Chronic kidney disease (CKD) is associated with a range of metabolic bone diseases. Fracture rates are higher in CKD patients than age-matched controls throughout all the five stages of CKD. Dialysis patients have 4 times as many hip fractures as expected for their age. CKD forms an independent risk factor for osteoporosis, even in the absence of traditional risk factors. This study was carried out at the nephrology unit in a tertiary care center of Kashmir to know the prevalence of osteoporosis in CKD patients having glomerular filtration rate (GFR) <60 mL/min (stages 3-5). Among the 151 cases studied, the average estimated GFR was 16.78 ± 10.714 mL/min. There were 98 males (64.9%) and 53 females (35.1%). Their mean age was 51.01 ± 14.138 years. Osteoporosis based on femoral neck T-Score was seen in 31 patients (31.6%) while 43 patients (28.5%) had osteoporosis at L1, L2 lumbar vertebrae. The prevalence of osteoporosis based on femoral neck T-Score as well as osteopenia was highest in stage-5 CKD. In our study, the body mass index (BMI) had a positive correlation with osteoporosis; low BMI patients were at higher risk for osteoporosis (P = 0.014). In the Kashmir valley, the prevalence of osteoporosis was 31.8% in CKD patients against 22% in controls. Thus, CKD forms an important risk factor for osteoporosis even in the absence of traditional risk factors. We recommend early screening, detection, and management of osteoporosis to reduce the burden of morbidity and mortality in this subset of patients.

IgA nephropathy (IgAN) remains one of the most common glomerular lesions, which has a striking geographic distribution and is the most common form of primary glomerular disease in Asia. However, the exact prevalence or clinicopathological spectrum of IgAN in India is not well documented. This retrospective study analyzed the presentation in 126 patients of primary IgAN out of 298 native kidney biopsies (42.28%) performed over a period of three years (2013-2015). The patients were followed up for three months. This is the second highest prevalence recorded in the world after Japan. Among the clinical features of our cohort, the mean age was 31 years, with a male-to-female ratio of 2:1, with the highest incidence observed in the third decade of life in both sexes. The majority of our patients (47%) presented with renal failure with a mean serum creatinine value of 3.1 mg/dL and with burnt out morphology on histo-pathology; 72.2% of patients were hypertensive at presentation. On histopathology, Haas class V (35.5%) had the highest frequency followed by class IV (25.8%). The Oxford MEST score was not applicable in 36 patients because of advanced sclerosis (>50%). In the remaining ninety patients, majority had tubular atrophy and interstitial fibrosis of varying degrees. At three months of follow-up, the patients who had presented with renal failure (47.6%), settled in chronic kidney disease stage III (25.4%) followed by stage IV (18.6%) and stage V (11.8%). Our study in Kashmir suggests that IgAN is more common in the younger age group, with a significant number of patients presenting with advanced renal failure and, on morphology, showing a burnt out disease, with many developing end-stage renal disease. Studies evaluating the underlying factors can have immense importance in dealing with the disease.

Patients with CKD are highly predisposed for developing accelerated atherosclerosis. These patients have non-traditional risk factors such inflammation, malnutrition and increased oxidative stress that enhance and accelerate atherosclerosis in addition to traditional risk factors. Although relation between cardiovascular and cerebrovascular diseases with CKD is well established, studies are suggesting about association of Peripheral Arterial Disease (PAD) with CKD. PAD is associated with increased morbidity and mortality in patients of CKD.This study is rendezvous to look for PAD and related risk factors in patients of CKD having eGFR less than 60 ml/ min/ 1.73 m 2 (MDRDS) and not on RRT.Two hundred ten subjects with CKD attending department of nephrology at tertiary care institute in valley were included in study. Out of 210 subjects selected, 30 were having PAD that constituted 14% of study population. IC was seen in 25 (11.9%) of 210 subjects. Out of PAD patients 16 (53.3%) were having history of IC and 14 (46.7%) were asymptomatic. As reported in literature, prevalence of peripheral arterial disease in CKD patients not on dialysis ranged from 7% to 32% in previous cases. This study will sensitize us to plan more effective screening, preventive and management strategies. This will go long way to decrease morbidity and mortality in patients.

Asthma and chronic obstructive pulmonary disease (COPD) are common diseases with a huge public fitness impact. The aim of this study was to investigate the prevalence of asthma COPD overlap syndrome (ACOS) amongst patients of obstructive airway disease and also to determine the clinical characteristics and demographic profile of such cases with overlap syndrome. Material and Methods: A hospital based, prospective, observational study was conducted on individuals of both sexes within the age group of 40 and 80 years. Patients with history suggestive of obstructive airway disease were subjected to pulmonary function test. Patients found to have obstructive pattern on pulmonary function test were subjected to sputum eosinophil count and serum IgE levels. Results: Of 130 patients enrolled in the study 59 (45.38%) were pure COPD, 48 (36.92%) were pure Asthma and 23 (17.69%) were ACOS phenotype. Also patients with ACOS phenotype were found to have more number of acute exacerbations and hospitalizations. Obstructive airway disorders encompass bronchial asthma and chronic obstructive pulmonary disease (COPD). Conclusion: A subset of patients with obstructive airway disease display characteristics of both asthma and COPD. Such patients are called having asthma COPD overlap syndrome (ACOS). But, the prevalence and the characteristics of these patients with ACOS are not nicely understood.

No abstract