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Saudi Journal of Kidney Diseases and Transplantation
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   2011| March-April  | Volume 22 | Issue 2  
    Online since March 18, 2011

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Penile gangrene: A devastating and lethal entity
Vishwajeet Singh, Rahul Janak Sinha, SN Sankhwar
March-April 2011, 22(2):359-361
  23,643 689 2
Skin changes in patients with chronic renal failure
Olarenwaju Falodun, Adebola Ogunbiyi, Babatunde Salako, Ade Kunle George
March-April 2011, 22(2):268-272
Management of patients with renal failure remains a major problem in poor­resource nations. Cutaneous manifestations in this group of patients are varied and remain helpful in differentiating acute from chronic renal failure (CRF). We studied the prevalence and pattern of skin disorders in patients with CRF at The University College Hospital, Ibadan, Nigeria, during the period between May 2006 and February 2007. Relevant information was collected with the aid of a questionnaire. The patients were then examined for skin disorders. One hundred and twenty patients who met the inclusion criteria were recruited into the study. The mean age of the CRF patients was 43.12 ± 15.38 years, while that of the control subjects was 43.13 ± 15.38 years. Seventy-six of the 120 patients (63.3%) were on chronic hemodialysis while 44 (36.5%) were on conservative management. A total of 107 patients (89.1%) had at least one skin problem. The skin disorders seen include xerosis in 72 (60%), pruritus in 32 (26.7%), hyper-pigmentation, icthyosis and pityriasis versicolor in nine patients each (7.5%), either singly or in combination. Pallor of the skin was seen in three of the patients (2.5%), while uremic frost was seen in one (0.8%). Nail changes were seen in 48 patients (40%). We conclude that xerosis, pruritus, pigmentary and nail changes were the most common skin disorders in patients with CRF in our environment.
  9,008 1,454 3
Clinical profile of distal renal tubular acidosis
Ratan Jha, J Muthukrishnan, Shekhar Shiradhonkar, Kiran Patro, KVS Harikumar, KD Modi
March-April 2011, 22(2):261-267
To determine the clinical profile and progression of renal dysfunction in distal renal tubular acidosis (dRTA), we retrospectively studied 96 consecutive cases of dRTA diagnosed at our center. Patients with unexplained metabolic bone disease, short stature, hypokalemia, re­current renal stones, chronic obstructive uropathy or any primary autoimmune condition known to cause dRTA were screened. Distal RTA was diagnosed on the basis of systemic metabolic acidosis with urine pH >5.5 and positive urine anion gap. In those patients who had fasting urine pH >5.5 with normal baseline systemic pH and bicarbonate levels (incomplete RTA), acid load test with ammonium chloride was done. A cause of dRTA could be established in 53 (54%) patients. Urological defect in children (22/44) and autoimmune disease in adults (11/52) were the commonest causes. Hypokalemic paralysis, proximal muscle weakness and voiding difficulty were the common modes of presentation. Doubling of serum creatinine during the study period was noted in 13 out of 27 patients who had GFR <60 mL/min at presentation whereas in only one of the 70 with initial GFR >60 mL/min (P <0.005). In conclusion, urological disorders were the commonest cause of dRTA in children while autoimmune disorders were the commonest asso­ciation in adults. Worse baseline renal function, longer duration of disease and greater frequency of nephrolithiasis/nephrocalcinosis and urological disorders were noted in those who had wor­sening of renal dysfunction during the study period.
  8,566 1,720 4
Current indication of plasma exchanges in nephrology: A systematic review
Sidy M Seck, Dussol Bertrand, Diouf Boucar
March-April 2011, 22(2):219-224
Therapeutic plasma exchange (TPE) has been firstly performed with centrifugation devices used in blood banking procedures. Nowadays, TPE is increasingly performed in intensive care units using hemodiafiltration generators that ensure better efficiency and simplicity. However, prescription for the different medical pathologies depends on weak evidence-based recommen­dations, and is often guided by the clinician's own experience. In this review, we briefly recall the rationale of TPE prescription before discussing the evidence level of common indications of TPE in nephrology. Currently, strong evidence-based data for the benefit of TPE is clearly demonstrated in renal diseases such as hemolytic uremic syndrome, anti-glomerular basement membrane vasculitis, and recurrent glomerulonephritis after kidney transplantation and management of humoral renal allograft rejection in high-risk recipients. However, the other indications of TPE, such as renal vasculitis associated with anti-neutrophil cytoplasmic antibodies, mixed cryoglobulinemia, periarte­ritis nodosa, and acute renal failure in myeloma are still controversial. Finally, TPE have been found to be clearly inefficient in lupus nephritis, except for patients with associated thrombotic mic­roangiopathy or catastrophic antiphospholipid antibodies syndrome. More randomized clinical trials are required to precisely place TPE in the management of renal diseases. Meanwhile, the decision to use this burdensome and costly therapy should be individualized according to its proven benefits and potential complications.
  7,006 2,416 2
Superior vena cava syndrome in hemodialysis patient
Azeb Molhem, Alaa Sabry, Hassan Bawadekji, Khalid Al Saran
March-April 2011, 22(2):381-386
Obstruction of blood flow in the superior vena cava (SVC) results in symptoms and signs of SVC syndrome. SVC obstruction can be caused either by invasion or external compression of the SVC by contagious pathologic processes involving the right lung, lymph nodes, and other mediastinal structures, or by thrombosis of blood within the SVC. Occasionally, both mechanisms co-exist. We hereby report a case of a 28-year-old male, Saudi patient who was diagnosed with end­stage renal disease and was maintained on regular hemodiaysis via right jugular vein dual lumen catheter for ten months. Three years later, the patient presented with signs and symptoms suggestive of SVC obstruction that was successfully managed with SVC stenting.
  7,683 704 2
Foreign bodies in urinary bladders
Biswajit Datta, Mriganka Ghosh, Siddhartha Biswas
March-April 2011, 22(2):302-305
We studied the patients admitted in our hospital with intravesical foreign bodies from February 2007 to January 2009 regarding their clinical presentation, nature of the foreign bodies, and methods used to remove them. The patients with intravesical foreign bodies were investigated and underwent cystoscopy for direct visualization of the foreign body and an attempt to remove it through the cystoscope. If cystoscopic removal failed, then suprapubic cystostomy was done to remove it. Nine patients (six males and three females, with a mean age of 24.5 years) with intra­vesical foreign bodies were admitted during the study period. In all the female patients and one male patient, foreign bodies were introduced inside the bladder by the patients themselves. In four cases, the foreign bodies were iatrogenic in nature, and in one case, it migrated accidentally through the urethra. In conclusion, intravesical foreign bodies are not very uncommon. Self-introduced and iatrogenic foreign bodies into the bladder are more common than accidental migration through the urethra. Cystoscopic removal is successful in most of the cases. If cystoscopic removal is not possible, then suprapubic cystostomy is required to accomplish this task.
  7,444 621 3
Prostatic abscess: Diagnosis and management in the modern antibiotic era
Punit Tiwari, Dilip K Pal, Astha Tripathi, Suresh Kumar, Mukesh Vijay, Amit Goel, Pramod Sharma, Arindam Dutta, Anup K Kundu
March-April 2011, 22(2):298-301
This retrospective study was aimed at analyzing the clinical findings and thera­peutic strategies in 24 patients who were admitted with prostatic abscess, during the period from 1999 to 2008. The diagnosis of prostatic abscesses was made clinically by digital rectal palpation based on the presence of positive fluctuation with tenderness. All cases were confirmed by trans­rectal ultrasound (TRUS), and only positive cases were included in this study. The diagnostic work­up included analysis of midstream urine and abscess fluid culture for pathogens. Therapeutic options included endoscopic trans-urethral incision or trans-perineal aspiration under ultrasound guidance, or conservative therapy. Of the 24 patients studied, 45.83% of the cases had a pre-di­posing factor, and diabetes mellitus (37.50%) was the most common. Digital rectal palpation re­vealed fluctuation in 70.83% of the cases. Trans-abdominal ultrasonography missed the condition in 29.16% of the cases. On TRUS, all the study patients showed hypo-echoic zones, while nine others showed internal septations. In most of the cases, the lesion was peripheral. A causative pathogen could be identified in 70.83% of the cases. Surgical drainage of the abscess by trans­urethral deroofing was performed in 17 cases (including one with failed aspiration), trans-perineal aspiration under TRUS guidance was performed in three cases and conservative therapy was followed in five cases. Our data confirms the importance of predisposing factors in the patho­genesis of prostatic abscess. In most of the cases, the clue to diagnosis is obtained by digital rectal palpation. TRUS gives the definite diagnosis and also helps in follow-up of patients. Trans­urethral deroofing is the ideal therapy where the abscess cavity is more than 1 cm, although in some selected cases, TRUS-guided aspiration or conservative therapy does have a role in treatment.
  7,200 856 4
The right sided syndrome, congenital absence of kidney and testis
KVS Hari Kumar, B Srinivas Rao, Shekhar Shiradhonkar, Ratan Jha, Girish Narayan, KD Modi
March-April 2011, 22(2):315-318
Unilateral renal agenesis (URA) is a developmental defect associated with ano­malies of the genitourinary system. The associations vary from absence of testis alone to high anorectal anomalies in other patients. We present two interesting patients with URA, encountered recently. Our first case was diagnosed with URA at the age of 11 years, which was detected on sonography, when he presented with pain abdomen. The presence of an epididymal cyst masked the absence of ipsilateral testes leading to delay in the diagnosis. Our second case was diagnosed with URA during the neonatal period when he presented with anorectal agenesis. He underwent abdomino-anal pull-through operation and later clinical course was complicated by recurrent cystitis, secondary vesicoureteral reflux and hydroureteronephrosis of solitary kidney, progressing to chronic kidney disease.
  7,275 519 -
Prevalence of anemia in type 2 diabetes and role of renal involvement
Shokoufeh Bonakdaran, Mohammad Gharebaghi, Mohammad Vahedian
March-April 2011, 22(2):286-290
Anemia is more common and more severe in diabetics compared to nondiabetic chronic kidney disease patients. This study was undertaken to determine the prevalence of anemia and the contribution of level of nephropathy to anemia in type 2 diabetic patients. A total of 1,962 patients with type 2 diabetes were evaluated for anemia and biochemical profile. 19.6% of the pa­tients had anemia. 38.1% of patients had albuminuria, 8.1% had moderate (creatinine clearance (CrCl) <60 mL/min/1.73 m 2 ) and 31.4% had mild (CrCl = 60-90 mL/min) renal impairment. Dia­betic patients with moderate renal impairment had significantly more anemia than diabetics with mild renal failure (30% vs. 9%, P = 0.000 Albuminuria was also associated with anemia (8.4% vs. 5.7%, P = 0.000). Cardiovascular disease and retinopathy were also more frequent in diabetic patients with anemia (P = 0.01 and 0.001, respectively). In conclusion, anemia is a highly prevalent finding in Iranian type 2 diabetic patients. Any degree of renal impairment and albumi­uria are the greatest risk factors for anemia in these patients.
  5,286 1,255 2
Outcome and complications in peritoneal dialysis patients: A five-year single center experience
Jamal S Alwakeel, Abdulkareem Alsuwaida, Akram Askar, Nawaz Memon, Saira Usama, Mohammed Alghonaim, Niaz A Feraz, Iqbal Hamid Shah, Hamsaveni Wilson
March-April 2011, 22(2):245-251
Peritoneal dialysis (PD) is one of the modes of renal replacement therapy being utilized for the management of end-stage renal failure in King Khalid University Hospital, King Saud Uni­versity, Riyadh, for more than two decades. The aim of this study was to evaluate the complications related to PD as well as its outcome in patients on this mode of therapy during the period between January 2004 and December 2008. There were 72 patients included in the study, of whom 43 were females. The average age was 50.7 ± 30.1 years (14-88 years). Diabetes was the leading cause of end­stage renal disease (ESRD) seen in 40.2% of the study patients. Twenty-eight patients (38.9%) were on continuous ambulatory peritoneal dialysis (CAPD) and 44 (61.1%) were on automated PD (nocturnal intermittent peritoneal dialysis, NIPD or continuous cycler peritoneal dialysis, CCPD). The mean du­ration on PD of the study patients was 25.5 ± 16.58 months (1-60 months). The peritonitis rate was one episode per 24.51 patient-months or one episode per 2.04 patient-years. The incidence of peritonitis per person-year was calculated as 0.42. The leading causative agent for peritonitis was Staphylococcus (32%). Exit-site infection (ESI) rate was one episode per 56.21 patient-months. The incidence of ESI was 0.214 per person-years. The most common infective organism for ESI was Pseudomonas aeru­ginosa (58.8%). At the end of 5 years, 35 patients were continuing on PD, 13 patients were shifted to hemodialysis (HD), nine patients underwent renal transplantation, and six patients were transferred to other centers. Among the 13 patients who were shifted to HD, four patients had refractory peritonitis, four others had catheter malfunction, three patients had inadequate clearance on PD and two patients had lack of compliance. A total of 11 patients died during the study period, giving an overall mortality rate of 15.27% for the five-year period. Our study suggests that there has been considerable improvement in overall outcome and mortality in patients on PD. Additionally, a marked reduction in the infectious and non-infectious complications was noted with the peritonitis and ESI rates in our center being comparable to other studies and international guidelines.
  5,023 1,483 -
Entamoeba histolytica/Entamoeba dispar infection in chronic hemodialysis patients
Sebastiáo Rodrigues Ferreira-Filho, Fabiola Corrêa da Costa Braga, Danilo Martins de Sa, Evandro Batista Nunes, Juliana Santos Parreira Soares, Silvia Mamprim Padovese, Andreia Camara de Oliveira, Gredista Maria Ferreira Oliveira, Gilberto dos Passos, Hélton Pereira Lemes
March-April 2011, 22(2):237-244
To determine the prevalence of Entamoeba histolytica/E. dispar (Eh/Ed) in chronic hemodialysis (HD) patients, we collected 330 samples of feces from 110 patients, and nine indivi­duals were found to be positive for Eh/Ed. We compared the infected patients with a group of 14 uninfected HD patients. Both groups were analyzed for their signs, symptoms and socio-economic characteristics using questionnaires. Blood tests were also performed in both the groups. Although both groups did not differ statistically with respect to their signs, symptoms and socio-economic conditions, there was a trend toward a greater number of individuals with diarrhea in the Eh/Ed infected group. In conclusion, we suggest that a parasitological examination of the patient's stool to detect the Eh/Ed complex should be included with the routine tests so that those patients with a positive fecal test could be initiated on appropriate anti-Eh/Ed therapy.
  5,393 533 1
Gigantic scrotal calcinosis
Hassen Khouni, Nizar Bouchiba, Yasser Amara, Rahma Sbabti, Meher Charfi, Faycel Elkateb, Adnene Chouchene, Maamoun Benchikh, Med Hedi Balti, Habib Bouhaoula
March-April 2011, 22(2):357-358
  5,038 312 -
Association of HLA class II alleles and CTLA-4 polymorphism with type 1 diabetes
Rana J EI Wafai, Hania Nakkash Chmaisse, Rajaa F Makki, Hana Fakhoury
March-April 2011, 22(2):273-281
Type-1 diabetes mellitus (T1DM) is a progressive complex autoimmune disease in which combinations of environmental as well as genetic factors contribute to T-cell mediated destruction of insulin-secreting β-cells of the pancreas. HLA class II alleles on chromosome 6p21 [insulin dependent diabetes mellitus 1 (IDDM1)], especially DR and DQ, show strong association with T1DM. In addition, several studies have suggested that polymorphisms in the CTLA-4 gene (IDDM12) on chromosome 2q33 form part of the genetic susceptibility for type 1 diabetes. The aim of this study was to analyze HLA alleles of the DQB1 and DRB1 genes using polymerase chain reaction using sequence specific primers (PCR-SSP) technique and to investigate the asso­ciation of the A49G CTLA-4 polymorphism using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis in Lebanese T1DM patients. The study was conduc­ted on 39 Lebanese T1DM patients. Results of HLA typing showed an increased frequency of the HLA-DQB1*0201, HLA-DQB1*0302, HLA-DRB1*0301 and HLA-DRB1*0401 alleles, sugges­ting risk association and thus can be considered as susceptibility alleles. On the other hand, strong protection against the disease was conferred by the HLA-DRB1*110101, HLA-DQB1*0301 and HLADQB1*0601 alleles. RFLP analysis of the A49G polymorphism showed a significant increase in the G allele and GG genotype frequencies in patients, suggesting that CTLA-4 may be considered as a susceptibility gene for the development of T1DM in the Lebanese population. Analysis of the two polymorphisms showed no detectable association between the two genes. However, a significant negative association of the G allele with the DQB1*0201 allele was ob­served. This might indicate that the two genetic risk factors, namely HLA and CTLA-4, act independently of each other with no additive effect.
  4,299 775 5
Causes of end-stage renal disease in Sudan: A single-center experience
Mohamed Elhafiz Elsharif, Elham Gariballa Elsharif
March-April 2011, 22(2):373-376
Very limited data are available about the causes of renal diseases leading to chronic renal diseases in all states of Sudan, including Gezira state. Awareness of the cause of end-stage renal disease (ESRD) helps the nephrologists to anticipate problems during renal re­placement therapy and plan preventive measures for the community. Over 1.1 million patients are estimated to have ESRD worldwide, with an addition of 7% annually. This is a cross-sectional study designed to determine the etiology of ESRD among patients with ESRD on regular he­modialysis (HD) at Gezira Hospital for renal disease. This study was conducted in May 2009. The population examined here consisted of 224 patients on regular HD in Gezira Hospital for renal disease. We found that the etiologies were dominated by unknown causes (53.57%). The leading cause of ESRD for those who were younger than 40 years was glomerular disease, hypertension for those between 40 and 60 years and obstruction for those who were older than 60 years.
  4,159 641 -
Tumoral calcinosis, calciphylaxis, hyperparathyroidism and tuberculosis in a dialysis patient
Khawla Kammoun, Faiçal Jarraya, Mohamed Ben Hmida, Abedelmajid Khebir, Mahmoud Kharrat, Tahia Boudawara, Jamel Mnif, Jamil Hachicha
March-April 2011, 22(2):306-310
Tumoral calcinosis and calciphylaxis are uncommon but severe complications in ure­mic patients. They occur generally after long-term hemodialysis (HD) treatment explained by ad­vanced secondary hyperparathyroidism and longstanding high calcium phosphorus product (Ca × P). Other factors such granulomatous diseases may worsen the calcium phosphate homeostasis alterations. We report a young male patient treated by HD for 6 years who developed tuberculosis in addition to tumoral calcinosis and calciphylaxis.
  4,260 532 -
Restless legs syndrome in patients on hemodialysis
Saleh Mohammad Yaser Salman
March-April 2011, 22(2):368-372
Restless legs syndrome (RLS) is common among dialysis patients, with a reported prevalence of 6-60%. The prevalence of RLS in Syrian patients on hemodialysis (HD) is not known. The purpose of this study is to determine the prevalence of RLS in patients on regular HD, and to find the possible correlation between the presence of RLS and demographic, clinical, and biochemical factors. One hundred and twenty-three patients (male/female = 70/53, mean age = 41.95 ± 15.11 years) on HD therapy at the Aleppo University Hospital were enrolled into the study. RLS was diagnosed based on criteria established by the International Restless Legs Syn­drome Study Group (IRLSSG). Data procured were compared between patients with and without RLS. Applying the IRLSSG criteria for the diagnosis, RLS was seen in 20.3% of the study pa­tients. No significant difference in age, gender, and intake of nicotine and caffeine was found between patients with and without the RLS. Similarly, there was no difference between the two groups in the duration of end-stage renal disease (ESRD), the period of dialysis dependence, dialysis adequacy, urea and creatinine levels, and the presence of anemia. The co-morbidities and the use of drugs also did not differ in the two groups. Our study suggests that the high prevalence of RLS among patients on HD requires careful attention and correct diagnosis can lead to better therapy and better quality of life. The pathogenesis of RLS is not clear and further studies are required to identify any possible cause as well as to discover the impact of this syndrome on sleep, quality of life, and possibly other complications such as cardiovasculare disease.
  3,584 866 5
Cholesterol crystal embolization (CCE): Improvement of renal function with high-dose corticosteroid treatment
Madhav Desai, R Ram, Aruna Prayaga, KV Dakshinamurty
March-April 2011, 22(2):327-330
Cholesterol crystal embolization (CCE) is an important and often under-diagnosed cause of renal insufficiency in patients with atherosclerosis. So far, only statins are the mainstay of therapy and the role of corticosteroids is controversial. We describe a 57-year-old gentleman who presented with accelerated hypertension and renal failure three months after coronary angio­gram. Renal biopsy showed cholesterol clefts in the arteriole. Initially, management with anti­hypertensives alone (already receiving statins since angiogram) was unsuccessful. A trial of high­dose corticosteroids resulted in an improvement of the general condition in the next two days, and the serum creatinine reduced gradually to 1.6 mg/dL over the next one month. In conclusion, high­dose corticosteroids are useful in the treatment of CCE associated renal failure, especially in cases with no spontaneous recovery of function.
  3,623 752 2
Kaposi's sarcoma following immunosuppressive therapy for vasculitis
Tarik Bouattar, Laila Kazmouhi, Zaitouna Alhamany, Kawtar Beqqal, Laila Haffane, Tarik Sqalli Houssaini, Hakima Rhou, Loubna Benamar, Karima Senouci, Rabia Bayahia, Naima Ouzeddoun
March-April 2011, 22(2):319-323
Kaposi's sarcoma (KS) is widely reported to develop after renal transplantation and is induced by activation of a latent human herpes virus 8. We report the clinical features and outcome of a 50-year-old woman who presented with KS 18 weeks after starting immuno­suppressive therapy for vasculitis. She had positive-titer IgG antibody to human herpes virus 8. Cyclophosphamide pulses were interrupted, and prednisone was decreased gradually to 10 mg/day. Skin lesions showed important regression with stabilization of the general state and renal function. Eight months later, the patient presented with a diffuse cutaneous KS that required the discontinuation of steroids. Within 1 month, her general status and renal function deteriorated, and she died with a disseminated intravascular coagulation syndrome.
  3,695 523 -
Can contrast-enhanced renal MR angiography replace conventional angiography in preoperative evaluation of living renal donors?
Abdelhady Taha Emam, Ibrahim Abdulkarim Aloraifi, Siddig Adam Egail
March-April 2011, 22(2):225-231
The aim of the study was to detect if gadolinium-enhanced renal magnetic reso­nance angiography (MRA) can replace conventional angiography in imaging vascular anatomy in potential living renal donors and compare with surgical findings. MR imaging (MRI) and breath-hold three-dimensional gadolinium-enhanced MRA of kidneys were done for 60 conse­cutive patients for whom successful nephrectomy was done. MRA findings were compared with the findings of nephrectomy. MRI and MRA identified 28 out of 60 patients with normal arterial and venous anatomy, and concordance was found at surgery in 27 of these patients. Vascular anomalies were depicted on MRI in 32 patients, with concordance at surgery in 27 patients. Re­garding arterial anomalies, the MRA had a sensitivity of 89.3%, a specificity of 94.0% and an accuracy of 90.8%. For venous anomalies, the sensitivity was 98.5%, specificity was 100% and accuracy was 98.6%. In conclusion, gadolinium-enhanced MRA of the kidneys can replace con­ventional angiography as a safe and accurate modality for the assessment of potential living renal donors.
  3,486 507 -
Clinical features and histological patterns of lupus nephritis in Eastern Nepal
Subodh Sagar Dhakal, Sanjib Kumar Sharma, Narendra Bhatta, Sabina Bhattarai, Smriti Karki, Shailendra Shrestha, Suman Rijal, Prahlad Karkil
March-April 2011, 22(2):377-380
To determine the clinical profile and patterns of lupus nephritis patients in Eastern Nepal, we studied 38 patients fulfilling the 1982 revised criteria of American College of Rheu­matology for systemic lupus erythematous (SLE), followed up from January 2004 to January 2008. Arthritis was a common initial feature in addition to variable cutaneous, cardiac, pulmonary and neuropsychiatric manifestations. Renal biopsy showed grade 1 changes in 5 (13.5%) patients, grade 2 changes in 13 (35.1%) patients, grade 3 changes in 9 (24.3%) patients, grade 4 changes in 7 (18.9%) patients, grade 5 changes in 2 (5.4%) patients, and grade 6 changes in 2.7% patients. Antinuclear antibody (ANA) assay and anti-ds DNA were positive in 78.4 and 81.1%, respec­tively. We conclude that mesangial proliferative glomerulonephritis (grade 2) was the most common pattern of lupus nephritis encountered in our study. Timely diagnosis and treatment may improve the overall patients' survival.
  3,322 583 -
Utility of free prostate specific antigen serum level and its related parameters in the diagnosis of prostate cancer
Azmi A Haroun, Azmy S Hadidy, Ziad M Awwad, Caramella F Nimri, Waleed S Mahafza, Emad S Tarawneh
March-April 2011, 22(2):291-297
We evaluated the role of free prostate specific antigen (f-PSA) serum level and its related parameters in detecting prostate cancer. This retrospective study was conducted between January 2006 and March 2008. Trans-rectal ultrasound guided prostate biopsy was performed for 107 patients who had total PSA (t-PSA) level of either >4 ng/mL with or without palpable nodule or ≤4 ng/mL with palpable nodule on digital rectal examination. The perfor-mance measurements for f-PSA, percent free PSA (%f-PSA) and free PSA density (f-PSAD) were determined and compared with those for t-PSA and total PSA density (t-PSAD). Descriptive statistics for all variables of interest were calculated, and receiver operating characteristic curves were generated. Nine patients (8.4%) had normal histology, 69 patients (64.4%) had benign disease and 29 patients (27.1%) had prostate cancer. The performance of f-PSA in PCa detection was better than other evaluated parameters. The largest area under the curve for patients in the gray area (t-PSA range 4.1-10 ng/mL) was for f-PSA, with a value of 0.64 and a sensitivity and specificity of 44% and 87%, respectively. For %f-PSA, these values were 0.59, 63% and 62%, respectively. For patients with a t-PSA level of 10.1-20 ng/mL, they were 0.68, 67%, and 81%, respectively, for f­PSA, and 0.64, 67%, and 76%, respectively, for %f-PSA. In conclusion, f-PSA serum levels performed better than free to total PSA ratio and t-PSA for prostate cancer screening. It is of clinical value which could affect the biopsy decision avoiding unnecessary interventions.
  3,233 664 1
Epidemiology of erectile dysfunction in hemodialysis patients using IIEF questionnaire
Leila Malekmakan, Saeed Shakeri, Sezaneh Haghpanah, Maryam Pakfetrat, Ali Sadeghi Sarvestani, Alireza Malekmakan
March-April 2011, 22(2):232-236
Erectile dysfunction (ED) is defined as the inability to attain or maintain an erec­tion sufficient for satisfactory sexual performance. This cross-sectional study was conducted on pa­tients on hemodialysis (HD) in Shiraz, Iran, using the International Index of Erectile Dysfunction questionnaire for determination of the frequency and severity of ED in these patients. We used the Chi-square, Mann-Whitney, Kruskal-Wallis and Pearson's correlation coefficient tests for statis­tical analysis. A total of 73 patients were enrolled into this study. The mean score of ED was 10.3 ± 6.3 (total score 25). The prevalence of ED of various degrees was 87.7%. There was a signi­ficant correlation between different degrees of ED and age (P = 0.002); it was significantly higher in patients older than 50 years (P = 0.005). Also, ED was more common in patients whose Kt/V was <1.2 (P = 0.04). Our study suggests that ED is a major health concern in patients on HD. Improvement of ED may improve their quality of life. Our results can give the basic data for future research in this field.
  3,143 697 2
Renal artery pseudoaneurysm following percutaneous nephrolithotomy
Mukesh Kumar Vijay, Preeti Vijay, Ranjit Kumar Das, Anup Kumar Kundu
March-April 2011, 22(2):347-348
  3,326 466 1
Leydig cell tumor with mediastinal and lung metastasis
Punit Tiwari, Amit Goel, Pramod Sharma, Suresh Kumar, Mukesh Vijay, Arindam Dutta
March-April 2011, 22(2):354-356
  3,352 413 -
Helicobacter pylori specific IgG antibody and serum magnesium in type-2 diabetes mellitus chronic kidney disease patients
Azar Baradaran, Hamid Nasri
March-April 2011, 22(2):282-285
Infection with Helicobacter pylori (H. pylori) is common in diabetics with inade­quately controlled blood sugar. Evidence has been published suggesting that the prevalence of H. pylori infection is higher in patients with type-2 diabetes mellitus (T2DM) as opposed to the normal population. This study was conducted to investigate the association between serum magnesium (Mg) levels and H. pylori infection in T2DM patients with various glomerular function rates (GFRs). A total of 94 patients with mean age of 62 (±12) years and the duration of diabetes of 7.9 (±6.9) years (median: 7 years), were studied. The mean HbA1c in the study patients was 7.8 (±1.9) g/dL. The mean serum Mg was 2 (±0.50) mg/dL (median: 2 mg/dL), and the mean creatinine clea­rance was 62 (±23) mL/min (median: 64 mL/min). The mean value of serum H. pylori specific IgG antibody titers in the study patients was 3.9 ± 4 U/mL (median 1.9 U/mL). No significant relation­ship was found between the serum H. pylori specific IgG antibody titers and serum Mg levels and the age of the patients, creatinine clearance and duration of diabetes mellitus (DM). We could not find any significant positive association between serum Mg and H. pylori infection even among patients who had GFR below 40 mL/min. In a previous study on a group of patients on hemo­dialysis (HD), we had found a positive correlation between serum Mg and H. pylori infection. Thus, the high serum Mg level as well as its higher concentration in the gastric mucosa might facilitate the colonization of H. pylori in the stomach of patients on HD, but not in patients with various stages of renal failure that were not on HD.
  3,053 675 -
An unusual association of anti-GBM diseases and lupus nephritis presenting as pulmonary renal syndrome
Manjusha Yadla, C Krishnakishore, Sandeep Reddy, P Sriram Naveen, VV Sainaresh, M Kumaraswamy Reddy, V Sivakumar
March-April 2011, 22(2):349-351
  2,994 549 1
Mucinous tubular and spindle cell carcinoma of the kidney associated with tuberculosis
Saloua Krichen Makni, Chiraz Chaari, Sameh Ellouze, Lobna Ayadi, Slim Charfi, Karima Abbes, Mohamed Haj Slimen, Mohamed Nabil Mhiri, Tahia Sallami Boudaoura
March-April 2011, 22(2):335-338
Mucinous tubular and spindle cell carcinomas (MTSCC) are low-grade renal epi­thelial neoplasms with approximately 100 documented cases reported in the literature. We report a case of MTSCC in a 79-year-old patient in association with a renal tuberculosis infection that has never been reported. Further investigations are needed to determine the frequency and true prognosis of these tumors.
  2,996 450 2
The current status of hemodialysis in Baghdad
Ali J.H. Al-Saedy, Hayder R.A. Al-Kahichy
March-April 2011, 22(2):362-367
This study aims to assess the different aspects of hemodialysis (HD) in Baghdad in­cluding the population on dialysis, dialysis dose, nutritional status, and comobidities. We studied the HD patients recruited from five major hospitals in Baghdad from July 2008 to February 2009. There were 86 patients (mean age 46.05 ± 14.28 years). We evaluated their social status, co­morbidities, adequacy of dialysis, and nutritional status. The mean duration of patients on HD was 2.2 years, only 14% are currently employed, hepatitis was present in 43%, and other co-morbidities were present in 35%. Dialysis time was 6.4 ± 1.9 hours/week and Kt/V was 1.02 ± 0.2. Malnutrition was present in 63.5% of patients (moderate in 45.9% and severe in 17.6%) with no significant sex difference. We conclude that dialysis in Baghdad is below the standards with low adequacy and frequency of sessions. Malnutrition is prevalent, especially the severe forms, and requires more attention and re-evaluation of the dialysis prescription.
  2,949 446 2
Pregnancy-related acute renal failure: A ten-year experience
V Sivakumar, G Sivaramakrishna, VV Sainaresh, P Sriramnaveen, C Krihna Kishore, Ch Shoba Rani, K Jagadeesh
March-April 2011, 22(2):352-353
  2,611 688 3
Microscopic polyangiitis: An unusual neurologic complication
Hayet Kaaroud, Karima Boubaker, Soumaya Beji, Sami Turki, Sonia Neji, Hedi Ben Maiz, Fethi Ben Hamida, Taieb Ben Abdallah, Adel Kheder
March-April 2011, 22(2):331-334
Microscopic polyangiitis is a systemic necrotizing vasculitis of the small vessels. Its typical clinical manifestations are rapidly progressive glomerulonephritis and alveolar hemorrhage. We describe a 30-year-old woman with rapidly progressive glomerulonephritis. Seven years later, she presented with partial loss of motor and sensory function in both lower limbs with sphincter dysfunction. This is the first reported case of epidural inflammation ascribed to microscopic poly­angiitis. Possible mechanisms include auto-immune disease.
  2,869 400 1
Hemodialysis-associated pseudoporphyria resistant to N-acetylcysteine
Driss El Kabbaj, Aziza Laalou, Zoubida Alouane, Abdellali Bahadi, Zouhir Oualim
March-April 2011, 22(2):311-314
We report a 33-year-old female patient who had hemodialysis-associated pseudo­porphyria which did not respond to treatment with oral N-acetylcysteine. She responded favorably to treatment with the anti-malarial drug, chloroquine. The case is being reported to highlight the difficulty in interpreting the urinary porphyrin assays in patients on hemodialysis. Additionally, the current literature on pseudoporphyria disorders in patients with end-stage renal disease is briefly discussed.
  2,468 441 -
Attitude of physicians towards the evaluation and treatment of the glomerulonephritis patients
Muhammad Ziad Souqiyyeh, Faisal A.M. Shaheen
March-April 2011, 22(2):252-260
To survey the attitude of the physicians in Saudi Arabia toward the evaluation and treatment of glomerulonephritis (GN) patients, a questionnaire was sent to the medical directors of 175 dialysis centers in the KSA. The study was performed from July to November 2010. A total of 171 (97.7%) medical directors of dialysis centers answered the questionnaire. There were 131 (77%) res­pondents who followed up hospitalized or out-patients with nephrological problems other than dialysis at their corresponding hospitals. Only 111 (65%) of the respondents attended general nephrology clinics. Furthermore, 115 (80%) respondents followed up GN patients at their corresponding hospitals, with an average of more than 6 patients/year reported by 70 (61%) respondents. The availability of the specific serologic tests, performance of kidney biopsies and a pathologist to read them were disclosed by 55 (32%), 50 (29%), and 46 (27%) respondents, respectively. There were 46 (27%) respondents who encountered very often minimal change disease in the patients they followed up in their corresponding hospitals, 26 (15%) encountered it sometimes, and 21 (12%) encountered the disease rarely, while 78 (46%) never encountered this disease. Similar patterns were stated by the respondents for the rest of the primary and secondary GN; IgAN was the least encountered among the other types of GN. For the steroids and immunosuppressive agents use in the treatment of GN, the respondents were close in frequency to the current practice for the different types of this disease. There were 52 (30%) respondents who believed that the current protocols for treatment of GN are satisfactory, with a minimal room for improvement, while 74 (43%) had no idea about this issue. Moreover, there were only 44-49 (26-29%) respondents who answered the questions about the use of rituximab in the different types of GN and believed that the indications of it could cover most GN with variable degrees; the most popular use of rituximab in GN included MGN and lupus nephritis. We conclude that the set-up for the evaluation and treatment of GN patients is restricted in Saudi Arabia. The expo­sure and expertise in treatment of the GN is limited and needs better addressing through more availability of nephrologists and performance of kidney biopsies. The quest for innovative effective therapy, such as rituximab, to prevent progression of CKD secondary to GN is still warranted.
  2,350 432 -
C1q nephropathy presenting as acute renal failure
Pavan Malleshappa, Ravi Ranganath, Anup P Chaudhari, Ashwinikumar Ayiangar, Suratkal Lohitaksha
March-April 2011, 22(2):324-326
We describe a 42-year-old male patient who presented with high grade fever asso­ciated with acute renal failure requiring hemodialysis. Renal biopsy revealed that he had focal proliferative glomerulonephritis on light microscopy, dominant mesangial deposition of C1q by immunofluorescent staining, and electron dense deposits on electron microscopy, with no evi­dence of systemic lupus erythematosus, compatible with the diagnosis of C1q nephropathy. Intensive treatment with a combination of methyl prednisolone pulse therapy and oral predni­solone was successful in achieving complete remission and disappearance of proteinuria in our patient.
  2,297 402 -
Hyperlipidemia in children with normal allograft function
Nima Derakhshan, Dorna Derakhshan, Ali Derakhshan, Ghamar Hashemi, Mohammad Hossein Fallahzadeh, Mitra Basiratnia, Zahra Bazargani, Hamed Jalaeian, Seyed Ali Malek-Hosseini
March-April 2011, 22(2):339-340
  2,005 378 -
Deceased donor kidney recovery procedure: Safe and simple in situ separation protects vascular anatomy
Taqi Khan, Anzar Baig
March-April 2011, 22(2):341-344
  1,815 252 -
Deceased heart beating donor and organ transplantation in Saudi Arabia

March-April 2011, 22(2):387-392
  1,690 187 -
Renal biopsies in glomerular diseases
Abdul Hakeem Attar, MN Jadhav, B Zeenath, RM Madraki, BR Yelikar
March-April 2011, 22(2):345-346
  1,417 321 -
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