The Journal of Indian Association of Physiotherapists (Physiother - J Indian Assoc Physiother)

Expanding the horizon of physiotherapy profession Sanjiv Kumar Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):49-52

Cognition and quality of life in older adults Dhara Abhinav Sharma, Megha Sandip Sheth, Disha Janak Dalal Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):53-57 BACKGROUND: According to the recent report by the Ministry of Statistics in India, number of elderly accounts for 8.6% of the country's population. Aging causes biological as well as psychological changes. Decline in cognitive functions is one of the normative changes of aging; however, this may impact both physical and mental health of an individual. Quality of Life (QoL) is one of the prime features of successful aging. Hence, this study was undertaken to correlate the level of cognition and QoL in older adults. METHODOLOGY: One twenty-nine males and females of age 60–75 with or without cognitive impairment were selected using convenience sampling, those who could not read Hindi, who had any unstable medical condition, whose vision could not be corrected to normal level, and those with impaired speech were excluded from the study. Montreal cognitive assessment (MoCA) was administered to assess the cognitive level. QoL was assessed by QoL-Alzheimer's disease (AD) scale. RESULTS: Result indicated that there is a moderate positive correlation between MoCA and QoL-AD with r = 0.465 and P < 0.05. CONCLUSION: The study concludes that the level of cognition and QoL of older adults are moderately in positive correlation with each other.

Reaction time in sitting and standing postures among typical young adults MN Anitha, Vijay Raj V Samuel Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):58-62 CONTEXT: Reaction time (RT) is one of the important components of physical fitness. Evaluation of RT is vital to understand and plan a training program. There is a need to comprehend the normative values of RT in young adults in different functional postures, which will enable the clinician to plan the fitness program effectively. AIMS: The aim of this study was to observe the RT in sitting and standing postures among typical young adults. SETTINGS AND DESIGN: This was an observational study. SUBJECTS AND METHODS: Sixty-five young Indian men and women students from a college at Mysore were included in the study. The participants' dominant hand was used to assess the RT in standing and sitting postures with their dominant hand. With the given distance, the RT was then calculated using standard conversion formulae. STATISTICAL ANALYSIS USED: The RT between standing and sitting was analyzed using mean, standard deviation (SD), and paired t-test. RESULTS: The RT analyzed for 22 men in sitting showed excellent RT with a mean 0.1188 (SD 0.0455) and 0.0929 (SD 0.0385) in sitting and standing postures, respectively. Women (n = 43) in sitting had a good RT with a mean of 0.1401 (SD 0.0314) and in standing an excellent RT with a mean of 0.1092 (SD 0.0323). Men had better performance when compared with women, both in standing and sitting postures. Paired test for standing and sitting showed significant difference with t value of 5.364 and P < 0.005, with reduced RT in standing. CONCLUSIONS: The study concludes that the RT is comparatively reduced in standing than in sitting among the young adults.

Comparative effects of Stratified Back care approaches in individuals with nonspecific low back pain Bashir Bello, Muhyiddeen Suleiman Bichi Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):63-72 BACKGROUND: Stratified Back care is a recently developed method for treating low back pain. PURPOSE: This study compared the effects of two stratified care approaches (sub-grouping for targeted treatment [STarT] and specific treatment of the problems of the spine [STOPS] in patients with nonspecific low back pain [NSLBP]). MATERIALS AND METHODS: Forty-six individuals, with NSLBP, participated in this single-blinded, randomized clinical trial. Participants were randomly assigned into one of the two groups: STarT Back Group (n = 23) or STOPS group (n = 23). Treatment was applied twice weekly for 8 weeks. Outcomes assessed pre- and post-interventions were pain intensity (PI) using numeric pain rating scale and functional disability (FD) using the Oswestry Disability Index. Participants in both groups were comparable in age (44.65 ± 9.03 vs. 46.40 ± 7.39) years. At baseline, PI, FD, and anthropometric values were comparable in both groups. RESULTS: The Results showed a significant difference in PI between the STarT and STOPS with a mean difference of −1.24 and 95% confidence interval (−0.86 to −0.04), P < 0.05, with no significant difference in FD, P > 0.05 between the groups. However, there was a significant difference within each group in pain and FD with P < 0.05. CONCLUSION: It was concluded that STarT Back approach was more effective in reducing PI only than STOPS approach in individuals with NSLBP.

Enhancing professionalism in physiotherapy interns using a structured teaching and assessment module Mariya Jiandani, Amita Mehta Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):73-78 INTRODUCTION: Professionalism describes the skills, competency, attributes, and behavior of an individual belonging to a profession. The physiotherapy graduate on completion of internship has direct access with the community as a professional. Hence, there is a need to explicitly teach and assess professionalism. The purpose of this study was to prepare a module to enhance professionalism and use tools to assess the professional attributes uniformly. MATERIALS AND METHODS: A module was formulated with the help of experts, literature review, and guidelines of various physiotherapy regulatory bodies nationally and internationally. Focused group discussions were used as a method to identify competencies. After designing the module, a prospective intervention trial was conducted wherein 40 students who joined the internship program of a tertiary care hospital of India, were enrolled for the study. A participatory approach was used which included an interactive workshop on “ethics in clinical practice, communication skills, and professionalism.” A written pre-post evaluation and workplace-based assessment were carried out in four core physiotherapy areas. Competencies and attributes were measured using tools such professional mini-evaluation exercise (P-MEX), prevalidated checklist for clinical reasoning, patient feedback form, and a retro-preevaluation of self-assessment form of the American Physical Therapy Association. RESULTS: A total of 34 students completed the module. Data were analyzed using SPSS 16 software. Nonparametric Wilcoxon Signed Rank test was used to analyze the descriptive data. The statistical significance was kept at P < 0.05 at a confidence interval of 95%. There was a statistically significant increase in the knowledge component pre-post analysis (P < 0.00). Change in professional attributes as measured by P-MEX showed a significant change in Doctor-patient relationship (P < 0.01) and interprofessional skills (P < 0.001) followed by reflective skills (P < 0.007) and time management skills (P < 0.003). There was also a significant difference in total patient feedback scores from baseline (P < 0.01). CONCLUSION: The module helped students gain the knowledge and skills required to communicate and handle difficult situations relevant to physiotherapy practice.

Cross-cultural adaptation, reliability, validity, and factor analysis of the Gujarati version of the Tampa scale of kinesiophobia in chronic low back pain Dibyendunarayan Dhrubaprasad Bid, A Thangamani Ramalingam, Saumi R Sinha, Payal B Rathi, Vidhi N Patel, Jainab M Rajwani, Krutika N Patel Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):79-86 BACKGROUND: Nowadays more attention is being given to standardizing the outcome measures for improving treatment methods for chronic low back pain (CLBP). The Gujarati translation of the Tampa scale of kinesiophobia (TSK) in patients with CLBP has never been validated in the native Gujarati population. PURPOSE: Translating, culturally adapting, and validating the Gujarati version of the TSK-Gujarati (TSK-G) to allow its use for Gujarati-speaking patients with CLBP. MATERIALS AND METHODS: The development of the TSK-G questionnaire involved its translation and backtranslation, a final review by an expert committee, and testing of the pre final version in establishing its correspondence to the original English version. The psychometric testing included reliability by internal consistency (Cronbach's α), test-retest reliability (intraclass coefficient correlation [ICC]), convergent and divergent validity (Pearson's correlation) by comparing TSK-G to a numerical pain rating scale, fear-avoidance beliefs questionnaire (FABQ), the Roland Morris disability questionnaire (RMDQ), and patient health questionnaire-9 (PHQ-9); and factor analysis. RESULTS: Factor analysis indicated a 6-factor 17-item solution (64.07% of explained variance). The questionnaire showed satisfactory internal consistency (0.639) and moderate test-retest reliability (ICC 0.696). Divergent validity showed low correlations with numerical pain rating scale (r = 0.044), the RMDQ-G (r = 0.06), and PHQ-9-G (r = 0.269); but convergent validity showed highly significant correlation with FABQ-G (r = 0.407, P = 0.001). CONCLUSION: The successful translation of TSK questionnaire into the Gujarati language shows good psychometric properties and factorial structure and approximates the results of the current English version of the TSK questionnaire.

Long-term effectiveness of physiotherapy in a case of ankylosing spondylitis Ratan P Khuman Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):88-92 Ankylosing spondylitis (AS) is a relatively uncommon inflammatory arthritis that affects the axial joints. The diagnosis is often missed and markedly delayed. Here, we report a delayed diagnosis of AS in a 47-year-old male, 10 years after the onset of back symptoms, using the modified New York criteria. The objective of this case report is to outline the long-term effectiveness of physiotherapy interventions. The condition was managed with supervised physiotherapy intervention and unsupervised home exercises for 3 months and was followed for 1 year to investigate the long-term effectiveness of the interventions. It was found that the combination of supervised physiotherapy interventions and unsupervised home exercises had promising short term as well as long-term effects without deterioration in AS symptoms with increased patient satisfaction and confidence.

Feasibility of application of constraint-induced movement therapy in a child with hemiplegic cerebral palsy: A single-case study Darshanaben J Tadvi, Vasanthan Rajagopalan Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):93-97 Children suffering from hemiplegic cerebral palsy (CP) develop developmental disregard (DD). In addition, they fail to comprehend the consequences of nonuse. The utility of affected upper limb is jeopardized. Current evidence supports the use of constraint-induced movement therapy (CIMT) for upper limb function in individuals with hemiplegia. This single-case study attempts to identify feasibility of application of pediatric CIMT on a child with hemiplegic CP. The aim of this study is to identify the benefits and feasibility of application of CIMT for improving quality of the upper limb movement in a child with hemiplegic CP. A 2½-year-old girl with hemiplegic CP visited the outpatient department (OPD) with the problem of lack of use of the right upper limb for activities and play along with the poorer quality of the upper limb movement. Disregard index was calculated to identify the presence of DD. CIMT was chosen as the child had above minimal ability to open fingers and extend the wrist. A 2-week intervention was designed based on the goal-oriented, ability-specific, child-specific practice of functional tasks. A rigid tape was used to provide constraint. The child was motivated to play with the affected hand for 2 h in the OPD and 2 h at home. Tasks of incremental difficulty were utilized as shaping method. The improvement in the quality of movement was measured using quality of upper extremity skilled test (QUEST) and Assisting Hand Assessment (AHA). The score on QUEST improved from 66.35 to 72.1, AHA improved from 66 to 73, and the disregard index score improved from 42.75 to 26.3 in 2 weeks. The treatment was adjusted to accommodate the behavior of the child.

Providing cancer rehabilitation services: Are there some guiding principles? Tan Yeow Leng, Saw Hay Mar Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):98-99

Vitamin D Supplements Don’t Reduce Cancer Incidence

Vitamin D Supplements Don't Reduce Cancer Incidence, Trial Shows
12/13/2018
	In the largest-ever randomized trial testing vitamin D for cancer prevention, the supplement did not lower the risk of developing cancer. The Vitamin D and Omega-3 Trial (VITAL) includes a nationally representative sample of nearly 26,000 participants.

Indian Journal of Nephrology (Indian J Nephrol)

ORIGINAL ARTICLES
	Epidemiology and outcomes of acute kidney injury in critically ill: Experience from a tertiary care center	p. 413
	PS Priyamvada, R Jayasurya, Vijay Shankar, S Parameswaran DOI:10.4103/ijn.IJN_191_17   There is only limited information on the epidemiology and outcomes of acute kidney injury (AKI) in critically ill patients from low- and middle-income countries. This study aims to identify the etiology, short-term outcomes, and determinants of mortality in patients with AKI admitted to multiple medical and surgical Intensive Care Units (ICU's) in a tertiary care center. The study also aims to compare the clinical characteristics and outcomes of community-acquired AKI (CAAKI) and hospital-acquired AKI (HAAKI). A prospective, observational study was done from June 2013 to October 2015. All patients over 18 years with AKI admitted in various medical and surgical ICU's seeking nephrology referral were included. AKI was defined according to KDIGO criteria. The follow-up period was 30 days. A total of 236 patients were recruited from five medical and nine surgical ICU's. Majority (73.3%) were males. About 53.38% patients had CAAKI, whereas 46.61% had HAAKI. The predominant etiologies for AKI were sepsis (22.4%), trauma due to road traffic accidents (21.18%), acute abdomen (perforation, acute pancreatitis, bowel gangrene, intestinal obstruction and cholangitis) (18.64%), and cardiac diseases (10.59%). Sepsis and acute abdomen were the most common causes of CAAKI, whereas trauma and cardiac causes were the predominant causes of HAAKI (P < 0.05). Patients with HAAKI were younger, admitted in surgical units, had lower SOFA scores, lower serum creatinine, lesser need for dialysis, longer hospital stay, and earlier stages of AKI compared to patients with CAAKI (P < 0.05). The 30-day mortality was 52.54%. The mortality was not different between CAAKI and HAAKI (56.3% vs. 48.18%; relative risk = 0.86: 95% confidence interval 0.67–1.1). The mortality was similar across different stages of AKI.
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	Skin microcirculatory changes in relation to arteriovenous fistula maturation	p. 421
	Siew Cheng Chai, Wan Azman Wan Sulaiman, Arman Zaharil Mat Saad, Aida Hanum Rasool, Amran Ahmed Shokri DOI:10.4103/ijn.IJN_402_17   Maturation of arteriovenous fistula (AVF) involves complex vascular remodeling. In this study, we evaluated the changes of skin microvascular perfusion over the extremity with AVF maturation using the laser Doppler fluximetry (LDF). A total of 45 patients with chronic kidney disease, Stages IV–V, were included; they had undergone AVF creation from July 2014 to June 2016 at our institute. The measurement of skin microvascular perfusion was accomplished proximal and distal to the fistula anastomosis site: pre- and post-operative day 1, week 2, week 6, and week 12. Thirty-two patients with mean age of 55.6 had achieved AVF maturation. There were 40.6% radial-based and 59.4% brachial-based AVF. There was a 32.8% reduction of mean skin perfusion distal to the fistula by day 1 compared to the baseline perfusion; however, perfusion increased 47% by week 2 compared to day 1 and no dramatic change was subsequently noted. There was an increase of mean skin perfusion, proximal to fistula anastomosis, over 12 weeks with 35.8% at day 1 from the baseline. However, the changes of the mean skin perfusion were not statistically significant. There was no significant relation of skin perfusion changes with the type of fistula, diabetes mellitus, hypertension, and hyperlipidemia. LDF successfully detected the subclinical change of skin microvascular perfusion in relation to AVF creation. Reduction of skin perfusion distal to the fistula suggests that in patients with existing perfusion inadequacy of extremities, they may experience ischemic symptoms as early as day 1 postoperation, and require close monitoring for distal limb ischemic-related complications.
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	Urinary neutrophil gelatinase-associated lipocalin and urinary soluble CXCL16 as biomarkers of activity in pediatric lupus nephritis	p. 427
	MA El-Gamasy, W El-Naghy DOI:10.4103/ijn.IJN_265_17   One of the challenges of treating patients with lupus nephritis (LN) is to assess disease activity. The aim of this study was to measure the urinary neutrophil gelatinase-associated lipocalin (uNGAL) and urinary soluble chemokine (C-X-C motif) ligand 16 (CXCL16) levels in children and adolescents with systemic lupus erythematosus (SLE) and investigate whether they are elevated in active LN. This study was conducted on 80 patients diagnosed as SLE by the Systemic Lupus International Collaborating Clinics criteria and 60 apparently healthy individuals as controls. Global and renal disease activities were evaluated by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and renal SLEDAI, respectively. uNGAL and urinary CXCL16 were measured for all participants by ELISA. Renal biopsy was done for all cases at initial diagnosis and was graded using ISN/RPS classification. uNGAL and CXCL16 were higher in patients than in the controls (8.9 ± 3.56 ng/dl and 1067 ± 367 ug/L vs. 2.26 ± 1.95 ng/dl and 471 ± 106 ug/L, respectively). uNGAL had higher sensitivity and specificity than urinary CXCL16 as predictor of LN (95% and 90% vs. 85% and 80%, respectively). There was significant positive correlations between uNGAL levels, 24-h urinary proteins (r = 0.732, P = 0.001), and SLEDAI (r = 0.359, P = 0.001). There was also significant positive correlations between urinary CXCL16 levels, 24-h urinary proteins (r = 0.47, P = 0.001), and SLEDAI (r = 0.17, P = 0.001). uNGAL and CXCL16 were reliable indicators of the activity of LN.
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	Optimization of treatment modality in elderly end-stage renal disease population: Peritoneal dialysis versus transplant	p. 433
	A Kaul, MR Behera, R Kishore, B Karthikeyan, DS Bhadauria, P Mishra, N Prasad, A Gupta, RK Sharma DOI:10.4103/ijn.IJN_305_17   Despite kidney transplantation (KT) being considered as the best treatment modality for end-stage renal disease (ESRD), patient and graft survival in the elderly population is poorer than younger individuals. Many authors argue that prolonged life expectancy outweighs the risk of remaining on dialysis, but few studies had compared the treatment modalities, especially with peritoneal dialysis (PD). A retrospective study was conducted at a tertiary care institute to compare outcome of elderly ESRD patients, who received KT with those continued on PD; and to evaluate the predictors of patient survival. Patient survival at 1 year was (76.2% vs. 91.1%); 5 years (53.7% vs. 21.8%); and 10 years (35.6% vs. 0.00%) among KT and PD population, respectively. Infection was the most common cause of death among KT group (35 [41.2%] vs. 34 [28.2%]) while cardiovascular mortality in PD group (55 [46.2%] vs. 7 [8.2%]). Technique survival at 1, 5, and 10 years in PD group was 92.8%, 58.5%, and 0%, respectively. Similarly, graft survival at 1, 5, and 10 years in KT group was 98.7%, 90.2%, and 90.2%, respectively. Multivariate analysis showed body mass index (BMI) (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.82–0.93, p < 0.001), and albumin (HR 0.55, 95% CI 0.37–0.80, p = 0.002) were significant predictors of survival. In the 1st year, patient survival was better in PD than KT, but after adjustment for BMI and albumin, both short-term and long-term survival in elderly KT group was better than that of PD. Hence, elderly ESRD patients should not be barred from KT just because of age.
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	Role of blood oxygen level-dependent MRI in differentiation of acute renal allograft dysfunction	p. 441
	Hira Lal, Ezaz Mohamed, Neelam Soni, Priyank Yadav, Manoj Jain, Dharmendra Bhadauria, Anupma Kaul, Narayan Prasad, Amit Gupta, RK Sharma DOI:10.4103/ijn.IJN_43_18   Early graft dysfunction after renal transplantation manifests as acute rejection (AR) or acute tubular necrosis (ATN). Blood oxygen level-dependent (BOLD) magnetic resonance (MR) imaging is a noninvasive method of assessing tissue oxygenation, which may be useful for predicting acute allograft dysfunction. This was a prospective study involving 40 patients scheduled for renal transplantation from August 2012 to August 2014. In addition, 15 healthy donors were also enrolled in this study. All recipients underwent BOLD MR imaging (MRI) and R2* mapping 10–20 days after transplant, and additionally within 48 h of biopsy if there was any evidence of graft dysfunction. The healthy donors underwent BOLD MRI 1–2 days before surgery. The biopsies were grouped into AR, ATN, and no evidence of AR or ATN. The mean medullary R2*, cortical R2*, corticomedullary gradient, and medullary: cortical R2* ratio were compared between groups using one-way analysis of variance. Spearman's correlation and multinomial linear regression were applied to determine the influence factors of R2* value. Overall, nine patients had graft dysfunction. Six were reported as AR, two as ATN, and one as no evidence of ATN or rejection. The mean medullary and cortical R2* were significantly higher in ATN group compared with AR and normal group, whereas the mean medullary and cortical R2* of AR group were significantly lower than normal group. The corticomedullary gradient of AR group was significantly lower compared with ATN and normal group. Medullary R2*:cortical R2* ratio was significantly lower in AR group compared with normal group. No significant difference was noted between the 15 donors and patients with normal graft function. R2* values on BOLD MRI are significantly decreased in AR allografts and increased in an early stage of ATN allografts, suggesting that BOLD MRI can become a valuable tool for discriminating between AR and ATN.
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	Prevalence and clinical correlates of white coat effect in patients with chronic kidney disease and the role of automated blood pressure device in its assessment	p. 448
	Srinivas Shenoy, Shankar Prasad Nagaraju, Nileshwar R Rau, Ravindra A Prabhu, Uday Venkat Mateti, Dharshan Rangaswamy, Indu R Rao, Karan Saraf DOI:10.4103/ijn.IJN_418_17   Context: Hypertension in chronic kidney disease (CKD) is an important modifiable cardiovascular risk factor. Patients with CKD can have clinically significant white coat effect (WCE), making routine clinic blood pressure (BP) measurements an unreliable indicator of actual BP control. Automated BP monitoring is useful in identifying WCE. The utility of automated BP monitoring has seldom been part of clinical practice in developing countries. Aim: The goal of this study was to estimate the prevalence and determinants of WCE in adult patients with CKD in an outpatient setting using an automated BP device. Materials and Method: In this prospective observational study, patients with CKD attending the nephrology clinic over a period of 6 months (January 2016 to July 2016), who were suspected to have WCE by the treating physician, were assigned to measurement of BP by both the standardized manual BP recording by a single nephrologist and with automated machine as per a defined protocol. Clinical, demographic characters that would influence outcomes were also studied. Results: Among 118 patients with CKD with suspected WCE, 57.6% showed WCE. The mean systolic and diastolic BPs were significantly lower with automated machine when compared with manual BP recordings in patients with WCE (p = 0.04). WCE was seen in all stages of CKD. Occurrence of WCE in CKD was not dependent on factors such as old age, sex, diabetes mellitus, or smoking status in our study. Conclusion:WCE is a highly prevalent and underdiagnosed entity in patients with CKD. Automated machine is a useful and time-saving tool in detection of WCE in patients with CKD attending the outpatient clinic and guide management.
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	Acute pyelonephritis: A single-center experience	p. 454
	L Umesha, SM Shivaprasad, EN Rajiv, MM Satish Kumar, V Leelavathy, CG Sreedhara, MR Niranjan DOI:10.4103/ijn.IJN_219_16   Acute pyelonephritis (APN), although a common clinical entity, still not much is known about the clinical profile in the Indian scenario. We prospectively collected clinical, biochemical, and radiological data of patients hospitalized with a diagnosis of APN from March 2014 to June 2016. A total of 296 cases were included in the study. Mean age was 53.85 ± 9.78 years. Male to females ratio was 1.93:1. Among the risk factors recognized for complicated pyelonephritis (PN), diabetes mellitus (DM) (54.4%) was the most common factor followed by renal calculi (14.4%), benign prostatic hyperplasia (6.7%), immunocompromised state (3.3%), stricture urethra and meatal stenosis (3.3%), and neurogenic bladder (2%). Urinary culture was negative in 153 (51.7%) and positive in 143 patient (48.3%). Most common organism isolated was Escherichia coli (29.7%), followed by Klebsiella pneumoniae (5.4%), pseudomonas (5.4%), Enterococcus (4.4%), and Proteus in 10 (3.4%). Serum creatinine of more than 1.5 mg/dl at admission was seen in 96.3% patients; 40% of them had underlying chronic kidney disease with DM being the most common. Multiorgan dysfunction either at admission or during the course in hospital stay was seen in 31.8% patients. Twelve (2%) had emphysematous PN. Six patients had Class II, 4 had Class III, 1 with Class I, and another with Class IV. A total of 18 deaths were noted (6.1%). Hemoglobin <10 g/dl, serum creatinine at admission >1.5 mg/dl, HbA1c% >10%, and immunosuppression had statistically significant association with the development of multiorgan dysfunction on univariate analysis, but on multivariate analysis, only hemoglobin, HbA1c%, and immunosuppression reached statistical significance. Even with attributable risk of mortality, only hemoglobin, HbA1c%, and immunosuppression reached statistical significance on multivariate analysis. HbA1c% adds to the predictive parameters to recognize at-risk patients to intensify the treatment and avoid complications.
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CASE REPORTS
	Hepatitis C virus-associated membranoproliferative glomerulonephritis treated with directly acting antiviral therapy	p. 462
	S Nayak, A Kataria, MK Sharma, A Rastogi, E Gupta, A Singh, SC Tiwari DOI:10.4103/ijn.IJN_235_17   Hepatitis C virus (HCV) infection has been shown to affect kidneys with various histopathological pattern on the kidney biopsy. These commonly include a membranoproliferative glomerulonephritis (MPGN) pattern with mixed cryoglobulinemia (CG), thrombotic microangiopathy, membranous nephropathy, and vasculitis affecting medium and small vessels of the kidneys causing polyarteritis nodosa. It has been rarely associated with MPGN without detectable CG. We present one such patient who presented to us with HCV-associated MPGN without detectable CG, who recovered completely with directly acting antiviral therapy without any immunosuppression.
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	Systemic lupus erythematosus with linear IgA bullous dermatosis and renal vascular lesions: An extremely rare association	p. 465
	R Malipatel, V Gnanapriya, A Manocha, YK Inchara DOI:10.4103/ijn.IJN_200_17   We report a rare case of systemic lupus erythematosus presenting initially with cutaneous manifestations of linear IgA bullous dermatosis. Later the patient developed renal abnormalities due to thrombotic microangiopathy and lupus nephritis with inflammatory necrotizing vasculitis. Paucity of immune deposits was observed on Immunofluorescence. This association of SLE with these cutaneous and renal lesions is rarely reported in the literature.
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	Xanthogranulomatous pyelonephritis: Intrahepatic and intrathoracic extension	p. 468
	U Anandh, N Birajdar, R Kumar, S Babu DOI:10.4103/ijn.IJN_213_17   A 32-year-old female presented to us with worsening cough and expectoration, low-grade fever, and malaise for 3 months. She gave a history of pregnancy loss secondary to urinary tract infection (UTI) a year back. At that time, she was told to have an obstructive right renal calculus. She also had a history of recurrent UTI in the past 1 year. She had no other comorbidities. Her clinical evaluation revealed an enlarged right kidney and reduced air entry in the right hemithorax. Radiological investigations revealed a large right kidney invading into the inferior surface of the right lobe of the liver and the right pleural space. A clinical diagnosis of xanthogranulomatous pyelonephritis was made, and she was advised nephrectomy. Intraoperatively, the right kidney was found to invade both the right lobe of the liver and the right pleural cavity through a right diaphragmatic defect. Histopathology of the kidney revealed the presence of foamy histiocytes suggestive of xanthogranulomatous pyelonephritis. Invasive xanthogranulomatous pyelonephritis is known, however, invasion into the extra-abdominal structures has not been reported in the literature. Our case is a rare manifestation of a rare clinical entity – xanthogranulomatous pyelonephritis.
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	Crystalline nephropathy in renal transplant: A series of 4 cases	p. 472
	K Mnif, S Yaich, M Mars, K Kammoun, F Fendri, K Charfeddine, F Jarraya, T Boudawara, J Hachicha DOI:10.4103/ijn.IJN_76_17   Crystals are particles of endogenous inorganic or organic composition that can trigger kidney injury when deposited or formed inside the kidney. The most common forms of crystalline nephropathies (CNs) are nephrocalcinosis and oxalate nephropathy. The causes of early allograft dysfunction are changing constantly, and recently calcium oxalate (CaOx) crystal deposition has been added to this list. CaOx deposition in renal allograft is important and probably under-recognized cause of delayed graft function that requires adequate awareness with early intervention to improve the allograft outcome. Here, we describe four cases of irreversible renal graft injury due to CNs.
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	Allopurinol-induced drug reactions with eosinophilia and systemic symptoms syndrome with interstitial nephritis	p. 477
	T Aatif, J Fatihi, H El Annaz, O Qamouss DOI:10.4103/ijn.IJN_166_17   Allopurinol-induced drug reactions with eosinophilia and systemic symptoms (DRESS) is a severe illness related to hypersensitivity syndrome characterized by fever, skin rash, lymph node enlargement, hematological abnormalities, especially eosinophilia and atypical lymphocytosis, and single or multiple organ involvement. The syndrome is difficult to diagnose in view of its clinical heterogeneity and long latency period within 8 weeks after start treatment. We report a case of DRESS syndrome in a 64-year-old man, induced by allopurinol treatment for asymptomatic hyperuricemia, started 8 weeks earlier but stopped only 3 days after because of the onset of rash. The diagnosis was retained due to combining of interstitial nephritis with the clinical findings of fever, skin rash, cervical lymphadenopathy, eosinophilia, and reactivation of human herpesviruses specifically HHV-6. The glucocorticoids were started to relieve hypersensitivity. Five days later, the patient became afebrile, and the rash improved significantly. However, interstitial nephritis with renal function impairment progressed to severe azotemia, and even anuria requiring hemodialysis. Allopurinol-induced DRESS syndrome is associated with significant mortality, and care must, therefore, be exercised when given this drug.
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	Autosomal dominant polycystic kidney disease: Presence of hypomorphic alleles in PKD1 Gene	p. 482
	S Pandita, D Khullar, R Saxena, IC Verma DOI:10.4103/ijn.IJN_236_17   Autosomal dominant polycystic kidney disease is characterized by multiple cysts in both kidneys manifesting in adult life. In general, the disorder is caused by a pathogenic variant in one allele of PKD1 or PKD2 genes, while the other allele is normal. Pathogenic variants in both the alleles are rare and have variable phenotypes, from lethal or perinatal presentation to a mild form in later adulthood, depending on the type of variant. Here, we describe a proband with two variants (p.Thr1773Ile and p.Ala1871Thr in trans) in PKD1 gene, who presented with disease at age 24 years. Both the parents and one brother had a variant in one allele, the other being wild type only and had normal ultrasound findings. Segregation studies suggest that both the variants may act as "hypomorphic" or "incompletely penetrant" alleles and acting together resulted in haploinsufficiency of protein PC1 in renal cells, leading to cystogenesis in the proband. The consequences of the presence of two hypomorphic variants have been poorly documented in literature. We reviewed the few published cases having two hypomorphic variants and the data conform to the conclusions that we reached by study of the family described. It is emphasized that to resolve the significance of suspected hypomorphic variants, segregation studies in the parents and siblings are essential.
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	An unusual association of renal cell carcinoma and renal malakoplakia with focal segmental glomerulosclerosis in an elderly patient	p. 485
	M Vijayan, P Koshy, R Parthasarathy, M Mathew, G Abraham DOI:10.4103/ijn.IJN_289_17   The association of malignancy and glomerulonephritis may be missed, especially in elderly patients. Here, we report a case of eosinophilic variant of renal cell carcinoma and renal parenchymal malakoplakia discovered on renal biopsy in a patient with steroid-dependent nephrotic syndrome. The presence of malakoplakia in our biopsy was probably due to systemic steroid therapy for glomerulonephritis, presence of concomitant asymptomatic urinary tract infection, and/or history of diabetes mellitus. The patient had remission of proteinuria following laparoscopic removal of the tumor, indicating probable remission of glomerulonephritis.
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	Kidney transplantation from a hepatitis C virus-positive donor to a hepatitis C virus-negative recipient	p. 488
	M Kamalkiran, V Ravikiran, C Shashidhar, K. V. R Prasad, V Yeldandi DOI:10.4103/ijn.IJN_267_17   Kidney transplantation from a hepatitis C virus (HCV)-positive donor to an HCV-negative recipient till recently has been a contraindication. In view of the excellent sustained virological response (SVR) rates with directly acting antiviral agents, HCV-positive donors are being considered for the HCV-negative recipients in a few centers. We report the successful transplantation of an HCV-negative recipient transplanted with an HCV-positive donor kidney. Donor was treated with sofosbuvir and ribavirin for 12 weeks. At 10th and 16th weeks of starting treatment, her HCV-RNA PCR was negative. Three weeks later, transplantation was performed with basiliximab induction and triple immunosuppression with tacrolimus, mycophenolate, and prednisolone. The recipient was administered sofosbuvir and ribavirin for 12 weeks. He attained good graft function with a stable creatinine. His serial alanine transaminases were normal on 3rd, 6th, and 12th months, respectively. Six months posttransplant his anti-HCV antibody, and HCV-RNA PCR were negative.
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LETTERS TO EDITOR
	Cystinuria in a 13-Month-Old girl with absence of mutations in the SLC3A1 and SLC7A9 genes	p. 490
	MD Al-Mendalawi DOI:10.4103/ijn.IJN_46_18
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	Improving crossmatch techniques and graft outcomes	p. 491
	L Vincent DOI:10.4103/ijn.IJN_362_17
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	Estimated glomerular filtration rate using creatinine-based chronic kidney disease epidemiology collaboration equation	p. 492
	AA Rani, V Viswanathan DOI:10.4103/ijn.IJN_439_17
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