1 The processing time does not apply to services where prior approval has to be obtained from authorities in India or elsewhere. For such cases, the processing time is a minimum of thirty (30) business days.  The Consular Officer can at any time call an applicant for a personal interview.
The simian crease is one of the listed signs in Down Syndrome which would imply there's some genetic factor at play. My eldest daughter has a simian crease on one hand and the other hand is 'normal'.
Once prerenal and postrenal causes are ruled out, intrinsic renal failure is likely. Intrinsic ARF, caused by disease of the renal parenchyma, accounted for 69% of cases in the Madrid study. Acute tubular necrosis (ATN), the most common type of intrinsic ARF, accounted for 45% of all cases of ARF.