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  1. Article: Atypical HUS Associated with

    Negi, Sharon / Chakurkar, Vipul / Agarwal, Meenal / Lobo, Valentine

    Indian journal of nephrology

    2020  Volume 30, Issue 5, Page(s) 342–345

    Abstract: Atypical hemolytic uremic syndrome is a rare form of thrombotic microangiopathy caused by complement pathogenic variants. We describe a case of a 33-year-old woman who presented as rapidly progressing renal failure requiring dialysis and had anemia, ... ...

    Abstract Atypical hemolytic uremic syndrome is a rare form of thrombotic microangiopathy caused by complement pathogenic variants. We describe a case of a 33-year-old woman who presented as rapidly progressing renal failure requiring dialysis and had anemia, microhematuria, low C3, normal C4 levels, and normal platelet count. Renal biopsy revealed arteriolar thrombotic microangiopathy and acute tubular injury. Patient was treated with plasma exchange and hemodialysis as required. This resulted in partial recovery at 1 month. Genetic workup by multiplex ligation-dependent probe amplification revealed a 1.5 times higher signal intensity on downstream region of
    Language English
    Publishing date 2020-08-28
    Publishing country India
    Document type Case Reports
    ZDB-ID 2134388-3
    ISSN 1998-3662 ; 0971-4065
    ISSN (online) 1998-3662
    ISSN 0971-4065
    DOI 10.4103/ijn.IJN_347_19
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  2. Article: Renal Microvascular Ischemia Secondary to Nonsteroidal Anti-inflammatory Drugs.

    Kulkarni, Sagar / Chakurkar, Vipul / Lobo, Valentine

    Indian journal of nephrology

    2020  Volume 31, Issue 4, Page(s) 383–385

    Abstract: Nonsteroidal anti-inflammatory drugs (NSAIDs), widely prescribed for pain, can affect kidneys in various ways. We present a case of a 37-year-old woman with multiple NSAIDs intake over a short period for dysmenorrhea followed by the development of new- ... ...

    Abstract Nonsteroidal anti-inflammatory drugs (NSAIDs), widely prescribed for pain, can affect kidneys in various ways. We present a case of a 37-year-old woman with multiple NSAIDs intake over a short period for dysmenorrhea followed by the development of new-onset bilateral flank pain. Computed tomography revealed bilateral multiple renal infarcts. Renal function was normal. Investigations showed no cardiac or renal artery lesion and vasculitis work-up was negative. She was treated conservatively and further NSAID intake was avoided. Follow-up scan showed complete restoration of the blood flow in previously affected areas. Thus, microvascular ischemia secondary to NSAIDs was thought to be responsible.
    Language English
    Publishing date 2020-11-07
    Publishing country India
    Document type Case Reports
    ZDB-ID 2134388-3
    ISSN 1998-3662 ; 0971-4065
    ISSN (online) 1998-3662
    ISSN 0971-4065
    DOI 10.4103/ijn.IJN_211_20
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  3. Article: Continuous Hemodiafiltration with the oXiris Filter Ameliorates Cytokine Storm and Induces Rapid Clinical Improvement in COVID-19 - A Case Report.

    Lobo, Valentine A / Lokhande, Arati / Chakurkar, Vipul / D'Costa, Pradeep M

    Indian journal of nephrology

    2021  Volume 31, Issue 6, Page(s) 555–558

    Abstract: Delayed interferon secretion and cytokine dysregulation are responsible for the life-threatening acute respiratory distress syndrome (ARDS), multiorgan dysfunction and shock in COVID 19, which closely resembles secondary hemophagocytic ... ...

    Abstract Delayed interferon secretion and cytokine dysregulation are responsible for the life-threatening acute respiratory distress syndrome (ARDS), multiorgan dysfunction and shock in COVID 19, which closely resembles secondary hemophagocytic lymphohistiocytosis (sHLH). IL-6, a marker of hypercytokinemia in patients with COVID-19 is positively correlated with disease severity, development and progression of ARDS, and mortality. Therapy to either reduce IL-6 or inhibit its action with either non-specific inhibitors of inflammation like dexamthasone or Toclizumab a specific inhibitor of IL-6 has produced decrease in mortality. We describe a novel method of treatment in a patient with multiorgan involvement in COVID 19, using the oXiris hemofilter which delivers renal replacement therapy while also reducing cytokines like IL-6.
    Language English
    Publishing date 2021-04-07
    Publishing country India
    Document type Case Reports
    ZDB-ID 2134388-3
    ISSN 1998-3662 ; 0971-4065
    ISSN (online) 1998-3662
    ISSN 0971-4065
    DOI 10.4103/ijn.IJN_429_20
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  4. Article ; Online: High prevalence of CFHR deletions in Indian women with pregnancy-associated hemolytic uremic syndrome.

    Kandari, Sharon / Chakurkar, Vipul / Gaikwad, Snehal / Agarwal, Meenal / Phadke, Nikhil / Lobo, Valentine

    Nephrology (Carlton, Vic.)

    2021  Volume 27, Issue 3, Page(s) 231–237

    Abstract: Aim: Pregnancy-associated hemolytic uremic syndrome (P-aHUS) is an important cause of peripartum acute kidney injury. Studies from Europe have described mutations in complement regulator genes, and data in Indian patients is scarce. Hence this study ... ...

    Abstract Aim: Pregnancy-associated hemolytic uremic syndrome (P-aHUS) is an important cause of peripartum acute kidney injury. Studies from Europe have described mutations in complement regulator genes, and data in Indian patients is scarce. Hence this study used multiplex ligation-dependent probe amplification (MLPA) to identify variants in complement genes in P-aHUS patients.
    Methods: We present 17 patients of P-aHUS who were investigated for complement protein levels and genetic analysis with MLPA for complement genes. Plasma exchange therapy was offered to all patients presenting in acute phase.
    Results: Mean age 26.74 (3.36) years with 15/17 delivered by caesarean section. Eleven patients received early (within 7 days) plasma exchange, three were dialysis-dependent at 3 months and seven were dialysis-free. Only one of the three patients receiving late (after 7 days) plasma exchange was dialysis-free. MLPA showed that 11 patients had heterozygous deletions of exons 3, 5, 6 of CFHR1 and upstream region of exons 1, 2, 3, 6 and intron 4 of CFHR3 gene while four patients had homozygous deletions at the same loci. Two patients had no MLPA-detectable variations.
    Conclusion: This study reports a high proportion of deletions of exons of CFHR1 & CFHR3 genes in Indian P-aHUS patients detectable by MLPA by copy number variations. This needs confirmation in large multicentre studies. Plasma exchange can be an effective therapy in the non-availability of Eculizumab.
    MeSH term(s) Adult ; Blood Proteins/genetics ; Complement C3b Inactivator Proteins/genetics ; Female ; Gene Deletion ; Hemolytic-Uremic Syndrome/genetics ; Humans ; India ; Pregnancy ; Pregnancy Complications/genetics ; Prospective Studies ; Young Adult
    Chemical Substances Blood Proteins ; CFHR1 protein, human ; CFHR3 protein, human ; Complement C3b Inactivator Proteins
    Language English
    Publishing date 2021-12-07
    Publishing country Australia
    Document type Journal Article ; Observational Study
    ZDB-ID 1303661-0
    ISSN 1440-1797 ; 1320-5358
    ISSN (online) 1440-1797
    ISSN 1320-5358
    DOI 10.1111/nep.14004
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 4822: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
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  5. Article ; Online: Increased serum catalytic iron may mediate tissue injury and death in patients with COVID-19.

    Chakurkar, Vipul / Rajapurkar, Mohan / Lele, Suhas / Mukhopadhyay, Banibrata / Lobo, Valentine / Injarapu, Ramakrishna / Sheikh, Muddassir / Dholu, Bharatkumar / Ghosh, Arpita / Jha, Vivekanand

    Scientific reports

    2021  Volume 11, Issue 1, Page(s) 19618

    Abstract: The pathophysiology and the factors determining disease severity in COVID-19 are not yet clear, with current data indicating a possible role of altered iron metabolism. Previous studies of iron parameters in COVID-19 are cross-sectional and have not ... ...

    Abstract The pathophysiology and the factors determining disease severity in COVID-19 are not yet clear, with current data indicating a possible role of altered iron metabolism. Previous studies of iron parameters in COVID-19 are cross-sectional and have not studied catalytic iron, the biologically most active form of iron. The study was done to determine the role of catalytic iron in the adverse outcomes in COVID-19. We enrolled adult patients hospitalized with a clinical diagnosis of COVID-19 and measured serum iron, transferrin saturation, ferritin, hepcidin and serum catalytic iron daily. Primary outcome was a composite of in-hospital mortality, need for mechanical ventilation, and kidney replacement therapy. Associations between longitudinal iron parameter measurements and time-to-event outcomes were examined using a joint model. We enrolled 120 patients (70 males) with median age 50 years. The primary composite outcome was observed in 25 (20.8%) patients-mechanical ventilation was needed in 21 (17.5%) patients and in-hospital mortality occurred in 21 (17.5%) patients. Baseline levels of ferritin and hepcidin were significantly associated with the primary composite outcome. The joint model analysis showed that ferritin levels were significantly associated with primary composite outcome [HR (95% CI) = 2.63 (1.62, 4.24) after adjusting for age and gender]. Both ferritin and serum catalytic iron levels were positively associated with in-hospital mortality [HR (95% CI) = 3.22 (2.05, 5.07) and 1.73 (1.21, 2.47), respectively], after adjusting for age and gender. The study shows an association of ferritin and catalytic iron with adverse outcomes in COVID-19. This suggests new pathophysiologic pathways in this disease, also raising the possibility of considering iron chelation therapy.
    MeSH term(s) Adult ; Aged ; COVID-19/mortality ; COVID-19/pathology ; COVID-19/virology ; Cross-Sectional Studies ; Female ; Ferritins/blood ; Ferritins/metabolism ; Hepcidins/blood ; Hepcidins/metabolism ; Hospital Mortality ; Humans ; Iron/blood ; Iron/chemistry ; Male ; Middle Aged ; Proportional Hazards Models ; Respiration, Artificial ; SARS-CoV-2/isolation & purification ; Severity of Illness Index ; Transferrin/chemistry ; Transferrin/metabolism
    Chemical Substances Hepcidins ; Transferrin ; Ferritins (9007-73-2) ; Iron (E1UOL152H7)
    Language English
    Publishing date 2021-10-04
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-021-99142-x
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  6. Article ; Online: Inadvertently high dialysate magnesium causing weakness and nausea in hemodialysis patients.

    Chakurkar, Vipul V / Gade, Pritam S / Godbole, Anil V / Wadia, Farrokh F / Lobo, Valentine A

    Hemodialysis international. International Symposium on Home Hemodialysis

    2019  Volume 23, Issue 4, Page(s) E106–E110

    Abstract: As maintenance hemodialysis patients are exposed to large quantities of dialysis water, any contamination of it might be reflected in plasma levels. We present a series of cases due to such a contamination. Six maintenance hemodialysis patients dialyzing ...

    Abstract As maintenance hemodialysis patients are exposed to large quantities of dialysis water, any contamination of it might be reflected in plasma levels. We present a series of cases due to such a contamination. Six maintenance hemodialysis patients dialyzing at the same peripheral hemodialysis facility presented to us over a short period of time with symptoms mimicking inadequate dialysis. Their blood urea and creatinine levels were not very high, but all the patients had hypermagnesemia [serum Mg levels = 1.8 (±0.3) mmol/L]. Except for one patient who had cardiac arrest at presentation, all patients improved after undergoing hemodialysis at our center [serum Mg at discharge = 0.86 (±0.01) mmol/L]. The origin of hypermagnesemia was traced to dialysis water contamination with magnesium due to inadequate maintenance of the water treatment system. Corrective measures improved the quality of water, and no further cases were reported from that center. Proper maintenance and periodic checks of the quality of water are central to the outcomes of maintenance hemodialysis patients.
    MeSH term(s) Dialysis Solutions/adverse effects ; Humans ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/therapy ; Magnesium/adverse effects ; Magnesium/blood ; Male ; Middle Aged ; Muscle Weakness/chemically induced ; Nausea/chemically induced ; Renal Dialysis/adverse effects ; Renal Dialysis/methods
    Chemical Substances Dialysis Solutions ; Magnesium (I38ZP9992A)
    Language English
    Publishing date 2019-05-21
    Publishing country Canada
    Document type Case Reports ; Journal Article
    ZDB-ID 2192458-2
    ISSN 1542-4758 ; 1492-7535
    ISSN (online) 1542-4758
    ISSN 1492-7535
    DOI 10.1111/hdi.12763
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 6091: Show issues Location:
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  7. Article ; Online: Increased serum catalytic iron may mediate tissue injury and death in patients with COVID-19

    Vipul Chakurkar / Mohan Rajapurkar / Suhas Lele / Banibrata Mukhopadhyay / Valentine Lobo / Ramakrishna Injarapu / Muddassir Sheikh / Bharatkumar Dholu / Arpita Ghosh / Vivekanand Jha

    Scientific Reports, Vol 11, Iss 1, Pp 1-

    2021  Volume 8

    Abstract: Abstract The pathophysiology and the factors determining disease severity in COVID-19 are not yet clear, with current data indicating a possible role of altered iron metabolism. Previous studies of iron parameters in COVID-19 are cross-sectional and have ...

    Abstract Abstract The pathophysiology and the factors determining disease severity in COVID-19 are not yet clear, with current data indicating a possible role of altered iron metabolism. Previous studies of iron parameters in COVID-19 are cross-sectional and have not studied catalytic iron, the biologically most active form of iron. The study was done to determine the role of catalytic iron in the adverse outcomes in COVID-19. We enrolled adult patients hospitalized with a clinical diagnosis of COVID-19 and measured serum iron, transferrin saturation, ferritin, hepcidin and serum catalytic iron daily. Primary outcome was a composite of in-hospital mortality, need for mechanical ventilation, and kidney replacement therapy. Associations between longitudinal iron parameter measurements and time-to-event outcomes were examined using a joint model. We enrolled 120 patients (70 males) with median age 50 years. The primary composite outcome was observed in 25 (20.8%) patients—mechanical ventilation was needed in 21 (17.5%) patients and in-hospital mortality occurred in 21 (17.5%) patients. Baseline levels of ferritin and hepcidin were significantly associated with the primary composite outcome. The joint model analysis showed that ferritin levels were significantly associated with primary composite outcome [HR (95% CI) = 2.63 (1.62, 4.24) after adjusting for age and gender]. Both ferritin and serum catalytic iron levels were positively associated with in-hospital mortality [HR (95% CI) = 3.22 (2.05, 5.07) and 1.73 (1.21, 2.47), respectively], after adjusting for age and gender. The study shows an association of ferritin and catalytic iron with adverse outcomes in COVID-19. This suggests new pathophysiologic pathways in this disease, also raising the possibility of considering iron chelation therapy.
    Keywords Medicine ; R ; Science ; Q
    Subject code 610
    Language English
    Publishing date 2021-10-01T00:00:00Z
    Publisher Nature Portfolio
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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