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Saudi Journal of Kidney Diseases and Transplantation
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   2010| March-April  | Volume 21 | Issue 2  
    Online since March 9, 2010

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Sleep disorders in hemodialysis patients
Alaa A Sabry, Hamdy Abo-Zenah, Ehab Wafa, Khaled Mahmoud, Khaled El-Dahshan, Ahmed Hassan, Tarek Medhat Abbas, Abd El-Baset M Saleh, Kamal Okasha
March-April 2010, 21(2):300-305
The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 ± 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura Uni­versity, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness (EDS), narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific ques­tions of Hatoum's sleep questionnaire. The prevalence of sleep disorders was 79.5% in our pa­tients, and the most common sleep abnormality was insomnia (65.9%), followed by RLS (42%), OSAS (31.8%), snoring (27.3%), EDS (27.3%), narcolepsy (15.9%), and sleep walking (3.4%). Insomnia correlated with anemia (r=0.31, P= 0.003), anxiety (r=0.279, P= 0.042), depression (r=0.298, P= 0.24) and RLS (r=0.327, P= 0.002). Also, RLS correlated with hypoalbuminemia (r=0.41, P= < 0.0001), anemia (r=0.301 and P= 0.046), hyperphosphatemia (r=0.343 and P= 0.001). EDS correlated with OSAS (r=0.5, P= < 0.0001), snoring (r=0.341, P= 0.001), and social worry (r=0.27, P= 0.011). Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomno­graphy, is necessary to confirm our results. Interventional studies for management of sleep disor­ders in HD patients are warranted.
  9,138 1,860 20
Hyperkalemia presenting as wide-complex tachycardia in a dialysis patient
Ankur Gupta, Anil P Bhatt, Ambar Khaira, Dipankar M Bhowmik, Suresh C Tiwari
March-April 2010, 21(2):339-341
  9,680 609 -
Urinary tract infection in pregnancy
Abdelaali Bahadi, Driss El Kabbaj, Hicham Elfazazi, Rachid Abbi, Moulay Rachid Hafidi, Moulay Mehdi Hassani, Rahali Moussaoui, Mohammed Elouennass, Mohammed Dehayni, Zouhair Oualim
March-April 2010, 21(2):342-344
  7,829 1,920 -
Paraneoplastic syndromes and the kidney
Pedro Henrique de Oliveira Filgueira, Leonardo Fernandes Vasconcelos, Geraldo Bezerra da Silva, Elizabeth De Francesco Daher
March-April 2010, 21(2):222-231
A paraneoplastic syndrome is defined as a group of symptoms that develop when substances released by some cancer cells disrupt the normal function of the surrounding cells and tissue. Paraneoplastic renal syndromes are diseases that indirectly compromise tubular and glomerular function by electrolyte imbalance, hormone-producing tumors or deposition of antigen-antibody complexes in the glomeruli. In order to describe the most common paraneoplastic syndromes, which may compromise the renal function, an extensive review was performed of papers, including case reports, guidelines, meta-analysis and other scientific publications. Renal function can be affected by many paraneoplactic syndromes: hypercalcemia in malignancies, syndrome of inappropriate sec­retion of antidiuretic hormone, tumor lysis syndrome, renin-producing tumors and paraneoplastic glomerulopathies. An early diagnosis and effective treatment might improve quality of life and alter prognosis of these patients.
  7,776 1,837 2
Hematological profile of chronic kidney disease (CKD) patients in Iran, in pre-dialysis stages and after initiation of hemodialysis
Reza Afshar, Suzan Sanavi, Javad Salimi, Mahnaz Ahmadzadeh
March-April 2010, 21(2):368-371
Anemia is a common sequealae of chronic kidney disease (CKD), associated with significant morbidity. A cross-sectional study was conducted on 100 CKD patients (54 hemodia­lyzed, 46 pre-dialyzed). Data including, complete blood count, BUN, creatinine, creatinine clea­rance, underlying diseases and hemodialysis duration were collected by a questionnaire. The most frequent morphologic features were normochromic-normocytic (80%), hypochromic-microcytic (15%) and macrocytic (5%). The frequency of anemia in hemodialyzed and pre-dialyzed patients (with mean Hgb level of 10.27 and 11.11 g/dL) were 85% and 75%. Hemoglobin concentration was positively correlated to calculated creatinine clearance (P < 0.001). The severity of anemia among hemodialyzed patients was mild (Hgb > 10 g/dL) in 5%, moderate in 70% and severe (Hgb < 7 g/dL) in 25%, while in pre-dialyzed was mild in 45% and moderate in 55%. There was no correlation between the anemia and CKD causes or hemodialysis duration. In conclusion, data shows that anemia in our patients with CKD is a predominant manifestation, with high frequency but of moderate degree. The most likely cause is inadequate erythropoietin production.
  8,193 1,311 3
Prostate specific antigen levels in pre-dialysis chronic kidney disease patients
Shahid Hussain, Ghulam Abbas
March-April 2010, 21(2):354-356
  7,984 411 -
Urinary infection before and after prostatectomy
Gholamreza Pourmand, Amir Reza Abedi, Ali Akbar Karami, Patricia Khashayar, Abdul Rasoul Mehrsai
March-April 2010, 21(2):290-294
To determine the prevalence of pre and post prostatectomy related urinary tract in­fection and its correlation with peri-operative events, we studied 120 patients who underwent pros­tatectomy due to benign prostatic hypertrophy from September 2005 to September 2006. Urine cultures were performed before the operations, after a week, and three months later. Data including prostate volume, prostatic specific antigen (PSA), post voiding residue (PVR) and histopathological reports as well as the duration of urinary leak, bladder irrigation, hospitalization, and catheterization were studied. The mean age of the studied patients was 70.5 ± 8 years. Significant preoperative bac­teriuria was revealed in 18 (15%) patients of whom 14(77%) patients developed negative cultures following the operation. Postoperative bacteriuria was detected in 9(7.5%) patients who negative urine cultures preoperatively. Pre and post operative micro-organisms were different in the majority of the cases. The mean PSA was higher in patients with a positive history of infection. Following prostatectomy, patients with positive urine cultures had significantly longer urinary leakage, cathe­terization, and hospital stays compared with those who remained culture negative. We conclude that the incidence of positive urine culture pri-prostatectomy for BPH can be improved by appropriate antibiotic therapy, and the risk factors for postoperative urinary infection include preoperative infec­tion, prolonged urinary leakage, catheterization, and hospital stay. The elevated PSA may be a risk factor.
  6,790 912 3
Surgical revision of failing or thrombosed native arteriovenous fistulas:A single center experience
Gdoura Moncef
March-April 2010, 21(2):258-261
This study reports our experience at the Chams Clinic, Sfax, Tunisia, with surgical revision of malfunctioning native arteriovenous fistula (AVF). The etiological diagnosis of in­adequate access flow was determined by physical examination and a variety of clinical and phy­siological parameters. Between 1990 and 2006, surgical revisions were performed on 471 patients (mean age 52.8 years, 285 men and 186 women). There was radio-cephalic distal AVF malfunction in 299 patients (63%); the causes of malfunction in these patients included thrombosis in 47 and juxta-anastomotic vein stenosis or occlusion in 248 patients. The initial clinical success rate of all interventions was 98%. Post-intervention primary patency by Kaplan-Meier analysis at one, two, three, four, five and 10 years was 96%, 91%, 88%, 86%, 83% and 63%. Eighty-five patients had involvement of the brachial-cephalic proximal AVF. The post-intervention patency at six months, one, two and three years was 89%, 74%, 61%, 54% in these patients. There were 87 patients with the brachial-basilic upper arm AVF. The post-intervention patency at six months, one, two and three years was 94%, 84%, 64% and 55%. In conclusion, by surgical techniques, which are often simple, excellent results were obtained, and were much better than those obtained with angioplasty.
  6,679 562 1
Early evaluation of renal hemodynamic alterations in type I diabetes mellitus with duplex ultrasound
Aasem Saif, Neveen A Soliman, Alaa Abdel-Hameed
March-April 2010, 21(2):295-299
To evaluate the role of renal duplex ultrasonography in the detection of early alte­ration of renal blood flow in type I diabetic patients, we studied with duplex ultrasound 32 patients with type I diabetes mellitus (19 males, 13 females, age range 8-19 years) and 35 age and sex-matched controls. The resistivity indices (RIs) and pulsatility indices (PIs) of the main renal as well as intra­renal arteries were calculated. Compared with the healthy control subjects, diabetic patients had significantly higher resistivity indices (RIs) in the intrarenal (segmental, arcuate and interlobar) ar­teries (P= 0.001). The study, also revealed a significantly positive correlation between the RIs in the intrarenal arteries in diabetics and the albumin/creatinine ratio (r= 0.54, 0.52 and 0.51 respectively), glycated hemoglobin (r= 0.61, 0.59 and 0.63 respectively), as well as the estimated GFR (e-GFR) (r= 0.53, 0.51 and 0.57 respectively). We conclude that the current study documented early intra­renal hemodynamic alterations in the form of pathologically elevated intrarenal RIs. This denotes the potential usefulness of duplex evaluation of the intrarenal arteries, as a noninvasive procedure, for monitoring type 1 diabetic patients to predict those at risk of diabetic nephropathy.
  5,144 1,602 1
Evaluation of factors causing delayed graft function in live related donor renal transplantation
AK Sharma, SL Tolani, GL Rathi, P Sharma, H Gupta, R Gupta
March-April 2010, 21(2):242-245
To determine the incidence and determinants of delayed graft function due to post­transplant acute tubular necrosis in live related donor renal transplantation. This is a retrospective study of 337 recipients of live related donor renal graft performed between1986 and 2006. Of these recipients, 24 (7.1%) subjects developed delayed graft function with no evidence of acute rejection, cyclosporin toxicity, vascular catastrophe or obstructive cause and had evidence of acute tubular necrosis (ATN Group). These subjects were compared with recipients (n= 313, 92.9%) who had no clinical or biochemical evidence of ATN. Mean age, and gender distribution of recipients was similar in the two groups (ATN group 35.7 ± 8.3, non-ATN group 34.3 ± 7.5, P= 0.43). Gender distribution of the recipients (men 279, 89.1% vs. 21, 87.5%, P= 0.80) as well as donors (women 221, 70.6% vs. 18, 75.0%, P= 0.75) was also similar. In ATN group as compared with non-ATN group the donor age was significantly greater (56.6 ± 8.3 vs. 46.6 ± 11.2 years, P< 0.0001). There was marginal difference in pre-operative systolic BP (154.5 ± 18.3 vs. 147.4 ± 20.2 mm Hg, P= 0.077) and significant difference in diastolic BP (87.8 ± 9.5 vs. 83.4 ± 11.4 mmHg, P= 0.041). Incidence of multiple renal arteries was similar (16.7% vs. 7.3%, P= 0.22). The warm ischemia time was significantly greater in ATN group (33.3 ± 6.2 min) as compared to non-ATN group (30.4 ± 5.7 min, P= 0.042). Duration of hospital stay was more in ATN group (19.9 ± 6.7 vs. 16.8 ± 8.4 days, P= 0.04) but there was no difference in 1 year survival (284 subjects, 90.7% vs. 21 subjects, 87.5%, P= 0.873). This study shows that greater donor age, higher baseline diastolic BP and greater warm ischemia time are major determinants of delayed graft function due to acute tubular necrosis after related donor renal transplantation.
  4,802 853 6
Diabetic kidney disease: Act now or pay later
Robert C Atkins, Paul Zimmet
March-April 2010, 21(2):217-221
  4,117 1,473 1
The role of renal autotransplantation in treatment of nutcracker syndrome
Mehdi Salehipour, Alireza Rasekhi, Mehdi Shirazi, Abdolreza Haghpanah, Shahrokh Jahanbini, Seyed Ali Eslahi
March-April 2010, 21(2):237-241
To report our experience with renal autotransplantation in treatment of gross hema­turia caused by nutcracker Syndrome (NCS). Between September 2005 and January 2008, four pa­tients of mean age 25.5 years (range: 23-28) with gross hematuria were diagnosed to have NCS. Investigations revealed isolated hematuria on urinalysis, a bloody efflux from left ureteral orifice by urethrocystoscopy, dilatation of left renal vein (LRV) with significant difference in peak sys­tolic velocity in Colour Doppler UltraSonography (CDUS) and dilatation and compression of LRV between aorta and superior mesenteric artery in MRA. After operation, hematuria dis­appeared in all patients. No vascular or urological complication was seen. Follow up ranged from 4 to 24 months. In conclusion, autotransplatation of left kidney is very effective for the treatment of symptomatic NCS.
  4,222 633 2
Giant renal angiomyolipomas and pulmonary lymphangiomyomatosis
Kiran Nasir, Aasim Ahmad
March-April 2010, 21(2):314-319
Renal Angiomyolipomas (AML) are benign tumors, which can acquire huge size and when bilateral, they are diagnostic of tuberous sclerosis (TS). Pulmonary Lymphangiomyo­matosis (LAM) is more common in female patients with TS and mostly diagnosed in patients with renal AMLs. We report a case of giant bilateral AMLs and pulmonary LAM in a 48-year-old female patient, who required nephrectomy for life-threatening hemorrhage.
  4,211 598 3
Membranous glomerulopathy associated with idiopathic hypereosinophilic syndrome
Makram Frigui, Mohamed Ben Hmida, Moez Jallouli, Manel Kechaou, Faten Frikha, Zouhir Bahloul
March-April 2010, 21(2):320-322
Renal involvement is rarely reported and little is known about the renal morpho­logic changes in the idiopathic hypereosinophilic syndromes. We reported a case of a 52-year-old man with idiopathic hypereosinophilic syndrome associated with membranous glomerulopathy. The eosinophilia and the proteinuria greatly improved with corticosteroid treatment. We review the literature regarding the nephropathy of this hematologic disorder.
  3,866 816 4
Remnant kidney function and size in living unrelated kidney donors after nephrectomy
Abolfazl Bohlouli, Mohammad Kazem Tarzamni, Afshar Zomorodi, Sedigeh Abdollahifard, Bahram Hashemi, Nariman Nezami
March-April 2010, 21(2):246-250
There are few published reports examining the extended outcome of donors after nephrectomy. The aim of present prospective study was to evaluate the changes of glomerular fil­tration rate (GFR) and ultrasonographic kidney size in unrelated living kidney donors during post­nephrectomy period. Thirty nine unrelated living kidney donors were prospectively followed after nephrectomy. Length, anterioposterior (AP) diameter, and cortical thickness of the kidney were determined before, one week and three months after nephrectomy. GFR and serum creatinine (Cr) level were assessed simultaneously. The mean age of participants was 25.41 ± 2.67 years with the male to female ratio of 29 to 10. Although GFR decreased 1 week after nephrectomy (P= 0.001), considering the pre-nephrectomy GFR as a result of both kidneys' function and half of its value as a marker of the remnant kidney's function [(123.68 ± 17.99)/2], the calculated GFR for the remnant kidney increased about 63% after one week and 91%, after three months of nephrectomy (P= 0.003). Remnant kidney length, AP diameter, and cortical thickness were significantly in­creased during post-nephrectomy follow up (P< 0.001, P< 0.001, and P= 0.001, respectively). Results of present study showed that the GFR of remnant kidney was increased after nephrectomy, and serum Cr level was not changed, despite the mild increase at first post nephrectomy week. Also, remnant kidney size increased following nephrectomy in donors.
  4,093 466 1
Frequency of occurrence of vesico-ureteral reflux in kidney transplanted patients with the new technique of uretero-neo­ cystostomy (Barry-Taguchi)
Mohammad-Reza Mohammadi Fallah, Ali Taghizade Afshari, Keivan Estifayi, Ali Ghafari, Nariman Sepehrvand, Sanaz Hatami
March-April 2010, 21(2):232-236
There are several ways of performing vesico-ureteral anastomosis in kidney trans­plantation (Tx); they are broadly classified into two categories: extra-vesical and intra-vesical. Extra-vesical methods are preferred in kidney transplantation. In this study, we attempt to integ­rate two extra-vesical techniques of Barry and Taguchi and to evaluate the frequency of occu­rrence of vesico-ureteral reflux (VUR) with this technique. Also, an attempt is made to compare the results with other techniques reported in the literature. Fifty consecutive transplant recipients, who underwent uretero-neo-cystostomy (uretero-vesical anastomosis) by the new technique of Barry-Taguchi were evaluated for VUR by sonography and cystoureterography, six months after Tx. The mean age of the study subjects was 34.8 years; there were 33 males and 17 females. The mean time between Tx and evaluating for VUR was 6.6 months. Two cases of asymptomatic VUR (4%) were detected at the end of the study period. The occurrence of 4% asymptomatic VUR suggests that this technique is more acceptable compared to others. Because of the simple nature of the procedure as well as the short time required, this technique could be a suitable choice in kidney transplantation.
  3,612 882 -
Clinical significance of N-Terminal Pro-B-type natriuretic peptide (NT-proBNP) in hemodialysis patients
Imed Helal, Raja Belhadj, Amira Mohseni, Lilia Bazdeh, Habiba Drissa, Fethi ELyounsi, Taieb Ben Abdallah, Jaouida Abdelmoula, Adel Kheder
March-April 2010, 21(2):262-268
Circulating biomarkers play a major role in the early detection of cardiovascular di­sease. The purpose of this study was to determine levels of N-Terminal Pro-B-type Natriuretic Pep­tide (NT-proBNP) in hemodialysis (HD) patients and to examine the relationship of this marker to left ventricular hypertrophy and to cardiac dysfunction. Plasma NT-proBNP concentrations were measured in patients undergoing chronic HD, who did not any clinical evidence of heart failure, (n=32; mean age 43.14 ± 12 years; sex-ratio 1.8) as well as healthy volunteers (n=32; mean age 45.84 ± 1.9 years; sex-ratio 1). In addition, the correlation between plasma NT-proBNP concentration and parameters of echocardiography was examined. The plasma NT-proBNP levels in the HD patients were significantly higher (14422.6 ± 13757.8 pg/mL) than those in healthy volunteers (39.21 pg/mL) (P< 10 -3 ). In addition, the area under the receiver operating characteristic curve (ROC) re­vealed that the cut-off level of NT-proBNP was 288 pg/mL. On univariate analysis, the plasma NT­proBNP concentrations, in patients on HD, correlated positively with age (P= 0.004; r=0.5), systolic (P= 0.046; r= 0.36) and diastolic blood pressures (P= 0.037; r= 0.37), residual diuresis (P= 0.09; r= 0.3), the left atrial diameter (LAD) (P= 0.006; r= 0.55), left ventricular mass index (LVMI) (P= 0.01; r= 0.44) and negatively with albumin (P= 0.01; r= -0.44). However, there was no correlation bet­ween plasma levels of NT-proBNP and gender, body mass index (BMI), mean period on dialysis, pulse pressure, dry weight and left ventricular dysfunction. On multivariate analysis, only age (P= 0.014, RR= 2.8) was associated with significantly increased levels of NT-proBNP. Further studies are needed to carefully assess the diagnostic accuracy and prognostic value of NT-proBNP in patients on HD.
  3,647 790 1
Surgical complications in pediatric and adolescent renal transplantation
Rabih El Atat, Amine Derouiche, Sabra Guellouz, Tahar Gargah, Rachid Lakhoua, Mohamed Chebil
March-April 2010, 21(2):251-257
To report the surgical complications among our pediatric and adolescent renal transplants and to compare these results with other reported series in the literature. A total of 50 pediatric and adolescent renal transplants were included in this study. There were 30 boys and 20 girls with a mean age of 13 years (range 6 - 18 years). 70% of patients received their kidneys from living donors. Two patients underwent renal re-transplantation. Among the 52 transplantations, 17 surgical complications were encountered in 15(30%) patients. The incidence of urological and vascular complications was respectively 13.2% and 18.9%. These complications included vesico­ureteral reflux (9.4%), urinary leakage (3.8%), lymphocele (5.8%), peri-renal hematoma (1.9%), renal artery stenosis (3.7%), and thrombosis of the allograft (7.5%). The patients with vesico­ureteral reflux were treated by antibiotic prophylaxis. In four recipients, thrombosis of the allo­graft with subsequent graft loss occurred. The graft survival rate was 90% in 1 year, 77% in 5 years and 40% in 10 years follow-up. The patient survival rate was 94.4% in 1 year and 84% after 8 years follow-up. We conclude that surgical complications can be minimized if basic principles of careful transplant techniques are used. Prompt identification and treatment of any complication are critical for graft and patient survival.
  3,569 814 3
Pulse cyclophospamide in severe lupus nephritis: Southern Indian experience
Uttara Das, KV Dakshina Murty, Neela Prasad, Aruna Prayag
March-April 2010, 21(2):372-378
To evaluate the efficacy and safety of the monthly pulse IV cyclophosphamide (IVC) therapy in patients with severe lupus nephritis, we studied 39 patients of lupus nephritis on IVC therapy between 1998 to 2002. Single monthly cyclophosphamide (0.75-1 g/m²) was infused intravenously with oral prednisolone (0.5 mg/kg per day) and appropriate hydration. Of the 39 pa­tients 25 (86.2%) patients were females and 4 (13.8%) were males. Six (2%) cases had irregular follow-up and 3 patients had expired during the initial cycles and were excluded from the study. The mean age was 25.6 + 6.72 years (range 10-40 years). The mean duration of the disease from the onset to renal biopsy was 24.2 + 18.5 months. The clinical presentations included nephrotic syndrome (34.5%), acute glomerulonephritis (31.0%), Pyrexia of unknown origin (PUO) (10.3%), and rapidly progressive renal failure (6.7%). Renal insufficiency was present in 47.2% cases. Twenty-two (75.9%) patients had diffuse proliferative glomerulonephritis (class IV), 6 (20.7%) focal proliferative glomerulonephritis (class III), and one (3.4%) class Vd. After a mean follow-up of 15.8 months, out of 29 patients, 13 (44.8%) had achieved complete remission, 7 (24.1%) partial remission and 9 (31.0%) cases did not respond to the therapy. Side effects of the therapy included vomiting and nausea (100%) and hair loss during the first few doses of IVC. In addition, one case had dysfunctional uterine bleeding and two patients had avascular necrosis of femoral head. We conclude that our data indicate that IVC in severe lupus nephritis is effective in Indian patients though longer follow-up is required.
  3,442 789 4
Nephrocalcinosis in very low birth weight infants
Fatemeh Nasseri, Afshin Azhir, Shiva Rahmanian, Ramin Iranpour, Atoosa Adibi
March-April 2010, 21(2):284-289
To determine the incidence and risk factors of nephrocalcinosis in preterm infants, we studied in a prospectively 64 preterm infants of birth weight :5 1500 g from February 2006 to November 2007. Data were collected on gestation, birth weight, gender and family history of renal calculi, respiratory support, and use of nephrotoxic drugs. The parameters of mineral meta­bolism were assessed in blood and spot urine samples at the end of 2 nd and 4 th weeks of age. Forty-nine babies completed the study, and nephrocalcinosis was observed in 13 (26.5%) babies and was bilateral in 7 (14.3%) infants. The mean age of diagnosis of nephrocalcinosis was 52.58 days (range 30-123 days). Gestational age, birth weight, and sex were not significantly associated with increased risk of nephrocalcinosis. The mean duration of ventilation was significantly less in babies with than without nephrocalcinosis (P= 0.020), and the mean levels of urine calcium and phosphate at 4 weeks of age, respectively (P= 0.013, P= 0.048). There were also significant diffe­rences in urine calcium/creatinine ratio (P= 0.001), mean plasma levels of calcium at 2 weeks of age (P= 0.047) and plasma levels of phosphate at 4 weeks of age (P= 0.016) between babies with and without nephrocalcinosis. Using logistic regression analysis, family history of renal stone (P= 0.002) and urine calcium/creatinine ratio (P= 0.011) were significant predictors of nephrocalci­nosis. However, there were no significant differences in the length of stay in the intensive care unit, duration of total parenteral nutrition, and duration and cumulative doses of nephrotoxic drugs between these two groups. We conclude that the incidence of nephrocalcinosis was similar in our population to the previous studies. Family history of renal stone and urine calcium/ creatinine ratio are the major risk factors of nephrocalcinosis in very low birth weight neonates.
  3,290 901 1
Kidney transplantation in Erbil, Iraq: A single-center experience
Pishtewan H Al-Bazzaz
March-April 2010, 21(2):359-362
Kidney transplantation is associated with improved quality of life and better survival among patients with end-stage renal disease. The aim of this study is to assess the experience of kidney transplant program in a single center in Erbil, Iraq. The records of 83 pairs, donors and reci­pients, treated with kidney transplantation at the Zheen Hospital in Erbil, over a two-year period were collected and analyzed. The mean donor age was 28.5 ± 7.34 years (range 19-49 years) and re­cipient age was 37.6 ± 14.9 years (range 12-66 years). The male to female ratio was 6.5:1 among donors and 3.2:1 among recipients. Among the 83 pairs studied, the donors and recipients were genetically related in seven cases (8.5%) and emotionally related in one case (1.2%). Delayed graft function was seen in 3.2% of cases and acute rejection in 5.3% of cases. Graft survival at six months was 88% while patient survival at the same period was 90%. In conclusion, even though experience related to kidney transplantation in Erbil is limited, the reported results are encouraging for a promising future.
  3,388 735 1
Dilated cardiomyopathy in a patient with antibody-negative Goodpasture's syndrome and pulmonary relapse
Yalcin Solak, Nedim Yilmaz Selcuk, Ilker Polat, Huseyin Atalay, Kultigin Turkmen
March-April 2010, 21(2):332-336
The Goodpasture's syndrome, also konwn as anti-GBM disease, is an uncommon disease, responsible for 20% of all cases of rapidly progressive glomerulonephritis. Anti-GBM antibodies are directed against non-collagenous domain (NC-1) of the alpha-3 chain of type IV collagen. When conventional ELISA assays are used, these antibodies can be detected in almost all the patients. Nevertheless, some reports have described antibody-negative relapsing disease. Some aggravating factors, namely, smoking, pulmonary infection and hypervolemia, may expose embedded antigenic target and may be responsible for the relapse. In addition, these antibody­negative relapses also respond to standard treatment, which comprises of plasma exchange, pulse steroids and cyclophosphamide. Herein, we report a patient who presented at the Selcuk Univer­sity Meram School of Medicine, Meram, Konya, Turkey, with the pulmonary-renal syndrome. He was also found to have idiopathic dilated cardiomyopathy (DCM). To our knowledge, this is the first report describing co-existence of DCM and anti-GBM disease. There is growing evidence showing strong relation of both DCM and anti-GBM disease with HLA. Although not proven, this might have occurred in our patient. In our opinion, volume overload was facilitated by anuria and DCM and led to an antibody-negative pulmonary relapse. The relapse was treated just as the first episode and the patient improved satisfactorily.
  3,566 533 1
Xanthine urolithiasis
Tahar Gargah, Afif Essid, Aymen Labassi, Mourad Hamzaoui, Mohamed Rachid Lakhoua
March-April 2010, 21(2):328-331
Hereditary xanthinuria type I, a defect of purine matabolism, results from a genetic deficiency of xanthine oxidase. It is an uncommon cause of stone formation in children. We report here two children with xanthine urolithiasis. The first patient was an 8-year-old boy who presented with repeated episodes of hematuria evaluated with excretory urography, which demonstrated radio­lucent pelvic stone in the right kidney, causing hydronephrosis. He had pyelolithotomy, and the extracted stone consisted of pure xanthine. Family study revealed an asymptomatic xanthinuria in younger brother. The second patient was a 5-year-old boy who had a 2-week history of abdominal pain and gross hematuria. Conventional excretory intravenous urography showed a non-functioning right kidney. Nephrectomy was performed, and histology revealed end-stage pyelonephritis. The calculi consisted of pure xanthine. In both patients, plasma and urinary concentrations of uric acid were low but xanthine and hypoxanthine concentrations were markedly elevated. Xanthine uroli­thiasis is usually a benign condition, easy to prevent or cure by appropriate alkalinization, forced hydration and restriction of dietary purines. However asymptomatic, and therefore undiagnosed, stones may invade the kidney and urinary tract, resulting in destruction of parenchyma, nephrec­tomy and renal failure.
  3,245 779 2
IgA nephropathy: A clinicopathologic study from two centers in Saudi Arabia
Azhar Qayyum Khawajah, Jaudah Al-Maghrabi, Hassan D Kanaan, Saeed Al-Ghamdi
March-April 2010, 21(2):269-275
A total of 42 patients, who were diagnosed to have primary Immunoglobulin A neph­ropathy (IgAN) at the King Abdul Aziz University Hospital and King Faisal Hospital, Jeddah over the last seven years, were studied. The objective was to analyze their clinical and pathological fea­tures and to classify them according to Hass Classification by using light, immunofluorescence and electron microscopy. Majority of the study cases were males in the second, third and fourth decades of life. Hematuria was the most common clinical complaint followed by proteinuria. There were varying degrees of mesangial proliferation. Majority of the cases presented with class-2 followed by class-3. Immunofluorescence demonstrated diffuse granular deposition of IgA in the glomerular mesangium in majority of the cases. Ultrastructural analysis showed electron dense deposits within the matrix of the mesangium and paramesangium in majority of the cases. Sub-endothelial deposits and mesangial interposition were demonstrated in few cases. Extensive effacement with fusion of the visceral epithelial foot processes was detected in only few patients while focal effacement was demonstrated in many cases. Irregularities of the glomerular basement membrane were seen in some cases. We conclude that IgA nephropathy is an immune-complex glomerular disease, which occurs at all ages and with higher frequency in males and presents mostly with hematuria and proteinuria. Public health awareness is seriously needed to perform the investigations at an early stage.
  3,347 602 -
The role of theophylline in prevention of radiocontrast media-induced nephropathy
Mahmoud Malhis, Sami Al-Bitar, Khair Al-Deen Zaiat
March-April 2010, 21(2):276-283
Contrast media induced nephropathy (CIN) results in significant morbidity and mortality. We therefore investigated whether theophylline (adenosine antagonist) reduces the inci­dence of contrast media induced nephropathy. Two hundred and eighty patients were randomly assigned to prophylactic administration of hydration with sodium bicarbonate plus theophylline (either orally or intravenously) (n=128) or hydration with sodium bicarbonate only (n=152). Blood Urea, creatinine, and glomerular filtration rate (MDRD) were measured before and after administration of contrast media. Both groups were similar in clinical characteristics and amount of contrast used. Theophylline prophylaxis significantly reduced the incidence of CIN (1.6% vs 7.9%; P= 0.015). Compared to low-risk patients, Theophylline prophylaxis significantly reduced the incidence of CIN in moderate and high-risk patients (0% vs 8.8%; P= 0.022 and 9.1% vs 42.1%; P= 0.014 respectively). In conclusion, prophylactic administration of theophylline re­duces the incidence of CIN in moderate and high-risk patients for CIN.
  3,052 890 3
Survey the seroprevalence of CMV among hemodialysis patients in Urmia, Iran
Nariman Sepehrvand, Zakieh Rostamzadeh Khameneh, Hamid-Reza Farrokh Eslamloo
March-April 2010, 21(2):363-367
Cytomegalovirus (CMV) causes infection in immunocompromised, transplant reci­pients and those who received blood transfusion frequently. Risk factors for primary CMV infec­tion are blood transfusion (including clotting factors, etc), recipients of infected transplants, hemo­dialysis and the frequency of dialysis in a week. This study aimed at determining the prevalence of cytomegalovirus (CMV) antibodies in end-stage renal disease (ESRD) patients who undergo hemodialysis. A cross-sectional study of hemodialysis patients in Urmia, Iran was undertaken in 2007. Sera of 84 Hemodialysis patients were investigated for CMV-specific immunoglobulin G (IgG). Forty-four (52%) patients were males. 65 patients (77.4%) were anti-CMV IgG positive and 6 (7.1%) were anti-CMV IgM positive. There was no relationship between the antibody titer and dialysis duration, or frequency of HD in a week. In conclusion, we recommend that every patient who has undergone hemodialysis receive blood products free of CMV if CMV negative to reduce the incidence and prevalence of CMV among HD patients.
  3,362 563 1
Unusual causes of obstruction to transplant ureter
Subodh R Shivde, Jaydeep Date, Tushar A Dighe, Pankaj M Joshi
March-April 2010, 21(2):310-313
Surgical complications remain a significant clinical problem following renal trans­plantation. Ureteral obstruction following transplantation is not uncommon. Persistent obstruc­tion of the ureterovesical anastomosis is the most common urologic complication. Obstruction occurring beyond the first post operative month remains frequent (2-7.5%) and mostly related to ureteral stenosis. We report here a case of Ureteral stenosis due to an unusual cause and review the literature.
  3,310 559 2
Catastrophic calciphylaxis in a patient with lupus nephritis and recent onset of end-stage renal disease
Fatma I Al Beladi
March-April 2010, 21(2):323-327
Painful violaceous skin lesions that progress to non-healing ulceration and gangrene characterize calciphylaxis. These lesions are associated with secondary hyperparathyroidism and generally occur in patients on dialysis for more than one year. Hyperphosphatemia and hypoalbumi­nemia are the major risk factors for calciphylaxis. It is usually resistant to medical treatment al­though parathyroidectomy can help in controlling the disease. The mortality rate of calciphylaxis is very high due to uncontrollable sepsis. In our case, a young female with systemic lupus erythema­tosus (SLE) developed calciphylaxis within a short period after the onset of hemodialysis; she had a short period of hyperphosphatemia prior to dialysis. The serum phosphate was 4.24 mmol/L, cal­cium was 1.66 mmol/L, parathormone was 38 and calcium-phosphate was 7.0 mmol/L. It is likely that SLE provoked the development of calciphylaxis. The patient was treated medically but un­fortunately died secondary to sepsis.
  2,628 609 3
Is the omission of assessing split renal function from living kidney donor's work-up justified?
Nasrulla Abutaleb
March-April 2010, 21(2):350-353
  2,511 324 -
Hepatitis C in hemodialysis patients needs more attention for control and review the risk factors
Seyed-Moayed Alavian
March-April 2010, 21(2):357-358
  2,297 469 4
Simultaneous Hodgkin's disease and kaposi sarcoma in a renal transplant recipient
S Yaich, S Zagdane, K Charfeddine, D Hssairi, J Hachicha
March-April 2010, 21(2):306-309
A 38-year-old women underwent first cadaver kidney transplantation. Her panel re­active antibody was 0%, and she had never previously been transfused nor pregnant. She received induction therapy with antithymoglobulin (ATG) as standard protocol and maintained on immuno­suppressive treatment of cyclosporine A, mycophenolate mofetil (MMF), and prednisone. Nine months after transplantation, she presented with anorexia, asthenia and weight loss. Cutaneous Ka­posi's sarcoma and a Hodgkin disease were diagnosed. MMF was discontinued and cyclosporin A was switched to sirolimus. She also received a poly-chemotherapy associated with 4 courses of rituximab. Twelve months later, the patient had normal graft function and both malignancies were in complete remission.
  2,082 429 5
Carotid body tumor and amyloidosis: An uncommon association
Ankur Gupta, Ambar Khaira, Dipankar Bhowmik, Sanjay Kumar Agarwal, Suresh C Tiwari
March-April 2010, 21(2):337-338
  1,949 357 -
Seeking consent in the country of origin for transplantation from a brain-dead refugee in the host country
Katayoun Najafizadeh, Fariba Ghorbani, Ameneh Rostami, Omid Ghobadi, Esmail Barbati, Shahram Salehi Rad, Shervin Assari
March-April 2010, 21(2):345-347
  1,915 311 1
Evaluation of needle insertion sites in side-to-side elbow arteriovenous fistulas
Majid Moini, Marjan Rasouli, Hamid Reza Nasiri, Kamran Aeenfar
March-April 2010, 21(2):348-349
  1,773 308 -
Author's reply
Mohammed Al-Jamal
March-April 2010, 21(2):358-358
  1,302 210 -
Deceased heart beating donor and organ transplantation in Saudi Arabia

March-April 2010, 21(2):379-383
  1,106 249 1
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