPT) in India, unlike in the Western world, is largely asymptomatic disease. Due to lack of awareness and routine calcium estimation, delayed presentation and co-existing calcium and Vitamin D (Vit D) deficiency, bone and other systemic involvement are more commonly seen. [1] With greater awareness among physicians, widespread use of AutoAnalyzers, and increasing trend of

Clinical Kidney Journal, 2012

Journal of the Indian Medical Association, 2013

Acute transverse myelitis is a well known neurological complication occurring in systemic lupus e... more Acute transverse myelitis is a well known neurological complication occurring in systemic lupus erythematosus. Many prior studies have shown a link between transverse myelitis and the presence of antiphospholipid antibodies. Earlier theories have linked thrombotic tendency to be the culprit in such manifestations but currently there is evidence to support other causative mechanisms. A case of a young female diagnosed as systemic lupus erythematosus has been reported who presented with acute transverse myelitis and was found to be seronegative for antiphospholipid antibody. It is important to pay heed to and accordingly treat complications like acute transverse myelitis that occur regardless of antiphospholipid antibody positivity in a systemic lupus erythematosus setting.