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Saudi Journal of Kidney Diseases and Transplantation
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   2006| January-March  | Volume 17 | Issue 1  
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Panel Reactive Antibody test (PRA) in renal transplantation
Ali H Hajeer
January-March 2006, 17(1):1-4
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Treatment of Tacrolimus-associated thrombotic microangiopathy in renal transplant recipient with fresh frozen plasma: A case report
Harzallah Kais, Cherif Nourredine, Belhadj Raoudha, Chelbi Emira, Sraeib Tarek, Saddek Fehmi, Boussema Ezzedine, Hmida Jalel, Manaa Jamel
January-March 2006, 17(1):58-61
Thrombotic microangiopathy (TMA) is a rare serious adverse reaction of calcineurin inhibitors, tacrolimus and cyclosporin. We report a case of a young male renal transplant recipient treated with tacrolimus, who developed TMA. Treatment included discontinuation of tacrolimus, increasing the dose of mycophenolate mofetil and infusion of fresh-frozen plasma. This was followed by normalization of renal function and dis­appearance of proteinuria. The remission has been sustained after a follow-up of nine months.
  6,476 507 -
Local Versus General Anesthesia in Pediatric Renal Biopsy: Which is Associated With Better Outcome?
Wasiu Adekunle Olowu
January-March 2006, 17(1):25-33
Percutaneous renal biopsy (PRB) of the native kidneys of 32 Nigerian children with varied renal diseases were studied to evaluate which of the two anesthetic techniques (local or general) was associated with better outcome. The children were randomly assigned into two anesthetic groups of 16 subjects each. PRB was performed with Franklin-modified Vim-Silverman renal biopsy needle. The outcome indices in this study were, number of biopsy attempts, duration of the biopsy procedure, number of successful biopsies, episodes and duration of macrohematuria, if any, renal biopsy related trauma (RBT) and other associated complications. There were 19 boys and 13 girls. Mean ages were similar in both local (LA) (8.7 ± 4.14 years) and general anesthesia (GA) (9.9 ± 3.5 years) groups, P > 0.5. The mean biopsy attempts were 3.1 ± 1.8 and 1.6 ± 1.8 in the LA and GA groups respectively (P < 0.05). Mean biopsy duration was significantly longer in the LA group (21.6 ± 6.3 min) than in the GA group (7.6 ± 5.4 min), P < 0.001. Number of successful biopsies were similar in both groups; 12/16 in LA group and 15/16 in the GA group, P = 0.1446. The overall success rate was 84.4%. Mean episodes and duration of macrohematuria were similar in the two groups (P>0.5). It is concluded that in the anxious, fretful and uncooperative children, GA should be the anesthetic technique of choice for kidney biopsy given the fewer biopsy attempts as well as shorter biopsy duration associated with it.
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Management of Hypertension in Adults with Diabetes
Abdulkareem Alsuwaida
January-March 2006, 17(1):38-46
  3,515 420 -
Lymphocele Following Renal Transplantation
M Samhan, M Al-Mousawi
January-March 2006, 17(1):34-37
We attempt in this retrospective study to evaluate the incidence, clinical presentations, and outcome of lymphocele in renal transplant recipients. 528 patients (313 males and 215 females) have received renal allografts from 384 living and 144 cadaveric donors. Diagnosis of lymphocele was made basically by ultrasound examination, and symptomatic collections were drained either percutaneously or into the peritoneal cavity. There were 50 (9.5%) instances of lymphocele encountered between 2 weeks and 6 months after transplantation. The lymphocele presented clinically predominantly as a single pelvi-abdominal swelling in 28 (56%) cases or as a swelling associated with manifestations of utereric and/or venous compression in 18 (36%) cases, and it was more common after cadaveric transplantation. All the cases of lymphocele were successfully treated with no graft loss. Lymphocele is an uncommon complication after renal transplantation, and is formed during the early post transplantation period. If not treated, it could seriously affect the kidney function. Intraperitoneal drainage is the most effective method for the treatment of symptomatic lymphocele.
  3,168 416 -
Post-Transplant Erythrocytosis: A Disease With Multifactorial Etiology
Reda Ghacha, Ali Rafi, Mohd Abdelrahman, Tahir Qayyum Malik, Ayman Karkar
January-March 2006, 17(1):54-57
Post-transplant erythrocytosis (PTE) is defined as an increase in hematocrit greater than 51%. This phenomenon affects 5 to 17% of renal transplant patients within two years of transplantation. Its etiology is not clearly known, but several factors have been implicated in its pathogenesis. We report on a 50-year-old male, known to have autosomal dominant polycystic kidney disease, diabetes mellitus and hypertension for 20 years, who underwent a living unrelated donor transplantation. Three years following renal transplan­tation, he was noted to have high hemogloblin and hematocrit (18.3 gm%, 53.8%). This erythrocytosis persisted for nine months during which period he underwent multiple phlebotomies before undergoing spontaneous remission. He did not develop any compli­cations of erythrocytosis. Our patient had multiple factors to account for occurrence of PTE: diabetes mellitus, hypertension, mild allograft dysfunction, polycystic kidney disease and cyclosporin therapy. Our case suggests that multiple factors may be operative in a given patient leading to the development of PTE.
  3,022 362 -
Association of Hydrocarbon Exposure with Glomerulonephritis in Nigerians: A Case Control Study
DA Ishola, FA Arogundade, AA Sanusi, A Akinsola
January-March 2006, 17(1):82-89
Glomerulonephritis (GN) is a major cause of CRF in Nigerians. Experimental evidence and clinical studies mostly in Caucasian subjects have associated hydrocarbon (HC) exposure with GN. We conducted a case-control study using a questionnaire-based quantitative HC exposure measurement to compare lifetime HC exposure levels between Nigerian patients with GN-induced CRF and matched healthy control subjects. Fifty consecutive patients with CRF from GN were compared with age and sex matched group of 45 healthy controls. A questionnaire designed to assess the sources, duration and intensity of HC exposure was used to compute an HC exposure score (HES) for each participant and the scores for the two groups were then compared. The HES was significantly higher in the patients (score ± SEM) of 2307.5 ± 698.8 vs. 53.4 ± 16.5; p < 0.001. The HES was dichotomised by classifying all study subjects within the upper third of scores as a high-exposure sub-group. A significantly higher proportion of patients had high exposure (p<0.002). Logistic regression analysis excluded age and gender as confounding factors and determined a greater than four-fold risk of GN-induced CRF with high HC exposure (OR 4.3; 95% CI 1.7 - 11). In conclusion, our findings suggest that HC exposure is a significant risk factor for GN in Nigerians with CRF. Exposure limitation could help to reduce the burden of CRF in the country.
  2,947 261 -
The spouse as a donor in renal transplants
Amitava Mukherjee, Nitin S Kekre, Ganesh Gopalakrishnan
January-March 2006, 17(1):77-81
Most renal transplants performed in India are from live related donors. The mother is the most frequent donor. In India, the Transplantation of Human Organs Act, which was passed in 1994, allowed organ procurement from "near relatives" live donors. In the period between 1999 and 2003 we performed in our center 41 spouse to spouse transplants, and 356 transplants among the live genetically related. The two groups showed comparable mean creatinine at one (136 ± 38 µmol/L vs. 151 ± 53 µmol/L) and three years (136 ± 41 µmol/L vs. 154 ± 53 µmol/L). The spouse allograft recipients had 26% incidence of acute rejections vs. the genetically related recipients who had 22% incidence over a similar period. We believe that though spouse donated kidneys survive comparably with those from genetically related donors; strict criteria for their acceptance should be enforced considering the social background in India, in order to prevent exploitation of female spouses from coercion of donation. In addition to our results, we discuss our policy for accepting the spouse as a kidney donor.
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Chronic Renal Failure in Children in the Western Area of Saudi Arabia
Jameela A Kari
January-March 2006, 17(1):19-24
Sixty-six children (35 boys and 31 girls) aged 14 years or younger, with chronic renal failure (CRF), were reviewed in the department of pediatrics at The King Abdul Aziz University Hospital (KAUH), Jeddah, over a four-year period from September 2000 until July 2004. Fifty-nine percent (39 patients) were Saudi Nationals while the remaining were from other nationalities. Forty-two percent lived outside Jeddah in other cities of the western or the southern provinces. Their mean glomerular filtration rate (GFR) was 15.3 + 11.1 ml/minute/1.73m 2 ; 50 patients (76%) had severe CRF with GFR of < 25 ml/minute/1.73m 2, of whom 34 (52%) were in end-stage renal failure (ESRF), with GFR < 10 ml/minute/1.73m 2 . The mean age at first presentation was 4.5 + 4.3 years, while the mean age at referral to a pediatric nephrologist was 6.6 + 4.4 years. Congenital abnormalities of the renal system were the major cause of CRF (33 patients, 50%) followed by neurogenic bladder (19.6%), either idiopathic (6%) or associated with neural tube defects (13.6%). Hereditary conditions were the cause in 12% and glomerular disease in 13.6%. Fourteen children (21.2%) received peritoneal dialysis, seven (10.6%) received hemodialysis, two (3%) were transplanted abroad and 12 patients (18%) died. Our study, which is the first from Jeddah on the epidemiology of CRF in children, shows that the profile is similar to other parts of the KSA with a predominance of congenital causes. There was a considerable delay in referring children with CRF patients to a pediatric nephrologist resulting in delay in the management of preventable causes such as neurogenic bladder associated with neural tube defects.
  2,713 379 -
Aggrenox-Associated Acute Interstitial Nephritis
Abdullah Al Hwiesh
January-March 2006, 17(1):50-53
Acute interstitial nephritis (AIN) associated with the administration of the combination drug Aggrenox ( acetylsalicylic acid 25 mg and dipyridamole 200 mg) has not been previously reported. This is an 83-year-old man who presented with nausea, vomiting, weakness, and non-oliguric renal failure. He started to have these complaints four days after starting Aggrenox one tablet daily. There were no recent medication changes aside from the addition of Aggrenox. The patient had normal serum creatinine one year prior to this event. The renal biopsy showed acute interstitial nephritis (AIN). The Aggrenox was stopped and the patient received saline intravenously. The serum creatinine rose from 494 µmol/L on admission to a peak of 798 µmol/L on day 5 then decreased gradually to 179 µmol/L over four months. The serologic investigations for common infectious and immune causes of AIN were negative. In conclusion, this patient suffered AIN associated with the administration of Aggrenox and improved with discontinuation of this drug. Further investigation may be needed to evaluate the prevalence of AIN associated with Aggrenox.
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Causes of Chronic Renal Failure in Hemodialysis Unit: A single center experience in Yemen
Ahmed M Badheeb
January-March 2006, 17(1):66-69
This cross-sectional study was carried out to determine the possible causes of chronic renal failure (CRF) in Ibn Sina Teaching Hospital (ISTH) in Hadramout, Yemen. Fifty-one CRF patients (29 men and 22 women) on regular hemodialysis were included in the study. Glomerulonephritis (25.4%) was the commonest cause of CRF, followed by obstructive nephropathy (13.7%), hypertension (11.8%), pyelonephrits (11.8%), diabetic nephropathy (7.8%), arthritis, malaria, vasculitis and postpartum hemorrhage (5.9% each) and the least common one was Alport's syndrome (3.9%). There were more men than women (57% and 43%, respectively). The mean age range of the patients was 42 years. More patients were the from coast of Mukalla than from the valley and desert (59% and 41%) respectively
  2,397 344 -
Immunological Factors and Renal Allograft Survival for More than Fifteen Years: A Single Center Study from Tunisia
K Boubaker, B Bouabid, R Bardi, E Abderrahim, T Ben Abdallah, Kh Ayed
January-March 2006, 17(1):70-76
Late loss of kidney allograft, caused by immunological and non-immunological factors, remains a major problem in the field of transplantation. The aim of this study was to analyze the risk factors affecting long-term kidney graft survival more than 15 years. In a retro­spective analysis, clinical and laboratory variables and outcome of 330 patients who received a kidney transplant from living or cadaveric ABO-compatible donors at the Charles Nicolle Hospital, Tunis between 1986 and 2005 were recorded. A total of 58 patients who had follow-up data longer than 15 years constituted the subjects of this study. Patients were classified into two groups: Group I (Gp I), those who had kidney graft survival more than 15 years and Group II (Gp II), those who had kidney graft survival less than 15 years. There were 27 patients in Gp I (46.5%) and 31 in Gp II (53.5%). Graft loss in Gp II patients occurred in the first year in 15.1%, at three years in 35.5 %, at five years in 71 % and at 10 years in 83.9 %. The cause of graft loss was chronic graft dysfunction in 24 cases (77.4%), recurrence of the original kidney disease in three and graft versus host disease, urinary fistula, vascular rejection and graft rupture in one case each. There was no statistically significant difference between recipient and donor age or sex, duration on dialysis, number of acute rejections and infections between the two groups. Eleven of 27 patients (40.7 %) in Gp I and eight of 31 patients (25.8 %) in Gp II received total mismatched kidneys while the others received kidneys with varying degrees of match. The HLA DR2 matching was higher in Gp I (44.4 %) than in Gp II (29 %), whereas DR3 matching was higher in Gp II (45.2 %) in comparison with Gp I (11.1 %). Cross-match was negative in all our patients. Thirteen patients (48.1%) in Gp I and 17 (54.8 %) in Gp II.had a history of having episode(s) of acute rejection The number of acute rejection episodes did not contribute significantly to long-term graft survival in our series. Delayed graft function significantly lowered long-term graft survival; it was seen in seven cases in Gp I (25.9 %) versus 23 cases in Gp II (74.2 %) (X2=13.46). In our study, the long-term graft survival was similar to what is reported from developed countries. The main risk factors were HLA DR matching and delayed graft function.
  2,371 320 -
Rhodotorula Species Peritonitis in a Liver Transplant Recipient: A Case Report
Adel Alothman
January-March 2006, 17(1):47-49
A 62-year-old man with a six months status post liver transplant due to hepatitis C infection, was admitted with ascites and pyrexia of unknown origin. Despite extensive investigations, his fever remained undiagnosed, so he was started empirically on anti tuberculous agents, ganciclovir and trimethoprim/sulfa. The liver function deteriorated and a liver biopsy showed evidence of allograft rejection for which the patient was started on systemic steroids. Later, yeast grew from the ascitic fluid, which was identified as Rhodotorula species. The draining peritoneal catheter was removed and the patient was started on Amphotericin B. The amphotericin was continued for 10 days during which the patient defervesced and repeat ascitic fluid culture became negative. In conclusion, Rhodotorula species infection is a rare form of infection in the immunocompromised host that is usually associated with indwelling catheter insertion. The infection responded to the removal of the indwelling catheter and amphotericin B treatment.
  2,232 263 -
Post dialysis Rhino cerebral Mucormycosis
Weal L Jabur, Harith M Aljebory
January-March 2006, 17(1):62-63
  2,150 203 -
Attitude of Physicians towards the Management of Bone Disease in Hemodialysis Patients: A Questionnaire Based Survey
Muhammad Ziad Souqiyyeh, Faissal AM Shaheen
January-March 2006, 17(1):10-18
This study is aimed at evaluating the attitude of physicians in dialysis centers in the Kingdom of Saudi Arabia (KSA) towards the management of bone disease. We sent a questionnaire to 168 physicians who jointly cared for 7214 chronic hemodialysis (HD) patients. A total of 134 physicians (79.8%) answered the questionnaire from 134 dialysis centers (91.7%) that cumulatively catered to 7030 dialysis patients (97.6%). Of them, 71 (53.4%) had a protocol for management of bone disease at their centers, while 87 (67.4%) believed that the current results of management of bone disease were satisfactory. About 84.2% and 82.7% of the physicians checked serum calcium and phosphorus levels respectively monthly, while only 24.6% would check parathormone (PTH) once every three months; 32.8% did not have this latter test available in their centers. Bone x-rays of the hands and clavicles were being performed once every year by 47.4%, while 38.4% would perform the x-rays as indicated by the clinical status. Therapy would be aimed to achieve mid-normal calcium and phosphorus levels by 64.9% and 56.8 % of the respondents respectively, while only 29.3% would try to achieve three times the normal level of the PTH. Only 43.3% of the respondents believed that sevelamer would be a safer phosphate binder than calcium or metal based one. Almost all the respondents used vitamin D, mostly by daily oral administration. Fifty-nine respondents (44.4%) believed that sevelamer plus vitamin D was better to control PTH than calcium-based phosphate binder plus vitamin D, while 51 (38.3%) had no idea about this issue. There were 57 respondents (42.5%) who believed that high intake of calcium would increase the risk of vascular and metastatic calcifications without hypercalcemia, while 43 (32.1%) had no idea. There were a significantly lower percentage of MOH centers having a protocol for management of bone disease in the dialysis patients. Also, there was a higher percentage of non-availability of PTH assay, lower tendency of the physicians to target low normal level of phosphorus and higher percentage to target normal levels of PTH in MOH centers. In addition, MOH physicians had significantly lesser tendency to consider sevelamer the best phosphate binder for the dialysis patients. Our study suggests that the current practices concerning the management of bone disease in dialysis centers in the KSA require refinement and a protocol to guide the management is required.
  2,015 273 -
Renal Allograft Antibody Mediated Rejection in Highly Sensitized Patient
Ammar Abdulbaki
January-March 2006, 17(1):97-102
  2,049 216 -
Role of Increased Factor VIII Levels in Recurrent Thrombosis of Vascular Access: A Case Report
Mahmoud Kharrat
January-March 2006, 17(1):64-65
  1,777 249 -
Chemokines and Glomerulonephritis
E Nigel Wardle
January-March 2006, 17(1):5-9
  1,766 224 -
Simplicity in Medicine
Sadek Pharaon
January-March 2006, 17(1):95-96
  1,200 196 -
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