The syndrome of hemolysis, elevated liver enzymes and low platelets (HELLP) is not uncommon in patients with pre-eclampsia and eclampsia. Acute renal failure is not common in patients with HELLP syndrome. We present here a young patient who developed HELLP syndrome on the first post-partum day complicated with acute renal failure which necessitated dialysis. The patient made complete recovery.

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We retrospectively analysed the clinical data and investigations of 85 adult patients who underwent nephrectomy at a referral hospital in Asir region. The patients were fairly young with mean age of 44 years except those with transitional cell carcinoma of the upper urinary tract who had a mean age of 67 years. The male to female ratio was 1.9:1 and there was slight predominance of right sided lesions. Loin pain was the leading presenting feature with only a few cases presenting with hematuria and some with a loin mass. The leading indication for nephrectomy was chronic obstruction culminating in end-stage pyelonephritis (65%), followed by malignancy of kidneys and upper urinary tract (22%). Fifty six percent of the cases with obstruction had associated upper urinary tract stones. Ultrasonography and intravenous urography were excellent in the evaluation of clinically significant obstruction but many ancillary imaging procedure were needed to evaluate the nature of the obstructing lesion. We conclude that obstructive nephropathy is the main cause for nephrectomy in Asir, with urolithiasis implicated in more than half of the cases of obstruction.

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Ammonia generated by the action of urease producing organism(s) on urea is generally held responsible for the gastrointestinal symptoms of uremia, however, little information is available on the exact organism(s) responsible. We have studied prospectively 70 consecutive patients with moderate or severe degree of chronic renal failure for the presence of Helicobacter pylori (H. pylori) infection of the gastric and duodenal mucosa using bacteriological and histological methods. All patients were endoscoped for presence of gastroduodenal mucosal lesions and graded for the severity of uremia related gastrointestinal symptoms. Uremic symptoms of varying severity were present in all the patients, while H. pylori was present in 81.4% and gastroduodenal erosions and/or ulcers were in 53% of them. No direct correlation was demonstrated between H. pylori infection of the gastroduodenal mucosa, endoscopic findings and presence or severity of uremia related gastrointestinal symptoms. It is concluded that H. pylori is present in the gastroduodenal mucosa of a large number of patients with advanced renal failure however, it does not appear to play a causative role in gastritis or dyspeptic symptoms associated with uremia. Histological examination provided a higher yield over microbiological methods in demonstrating H. pylori infection of gastroduodenal mucosa.

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It is known that high dose cyclophosphamide (cycloph), through its metabolite acrolein can cause hemorrhagic cystitis (HC) which can be a serious and life threatening complication. We decided to perform an analysis of risk factors for the development of HC in patients receiving cycloph as part of their conditioning regimen for bone marrow transplantation (BMT). A total of 45 patients (25 males &. 20 females) underwent BMT as treatment for hematological and malignant diseases. The median age was 12 years (range 2-43). The conditioning regimen was either cycloph 120 mg/kg over two days and total body irradiation 1440 mg/kg over four days, or cycloph 200 mg/kg over four days and Busulfan, 14 mg/kg over four days. The uroprotective measures taken included Mesna 160% of the cycloph dose with fluid hydration (120 ml/m2/hr) over two days. The overall incidence of hematuria was 60% (31% microscopic and 29% gross hematuria) and the median onset was at day three post start of chemotheraphy (range 1-33 days). We found no difference between the two groups (HC or non­-HC) in respect of age, conditioning regimen, frequency of bladder emptying and fluid input (p values > 0.05). The only significant difference was in the mean urine output; 3200 ml/m2/day (133 ml/m2/hr) for HC and 3560 ml/m2/day (150 ml/m2/hr) for non HC (p values = 0.02). We advise prolonging the IV fluid hydration to a total of three days and maintaining a high urine output more than 3560 ml/m2 /day (150 ml/m2 /hr) during cycloph administration.

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Renal diseases are often discovered accidently during routine urinalysis. To test the diagnostic value of screening for renal disease by urinalysis, a cross-sectional study was conducted in two major Primary Health Care Centers (PHCCs) in Abha, Saudi Arabia, on patients attending these PHCCs with different medical problems. A total of 10,500 patients visited the two PHCCs during the study period between January 1994 and September 1994, and 1,006 urine samples were examined. Patients known to have renal diseases, pregnant women and menstruating women were excluded from the study. There were 390 males (38.8%) with a mean age of 30.9 + 18.3 years (range 1 - 78 years) and 616 females (61.2%) with a mean age of 28.7 ± 13.9 years (range 2 - 87 years). Proteinuria was present in 12.8% of the males and 11.0% of the females. Pyuria was present more significantly in females (25%) than in males (9.5%) with a p value of 0.0001. This study shows a high prevalence of abnormal urinalysis in a country where most patients present late with advanced renal disease of unknown cause. Also, such a screening test at the PHCC level is cost-effective.

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