Papers by Mukunda P Kafle
Kathmandu University Medical Journal, 2012
Background Renal transplantation is a regular service at Tribhuvan University Teaching Hospital a... more Background Renal transplantation is a regular service at Tribhuvan University Teaching Hospital and complications have been known to occur after it. This study was conducted to assess complications after transplantation. Objectives To determine the incidence of urological complications after living related renal transplantation at Tribhuvan University Teaching Hospital. Methods A clinical study was performed (from August 2008 to July 2010) which included 50 living-related renal transplantations at Tribhuvan University Teaching Hospital. All the donors and recipients were evaluated preoperatively with necessary investigations and followed up postoperatively with standard hospital transplant protocol. The incidence of urological complications were documented and analyzed. Results Fifty living-related, renal transplantations were carried out during the study period. Seven doors had minor post operative complications; three had post operative fever, two had chest infections and each one...
Lupus, 2016
Nepal is a small country that is landlocked between India and China. Several ethnic groups live w... more Nepal is a small country that is landlocked between India and China. Several ethnic groups live within the 147,181 km2 of this country. Geographic diversity ranges from the high Himalayas to the flatlands of the Ganges plains. Lupus nephritis (LN), a complication of systemic lupus erythematosus (SLE), is a common kidney problem in Nepal; but the real incidence and prevalence of SLE in Nepal is largely not known. Here, it more commonly affects people (mostly women) living in the southern flatlands, but SLE is reported to be uncommon further south in India. Even though the disease appears to be common, good quality research is uncommon in Nepali literature. This article was written to provide a review of the articles published to date about SLE in Nepal and to discuss the gaps in knowledge that require further evaluation.
Kidney International Reports, Jul 1, 2019
Korean Journal of Transplantation
Transplantation Proceedings
Background. Kidney transplant recipients are always at risk of infections because they are on lif... more Background. Kidney transplant recipients are always at risk of infections because they are on lifelong immunosuppressive medications. The spectrum of infections in this special population is not the same as in the general population. Post-transplant infections are extensively studied in the developed world. Publications about post-transplant infections from Nepal are scarce. This study was carried out to study the spectrum of infections, the trends in treatment, and the incidence of tuberculosis in kidney transplant recipients. Methods. This is a retrospective analysis of the patient data in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Follow-up data from the first 100 kidney transplant recipients was recorded in a Microsoft Excel worksheet and descriptive analysis was done. Results. In the first 100 transplants done until 21 September 2011, 92 patients' data were recorded and 8 patients' data were missing. The mean follow-up period was 61.03 months. The population was 76.09% male (n ¼ 70) and 23.91% female (n ¼ 22). A total of 641 episodes of infections were recorded. Urinary tract infections were the most common type of infection. Escherichia coli was the most common organism isolated (36% of all cultures). There were 17 (2.65%) episodes of viral and 42 (6.6%) episodes of fungal infections. Tuberculosis was diagnosed in 6 (6.5%) patients. Conclusion. Urinary tract infection is the most common type of infection in post-kidney transplant patients. Quinolones were the most common agents used to treat urinary tract infections. The incidence of tuberculosis in kidney transplant recipients is 6.5% in 5 years' follow-up. BACKGROUND AND OBJECTIVES K IDNEY transplant recipients are always at risk of
Annals of Medicine & Surgery
Transplantation Proceedings, 2018
BACKGROUND Increasing graft survival is the prime focus of every transplantation program. Detecti... more BACKGROUND Increasing graft survival is the prime focus of every transplantation program. Detection of subclinical abnormalities with the help of protocol renal graft biopsies performed at predetermined intervals after transplantation has been one of the approaches. The objective was to study the abnormalities in protocol renal graft biopsy specimens at 6 months posttransplantation. METHODS This was a hospital-based observational descriptive study. It included the recipients who underwent kidney transplantation between October 2014 and September 2015. The recipients were followed up postoperatively on an outpatient basis, as per the institution protocol. At 6 months posttransplantation, protocol graft biopsy was performed in all patients with normal functioning allograft without proteinuria after obtaining informed written consent. RESULTS A total of 57 patients with chronic kidney disease underwent renal transplantation during the study period. Protocol biopsy was performed in 47 recipients. Subclinical rejection was found in 4 (8.5%) recipients. Two recipients had significant tubulitis and interstitial inflammation. One of them showed features of Banff Type IA cellular rejection (t2, i2) and another showed Banff Type IB cellular rejection (t3, i2). Biopsy specimen of 1 recipient showed significant glomerulitis and peritubular capillaritis (g3, ptc1). Another recipient showed significant peritubular capillaritis (ptc2) with C4d positivity. IgA nephropathy was present in 6 (12.8%) recipients. BK virus nephropathy was found in 2 (4.3%) recipients. CONCLUSION This study demonstrates that abnormal histologic findings occur in protocol graft biopsy specimens at 6 months post renal transplantation in patients without any clinical or laboratory abnormalities.
Journal of Nepal Medical Association, 2012
Chronic acidosis is an important, often overlooked cause of growth retardation. Here we present t... more Chronic acidosis is an important, often overlooked cause of growth retardation. Here we present the case of a girl with distal renal tubular acidosis who had visited multiple hospitals before the diagnosis was made. She presented to us in adolescence with non anion gap metabolic acidosis, hypokalemia, severe growth retardation and nephrocalcinosis. In 18 months follow up with alkali therapy, she had good weight gain and growth velocity. Keywords: growth retardation; hypokalemia; nephrocalcinosis; renal tubular acidosis.
Transplantation, 2018
Introduction: Infection with Mycobacterium tuberculosis is a major public health issue in the dev... more Introduction: Infection with Mycobacterium tuberculosis is a major public health issue in the developing world. Immunosuppressed patients are at high risk of acquiring new infection whilst being equally at risk for reactivation of an indolent disease. Because tuberculosis (TB) can affect any organ system, and even typical infections may present atypically in the immunosuppressed, clinical diagnosis of TB is not easy. Rifampicin based treatment is further challenging because of its interactions with calcineurine inhibitors, an integral component of post-transplant medication. We aimed to study the burden, clinical characteristics and outcome of TB in this setting.
Transplantation, 2018
Introduction: Kidney transplantation leads to a complex milieu in the human body. Engraftment of ... more Introduction: Kidney transplantation leads to a complex milieu in the human body. Engraftment of a solid organ with the help of multiple immunomodulating agents in a patient with pre-existing complexity of uremic environment puts these individuals into a special risk of predictable and unforeseen complications. In this study we aim to investigate the medical complications observed during the follow up of living kidney recipients in our centre.
Kidney International Reports, 2019
Transplantation Journal, 2010
Kathmandu University Medical Journal, 2012
Immune thrombocytopenic purpura (ITP) is a hematological disorder characterized by immunologicall... more Immune thrombocytopenic purpura (ITP) is a hematological disorder characterized by immunologically mediated destruction of platelets and absence of other causes of thrombocytopenia. Treatment is required when the low platelet count entails risk of serious bleeding. Steroid is the first line of management. Acute refractory ITP with very low platelet count is variably treated with high dose steroid, intravenous immunoglobulin (IVIg), anti D or emergency splenectomy. Here, we present a case of steroid resistant ITP with severe thrombocytopenia treated with plasma exchange and low dose IVIg who responded dramatically to the therapy with maintained platelet count till one month from the institution of therapy. KATHMANDU UNIVERSITY MEDICAL JOURNAL VOL.10 | NO. 1 | ISSUE 37 | JAN - MAR 2012 | 85-87 DOI: http://dx.doi.org/10.3126/kumj.v10i1.6922
Bangladesh Journal of Medicine
Anemia is common in patients with chronic kidney diseases (CKD). It is a common complication of a... more Anemia is common in patients with chronic kidney diseases (CKD). It is a common complication of advanced CKD. Its prevalence in CKD stage 5 populations is over 50%. The hormone “erythropoetin” (EPO) secreted by the kidneys is essential in the maintenance of adequate hemoglobin in human body. Scientific Presentation BJM Vol. 34 No. 2(1) Suppliment 2023 177 Apart from failure of EPO secretion, many other factors including chronic inflammation, uremic bone marrow suppression, hyperparathyroidism, poor absorption of substrates from the uremic gastrointestinal tract etc. contribute to development of anemia in patients living with advanced kidney failure and dialysis. Iron deficiency state due to absolute or relative iron deficiency is common in CKD population. Furthermore, nutritional anemia is common in general population in our part of the world. Majority of this is also a result of iron deficiency. Replenishing iron stores in the body is the first strategy in the management of this co...
Pediatric Transplantation, 2019
KT is the treatment of choice for ESRD. It is financially and technically demanding modality. Whe... more KT is the treatment of choice for ESRD. It is financially and technically demanding modality. Whether that is for the emerging or the prosperous nations, the cost incurred is proportionately high. Living and deceased donor organs are the main foundations of any transplant program. In general, living donors are the predominant contributors to KT in poor countries, 1 where deceased donor program is not yet well established. While some emerging nations have also demonstrated effective deceased donor transplantation, it is more common than LDKT in the richer countries. Moreover, living donors are readily available for adults but, when a child is to be benefitted, living donor organs are few. This
BMC Nephrology, 2016
Background: The current standard for induction phase treatment of lupus nephritis is steroid comb... more Background: The current standard for induction phase treatment of lupus nephritis is steroid combined with mycophenolate mofetil or pulse intravenous cyclophosphamide (IVC). The lowest dose of IVC recommended for induction therapy is that used in the Euro-Lupus Trial. It is not known whether same cumulative dose of IVC would be effective when given over six months. Methods: We carried out a prospective, observational study on 41 patients of biopsy-proven lupus nephritis (class III, IV, V or mixed). For induction, patients received six pulses of monthly IVC (500 mg each), along with steroid. Patients were followed up monthly until one month beyond completion of the sixth pulse. The outcomes assessed were complete remission (proteinuria < 200 mg/day or urine albumin nil with serum albumin >35 gm/L, stable estimated glomerular filtration rate (eGFR) if normal at baseline or increase in eGFR by 25 % if abnormal at baseline and normal urinary sediment), response (complete or partial remissions), complications of therapy and death. Results: Twenty two patients (53.7 %) had class IV nephritis. Eighteen patients (43.9 %) achieved complete remission, 16 (39.0 %) achieved partial remission, yielding an overall response rate of 82.9 %. Nephrotic range proteinuria (UTP ≥ 3 g/ day) and severe hypoalbuminemia (serum albumin < 20 g/L) at baseline influenced remission (p <0.05). Infection, seen in 12 patients (29.3 %), was the most common complication. Four deaths (9.6 %) were observed, all due to infection. Conclusions: For induction phase treatment, Nepalese patients with lupus nephritis responded favorably to steroid and low dose IVC of 3 grams given as six monthly pulses.
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2010
A successful renal transplantation service was started in Nepal at the Tribhuvan University Teach... more A successful renal transplantation service was started in Nepal at the Tribhuvan University Teaching Hospital in August 2008, and a continuing regular service is being provided currently to needy people. We report here our experience in thirty five end stage renal disease patients who received kidneys from close relatives during a one year period. The mean age of donors was 46.7 years. Seventeen (49%) donations were from parents, 13 (37%) from spouses, four (11%) between siblings and one (3%) between mother and daughter in law. Although the left kidney was given preference, right sided donor nephrectomy was needed in five (14%) cases. Six (17%) donors had minor postoperative problems. The mean age of recipients was 33.2 years, four (11%) of whom had pre-emptive renal transplantation. Recipients were immunosuppressed with dacluzimab, prednisolone, mycophenalate, and cyclosporine or tacrolimus. The average time taken for graft implantation was 137 minutes. The mean cold ischemia time ...
Journal of Advances in Internal Medicine, 2014
Background and aims: Prevalence of various types of kidney diseases in Nepalese population has la... more Background and aims: Prevalence of various types of kidney diseases in Nepalese population has largely been unknown. Knowledge of the prevalence of specific type kidney disease in renal patients has important implications in starting the treatment modalities and prognostification of these patients. We tried to find out the various types of kidney diseases in patient population undergoing kidney biopsy at our centre. Methods: We retrospectively analyzed kidney biopsy reports of patients who underwent Kidney Biopsy from 2007 to 2009 in Tribhuvan University Teaching Hospital (TUTH), Kathmandu. Results: Of the 194 kidney biopsy reports analyzed, 100(51.5%) were females and 94(48.5%) males. Most of the patients 75.773% (n=147) were 16-45yrs age (Mean age 33.7years). Biopsy reports showed Lupus Nephritis in 20.6%(n=40), Focal Segmental Glomerulosclerosis (FSGS) in 19.6%(n=38), IgA Nephropathy in 9.8%(n=19), MPGN 9.8%(n=19), Membranous Nephropathy 8.2%(n=16) and Minimal Change Disease (MCD...
Nephrology, 2013
Shah et al. describe the first 70 live donor kidney transplants performed in Nepal, since the dev... more Shah et al. describe the first 70 live donor kidney transplants performed in Nepal, since the development of a national, government sanctioned, transplant service. This is a truly remarkable achievement.
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Papers by Mukunda P Kafle