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Biomedical subjects

R N Srivastava

Publications and source records attributed to R N Srivastava.

At least 19 recordsLinked to original sources
PubMed1992

Long-term, low-dose prednisolone therapy in frequently relapsing nephrotic syndrome.

The efficacy of daily administration of a small dose of prednisolone was examined in 21 patients with corticosteroid-responsive, frequently relapsing nephrotic syndrome (FRNS). After induction of remission of a third or subsequent relapse with a 6-week course of prednisolone (standard therapy with prednisolone, STP), this drug was continued in a single daily dose of 0.25 mg/kg body weight (low-dose prednisolone, LDP) for 18 months. Relapses occurring during this period were treated with STP, following which LDP therapy was resumed. The historical controls comprised 14 patients with FRNS in whom relapses were treated with STP and who were observed over a minimum period of 30 months. The two groups were comparable for age at the onset of nephrotic syndrome and sex. Twenty patients completed LDP therapy, during which 12 had no relapse, 6 had infrequent and 2 frequent relapses (1 patient became steroid dependent and was taken off LDP). Twelve patients were followed for 12-42 months after stoppage of LDP; during this period 7 had no relapse, 4 had infrequent relapses and 1 showed steroid dependence. The number of relapses during LDP therapy (0.5/patient per year) was significantly less (P less than 0.001) than in the preceding 12 months (3.62/patient per year), and continued to remain low during the following 12 months (0.6/patient per year). Whereas the frequency of relapses in the LDP group was similar to that in the historical control group in the 1st year of comparison, it was significantly less during LDP therapy (0.5/patient per year versus 2.25/patient per year). No side effects were observed in patients on the LDP regimen, at the end of which the height percentiles improved in 6 patients and remained unchanged in 14. Our observations indicate that long-term therapy with a small daily dose of prednisolone can significantly reduce the number of relapses in patients with FRNS, and that the beneficial effect may continue even after its stoppage.

Child↗
PubMed1992

Serum antibodies to verotoxin-producing Escherichia coli (VTEC) strains in patients with haemolytic uraemic syndrome.

Serological evidence of infection with verotoxin-producing Escherichia coli (VTEC) was sought in 28 patients suffering from haemolytic uraemic syndrome (HUS) and 25 age- and sex-matched controls. ELISA was used to detect anti-lipopolysaccharide (LPS) antibodies to E. coli strains O157, O111, O26 and NCTC 10418, a non-VTEC strain, and Shigella dysenteriae O1. Sera from 19 of the HUS patients but from none of the 25 controls had significant antibody levels to the verotoxin-producing bacteria. Sera from 13 patients reacted with only one LPS of the four verotoxin-producing bacteria; sera from six reacted with more than one LPS antigen but not with LPS of E. coli NCTC 10418. Paired sera taken 2-3 weeks apart were obtained from 20 HUS patients; 14 of these had high levels of antibody in the acute phase sample. Analysis of antibody levels in the convalescent sera showed that one patient had an increase, one was unchanged and 12 patients had a decrease in antibody to the verotoxin-producing bacteria.

Animals↗
PubMed1992

Crescentic glomerulonephritis in children: a review of 43 cases.

Forty-three children with crescentic glomerulonephritis (GN), having large crescents in more than 50% of the glomeruli, were observed during a period of 22 years. There were 17 boys and 26 girls between the ages of 3.5 and 14 years (mean 8.7 +/- 2.6). Thirty-one patients (72%) presented with acute nephritic features and increasing renal insufficiency (rapidly progressive GN) whereas 12 had an insidious onset with nephrotic syndrome, or rarely with nonspecific symptoms. Eleven patients had evidence of poststreptococcal GN and 6 an underlying systemic disorder. Renal biopsy showed large crescents in greater than 80% of the glomeruli in 38 cases (100% in 28) which were predominantly fibrocellular or fibrous in 80% of the patients. Nineteen patients (44%) were treated with prednisolone, cyclophosphamide and dipyridamole; in addition, 8 were also given anticoagulants. Six patients received pulse doses of corticosteroids. In 23 patients, there was inexorable progression of renal failure, 14 showed partial improvement but subsequently had varying degrees of renal insufficiency and in 6, there was recovery of renal function with normal levels of serum creatinine. Of the latter, 4 had received immunosuppressive anticoagulant therapy and 2 only supportive care. Of 11 patients with poststreptococcal crescentic GN, 7 progressed to end-stage renal disease and 2 developed chronic renal insufficiency. Our findings confirm the poor outcome of crescentic GN in children, irrespective of the underlying etiology. In a small proportion of cases, the disorder may have an insidious onset and a slowly progressive course, but an equally grave prognosis.

Anticoagulants↗
PubMed1992

IgA associated glomerulonephritis.

Immunohistological analysis of 1146 renal biopsies revealed IgA associated glomerulonephritis (IgAGN) in 83 (7.24%) patients (33 children, 50 adults). Clinical features were unusually severe in a high proportion. Nephrotic syndrome (NS) responding poorly to prednisolone was found in 24%, hypertension (HT) in 39%, and azotemia in 34% of patients. NS was slightly more frequent in children than in adults, but HT and azotemia occurred twice as often in adults as in children. Histologically, extensive glomerular crescents and sclerosis were prominent. In addition, moderate arteriolitis and arteriolosclerosis and marked tubulointerstitial nephropathy were notable features. Thus, a low incidence and marked severity characterized IgAGN in this study.

Adult↗
PubMed1991

Hemolytic uremic syndrome in children in northern India.

We observed 73 patients with the hemolytic uremic syndrome (HUS) in 9 years (1980-1988), comprising 34% of patients with acute renal failure treated over the same period. There were 53 boys and 20 girls; 59% were below the age of 2 years and 33% between 2 and 5 years. Acute, usually severe dysentery, responding poorly to various antibiotics, was the prodromal illness in 80%, whereas 12% had watery diarrhea. Most patients had severe renal involvement with anuria in 56% and oliguria in 30%. A polymorphonuclear leukocytosis was present in 85% of cases, but had no correlation with the highest levels of blood urea. Coagulation abnormalities suggesting consumption coagulopathy were found in 24 of 30 cases. The results of stool culture showed Shigella species in 7 cases and nontyphoidal Salmonella in 9. Escherichia coli were isolated in 11 cases, but were not further characterized. Renal biopsy showed total or patchy cortical necrosis in 20 of 50 cases. The patients were managed with supportive care, including transfusion of fresh blood or plasma and dialysis as required. The mortality was 60%, being chiefly related to the duration of renal failure and presence of renal cortical necrosis, whereas persistent dysentery and infections were complicating factors. The presence of convulsions and coagulation defects had no relation to the outcome. Our observations indicate that HUS in children in northern India is mostly related to dysentery, likely to be shigellosis, and is usually associated with severe renal damage and a high death rate.

Acute Kidney Injury↗
PubMed1991

Type O renal glucosuria.

We observed a 7-year-old boy with virtual absence of renal tubular glucose reabsorption (type O renal glucosuria). Glucose titration studies in his family revealed severe type A renal glucosuria in a younger brother, a mild type A defect in the mother and normal glucose reabsorption in the father; thus a spectrum of renal glucose transport defects was observed in members of the same family.

Biological Transport↗
PubMed1991

Gentamicin therapy: medical audit.

In order to evaluate the prescription practices on gentamicin, we screened retrospectively the case records of 600 patients admitted to this hospital. Of these, 100 received gentamicin, in combination with other antibiotics, as the initial treatment. Therapy with gentamicin was considered to be indicated in 71 cases; 62% were below 1 year. Patients with neonatal septicemia, meningitis, serious staphylococcal infections and those who were immunocompromised received appropriate treatment with the drug. All the bacteria cultured were sensitive to the antibiotic. Gentamicin was unnecessarily prescribed to 29 cases including bronchial asthma (n = 7), bronchiolitis (n = 6) and acute gastroenteritis with dehydration (n = 8). In most of the latter cases, the use of gentamicin indicated the psychologic dependence, of the physician, on the drug. Nine patients showed gentamicin-related nephrotoxicity. Formulation of standard treatment guidelines and regular medical audits are necessary to improve quality of prescribing and avoid misuse of drugs.

Bacterial Infections↗
PubMed1991

Henoch-Schonlein syndrome in northern Indian children.

In order to evaluate clinical features and renal pathological findings of Henoch-Schonlein syndrome (HSS) in northern Indian Children, we studied 47 such cases. The mean age at onset was 8.5 yr; sex ratio (M:F) 2.6:1. The clinical features were purpuric rash (96%), abdominal pain (64%), Henoch-Schonlein nephritis (51%) and arthralgias (47%). Patients younger than 6 yr also showed urticarial rash or edema of scalp and extremities. Henoch-Schonlein nephritis (HSN) and abdominal symptoms were more common in older cases. The manifestations of HSN were asymptomatic hematuria and/or proteinuria (n = 15), acute nephritic syndrome (n = 6), and nephrotic syndrome (n = 3). The severity of clinical manifestations correlated with the renal pathologic findings. On follow up, 29% cases showed renal impairment. The prognosis was poor in patients with the acute nephritic or nephrotic syndrome and crescents in more than 50% glomeruli. Combination of clinical data and renal biopsy findings are important in assessing the long-term outcome in cases with HSN.

Abdominal Pain↗
PubMed1991

Renal transplantation in children: experience of 23 years at the children's renal center of the University of Texas Medical Branch at Galveston.

This report describes a 23-year experience with renal transplantation in infants, children, and adolescents at the Children's Renal Center of the Division of Pediatric Nephrology at The University of Texas Medical Branch at Galveston. One hundred ninety-four transplants have been performed in 162 persons. Patient and graft survival is illustrated and is similar to that from other US centers. The data suggest an enhanced graft survival in transplants from living, related donors and from cadaveric donors after introduction of cyclosporine A as the primary immunosuppressive agent. The data for infants and small children are similar to that reported for adolescents and adults. Thus, all infants, children, and adolescents with chronic renal failure are potential candidates for renal transplantation. The timing of the transplant appears more critical than in the adult due to the need to consider growth and developmental milestones as well as the level of renal function. It is recommended that the counsel of a pediatric nephrologist be sought early in the course of any renal disease where progression to end-stage renal disease is probable.

Adolescent↗
PubMed1990

Measurement of the personal cost of illness due to some major water-related diseases in an Indian rural population.

A field study, aimed at measuring the personal cost of illness from five major water-related diseases was undertaken in a rural area of Uttar Pradesh (India) in 1981-82. The diseases included in the study were--enteric fever, acute diarrhoeal diseases, infective hepatitis, conjunctivitis and scabies. The measurement of the cost of illness included information on losses in productivity and treatment costs. The annual costs of illnesses per 100 people in 1981 were Rs 7353 (US $525) for enteric fever, Rs 5333 (US $381) for acute diarrhoeal diseases, Rs 7364 (US $526) for conjunctivitis, Rs 1839 (US $131) for scabies and Rs 211 (US $15) for infective hepatitis. In 1982, costs for above diseases were Rs 8622 (US $616), Rs 5191 (US $371), Rs 3289 (US $235), Rs 7402 (US $529) and Rs 323 (US $23) respectively. The aggregate annual costs of illnesses due to the above five diseases per person ranged between Rs 221 (US $16) and Rs 248 (US $18) in the two years.

Adolescent↗
PubMed1990

Acute renal failure in north Indian children.

The spectrum and outcome of acute renal failure (ARF) were studied in 205 children aged between 1 month and 12 yr. There were 145 boys and 60 girls; 23 per cent were below 1 yr and 49 per cent between 1 and 4 yr. The main causes of ARF were haemolytic uraemic syndrome (HUS) in 36 per cent, serious infections in 19 per cent, acute gastroenteritis and dysentery in 17 per cent, glomerulonephritis (GN) in 13 per cent and intravascular haemolysis (IVH) in 6 per cent. Most patients with HUS, serious infections and gastroenteritis were below 5 yr, whereas GN and IVH occurred in older children. HUS was mostly associated with dysentery; Shigella and several other pathogens were isolated from stools in 35 per cent. In most patients with HUS disseminated intravascular coagulation and renal cortical necrosis were present, with a high mortality. The outcome was also poor in infants with serious infections. IVH occurred in patients with G-6-PD deficiency. In such patients and in those with post-streptococcal GN the prognosis was good. Crescentic GN had a poor outcome. Our observations highlight the common and serious nature of ARF in India. However, most of the underlying causes are preventable.

Acute Kidney Injury↗