Browsing by Author "Thakur, Jitendra"
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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 Assessment of Nutritional Status of Children Attending Paediatrics OPD of a Tertiary Care Hospital in Eastern Nepal(Nepal Paediatric Society (JNPS), 2017) Thakur, Jitendra; Bhatta, Nisha Keshary; Poudel, Prakash; Shah, Gouri Shankar; Singh, Rupa RajbandariAbstract: Introduction: Malnutrition is one of the major health problem worldwide, especially in developing world and so is in Nepal, the causes being numerous. The objectives of this study were to assess the nutritional status of children attending paediatric OPD of BPKIHS and to find relation of the nutritional status with different factors. Material and Methods: This descriptive cross sectional study was done by face to face interviews using semi-structured questionnaire and anthropometric variables were recorded. Data of total 192 children was analysed by descriptive statistics. p-value <0.05 was considered significant. Results: According to IAP classification 50.52% were malnourished [grade I 65.97%, grade II 26.8%, grade III 7.21%]. According to WHO classification 47.39% stuntedmoderate 89%, severe 11% and 9.89% wasted [moderate 94.73%, severe 5.26%]. Female sex, low education level in mother, low economic status, unavailability of exclusive breast feeding, low birth spacing and hospitalization were significantly associated with malnutrition. Conclusion: Malnutrition is common in children visiting paediatric OPD of BPKIHS. Female sex, maternal illiteracy, poverty, early weaning, birth spacing and hospitalization in past were major risk factors for malnutrition.Publication Prevalence of Tuberculosis in Severe Acute Malnutrition: A Prospective Observational Study(Nepal Paediatric Society (JNPS), 2022) Thakur, Jitendra; Thakur, Ranjana; Bhatta, Nisha Keshary; Yadav, Shankar Prasad; Khanal, Basudha; Bhattarai, Narayan RajAbstract: Introduction: Tuberculosis (TB) and malnutrition are important causes of morbidity and mortality in children in the developing world. This study was done to determine the prevalence of tuberculosis in severe acute malnutrition (SAM) cases and to observe different presentations of SAM. Method: This prospective observational study was carried out in the Department of Paediatrics and Adolescent Medicine at a tertiary care center in Nepal for a duration of one year from December 2018 to November 2019. All cases of SAM meeting the inclusion criteria were evaluated with Mantoux test, chest X-ray, gastric aspirate / sputum analysis and gene-Xpert for diagnosis of TB. Other relevant investigations for diagnosis of TB were also sent as per the clinical scenario. Data were entered and analyzed using Microsoft excel. Descriptive statistics was used for analysis of data. Results: Total 107 SAM cases were analyzed. The hospital prevalence of wasting and severe wasting was 11.98% and 0.73% respectively. The prevalence of TB in SAM was 4.67%, commonest being pulmonary TB (60%). Among TB cases, 40% were without any systemic complaints. Only 19.6% cases presented with nutritional complaint. Conclusions: This study found that a significant percentage of cases with SAM had TB and hence adds on the importance of screening for TB (Pulmonary TB) in every case of SAM, irrespective of symptoms.Publication Role of Renal Biopsy in Managing Paediatric Renal Disease in a Tertiary Care Setting(Nepal Paediatric Society (JNPS), 2021) Yadav, Shankar Prasad; Thakur, JitendraAbstract Introduction: The contribution of renal biopsy is of major importance in many paediatrics renal diseases. This prospective study analysed the clinic-pathological spectrum of the biopsied cases, complications related to renal biopsy and its effect on management. Methods: USG guided percutaneous renal biopsy was performed in indicated children. Laboratory findings, complications of the procedure, histological diagnosis and its effect on management were obtained from all patients who underwent renal biopsy from April 2019 to March 2020. The data were finally analysed using descriptive statistics. Results: Total 50 cases were enrolled during the study period. There were 24 males and 26 females with age range from two to 16 years. The common indications for biopsy were acute nephritic syndrome (25 cases), including both primary glomerulonephritis (11 cases) and secondary glomerulonephritis (14 cases), of which lupus nephritis contributed (11/25) cases, followed by atypical/ steroid resistant or dependent nephrotic syndrome (18 cases). Among primary glomerulonephritis, diffuse proliferative glomerulonephritis was most common pathological finding (11/25). One had crescentric glomerulonephritis. Lupus nephritis predominantly had Class IV/V pathology (6/11). Of 18 nephrotic syndrome cases, nine had minimal-change-disease and five had focal-segmental-glomerulosclerosis. The complications associated with procedure were self-resolving gross hematuria in eight cases, perirenal hematoma requiring plasma transfusion in one case. Adequate renal tissue sample was obtained in 47 of the renal biopsies. Three cases underwent repeat biopsy. Immunosuppressive therapy was altered as per the biopsy report among 18 cases. Conclusions: Our study showed that renal biopsy is a safe, reliable and effective technique in children. It resolutes many diagnostic dilemma and helps in effective management.Publication Tuberculosis in Early Infancy: Rare in Today’s World(Nepal Paediatric Society (JNPS), 2018) Thakur, Jitendra; Rai, Rupa Rajbhandari; Singh, Rupa Rajbhandari; Ghosh, Sohini; Gyawali, PratyushAbstract: Tuberculosis in early infancy was not so common earlier also and has become rare these days. Since the disease is occasionally encountered, pediatricians should suspect tuberculosis in infants not responding to standard therapy. Here we report a case of three months old female who had presented with complaints of fever for two months, cough for one and half months and difficulty breathing for seven days and was being treated in line of bacterial pneumonia without improvement. She was found to be mycobacterium positive and was treated with anti-tubercular therapy leading to improvement and discharge. So, though rare, it is important to consider tuberculosis even in early infancy not responding to standard antibiotic therapy.