Biomedical subjects
Publications and source records attributed to K Tripathi.
Carbonic anhydrase enzyme activity could be measured by manometeric and colorimetric techniques. A simpler and modified method of carbonic anhydrase enzyme activity assessment in blood is proposed. In the present method differences in pH by hydration of CO2 in absence and presence of carbonic anhydrase inhibitor have been used to measure the carbonic anhydrase activity in the blood.
Of 63 patients of obstetrical acute renal failure, 15 cases (23.8%) had biopsy proven bilateral renal cortical necrosis. Remaining 48 patients (76.2%) had acute tubular necrosis. Eight of 39 cases in early pregnancy had cortical necrosis (postabortum) and 7 of 24 patients in late pregnancy revealed cortical necrosis. Diffuse and patchy cortical necroses were seen in 12 and 3 patients respectively. The incidence of cortical necrosis was almost equal in both early as well as late pregnancies. The high incidence (20.5%) of cortical necrosis following septic abortion remains the interesting feature of the present study in contrast to very low incidence (1.5%) of cortical necrosis in postabortum group in developed countries. The death occurred in most patients (14 ie, 93.3%) of cortical necrosis because of uraemic complications and sepsis.
Renal cortical necrosis is an uncommon cause of acute renal failure. We report 23 cases of biopsy-proven renal cortical necrosis which constituted 6.3% (23/363) of all cases of acute renal failure studied over a period of seven years (1985-92). The patients were divided into two groups: obstetric and non-obstetric. Obstetric complications were responsible for renal cortical necrosis in 15 (65.2%) patients while non-obstetric conditions accounted for the remaining eight (34.8%) cases. The overall incidence of cortical necrosis in obstetric acute renal failure was 15/63 (23.8%) patients, the incidence being nearly equal in early (20.5%) and late (29%) pregnancy. Post-abortum renal failure was the sole cause of cortical necrosis in early pregnancy in the obstetric group. Haemolytic uraemic syndrome (three patients) and septicaemia (two patients) were the main cause of necrosis in the non-obstetric group. The cortical necrosis was diffuse and patchy in 17 and six patients, respectively. The disease had a fatal prognosis in 20 (87%) patients; mortality was due to uraemic complications and infections in the majority of patients. The high frequency of post-abortum renal cortical necrosis in our patients is similar to the experience of other Indian workers.
The present study included 426 patients with acute renal failure age range 7 months to 85 years, during 8-year period (1984-1992). Medical, surgical and obstetric causes were responsible for ARF in 68.3, 17.8, and 14% of cases respectively. The main aetiological factors encountered were volume depletion secondary to gastrointestinal fluid loss (35.2%), acute glomerulonephritis (10.3%), nephrotoxin (8.6%), falciparum malaria (4.2%), obstructive uropathy (13%), post-abortal (10.5%), and miscellaneous factors (1.4%) of patients. The overall mortality was 19.2%. Thus our observation revealed that diarrhoeal diseases (35.2%), obstructive uropathy (13.3%), and septic abortion (10.5%) were the main causes for ARF in medical, surgical, and obstetric groups respectively. In contrast to our studies, acute renal failure associated with diarrhoeal diseases, septicaemia, falciparum malaria and septic abortion are rare in European countries.
Three hundred twenty renal biopsies were done in 305 patients over a period of 5 years. Adequate tissue for pathologic diagnosis was obtained in about 79% of biopsy attempts. The overall morbidity of procedure was 6.8%. Haematuria in 11.8% cases was the commonest complication. Haematuria resolved spontaneously in 63.8% of patients within 4-12 hours. Hypotension due to blood loss occurred in 3 patients (0.98%) who required blood transfusion. Five patients (1.6%) developed perirenal haematoma. Urinary retention requiring single catheterisation was seen in 12 cases (3.9%). Perirenal abscess occurred in one case. Minor complications improving with symptomatic medication included vomiting, abdominal pain and vasovagal attack in 3.6%, 2.6% and 1.6% cases respectively.
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Out of 152 cases of Acute renal failure (ARF) 32 patients (21%) were subjected to kidney biopsy. All patients had intrinsic ARF. Prerenal azotemia and obstructive uropathy were excluded. Histologic observations were: Crescentric glomerulonephritis in 7 (21.9%), acute endocapillary proliferative glomerulonephritis 5 (15.6%), acute interstitial nephritis 7 (21.9%), necrotizing vasculitis 4 (12.5%), acute tubular necrosis in 5 (15.6%) and membrano-proliferative GN with superimposed crescent in 2 (6.2%) while renal cortical necrosis was seen in 6.2% of cases. Prebiopsy diagnosis was correct in only 10 (31.25%) cases. The result of biopsy had altered clinical diagnosis in 22 (68.75%) patients and precise renal biopsy diagnosis resulted in therapeutic changes in 54.8% of patients with ARF.
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Two hundred and ninety three sessions of intermittent peritoneal dialysis were carried in 158 cases of renal failure between 1984 and 1987. The complications encountered during the procedure were grouped as mechanical in 29 (17.9%), circulatory in 26 (15%), neurologic in 21 (13.4%) and biochemical in 54 (34.1%) cases. Unexplained respiratory arrest with spontaneous recovery occurred in 2, infections in 5 and miscellaneous complications in 19 (12%) cases. Bradycardia and cardiac standstill were observed in one patient. Most of the complications were managed uneventfully. There was no mortality.
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