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Arvind Bagga

Publications and source records attributed to Arvind Bagga.

26 records · Page 2Linked to original sources
PubMed2003

Intravenous cyclophosphamide in steroid-resistant nephrotic syndrome.

We prospectively examined the effect of treatment with intravenous cyclophosphamide in patients with steroid-resistant nephrotic syndrome. Twenty-four patients (minimal change disease in 11, focal segmental glomerulosclerosis in 9, and mesangioproliferative glomerulonephritis in 4), who did not show remission of proteinuria despite treatment with 8 weeks of oral prednisolone and six intravenous pulses of dexamethasone, were studied. Cyclophosphamide was administered intravenously, at a dose of 750 mg/m(2) once a month for 6 months; therapy with alternate-day prednisolone was continued. The mean (SD) age at treatment was 7.8 (4.0) years; 18 patients had initial resistance and 6 had late resistance. At the end of 6 months treatment, 7 (29.2%) patients each had complete remission (absent proteinuria, normal serum albumin) and partial remission (1-2+ proteinuria, normal serum albumin). Ten (41.6%) patients showed no response to therapy. The mean time to complete or partial remission, after initiation of treatment with cyclophosphamide, was 2.4+/-1.7 months and 2.7+/-1.8 months, respectively. Most responders (85.8% complete and 57.2% partial responders) achieved remission by the third dose of pulse cyclophosphamide. More patients with late resistance (50%) compared with initial resistance (22.2%) achieved complete remission. Partial remission was transient and lasted for a mean duration of 6.4+/-3.5 months. Serious infections were observed during therapy in 5 patients. On long-term follow-up, 5 (20.8%) patients were in remission, while nephrotic-range proteinuria or end-stage renal disease was seen in 17 (70.8%). Findings from the present study suggest that therapy with intravenous cyclophosphamide has limited efficacy in inducing sustained remission in patients with initial corticosteroid resistance. Sustained remission is likely to occur in a significant proportion of patients with late resistance and those with absence of significant tubulointerstitial changes on renal histology.

Adolescent↗
PubMed2003

Bacteriuria and urinary tract infections in malnourished children.

We prospectively examined the incidence of bacteriuria in malnourished patients between 6 months and 5 years of age. For each patient, a normally nourished control matched for age, sex, and presence of fever and diarrhea was included. Of 112 patients (65 boys), 55 had moderate and 57 had severe malnutrition; 43 had diarrhea and 35 had fever. Clean-catch and suprapubic urine specimens were examined microscopically and cultured. Significant bacteriuria was found in 17 (15.2%) malnourished and 2 (1.8%) control subjects ( P<0.01). The incidence of bacteriuria in malnourished and normally nourished subjects with fever was 28.6% and 5.7%, respectively ( P<0.05). The risk of bacteriuria increased significantly with the severity of malnutrition and in patients with diarrhea. Bacteriuria was associated with symptoms (70.6%) and elevated levels of acute-phase reactants (88.2%), indicating the presence of urinary tract infections (UTI) rather than asymptomatic colonization. Our observations show that malnourished children, particularly those with fever, are at risk for UTI. Urinalysis is useful for screening for UTI in these subjects. Urine culture should be performed in patients showing an abnormal urinalysis, and if the likelihood of detecting bacteriuria is high (as in patients with fever or diarrhea). Significant bacteriuria in malnourished subjects should be treated with appropriate antimicrobials.

Acute-Phase Proteins↗
PubMed2003

Management of urinary tract infections.

Urinary tract infection (UTI) is common in childhood. It may result in long-term complications due to renal scaring. Younger children are at higher risk of renal scarring. The diagnosis of UTI is based on urine culture. The bacterial count for diagnosis of UTI depends on the method of urine collection. Urinalysis is useful for making a presumptive diagnosis of UTI and allows initiation of empirical treatment in high-risk patients, after urine culture has been obtained. The treatment of UTI is guided by the severity of illness and age of the patient. Following a UTI, investigation should be performed to identify an underlying urinary tract anomaly. Recurrence of UTI occurs in 30-50% children. Important predisposing factors include VUR, urinary tract obstruction, voiding dysfunction and constipation. Vesicoureteric reflux (VUR) is seen in 30-50% children with UTI. The cornerstone of management of VUR is long-term antibiotic prophylaxis, which has been found to be as effective as surgical reimplantation.

Antibiotic Prophylaxis↗
PubMed2003

Mycophenolate mofetil and prednisolone therapy in children with steroid-dependent nephrotic syndrome.

BACKGROUND: A proportion of patients with steroid-dependent nephrotic syndrome (SDNS) experience frequent relapses despite long-term treatment with steroids, levamisole, or/and cyclophosphamide. We prospectively examined the efficacy of long-term therapy with mycophenolate mofetil (MMF) as a steroid-sparing agent in this group. METHODS: Nineteen patients with a mean age of 99.1 months (95% confidence interval [CI], 85.3 to 113) who had previously undergone long-term therapy with prednisolone (n = 19), levamisole (n = 16), and cyclophosphamide (n = 15), but had continued to show steroid dependence over many years, were studied. Renal biopsy showed minimal change disease and focal segmental glomerulosclerosis in 10 and 3 patients, respectively. Patients were administered MMF at a mean dose of 29 mg/kg/d (95% CI, 27.4 to 30.7) in 2 divided doses and decreasing doses of alternate-day prednisolone for a mean of 11.8 months (95% CI, 11.4 to 12.2). Relapses were treated with daily prednisolone until remission, with tapering later. They were additionally followed up for a mean of 17 months (95% CI, 15.9 to 18.1). RESULTS: Mean relapse rates decreased from 6.6 (95% CI, 5.4 to 7.7) to 2 episodes/y (95% CI, 1.2 to 2.7) during MMF treatment (P < 0.0001). Four patients each had 0, 1, 2, and 3 relapses; failure of MMF therapy (>3 relapses during treatment) was seen in 3 patients. Treatment with MMF resulted in steroid sparing, with a reduction in mean prednisolone dose from 0.7 (95% CI, 0.6 to 0.8) to 0.3 mg/kg/d (95% CI, 0.2 to 0.4; P < 0.0001). Fourteen patients showed a 50% or greater reduction in relapse rates; prednisolone therapy could be discontinued for 6 or more months in 8 patients. No significant gastrointestinal or hematologic side effects of MMF treatment were noted. After discontinuation of MMF treatment, 68.4% of patients had an increased frequency of relapses and recurrence of steroid dependence, requiring treatment with other medications. CONCLUSION: Long-term therapy with MMF results in significant steroid sparing and reduction in relapse rates in patients with SDNS. Therapy with MMF and tapering doses of prednisolone appears to be a promising intervention in children with SDNS.

Child↗
PubMed2003

Chronic renal failure in children.

OBJECTIVE: To determine the etiology of chronic renal failure amongst children attending the Pediatric Nephrology services at a tertiary care center. SUBJECT: We reviewed the records of 305 children, diagnosed to have chronic renal failure (CRF) over a 7-year period. CRF was defined as glomerular filtration rate (GFR) below 50-mL/1.73 m2/min persisting for more than 3 months. RESULTS: The mean age at onset and presentation of CRF in these patients was 5.9 and 8 years respectively. Ninety-six children were below 5 years of age. Mean (SD) levels of blood urea and creatinine at presentation were 150 and 4.6 mg/dL respectively. The median GFR at presentation was 18.5 mL/min/1.73 m(2) while 25.3 patients were already in end stage renal failure indicating that these patients were referred late. The mean (SD) hemoglobin at presentation was 7.6 (2.6) g/dL. The mean height and weight SD scores were 2.9 and 2.4 respectively. Obstructive uropathy was the commonest cause of CRF present in 97 children. Other causes included chronic glomerulonephritis in 84, reflux nephropathy in 51, hereditary nephritis in 20, renal dysplasia in 15 and hemolytic uremic syndrome in 5 children. The mean (SD) duration of follow-up was 11(15) months. Peritoneal or hemodialysis was performed in 63 patients. Fifteen patients underwent a live-related renal transplantation. The rest opted out of dialysis program and were conservatively managed due to financial constraints. CONCLUSIONS: The commonest causes of CRF were obstructive and reflux nephropathy. A significant proportion of patients presented late; had severe CRF and were malnourished and stunted. Majority of these were managed conservatively due to lack of financial resources.

Adolescent↗