Calcineurin inhibitors (CNIs) are the preferred drugs for treatment of childhood steroid-resistant nephrotic syndrome (SRNS) who are also resistant to cyclophosphamide (CYC). Although few studies have shown a benefit of one over the other, efficacy and safety of either CNIs (tacrolimus [TAC] or cyclosporine [CSA]) in this special population remained to be assessed in long-term studies. Forty-five children with SRNS who were also resistant to CYC (CYC-SRNS) from January 2006 to June 2011, were included in the study. Patients were treated with CNI either TAC or CSA based on 1:1 allocations and were prospectively observed. Patients who were nonresponsive to CNIs had been treated with mycophenolate mofetil. Outcomes were measured in terms of remission of NS, adverse effects of drugs, and progression of disease. After 6 months of treatment, 16/23 (69.5%) patients on CSA achieved remission and 18/22 (81.8%) on TAC achieved remission (P = 0.3). The side effects hypertrichosis, and gum hyperplasia were significantly less in TAC group as compared to CSA group (P < 0.001). The 1-, 2-, 3-, 4-, and 5-year estimated renal survival (doubling of serum creatinine as event) in CSA group was 96%, 91%, 85%, 54%, and 33% and in TAC group was 96%, 95%, 90%, 89%, and 79%, respectively (P = 0.02). Although TAC and CSA are equally efficacious, TAC has significantly less side effects. The long-term outcome of renal function was significantly better in patients who were treated with TAC as compared to CSA.

Patients with chronic kidney disease (CKD) experience high symptom burden, both physical and psychological, that is underrecognized and undertreated. The high symptom burden significantly impacts the quality of life for patients and their families. This review enumerates the various physical and psychological symptoms that patients with CKD often experience and guides in the management of these symptoms. This review follows the recommended international guidelines and has been tailored to suit the Indian context.

Introduction: In hemodialysis (HD) patients, catheter-related bloodstream infections (CRBSI) cause significant morbidity and mortality. Objectives: We analyzed dialysis CRBSI incidence, associated factors, and the spectrum of the causative organisms. Patients and Methods: Patients aged ≥18 years either on maintenance HD or with acute kidney injury having CRBSI (NKF-KDOQI criteria) were included in this prospective observational study and patients with other infections were excluded. Blood, catheter tip culture, and antibiogram were analyzed. All patients were initially treated with antibiotics covering both gram-positive and gram-negative pathogens. Results: Of 921 catheters (882 patients) included, 212 (23%) had CRBSI, of which 69(32.5%) and 143 (67.5%) had culture-positive probable CRBSI and culture-negative possible CRBSI respectively. 131 (61.8%) were <60 years, 133 (62.7%) were males, 177 (83.5%) had diabetes, 141 (66.5%) had leukocytosis and 172(81.1%) had positive procalcitonin. In addition, 193 (91%) had uncuffed catheters and 162 (76.4%) had jugular catheters. Our study showed a CRBSI incidence of 13.39/1000 catheter days, median catheter days, and median time to CRBSI was 40 and 17.2 days respectively. 41 (19.3%) catheters were salvaged (with antibiotic administration or guidewire exchange) and 42 (19.8%) had exit site infection. Gram-positive coagulase-negative Staphylococcus aureus (CoNS) (n=31; 44.9%) followed by extended-spectrum beta-lactamase (ESBL) enteric gram-negative organisms (n=30; 43.4%) were common isolates and remaining had fungal etiology (n=8; 11.7%). In our study, the mortality rate was 6.6% (n=14). Conclusion: The incidence of CRBSI was high in our population. In culture-positive cases, gram-positive organisms contributed marginally higher than gram-negative organisms. CoNS and ESBL enteric gram-negative organisms are the commonest isolates. More than two-thirds of patients with CRBSI had diabetes mellitus and leukocytosis at presentation.