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Saudi Journal of Kidney Diseases and Transplantation
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   2010| January-February  | Volume 21 | Issue 1  
    Online since January 8, 2010

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Organ donation, awareness, attitudes and beliefs among post graduate medical students
Usha Bapat, Prashanth G Kedlaya, Gokulnath
January-February 2010, 21(1):174-180
Organ transplantation is the most preferred treatment modality for patients with end-stage organ disease. There is an inadequate supply of cadaver organs commensurate with need. Health-care professionals are the critical link in augmenting public awareness about organ donation. Their attitudes and beliefs can influence the public opinion. This study aims at understanding the awareness, attitudes, and beliefs among the medical postgraduate students. A total of 123 post-graduates of a medical college hospital in South India participated in the study. A specially de-signed questionnaire was used in assessment. Data were statistically analyzed using SPSS Windows version 10.0. The mean age of the postgraduate students was 28.32 ± 3.5 years, 54% were males, 62% belonged to Christian religion, 69% were single, 77% were from nuclear families, 87% had urban background, and 54% were from upper socio-economic strata. About 97% said they were aware of organ donation through media, 23 unders­tood the concept of "cadaver" as "brain-death" and 93% were able to distinguish between brain-death and persistent vegetative state. Eighty-nine percent wished to donate their organs, 77% did not believe in body disfigurement and 87% did not believe in rebirth without the donated organs, if they pledged their organs. Sixty-nine percent were willing to donate the organs of their family members. Eighty percent were willing to receive organs from family and cadaver, 40% were willing to donate a child's organs, 95% did not believe that organ donation is against their religion, 87% disagreed with the notion that doctors would not impart adequate care if they were pledged organ donors and 79% agreed that doctors would not declare death prematurely, if they had pledged their organs during life. There was a statis­tically significant correlation between attitudes, beliefs and demographics. In conclusion, the concept of brain-death was clearly understood by only a small number of medical postgraduate students. They how­ever, had positive attitudes and beliefs towards organ donation.
  17,782 2,212 6
Knowledge and attitudes toward organ donation: a community-based study comparing rural and urban populations
Saad Abdullah Alghanim
January-February 2010, 21(1):23-30
The study was set to determine whether knowledge and attitudes toward organ dona­tion differ according to geographical location. Self-administered questionnaires were employed to collect data such as demographic characteristics, basic knowledge, attitudes and source of information about organ donation from subjects in rural and urban areas. The questionnaires were distributed randomly to 1,000 individuals in both areas during 2008. The data were analyzed in a descriptive fashion. Despite similarities in knowledge and attitudes of respondents in both areas, rural res­pondents were less likely to have information about organ donation, to report willingness to donate organs, and to have knowledge about "brain death" or the "organ donation card" than their counter­parts in urban areas. The study identified that the principle respondents' source of information about organ donation was the television. More than 90% of respondents in rural and urban areas reported that the contribution of health care providers in providing them with knowledge about organ dona­tion and transplantation was "none" or "little". Respondents identified several reasons, which may influence their decisions to donate organs. In conclusion, the deficit in knowledge and attitudes of rural respondents about organ donation may be justified by the lack of information about this signi­ficant issue. Accordingly, health facilities, local mass media and educational institutions should provide intensive educational programs to encourage the public donate organs.
  12,916 2,235 8
Severe renal failure in acute bacterial pyelonephritis: Do not forget corticosteroids
Tarik Houssaini Sqalli, Hakim Hamzaoui, Elsa Guiard, Laure-Helene Noel, Fadi Fakhouri
January-February 2010, 21(1):118-122
Acute renal failure (ARF) is a rare complication of acute pyelonephritis in adult immunocompetent patients. Recovery of renal function usually occurs if antibiotics are promptly initiated. However, long-term consequences of renal scarring due to acute pyelonephritis are probably underestimated, and some patients present with prolonged renal failure despite adequate antibiotic therapy. We report two cases of severe ARF complicating bacterial pyelonephritis successfully treated with corticosteroids in association with conventional antibiotics.
  11,141 956 -
Implementing strategies for hepatitis B vaccination
Seyed Moayed Alavian, Farahnaz Fallahian, Kamran Bagheri Lankarani
January-February 2010, 21(1):10-22
This study reviewed the effects of hepatitis B virus (HBV) vaccination programs on disease control and the need, if any, to introduce additional strategies taking into account the various risk factors of transmission. We performed a search conducted on vaccine administration, hepatitis B risk factors and the impact of HBV vaccination on prevention of disease, using the electronic database MEDLINE (1987 to 2008), EMBASE, OVID, Google (for Local websites and medical journals), Websites of Iranian universities and Iran medex in English and Persian language. We recommend in addition, to routinely practice the Extended Program of Immunization (EPI) schedules for infants as well as implementing HBV vaccination in selected adolescents at risk for HBV infection. Routine screening and immunization is mandatory in the following people: preg­nant women and adults at risk for HBV infection including health-care workers, police, fire fighters, barbers, people with certain risk behaviors such as inmates of correctional facilities, injection­drug users and persons at risk for sexual transmission, as well as patients exposed to blood and blood products and those on chronic hemodialysis. Vaccine providers in areas with high rates of chronic HBV infection should assess infection screening by performing serologic tests in sus­ceptible subjects to identify persons who require counseling and management. Also, additional studies are needed to determine the effectiveness of currently employed immunization strategies.
  6,883 2,135 4
Protocol biopsies for renal transplantation
David Rush
January-February 2010, 21(1):1-9
Protocol biopsies in renal transplantation are those that are procured at predetermined times post renal transplantation, regardless of renal function. These biopsies have been useful to study the natural history of the transplanted kidney as they have detected unexpected - i.e. "subclinical" pathology. The most significant subclinical pathologies that have been detected with protocol biopsies have been acute lesions, such as cellular and antibody mediated rejection, and chronic lesions, such as interstitial fibrosis and tubular atrophy, and transplant glomerulopathy. The potential benefit of early recognition of the above lesions is that their early treatment may result in improved long-term outcomes. Conversely, the identification of normal histology on a protocol biopsy, may inform us about the safety of reduction in overall immunosuppression. Our centre, as well as others, is attempting to develop non-invasive methods of immune monitoring of renal transplant patients. However, we believe that until such methods have been developed and validated, the protocol biopsy will remain an indispensable tool for the complete care of renal transplant patients.
  4,993 2,127 3
Clinical manifestations and etiology of renal stones in children less than 14 years age
Mohsen Akhavan Sepahi, Akram Heidari, Ahmad Shajari
January-February 2010, 21(1):181-184
Urolithiasis is one of the commonest problems in pediatric nephrology. Prevalence of urolithiasis in pediatric patients is increasing. The purpose was to properly diagnose and treat with the special attention to the risk factors. This study is case-series and was performed on 100 pediatric patients for evaluation of clinical manifestation and etiology of renal stone in Qom. Hundred Children, fewer than 14 years old with mean age of 3.32 years, were included (54% male). Etiology of urolithiasis in 5% was unclear. Metabolic disorders found in patients were mainly: Hypocitraturia in 54, hyperoxaluria in 14, hyperuricosuria in 25, cystinuria in 6, hyper­calciuria in 28 and phosphaturia in 8 patients. The main clinical presentation was fever, pain, irri­tability, dysuria and hematuria. Family history of urolithiasis was found in 23% of patients and 54% presented with urinary tract infection (UTI). We conclude that majority of patients were symptomatic and hypocitraturia was the commenest risk factor among others.
  5,550 1,036 10
The long-term results of pediatric patients with primary focal and segmental glomerulosclerosis
Betul Sozeri, Sevgi Mir, Fatma Mutlubas, Sait Sen
January-February 2010, 21(1):87-92
Focal and segmental glomerulosclerosis (FSGS) is a major cause of idiopathic steroid­resistant nephrotic syndrome (SRNS) and end-stage renal disease (ESRD). In this retrospective study, we report on 34 pediatric patients with FSGS who were diagnosed and treated from 1992 to 2006. The mean age at onset was 6.3 ± 4.3 years. All patients had nephrotic-range proteinuria. Micros­copic hematuria was seen in three patients and hypertension was seen in 15 patients at presentation. All patients were treated with steroids (oral and/or methylprednisolone), while 23 patients received cytotoxic therapy in addition. The mean follow-up period was 8.6 ± 3.3 years at the end of which, 59% of patients achieved complete or partial remission, 20.5% continued to have active renal di­sease while 20.5% of the patients developed CKD. Our study suggests that most of the patients with FSGS progress to renal insufficiency. Steroid therapy increases the chances of remission and pre­serves renal function in patients with sporadic primary FSGS.
  5,389 858 7
Cardiovascular risk factors in hemodialysis and peritoneal dialysis patients
Imed Helal, Wided Smaoui, Fethi Ben Hamida, Monder Ouniss, Ezzeddine Aderrahim, Hafedh Hedri, Fethi ELyounsi, Hedi Ben Maiz, Taieb Ben abdallah, Adel Kheder
January-February 2010, 21(1):59-62
Cardiovascular diseases are a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). The aim of our investigation was the evaluation of an extensive cardiovascular profile in hemodialysis (HD) and peritoneal dialysis (PD) patients. We studied 74 patients with ESRD (38 males, 36 females), maintained either on chronic HD (n= 50) or chronic PD (n= 24) and age and sex matched 20 healthy subjects as controls. The lipid profile, homo­cysteine (Hcy) and C reactive protein (CRP) were measured. When compared to a healthy popu­lation, HD patients displayed a marked atherogenic profile, as attested by increased levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C), apolipoprotein A (Apo A), CRP, Hcy and lower concentrations of high-density lipoprotein-cholesterol (HDL-C), Apo B, albumin (ALB). A significant difference was noted concerning the rates of Apo B, HDL­C, TC, ALB and Hcy. Same biological disorders that those found at HD patients were noted in these PD patients. One also noted lower concentration in Apo A. there were a significant diffe­rence with the reference group concerning the rates of albumin, Apo A, HDL-Cl and Hcy. When compared to PD patients, HD patients had significantly decreased concentration of LDL-C. The peculiar metabolic changes observed in the present study confirm the marked tendency of patients with impaired renal function for developing cardiovascular diseases, irrespectively of the type of dialysis. We suggest including uremia-related risk factors in the panel for evaluation of cardio­vascular risk in dialysis patients.
  5,145 1,076 6
Combination of oral activated charcoal plus low protein diet as a new alternative for handling in the old end-stage renal disease patients
CG Musso, H Michelangelo, J Reynaldi, B Martinez, F Vidal, M Quevedo, M Parot, G Waisman, L Algranati
January-February 2010, 21(1):102-104
Chronic dialysis is a valid therapeutic option in very elderly ESRD patients, even though the decision to dialyze or not has little impact on survival. Additionally, very old patients usually do not agree with starting chronic dialysis. Even though, activated charcoal is a cheap treatment for working as adsorbent for nitrogenous products its utility is very limited. We studied the combination of a low protein diet and oral activated charcoal to reduce serum urea and crea­tinine levels in very old ESRD patients who had refused to start chronic dialysis. Nine lucid, very old > 80 years, ESRD patients who had refused to start dialysis were prescribed a treatment based on a combination of a very low protein diet and oral activated charcoal (30 gram/day). None of the patients had anuria, oliguria, edema, significant metabolic acidosis or hyperkalemia. None of them had significant gastrointestinal symptoms. After one week and ten months of charcoal use signi­ficant decrease in blood urea and creatinine levels was observed and none of them required emer­gency dialysis during this time. In conclusion, in patients more than 80 years of age low protein diet and oral activated charcoal may control the uremic symptoms effectively.
  5,363 821 -
Influence of intralumenal and antibiotic-lock of vancomycin on the rate of catheter removal in the patients with permanent hemodialysis catheters
Ali Akbar Beigi, Sahar Khansoltani, Hassan Masoudpour, Abdol Amir Atapour, Afrooz Eshaghian, Elham Fatemeh Khademi
January-February 2010, 21(1):54-58
Infection of permanent catheters (Permcath) in hemodialysis (HD) patients can lead to catheter removal. The successful use of an antibiotic-lock to treat infection has reported good results in the treatment of catheters' infections. This study was designed to evaluate the impact of the intraluminal vancomycin in comparison with intravenous antibiotic administration. We included 67 (37 males and 30 females) chronic HD patients requiring Permcath insertion at our tertiary care hospital from July 2004 to June 2007. We studied two subgroups: an intervention group, which received 500 mg vancomycin infusion via both lumens of the Permcath and antibiotic lock of 1.5 mL each 48 hours with 1 g i.v. ceftriaxone every 12 hours for 7 days, followed by oral antibiotics according to the culture for three weeks; and a control group, which received 500 mg intravenous vancomycin with daily 100-150 mg amikacin intravenously. Our endpoint was the rate of catheter removal. The patients characteristics including age, sex, time of insertion of the catheter and number of dialysis sessions per week did not differ between both subgroups. Of 28 patients in the intervention group, there was one catheter removal, and of 39 patients in the control group, there were 22 catheter removals, (P< 0.001). We conclude that administration of vancomycin as an antibiotic-lock in permcaths is more effective than its mere intravenous injection, and can increase the life span of catheters.
  4,808 993 2
Response to rituximab in a refractory case of thrombotic thrombocytopenic purpura associated with systemic lupus erythematosus
Faraz Azim Niaz, Aamer Aleem
January-February 2010, 21(1):109-112
Thrombotic thrombocytopenic purpura (TTP) is a serious disorder with a significant morbidity and mortality. Majority of cases of TTP are idiopathic, but some cases may be secon­dary to connective tissue diseases. TTP has been rarely associated with systemic lupus erythe­matosus (SLE) and may be refractory to treatment with plasma exchange, requiring immuno­suppressive therapy. We describe a patient with TTP and SLE who was refractory to plasma exchange and corticosteroids but responded to anti-CD20 antibody rituximab with continued re­mission after eight months of follow-up. Rituximab appears to be an effective treatment in re­fractory cases of TTP associated with SLE.
  4,075 1,224 4
Profile of low molecular weight tinzaparin sodium for anticoagulation during hemodialysis
Khalid A Al-Saran, Alaa Sabry, Moammer Taha, Mamdouh Abdul Ghafour, Fawzan Al Fawzan
January-February 2010, 21(1):43-49
Low-molecular-weight heparin (LMWH) has been suggested as providing safe, effi­cient, convenient, and possibly more cost-effective anticoagulation for hemodialysis (HD) than un­fractionated heparin (UFH) with a single bolus dose at the start of hemodialysis effectively pre­vents clot formation in the dialyzer and bubble trap with fewer side-effects and possible benefits on uremic dyslipidemia. In this study, we compared the safety, clinical efficacy, and cost effectiveness of Tinzaparin sodium (Innohep) with unfractionated heparin (UFH) in 23 chronic HD patients; their extracorporeal anticoagulant protocol-consisted of UFH was switched to Tinzaparin for a period of 6 months. Clinical clotting (grade 1-4) was evaluated by visual inspection after blood draining of the air trap every hour and the dialyzer after each session. Anticoagulation with Tinzaparin sodium re­sulted in less frequent dialyzer and air-trap clotting compared to UFH (P= 001 and 0.04 respec­tively). Over 24 weeks, we observed no alteration in the serum lipid profile of the patients. There was a statistically significant improvement in the dialysis single pool Kt/V after 6 months of Tinza­parin use (1.40 ± 0.28 for Tinzaparin versus 1.23 ± 0.28 for heparin) without any modification in the hemodialysis prescription. The total cost for 24 weeks use of Tinzaparin sodium was 23% more expensive compared to that for UFH. We conclude that a single bolus of Tinzaparin sodium injec­tion at the start of the dialysis session was more effective and convenient in our patients than UFH, but at a higher total cost. Furthermore, at least on the short term, there was no observed benefit on the lipid profile.
  4,179 900 1
Effect of extract of Withania Somnifera on dehydration-induced oxidative stress-related uremia in male rats
Koushik Das, Tanushree Tulsian Samanta, Pradip Samanta, Dilip Kumar Nandi
January-February 2010, 21(1):75-80
Dehydration or water deprivation in the body decreases urinary excretion and allows urea and other protein waste products to accumulate in the blood. The aim of the present study is to evaluate the association of uremia and oxidative stress by applying the herbal plant Withania somnifera (W. somnifera) (Aswagandha). The study was performed on male Wister strain rats in which, dehydration was achieved by water withdrawal. A total of 18 rats were studied and were randomly divided into three Groups: Group-1, control, Group-2, only dehydration and Group-3, dehydration + administration of aqueous root extract of W. somnifera, orally (50 mg/100 gm body weight/day) for 25 days. After 25 days of treatment, it was observed that the body weight of Group-3 animals had increased significantly, while that in Group-2 had decreased significantly. The liver enzymes in both blood and kidneys did not show any significant change in the three groups implying absence of any toxicity of the root extract. In Group-2 animals, the serum urea and creatinine levels increased sig­nificantly when compared with animals in Groups-1 and 3. The low levels of serum urea and crea­tinine in Group-3 animals indicates the protective effect of the plant extract against renal injury caused by dehydration. Dehydration-induced oxidative stress was established in our study by noting the low activities of super-oxide dismutase and catalase, both important antioxidant enzymes, in Group-2 animals; both enzymes were stabilized in animals of Groups-3 and 1. In conclusion, it is hypothesized that there is an antioxidative role of W. somnifera resulting in reducing the extent of renal injury as a result of oxidative stress.
  4,226 705 3
Nephrotic syndrome and Guillan-barre syndrome: A rare association in child
Olfa Bouyahia, Ibtissem Khelifi, Lamia Gharsallah, Kais Harzallah, Sonia Mazigh Mrad, Tahar Ghargah, Samir Boukthir, Sammoud El Gharbi Azza
January-February 2010, 21(1):135-137
Only few cases of nephrotic syndrome associated with Guillain-Barre Syndrome (GBS) have been reported in the adult and pediatric literature. A 3-year-old boy was initially admitted to our hospital following five days of progressive weakness of his extremities, fatigue, right leg pain and numbness. There was no past history of renal or neurological disease. Cerebro­spinal fluid studies showed a protein level of 92 mg/dL and a white cell count of 1 per high-power field. The diagnosis of GBS was verified with a nerve conduction velocity test as well as. The GBS symptoms improved gradually on intravenous immunoglobulin. Three weeks later, he deve­loped severe proteinuria and edema; laboratory investigation showed nephrotic syndrome which responded to steroid therapy. Renal biopsy showed minimal change glomerulonephritis. He re­mained free of proteinuria during his 20 months of follow-up.
  4,060 734 1
Measurement of tumor markers in chronic hemodialysis patients
G Tzitzikos, M Saridi, T Filippopoulou, A Makri, A Goulioti, T Stavropoulos, K Stamatiou
January-February 2010, 21(1):50-53
Tumor markers are widely used for screening certain tumors, however, their use in chronic hemodialysis (HD) patients in hemodialysis has been a controversial issue. To determine the reliability of the tumor markers, CA 15-3, CA 19-9, CA 125, Alpha-Fetoprotein and Carcinoem­bryonic antigen (CEA), in chronic HD patients, and the impact of active hepatitis C on the variation of tumor markers values, we studied 30 patients (16 men and 14 women) aged from 40 to 78 years old (mean age: 54 ± 5 years), on intermittent hemodialysis (with a mean duration of 10.5 years), and clinically free from neoplastic disease. The control group included 30 healthy volunteers. All subjects were of Greek origin and residents of the Korinthos region. The tumor markers were measured once in the control group and before and afterwards the hemodialysis, in the study group. Alpha fetopro­tein was within normal limits in all the study patients, CA 125 was slightly increased in one (3.3%) patient, CA 15-3 levels were twice normal in 4 (13%) patients, CA 19-9 levels were twice normal in 5 (16%) patients, and CEA levels were twice normal in 4(13%) patients. More than half (7/13) of anti HCV positive and all Australian antigen positive patients had abnormal serum levels of CA 15­3 and CA 125 after hemodialysis treatment. We conclude that measurement of some tumor markers such as alfa-fetoprotein may be beneficial in HD patients. However, the elevated levels of other markers including CA 15-3 and CA 125 are not specific for neoplasms and related to active hepatitis C.
  3,911 833 2
The declaration of Istanbul on organ trafficking and transplant tourism

January-February 2010, 21(1):138-147
  1,845 2,797 -
Rapid improvement in renal function in patients with multiple myeloma and renal failure treated with bortezomib
Abdul Qayum, Aamer Aleem, Abdel Rehman Al Diab, Faraz Niaz, Abdel Karim Al Momen
January-February 2010, 21(1):63-68
Multiple Myeloma (MM) frequently presents with renal dysfunction apart from other manifestations. Development of renal failure in patients with MM carries a poor prognosis. Bortezo­mib is a new addition to drugs used in MM and has shown good efficacy and safety profiles. Previous trials have shown its efficacy in relapsed and refractory MM as well. Studies have also shown that bortezomib is also effective in patients with MM who present with renal failure. We report here six cases of renal failure secondary to MM treated with bortezomib. All patients had poor performance status of 3-4 on ECOG scale. Five out of six patients showed satisfactory anti-myeloma response to bortezomib. Reversal of renal failure was observed in all six patients. Adverse effects to bortezomib were mild and manageable. Reversal of renal failure persisted despite incomplete response to MM in two cases, and progression of disease in one patient. It appears that bortezomib may have an effect on the kidneys in reversal of renal failure, other than its anti-myeloma effect. In conclusion, borte­zomib appears to be an effective treatment for patients with advanced MM and renal failure irres­pective of performance status and age.
  3,713 855 7
Survey of attitudes of physicians toward the current evaluation and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD)
Muhammad Ziad Souqiyyeh, Faissal Abdulraheem Shaheen
January-February 2010, 21(1):93-101
We aimed in this study to determine the opinion of the medical directors of dialysis centers in the Kingdom of Saudi Arabia (KSA) about the updates of strategies for evaluation and treatment of chronic kidney disease-mineral and bone Disorder (CKD-MBD). A questionnaire was sent to medical directors of 174 dialysis centers in the KSA between July and November 2009. The questionnaire was opinion based and comprised the prevalence of the CKD-MBD, strategies of therapy and indications of cinacalcet, a new therapy in the CKD patients. A total of 154 medical directors of the 174 (88.5%), who are the therapeutic decision-makers for 10100 (89%) dialysis patients, answered the questionnaire. There were 84 respondents (54%) who believed that the parathormone (PTH) blood levels initially increase at a glomerular filtration rate (GFR) < 30%. There were 80 (53%) respondents who believed that changes of phosphorus (PO4) and cal­cium (Ca) blood levels are initially observed at GFR < 30 mL/min. The majority of respondents, 115 (77%), 116 (80%), 95 (66%), and 134 (90%) currently have observed increased prevalence of vascular calcifications, adynamic bone disease, PTH > 500 pmol/L, and elevated Ca blood levels, respectively, only in the minority of advanced CKD. However, 88 (58%) respondents observed increased prevalence of elevated PO4 blood levels in the majority of new dialysis and advanced CKD patients. There were 137 (89%) respondents who believed from the current published evi­dence that CKD-MBD may result in increased morbidity (e.g. fractures) and mortality (e.g. cardiovascular) in advanced CKD and new dialysis patients. However, only 41 (27%) respondents follow the PTH levels in their patients every 2-3 months, while 81(53%) follow it every 6 months. There were 127 (83%), 129 (84%), 114 (75%) respondents who would start vitamin D (vit D) in dialysis and CKD patients for hypocalcemia, high PTH, and vit D 1,25 deficiency, respectively. However, only 51 (34%) respondents would start vit D therapy for vit D 25 deficiency. There were 98 (75%), 73 (57%) 74 (59%), and 88 (68%) respondents who claimed that they could achieve control of calcium levels alone, control of PO4 levels alone PTH levels alone , and all parameters of CKD-MBD in > 50% of their patients, respectively. There were 126 (82%) and 126 (82%) respondents who agreed to the indications of the cinacalcet that include refractory secondary hyperparathyroidism of dialysis patients to vit D and diet and phosphate binders together, and when surgical parathyroidectomy is contraindicated or fail in this population, res­pectively. However, 127 (83%) and 139 (91%) respondents disagreed to the indications that include indiscriminate prescription to all CKD patients or off label to some early CKD patients, respectively. We conclude that the medical directors of the active dialysis centers in Saudi Arabia are well aware of the morbidity and mortality caused by the CKD-MBD in addition to the indications of vit D and phosphate binders and cinacalcet therapy. However, the study suggests inadequate assessment of the prevalence, patterns of CKD-MBD, and results of intervention in the CKD patients such as treatment of vit D 25 deficiency, and knowledge of the availability of cinacalcet for the treatment of CKD-MBD. More local studies and guidelines are required to disseminate information about the current patterns of CKD-MBD for better approach to the management of this disorder in the kidney centers in this country.
  3,462 1,093 2
Patterns of autosomal dominant polycystic kidney diseases in black Africans
Elhadj Fary Ka, Sidy Mohamed Seck, Abdou Niang, Mouhamadou Moustapha Cisse, Boucar Diouf
January-February 2010, 21(1):81-86
Autosomal dominant polycystic kidney disease (ADPKD) is not well described in black Africans while some data suggesting the disease is exceptional in this race. A retrospective study of patients with ADPKD followed in nephrology department of a teaching hospital in Dakar (January 1, 1995 to December 31, 2005) was therefore undertaken. Prevalence of ADPKD was one in 250. Mean age was 47 ± 5 years with a predominance of male (57%). High blood pressure (HBP) was present in 68% of patients. Other renal manifestations were flank pain, hematuria and proteinuria. Majority of patients had impaired renal function at time of diagnosis. Extra-renal cysts were essentially found in liver (45.5%), pancreas and seminal vesicles. Main complications: ESRD (51%) occurred within a 6 year mean period, urinary tract infection (13%) and cerebral haemorrhage (2%). HBP control, in general needed 2 or more antihypertensive drugs. Fourteen patients died, ten patients had been on haemodialysis and four others died from uremic compli­cations. In conclusion, ADPKD in black African adults is not rare and probably underdiagnosed. Early HBP and ESRD are likely more frequent than in other races. Earlier ultrasound detection and strategies to preserve renal function should be offered to at-risk individuals to improve outcomes.
  3,316 596 2
Microbial spectrum and outcome of peritoneal dialysis related peritonitis in Qatar
Mazin M.T Shigidi, Omar M Fituri, Sajimol K Chandy, Muhammed Asim, Hassan A Al Malki, Awad H Rashed
January-February 2010, 21(1):168-173
Peritoneal dialysis therapy rapidly expanded in Qatar during the last decade. Peritoneal dialysis related peritonitis remains the leading cause of morbidity and technique failure. The objec­tive of this study was to determine the incidence of peritoneal dialysis related peritonitis in Qatar, during a five year study period. The records of all patients on maintenance peritoneal dialysis from January 1, 2003 to December 31, 2007 were reviewed. Episodes of peritonitis, microbial profile, cli­nical course and outcome were analyzed. A total of 241 patients were included, males represented 74%, the mean age was 53 ± 13 years, and 48% of patients were diabetics. During the study period 118 episode of peritonitis were observed, with a mean incidence of 0.24 ± 0.1 episodes per patient year. Gram-positive organisms were isolated in 40% of episodes, with Staphylococcus epidermidis and Staphylococcus hemolyticus being the commonest organisms, isolated in 21% and 9% of infec­tions, respectively. Escherichia coli was the commonest Gram-negative organism and was isolated in 9% of peritonitis episodes, whereas culture-negative peritonitis represented 28% of all diagnosed infections. Seventy nine percent of peritonitis episodes completely resolved with the use of intra­peritoneal antimicrobial therapy. Peritoneal dialysis catheters were removed in 19% of episodes. Peritonitis related mortality rate was 3%, and it was due to Candida spp. and Pseudomonas aerugi­nosa. Despite its low incidence, peritonitis remained the leading cause of patient dropout. Prompt diagnosis and prudent management as well as psychological support to the patients remained essential to reduce the incidence of technique failure following peritonitis episodes.
  3,192 605 2
Enigma of forgotten double J stent
Ashutosh Niranjan, Nivesh Agarwal, Vijay Agarwal, Arati Srivastava
January-February 2010, 21(1):157-159
  3,210 510 -
Behavioural induced severe hypernatremia without neurological manifestations
Hossam A Hassan, Zohair A Al Aseri, Owais M Suriya
January-February 2010, 21(1):113-117
Hypernatremia is a relatively common entity and is more prevalent among the elderly and critically ill. A number of medical conditions are commonly associated with hypernatremia, and these differ substantially among children and adults. Severe hypernatremia is usually associated with central nervous system manifestations and carries a high mortality rate. We report a case of a female patient who presented to the emergency department of the King Khalid University Hospital, Riyadh, Saudi Arabia with severe hypernatremia and without any associated co-morbid conditions or neurological manifestations. We did not find any etiological background despite extensive eva­luation other than under hydration due to decreased fluid intake, which was secondary to beha­vioural causes.
  3,008 426 -
Management of chronic allograft dysfunction by switch over to rapamycin
Varun Sundaram, Georgi Abraham, Nusrath Fathima, Vivek Sundaram, Yogesh N.V Reddy, Milly Mathew, Vijaiaboobbathi Sathiah
January-February 2010, 21(1):37-42
The aim of this study was to evaluate the efficacy of conversion from Calcineurin Inhibitors (CNI)-based to a rapamycin-based immunosuppressive regimen in renal transplant reci­pients who had allograft dysfunction, in a South Indian population. We analyzed the results of 75 (19.5%) of the 398 renal transplants performed over a five-year period from 2002 to 2007, who were converted from a CNI-based immunosuppression to rapamycin including patients with chronic allograft dysfunction, chronic allograft injury and malignancy. The data analyzed included serial rapamycin levels, serum creatinine, eGFR by nankivel formula, lipid profile, hemoglobin and serum potassium levels. Statistical analysis was performed using student's t test and the Kaplan Meir survival curve was used to predict probability of survival among patients on rapamycin. The mean age of the study patients was 39.6 ± 12.2 yrs and there was a male predominance (74.6%). Diabetic nephropathy was the predominant cause (36%) of end-stage renal disease (ESRD). Statistical analysis revealed a significant improvement in GFR of 14.6 mL/min and decrease in potassium by 0.7 mmol/L after initiation of rapamycin. There were no significant differences in terms of lipid profile, platelet count, hemoglobin and urine albumin levels. Rapamycin was discontinued in one patient due to hypokalemic nephropathy and in another patient due to delayed wound healing. To our knowledge, this is the first study to provide information on the conversion from a CNI to rapamycin-based immunosuppression in a cohort of Indian renal transplant recipients. In conclusion, the findings of our study confirm that rapamycin-based immunosuppressive regimen improves renal function and graft survival with mini­mal side effects, in comparison to CNI-based immunosuppression.
  2,832 536 3
Prognostic value of insulin- like growth factor-I receptor expression in renal cell carcinoma
Mehrdad Mohammadi Sichani, Fateme Sarreshtedar Yazdi, Noushin Afshar Moghaddam, Ali Chehrei, Mahmud Kabiri, Amin Naeimi, Diana Taheri
January-February 2010, 21(1):69-74
The Insulin-Like growth factor-I receptor (IGF-IR), a tyrosine-kinas receptor over expressed in many tumor cell lines and in some human tumors, plays a critical role in trans­formation, tumorigenicity and metastasis. The aim of the present study is to investigate the role of IGF-IR expression as a prognostic factor in RCC. This study was conducted in a historical cohort of 82 patients who had RCC treated with radical nephrectomy from 1994 to 2005. Specimens were reevaluated with regard to histological subtype, nuclear grade, stage and IGF-IR expression. The IGF-IR stain was semi- quantitatively evaluated using the Allred score system. Kaplan-Meier analysis demonstrated a significant positive correlation between Fuhrman nuclear grade and IGF­IR Allred score (P< 0.0001). Survival in patients with score IGF-I ≤ 4 was 90.21 month and in patients with score IGF-1R> 4 was 33.39 month (P Value < 0.0001). Cox regression analysis in­dicated that expression of IGF-IR is a prognostic factor in patients with RCC (P Value < 0.0001, odds Ratio = 2.38). In conclusion, a statistically significant correlation was demonstrated between IGF-IR expression and Fuhrman nuclear grading and survival in patients with RCC. In stage-by­stage and grade-by-grade analysis; however, it seems that we cannot consider IGF-IR as an inde­pendent prognostic factor.
  2,736 577 3
Ultrasonographic diagnosis of an unusual vesical hemangioma presenting as hydroureteronephrosis
Rajul Rastogi, Sumeet Bhargava, Inderjeet Singh Sachdeva, Vaibhav Rastogi
January-February 2010, 21(1):131-134
Vesical hemangiomas are rare and benign tumors of mesenchymal origin. They usually present with multiple episodes of hematuria and the diagnosis is usually achieved patho­logically. We present a rare case of vesical hemangioma at vesicoureteric junction that presented with abdominal pain secondary to hydroureteronephrosis and the diagnosis was suspected on ultrasonography and confirmed later by pathology.
  2,870 395 -
Familial vitamin D deficient osteomalacia and renal osteodystrophy: Shaping up the debate
Wael Latif Jabur
January-February 2010, 21(1):128-130
Osteomalacia is a common occurrence world over due to the deficiency in vitamin D and calcium intake. We present here two sisters with features of sever osteomalacia, myopathy and hypophosphatemia hyperparathryroidism and 25(OH)D2, 25(OH)D3and 1,25(OH)D3 levels were very low.
  2,718 474 1
Arteriovenous shunt and its conversion to arteriovenous fistula: A relook
Ankur Gupta, Ambar Khaira, Dipankar M Bhowmik, Suresh C Tiwari
January-February 2010, 21(1):148-149
  2,832 346 -
Visceral leishmaniasis in a renal transplant recipient treated with allopurinol
Kais Harzallah, Raoudha Belhadj, Boutheina Jemli, Mondher Haloues, Naoufel Berraies, Saadia Gargouri, Jalel Hmida, Riadh Battikh, Jamel Manaa
January-February 2010, 21(1):105-108
Leishmaniasis is an infection caused by a protozoan parasite belonging to the genus Leishmania and transmitted by the Phlebotomus sandfly. We report a case of visceral leishmaniasis in a 49-year-old male renal transplant recipient, a resident of the western part of Tunisia, which is an endemic zone for the disease. Just before and after the transplantation, the patient resided in Tunis, which is non-endemic for leishmaniasis. Visceral leishmaniasis occurred eight years after renal transplantation, and the clinical picture was characterized by fever and pancytopenia. Leish­maniae were detected by bone marrow aspiration. Pentavalent antimonal was used for 28 days and was substituted by allopurinol (20 mg/kg per day). One year after the infection, the patient remains totally asymptomatic. Our report suggests that visceral leishmaniasis may complicate the clinical course of organ transplantation and can be fatal, particularly when untreated. Relapses may occur after completion of the apparently effective treatment. Allopurinol could be a solution to avoid these relapses.
  2,570 505 6
Changes in renal cortical and medullary perfusion in a patient with renal vein thrombosis
Jafar Al-Said, Olfat Kamel
January-February 2010, 21(1):123-127
Dynamic renal perfusion computerized tomographic (CT) scan was performed to test the cortical and medullary perfusion in a patient with unilateral renal vein thrombosis secondary to idiopathic focal and segmental glomerulosclerosis (FSGS). Forty mL of Iohexol was injected intra­venously. Multiple fixed repeated axial renal CT scan cuts at specific intervals, over the mid pole, were recorded over 400 seconds. Radio density was measured over the aorta, cortex and medulla during that period. Graphs for the radio contrast density against time were plotted. Aortic, cortical and medullary perfusions were calculated by estimating the slopes of the curves. Based on the CT scan findings, perfusion of different parts of the kidney was measured. The reduction in kidney function with renal vein thrombosis seems to be secondary to hypoperfusion of renal cortex and medulla. Further studies are required to confirm this observation. The blood flow to the kidney im­proved within four days after therapy with anticoagulation and pulse steroids. The sequences of events that take place need further studies for validation.
  2,589 471 -
Jet fuel intoxication and acute renal failure
Abdulkareem Alsuwaida
January-February 2010, 21(1):150-152
  2,622 409 -
Dent's disease and lowe's syndrome: A phenotypic spectrum of one gene
Ankur Gupta, Dipankar M Bhowmik, Ambar Khaira, Bakshish Singh, Suresh C Tiwari
January-February 2010, 21(1):155-156
  2,406 545 -
Prevalence of tuberculosis in hemodialysis patients
Driss El Kabbaj, Abdellali Bahadi, Zouhir Oualim
January-February 2010, 21(1):164-167
  2,280 578 -
Soluble CD30 in renal transplant recipients: Is it a good biomarker to predict rejection?
Negar Azarpira, Mahdokht Hosein Aghdaie, Zahra Malekpour
January-February 2010, 21(1):31-36
It has been suggested that the serum soluble CD30 (sCD30) level may be a poten­tial marker for the prediction of acute allograft rejection in kidney transplant recipients. Therefore, its serum concentrations might offer a promising non-invasive tool to recognize patients with an increased risk for developing an acute graft rejection. We retrospectively correlate pre and post transplant level on post transplant graft survival, incidence of acute rejection and graft function using stored serum samples. Ninety-nine patients were divided in two separate groups: Group A in whom sample collection was done one day before transplantation and Group B where sample collection was done five days after transplantation. Younger recipients (aged less than 20 years) had higher sCD30 levels (P= 0.02). There was neither significant difference in the incidence of acute rejection nor incomplete response rate after anti rejection therapy in relation to pre trans­plant or post transplant sCD30. We could not find a significantly inferior graft survival rate in the high sCD30 group. In conclusion, younger patients had higher sCD30 concentrations however no correlation existed between the serum concentrations and occurrence of rejection episodes or graft survival.
  2,294 525 3
Giant megaureter presenting as cystic abdominal mass
Garge Saurabh, Brijesh K Lahoti, Paliwal Geetika
January-February 2010, 21(1):160-162
  1,925 384 -
Acute tubular necrosis, acute renal failure and unusual histologic stigmata of acute malaria in HIV/AIDS patients from the democratic Republic of Congo
Nestor M Pakasa
January-February 2010, 21(1):153-154
  1,804 432 2
SLE Conundrums
E Nigel Wardle
January-February 2010, 21(1):163-163
  1,764 465 -
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