Background Hypercalcemia is known to cause acute kidney injury (AKI). Literature related to hypercalcemic AKI is predominantly in the form of case reports and case series. The purpose of this study is to find the incidence, etiology, and course of hypercalcemia-induced AKI in a non-critical care setting. To our knowledge, this is the first study done to look for the incidence, etiology, and course of hypercalcemia-induced AKI in a non-critical care setting. This is a prospective observational study conducted in the Department of Medicine in a tertiary care center from Jammu and Kashmir, India, from June 2010 to June 2012. Patients admitted with hypercalcemia were assessed for AKI and evaluated and treated for hypercalcemia. Renal function was monitored during hospitalization and at 1 month of discharge. AKI and hypercalcemia were arbitrarily defined as serum creatinine > 1.5 mg/dl and corrected serum calcium of ≥ 11.5 mg/dl (as per reference hospital lab), respectively. Results Thirty patients are included. Hyperparathyroidism and multiple myeloma accounted for 13(43.3%) and 10 (33.3%) cases, respectively. Mean ±SD corrected serum calcium at diagnosis and after treatment at 1 month was 13.56 ± 1.86 mg/dl and 9.49±1.35 mg/dl, respectively; p < 0.001. Mean ±SD serum creatinine at baseline and after treatment of hypercalcemia was 2.87 ±1.68 mg/dl and 1.49±1.34 mg/dl, respectively; p < 0.001. Twenty-three (76.7%) patients had AKI. AKI recovered after treating hypercalcemia in 25 (83.3 %) patients. Mean ± SD days taken for the decrease in serum creatinine to ≤ 1.5 mg/dl was 8.28 ± 4.17 days. Mean ± SD serum creatinine after treatment of hypercalcemia in hyperparathyroidism group versus non-parathyroid group was 0.97 ± 0.35 mg/dl and 1.88 ±1.67 mg/dl, respectively; p value 0.009. Conclusions Hypercalcemia is commonly associated with AKI. Primary hyperparathyroidism and multiple myeloma account for the majority of the cases. Hypercalcemic AKI with primary hyperparathyroidism is less common and the outcome is better, as compared to non-hyperparathyroidism-related causes. AKI is reversible in most cases.

Systemic lupus erythematosus (SLE) is a systemic autoimmune condition, characterized by the production of autoantibodies, predominantly against nuclear antigens. It primarily affects women of childbearing age. Men account for 4-22% of all cases in various series (1,2). Lupus nephritis can be diagnosed with high sensitivity and specificity based on histopathological criteria alone (3). We report lupus nephritis in a 50-year-old male diagnosed solely on renal histopathological findings.

Background Malnutrition is highly prevalent in chronic kidney disease (CKD). This study is conducted to find out the prevalence of malnutrition and its association with inflammation in patients with CKD stages 3–5. Method This is a hospital-based cross-sectional study conducted at the Sri Ram Murti Smarak Institute of Medical Science, Uttar Pradesh, India. CKD stages 3–5 patients were included. The nutritional status was assessed by subjective global assessment (SGA). Anthropometric and biochemical measurements were also checked at the time of enrollment. Results A total of 213/354 (60.2%) of patients were malnourished. The triceps skinfold thickness (TSFT) was 8.2 ± 1.2 mm and 10.9 ± 1.2 mm in the malnourished and well-nourished groups, respectively; p < 0.001. TSFT was ≤ 10 mm in 91.1% of patients with malnutrition. Mid-arm muscle circumference (MAMC) was 21.3 ± 2.2 cm and 24 ± 2.9 cm, and the body mass index (BMI) was 19.8 ± 1.5 and 22.5 ± 1.4 kg/m2 in the malnourished and well-nourished group, respectively; p < 0.001. A significant direct correlation between BMI, TSFT, MAMC, and eGFR was noted. Median eGFR was 11.9 ml/min/1.73 m2 in the malnourished compared to 24.2 ml/min/1.73 m2 in the well-nourished group; p < 0.001. Serum ferritin level was 246.77 ± 18.24 mg/L in the malnourished group, higher than the well-nourished group at 237.23 ± 16.13 mg/L; p < 0.001. CRP was elevated (> 0.6 mg/dl) in 53.5% patients with malnutrition; p 0.003. Conclusions Malnutrition is highly prevalent in the CKD population. The incidence increases as the eGFR decrease. TSFT ≤ 10 mm compares favorably with SGA in detecting malnutrition (sensitivity > 90%), and BMI > 20 kg/m2 compares favorably with SGA in ruling out malnutrition (specificity 97%). Malnutrition and inflammation often coexist. Early detection and appropriate management are crucial.

Background: Nephrologists have used percutaneous placements of peritoneal dialysis catheters (PDCs) with or without fluoroscopic guidance. PDCs are also placed using mini-laparotomy and laparoscopic techniques by surgeons. Percutaneous PDC placement by nephrologists is a simple, non-invasive technique with minimum intraoperative morbidity. We compared operative and immediate complications of PDCs using percutaneous versus open surgical mode of insertion. Methods: Data of all patients entering into CAPD programme in our center between July 2011 to July 2015 was collected. A total of 377 PDCs had been inserted over 48 months in 358 patients. Of 377 catheters inserted, 224 had been inserted by percutaneous method and 153 by surgical technique. Results: Wound hematoma developed in 3.5% of percutaneously placed catheters vs 2.6% of catheters placed by surgical technique, p-0.061. Haemorrhagic effluent was seen in 4.46% of percutaneously placed catheters vs 3.92% of surgically placed catheters, p-0.068. Bowel injury occurred in 1.33% of percutaneously placed catheters vs 0.65% of surgically placed catheters, p-0159. Dialysate leak occurred in 2.6% of catheters placed percutaneously vs 6.5% of catheters placed by surgical technique, p-0.068. Percutaneous PDC allowed a significantly shorter hospital stay, smaller wound size and less break-in period Conclusions: Percutaneously placed CAPD catheters by nephrologists ensues significantly less hospital stay, small sized incision, lesser break-in period and less post-surgical morbidity as compared with surgically placed catheters. Percutaneous PDC placement is minimally invasive, safe, less time consuming and dependable peritoneal access technique.