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Saudi Journal of Kidney Diseases and Transplantation
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    Table of Contents - Current issue
Coverpage
September-October 2018
Volume 29 | Issue 5
Page Nos. 1021-1255

Online since Friday, October 26, 2018

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ORIGINAL ARTICLES  

Evaluation of glycemic status during the days of hemodialysis using dialysis solutions with and without glucose Highly accessed article p. 1021
Abeesh Padmanabhan, Balaraman Velayudham, Nagendran Vijaykumar, Sheik Allauddin
DOI:10.4103/1319-2442.243951  PMID:30381496
Hypoglycemia has been documented during regular hemodialysis (HD) in both diabetic and nondiabetic end-stage renal disease (ESRD) patients. The aim of this study was to evaluate the glycemic fluctuations in diabetic and nondiabetic ESRD patients during HD days using glucose-free and glucose-containing dialysate. We conducted a prospective interventional study in which 32 ESRD patients (16 diabetic and 16 nondiabetic) were included in the study. All the patients underwent two HD sessions with glucose-free bicarbonate solution (phase 1) and next two HD sessions done with 100 mg/dL glucose-containing dialysate (phase 2). Serum glucose was measured using a continuous glucose monitoring system at the 1st h, 2nd h, and 4th h in both the phases. Percentage of time above and below preset target range (70–140 mg/dL) in 24 h on HD days in both phases was noted. Glucose loss in effluent fluid from dialyzer also was estimated at the 1st h, 2nd h, and 4th h. Statistical analysis was performed using Statistical Package for the Social Sciences software. Data are expressed as mean ± standard deviation. The Chi-square test was used for comparison of categorical variables. Continuous variables were compared using Student’s t-test. Value of P <0.05 was considered statistically significant. With glucose-free dialysate solution, 20 patients (diabetic - 15, nondiabetic - 5) had 22 episodes of hypoglycemia in 64 sessions and with glucose-containing solution, only five patients (diabetic - 4, nondiabetic - 1) had five episodes of hypoglycemia (P = 0.002). For all patients, glucose lost (g/h) in the effluent fluid was at lower values in phase 2 (5.91 ± 1.5) when compared to phase 1 (7.08 ± 10.9) (P <0.0002). This was also observed both among the diabetic and nondiabetic patients. The mean percentage of time below target out of 24 h on HD days in phase 1 was significantly higher as against phase 2 (33% vs. 18.7%; P = 0.0001) which was observed both among diabetic group (18.65% vs. 13.5%; P = 0.03) and nondiabetic group (48.12 % vs. 23.4%; P = 0.0003); the mean percentage of time above the target (>140 mg/dL) out of 24 h on HD days was significantly higher than phase 2 (21.1% vs. 9.3%; P = 0.0001). This was also observed among diabetics group of patients (18.8% vs. 8.6 %; P = 0.0001). Most of this time above target occurred during the post HD period. However, in the nondiabetic group, there was no significant difference between the two phases. Glucose-containing dialysate at 100 mg/dL significantly reduced the hypoglycemic episodes and also the intensity of hypoglycemia. Diabetic patients dialyzed with glucose-free dialysate had increased time above target (akin to Somogyi effect) in the post HD period compared to same patients dialyzed with glucose-containing dialysate. Hence, glucose-containing dialysate appears to offer better glycemic control and lesser glycemic fluctuations during HD days for both diabetic and nondiabetic ESRD patients.
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Scores of awareness and altruism in organ transplantation among Saudi health colleges students-impact of gender, year of study, and field of specialization p. 1028
Wafa AlHejaili, Faisal Almalik, Latifah Albrahim, Fatima Alkhaldi, Alaa AlHejaili, Abdulla Al Sayyari
DOI:10.4103/1319-2442.243947  PMID:30381497
This study aimed to evaluate the awareness of organ transplantation and willingness to donate among Saudi Health Colleges students and the impact of gender, year of study, and field of specialization on this. This is a cross-sectional survey-based study. The survey was distributed to all the students attending the annual national conference of Saudi Health Colleges students held in 2018. The survey had two parts. The first part collected the information about gender, university, college of specialization, and year of study. The second part asked 10 questions, seven of which were about the types, causes, treatment of organ failure (awareness questions), and three of which were about their willingness to donate (altruism questions). The participants had three response options: “Yes”, “No” and “I don’t know. Descriptive statistics (mean, standard) and the frequencies were generated for each parameter. Categorical data were compared using Chi-square and continuous data using an independent t-test or paired t-test. A total of 821 respondents completed the questionnaire; 58.1% were female, 41.3% studying medicine, 25.1% applied medical sciences, 12.7% pharmacy, 9.6% dentistry, and 4.5% nursing 4.5%. The overall awareness of the correct responses constituted 60.4% while 12.3 % gave incorrect responses and 27.3% did not know what the answers were. The highest awareness score was about the concept of brain death (86.4%). The overall awareness score was significantly higher than the altruism score (62.7% and 45.7% respectively (P = 0.0001). Female respondents proved more aware than the male respondents in all the questions did. However, the differences reached the significant levels in four of the ten questions. If we split and summate the responses into “awareness” questions and “altruism” questions, we find that, although female students score higher in both categories, this reaches the significant level for the altruism score (59.90% vs. 45.60% (P = 0.0001). Final year students were significantly more aware than the freshmen in seven of the 10 questions posed with the biggest gap seen in the awareness that Islamic Sharia permits donating organs after death (82.3% vs. 49.6% (P = 0.0001). When we compare of responses by the college, we find that significant differences between the College of Medicine students and applied medical sciences in two questions with the former having a higher awareness score. The overall awareness score was significantly higher than the altruism score (62.7% and 45.7% respectively). Female students have higher altruistic score than male students. The scores are significantly higher in the senior students than in the junior ones.
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Serum ferritin <70 μg/L predicts functional iron deficiency in patients with chronic kidney disease Highly accessed article p. 1035
Neha Garg, Mrinalini Kotru, Anil Yadav, Usha Rusia, Meera Sikka, Om Parkash Kalra
DOI:10.4103/1319-2442.243956  PMID:30381498
Anemia is a common complication of chronic kidney disease (CKD) which is treated by erythropoiesis-stimulating agents. However, most of the patients do not respond adequately due to the development of functional iron deficiency (FID). The study was conducted to explore the value of inflammatory markers, high sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6) along with serum ferritin (SF) in the diagnosis of FID. Seventy-seven clinically diagnosed patients of CKD (Stage 3, 4, and 5) of either sex, age >18 years with hemoglobin <11 g/dL were included in the study. Complete hemogram with peripheral smear, serum iron, total iron binding capacity, transferrin saturation, SF, transferrin receptors (sTfR), hsCRP, IL-6, and erythrocyte sedimentation rate were estimated and statistically analyzed. sTfR/log ferritin (taken as gold standard) detected 31/77 patients as having iron-deficient erythropoiesis. Nineteen patients were detected as having FID. SF at a cut-off <70 μg/L showed the best sensitivity (83.87%) and specificity (73.91%) in detecting FID in these patients and identified 14/19 cases of FID. The 5 FID cases who were missed had raised hsCRP. The presence of raised hsCRP reduced the sensitivity to 79.16%. SF <70 μg/L emerged as the most sensitive and specific in the identification of iron-deficient erythropoiesis. SF >12 μg/L - SF <70 μg/L was able to identify 14/19 cases of FID. Furthermore, hsCRP further stratified the subgroup of CKD patients in which FID could be detected with higher sensitivity and specificity.
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Interleukin-6 gene polymorphisms and serum erythropoietin and hemoglobin in hemodialysis Iraqi patients p. 1042
Mohanad Yasir Al-Radeef, Ali Abdulmajid Dyab Allawi, Hayder Adnan Fawzi
DOI:10.4103/1319-2442.243952  PMID:30381499
Chronic kidney disease (CKD) is characterized by elevated levels of pro-inflammatory cytokines. Interleukin-6 (IL-6) is a pleiotropic and pro-inflammatory cytokine involved in different biological activities such as hematopoiesis, inflammation, and acute-phase response. The rate of IL-6 synthesis and degradation is affected by single nucleotide polymorphisms. This study aimed to evaluate the frequencies of 174G/C IL-6 gene promoter polymorphism in Iraqi hemodialysis (HD) patient and to examine the association between the allelic variations and serum erythropoietin (EPO) and hemoglobin (Hb) levels. The frequencies of IL-6 gene polymorphism were studied in 70 chronic renal failure patients on maintenance HD (patients group) and in 20 healthy participants (control group). Genotyping of IL-6 gene was performed by conventional polymerase chain reaction-restriction fragment length polymorphism. The distribution of IL-6 genotypes between groups was similar, and GG genotype is the most frequent followed by CG and CC genotypes. Control group had a nonsignificant difference in serum EPO levels among different IL-6 genotypes, while patients with GG genotype displayed significant elevation in serum EPO with time, followed by CG and CC genotypes. No significant differences in Hb levels were observed in patients and control groups. A significant positive correlation was observed between serum EPO and Hb in control group with different IL-6 genotypes, while a nonsignificant negative correlation was observed in patients group throughout the study. CKD did not significantly alter IL-6 genotypes, and IL-6 gene polymorphism had a significant effect on serum EPO levels and a nonsignificant effect on Hb levels.
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Study of therapeutic efficacy of febuxostat in chronic kidney disease stage IIIA to stage VD p. 1050
Partha Saradhi Sarvepalli, Mehruq Fatima, Abdul Khalid Quadri, Aliya Raeesa Taher, Ayesha Habeeb, Fayeza Amreen, Badarunnisa Nikhat Parveen, KG Rajaram
DOI:10.4103/1319-2442.243953  PMID:30381500
Hyperuricemia [serum uric acid (SUA) >7.0 mg/dL] which is common in chronic renal diseases is associated with augmented vascular events. In addition to nonpharmacological therapy, hypouricosuric drugs reduce UA levels. The current study was a prospective observational study of six months duration November 2016 to April 2017 done to determine the efficacy of febuxostat in patients with hyperuricemia in chronic kidney disease (CKD) stage G3a to G5 and to correlate any association with reduction of hypertension, improvement in glomerular filtration rate (GFR), and reduction in comorbidities. The study was carried out at the Department of Nephrology, Owaisi Hospital and Research Center, Hyderabad. One hundred and ten patients were screened, of which 53 patients wherein stage G3a to G5 were recruited and SUA levels were obtained after inclusion criteria. SUA >6.0 in females and 7.0 in males were recruited. The drug febuxostat 40 mg was given once day to all patients with stage G3a to G5D with elevate uric acid levels >7.0 in males and more than 6.0 in females and three samples of UA were obtained monthly. The mean of GFR, blood pressure (BP), and SUA levels were obtained before and after the therapy. Of the 53 patients, males were 32 (60.3%), and females were 21 (39.6%). Mean age of the patients were 36.5 years. Mean UA levels before the start of febuxostat therapy were 8.6, and after adding febuxostat, it was 5.10 at the end of the third visit. The mean BP drop was 7.2 ± 2.1 mm in systolic BP (from 154–147 mm Hg) and diastolic BP drop was 93 ± 2.5 mm Hg (5.1 mm Hg). The mean GFR improved from 50.3 to 53.3 mL/min after the start of febuxostat. Febuxostat in asymptomatic CKD patients improves UA levels, BP and estimated GFR at low dose without any adverse events and no cardiac-related events.
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Plantago major protects against cisplatin-induced renal dysfunction and tissue damage in rats p. 1057
Soghra Parhizgar, Sara Hosseinian, Mohammad Soukhtanloo, Alireza Ebrahimzadeh Bideskan, Mousa-Al-Reza Hadjzadeh, Samira Shahraki, Zahra Samadi Noshahr, Nazanin Entezari Heravi, Milad Haghshenas, Abolfazl Khajavi Rad
DOI:10.4103/1319-2442.243960  PMID:30381501
The aim of the present study was to determine the effect of Plantago major (P. major) on cisplatin-induced kidney injury in the rat. Cisplatin was injected on the 6th day of the experiment. Animals were treated with P. major extract (300, 600, and 1200 mg/kg) and Vitamin E for five days before and two weeks after cisplatin administration. Cisplatin caused a significant decrease in glomerular filtration rate (GFR), urine osmolarity, and urinary excretion rate of potassium, but significant increase in the kidney index and histological damage compared with the control group. Administration of Vitamin E and P. major (300 and 600 mg/kg) significantly increased GFR compared to cisplatin group. Furthermore, urine osmolarity in Vitamin E and P. major (600 mg/kg) groups were significantly elevated compared to the cisplatin group. P. major (600 mg/kg) significantly increased the urinary excretion rate of potassium compared with cisplatin group. Furthermore, all doses of P. major and Vitamin E significantly attenuated the percentage of kidney tissue damage compared to the cisplatin group. However, only P. major (600 mg/kg) and Vitamin E treated rats showed a significant reduction in the kidney index. This study revealed that P. major extract in a dose-dependent manner provides protection against renal damage induced by cisplatin.
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Clinical and laboratory profile of renal amyloidosis: A single-center experience p. 1065
Divyesh P Engineer, Vivek B Kute, Himanshu V Patel, Pankaj R Shah
DOI:10.4103/1319-2442.243966  PMID:30381502
The kidney is the most common organ involved in systemic amyloidosis. We aimed to study etiology and clinicopathological profile of renal amyloidosis. This was a retrospective study of 40 consecutive adult patients with biopsy-proven renal amyloidosis evaluated over a period of two years. Emphasis was given to describing the clinical presentation, renal function, proteinuria, type of amyloidosis, and its etiology. Mean age of the study cohort was 44 ± 15 years (with a male-to-female ratio of 3:1). Amyloid A (AA) amyloidosis was the most common type of amyloidosis observed in 72.5% of cases. Amyloid light chain (AL) amyloidosis accounted for 17.5% of cases, and the rest remained undetermined. AA amyloidosis had widespread age distribution while AL amyloidosis was confined to those >40 years. Proteinuria was the most common renal manifestation observed in all patients. Nephrotic syndrome was seen in 70% of patients. Mean 24 h proteinuria was 6.4 g. Renal failure was the second most common manifestation seen in 70% of patients, of whom 21.4% required hemodialysis. Tuberculosis (TB) accounted for 90% cases of AA amyloidosis. The most prevalent form was pulmonary TB while the rest accounted for by rheumatoid arthritis and bronchiectasis. Among patients with TB induced amyloidosis, 61.5% had received adequate treatment for TB in the past. All patients with AL amyloidosis had nephrotic range proteinuria, five had renal failure out of which two required dialysis. Cardiac involvement was seen in two patients. AA amyloidosis was the most common type of renal amyloidosis in the present study and pulmonary TB was the most common etiology.
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Elimination of BK viremia in renal transplant recipients by optimization of immunosuppressive medications without precipitating acute rejection p. 1073
Amitabh Jha, Wasim Ahmed, Abbas Pakkyara, Faisal Shaheen, Issa Al Salmi
DOI:10.4103/1319-2442.243976  PMID:30381503
BK Polyomavirus-associated nephropathy (BKVAN) has been recognized as an increasing threat in renal transplant patients (RTP) for more than a decade. Reduction in immunosuppression is the mainstay of treatment through various options of treatment has been suggested. Published reports on these protocols have shown mixed results, and no randomized controlled trials have compared one strategy with another. In this context, we hypothesize that the appearance of BKV in the blood compels one to optimize the immunosuppression with possible long-term beneficial effects. We conducted a retrospective study among the RTP being followed up by the Renal Medicine Department at Royal Hospital who tested positive for BKV-polymerase chain reaction and whose immunosuppression was altered with a final aim to get rid of BK viremia, yet avoiding acute rejection. Results were analyzed by the clinical and statistical approach. Extensive literature review was carried out to look into the prevalence, prognosis, and treatment of BKVAN. In all the patients in whom BKV was detected alteration in immunosuppression resulted in eliminating the virus without precipitating acute rejection. The study shows that in the exercise of eliminating BKV by alteration of immunosuppression, we have “tailored” the immunosuppression in each particular RTPs, without precipitating acute rejection.
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Red cell distribution width reflects the early stage residual renal function in peritoneal dialysis patients p. 1082
Qi Zhang, Xueying Cao, Jianhui Zhou, Rui Ding, Jing Huang, Guangyan Cai, Xiangmei Chen
DOI:10.4103/1319-2442.243950  PMID:30381504
It has been verified that the red blood cell distribution width (RDW) is related to renal function. This study aimed to investigate the association of RDW with the residual renal function in peritoneal dialysis (PD) patients. The patients were categorized into three groups according to the quartiles of their baseline RDWs. The correlations between RDW and clinical parameters, dialysis adequacy, and residual renal function were analyzed. The clinical data, PD prescription and dialysis adequacy of 54 uremic patients on continuous ambulatory PD were collected. All the statistical analyses were performed using the Statistical Package for the Social Sciences program version 17.0. The baseline RDW of the patients was 13.56% ± 1.36%. No significant differences in the other indexes [hemoglobin, albumin, alkaline phosphatase, intact parathyroid hormone (iPTH), urea and creatinine] among the three groups were found. One month after beginning PD, the correlation between the RDW and the residual renal function has not been found in the multivariate regression model adjusted for the hemoglobin, albumin, and leukocyte. Three months after beginning the PD, a significant difference between Group 2 and Group 3 in iPTH was found. Multivariate regression analysis showed that the elevated RDW is associated with the declined residual glomerular filtration rate (heart rate = -0.587, 95% confidence interval -1.080 ~ -0.093) for the corresponding period after PD, adjusted for the hemoglobin, albumin, and leukocyte. This study showed that the RDW reflected the residual renal function in the corresponding period after PD in the PD patients.
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The long-term impact of hepatitis C infection in kidney transplantation in the pre-direct acting antiviral era p. 1092
Radhika Chemmangattu Radhakrishnan, Basu Gopal, Uday G Zachariah, Priya Abraham, Anjali Mohapatra, Anna T Valson, Suceena Alexander, Shibu Jacob, Kakde Shailesh Tulsidas, Vinoi G David, Santosh Varughese
DOI:10.4103/1319-2442.243964  PMID:30381505
Hepatitis C virus (HCV) infection in kidney transplantation is an important issue with effects on patient and graft survival. The current standard of care involves using oral Direct Acting Antiviral drugs. Till recently, pre-transplant treatment with interferon was the only option for treatment. We studied 677 consecutive kidney transplant recipients with HCV infection. 5.2% patients had evidence of HCV infection. 2.0% were newly detected to have HCV infection after transplant (de novo HCV group). Nearly 28.6% had negative antibody tests but positive Nucleic Acid Test at the time of diagnosis. Eighty-five percent of pre-transplant HCV-positive patients were treated with interferon-based regimens. Early virologic response was seen in 66.6%. End of treatment response was achieved by 94.1%. Sustained virologic response was seen in 81.2%. Overall, patient and graft survival were not different between HCV and control groups (log-rank P = 0.154). Comparing HCV and control groups, there was a tendency toward increased fungal (11.4% vs. 5.6%, P = 0.144) and CMV infections (25.7% vs. 17.1%, P = 0.191) in the HCV group, though it did not reach statistical significance. Eighty-percent of the interferon-treated patients suffered side effects. On comparing, the pre-transplant HCV-positive group (85% treated) with the de novo HCV group (none treated), the de novo group had significantly reduced patient survival (P = 0.020) and NODAT (35.7 vs 4.8%, P = 0.028), and a tendency toward higher CMV infections (35.7% vs 19%, P = 0.432). In addition, death and hepatic complications (decompensated liver disease, fibrosing cholestatic hepatitis) occurred only in de novo HCV group. These results highlight the need for continued post-transplant treatment of HCV positive patients. The newer anti-HCV drugs are expected to fulfill this felt-need in kidney transplantation but long-term results are awaited. This study can serve as a benchmark for future studies to compare the long-term effect of Direct Acting Antiviral drugs.
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Assessment of hypertension and its associated risk factors among medical students in Qassim University p. 1100
Ahmed Humaidan AlWabel, Mohammed Ali Almufadhi, Faisal Mohammed Alayed, Abdullah Yousef Aloraini, Hoor Mohammed Alobaysi, Rawan Mazyad Alalwi
DOI:10.4103/1319-2442.243959  PMID:30381506
Hypertension is a major risk factor for heart disease, stroke, kidney failure, and premature death. In Saudi Arabia, studies looking at the prevalence of hypertension in young adults are scarce. We aim to provide current data on the prevalence and associated risk factors of hypertension in young adults to allow us to assess the magnitude of the problem in this age group and suggest the appropriate recommendations to physicians and policymakers. The objective of the study is to assess the prevalence of hypertension and its associated risk factors in medical students attending the College of Medicine in Qassim University, Qassim, Saudi Arabia. It is a cross-sectional study that was conducted during the year 2017 on medical students attending the College of Medicine at Qassim University. A total of 130 students were selected using multistage stratified random sampling. We collected data on sociodemographic information and risk factors using a self-administered questionnaire derived from the WHO STEPS instrument, and we measured the blood pressure and body mass index (BMI) of the participants. Data were analyzed using Statistical Package for Social Sciences version 23.0. The prevalence of hypertension in the study sample was found to be 14.6%, 6.9% of which had isolated diastolic hypertension while 4.6% had isolated systolic hypertension, and the remaining 3.1% had systolic-diastolic hypertension. The prevalence of prehypertension was found to be 29.2%. Only 21.1% of the participants found to be hypertensive were diagnosed and on antihypertensive therapy. We found a significant association between gender, BMI, and history of diabetes and hypertension. Our study confirms the notion that there are high rates of prehypertension and hypertension among young adults, the majority of which are undiagnosed cases. This calls for the need of a comprehensive national screening program and campaigns that increase awareness about hypertension and its associated risk factors.
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Acute kidney injury in intensive care unit, hospital Universiti Sains Malaysia: A descriptive study p. 1109
Siti-Azrin Ab Hamid, Wan-Nor-Asyikeen Wan Adnan, Nyi Nyi Naing, Azreen Syazril Adnan
DOI:10.4103/1319-2442.243961  PMID:30381507
Acute kidney injury (AKI) was frequently encountered complication among intensive care unit (ICU) patients and recognized as a major public health problem. The present study aimed to determine the basic features of AKI patients admitted to ICU. A retrospective cohort study was conducted among 106 AKI patients admitted to ICU, Hospital Universiti Sains Malaysia from January 1, 2007 until the end of December 2013. The AKI patients ranged from 18 to 80 years old with the mean (standard deviation) of 58.93 (15.76) years, 60.4% were male and 91.5% were Malay ethnicity. Hypertension and diabetes were in 38.1% and 28.8%, respectively. The median (interquartile range) length of ICU stay was 4.50 (9.00) days. Eighty-two patients (79.6%) were classified as the Acute Kidney Injury Network (AKIN)-I, 12 (11.7%) as AKIN-II, and nine (8.7%) as AKIN-III. Sepsis was the common etiology among AKI patients (74.3%). Twenty-four patients (22.9%) required dialysis and 90.5% were mechanically ventilated. In conclusion, AKI developed more in male patients, Malay ethnicity, presented with comorbid, caused by sepsis, admitted to ICU, required mechanical ventilation, and need for renal replacement therapy.
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Saudi medical students knowledge, attitudes, and beliefs with regard to organ donation and transplantation p. 1115
Saad M AlShareef, Richard M Smith
DOI:10.4103/1319-2442.243963  PMID:30381508
A positive attitude to organ donation among doctors is key to increasing organ donation. Education of medical students is suggested to be central to achieving this. This study examined whether knowledge of organ donation and transplantation (ODT) correlates with attitudes and beliefs relevant to ODT among medical students in Saudi Arabia. Two hundred and thirty-three students completed a self-administered questionnaire. A knowledge score was calculated for each student and correlated with answers on attitudes and beliefs with regard to ODT. This study revealed a complex interaction between knowledge, attitudes, and beliefs to ODT. The majority of students support ODT in general, but a significant proportion have negative beliefs when asked about specific details of the process and concern for family members with regard to both deceased and live donation is evident. Despite almost all students believing that Islamic beliefs do not preclude ODT, 27.1% believe transplantation to be unacceptable in the Society in which they live. Education is an important strategy to improve donation rates. These findings can guide development of medical student education programs suggesting inclusion of open debate about views in society and the importance of discussion with family members to be essential.
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BRIEF COMMUNICATIONS Top

Acute kidney injury in hospitalized patients during muslim pilgrimage (Hajj: 1432) p. 1128
Walid H Elrewihby, Nabil F Hasan, Walaa Fikry, Ehab Wafa
DOI:10.4103/1319-2442.243971  PMID:30381509
Acute kidney injury (AKI) increases mortality and morbidity of hospitalized patients. We aimed to evaluate the prevalence of AKI, etiology, and associated risk factors among hospitalized patients during the Hajj time. Also to do comparative analysis for the use of slow continuous therapy versus conventional hemodialysis (HD) therapy on the patient outcome. The study was conducted between September 29 and November 25, 2011, inclusive (Islamic lunar dates Dhu’l-Qa’dah 1 to Dhul-Hijjah 29, 1432) at King Abdul-Aziz Hospital, a 250-bed hospital, in Makkah, Saudi Arabia. From 851 patients of 47 different countries were admitted, 87 (10.2%) patients developed AKI with mean age (±standard deviation) of 60.26 (±9.28) years with a male predominance: men constituted 65 (74.7%) and females 22 (25.3%). The major cause for admission was infections accounted for 51.7% (45 patients) of all the admitting patients who developed AKI. Hypertension and diabetes mellitus were the most common underlying comorbidities, present in 61 (70.1%) and 53 (60.9%) patients, respectively. Only 21 (24.1%) patients who developed AKI required replacement therapy (RRT). Fourteen patients (16.1%) received conventional HD, seven (8%) patients received continuous renal replacement therapy and 66 (75.9%) patients did not need RRT. Fifty-two (59.8%) patients had improved renal function on discharge from our hospital, 4 (4.6%) patients were discharged on dependent HD, 5 (5.7%) patients were discharged as chronic kidney disease patients on conservative management and 26 (29.9%) patients died during admission. There was no significant difference on the outcome according to the use or even the type of RRT. Infection was the main cause of admission for patients who developed AKI. The type of RRT used had no different effect on the outcome at time of discharge.
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Depression and impaired work productivity among hemodialysis patients in south region of Saudi Arabia p. 1133
Mohammed Abdullah AlShahrani, Ahmad Saeed Mohammad Alayed, Abdullah Hassan AlShehri, Osama Solaiman, Nabil J Awadalla, Mohammed Alhomrany
DOI:10.4103/1319-2442.243970  PMID:30381510
Various studies have been published in different regions and countries about the prevalence of depression and its relationship with sociodemographic factors in patients on hemodialysis (HD). However, a gap in knowledge about the prevalence, correlates, detection, and treatment of depression and symptoms among dialysis patients in the Kingdom of Saudi Arabia. This is cross-sectional study to assess the prevalence of depression in HD patients and work productivity in Aseer region using Beck’s questionnaire to screen depression and work productivity and activity impairment questionnaire to assess the work productivity. The study was conducted in two governmental centers one in Abha and one in Khamis Mushait and involved 233 patients. Participants were interviewed personally and responded to specially designed structured anonymous questionnaire composed of four parts; sociodemographic, clinical and laboratory, Beck’s depression inventory, and impaired productivity scale. Of the HD patients studied, 42% and 48.4% were suffering from clinical depression and impaired work productivity, respectively. The risk of clinical depression was significantly higher in the age group >40 years old and when the duration of dialysis is >5 years. Prevalence of clinical depression and impaired work productivity are relatively high among HD patients in Abha and Khamis Mushait cities.
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RENAL DATA FROM ASIA–AFRICA Top

A clinical and electrophysiological study of peripheral neuropathies in peritoneal dialysis patients: Our experience from rural South India p. 1139
Sarat Mallipeddi, Dushyanth Babu Jasti, A Apparao, B Vengamma, V Sivakumar, Satyarao Kolli
DOI:10.4103/1319-2442.243942  PMID:30381511
The objective was to study the prevalence, clinical features, electrophysiological features, and severity of peripheral neuropathy in chronic kidney disease (CKD) patients on peritoneal dialysis (PD) and effect of the presence of diabetes mellitus (DM). Between May 2015 and December 2016, 100 CKD patients on PD were assessed. The prevalence of peripheral neuropathy was 65% based on clinical symptoms and 92% based on electrophysiological parameters. The mean age was 55.7 ± 10.9 years. About 64% were male. Twelve patients (12%) had motor weakness, 64 patients (64%) had positive symptoms and 60 patients (60%) had negative symptoms. Autonomic symptoms were seen in 14 patients (14%). Definite damage was seen in 68 patients (68%), early damage was seen in 16 patients (16%). In PD patients with DM (n = 50), 50 patients (100%) had definite damage. In PD patients without DM (n = 50), 18 patients (36%) had definite damage, 16 patients (32%) had early damage. In CKD patients on PD, patients aged >50 years (definite damage in 75.7%) showed more severe peripheral neuropathy when compared to patients aged ≤50 years (definite damage in 53%). Most common nerves involved in the present study were median motor nerve, sural nerve, ulnar sensory nerve, common peroneal nerve, posterior tibial nerve followed by the median sensory nerve. Peripheral neuropathy is common in CKD patients on PD, with higher prevalence and severity in elderly females and diabetics. Rationale management of diabetes in CKD patients on PD probably lowers the prevalence and severity of peripheral neuropathy.
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Risk factors of hospitalization among chronic kidney disease patients in tertiary care hospitals - A single-center experience p. 1150
Beena Salman, Mehwish Hussain, Kashif Shafique, Salman Imtiaz, Murtaza Fakhruddin Dhrolia
DOI:10.4103/1319-2442.243973  PMID:30381512
Chronic kidney disease (CKD) affects health and life of patients. They confront anemia, hypertension, infections and cardiovascular disease. Due to these health issues, they are at risk of repeated hospitalizations. The risk factors which propel them to hospitalize are important to know, and by controlling these factors, we can impede preventable hospitalization. This case–control study included 1050 adult CKD patients, conducted in two tertiary care hospitals of Karachi. Variables included were age, gender, ethnicity, area of residence, marital status, education smoking status, comorbids, blood pressure, type of angioaccess, hemodialysis (HD) status, stage of CKD, activity level, and laboratory parameters. Two predicted models using multivariable logistic regression analysis were established to evaluate the effect of factors leading toward hospitalization. Patients with ischemic heart disease had 3.56 [95% confidence interval (CI): 2.14–5.9] times higher rate of admission. The nonactive and moderately active patients were admitted 3.8 and 2.26 times more respectively as compared to the active patients (P <0.001). Patients with HD venous catheter were admitted 33.43 (95% CI: 12.45–89.81) times more than patients without any angioaccess. All laboratory parameters had highly significant effect on admission (P <0.001), odds ratio for low albumin, low hemoglobin, and high total leukocyte count were 6.87(95% CI: 4.45–10.6), 4.2 (95% CI: 2.73–6.57) and 7.9 (95% CI: 4.93–12.66) respectively. In conclusion, cardiovascular disease was observed as the most important risk factor of hospitalization for CKD patients. The other plausible risk factors were late referral to nephrologist, low activity level anemia, and hypoalbuminemia.
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Histomorphological pattern of renal biopsy in Dhaka: A single center study p. 1159
Sk. Md. Jaynul Islam, Wasim Selimul Haque, Selina Akhter, SM Mahbubul Alam
DOI:10.4103/1319-2442.243940  PMID:30381513
Renal biopsy is a useful procedure to understand the histological pattern of renal disease. We present the histomorphological characteristics of renal biopsy specimen received at histopathology department, Armed Forces Institute of Pathology, Dhaka received during July 2015 to December 2015 for six months period was included in the study.
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Prevalence of depression and its associated factors among patients of chronic kidney disease in a public tertiary care hospital in India: A cross-sectional study p. 1165
Rajiv Ahlawat, Pramil Tiwari, Sanjay D'Cruz
DOI:10.4103/1319-2442.243972  PMID:30381514
Chronic kidney disease (CKD) patients are at high risk of depressive disorders because of considerable psychological stress due to physical and social changes brought on by disease. The aim of this study is to assess the prevalence of depression in patients with CKD and the factors affecting it at a public tertiary care hospital. This cross-sectional study was carried out at the renal clinic of a tertiary care hospital. Data on 612 patients diagnosed with CKD from September 2014 to April 2016 was obtained. Nine-item Patient Health Questionnaire from PRIME-MD was used to assess the depression. Of all the patients, 55.9% had no depression. Mild depression was found to affect 28.4% of the patients followed by moderate depression, moderately severe, and severe depression (11.8%, 3.8%, and 0.8%, respectively). According to multiple logistic regression, the occurrence of depression was significantly higher with age below 60 years [odds ratio (OR) 1.6, 0.8–2.7; P<0.05], male gender (OR 1.3, 0.9–3.1; P<0.05), no treatment funding (OR 2.6, 1.2–4.5; P<0.05), education less than grade 12 (OR1.3, 1.3–3.2; P<0.05), monthly income ≤INR 20,000 (OR 1.6, 1.1–3.6; P<0.05), CKD stage V (OR 1.3, 1.02.9; P <0.05), Patients on hemodialysis (hD) (OR 2.6, 1.2–4.5; P<0.05), comorbidities ≥3 (OR 1.7, 1.1–2.9; P<0.05), overweight (OR 2.5, 1.3–2.9; P<0.05), and duration of CKD >2 (OR 2.2, 1.3–4.3; P<0.05). About 44% of the patients were found to have depression. Patients’ age, gender, body mass index, treatment funding, education status, income, CKD duration and stage, HD status, and comorbidities were found to be significant factors affecting depression.
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Analysis of native kidney biopsy: Data from a single center from Bihar, India p. 1174
Amresh Krishna, Harsh Vardhan, Prit Pal Singh, Om Kumar
DOI:10.4103/1319-2442.243975  PMID:30381515
This is a retrospective study of all native kidney biopsies performed at our center between October 1, 2012 and March 31, 2015. Relevant clinical and laboratory variables were recorded. Biopsy samples were processed for light microscopy and immunofluorescence in all cases. Histological classification was adapted from the World Health Organization recommendations. The indications for kidney biopsy were nephrotic syndrome in adults in 190 cases, rapidly progressive renal failure in 43, unexplained renal failure in 25, and steroid-resistant nephrotic syndrome in children in 12. The mean age of the patients was 31.48 ± 13.46 years. Male-to-female ratio was 1.87:1. Mean serum creatinine (SCr) of the patients was 2.36 ± 2.07 mg/dL. Primary glomerulonephritis accounted for 88.89% of cases (240) while secondary glomerulonephritis accounted for 7.40% of total cases (20). Interstitial disease accounted for 1.5% and vascular disease for 2.2%. The most common lesion among primary glomerulonephritis was focal segmental glomerulosclerosis (FSGS) (31.11%) followed by diffuse proliferative glomerulonephritis (DPGN) (13.33%) and membranous glomerulonephritis (MGN) (12.59%). Among secondary glomerulonephritis, lupus nephritis was the most common (5.56%). In patients with SCr 1.4 mg/dL or less (n = 131), FSGS was the most common histology (17.26%) followed by MGN (23.66%) and minimal change disease (7.63%). Whereas, in patients with SCr more than 1.4 mg/dL (n = 139), DPGN was the most common diagnosis (23.74%) followed by FSGS (17.26%) and IgAN (12.23%). Fourteen patients (5.2%) had one or more episode of gross hematuria, three of whom required blood transfusion. The overall FSGS was the most common lesion seen. When we consider only patients with deranged renal function, DPGN was the most common histopathological lesion. The reason for disproportionate high incidence for DPGN is not clear and requires further research.
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Expanding renal transplantation organ donor pool in Nigeria p. 1181
Ademola Alabi Popoola, Timothy Olusegun Olanrewaju, Benjamin Olusomi Bolaji, Tajudeen Olalekan Ajiboye
DOI:10.4103/1319-2442.243946  PMID:30381516
Kidney transplantation is the gold standard for end-stage renal disease. All over the world there are several challenges preventing sufficient organ donation to meet the growing needs of patients on the waiting list. One major challenge which is common to most countries is the shortage of organs from willing living donors. Many countries, especially, the developed countries, have devised several models of expanding their donor pools to meet the growing needs of patients on the waiting list. Nigeria, a developing country has very low kidney transplantation rate even though some progress have been made in making the procedure feasible in about a dozen hospitals in Nigeria. One very major challenge has been the shortage of donor organ supply. This paper intends to proffer suggestions on how to expand the organ donor pool in Nigeria.
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Chronic kidney disease in Sub-Saharan Africa p. 1188
Samuel B Ogundele
DOI:10.4103/1319-2442.243945  PMID:30381517
Chronic kidney disease has been observed to be a major threat to the world’s health, and in some African countries, it is a death sentence. It affects economically productive young adults between the ages of 20–50 in Sub-Saharan Africa as against the middle age and elderly in the developed world. Challenges of renal care in Africa are numerous among which are equity, accessibility, financial constraint, and lack of workforce to mention a few. Therefore, Africa countries must prioritize renal care and include it in the health agenda to cater for the present and future health need of the people.
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Pattern of glomerulonephritis in the Kashmir valley p. 1192
Abdul Majeed Chowdry, Mohd. Ashraf Bhat, Mohd. Saleem Najar, Ankush Sharma, Hilal Azad, Intikhab Mir
DOI:10.4103/1319-2442.243967  PMID:30381518
Glomerulonephritis (GN) is a common cause of end-stage kidney disease (ESKD) that can affect patients at any age. With respect to ESKD, there are significant global variations in the percentage of the incident and prevalent patients secondary to GN. The present study was therefore conducted to know the pattern of GN in the Kashmir valley. Retrospective study was conducted in the tertiary center Sher-I-Kashmir Institute of Medical Sciences of Kashmir valley which included cases of different types of GN diagnosed on histopathology over a period of three years. Basic demographic profile including age, sex, clinical presentation, relevant investigations, and the histopathological type of GN was noted for each patient. Histopathological examination due to various nonneoplastic renal diseases was done in 336 cases and out of these, glomerular diseases were diagnosed in 298 cases. Proteinuria and edema was the most common presentation. Primary GN was observed in 81% of cases and secondary GN in 16% of cases. IgA nephropathy was the most common primary GN 42% and nephropathy due to lupus was the most common secondary GN. The study concluded that primary GN is the most common primary renal disease with IgA as the most common primary GN and most presented as renal failure, highest until date recorded in India and lupus nephritis as the most common secondary GN which is similar to other studies from India and other regions of the world. This study may be useful to pathologists, nephrologists, and health care providers to formulate a basic platform for effective diagnostic, therapeutic, and research base for glomerular diseases so as to prevent its complications.
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CASE REPORTS Top

Acquired zinc deficiency in a renal transplant recipient with gastrointestinal tuberculosis responding promptly to oral correction p. 1199
Priyanka Ghuge, Rusina Karia, Ram H Malkani
DOI:10.4103/1319-2442.243962  PMID:30381519
Zinc deficiency is an uncommon condition, known to occur in two forms: inherited type, known as Acrodermatitis enteropathies and the acquired type. Cutaneous clinical manifestations observed include characteristic dermatitis on acral, periorificial, and anogenital areas through an unknown mechanism. The patient had a combination of causes which lead to a state of zinc deficiency. We are presenting it due to the rarity of acquired acrodermatitis in patients of gastrointestinal tuberculosis and renal transplant recipients. We emphasize the awareness about this condition, especially in resource-poor settings, where serum zinc levels may not be available, and a trial of oral zinc may be given.
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Renal stones in two children with two rare etiologies p. 1203
Gurinder Kumar, Rami Raad AlAni
DOI:10.4103/1319-2442.243955  PMID:30381520
The incidence of urolithiasis in children has shown an increase in recent years which may be attributed to changing dietary patterns, sedentary lifestyles, and obesity. Among the various etiologies for renal stones in children, two rare entities worth mentioning are cystinuria and 2, 8-dihydroxyadenine (DHA) urolithiasis. Cystinuria is an inherited cause of nephrolithiasis which occurs due to impaired cystine reabsorption in the renal proximal tubule. 2, 8-DHA urolithiasis is an inherited autosomal recessive disease resulting in urinary stone disease secondary to deficiency of adenine phosphoribosyltransferase (APRT) activity. We describe two children who presented to our clinic with these two rare causes of stones.
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Lymphocutaneous nocardiosis in a kidney transplant patient successfully treated with tigecycline p. 1207
Eleni Mylona, Vasilios Papastamopoulos, Myrto Giannopoulou, Efstathia Perivolioti, Zoi Psaroudaki, Athanasios Skoutelis
DOI:10.4103/1319-2442.243954  PMID:30381521
Cutaneous nocardiosis is an infrequent infection which has been increasingly reported in immunocompromised patients. Although trimethoprim-sulfamethoxazole is considered to be the agent of choice for treatment of nocardiosis, newer antimicrobials such as tigecycline have been proven to be effective in vitro, as well. We report the first case of primary cutaneous nocardiosis in a renal transplant recipient having corresponded well to treatment with tigecycline.
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Bilateral renal cortical necrosis following acute pancreatitis - A rare complication of a common disease p. 1211
Arun Karat Anandan, Pradeep Balachandran, Arpitha Chowksey, Gomathy Sankaranarayanan, Usha Samuel
DOI:10.4103/1319-2442.243968  PMID:30381522
Acute renal cortical necrosis is a rare cause of intrinsic acute kidney injury (AKI) which is commonly associated with obstetric complications such as placental abruption and some serious systemic disorders such as hemolytic-uremic syndrome, sepsis, severe burns, and snake bite. Acute pancreatitis is an extremely rare cause of renal cortical necrosis, and only less than 10 cases are reported in the literature. Here, we present a 24-year-old male presented with features of acute pancreatitis and oliguric AKI. His pancreatic enzymes were above 1000 IU/mL at admission. He was initiated on hemodialysis. Percutaneous renal biopsy done at 4th week of illness showed features of diffuse renal cortical necrosis. Contrast-enhanced computed tomography demonstrated hypoattenuation of cortex compared to medulla consistent with renal cortical necrosis. He developed complications such as acute necrotic collection, pleural effusion and retinal detachment in addition to renal cortical necrosis which was managed conservatively. Since there was no improvement in the renal function now, he is being evaluated for renal transplantation.
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An initial evaluation of hypokalemia turned out distal renal tubular acidosis secondary to parathyroid adenoma p. 1216
Manish R Balwani, Amit Pasari, Amol Meshram, Anil Jawahirani, Priyanka Tolani, Hansini Laharwani, Charulata Bawankule
DOI:10.4103/1319-2442.243965  PMID:30381523
Primary hyperparathyroidism (PHPT) usually presents with hypercalcemia related symptoms and signs. Kidneys play an important role in calcium homeostasis. PHPT has been reported to be associated with hyperchloremia, defective urinary acidification, and renal tubular acidosis (RTA). The dysfunction of distal renal tubules is proposed to be secondary to calcium deposition in distal tubules. This case report highlights an initial presentation of parathyroid adenoma as hypokalemia due to distal RTA secondary to medullary nephrocalcinosis.
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Myroides odoratimimus urinary tract infection p. 1220
Ishthiaque Ahamed, Vellaichamy M Annapandian, Krithika D Muralidhara
DOI:10.4103/1319-2442.243957  PMID:30381524
Myroides species formerly known as Flavobacterium odoratum, a rare clinical isolate often considered as nonpathogenic. Myroides odoratimimus commonly found in the environment and frequently isolated from the immunocompromised patients. The incidence of urinary tract infection (UTI) caused by Myroides species is a rare phenomenon. We describe a rare case of UTI caused by Myroides odoratimimus in an elderly patient.
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A rare cause of acute renal failure: Aortic occlusion p. 1223
Bulent Kaya, Ibrahim Yildiz, Pinar Ozmen Yildiz
DOI:10.4103/1319-2442.243944  PMID:30381525
Aortic occlusion usually occurs in the infrarenal abdominal aorta while occlusion of the suprarenal aorta is much less common. The clinical presentation may vary from limb ischemia, neurologic symptoms of the lower extremities, abdominal symptoms, renal failure, and resistant hypertension (HTN). We present a case of suprarenal aortic occlusion presenting with renal failure and resistant HTN but without lower limb ischemia.
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Immune complex-mediated rapidly progressive glomerulonephritis in a patient with family history of systemic lupus erythematosus p. 1227
Ahmad Alflaiw, Ghormallah Alghamdi, Khalid Alsaad, Noura Aloudah
DOI:10.4103/1319-2442.243949  PMID:30381526
We describe here a case of a 53-year-old Saudi female who presented to the emergency room with shortness of breath progressive in nature for the previous one month, associated with a cough and occasional greenish sputum. She turned out to be a case of immunocomplex mediated glomerulonephritis presenting as rapidly progressive glomerulonephritis in a female patient with a history of systemic lupus erythematosus (SLE) in her daughter.
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Hemosiderin tubulopathy-induced acute kidney injury - A rare initial manifestation of paroxysmal nocturnal hemoglobinuria p. 1232
Srikanth Prasad Rao, Sindhura Lakshmi Koulmane Laxminarayana, Shankar Prasad Nagaraju, Mahesha Vankalakunti, Ravindra Prabhu Attur, Chethan Manohar
DOI:10.4103/1319-2442.243958  PMID:30381527
Paroxysmal nocturnal hemoglobinuria (PNH) is characterized by episodes of intravascular hemolysis, infections, and thromboembolic complications. Renal abnormalities are rare which occur either due to hemolytic crisis or repeated thrombotic episodes involving small venules. Acute kidney injury (AKI) requiring hemodialysis due to toxic effects of hemoglobinuria, with a stable disease is exceptional. We describe a case of an elderly gentleman presenting with features of severe AKI requiring hemodialysis due to hemosiderin tubulotoxicity as the first manifestation of PNH. The diagnosis was challenging because of the rarity and unfamiliarity with this entity. The outcome was complete recovery of renal function with hemodialysis.
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Hepatitis C virus, directly acting antivirals and Guillain-Barré syndrome p. 1237
Manish Balwani, Charulata Bawankule, Vishal Ramteke, Amit Pasari
DOI:10.4103/1319-2442.243969  PMID:30381528
Guillain-Barré syndrome (GBS) has been associated with both infective and noninfective etiologies. It is usually preceded by acute gastrointestinal or respiratory infections. We report an unusual case of GBS in a hepatitis C virus-positive hemodialysis (HD)-dependent patient who was being treated with sofosbuvir and daclatasvir along with antitubercular drugs for pulmonary tuberculosis. One should keep GBS in the differential diagnosis in HD patients whenever patient presents with lower limb weakness. Early diagnosis will help in timely initiation of treatment which is crucial to treat GBS.
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Distal renal tubular acidosis secondary to vesico-ureteric reflux: A case report with review of literature p. 1240
Anjali Bharani, Tanmay Bharani, Rajesh Bharani
DOI:10.4103/1319-2442.243943  PMID:30381529
Vesicoureteric reflux (VUR) is the most common congenital anomaly of the urinary tract that occurs in 30%–50% of children presenting with recurrent urinary tract infections. Long-standing untreated VUR results in renal scarring and hydronephrotic changes ultimately leading to chronic renal failure and arterial hypertension. However, it may also result in diffuse tubulopathy compromising the concentrating capacity of tubules and urinary acidification defects. Renal tubular dysfunction should be considered in all children with VUR presenting with failure to thrive, rickets, bony deformity/pain, hypokalemia, and metabolic acidosis. We report such a case of a 16-year-old male adolescent who presented with rickets, failure to gain weight and height, bony pains, and muscle weakness with a history of VUR. On investigation, he was found to have normal anion gap metabolic acidosis with hypokalemia suggestive of distal renal tubular acidosis. He responded well to oral alkali and potassium replacement therapy.
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LETTERS TO THE EDITOR Top

A case of recurrent embolic stroke of undetermined source in a chronic kidney disease patient undergoing hemodialysis p. 1245
Mitsutoshi Shindo, Shohei Kaneko, Saori Minato, Yuko Mutsuyoshi, Katsunori Yanai, Hiroki Ishii, Taisuke Kitano, Haruhisa Miyazawa, Kiyonori Ito, Yuichiro Ueda, Keiji Hirai, Taro Hoshino, Susumu Ookawara, Yoshiyuki Morishita
DOI:10.4103/1319-2442.243941  PMID:30381530
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Self-care at home education impression on the quality of life in hemodialysis patients treated in Ardebil, Iran p. 1247
Nader Aghakhani, Solmaz Habibzadeh
DOI:10.4103/1319-2442.243974  PMID:30381531
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Acute renal failure related to cave visit: Evidence in literature and observation on the cave trapped victims in Thailand, 2018 p. 1249
Pathum Sookaromdee, Viroj Wiwanitkit
DOI:10.4103/1319-2442.243948  PMID:30381532
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SCOT DATA Top

Organ donation and transplantation in the Kingdom of Saudi Arabia 2017 p. 1250
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