Greetings from IMA Kauvery,
It gives me immense pleasure to present the September edition of our newsletter.
This edition focuses on creating awareness in Nephrology, Medicine and Anaesthesia cases – topics that are highly relevant to our daily clinical practice. We have curated insightful articles and case discussions that will enrich your knowledge.
At IMA Kauvery, we strive every month to bring you such academic updates which will greatly benefit Continuous Medical Education (CME) and enhance patient care.
I sincerely thank all the contributors and the editorial team for their efforts.
Yours in IMA service, Dr S Sivaram Kannan President
Dear Esteemed Colleagues,
It is my privilege to address you through the September edition of the IMA Kaveri Newsletter.
This month, we turn our focus to three specialties that form the backbone of modern clinical care – Nephrology, Medicine and Anaesthesia. Often intertwined in complex clinical scenarios, these disciplines demand both precision and collaboration. We have thoughtfully curated this issue to reflect that intersection, with articles that are contemporary, clinically relevant, and academically enriching.
At IMA Kauvery we believe that sharing knowledge is as vital as acquiring it. This journal is a step in that direction – to learn, to introspect, and to elevate our collective practice.
I wish you an engaging and insightful read.
Yours in IMA service, Dr. Bhuvaneshwari Rajendran Secretary
Dear Colleagues,
A warm welcome to the September issue of IMA Kaveri Newsletter.
In this issue, we have spotlighted topics in Nephrology, General Medicine and Anaesthesia – chosen keeping in mind their practical importance and the clinical challenges we face. You will find a blend of review articles, case scenarios and updates that we hope you will find useful in your practice.
Our constant endeavour at IMA Kaveri is to make this newsletter academically enriching and relevant, contributing to our collective journey of learning and CME.
I extend my sincere thanks to all authors, reviewers and the executive committee for their valuable support in bringing out this edition.
Happy reading!
With regards Dr. R. Balasubramaniyam Editor
INTRODUCTION
Aortic intramural hematoma (IMH) is an acute aortic syndrome caused by hemorrhage within the aortic media, in the absence of a conventional patent false lumen. IMH may progress to aortic dissection, rupture, aortic enlargement, or branch-vessel malperfusion. Malperfusion and persistent or recurrent pain are recognized features of complicated IMH and are associated with increased morbidity and mortality. [1]
Read Full Article
Nutcracker syndrome is a rare vascular compression syndrome caused by obstruction of the left renal vein. In the common anterior form, the left renal vein passes between the abdominal aorta and the superior mesenteric artery and becomes compressed within the aortomesenteric angle. This produces increased left renal venous pressure and may result in haematuria, proteinuria, left flank pain and collateral venous drainage.
Abstract
Anti‑glomerular basement membrane (anti‑GBM) disease is a rare autoimmune cause of rapidly progressive glomerulonephritis (RPGN). It is characterized by autoantibodies directed against the non‑collagenous domain of the α3 chain of type IV collagen. While pulmonary hemorrhage is a classical feature, renal‑limited forms are increasingly recognized and pose diagnostic challenges. We report a 73‑year‑old woman with previously normal renal function who presented with anorexia, nausea, exertional breathlessness, pedal edema, and anuria. Laboratory evaluation revealed severe azotemia and markedly elevated anti‑GBM antibody titres. Renal biopsy demonstrated diffuse crescentic glomerulonephritis with linear IgG deposition along the GBM. She required hemodialysis and was initiated on immunosuppression with glucocorticoids, cyclophosphamide, and plasma exchange. This case underscores the importance of early recognition of renal‑limited anti‑GBM disease, even in the absence of pulmonary involvement, and highlights the prognostic implications of histological findings.
We describe the case of a 52-year-old woman with chronic arthritis and long-term analgesic exposure who presented with constitutional symptoms and rapidly progressive renal dysfunction. Renal biopsy revealed pauci-immune crescentic glomerulonephritis with necrotizing vasculitis, consistent with MPO-ANCA associated vasculitis. Early immunosuppression with pulse steroids and cyclophosphamide, combined with plasmapheresis, led to progressive improvement in renal function. By September 2026, after the third cyclophosphamide dose, serum creatinine normalized to 0.9 mg/dl and the patient was successfully weaned off haemodialysis. This case highlights the importance of clinicopathological correlation in distinguishing vasculitis from drug-induced nephropathy and demonstrates the potential for complete renal recovery with timely intervention.
Abstract:
A 39-year-old man with previously stable diabetic kidney disease presented with rapidly progressive renal failure, hypercalcemia and nephrotic-range proteinuria; evaluation revealed kappa light-chain cast nephropathy, >60% bone marrow plasma cells and extensive skeletal lytic lesions, establishing the diagnosis of multiple myeloma with myeloma kidney superimposed on diabetic kidney disease.
