Biomedical subjects

Anupam Prakash

Publications and source records attributed to Anupam Prakash.

4 recordsLinked to original sources

PubMed2005

Psoriatic nephropathy--does an entity exist?

Psoriasis is an immune-mediated chronic inflammatory disorder of the skin. Association with kidney disease has been debated for a long time. Secondary renal amyloidosis in psoriatic arthropathy and drug-induced renal lesions secondary to methotrexate or cyclosporine are accepted accompaniments of psoriasis. IgA nephropathy is also known to occur in psoriatics. We report three interesting cases of renal involvement in long-standing established psoriasis on topical therapy alone. The patients presented with hypertension, significant proteinuria, hypoalbuminemia, and dyslipidemia. Kidney biopsies revealed "mesangioproliferative glomerulonephritis with IgA nephropathy," "focal proliferative glomerulonephritis," and "membranous glomerulonephropathy." The former two had marked active urinary sediment. Patients improved on prednisolone and angiotensin-converting enzyme inhibitors. Contrary to the belief that renal involvement in psoriasis is coincidental, we propose that kidney disease may be a common accompaniment of psoriasis, which may be labeled as "psoriatic nephropathy" or "psoriatic kidney disease." The exact mechanism of this entity is yet to be elucidated.

Adult↗

PubMed2003

Aplastic anemia complicating systemic lupus erythematosus: successful management with cyclosporine.

Anemia is common with connective tissue disorders, but pancytopenia is rare. We report a 22-year-old female who presented with menorrhagia, seizures, anemia, leukocytosis, thrombocytopenia, pericardial effusion, positive ANA, and evidence of vasculitis on CT head scan and was diagnosed with systemic lupus erythematosus (SLE). After 7 months of remission, she was readmitted with menorrhagia and pancytopenia. Investigations revealed aplastic anemia. She survived on transfusion support for 6 weeks, during which period she received methylprednisolone and cyclophosphamide pulses, and phenytoin was omitted but to no avail. Cyclosporine (300 mg/day) was started and the aplastic anemia responded. After 4 months of therapy, the cyclosporine was gradually tapered over the next 2 months. The patient has been on 10 mg/day of prednisolone for the last 6 months. Aplastic anemia is rare in SLE and the response to immunosuppressants is variable, but here is a success story.

Adult↗

PubMed2003

Staphylococcal pericarditis in a chronic renal failure patient.

A 34-year-old female with end-stage renal disease was admitted for severe metabolic acidosis, uremic encephalopathy, pericarditis and severe anemia following a bout of acute gastroenteritis. She improved on aggressive medical management including intensive hemodialysis and was initiated onto maintenance heparin-free hemodialysis (twelve hours per week) and discharged. After a week, she presented with fever with chills and rigors for three days, was toxic, severely orthopenic and had a pulsus paradoxus of 36 mmHg. Echocardiography suggested cardiac tamponade. Aspiration revealed frank pus with polymorphonuclear predominance and Staphylococcus aureus on culture. CT of the thorax revealed pericardial effusion. In the absence of any obvious septic foci, concomitant pleuro-pulmonary sepsis, mediastinal or intra-abdominal pathology; a diagnosis of "acute primary purulent pericarditis" was made. Patient was put on parenteral antibiotics-ceftriaxone and metrogyl. Vancomycin was added after sensitivity results. Pericardial drainage was required initially. After toxemia improved, paradox decreased and fever subsided, the pericardial catheter was removed and antibiotics continued for a period of four weeks. Maintenance hemodialysis was continued during hospital stay and after discharge.

Adult↗

PubMed2003

Renal and systemic amyloidosis in systemic lupus erythematosus.

A young male presented with oral ulceration for two years; swelling face and feet of seven days duration; diffuse goiter without signs of thyroid disease; normocytic normochromic anemia, thrombocytopenia, deranged renal functions, albuminuria of 2.5 g/24h with active urinary sediment. ANA and anti-ds DNA were positive, sonography of abdomen suggested medical renal disease. Testing for HIV, HBV, VDRL, CRP, rheumatoid factor, p-ANCA and c-ANCA were negative. Thyroid hormone assays were normal. Kidney biopsy done to stage lupus nephritis did not show any evidence of lupus involvement but staining for SAA amyloid was positive. Subsequent biopsies from the liver and rectum also stained positive for amyloid. Diagnosis of "Systemic lupus erythematosus with renal and systemic secondary amyloidosis with euthyroid diffuse goiter" was made. The case is being reported and discussed because of the interesting and rare association between amyloidosis and systemic lupus erythematosus.

Adult↗