Two rare cases of nephrocalcinosis (NC) due to a genetic mutation remained undiagnosed till adulthood. A 19-year-old male presented with a fever and was diagnosed with bilateral NC and renal dysfunction. He underwent a renal biopsy, which suggested nonspecific chronic tubulointerstitial nephritis. His blood chemistry review showed persistent severe hypouricemia, pointing to possible xanthinuria. The second case was a 25-year-old male, re-evaluated for bilateral NC with persistently high serum parathyroid hormone despite successful parathyroidectomy. His metabolic workup suggested possible Bartter’s syndrome (BS) with characteristic biochemical derangement. Whole exome sequencing detected a pathogenic homozygous mutation in the MOCOS gene in the first case and a KCNJ1 mutation in the second case. Soft clues like hypouricemia in the first and hypokalemia with metabolic alkalosis in the second case need to be recognized in NC for the appropriate work-up. Tailored management has stabilized the renal outcome in both patients.

Microfilarial infection is endemic in tropical regions, but renal involvement remains rare and under-recognized. The spectrum of biopsy-proven lesions is diverse, and its clinicopathological correlates are incompletely understood. We retrospectively analyzed renal biopsies that demonstrated intraglomerular microfilariae over a 6-year period. There were a total of seven patients (four males/three females; median age: 32 years, range 15-55). The presentations included nephrotic syndrome (2), acute nephritic syndrome (1), chyluria ± hematuria (2), and rapidly progressive renal failure (1). The biopsy spectrum showed non-proliferative glomerulonephritis (3), membranous pattern (1), amyloidosis (1), and crescentic lesions (2). Microfilariae were identified in glomerular (6) and peritubular (3) capillaries. DIF was positive in 3 (IgG and/or C3). All received diethylcarbamazine; 3 additionally received steroids. Clinical response was complete (4) and partial (3). Microfilaria-induced renal injury exhibits a wider morphological spectrum than previously recognized, including aggressive necrotizing crescentic glomerulonephritis. Awareness of this entity in endemic regions and timely institution of antifilarial therapy, with or without immunomodulation, can preserve renal function and improve outcome.

Background AKI remains a significant global health burden, with infectious etiologies predominant in tropical regions. Among these, scrub typhus, caused by Orientia tsutsugamushi , has emerged as a critical cause, particularly in endemic areas. Kidney involvement in scrub typhus varies widely, ranging from mild abnormalities to severe renal failure requiring dialysis. Materials and Methods A systematic review was conducted by searching PubMed/MEDLINE, EMBASE, and Cochrane CENTRAL databases for studies published between January 2000 and December 2024 on scrub typhus-associated AKI. Extracted data included demographics, clinical characteristics, AKI details, dialysis requirements, and long-term outcomes. Results Of the 1,969 records retrieved, 14 studies comprising 4,290 scrub typhus patients were included, with 1,094 (28.7%) developing AKI. The studies, conducted in India, Nepal, and South Korea, reported an AKI incidence of 13.16% to 53%. Diagnosis was based on RIFLE and KDIGO criteria in seven and six studies, respectively. AKI predominantly affected males (48-77.1%), with ages ranging from 30-71 years. Fever (94-100%) was universal, while eschar was more frequent in Korean studies. Key AKI predictors included older age, pre-existing CKD, hypoalbuminemia, and multi-organ dysfunction syndrome. Mortality ranged from 0.7% to 35.7%. Dialysis requirement varied (0.21-46.7%), but no study reported dialysis dependency at follow-up. Most patients recovered renal function within 3 months, though 1-2% had persistent dysfunction. Conclusion Scrub typhus-associated AKI is a significant complication with high morbidity and mortality. Early identification of risk factors and timely intervention can improve renal and patient outcomes.

Background Scrub typhus, caused by Orientia tsutsugamushi , is an underdiagnosed tropical infection endemic to India, often presenting with non-specific symptoms. AKI is a serious yet potentially reversible complication that significantly impacts outcomes. This study aimed to determine the prevalence, clinical characteristics, and predictors of AKI in patients primarily diagnosed with scrub typhus at a tertiary care center in Southern India. Materials and Methods This retrospective observational study analyzed 176 adult patients with rickettsia at a tertiary care center in Karnataka from January 2021 to December 2024. Patients with co-infections were excluded. AKI was defined and staged per KDIGO criteria. Demographic, clinical, laboratory, and outcome data were assessed to identify predictors of AKI. Results The prevalence of AKI was 44 (25%), with a mean age of 37.5 ± 16.3 years. KDIGO categorizes AKI into Stage 1 (15.3%), Stage 2 (4.5%), and Stage 3 (5.1%); 4% required dialysis. Winter seasonality (44% cases in Dec-Feb) was noted. Independent predictors of AKI included older age (OR 3.60), male sex (OR 4.14), diabetes mellitus (OR 3.13), septic shock (OR 5.42), and Multi-organ dysfunction syndrome (MODS) (OR 52.8). Hypoalbuminemia was also associated with AKI. Overall mortality was 2.8%. Conclusion AKI occurs in 1/4 of scrub typhus patients and is associated with substantial morbidity, especially among elderly males with comorbidities and systemic complications. Despite its severity, AKI in scrub typhus is often reversible with early recognition and aggressive supportive care. These findings highlight the need for heightened clinical suspicion and timely intervention in endemic settings to reduce AKI-related complications.

Background The clinical presentation of chronic kidney disease of unknown origin (CKDu) is consistent with tubulointerstitial disease. Tests for tubular function, such as fasting urine osmolality, may be impaired in residents of endemic areas before GFR declines. This study describes fasting urine osmolality in individuals residing in areas endemic for CKDu who visited the All India Institute of Medical Sciences (AIIMS), Raipur. Materials and Methods This cross-sectional study was conducted at AIIMS, Raipur, Chhattisgarh, India, between June 2021 and May 2022. Adults >18 years, who had resided in endemic areas for at least 10 years, and were relatives of patients with CKDu admitted to the Department of Nephrology, were invited to participate in the study. Fasting urine osmolality was measured after 12 hours of overnight fasting, by the depression of freezing point method. An impaired urine concentration ability was defined as fasting urine osmolality <600 mOsm/kg. Results The study included 93 admitted relatives of 108 CKDu patients. The median age and eGFR of participants were 35 (IQR: 28, 46) years and 105 (IQR: 95, 116.5) mL/min/1.73m 2 , respectively. The median fasting plasma and urine osmolality were 290 mOsm/Kg (IQR: 286, 294) and 620 mOsm/kg H 2 O (IQR: 484, 850), respectively. Fasting urine osmolality was ≤600 mOsm/kg H 2 O in 46 patients (49.5%), 23 had (24.7%) values between 601 and 800 mOsm/kg H 2 O, and 24 (25.8%) had values >800 mOsm/kg H 2 O; 43 (46.2%) participants had hypokalemia, 15 (16.1%) had hyponatremia, and 14 (15.1%) had hypochloremia. Conclusion Almost 50% of seemingly healthy participants from the endemic CKDu belt visiting AIIMS Raipur have low mean fasting urine osmolality after 12-hour overnight water deprivation, suggesting a defect in concentrating ability.

Ticagrelor is an uncommon cause of thrombotic microangiopathy (TMA). We report a 25-year-old female with uncontrolled hypertension. She presented with acute kidney disease secondary to bilateral renal artery thrombosis. She underwent successful angioplasty with stenting and was started on aspirin and ticagrelor. Within 24 hours, she developed TMA, which was refractory to five cycles of plasmapheresis. Rituximab treatment led to complete hematologic and renal recovery, suggesting an immune-mediated cause.

Background Hemodialysis (HD) in patients with cirrhosis often poses several challenges. Continuous ambulatory peritoneal dialysis (CAPD) has emerged as an alternative, particularly those with refractory ascites. However, concerns regarding hypoalbuminemia, peritonitis, and long-term outcomes remain. Materials and Methods This retrospective, single-center study included 34 cirrhotic patients with refractory ascites on maintenance HD who underwent CAPD catheter placement between January 2018 and March 2023. Clinical, biochemical, and procedural data were collected, including ascites management protocols, nutritional status, and peritonitis episodes. Primary outcomes included patient survival, peritonitis rate, and changes in serum albumin over 12 months. Results The mean follow-up was 12±2.1 months, and 94% survived at 1 year. Two transitioned to HD due to ultrafiltration failure after episodes of peritonitis. The peritonitis rate was 1 episode/45 patient months. A modest initial decline in serum albumin (-6%) occurred during the first 2 months of therapy, which later stabilized. Mechanical complications, pericatheter leaks, omental wrapping requiring omentopexy, and one umbilical hernia, were managed with a combination of conservative measures and minor invasive procedures as indicated. Conclusion CAPD is a feasible and effective modality for ESKD patients with refractory ascites, offering high 1-year survival, stable serum albumin levels, and acceptable peritonitis rates when compared to standard peritoneal dialysis (PD) cohorts.