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Saudi Journal of Kidney Diseases and Transplantation
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   2009| March-April  | Volume 20 | Issue 2  
    Online since February 19, 2009

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Causes and outcome of prenatally diagnosed hydronephrosis
Ali Ahmadzadeh, Morteza Tahmasebi, Mohammad Momen Gharibvand
March-April 2009, 20(2):246-250
Hydronephrosis is the most common abnormal finding in the urinary tract on prenatal screening with ultrasonography (U/S). Hydronephrosis may be obstructive or non­obstructive; obstructive lesions are more harmful to the developing kidneys. The aim of the study was to evaluate the causes of renal pelvic dilatation and the outcome of postnatal treatment in infants with hydronephrosis diagnosed prenatally with U/S. We prospectively studied 67 (60 males) newborns with hydronephrosis diagnosed prenatally and confirmed postnatally with U/S from Sept. 2005 to Oct. 2007. The patients were allocated to three groups based on the mea­surement of the anteroposterior renal pelvic diameter (APRPD) in transverse plane: mild (6-9.9 mm), moderate (10-14.9 mm) and severe (> 15 mm) hydronephrosis. Voiding cystourethrography (VCUG) was obtained in all of the patients to rule out vesicoureteral reflux (VUR). In cases with negative VUR, Diethylenetriamine-pentaacetic acid (DTPA) scan with diuretic renography was performed to detect ureteropelvic joint obstruction (UPJO). Twenty two cases (32.8%) had mild, 20 (29.9%) had moderate, and 25 (37.3%) had severe hydronephrosis. The causes of hydroneph­rosis were VUR (40.2%), UPJO (32.8%), posterior urethral valves (PUVs) (13.4 %), and transient hydronephrosis (13.4 %). The lesion was obstructive in 37 (55.2%) infants. Totally, 33 (49.2%) patients with hydronephrosis (9 mild, 9 moderate, and 15 severe) subsequently developed com­plications such as UTI and renal insufficiency, or required surgery. Associated abnormalities were observed in 15 (22.4%) patients. We conclude that every newborn with any degree of hydro­nephrosis should be assessed postnatally for specific diagnosis and treatment.
  8,983 1,067 4
Hypokalemic paralysis due to primary hyperaldosteronism simulating gitelman's syndrome
Timucin Kasifoglu, Aysen Akalin, Dondu Uskudar Cansu, Cengiz Korkmaz
March-April 2009, 20(2):285-287
Some diseases, such as Gitelman's syndrome, Bartter's syndrome, and primary hyperaldosteronism (Conn's syndrome), may bear some similar clinical and laboratory findings. Their treatment modalities being different from one another, the need for a scrupulous diagnostic evaluation arises as far as clinical practice is concerned. In this report, we present a patient with Conn's syndrome who was initially considered to have Gitelman's syndrome due to displaying a few overlapping features of both diseases. We also give an account of the hardships encountered during the diagnostic evaluation.
  7,261 726 2
Psychosocial issues and quality of life in patients on renal replacement therapy
Alkioni Panagopoulou, Andreas Hardalias, Stavroula Berati, Costas Fourtounas
March-April 2009, 20(2):212-218
The aim of the present study was to investigate psychosocial variables related to objective and subjective indicators of quality of life in a single center cohort study of patients undergoing in-center hemodialysis (HD), Continuous Ambulatory Peritoneal Dialysis (CAPD) and renal transplant recipients (RTx). We studied 40 HD patients, 36 CAPD, and 48 RTx patients by a special questionnaire examining demographics, functional status, employment status, and impact of therapy on psychosocial issues such as anxiety and depression. The RTx patients disclosed a better functional and employment status than the CAPD and the HD patients. They were also more compliant and satisfied with their therapy and their relationship with the medical and nursing personnel. The CAPD patients were also more satisfied, more compliant, better motivated, and less anxious and depressed compared with the HD patients who scored low in every aspect studied. Successful renal transplantation is a superior modality of therapy than HD or CAPD regarding psychosocial and quality of life issues. However these results can partially be explained by some selection bias, as RTx patients are usually younger and CAPD patients are selected for this modality after examining functional and social status.
  5,385 1,221 6
Conns' syndrome - atypical presentations
KVS Hari Kumar, Sangeeta Jha, Ratan Jha, KD Modi
March-April 2009, 20(2):278-281
Primary hyperaldosteronism (Conns' syndrome) commonly presents with a combi­nation of clinical features of hypokalemia and hypertension. Atypical presentations like normo­tension, normokalemia and neurological ailments are described in few cases. We encountered two such cases, the first presenting with acute neurological complaint and second case having insig­nificant hypertension. Both the patients had a characteristic biochemical and imaging profile consistent with primary hyperaldosteronism and responded to surgical resection of adrenal adenoma.
  5,617 601 -
Risk score for contrast induced nephropathy following percutaneous coronary intervention
Amal Abdel Ghani, Khalid Y Tohamy
March-April 2009, 20(2):240-245
Contrast-induced nephropathy (CIN) is an important cause of acute renal failure. Identification of risk factors of CIN and creating a simple risk scoring for CIN after percutaneous coronary intervention (PCI) is important. A prospective single center study was conducted in Kuwait chest disease hospital. All patients admitted to chest disease hospital for PCI from March to May 2005 were included in the study. Total of 247 patients were randomly assigned for the development dataset and 100 for the validation set using the simple random method. The overall occurrence of CIN in the development set was 5.52%. Using multivariate analysis; basal Serum creatinine, shock, female gender, multivessel PCI, and diabetes mellitus were identified as risk factors. Scores assigned to different variables yielded basal creatinine > 115 µmol/L with the highest score(7), followed by shock (3), female gender, multivessel PCI and diabetes mellitus had the same score (2). Patients were further risk stratified into low risk score (< 4), moderate (5-8), high (9-12), and, very high risk score (>_ 12). The developed CIN model demonstrated good dis­criminative power in the validation population. In conclusion, use of a simple risk score for CIN can predict the probability of CIN after PCI; this however needs further validation in larger multi­center trials.
  4,878 1,092 6
Epidemiology of nutritional rickets in children
MS Al-Atawi, IA Al-Alwan, AN Al-Mutair, HM Tamim, NA Al-Jurayyan
March-April 2009, 20(2):260-265
In most developing countries, nutritional rickets is a major health problem. The aim of this study was to explore the magnitude of nutritional rickets among Saudi infants, and the various clinical presentations, as well as to address the possible operating risk factors behind the disease. We carried out a retrospective study at King Abdulaziz Medical City-King Fahad National Guard Hospital in Riyadh, Saudi Arabia. The records of Saudi infants under the age of 14 months over a 10-year period (between January 1990 and January 2000) were reviewed. Infor­mation collected included age, sex, clinical presentations, biochemical, radiological findings, infant nutrition, presence of other nutritional deficiencies and exposure to sunlight. There were 283 infants diagnosed with nutritional rickets due to Vitamin D deficiency (67% males) who were between 6 and 14 months of age. Among the total, 70% were exclusively breast-fed, and 23% were breast-fed until the age of 1 year. The most frequent clinical presentation was hypo-calcemic convulsions (34%) followed by chest infections (33%) and gastroenteritis (25%). In conclusion, nutritional rickets is still prevalent in Saudi Arabia with the primary etiology being vitamin D deficiency. Therefore we recommend that every infant, who is exclusively on breast-feeding, has routine supplement of vitamin D in the range of 200 IU/day (alone or as apart of multivitamin), started soon after birth until the time of weaning.
  4,742 1,068 25
Fasting ramadan in kidney transplant patients is safe
Yousef Boobes, Bassam Bernieh, M Raafat Al Hakim
March-April 2009, 20(2):198-200
Muslims with renal transplant often ask their doctors whether fasting Ramadan is safe. Scanty studies have addressed this question. This prospective study was undertaken to identify any clinical or biological changes with Muslim fasting. 22 kidney transplant patients with stable kidney functions, who were transplanted for more than one year, and voluntarily chose to fast during Ramadan in 1425 H (October-November 2004), were studied. Total of 22 subjects (10 men and 12 women) with a mean age of 47 ± 11.6 years were studied. Full clinical and biological assessment was done before during and after the month of Ramadan fasting. Medications were taken in two divided doses at sunset (time of breaking the fast) and pre dawn (before the fast). None of the patients experienced any undue fatigue, or symptoms. Body weight, blood pressure, kidney function tests, blood sugar, lipid profile, and cyclosporine levels remained stable. In conclusion it is safe for renal transplant recipients of more than one year and having stable graft function to fast during the month of Ramadan; however caution is advised for moderate to severe impaired renal function.
  4,207 1,452 5
Antimicrobial susceptibility pattern of urinary tract pathogens
Zakieh Rostamzadeh Khameneh, Ali Taghizadeh Afshar
March-April 2009, 20(2):251-253
Microbial drug resistance is a major problem in the treatment of infectious diseases worldwide. The purpose of this survey is to determine the prevalence of the type of bacterial agents that cause urinary infection and to assess the antimicrobial sensitivity pattern in the Urmia Medical University, Iran. In the period between 2005 and 2006, urine cultures collected were analyzed. Positive culture was defined as growth of a single bacterial species with colony count of > 100,000 CFU/mL. Stratification was done according to age-group and gender. Statistical tests used included chi-square to evaluate differences between susceptibility rates. A total of 803 urine culture positive patients were studied of whom 81.6% were females and 18.4% were males. The common micro-organisms isolated were E. coli (78.58%), Klebsiella (5.48%), Proteus and Staphylococcus. About 89% of the E. coli isolated showed sensitivity to cephtizoxin, 83.9% to gentamycin and 83.2% to ciprofloxacin; the highest resistance was shown to ampicillin and co­trimoxazole. Surveys of this nature will give a clear idea about the bacteriologic profile in a given institution as well their antibiotic sensitivity profile. This will act as a guide to commencing empirical antibiotic treatment in patients with urinary infections until such time culture reports are available.
  4,537 1,009 9
Technical aspects of home hemodialysis
B Alhomayeed, RM Lindsay
March-April 2009, 20(2):185-191
Home hemodialysis (HHD) has proved to be a useful form of renal replacement therapy. The economic advantage of HHD is well established and interest in it is renewed. Once it has been decided to establish a HHD program, a well developed strategic plan is required. This should address financial and logistical issues and establish policies that will address responsi­bilities of both patients and HD centers. The recruitment of patients is facilitated by ensuring that all incident patients have early access to an education program describing all forms of renal replacement therapy that the regional renal program provides. Patients and members of the pre­dialysis education program should understand the selection process criteria in advance. Once the assessment is completed and the patient agrees to the proceedings, a plan of action should be esta­blished for enrolling the patient into the program and initiating training. Patients' education pro­gram should take into consideration principles of adult learning. When choosing dialysis equip­ment for home use, the needs and preferences of the patients should be respected. As a rule of thumb, the equipment should be simple to use, yet still provide adequate and reliable therapy. De­ciding where to set up and position the HHD equipment is important. Installation of HHD ma­chine at home requires a continuous supply of accessories. Before establishing a HHD program, commitment of the dialysis center to provide and maintain the infrastructure of the program is mandatory. The estimated patients suitable for HHD are less than 15% of all prospective dialysis patients. Generally, those who are have greatly improved quality of life and by using modalities such as nocturnal and daily dialysis can have improved physical well-being with considerable potential cost savings.
  3,493 1,703 -
The epidemiology of viral hepatitis in Qatar
Abdulbari Bener, Saad Al-Kaabi, Moutaz Derbala, Ajayeb Al-Marri, Ammar Rikabi
March-April 2009, 20(2):300-306
Viral hepatitis is a major public health problem in many countries all over the world and especially in Middle East, Asia, East-Europe, and Africa. The aim of our study was to assess the incidence of viral hepatitis A, B and C in Qatar and compare it with other countries. This is a retrospective cohort study, which was conducted at Hamad General Hospital, State of Qatar from 2002-2006. Patients who were screened and diagnosed with viral hepatitis were included in this study. The diagnostic classification of definite viral hepatitis was made in accordance with criteria based on the International Classification of Disease tenth revision (ICD-10). A total of 527 cases of hepatitis C, 396 cases of hepatitis B, 162 cases of hepatitis A and 108 cases of unspecified were reported during the year 2006. Reported incidence rate per 10,000 populations during the year 2006 for hepatitis A was 1.9, hepatitis B 4.7, and Hepatitis C 6.3. The proportion of hepatitis B and C was significantly higher in male population than females across the years (2002-2006). Hepatitis A was more prevalent in children below 15 years (72.3%), hepatitis B in adults aged above 15 years, and hepatitis C in the population above 35 years of age. The incidence of hepatitis A has been declining in Qataris and increasing in expatriates. There was a significant relationship in gender and age group of the patients with hepatitis A, B and C. We conclude that hepatitis has become a national health issue in Qatar. The incidence rate of hepatitis in Qatar is comparable to its neighboring countries, United Arab Emirates and Saudi Arabia. There is a need for further research on hepatitis and the associated risk factors.
  4,146 688 3
Use of iron sucrose in dialysis patients sensitive to iron dextran
Ayham Haddad, Rabe'a Abbadi, Ann Marji
March-April 2009, 20(2):208-211
This study aimed to assess the safety and efficacy of iron sucrose in hemodialysis (HD) patients with documented hypersensitivity reactions to iron dextran. Of 205 HD patients who received low molecular weight iron dextran, 15 (7.3%) patients developed documented hypersensitivity reactions. The patients were treated with iron sucrose (100 mg administered as an intravenous push over 5-10 minutes once a week) for 8 weeks. Complete blood count, serum iron, serum ferritin, and parathyroid hormone were measured at the beginning and at the end of the study (except parathyroid hormone). All patients received subcutaneous erythropoietin at a constant dose of 5000 IU twice weekly unless a change was required. All the patients completed the study period and none of them developed hypersensitivity reactions to iron sucrose. The mean hematocrit increased from 23.8% to 32.27% (p < 0.0001), the mean serum ferritin from 185 ng/mL to 599 ng/mL (p < 0.0001), and the mean serum iron from 29.3 ng/dL to 76.8 ng/dL (p = 0.01). We conclude that iron sucrose is safe and effective in HD patients with documented hypersensitivity reactions to low molecular weight iron dextran.
  3,379 756 4
Inherited renal tubular defects with hypokalemia
J Muthukrishnan, KD Modi, P Jagdish Kumar, Ratan Jha
March-April 2009, 20(2):274-277
Bartter's and Gitelman's syndrome are two ends of a spectrum of inherited renal tubular disorders that present with hypokalemic metabolic alkalosis of varying severity. Clinical features and associated calcium and magnesium ion abnormalities are used to diagnose these cases after excluding other commoner causes. We report on two cases, the first being a young boy, born of pregnancy complicated by polyhydramnios, who had classical dysmorphic features, polyuria, hypokalemia and hypercalciuria and was diagnosed as having Bartter's syndrome. The second patient is a lady who had recurrent tetany as the only manifestation of Gitelman's syndrome, which is an unusual presentation. Potassium replacement with supplementation of other deficient ions led to satisfactory clinical and biochemical response.
  3,265 811 4
Transplantation: New protocols and new worries
Josep M Grinyo
March-April 2009, 20(2):192-197
  2,505 1,396 -
Advance care planning preferences among dialysis patients and factors influencing their decisions
Hamdan H Al-Jahdali, Salim Bahroon, Yaser Babgi, Hani Tamim, Saeed M Al-Ghamdi, Abdullah A Al-Sayyari
March-April 2009, 20(2):232-239
To determine the resuscitation preferences of hemodialysis (HD) Saudi patients, we con­ducted a cross-sectional, observational descriptive questionnaire study in two major tertiary hospitals in Saudi Arabia from March to December 2007. We enrolled all the patients on HD for two years or more, and excluded the patients who were transplant candidates, confused, or demented. The questionnaire was com­posed of 4 sections. The first 3 sections were concerned with demographic data, education levels, employ­ment, family size, number of children, and functionality status besides knowledge about cardiopulmonary resuscitation (CPR), mechanical ventilation, and ICU admission. The fourth section contained different sce­narios and questions on personal and preferences such as end of life decisions, medical interventions, CPR, ICU admission, and the decision maker in these events. A total of 100 patients (53% males, 67% Saudis, and 85% married) were enrolled in the study. The mean duration on dialysis was 6.0 years (± 4.1). More than 70% of the patients viewed themselves as above average in the religiosity score, and 44% disclosed a good life quality. More than 95% had little or no knowledge about cardiac resuscitation, intubation, and mechanical ventilation. The majority of the patients authorized their treating physician to decide for them about cardiac resuscitation in case they did not make advanced directives and only 22% believed that this decision should be made by their family members. If their physician believed their condition was hopeless, 77% preferred to stay at home. We conclude that the majority of our patients had limited awareness about cardiac resuscitation measures. The majority of the patients trust their physicians to decide about the futility of resuscitation. Patients were able to decide reasonably well when they are well informed.
  3,074 811 3
The cost of hemodialysis in Iran
Alireza Arefzadeh, Mahboub Lessanpezeshki, Sepideh Seifi
March-April 2009, 20(2):307-311
The use of dialysis in patients with end-stage renal disease (ESRD) remains one of the most resource-intensive and hence, expensive therapeutic interventions. The purpose of this study was to assess the cost of hemodialysis (HD) in Iran. This study was conducted in the Department of Nephrology at the Imam Khomeini Hospital of Tehran University of Medical Sciences, Iran, between April 2006 and June 2007. Patients with ESRD on chronic HD were involved in the study. Relevant data were collected using interview and questionnaire. Analyzed costs included: transportation plus absence from work, treatment instruments, drugs and other medical procedures, diet, staff salary, equipment and building support services, non-medical supplies, depreciation of installations and equipments, depreciation of reverse osmosis (RO) and building rent. Sixty-three patients of whom 47.7% were males and 52.3% were females, with mean age of 47 ± 12 years were studied. The estimated cost of each HD session was about 74 US dollars by which an annual cost of $11549 could be estimated for each patient. Transportation and work leaves (28.9%), staff costs and salaries (21.5%), and treatment instruments (21.1%) were among the greatest expenses. We conclude that the annual cost of dialysis in Iran is similar to other developing countries, but significantly less than the cost in developed countries.
  3,262 608 4
Characteristics and outcomes of end-stage renal disease patients with active tuberculosis followed in intensive care units
Sevinc Sarinc Ulasli, Gaye Ulubay, Nevra Gullu Arslan, Siren Sezer, Sule Akcay, Fusun Oner Eyuboglu, Mehmet Haberal
March-April 2009, 20(2):254-259
Tuberculosis (TB) remains a common problem in patients with chronic renal failure. In intensive care units, misdiagnosis or delayed diagnosis of TB is common. Therefore, a description of characteristics of active TB in patients with renal failure followed in intensive care units is important to reduce mortality and transmission of the disease. This study was performed to describe the characteristics of patients with renal failure admitted to the intensive care units and having active TB and evaluate predictive factors for in hospital mortality. The hospital records of 24 patients (11 women, 13 men) having ESRD and TB between 2001-2006 were reviewed. Clinical, radiological, and laboratory data on admission were recorded. Possible parameters contributing to in-hospital mortality were obtained from the medical records. In-hospital mortality rate was 66.6%. Factors associated with mortality were decreased partial pressure of oxygen and malnutrition. Fever was reported in 8 patients and hemoptysis was reported in 3 patients. Eight patients had consolidation on chest radiograph, while 4 had normal findings Seventeen patients had pulmonary involvement, and 11 had extra pulmonary involvement. The mortality rate in TB patients followed in intensive care units is high, with 3 factors contributing to in-hospital mortality. Clinicians should consider active TB in renal failure patients being followed in the intensive care unit, even when results of a chest radiograph are normal especially in patients with unexplained poor general health or respiratory failure.
  3,195 501 -
The impact of left ventricular preload reduction on cardiac pulsed doppler indices during hemodialysis and its relation to intra-dialysis hypotension: A pulsed doppler study
Sameer Alarrayed, Taysir Said Garadah, Abdulhai Ali Alawdi
March-April 2009, 20(2):201-207
Fluid status in the body plays an important role on left ventricular (LV) filling in patients with end-stage renal disease (ESRD) on regular hemodialysis (HD), and plays a role in intra-dialysis hemo­dynamic derangement. Fifty-two patients with ESRD on regular HD, including 34 males with a mean age of 45.5 ± 13 years (range 18-72 years), were studied. All patients underwent Echo-pulsed Doppler study before and immediately after a HD session. The Echo Doppler indices noted were: LV cavity dimension and wall thickness, LV ejection fraction (LVEF%), trans-mitral early diastolic filling velocity (E wave), atrial filling diastolic velocity (A wave), E/A ratio, Deceleration Time (DT) of E wave, Isovolumic relaxation time (IVRT), Aortic Velocity Integral (AVI) and Inferior Vena Cava Diameter (VCD) at expiration. Patients were divided into two groups according to the amount of net ultra filtrate loss after HD. Group I comprised of 25 patients with fluid loss of < 2 liters, and Group II had 27 patients with fluid loss > 2 liters. During the HD session, each patient was observed for the development of acute clinical events such as arterial hypotension (systolic BP less than 90 mmHg), chest pain and arrhythmias. There was a significant difference between the two groups in the mean values, pre- and post- HD, of reduction of E wave velocity (p< 0.01), the reduction of E/A ratio (p< 0.05), the increment in DT of E wave (p< 0.05), the reduction in AVI (p< 0.01) and the reduction of VCD (p< 0.05). There was no significant difference between the groups in the reduction of A wave velocity and the reduction of IVRT. Among the study patients, 11 (21%) developed systolic hypo­tension during HD. The pre-dialysis mean values of E/A ratio and DT of E wave in patients who developed hypotension compared to those who did not was 0.7 ± 0.2 vs 1.1 ± 0.2.1 (p< 0.001) and 246 ± 40 vs 224 ± 34 msec (p< 0.05), respectively. Our study suggests that preload reduction in patients with ESRD on regular HD is directly proportional to the reduction of left ventricle early filling and prolongation of Deceleration Time of E wave. The potential risk of intra-dialysis hypotension can be predicted, if LV diastolic Pulse Doppler pre­dialysis E/A ratio is less than 0.7 and Deceleration Time of E wave is more than 246 msec. Careful assess­ment of these patients is crucial to prevent hypotension, especially if a large preload reduction is required.
  2,681 615 -
Prevalence of Helicobacter pylori infection in maintenance hemodialysis patients with non-ulcer dyspepsia
Mohammad Kazem Hosseini Asl, Hamid Nasri
March-April 2009, 20(2):223-226
The purpose of this prospective study is to determine the prevalence of Helico­bacter pylori (H. pylori) infection among stable chronic hemodialysis (HD) patients having non ulcer dyspepsia. The study was carried out on 80 patients consisting of 40 patients with dyspepsia and 40 consecutive control subjects without renal disease and dyspepsic symptoms. Mean age of patients were 56 ± 14 and 47 ± 15 respectively. This study showed no significant difference of H. pylori infection between the two groups. Tissue examination of gastric antrum showed higher localization of H. pylori in HD patients in contrast to controls. This finding has not been reported before and needs further confirmation and evaluation for its significance.
  2,767 524 3
Lipid profile in post renal transplant patients treated with cyclosporine in Sudan
Bahga Suleiman, Mohamed El Imam, Mohamed Elsabigh, Khalid Eltahir, Ahmed Eltahir, Elhadi Miskeen
March-April 2009, 20(2):312-317
Lipid profile abnormality places kidney graft recipients at an increase risk for cardiovascular diseases.This study was undertaken to determine the impact of cyclosporine A (CsA) on lipid profile of transplant patients in Gezira Hospital for Renal Diseases, Medani, Sudan. We studied 78 renal transplant patients with mean age of 42.1 years and mean transplant duration of 3.8 years. Cyclosporine A (CsA), total cholesterol (Tch), triglyceride (TG), HDL cho­lesterol (HDLch), LDL cholesterol (LDLch), and VLDL cholesterol (VLDLch) were estimated. 62.8% of the patients showed significant lipoprotein abnormalities. Renal allograft recipients showed significantly high levels of TG (p< 0.002), Tch (p< 0.00), LDLch (p< 0.01), and VLDLch (p< 0.05) compared with age and sex matched normal subjects. Increased CsA was reported in females and hypertensive patients. A significant negative correlation was noted between post­transplant duration and VLDLch. The study confirms the existence of dyslipidemia in renal trans­plant patients in our patients.
  2,658 463 -
Serum cystatin C: A surrogate marker for the characteristics of peritoneal membrane in dialysis patients
Jamal S Al-Wakeel, Durdana Hammad, Nawaz Ali Memon, Nauman Tarif, Iqbal Shah, Abdulrauf Chaudhary
March-April 2009, 20(2):227-231
To evaluate whether cystatin C levels can be a surrogate marker of creatinine clearance and reflect the characteristics of peritoneal membrane in dialysis patients, we performed peritoneal equilibration tests (PET) in 18 anuric adult chronic peritoneal dialysis (PD) patients with a mean age of 39.7 ± 20 years. All the samples were analyzed for urea, creatinine, and cystatin C. Peritoneal transport, mass transfer, and peritoneal clearance of cystatin C were calculated. Correlation and regression analysis was done using cystatin C as a dependent variable and age, sex, height, weight, body surface area, and creatinine as independent variables. Cystatin C demonstrated a significant time dependent increase of dialysate concentration and decline in the serum concentrations during PET, and a strong correlation between serum creatinine and serum cystatin C concentrations(r: 0.62, p= 0.008). The trans-peritoneal clearance (mL/min/1.73 m 2 ) of cystatin C was related to its serum concentration and was similar to creatinine in its pattern but of smaller magnitude. Peritoneal mass transfer (mg/4 hr per 1.73 m 2 ) for cystatin C serum creatinine was 1.68 ± 0.67 and 73.3 ± 29.8, respectively. The dialysis/plasma D/P cystatin C concentration was > 0.1 at 4 hrs of PET denoted high peritoneal transport, while the values of < 0.1 denoted low transport type. We conclude that cystatin C follows the same pattern of peritoneal exchange as creatinine but the magnitude of transfer is many folds lower than creatinine. At present clinical utility of cystatin C in the evaluation of solute clearance is probably limited due to the minute amounts transferred across the membrane and the high renal clearance in the presence of residual renal function.
  2,498 501 1
Assessment of inflammatory factors and cardiac troponin T in hemodialysis patients
Kianoosh Falaknazi, Nazila Bagheri, Omolbanin Taziki
March-April 2009, 20(2):219-222
Hemodialysis (HD) patients suffer from chronic inflammations which make them at increased risk of cardiovascular diseases. The purpose of this study was to see if there is a significant association between inflammatory factors such as ferritin and C-reactive protein (CRP) as well as troponin T in patients on HD. We assessed these serum factors as well as other known cardiac risk factors in 53 patients on HD. The serum ferritin and CRP levels were measured by chemiluminescence's immune assay while troponin T levels were measured by electrochemist luminescence immune assay. We found that serum concentrations of CRP and ferritin were not significantly higher in patients on HD with known cardiac risk factors (compared with the control group) (p< 0.05). However, the serum troponin T levels in HD patients with cardiovascular risk factors were significantly higher than the control group. Our study suggests that elevated serum troponin T levels can play an important role as a predictor of cardiovascular disease in HD patients. Also, inflammatory factors such as CRP and ferritin may be influenced by chronic inflammation or nutritional status of these patients.
  2,413 530 1
Renal abscess in a child with sickle cell anemia
Amar M Taksande, KY Vilhekar
March-April 2009, 20(2):282-284
Renal abscess is rare in children and the usual presenting features include fever, lumbar pain, abdominal pain and occasional flank mass. Renal ultrasonography facilitates an early diagnosis and helps in percutaneous drainage. We herewith report on a child with sickle cell anemia who developed a renal abscess.
  2,283 439 -
Patterns of primary glomerular diseases among adults in the western region of Saudi Arabia
Sawsan M Jalalah
March-April 2009, 20(2):295-299
The frequency of primary glomerular diseases is variable from one part of the world to the other. Data published from Saudi Arabia has shown wide range of variation in the different regions of the country. This study reports the frequency of primary glomerulonephritis (GN) in adults in the Western region of Saudi Arabia. The study is based on retrospective evalua­tion of archived renal biopsy in the period of 18 years (1989-2007). The 296 selected cases of primary GN were studied by light, immunofluorescence, and electron microscopy. The patients age range between 17-76 years. Results show that the most frequent primary GN is membranous GN (MGN) constituting 25.7%, followed by focal segmental glomerulosclerosis (FSGSC) at 21.3%. Less frequent GN are immunoglobulins A nephropathy (IgAN) representing 17.6%, membrano­proliferative GN (MPGN) 11.5%, immunoglobulin M nephropathy (IgMN) 7.8%, minimal change disease (MCD) 5.4% and mesangioprolifertive GN (MesPGN) 4.7%. Other GN which are rarely encountered in this study are fibrillary GN (FGN) (3%), postinfectious GN (PIGN) (2%), Alport syndrome (AS) (0.7%) and membranoproliferative GN type II or dense deposit disease (DDD) (0.3%). In conclusion this study demonstrates that MGN is the most common primary GN encountered in the studied cases, the second more frequent is FSGSC. This result is in contrast to previous reports from Saudi Arabia where MGN is reported with low frequency and FSGSC is reported the most common primary GN.
  2,152 464 4
Nicotinamide as a potential novel addition to the anti-uremic pruritus weaponry
Mohammad R Namazi, Mohammad K Fallahzadeh, Jamshid Roozbeh
March-April 2009, 20(2):291-292
  2,024 479 2
Concurrent Kaposi's sarcoma, tuberculosis, and allograft dysfunction in a renal transplant patient
Fuad Alshaebi, Bappa Adamu, Waleed Alghareeb
March-April 2009, 20(2):270-273
The major long-term complications of renal transplantation (RT) include cardio­vascular disease, opportunistic infections, malignancies, and chronic allograft nephropathy. Long­term complications are generally considered as those occurring more than 1 year post trans­plantation; however, some of the complications can occur earlier. We present a 58-year-old man who presented with multiple complications of RT concurrently and relatively early post trans­plantation including Kaposi's sarcoma, tuberculosis and allograft dysfunction.
  2,012 376 1
Protective effect of pentoxifylline in the kidney perfusion fluid on the transplanted kidney
Alireza Hamidian Jahromi, Nicos Kessaris, Maryam Sharifian, Jamshid Roozbeh
March-April 2009, 20(2):290-291
  1,790 314 4
Successful removal of a foreign body from the urethra
Salim Jaber
March-April 2009, 20(2):293-294
  1,628 324 -
Late de novo minimal change disease in a renal allograft
Krishan K Madhan, Cynric R.E Temple-Camp
March-April 2009, 20(2):266-269
Among the causes of the nephrotic syndrome in renal allografts, minimal change disease is a rarity with only few cases described in the medical literature. Most cases described have occurred early in the post-transplant course. There is no established treatment for the condition but prognosis is favorable. We describe a case of minimal change disease that developed 8 years after a successful transplantation of a renal allograft in a middle-aged woman. The nephrotic syndrome was accompanied by deterioration of allograft function. Treatment with mycophenolate mofetil was successful in inducing remission and stabilizing allograft function.
  1,496 287 2
Time loss and quality of dialysis treatment
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