Browsing by Author "Jha, Ashish"
Now showing 1 - 3 of 3
Results Per Page
Sort Options
Publication A progressive ANCA associated glomerulonephritis leading to chronic kidney disease and stroke in a child with congenital heart disease: a case report(Madhesh Institute of Health Sciences (MIHS), 2025) Jha, Ashish; Shah, Shiv Kumar; Thakur, Baidyanath; Mandal, Abhay; Thakur, JitendraABSTRACT Nephrotic-nephritic syndrome in children is a rare but significant cause of chronic kidney disease (CKD). This case highlights a challenging diagnostic and therapeutic course involving persistent hematuria, ANCA positiv- ity, refractory hypertension, and cerebrovascular complications. A 10-year-old female, post-patent ductus ar- teriosus (PDA) closure, presented with generalized swelling, hematuria, and proteinuria. Initial workup sug- gested post-infectious glomerulonephritis (PIGN) with persistently low complement levels (C3, C4), and she was managed with diuretics. However, recurrent episodes led to further evaluation, revealing PR3-ANCA positivity, nephrotic-range proteinuria, and progressive renal dysfunction. Despite treatment, she developed refractory hypertension and an intracranial hemorrhage. The absence of renal biopsy posed challenges in definitive diag- nosis, and the patient is now on dialysis. This case underscores the diagnostic challenges in differentiating between PIGN, ANCA-associated glomerulo- nephritis, and rapidly progressive glomerulonephritis (RPGN) in pediatric patients. The interplay between con- genital heart disease and renal dysfunction highlights the need for interdisciplinary management. Early biopsy in recurrent nephrotic-nephritic cases is crucial to prevent irreversible renal damage. The case emphasizes the need for early renal biopsy and comprehensive management of pediatric nephrotic-nephritic syndrome with persistent proteinuria and hematuria.Publication Conservative management of a severe extravasation injury: A therapeutic nightmare(Madhesh Institute of Health Sciences (MIHS), 2025) Sah, Love Kumar; Jha, Ashish; Jayswal, Jitendra Prasad; Sah, Shiv Kumar; Yadav, Rakesh; Jha, SwetaABSTRACT: Intravenous calcium gluconate is commonly used in neonatal intensive care units (NICU) to treat hypocalcemia in preterm infants, who are especially prone to metabolic disturbances. Although effective, it carries the risk of extravasation injury, which can lead to local tissue necrosis and, rarely, systemic complications such as septic shock. We report a male preterm neonate (gestational age 31+4 weeks; birth weight 1750 g) who developed a significant extravasation injury following intravenous infusion of 10% calcium gluconate on day 1 of life for symptomatic hypocalcemia. Within 24 hours, progressive swelling and superficial skin and subcutaneous tissue necrosis extended from the dorsum of the right ankle to the knee. At presentation to our center on day 16 of life, the neonate was in septic shock, necessitating fluid resuscitation, inotropic support, and mechanical ventilation for 72 hours. Conservative wound management with daily dressing using normal saline and Vaseline gauze was undertaken. The patient’s sepsis resolved with antibiotics, and gradual wound healing occurred without the need for surgical intervention. Extravasation injuries from calcium gluconate are uncommon but can be severe, especially in preterm neonates with fragile skin and immature vasculature. Septic shock as a complication is rarely reported but highlights the critical need for vigilant monitoring. Management typically varies; however, this case demonstrates that timely conservative wound care, combined with supportive therapy, may result in favorable outcomes. This report underscores the importance of prevention, early recognition, and multidisciplinary management to reduce morbidity in this vulnerable population.Publication Wilson’s Disease with Lymphoproliferative Disorder: A Case Report(Nepal Medical Association, 2025) Jha, Ashish; Sah, Saroj Kumar; Pradhan, Ravi RanjanAbstract Wilson's disease is characterized by copper accumulation in organs like liver, brain, and eyes, presenting with a varied clinical features, making it challenging to diagnose. This report describes a case of Wilson’s disease with unusual hematological features. A 12-year-old from Himalayan region presented with weakness, dysarthria, tremors. Initial investigations revealed pancytopenia, and bone marrow showed a lymphoproliferative disorder. He developed behavioral changes, a flat affect, and scanning speech. Wilson’s disease was confirmed through Kayser-Fleischer rings, reduced serum ceruloplasmin levels, and elevated urinary copper, supported by imaging.