Sahil bagai | PGIMER,CHD,India - Academia.edu (original) (raw)

Papers by Sahil bagai

Case Reports in Nephrology and Dialysis

There has been a parallel rise in the need for bariatric surgery as the prevalence of obesity has... more There has been a parallel rise in the need for bariatric surgery as the prevalence of obesity has increased by leaps and bounds over the last 2 decades. Certain procedures like Roux-en-Y gastric bypass are associated with nephrolithiasis, hyperoxaluria, and, rarely, oxalate nephropathy. We report an interesting case of a patient who had relentless progression of his kidney disease post-bariatric surgery.

SN Comprehensive Clinical Medicine

Cardiac involvement occurs in an almost one quarter of all the patients with lung cancer. Lymphat... more Cardiac involvement occurs in an almost one quarter of all the patients with lung cancer. Lymphatogenous spread is a more common route of tumor dissemination than the hematogenous spread. It was a retrospective case report. We hereby report a case of myocardial involvement by non-small cell lung cancer leading to an uncommon presentation of a malignant stroke and death in a peritoneal dialysis patient.

Indian Journal of Clinical Biochemistry

Postgraduate Medical Journal, Apr 7, 2022

Indian Journal of Medical Specialities, 2022

Indian Journal of Medical Specialities, 2022

Background: The mortality of kidney transplant recipients (KTR) affected with coronavirus disease... more Background: The mortality of kidney transplant recipients (KTR) affected with coronavirus disease-2019 (COVID-19) is reported to be higher than the general population. There is a scarcity of data on the pattern and outcome of COVID-19 in KTRs in developing country like India. Materials and Methods: It was a retrospective study conducted in a tertiary care center in North India. The detailed data on the Covid-19 affected KTR admitted to our center from March 2020 to March 2021 was obtained from computerized records. Clinical and biochemical characteristics of the survivors and nonsurvivors were studied. The factors affecting the mortality in this cohort were analyzed. Results: Of the 35 participants, 25 (71.4%) were males. The mean age was 53.06 ± 11.84 years. Overall, mortality was 17.1% (Six out of 35). There was a significant difference in the oxygen saturation at presentation, computed tomography severity scores, level of inflammatory markers, level of serum albumin, and the abso...

Asian Journal of Research in Infectious Diseases, 2022

Background and Aim: Coronavirus disease 2019 (COVID-19) in kidney transplant recipients (KTR) is ... more Background and Aim: Coronavirus disease 2019 (COVID-19) in kidney transplant recipients (KTR) is associated with an increased risk of complications than in the general population. The double mutant variant of the coronavirus was responsible for the deadly second wave of the pandemic in India. So, we conducted this retrospective case study to look for the pattern and outcome of the hospitalized KTR affected with COVID-19 in our tertiary care center during the second wave. Study Design: This was single centre retrospective study. Place and Duration of Study: COVID-19 affected KTR admitted to Max Super Speciality Hospital, Saket, New Delhi during the second wave of the pandemic in the months of April and May 2021 were included in the study. Materials and Methods: All the necessary data were taken from the computerised records. Clinical and biochemical characteristics of the survivors and non-survivors were studied. The factors associated mortality were analysed. Results: Out of the 16 ...

Indian Journal of Medical Microbiology, 2019

Post-renal transplant fungal infections continue to be a major cause of mortality and morbidity. ... more Post-renal transplant fungal infections continue to be a major cause of mortality and morbidity. Universally reported fungi are Candida, especially Candida albicans, Cryptococcus, Aspergillus, Trichophyton rubrum and Pityriasis versicolor. Here, we report a case of infection caused by a rare fungus Diaporthe. It is an endophyte reported as plant pathogens and infrequently in humans and mammals. The patient was a renal transplant recipient on immunosuppressant. He had hypothyroidism and diagnosed with permanent pacemaker due to a complete heart block. The patient was treated with itraconazole (200 mg) successfully.

Indian Journal of Transplantation, 2019

Invasive mycosis is a serious complication of solid organ transplantation. Fungal infections even... more Invasive mycosis is a serious complication of solid organ transplantation. Fungal infections even if appropriately diagnosed and treated with current antifungal agents, have a high mortality rate. A high index of suspicion is required and an attempt should be made to confirm the microbiological diagnosis from each site involved to rule out multiple infections. We report here a 41-year-old allograft recipient, who presented with fever associated with chills and one episode of generalized tonic clonic seizure 1-year post transplantation. Neuroimaging revealed a brain abscess, stereotactic biopsy from which yielded Scedosporium apiospermum on fungal culture. Whole blood quantitative cytomegalovirus (CMV) polymerase chain reaction done was positive. He also developed pulmonary aspergillosis and secondary hemophagocytosis later in the course of his hospital stay. His tacrolimus and mycophenolate were stopped and he was managed with i.v ganciclovir, amphoterecin b, voriconazole, high dose i.v immunoglobulins and surgical draingae of abscess. With all measures, he showed improvement in his general and neurological condition and maintained good graft function. Scedosporium is a rare cause of brain abscess. CMV co-infection leads to increased chances of other opportunistic infections. Good microbiological workup from each site involved in immunosuppressed subjects is the need of the hour as early diagnosis can lead to lesser mortality and morbidity.

Indian Journal of Transplantation, 2019

Introduction: Renal transplant recipients now have better graft survival rates, but continue to d... more Introduction: Renal transplant recipients now have better graft survival rates, but continue to develop opportunistic infections. The present study was aimed at finding the incidence of opportunistic infections in the tropical environment in live-related transplant recipients. Materials and Methods: The study was carried out retrospectively with the help of medical records at a tertiary care hospital in North India from 2006 to 2010. The demographic and transplant details were noted, and data were analyzed for any possible risk factor. Results: A total of 1270 patients were studied, of which 231 infectious episodes were detected in 196 (15.4%) patients. Within 1 month, 11.7% of patients had infection, whereas 68.4% of patients had at least one infectious episode within the first 6 months of transplant. Bacterial infection (5.9%) followed by tuberculosis (4.9%), viral (3.8%), and fungal (2.1%) were the infections encountered. Aspergillosis (32.1%) was the most common fungal infection, followed by candidiasis and mucormycosis. The most common site of involvement was lung (26.4%), followed by urinary tract (13.0%). The overall patient survival was nearly 90%. Only 20% of patients had functional graft on follow-up in whom the graft was directly involved by a particular infection. Conclusions: Posttransplant infections continue to affect graft and patient survival. Higher rates are seen in the first 6 months posttransplant.

Indian Journal of Nephrology, 2019

Granulomatosis with polyangiitis (GPA) commonly affects upper/lower respiratory tract and kidneys... more Granulomatosis with polyangiitis (GPA) commonly affects upper/lower respiratory tract and kidneys. It causes necrotizing vasculitis of small and medium-sized blood vessels. Gastrointestinal (GI) involvement is an uncommon manifestation of GPA, and presentation with predominant GI manifestation is noteworthy. We report a case of 50-year-old male with melena due to GI vasculitis along with other systemic involvement. The patient was treated with pulse methylprednisolone, cyclophosphamide, and plasmapheresis. To manage the refractory GI bleed, the patient underwent surgical resection, and the histology of the surgical specimen confirmed necrotizing vasculitis.

Indian Journal of Transplantation, 2016

Malleefowl attacked by Brown Goshawk BIRD WATCHER Short Notes-Juvenile Golden Whistler and Juveni... more Malleefowl attacked by Brown Goshawk BIRD WATCHER Short Notes-Juvenile Golden Whistler and Juvenile Pied Currawong Eating Native Fruits The 1985 BOC Christmas camp was held at Noorinbee North, Victoria, some 18 km from the Cann River township along the Bombala road. At Log Creek near the camp site Mesdames Pam and Bess Kirton observed a female Golden Whistler Pachycephala pectoralis feeding a fledged offspring with ripe purple drupes from a Muttonwood tree Rapanea howittiana. A few hundred metres upstream two Pied Currawongs Strepera graculina were perched in a Pale-fruit Ball art Exocarpos strict a and feeding on the fruit comprising a fleshy pale lilac-coloured pedicel tipped by a dark seed body. On closer approach the adult flew off and perched in a tree some 20 m away. The juvenile continued to feed, taking and swallowing the fruit one at a time, and calling softly meanwhile. After a few minutes it flew to rejoin the adult. Golden Whistlers are known to eat some berries (Macdonald 1973) and Pied Currawongs are well known as consumers of exotic fruits (e.g. Blakers et al. 1984), but the specific identity of native fruits taken by these species has seldom been recorded. It is also noteworthy that fruits rather than insects were fed to the fledgling Golden Whistler.

Indian Journal of Nephrology

Saudi Journal of Kidney Diseases and Transplantation

Indian Journal of Transplantation

Hemodialysis International

The Journal of the Association of Physicians of India, 2019

Aim To determine the proportion of patients who have Acute Kidney Injury (AKI), identify severity... more Aim To determine the proportion of patients who have Acute Kidney Injury (AKI), identify severity of AKI using RIFLE criteria and to identify associated factors with AKI. Methods One thousand consecutive medical in-patients were screened for AKI and severity assessed using RIFLE criteria in tertiary care hospital in Northern India. Patients with medical renal disease and obstructive uropathy were excluded. Serum creatinine of all patients were done on days 0, 3, 7 and 14. CKD cases were also excluded. AKI patients were followed at 4 weeks and 3 months. Results Amongst 1000 patients screened, 65 had AKI. 27(41.5%), 15(23.0%) and 23(35.38%) patients belonged to risk, injury and failure classes of AKI respectively as per RIFLE criteria, and there was incremental risk of mortality (25.92%, 46.33% and 86.95%, p<0.001). In-patients with pneumonia, chronic liver disease and acute gastroenteritis have greater odds of developing AKI, with chronic liver disease having a high mortality (90%...

Indian Journal of Nephrology

406 Indian Journal of Nephrology | Volume 28 | Issue 5 | September-October 2018 3. Bianchini G, F... more 406 Indian Journal of Nephrology | Volume 28 | Issue 5 | September-October 2018 3. Bianchini G, Festuccia F, Laverde G, Cinotti GA. IgA myeloma: A potential outcome of IgA nephropathy. Nephrol Dial Transplant 1999;14:2780‐2. 4. Mustonen J, Pasternack A, Helin H. IgA mesangial nephropathy in neoplastic diseases. Contrib Nephrol 1984;40:283‐91. 5. Cambier JF, Ronco P. Onco‐nephrology: Glomerular diseases with cancer. Clin J Am Soc Nephrol 2012;7:1701‐12. 6. Feehally J. Immune mechanisms in glomerular IgA deposition. Nephrol Dial Transplant 1988;3:361‐78. 7. Feehally J, Allen AC. Structural features of IgA molecules which contribute to IgA nephropathy. J Nephrol 1999;12:59‐65. 8. Tomana M, Novak J, Julian BA, Matousovic K, Konecny K, Mestecky J, et al. Circulating immune complexes in IgA nephropathy consist of IgA1 with galactose‐deficient hinge region and antiglycan antibodies. J Clin Invest 1999;104:73‐81. 9. Forslund T, Sikiö A, Anttinen J. IgA nephropathy in a patient with IgG lambda light‐chain plasmacytoma: A rare coincidence. Nephrol Dial Transplant 2007;22:2705‐8. 10. Chandra A, Kaul A, Aggarwal V. Immunoglobulin A nephropathy in a patient with IgG kappa light‐chain myeloma. Saudi J Kidney Dis Transpl 2017;28:937‐41. 11. Dosa S, Cairns SA, Mallick NP, Lawler W, Williams G. Relapsing Henoch‐Schönlein syndrome with renal involvement in a patient with an IgA monoclonal gammopathy. A study of the results of immunosuppressant and cytotoxic therapy. Nephron 1980;26:145‐8. 12. Birchmore D, Sweeney C, Choudhury D, Konwinski MF, Carnevale K, D’Agati V, et al. IgA multiple myeloma presenting How to cite this article: Lakshmi BS, Padmavathi Devi SV, Sameera NS, Reddy AS, Ram R, Kumar VS. IgA nephropathy in a patient with IgG myeloma. Indian J Nephrol 2018;28:404-6.

Kidney International Reports

Tacrolimus is the mainstay of immunosuppression in renal transplantation (RT). However, it has hi... more Tacrolimus is the mainstay of immunosuppression in renal transplantation (RT). However, it has highly variable bioavailability and a narrow therapeutic range. Its metabolism depends upon CYP3A4 and ABCB1gene polymorphism. There is limited data regarding the influence of this polymorphisms on TAC drug level and complications from India. Methods: This is a prospective study done over a period of 2 years (2016-2018) from NIMS Hyderabad. A total of 152 patients were recruited. Frequency of CYP3AB(A6986>G) & ABCB1 (C1236>T, G2677>T and C3435>T) polymorphisms were detected by PCR followed by Sanger's sequence-based genotype & RFLP. Accordingly patients were divided into wild variant(CYP3A5-AA) where there is full expression of the enzyme, heterozygous(CYP3A5-AG), homozygous group who were non expressors (CYP3A5-GG). Day 3, 30,60,90 tacrolimus concentrations and tacrolimus concentration/drug (C/D) ratio were measured. Tacrolimus related toxicity, infections and rejections and the serum creatinine at the time of discharge were compared among the groups Results: Out of 152 renal transplant recipients, 120(78%) were males. 37 patients received deceased donor grafts.. Immediate graft function was seen in 117(76%). Tacrolimus C/D ratio was less in wild (AA) variety compared to both AG (0.006) and GG (P<o.ooo1). Tacrolimus toxicity was noted in 28(18%) patients, of which ATN 24(85%), TMA 3(11%), Pancreatitis in 1(3.5%). Most common infectious complication was UTI seen in 22(14%) patients (AA-3(10%), AG-9(14%), GG-10 (16.7%) followed by CMV disease. BPAR were seen in 5 patients. ABCB1 polymorphisms and showed no correlation with tacrolimus C/D ratio. Mean serum creatinine at the time of discharge was 1AE0.2 in AA, 1.3AE0.8 in AG (AA vs AG P < 0.002), 1.27AE0.47 in GG(AA vs GG P <0.004). Conclusions: Our study shows that genetic polymorphism effects the tacrolimus dose requirement. Enzyme expressor (AA) is associated with low C/D ratio and higher risk of acute rejection. Heterozygous (AG) and non expressors (GG) are at higher risk of developing tacrolimus related nephrotoxicity and infections. ABCB1 polymorphisms has no significant impact on tacrolimus C/D ratio Hence tacrolimus related complications can be predicted prior to renal transplant by analyzing CYP3A5 genetic polymorphisms and doses can be adjusted in order to prevent the complications.

Case Reports in Nephrology and Dialysis

There has been a parallel rise in the need for bariatric surgery as the prevalence of obesity has... more There has been a parallel rise in the need for bariatric surgery as the prevalence of obesity has increased by leaps and bounds over the last 2 decades. Certain procedures like Roux-en-Y gastric bypass are associated with nephrolithiasis, hyperoxaluria, and, rarely, oxalate nephropathy. We report an interesting case of a patient who had relentless progression of his kidney disease post-bariatric surgery.

SN Comprehensive Clinical Medicine

Cardiac involvement occurs in an almost one quarter of all the patients with lung cancer. Lymphat... more Cardiac involvement occurs in an almost one quarter of all the patients with lung cancer. Lymphatogenous spread is a more common route of tumor dissemination than the hematogenous spread. It was a retrospective case report. We hereby report a case of myocardial involvement by non-small cell lung cancer leading to an uncommon presentation of a malignant stroke and death in a peritoneal dialysis patient.

Indian Journal of Clinical Biochemistry

Postgraduate Medical Journal, Apr 7, 2022

Indian Journal of Medical Specialities, 2022

Indian Journal of Medical Specialities, 2022

Background: The mortality of kidney transplant recipients (KTR) affected with coronavirus disease... more Background: The mortality of kidney transplant recipients (KTR) affected with coronavirus disease-2019 (COVID-19) is reported to be higher than the general population. There is a scarcity of data on the pattern and outcome of COVID-19 in KTRs in developing country like India. Materials and Methods: It was a retrospective study conducted in a tertiary care center in North India. The detailed data on the Covid-19 affected KTR admitted to our center from March 2020 to March 2021 was obtained from computerized records. Clinical and biochemical characteristics of the survivors and nonsurvivors were studied. The factors affecting the mortality in this cohort were analyzed. Results: Of the 35 participants, 25 (71.4%) were males. The mean age was 53.06 ± 11.84 years. Overall, mortality was 17.1% (Six out of 35). There was a significant difference in the oxygen saturation at presentation, computed tomography severity scores, level of inflammatory markers, level of serum albumin, and the abso...

Asian Journal of Research in Infectious Diseases, 2022

Background and Aim: Coronavirus disease 2019 (COVID-19) in kidney transplant recipients (KTR) is ... more Background and Aim: Coronavirus disease 2019 (COVID-19) in kidney transplant recipients (KTR) is associated with an increased risk of complications than in the general population. The double mutant variant of the coronavirus was responsible for the deadly second wave of the pandemic in India. So, we conducted this retrospective case study to look for the pattern and outcome of the hospitalized KTR affected with COVID-19 in our tertiary care center during the second wave. Study Design: This was single centre retrospective study. Place and Duration of Study: COVID-19 affected KTR admitted to Max Super Speciality Hospital, Saket, New Delhi during the second wave of the pandemic in the months of April and May 2021 were included in the study. Materials and Methods: All the necessary data were taken from the computerised records. Clinical and biochemical characteristics of the survivors and non-survivors were studied. The factors associated mortality were analysed. Results: Out of the 16 ...

Indian Journal of Medical Microbiology, 2019

Post-renal transplant fungal infections continue to be a major cause of mortality and morbidity. ... more Post-renal transplant fungal infections continue to be a major cause of mortality and morbidity. Universally reported fungi are Candida, especially Candida albicans, Cryptococcus, Aspergillus, Trichophyton rubrum and Pityriasis versicolor. Here, we report a case of infection caused by a rare fungus Diaporthe. It is an endophyte reported as plant pathogens and infrequently in humans and mammals. The patient was a renal transplant recipient on immunosuppressant. He had hypothyroidism and diagnosed with permanent pacemaker due to a complete heart block. The patient was treated with itraconazole (200 mg) successfully.

Indian Journal of Transplantation, 2019

Invasive mycosis is a serious complication of solid organ transplantation. Fungal infections even... more Invasive mycosis is a serious complication of solid organ transplantation. Fungal infections even if appropriately diagnosed and treated with current antifungal agents, have a high mortality rate. A high index of suspicion is required and an attempt should be made to confirm the microbiological diagnosis from each site involved to rule out multiple infections. We report here a 41-year-old allograft recipient, who presented with fever associated with chills and one episode of generalized tonic clonic seizure 1-year post transplantation. Neuroimaging revealed a brain abscess, stereotactic biopsy from which yielded Scedosporium apiospermum on fungal culture. Whole blood quantitative cytomegalovirus (CMV) polymerase chain reaction done was positive. He also developed pulmonary aspergillosis and secondary hemophagocytosis later in the course of his hospital stay. His tacrolimus and mycophenolate were stopped and he was managed with i.v ganciclovir, amphoterecin b, voriconazole, high dose i.v immunoglobulins and surgical draingae of abscess. With all measures, he showed improvement in his general and neurological condition and maintained good graft function. Scedosporium is a rare cause of brain abscess. CMV co-infection leads to increased chances of other opportunistic infections. Good microbiological workup from each site involved in immunosuppressed subjects is the need of the hour as early diagnosis can lead to lesser mortality and morbidity.

Indian Journal of Transplantation, 2019

Introduction: Renal transplant recipients now have better graft survival rates, but continue to d... more Introduction: Renal transplant recipients now have better graft survival rates, but continue to develop opportunistic infections. The present study was aimed at finding the incidence of opportunistic infections in the tropical environment in live-related transplant recipients. Materials and Methods: The study was carried out retrospectively with the help of medical records at a tertiary care hospital in North India from 2006 to 2010. The demographic and transplant details were noted, and data were analyzed for any possible risk factor. Results: A total of 1270 patients were studied, of which 231 infectious episodes were detected in 196 (15.4%) patients. Within 1 month, 11.7% of patients had infection, whereas 68.4% of patients had at least one infectious episode within the first 6 months of transplant. Bacterial infection (5.9%) followed by tuberculosis (4.9%), viral (3.8%), and fungal (2.1%) were the infections encountered. Aspergillosis (32.1%) was the most common fungal infection, followed by candidiasis and mucormycosis. The most common site of involvement was lung (26.4%), followed by urinary tract (13.0%). The overall patient survival was nearly 90%. Only 20% of patients had functional graft on follow-up in whom the graft was directly involved by a particular infection. Conclusions: Posttransplant infections continue to affect graft and patient survival. Higher rates are seen in the first 6 months posttransplant.

Indian Journal of Nephrology, 2019

Granulomatosis with polyangiitis (GPA) commonly affects upper/lower respiratory tract and kidneys... more Granulomatosis with polyangiitis (GPA) commonly affects upper/lower respiratory tract and kidneys. It causes necrotizing vasculitis of small and medium-sized blood vessels. Gastrointestinal (GI) involvement is an uncommon manifestation of GPA, and presentation with predominant GI manifestation is noteworthy. We report a case of 50-year-old male with melena due to GI vasculitis along with other systemic involvement. The patient was treated with pulse methylprednisolone, cyclophosphamide, and plasmapheresis. To manage the refractory GI bleed, the patient underwent surgical resection, and the histology of the surgical specimen confirmed necrotizing vasculitis.

Indian Journal of Transplantation, 2016

Malleefowl attacked by Brown Goshawk BIRD WATCHER Short Notes-Juvenile Golden Whistler and Juveni... more Malleefowl attacked by Brown Goshawk BIRD WATCHER Short Notes-Juvenile Golden Whistler and Juvenile Pied Currawong Eating Native Fruits The 1985 BOC Christmas camp was held at Noorinbee North, Victoria, some 18 km from the Cann River township along the Bombala road. At Log Creek near the camp site Mesdames Pam and Bess Kirton observed a female Golden Whistler Pachycephala pectoralis feeding a fledged offspring with ripe purple drupes from a Muttonwood tree Rapanea howittiana. A few hundred metres upstream two Pied Currawongs Strepera graculina were perched in a Pale-fruit Ball art Exocarpos strict a and feeding on the fruit comprising a fleshy pale lilac-coloured pedicel tipped by a dark seed body. On closer approach the adult flew off and perched in a tree some 20 m away. The juvenile continued to feed, taking and swallowing the fruit one at a time, and calling softly meanwhile. After a few minutes it flew to rejoin the adult. Golden Whistlers are known to eat some berries (Macdonald 1973) and Pied Currawongs are well known as consumers of exotic fruits (e.g. Blakers et al. 1984), but the specific identity of native fruits taken by these species has seldom been recorded. It is also noteworthy that fruits rather than insects were fed to the fledgling Golden Whistler.

Indian Journal of Nephrology

Saudi Journal of Kidney Diseases and Transplantation

Indian Journal of Transplantation

Hemodialysis International

The Journal of the Association of Physicians of India, 2019

Aim To determine the proportion of patients who have Acute Kidney Injury (AKI), identify severity... more Aim To determine the proportion of patients who have Acute Kidney Injury (AKI), identify severity of AKI using RIFLE criteria and to identify associated factors with AKI. Methods One thousand consecutive medical in-patients were screened for AKI and severity assessed using RIFLE criteria in tertiary care hospital in Northern India. Patients with medical renal disease and obstructive uropathy were excluded. Serum creatinine of all patients were done on days 0, 3, 7 and 14. CKD cases were also excluded. AKI patients were followed at 4 weeks and 3 months. Results Amongst 1000 patients screened, 65 had AKI. 27(41.5%), 15(23.0%) and 23(35.38%) patients belonged to risk, injury and failure classes of AKI respectively as per RIFLE criteria, and there was incremental risk of mortality (25.92%, 46.33% and 86.95%, p<0.001). In-patients with pneumonia, chronic liver disease and acute gastroenteritis have greater odds of developing AKI, with chronic liver disease having a high mortality (90%...

Indian Journal of Nephrology

406 Indian Journal of Nephrology | Volume 28 | Issue 5 | September-October 2018 3. Bianchini G, F... more 406 Indian Journal of Nephrology | Volume 28 | Issue 5 | September-October 2018 3. Bianchini G, Festuccia F, Laverde G, Cinotti GA. IgA myeloma: A potential outcome of IgA nephropathy. Nephrol Dial Transplant 1999;14:2780‐2. 4. Mustonen J, Pasternack A, Helin H. IgA mesangial nephropathy in neoplastic diseases. Contrib Nephrol 1984;40:283‐91. 5. Cambier JF, Ronco P. Onco‐nephrology: Glomerular diseases with cancer. Clin J Am Soc Nephrol 2012;7:1701‐12. 6. Feehally J. Immune mechanisms in glomerular IgA deposition. Nephrol Dial Transplant 1988;3:361‐78. 7. Feehally J, Allen AC. Structural features of IgA molecules which contribute to IgA nephropathy. J Nephrol 1999;12:59‐65. 8. Tomana M, Novak J, Julian BA, Matousovic K, Konecny K, Mestecky J, et al. Circulating immune complexes in IgA nephropathy consist of IgA1 with galactose‐deficient hinge region and antiglycan antibodies. J Clin Invest 1999;104:73‐81. 9. Forslund T, Sikiö A, Anttinen J. IgA nephropathy in a patient with IgG lambda light‐chain plasmacytoma: A rare coincidence. Nephrol Dial Transplant 2007;22:2705‐8. 10. Chandra A, Kaul A, Aggarwal V. Immunoglobulin A nephropathy in a patient with IgG kappa light‐chain myeloma. Saudi J Kidney Dis Transpl 2017;28:937‐41. 11. Dosa S, Cairns SA, Mallick NP, Lawler W, Williams G. Relapsing Henoch‐Schönlein syndrome with renal involvement in a patient with an IgA monoclonal gammopathy. A study of the results of immunosuppressant and cytotoxic therapy. Nephron 1980;26:145‐8. 12. Birchmore D, Sweeney C, Choudhury D, Konwinski MF, Carnevale K, D’Agati V, et al. IgA multiple myeloma presenting How to cite this article: Lakshmi BS, Padmavathi Devi SV, Sameera NS, Reddy AS, Ram R, Kumar VS. IgA nephropathy in a patient with IgG myeloma. Indian J Nephrol 2018;28:404-6.

Kidney International Reports

Tacrolimus is the mainstay of immunosuppression in renal transplantation (RT). However, it has hi... more Tacrolimus is the mainstay of immunosuppression in renal transplantation (RT). However, it has highly variable bioavailability and a narrow therapeutic range. Its metabolism depends upon CYP3A4 and ABCB1gene polymorphism. There is limited data regarding the influence of this polymorphisms on TAC drug level and complications from India. Methods: This is a prospective study done over a period of 2 years (2016-2018) from NIMS Hyderabad. A total of 152 patients were recruited. Frequency of CYP3AB(A6986>G) & ABCB1 (C1236>T, G2677>T and C3435>T) polymorphisms were detected by PCR followed by Sanger's sequence-based genotype & RFLP. Accordingly patients were divided into wild variant(CYP3A5-AA) where there is full expression of the enzyme, heterozygous(CYP3A5-AG), homozygous group who were non expressors (CYP3A5-GG). Day 3, 30,60,90 tacrolimus concentrations and tacrolimus concentration/drug (C/D) ratio were measured. Tacrolimus related toxicity, infections and rejections and the serum creatinine at the time of discharge were compared among the groups Results: Out of 152 renal transplant recipients, 120(78%) were males. 37 patients received deceased donor grafts.. Immediate graft function was seen in 117(76%). Tacrolimus C/D ratio was less in wild (AA) variety compared to both AG (0.006) and GG (P<o.ooo1). Tacrolimus toxicity was noted in 28(18%) patients, of which ATN 24(85%), TMA 3(11%), Pancreatitis in 1(3.5%). Most common infectious complication was UTI seen in 22(14%) patients (AA-3(10%), AG-9(14%), GG-10 (16.7%) followed by CMV disease. BPAR were seen in 5 patients. ABCB1 polymorphisms and showed no correlation with tacrolimus C/D ratio. Mean serum creatinine at the time of discharge was 1AE0.2 in AA, 1.3AE0.8 in AG (AA vs AG P < 0.002), 1.27AE0.47 in GG(AA vs GG P <0.004). Conclusions: Our study shows that genetic polymorphism effects the tacrolimus dose requirement. Enzyme expressor (AA) is associated with low C/D ratio and higher risk of acute rejection. Heterozygous (AG) and non expressors (GG) are at higher risk of developing tacrolimus related nephrotoxicity and infections. ABCB1 polymorphisms has no significant impact on tacrolimus C/D ratio Hence tacrolimus related complications can be predicted prior to renal transplant by analyzing CYP3A5 genetic polymorphisms and doses can be adjusted in order to prevent the complications.