Browsing by Author "Sharma, Raj Kumar"

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    Cystatin C as a Marker of Glomerular Filtration Rate in Voluntary Kidney Donors
    (Başkent Üniversitesi, 2012-02) Jaisuresh, Krishnaswamy; Gupta, Amit; Jain, Apoorva; Prasad, Narayan; Badauria, Dharmendra Singh; Kaul, Anupma; Mehrothra, Sonia; Sharma, Raj Kumar
    Objectives: Cystatin C is emerging as an endogenous marker of glomerular filtration rate. This study sought to assess the usefulness of serum cystatin C as a marker of glomerular filtration rate in comparison with serum creatinine and serum creatinine-based glomerular filtration rate estimations in voluntary kidney donors. Materials and Methods: Serum cystatin C and serum creatinine were estimated in 35 voluntary kidney donors. Glomerular filtration rate was estimated using: (1) Cockcroft-Gault method normalized to 1.73 m2 of body surface area, (2) 4-variable Modification of Diet in Renal Diseases formulae, and (3) 99mTc-DTPA double plasma sampling method. Glomerular filtration rate-double plasma sampling method was used as a reference value. Results were expressed as means ± SD. Results: The mean age of the participants was 44.23 ± 8.61 years old (19 women, 16 men). The mean serum creatinine was 0.83 ± 0.14 mg/dL, and the mean serum cystatin C was 0.71 ± 0.12 mg/L. Serum cystatin C showed significant correlation with serum creatinine (r = 0.864; P < .001). Glomerular filtration rate-MDRD showed the strongest correlation with glomerular filtration rate-double plasma sampling method (r = 0.93; P < .001), followed by glomerular filtration rate-Cockcroft-Gault (r = 0.76; P < .001 ), serum creatinine (r = - 0.68; P < .001), and serum cystatin C (r = - 0.59; P < .001). The mean serum cystatin C values were 22.6% higher in men than in women. There was a significant correlation of serum cystatin C with glomerular filtration rate-Cockcroft-Gault (r = - 0.50; P = .002 ), glomerular filtration rate-MDRD (r = - 0.59; P < .001 ), and glomerular filtration rate-double plasma sampling method (r = - 0.59; P < .001 ). Conclusions: Serum cystatin C is an optimal marker of glomerular filtration rate in voluntary kidney donors.
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    Outcomes of De Novo Allograft Diabetic Nephropathy in Renal Allograft Recipients
    (Başkent Üniversitesi, 2013-06) Prasad, Narayan; Gupta, Amit; Kaul, Anupama; Sharma, Raj Kumar; Bhadauria, Dharmendra; Jain, Manoj; Gupta, Pallav
    Objectives: Despite increased use of diabetogenic immunosuppressive drugs and increased incidence of new-onset diabetes after transplant in renal allograft recipients, there are few case studies on the subject of de novo allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes. We sought to study the outcomes of allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes in patients with new-onset diabetes after transplant. Materials and Methods: We reviewed the case records of all new-onset diabetes after transplant patients who underwent graft biopsy for graft dysfunction from 1992 to 2010. We analyzed the clinical characteristics and outcomes of new-onset diabetes after transplant patients with de novo allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes. Results: Of the 1989 recipients, 421 patients developed new-onset diabetes after transplant and 26 underwent graft biopsy. Of the 26 patients, 9 had histopathologic evidence of de novo allograft diabetic nephropathy, and 17 had interstitial fibrosis/tubular atrophy without specific glomerular changes. The mean duration from transplant to developing novo allograft diabetic nephropathy was 115.2 months (range, 33-192 mo), and from developing new-onset diabetes after transplant to allograft diabetic nephropathy, was 109.66 months (range, 27-188.4 mo). Of the 9 patients with de novo allograft diabetic nephropathy, 3 died (33.3%), 2 reached end-stage renal disease (22.2%), and 4 remained stable (44.4%). Of the 17 with interstitial fibrosis/tubular atrophy, 2 died (11.7%), 5 developed end-stage renal disease (29.4%), and 10 remained stable on triple immuno­suppression and insulin therapy during follow-up (58.8%). Conclusions: De novo allograft diabetic nephropathy is a significant cause of graft and patient loss in renal allograft recipients who develop new-onset diabetes after transplant.