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IntroductionRenal involvement in type 2 diabetes mellitus (T2DM) may be due to diabetes (diabetic kidney disease (DKD)), causes other than diabetes (non-diabetic kidney disease (NDKD)) or overlap of DKD and NDKD (mixed kidney disease group). Prevalence of NDKD and predictive value of clinical or biochemical indicators have been explored in retrospective cohorts with preselection biases warranting the need for prospectively conducted unbiased renal biopsy study.Research design and methodsConsecutive subjects aged >18 years with T2DM and renal involvement with estimated glomerular filtration rate of 30–60 mL/min/m2and/or albumin:creatinine ratio of >300 mg/g were offered renal biopsy. Prevalence of DKD, NDKD and mixed kidney disease was documented. Clinical/laboratory parameters of subjects were recorded and compared between groups and were tested for ability to predict histopathological diagnosis.ResultsWe screened 6247 subjects with T2DM of which 869 fulfilled inclusion criteria for biopsy. Of the 869 subjects, biopsy was feasible in 818 subjects. Out of 818, we recruited first 110 subjects who agreed to undergo renal biopsy. Among those 110 subjects, 73 (66.4%) had DKD; 20 (18.2 %) had NDKD; and 17 (15.4 %) had mixed kidney disease. Subjects with NDKD as compared with DKD had shorter duration of diabetes (p<0.001), absence of retinopathy (p<0.001) and absence of neuropathy (p<0.001). Logistic regression revealed that only presence of retinopathy and duration of diabetes were statistically significant to predict histopathological diagnosis of DKD. 30% of DKD did not have retinopathy, thereby limiting the utility of the same as a discriminator. Use of traditional indicators of biopsy would have indicated a need for renal biopsy in 87.2% of subjects, though 64.5% of the subjects had DKD, who would not have benefitted from biopsy.ConclusionNDKD and mixed kidney disease in T2DM with renal involvement are very common and traditionally used parameters to select biopsies are of limited value in clinical decision making.
BACKGROUND There were about 21 lakh people living with HIV in India and number of new cases was 86,000 in 2015 as reported by UNAIDS in 2015. The scenario here is a bit different than the western population due to the differences in standard of living and access to ART. There is also insufficient knowledge regarding the burden and spectrum of opportunistic infections (OI) in HIV infected populations receiving HAART. Our study was designed to estimate the prevalence and outcome of OIs in HIV patients on HAART therapy at a tertiary hospital in Kolkata in order to define the local priorities. MATERIALS AND METHODS 100 patients of HIV on HAART for at least 1 year were taken up for a descriptive study with respect to the prevalence of OIs and their outcome. Clinical assessment and investigations were done as per the NACO guidelines. The data was analysed using multivariate and computerised statistical methods. RESULT The mean age of 100 patients in our study was 33.8 ± 1.10; 71% of the patients were male. Mean CD4 count was 239.9 ± 11.25. Most common presentation was fever (64%) and weight loss (35%). Tuberculosis was the most common opportunistic infection (55%) followed by candidiasis (51%), Pneumocystis carinii 16%, cryptosporidium diarrhoea 10%, cryptococcal meningitis 6%, cerebral toxoplasmosis 2%. 74 patients were successfully treated. 12 succumbed to death, of which 3 were of tubercular meningitis and pneumocystis carinii pneumonia and 2 were of cryptococcal meningitis, cerebral toxoplasmosis and bacterial pneumonia each. Mean CD4 count of those who survived was 263.17 ± 12.47 and those who succumbed was 133.25 ± 21.38. This was statistically significant showing that death occurred at a lower CD4 count. CONCLUSION Our descriptive study done at a tertiary care hospital of eastern India showed that the main burden of opportunistic infections in HAART experienced HIV patients still lies on tuberculosis followed by candidiasis. However, Pneumocystis carinii and tubercular meningitis are among the leading causes of mortality.
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