BACKGROUND: There is an increased prevalence of hypothyroidism in chronic kidney disease (CKD) patients as the glomerular filtration rate falls. However, there is a paucity of Indian data in this respect. METHODS: A cross-sectional analysis was performed based on the database of the information system of a tertiary care hospital in northern India to retrieve results of nephrology CKD outpatients (> 18 years of age) from September 2013 to October 2015 to determine the prevalence of hypothyroidism in the non–dialysis-dependent CKD population. Overt hypothyroidism was defined by a thyroid-stimulating hormone (TSH) level > 5.5 mIU/L and free T4 level < 0.89 ng/dL with clinical symptoms. Subclinical hypothyroidism was defined by a TSH level > 5.5 mIU/L and a free T4 level ≥ 0.89 ng/dL. RESULTS: Among 1,863 CKD patients, 358 patients underwent biochemical analysis for hypothyroidism. Among these, 143 had biochemical subclinical hypothyroidism and 59 had overt hypothyroidism. Patients in the overt hypothyroid group had significantly higher TSH levels and a lower free T4 level than those in the non-hypothyroid group. Patients with hypothyroidism (both clinical and subclinical) had significantly lower serum albumin and serum calcium levels than those in the non-hypothyroid group. Intact parathyroid hormone was also significantly higher in the hypothyroid groups. An increased prevalence of hypothyroidism was observed in patients with a reduction in the glomerular filtration rate. CONCLUSION: There is growing evidence of increased prevalence of hypothyroidism in dialysis-independent CKD patients. A number of findings such as lower serum albumin, serum calcium, and hemoglobin levels and higher intact parathyroid hormone levels are seen in this group. Specific treatment can help improve these. Hence, there is a need to formulate guidelines to screen this population for hypothyroidism.
Accidental Falls ; Calcium ; Cross-Sectional Studies* ; Glomerular Filtration Rate ; Humans ; Hypothyroidism* ; India* ; Information Systems ; Nephrology ; Outpatients ; Parathyroid Hormone ; Prevalence* ; Renal Insufficiency, Chronic* ; Serum Albumin ; Tertiary Healthcare ; Thyrotropin

BACKGROUND: Needle guides have recently come into use for ultrasound-guided percutaneous renal biopsies; however, it is not yet clear if the use of needle guides leads to decreased post-biopsy complication rates and improved tissue yields. Thus, we conducted a retrospective single center study comparing biopsy yield, adequacy, and rates of complications before and after utilization of a needle guide device. METHODS: A retrospective analysis was performed on all native kidney biopsies performed before and after June 2015 corresponding to the start of needle guide use. All biopsies in the latter period of the study were performed by a single operator. We compared clinical characteristics, indications, type of investigation, tissue yield, adequacy of procedure, and rates of major and minor complications. RESULTS: A total of 343 biopsies were analyzed, 140 in the pre-needle guide use period (Period I) and 203 in the needle guide use period (Period II). Biopsy yields were similar, irrespective of the use of needle guides. Tissue adequacy was better in Period II (93.7% vs. 84%, P < 0.001, with respect to pathologist-reported inconclusive biopsies. There were no differences in terms of major complications (1.7%) for the two periods; however, the rate of minor complications (8.4%) was significantly reduced in Period II (P = 0.006). According to multiple logistic regression analysis, not using a needle guide (odds ratio, 3.70; P < 0.001) along with low hemoglobin level, higher pre-dialysis serum creatinine level, and high urinary red blood cell count were significant predictors of biopsy complications. CONCLUSION: Use of a needle guide improves biopsy adequacy and is associated with reduced rates of minor complications in native renal biopsies. Therefore, needle guides may be recommended in percutaneous renal biopsies, especially when transitioning to single-operator performed procedures.
Biopsy* ; Biopsy, Needle ; Creatinine ; Erythrocyte Count ; Image-Guided Biopsy ; Kidney ; Logistic Models ; Needles* ; Renal Insufficiency ; Retrospective Studies ; Ultrasonography, Interventional

Objective Our previous study has shown that porcine antigen-primed and CD4 + T cells activated macrophages are capable of the ecognition and rejection of porcine xenografts but not mouse allografts, and therefore suggested the involvement of signaling between the graft and macrophages in this specific graft recognition and destruction. Methods NOD-SCID mice were transplanted with fetal pig pancreatic fragment (FPP) before adoptive transfer with exogenous macrophages isolated from rejecting FPP xenografts of BALB/c recipient mice. The exogenous macrophages were tracked by Ly5.1 surface antigen or via CSFE staining. Gene expression of CCR2 and CCR5 and their chemokines in transplanted FPP xenografts was evaluated by real-time PCR. Results After the adoptive transfer, recently transplanted but not established FPP xenografts were rejected by exogenous activated macrophages. In the meantime, greater level of chemokine gene expression was detected in recently-transplanted compared with the established xenografts. Furthermore, expression of both CCR2 and CCR5 genes was enhanced significantly in activated macrophages when compared with non-activated macrophages. Conclusion Upregulated chemokines were associated with macrophage recruitment and destruction of islet xenografts.

Objectives: Patients with chronic kidney disease (CKD) are known to develop sarcopenia, an agingrelated disorder, with low muscle mass, strength and physical performance. Ultrasound-derived thigh muscle and rectus femoris thickness (TMT and RFT) can be measured easily in clinical practice, but need validation for use in predialysis CKD (stages III through V) for muscle mass estimation. The study aims to compare ultrasound-derived TMT and RFT with bioelectrical impedance analysis (BIA)-derived muscle mass estimation in the diagnosis of sarcopenia in predialysis CKD. Methods: Patients with stable CKD stage III, IV, V and not yet on dialysis were recruited, and underwent anthropometric assessment, BIA and ultrasound examination of midthigh region. Appendicular skeletal muscle index (ASMI)/height2 derived from BIA was taken as a standard for the diagnosis of low muscle mass. Gait speed and handgrip were also measured. The Asian Working Group criteria were applied. Cutoff values for low muscle mass by TMT and RFT were obtained using receiver operator curve (ROC) analysis. Results: Of the total of 117 enrolled study participants, 52 (45%) had low muscle mass, 34 (29%) had sarcopenia, of whom 79% were male, majority (38%) were CKD stage IV and had a mean age of 58 years. Using ROC analysis, TMT cutoffs of 19 mm in males and 17 mm in females were computed. Comparison of TMT cutoffs and ASMI/h2 showed good agreement between the 2 methods using Bland-Altman plots. Conclusions Ultrasound-derived TMT and RFT can be used for muscle mass estimation in the diagnosis of sarcopenia.