Browsing by Author "Sigdel, Mahesh Raj"
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Publication BK Virus Nephropathy and Transplant Outcomes: A Single Center Study(Institute of Medicine, Tribhuvan University, 2024) Ojha, Prashanta; Shah, Dibya Singh; Phuyal, Mandira; Mishra, Anand; Sigdel, Mahesh RajAbstract: Background: A significant proportion of renal allografts are complicated by BK Polyoma Virus infection which, if not managed in time, leads to BK Polyoma virus Nephropathy (BKVN). Early recognition and reduction of immunosuppressants is the mainstay of management of BKVN. We aimed to study the clinical characteristics of patients with BKVN, its timeline, management strategies and its outcome at one year of diagnosis. Methods: An observational study was done in Tribhuvan University Teaching Hospital, Nepal, in September 2024. The medical records of living-donor renal transplant recipients between August 2008 to April 2024 with biopsy proven BK virus Nephropathy were reviewed. Time since transplant, recipient age, recipient sex, donor age, donor sex, relationship with Donor, Blood group compatibility, induction agent and immunosuppressive used at the time of BKVN diagnosis, mode of diagnosis and clinical presentation, co-morbid diabetes, other infections during the time of diagnosis, changes in maintenance immunosuppression, other treatments received, renal function 1 year after diagnosis and need for dialysis were studied. Results: Out of 847 living-donor kidney transplants, 15 (1.77%) had BK virus nephropathy. Thirteen (86.7%) were males; mean age was 42 ± 11.53 years and 5(were diabetic. Average HLA mismatch was 3/6. BKVN was diagnosed after a mean period of 16.07±13.24 months after transplant. Thymoglobulin was used as induction agent in 11(73.3%) cases. All the patients were on Tacrolimus, Mycophenolate mofetil and Prednisolone. Average creatinine was 147.93±40.882µMol/L. Patients were managed with reduction in immunosuppressives and fluoroquinolones. Average creatinine after 1 year of diagnosis was increased by 10% to 164.43 ± 101.03µMol/L while one patient required maintenance hemodialysis 3 years later. Conclusion: BKVN was seen in less than 2% of renal allograft recipients; at 16.07±13.24 months after transplant. There was significant renal dysfunction at diagnosis which did not improve at one year, while 1 patient required maintenance hemodialysis.Publication Cataract among Patients with Renal Transplantation in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Thapa, Madhu; Shrestha, Gulshan Bahadur; Gautam, Pragati; Sigdel, Mahesh RajAbstract Introduction: Intensive immunosuppressant therapy after renal transplantation has found to cause systemic and ocular side effects among them is cataracts. Studies on a similar topic have still remained explored in our setting. The aim of the study was to find out the prevalence of cataract among patients with renal transplantation in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among patients of renal transplantation at tertiary care centres from 1 May 2021 to 31 October 2021. The data was collected after the ethical approval from Institutional Review Committee [Reference number: 397(6-11) e2077/078]. Study proforma recorded the number of patients with cataracts, duration of steroid use, mean age and other comorbidities. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 31 renal transplant patients, 10 (32.26%) (15.80-48.72, 95% Confidence Interval) had cataract. Conclusions: The prevalence of cataract among renal transplantation patients was found to be lower than similar studies done in similar settings.Publication MEST C Score and Treatment Response in IgA Nephropathy in a Tertiary Care Hospital: A Descriptive Cross-sectional Study(Nepal Medical Association, 2024) Thapa, Sushma; Sigdel, Mahesh RajAbstract Introduction: IgA nephropathy is the leading cause of primary glomerulonephritis worldwide. The Oxford classification can predict IgA nephropathy prognosis through renal biopsy however its applicability to the Nepalese population remains unexplored. This study aimed to evaluate the MEST-C score and treatment response in patients with IgA nephropathy. Methods: This descriptive cross-sectional study was conducted at a tertiary care center from November 2021 to November 2022 after obtaining ethical approval [IRC-193(6-11)t2078/079]. Total population sampling was done. Fifty-two consenting patients aged 16 or older with confirmed IgA nephropathy were included, excluding those with liver disease or expected survival of less than six months. The study assessed the MEST-C score, demographic factors, and clinical parameters. Data analysis was done using Statistical Package of Social Sciences. Results: Among 52 patients with segmental glomerulosclerosis (S1), 11 (24.44%) achieved complete remission, 30 (66.67%) partial remission, and 5 (11.11%) progressed to end-stage renal disease. In those with tubular atrophy/interstitial fibrosis (T1), 1 (5.88%) achieved complete remission, 13 (76.47%) partial remission, and 4 (23.53%) progressed to end-stage renal disease. For glomerular crescents (C1), 9 (47.37%) achieved complete remission, 9 (47.37%) partial remission, and 1 (5.26%) progressed to end-stage renal disease. IFTA% of 0-25% had complete remission in 15 (46.88%). Among the two patients with IFTA% ≥50%, one (50%) developed end-stage renal disease and the other achieved partial remission. Conclusions: The S1 and T1/2 components of the MEST-C score had higher rates of partial remission and progression to end-stage renal disease, while other indices showed mixed results. The risk of failing to achieve complete increased with an IFTA of more than 25%.