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Saudi Journal of Kidney Diseases and Transplantation
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   2012| July-August  | Volume 23 | Issue 4  
    Online since July 9, 2012

 
 
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SPECIAL ARTICLE
Organ transplantation: A Sunni Islamic perspective
Mohammed Albar
July-August 2012, 23(4):817-822
DOI:10.4103/1319-2442.98169  
This paper reviews the standpoints of Muslim jurists within the Sunni tradition on organ transplantation. Muslim jurists allowed different forms of bone grafts (autograft, allograft and xenograft) for widely broken bones. Ibn Sina in 1037 discussed this subject in Al-Kanoon 1000 years ago. In 1959, the Muftis of Egypt and Tunisia allowed, under specific conditions, corneal transplants from dead persons. Thereafter, many fatwas (jurisprudence) on organ trans­plantation have been issued from different parts of the Muslim world. In Amman, Jordan, the International Islamic Jurist Council recognized brain-death as a recognized sign of death in Islam in October 1986. This paved the way for organ transplantation from brain-dead persons, which started immediately in Saudi Arabia. In 1990 and 2003, the International Islamic Fiqh Academy (IIFA) and the Islamic Fiqh Academy (IFA) issued important fatwas on organ transplantation. By the end of 2008, more than 3600 organs were transplanted from brain-dead persons in Saudi Arabia.
  8 18,525 1,427
ORIGINAL ARTICLES
Fatigue and depression and sleep problems among hemodialysis patients in a tertiary care center
Bincy Joshwa, Deepika C Khakha, Sandeep Mahajan
July-August 2012, 23(4):729-735
DOI:10.4103/1319-2442.98149  
High prevalence of sleep problems, fatigue and depression are reported in maintenance hemodialysis (MHD) patients. To assess fatigue, depression, sleep problems and their co-relates among MHD patients in a tertiary care center in India, we studied 47 patients on MHD for >3 months. Patients demographic, medical and co-morbidity profile were recorded. Pittsburgh Sleep Quality Index (poor sleeper if score >5) and Epworth Sleepiness Scale (EPSS, abnormal daytime sleepiness if score >13) were used to assess sleep abnormalities and quality. Beck Depression Inventory (BDI) was used to screen for depression. Depression was classified on BDI scores as mild-moderate (score 11-30) and severe (score >30). Fatigue Severity Scale was used to assess fatigue (score ≥36 indicates fatigue). The correlations of these parameters among themselves and with social and demographic parameters were also analyzed. The mean age of the study population was 37.1 ± 13.1 (range 19-65 years) years, with 89.3% being males. The majority (68.1%) of the MHD patients was poor sleepers, but only five (10.6%) patients had borderline or abnormal daytime sleepiness. Of the patients, 44.7% reported fatigue and (72.3%) had depression (mild to moderate in 59.7% and severe in 12.6%). Fatigue scores were found to be significantly associated with lesser frequency of dialysis (P < 0.05). There was higher daytime sleepiness in patients who were working (mean EPSS score 6.2 ± 3.7) than who were unemployed (mean EPSS score 3.9 ± 2.7). Depression was found to be higher in those who were paying for the treatment themselves (mean BDI score 20 ± 11.8) as compared with those who were getting medical expenditure reimbursed (mean BDI score 12.9 ± 8.8). Fatigue positively correlated with that of daytime sleepiness (P = 0.02), poor nighttime sleep (P = 0.02) and depression (P=0.006). In the present study, there was no correlation (P <0.05) found between daytime and night time sleep and depression. We found a high prevalence of fatigue, depression and poor sleep quality in our MHD patients. These abnormalities are closely related to each other and to the socioeconomic and demographic profiles of the population.
  5 5,303 1,079
CASE REPORTS
Pheochromocytoma of the urinary bladder: A rare cause of severe hypertension
Abhinandan M Hanji, Vinayak S Rohan, Jayesh J Patel, Rajena A Tankshali
July-August 2012, 23(4):813-816
DOI:10.4103/1319-2442.98167  
Paraganglioma of the urinary bladder is a rare entity, and accounts for less than 0.5% of all bladder tumors. In the genitourinary tract, the urinary bladder is the most common site for paragangliomas. These tumors commonly present with hematuria and intermittent hyper­tension during micturition along with generalized symptoms due to raised catecholamines. Surgical removal is the treatment of choice, with most of the patients requiring at least a partial cystectomy. We herewith report a 38-year-old lady who presented with a two month history of pain abdomen, burning micturition, headache and uncontrolled hypertension. Detailed investi­gations revealed a pheochromocytoma of the urinary bladder, which was treated with partial cystectomy, following which her blood pressure stabilized.
  4 4,522 546
ARC syndrome with complex renal problems: Nephrocalcinosis, proximal and hyperkalemic distal RTA and nephrogenic diabetes insipidus
Majid Malaki, Rafeei Mandana, Shamsi Ghaffari
July-August 2012, 23(4):804-809
DOI:10.4103/1319-2442.98165  
We present a female neonate with arthrogryposis, renal tubular abnormalities and cholestasis syndrome and complex renal structural and functional abnormalities that include medul­lary nephrocalcinosis, hydronephrosis, nephrogenic diabetes insipidus, Fanconi syndrome, proximal and distal hyperkalemic renal tubular acidosis, near-nephrotic range proteinuria, hypercalciuria and severe hypovitaminosis D.
  2 5,089 666
Collecting duct carcinoma: A rare renal tumor
Punit Bansal, Suresh Kumar, Neeru Mittal, Anup K Kundu
July-August 2012, 23(4):810-812
DOI:10.4103/1319-2442.98166  
The most common primary malignant renal tumor is renal cell carcinoma (RCC), which accounts for 3% of all adult malignancies. Bellini duct carcinoma or collecting duct carcinoma is an unusual rare variant of RCC. This histologically distinct tumor is very rare, with less than 100 cases reported in the literature, and accounts for approximately 1% of all malignant renal epithelial tumors. We report two cases of collecting duct carcinoma and highlight the rarity of these tumors and their similarity to RCC.
  2 2,991 570
ORIGINAL ARTICLES
Cefotaxime-heparin lock prophylaxis against hemodialysis catheter-related sepsis among Staphylococcus aureus nasal carriers
Anil K Saxena, Bodh R Panhotra, Abdul Aziz Al-hafiz, Dasappan S Sundaram, Bassam Abu-Oyun, Khalifa Al Mulhim
July-August 2012, 23(4):743-754
DOI:10.4103/1319-2442.98154  
Staphylococcus aureus nasal carriers undergoing hemodialysis (HD) through tunneled cuffed catheters (TCCs) form a high-risk group for the development of catheter-related bloodstream infections (CRBSI) and ensuing morbidity. The efficacy of antibiotic-locks on the outcomes of TCCs among S. aureus nasal carriers has not been studied earlier. Persistent nasal carriage was defined by two or more positive cultures for methicillin-susceptible (MSSA) or methicillin-resistant (MRSA) S. aureus of five standardized nasal swabs taken from all the participants dialyzed at a large out-patient HD center affiliated to a tertiary care hospital. Of 218 participants, 82 S. aureus nasal carriers dialyzed through TCCs (n = 88) were identified through April 2005 to March 2006 and randomized to two groups. Group I comprised of 39 nasal carriers who had TCCs (n = 41) "locked" with cefotaxime/heparin while group II included 43 patients with TCCs (n = 47) filled with standard heparin. The CRBSI incidence and TCC survival at 365 days were statistically compared between the two groups. A significantly lower CRBSI incidence (1.47 vs. 3.44/1000 catheter-days, P <0.001) and higher infection-free TCC survival rates at 365 days (80.5 vs. 40.4%, P <0.0001) were observed in the cefotaxime group compared with the stan­dard heparin group. However, no significant difference in MRSA-associated CRBSI incidence was observed between the two groups. Cefotaxime-heparin "locks" effectively reduced CRBSI-incidence associated with gram-positive cocci, including MSSA, among S. aureus nasal carriers. There remains a compelling requirement for antibiotic-locks effective against MRSA.
  2 3,833 743
Matricaria chamomilla attenuates cisplatin nephrotoxicity
Ragaa H.M. Salama
July-August 2012, 23(4):765-772
DOI:10.4103/1319-2442.98158  
Matricaria chamomilla is extensively consumed as a tea or tonic. Despite its widespread use as a home remedy, relatively few trials evaluated its benefits in nephro protection. Hence, this study evaluates the protective role of M. chamomilla in cisplatin nephrotoxicity rat model. The study was conducted on 32 rats divided into four groups. The first group (G1) was injected with saline intra-peritoneally (IP); G2 was injected with 5 mg/kg cisplatin on day 0 of the experiment and repeated four times, with five days free interval. G3 and G4 were injected daily with M. chamomilla (50 mg/kg) IP, starting five days before the experiment (-5 day); in addition, G4 was injected with cisplatin. On day 16, animals were scarified and serum and/or kidney tissue was used to determine: (a) kidney function tests (serum urea, creatinine, gamma glutamyl transferase (GGT), NAG, β-gal), (b) oxidative stress indices (NO, LPO), (c) antioxidant activities (SOD, GSH, total thiols), (d) apoptotic indices (Cathepsin D, DNA fragmentation) and (e) mineral (calcium). M. chamomilla significantly increased the body weight, normalized the kidney functions, improved the apoptotic markers, reduced the oxidative stress markers and corrected the hypo-calcemia that resulted from cisplatin nephrotoxicity. M. chamomilla is a promising nephro-protective compound reducing cisplatin nephrotoxicity most probably by its antioxidant activities and inhibition of gamma glutamyl transferase activity.
  2 3,525 586
CASE REPORTS
Synchronous primary cancers of urinary bladder and kidney and prostate
Punit Tiwari, Astha Tripathi, Punit Bansal, Mukesh Vijay, Aman Gupta, Anup Kumar Kundu
July-August 2012, 23(4):786-789
DOI:10.4103/1319-2442.98161  
Synchronous occurrence of two or more than two primary cancers of the urinary tract is quite rare, and poses a difficult treatment challenge. Here, we present a case of syn­chronous renal cell carcinoma, transitional cell carcinoma of urinary bladder and adenocarcinoma of prostate diagnosed within a short period. To the best of our knowledge, this is the first case reported from India and the youngest patient reported in the literature having this combination of urinary cancers.
  1 3,752 512
Mycophenolate mofetil associated with progressive multifocal leukoencephalopathy with successful outcome
Driss El Kabbaj, Mohammed Hassani, Mouncif Kadiri, Jamal Mounach, Hamid Ouhabi, Charki Haimeur, Zouhir Oualim
July-August 2012, 23(4):790-793
DOI:10.4103/1319-2442.98162  
The use of mycophenolate mofetil (MMF) is known to be associated with progres­sive multifocal leukoencephalopathy (PML). We report a case of PML in a patient receiving MMF, who showed improvement upon discontinuation of the drug. He was restarted on MMF, following which he went into coma. He showed prompt recovery upon stopping the drug again and made full recovery without any residual neurological deficit. This case is being reported to further highlight this neurological side-effect of MMF.
  1 4,163 566
Simultaneous hemorrhage in intracranial aneurysms and in renal cyst in a case of polycystic kidney disease
Amit Agrawal, Sankalp Dwivedi, Brij Raj Singh, Pankaj J Banode
July-August 2012, 23(4):794-798
DOI:10.4103/1319-2442.98163  
We report an unusual case of simultaneous hemorrhage in intracranial aneurysms and in renal cyst in a case of polycystic kidney disease. A 27-year-old gentleman presented with progressive headache and intermittent vomiting of one month duration. Initial computerized tomography (CT) scan and magnetic resonance imaging/angiography revealed a large mass lesion in the right temporal fossa. Over the previous 15 days, he developed progressive weakness in his left upper and lower limbs, and the headache worsened in severity. A repeat of CT scan showed an evidence of aneurysmal bleed and a large temporal lobe hematoma. The patient underwent urgent evacuation of the intracerebral of hematoma and excision of the redundant aneurysmal sac. The patient made excellent recovery in the post-operative period; however, for him, the pain abdomen was persisting. Detailed work-up with contrast-enhanced abdominal CT scan revealed bilateral multiple cysts in the kidneys with evidence of intracystic hemorrhage on the left side. An extensive search of the literature revealed that this kind of presentation has not been reported previously.
  1 2,828 470
LETTERS TO THE EDITOR
Endovascular management of iatrogenic renal artery aneurysm and arteriovenous fistula
Yesilkaya Yakup, Peynircioglu Bora, Cil Barbaros, Gulek Bozkurt, Demirbas Burak, Bilen Yucel Cenk
July-August 2012, 23(4):838-840
DOI:10.4103/1319-2442.98180  
  1 2,420 471
Increased urinary frequency: An unusual presentation of Plasmodium falciparum malaria
Syed Ahmed Zaki, Preeti Shanbag
July-August 2012, 23(4):844-845
DOI:10.4103/1319-2442.98182  
  1 4,980 333
Distal renal tubular acidosis associated with non-autoimmune hypothyroidism
Bashir Ahmad Laway, Imran Ali, Mir Iftikhar Bashir, Shahnaz Ahmad Mir, Mohd. Ashraf Ganie, Imtiyaz Ahmad Wani
July-August 2012, 23(4):846-849
DOI:10.4103/1319-2442.98185  
  1 3,155 412
ORIGINAL ARTICLES
Results of recombinant growth hormone treatment in children with end-stage renal disease on regular hemodialysis
Doaa Mohammed Youssef
July-August 2012, 23(4):755-764
DOI:10.4103/1319-2442.98157  
Children with chronic kidney disease are at high risk for growth retardation and decreased adult height. Growth hormone (GH) treatment is known to stimulate growth in children with short stature suffering from chronic kidney disease. However, the extent to which this the­rapy affects final adult height is not known. This study was performed on 15 patients with end­stage renal disease (ESRD) on regular hemodialysis to detect the effect of using recombinant human growth hormone (rhGH) on growth of patients with ESRD on regular hemodialysis and compa­ring this effect with the growth velocity in the same group without using rhGH in the year before therapy. There were eight females and seven males with mean age 10.6 ± 2.8 (range 5-14 years). For each patient, recombinant GH was given for one year, three-times weekly. The data of these 15 patients was compared with the year before treatment versus data of the same group of patients after six months and after one year of rhGH therapy. Our results showed that, in the year before therapy, height of these patients increased from a mean of 112.1 ± 11.6 cm to 112.7 ± 11.5 cm, which is a non-significant increase statistically (P >0.05) as well as clinically (mean growth velocity 0.6 cm/year), while height of these patients increased from a mean of 112.7 ± 11.5 cm at the start of therapy to 116.8 ± 11 cm after therapy for one year, which, although statically not significant (P >0.05), was of clinical significance as it makes rate of increase, i.e. the mean growth velocity, 4.1 cm/year close to the normal growth velocity, which is 5 cm/year, before puberty. rhGH therapy for patients with ESRD on regular hemodialysis is helpful in height gain and catch-up growth even when given three-times per week instead of five- or six-times per week. We recommend giving rhGH therapy as a routine supplementation to pediatric patients before epiphyseal closure.
  1 3,002 640
Association of adiponectin with cardiovascular events in diabetic and non-diabetic hemodialysis patients
Amir Elokely, Amira Shoukry, Tarek A Ghonemy, Mrwan Atia, Ghada Amr
July-August 2012, 23(4):736-742
DOI:10.4103/1319-2442.98151  
Adiponectin is a novel collagen-like protein synthesized by white adipose tissue. Its levels are decreased in obesity, type-2 diabetes and insulin-resistant states, and are increased in chronic renal failure. It has anti-inflammatory and anti-atherogenic properties. This study was planned to evaluate the levels of adiponectin in uremic patients with and without diabetes and to find any relationship between adiponectin levels and some cardiovascular risk factors, and to determine the possible predictive value of adiponectin for cardiovascular complications (CVC). The study included 100 subjects, 20 of them were healthy subjects and served as the control group (group I), 40 were uremic non-diabetic patients (group II) (half of them were without CVC, group IIA, and the other half were patients with CVC, group IIB) and, lastly, 40 uremic diabetic patients (group III) (half of them were without CVC, group IIIA, and the other half were patients with CVC, group IIIB). All subjects were subjected to complete clinical examination, including determination of mean arterial blood pressure (MABP), body mass index (BMI), waist to hip ratio, routine laboratory investigations, fasting plasma glucose, fasting plasma insulin, lipid profile (cholesterol, TG, LDL, HDL), determination of insulin resistance by homeostasis model assessment index (HOMA-IR) and estimation of serum levels of adiponectin. There was a significant increase in serum adiponectin levels in all the uremic patients (group II and group III) when compared with the control (group I) group, P <0.01; also, serum adiponectin levels were significantly decreased in uremic diabetic patients (group III) when compared with uremic non-diabetic patients (group II), P <0.01; but this was still higher than in the controls. The patients with CVC, whether uremic non-diabetic (group IIB) or uremic diabetic (group IIIB), had a significant decrease in serum adiponectin levels when compared with patients without CVC (group IIA and group IIIA), P <0.01. Serum adiponectin has a significant positive correlation with HDL and a significant negative correlation with MABP, BMI, plasma insulin, HOMA-IR, LDL, TG and choles­terol in all the patients. Therefore, it can be concluded that adiponectin levels in uremic patients, whether diabetic or non-diabetic, may be a good indicator of cardiovascular disease risk.
  1 2,610 607
The use of micro pulse oximetery as a new detector of tissue perfusion in solid organ transplantation
Alireza Rasekhi, Maryam Sharifian, Koroush Kazemi, Seyed Ali Malek Hosseini
July-August 2012, 23(4):715-718
DOI:10.4103/1319-2442.98144  
Vascular complications are a frequent cause of transplant failure; angiography, duplex sonography, computerized tomography (CT) scan, CT-angiography and microdialysis are the methods that were suggested for the detection of arterial obstruction after transplantation. In this study, we suggest a new method. Eight healthy adult dogs were included in the trial. All cases were operated by the same surgeon and the liver, pancreas, spleen, kidney and bowel tissue were exposed. The probes of the device, which were designed for this study, were inserted on the organ parenchyma. The device, a neonatal pulse oximeter, has two probes that were fixed by a holder in front of each other; the distance between the probes was changeable via a spring. The pulse and the oxygen saturation of the tissue were measured initially. Following this, by inducing ischemia with vessel clamping, the pulse and the oxygen saturation were measured again. The collected data were analyzed under the supervision of a statistician. In the liver and spleen, we could not detect a clear pulse wave and oxygenation. On the other hand, in the pancreas, kidney and bowel, we detected a clear curve of oxygenation and pulse in all cases. Obstruction caused significant changes: the pulse was not detected and the oxygenation decreased significantly. Our study suggests that with early diagnosis, the surgeons can detect arterial occlusion immediately and early intervention may decrease parenchymal damage. This study is the first experience in this field, and these findings need to be validated with further studies.
  1 2,451 346
Intestinal fungal and parasitic infections in kidney transplant recipients: A multi-center study
Afsoon Emami Naeini, Mehran Sharifi, Shahrzad Shahidi, Shahram Taheri, Shiva Seirafian, Dyana Taheri, Mahdi Tazhibi, Sayyed Hosein Hejazi, Pardis Emami Naini, Asghar Amini Harandi
July-August 2012, 23(4):677-683
DOI:10.4103/1319-2442.98110  
Kidney transplant recipients are susceptible to various infections due to the use of immunosuppressive drugs. The present study was performed as studies on the prevalence of intes­tinal fungal and parasitic infections in kidney transplant recipients are limited. A total of 150 kidney transplant recipients and 225 matched immunocompetent outpatients, who were referred to the laboratory of Noor Hospital, Isfahan, were studied. After recording demographic characte­ristics, direct test and specific laboratory cultures were carried out on the stool specimens. Patients were instructed on sanitary rules and, during each medical visit, they were reminded of the same. The overall prevalence of intestinal parasitic and fungal infections was 33.3% and 58.7%, respec­tively, in transplant recipients and 20% and 51%, respectively, in the control group; the difference was not statistically significant. The most prevalent intestinal parasite was Entameba coli, which was seen in 9.3% of the study patients and 6.7% of the controls. The most prevalent fungus was Candida sp., which was seen in 22% of the study patients and 24.4% of the control group. Co­existing infection with two or more fungi was seen in 14.8% and 3.4% in the case and control groups, respectively; P <0.001. Interestingly, there was no significant difference in the prevalence of infection by a single organism between the two groups. However, co-existing infection with two or more species was more prevalent in transplant recipients. We conclude that further investigations are needed to evaluate the pathogenesis of infection with these microorganisms.
  1 3,953 764
RENAL DATA FROM THE ARAB WORLD
Short- and long-term outcomes of kidney donors: A report from Tunisia
Imed Helal, Taieb Ben Abdallah, Monder Ounissi, Gargah Tahar, Mejda Cherif, Karima Boubaker, Cyrine Karoui, Fethi Ben Hamida, Ezzedine Adberrahim, Fethi El Younsi, Adel Kheder, Mohamed Sfaxi, Amine Derouiche, Mohamed Chebil, Jamil Hachicha, Mohamed Nabil Mehiri, Habib Skhiri, Mezri Elmay, Kais Harzallah, Mezri Jamel Elmanaa, Jalel Hmida
July-August 2012, 23(4):853-859
DOI:10.4103/1319-2442.98187  
Kidney transplantation remains the best treatment option of end-stage renal disease. Kidney donations are of particular interest with the currently increasing practice of living-donor transplantation. The purpose of this study was to analyze retrospectively the general health status as well as renal and cardiovascular consequences of living-related kidney donation. A total of 549 living-related kidney donors had donated their kidneys between 1986 and 2007. We attempted to contact all donors to determine short- and long-term outcome following kidney donation. All kidney donors who responded underwent detailed clinical and biochemical evaluation. The data were compared with age-matched health tables of the Tunisian general population. In all, 284 donors (52%) had a complete evaluation. They included 117 men and 167 women with a mean age of 42 ± 12 years. The major peri­operative complications that occurred in these donors included four cases of pneumothorax, six cases of surgical site infection, one case of phlebitis and one case of pulmonary embolism. None of the study cases died. The median length of hospital stay after donor nephrectomy was 6.5 days (range: 3-28 days). The median follow-up period was eight years. The mean creatinine clearance after donation was 90.4 ± 25 mL/min in men and 81.5 ± 27.2 mL/min in women. Proteinuria was >300 mg/24 h in 17 cases (5.9%). Fifty-eight (20.4%) donors became hypertensive and 19.6% of the men and 37.2% of the women became obese. Diabetes mellitus developed in 24 (8.4%), and was more common in patients who had significant weight gain. Our study suggests that kidney donors have minimal adverse effects on overall health status. Regular follow-up identifies at-risk populations and potentially modifiable factors. Creation of a national registry of living donors and their monitoring are an absolute necessity.
  1 2,776 547
RENAL DATA FROM THE ASIA - AFRICA
Pattern of glomerular diseases among adults in Rajshahi, the Northern Region of Bangladesh
MA Habib, SM Badruddoza
July-August 2012, 23(4):876-880
DOI:10.4103/1319-2442.98195  
To obtain a recent and comprehensive insight into the pattern of glomerular diseases in the Bangladeshi population, we studied 95 adequate renal biopsies done during July 2008 to June 2009, by light and direct immunofluorescence microscopy in the Department of Pathology, Rajshahi Medical College, Northern Region of Bangladesh. Of these, 38 (40%) were males and 57 (60%) were females, with a male to female ratio of 1:1.5. The most frequent clinical presentation was nephrotic syndrome (67.37%). Primary glomerular disease accounted for 91.25% of all glomerular disease and, of them, focal and segmental mesangial proliferative glomerulonephritis was the most common histological lesion in 29.47%. Diffuse mesangial proliferative glomerulonephritis (GN) was the second most common lesion (15.79%), followed by focal segmental GN (11.58%), minimal change disease (10.53%), membranous GN (7.37%), IgA nephropathy (6.85%), chronic sclerosing GN (2.11%) and crescentic GN (2.11%). Lupus nephri­tis was the most prevalent among secondary GN.
  1 2,539 455
BRIEF COMMUNICATIONS
Comparison of 5 IU and 10 IU tuberculin test results in patients on chronic dialysis
H Tayebi Khosroshahi, E Akhtari Shojaie, D Habibzadeh, B Hajipour
July-August 2012, 23(4):823-826
DOI:10.4103/1319-2442.98171  
Immunocompromised patients such as those with end-stage kidney failure under­going hemodialysis (HD) are at increased risk of developing tuberculosis (TB). For this reason, routine TB screening of HD patients with tuberculin test has been recommended. The Center for Disease Control and Prevention (CDC) has recommended that patients with chronic renal failure should undergo annual skin testing for TB with tuberculin [purified protein derivative (PPD)], with an induration of ≥10 mm at 48 h depicting a positive reaction. The aim of this study was to compare the results of two different doses of PPD in dialysis patients. This descriptive and comparative multicenter study was performed on 255 patients on chronic dialysis in Tabriz, Iran. These patients did not have the PPD test done within the preceding one year. Patients were divided into two groups randomly and conventional or double-dose tuberculin test was performed using the Mantoux technique with 5 IU (group 1) and 10 IU (group 2) of PPD. Results were interpreted 48-72 h after injection. Patients were divided into those with less than 10 mm and those with ≥10 mm duration. Mean age was 44.6 ± 15 years (M/F = 1.5/1). The mean duration on dialysis was 39 ± 7 months. There was no significant difference regarding the age, gender, dura­tion on dialysis, causes of chronic kidney disease, erythrocyte sedimentation rate, C-reactive protein and serum albumin between the two groups. The mean induration was 4.6 mm and 7.7 mm in groups 1 and 2, respectively. There was induration ≥10 mm in 19.6% and 25.5% of group 1 and 2, respectively, which showed a significant difference (P <0.05). In conclusion, because of the high frequency of TB in dialysis patients, an annual tuberculin test may be recommended. Our study showed that the double-dose tuberculin test may be a better substitute to the conventional test in dialysis patients.
  - 2,672 443
Evaluation and applicability of predictive equations of the glomerular filtration rate in chronic kidney disease
Manian Raghul, Manickavasagam Kannapiran, Ambarkar Madhusudhana Rao
July-August 2012, 23(4):827-831
DOI:10.4103/1319-2442.98173  
Prediction equations of glomerular filtration rate (GFR) may facilitate early detec­tion, evaluation and management of chronic kidney disease (CKD). However, the reliability of these equations was not extensively studied in our CKD population. Hence, the present study was aimed to determine the performance of modification of diet in renal disease (MDRD) and Cock-croft Gault formulas in predicting GFR in CKD patients and their relationship with the measured GFR. A total of 104 subjects (71 male and 33 female, aged 26-68 years) with different stages of CKD were recruited for this study; we excluded 51 patients due to improper collection of 24-h urine. The GFR was measured using 24-h creatinine clearance and predicted by the Cockcroft Gault, the 4-variable MDRD and the 6-variable MDRD equations. Prediction equations corre­lated well with the measured GFR. However, the predicted GFR using the 4-variable MDRD equation revealed a highly significant positive correlation with the GFR measured by creatinine clearance (r = 0.86, P < 0.001), followed by the 6-variable MDRD and Cockcroft-Gault equations with r = 0.85 and 0.77, P < 0.001, respectively. In conclusion, the present study predicts that the 4-variable MDRD is the best available equation for predicting GFR in our CKD population.
  - 2,343 391
CASE REPORTS
Dural sinus thrombosis - A rare manifestation of internal jugular venous occlusion
Pooja Binnani, MM Bahadur, Kuldeep Dalal
July-August 2012, 23(4):799-803
DOI:10.4103/1319-2442.98164  
The dural sinus thrombosis is an uncommon complication of a commonly done procedure of central venous catheterisation. We present a case of massive hemorrhagic venous infarct with gross cerebral edema due to dural sinus thrombosis along with right internal jugular vein thrombus. A 21-year-old male patient presented to the emergency department with fever and swelling of the right neck four days following discharge after his prior hospitalization two weeks ago for acute renal failure due to severe gastroenteritis, when he underwent hemodialysis through right internal jugular access. On presentation, he was conscious, with swelling on right side of the neck, which was diagnosed as right internal jugular vein occlusion. However, he rapidly dete­riorated and developed signs of raised intracranial pressure despite being on treatment with heparin. He was diagnosed as having massive hemorrhagic cerebral venous infarct with gross cerebral edema complicated with shift of the ventricles to the left due to dural sinus thrombosis. Despite emergency decompressive craniotomy, he succumbed in the next two days due to coning. Asymptomatic catheter-related thrombosis is frequent in the intensive care units, but major complications like retrograde extension into dural sinus causing thrombosis is rare. A high index of suspicion is required to diagnose this major catastrophe for an early and meaningful intervention.
  - 3,416 582
LETTERS TO THE EDITOR
Urinary tract infection in the kidney allograft recipients
NK Rathnamalala
July-August 2012, 23(4):832-833
DOI:10.4103/1319-2442.98174  
  - 1,882 395
Pregnancy desire unmasks a MYH9 syndrome in a kidney transplant woman
Gisella Vischini, Fabio Farneti, Pasquale Niscola, Ada Stefoni
July-August 2012, 23(4):834-835
DOI:10.4103/1319-2442.98175  
  - 1,708 288
Does zinc supplementation help in the treatment of anemia in patients on hemodialysis?
Maryam Sharifian, Jamshid Roozbeh, Mohammad Mahdi Sagheb, Sanaz Shabani, Alireza Hamidian Jahromi, Raha Afsharinai, Oveis Salehi, Ghanbarali Raais Jalali
July-August 2012, 23(4):836-837
DOI:10.4103/1319-2442.98177  
  - 5,271 482
Classical laboratory and point of care tests for screening for microalbuminuria
Viroj Wiwanitkit
July-August 2012, 23(4):841-843
DOI:10.4103/1319-2442.98181  
  - 1,581 302
A rare presentation of an enlarged isthmus of a horse shoe kidney composed of a well-differentiated renal architecture
Anup Shyamal, Pradeep Bokariya, Aaditya Tarnekar, Indira V Ingole
July-August 2012, 23(4):850-852
DOI:10.4103/1319-2442.98186  
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ORIGINAL ARTICLES
Nephroprotective effect of Kabab chini (Piper cubeba) in gentamycin-induced nephrotoxicity
Qazi Zaid Ahmad, Nasreen Jahan, Ghufran Ahmad, Tajuddin
July-August 2012, 23(4):773-781
DOI:10.4103/1319-2442.98159  
Kabab chini (KC) (Piper cubeba) is an important drug in Unani Medicine, widely described to be effective in renal diseases, and physicians are using it as a protective and curative agent in various renal disorders from ancient times. The present study was designed to evaluate the nephroprotective effect of KC against gentamycin-induced nephrotoxicity in Wistar rats. This was studied in two different sets of tests, in which both the protective as well as the curative effects were evaluated in groups of albino rats. The powder of the test drug was administered orally in a dose of 810 mg/kg and 1220 mg/kg, in suspension form, in the pre- and post-treated models. The nephroprotective effect was assessed on the basis of biochemical estimation of serum urea and creatinine levels and histopathological examination of the treated kidney. The effect observed in the pre-treated and post-treated groups was compared with plain as well as negative control groups using one-way ANOVA with Dunnett's multiple pair comparison test. The findings of the two tests demonstrated that KC produced a significant nephroprotective effect in both pre-treated and post-treated groups. The results of our study indicate that KC possesses significant benefit against gentamycin-induced nephrotoxicity.
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The effect of sublingual isosorbide dinitrate on acute urinary retention due to benign prostatic hyperplasia
Farhad Tadayyon, MohammadHossein Izadpanahi, Saeed Aali, Hamid Mazdak, Mohammad-Hatef Khorrami
July-August 2012, 23(4):782-785
DOI:10.4103/1319-2442.98160  
Acute urinary retention (AUR) is one of the most important long-term compli­cations of benign prostatic hyperplasia (BPH). Nitric oxide (NO) as a transmitter can relax smooth muscles of the bladder neck and external sphincter. Several studies have reported that sublingual isosorbide dinitrate (ISDN), as a NO donor, can lead to significant decrease in resting pressure of the external sphincter, and its rapid onset of action may be useful in the treatment of AUR. This study was designed to asses the effect of ISDN on AUR in patients with BPH. In this clinical trial, 60 men with BPH-induced AUR were randomly selected via a simple sampling method. Participants were randomly divided into case and control groups. Patients in the case group received 200 mg of sublingual ISDN and participants in the control group received placebo. After 20 min, participants were asked to void spontaneously and the urine was collected in scale containers. Following this, urethral catheterization was done on all the participants and the residual urine was measured. Data were analyzed using SPSS version 15. There was no signi­ficant difference in the mean age of the two groups (P-value = 0.28). The mean voided urine volume in the case group was 201 mL and, in the control group, it was 18 mL (P = 0.004). About 30% in the case group and 3.3% in the control group could void spontaneously after receiving ISDN or placebo (P = 0.006). In the case group, there was a significant correlation between voided urine volume and total urine volume in the bladder (P = 0.03) and in the size of the prostate (P = 0.001). Our study shows that ISDN can be effective in the treatment of BPH-induced AUR with decrease in bladder outlet resistance. ISDN is more effective in younger men and in those with smaller prostates.
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Graft outcomes in pediatric kidney transplantation: Focus on the role of race
Ibrahim F Shatat, David J Taber, Sheetal Shrivastava, Nicole A Weimert, David J Sas, Kenneth D Chavin, John K Orak, Prabhakar K Baliga
July-August 2012, 23(4):684-692
DOI:10.4103/1319-2442.98111  
While significant racial disparities in graft outcome persist among adult and pediatric kidney transplant recipients in the US, some international studies do not show these diffe­rences. The aim of this study is to examine predictors of graft outcomes and the impact of race in our pediatric kidney transplant cohort. Records of 109 pediatric kidney transplant recipients performed at our institution between 7/99 and 4/07 were studied. Patients were grouped based on race: African-American (AA) vs. non-AA. Fifty-five AA (12 ± 5 years) and 54 non-AA patients (11 ± 6 years) were studied. There were more females, pre-emptive transplants and living donors in the non-AAs. Survival analysis showed significantly higher rejection rates in AAs, P = 0.02, and lower unadjusted graft survival (P = 0.09). Cox Proportional Hazards Survival Regression Analysis revealed biopsy-proven acute rejection and delayed graft function contributed to worse graft survival, while pre-emptive transplantation had a favorable effect. Race was not an independent risk factor for decreased graft survival in the final model. In conclusion, our cohort showed several modifiable risk factors that can partially account for poorer graft survival in pediatric AA kidney transplant recipients.
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Predicting long-term graft survival in adult kidney transplant recipients
Brett W Pinsky, Krista L Lentine, Patrick R Ercole, Paolo R Salvalaggio, Thomas E Burroughs, Mark A Schnitzler
July-August 2012, 23(4):693-700
DOI:10.4103/1319-2442.98112  
The ability to accurately predict a population's long-term survival has important implications for quantifying the benefits of transplantation. To identify a model that can accurately predict a kidney transplant population's long-term graft survival, we retrospectively studied the United Network of Organ Sharing data from 13,111 kidney-only transplants completed in 1988- 1989. Nineteen-year death-censored graft survival (DCGS) projections were calculated and com­pared with the population's actual graft survival. The projection curves were created using a two-part estimation model that (1) fits a Kaplan-Meier survival curve immediately after transplant (Part A) and (2) uses truncated observational data to model a survival function for long-term projection (Part B). Projection curves were examined using varying amounts of time to fit both parts of the model. The accuracy of the projection curve was determined by examining whether predicted sur­vival fell within the 95% confidence interval for the 19-year Kaplan-Meier survival, and the sample size needed to detect the difference in projected versus observed survival in a clinical trial. The 19-year DCGS was 40.7% (39.8-41.6%). Excellent predictability (41.3%) can be achieved when Part A is fit for three years and Part B is projected using two additional years of data. Using less than five total years of data tended to overestimate the population's long-term survival, accurate prediction of long-term DCGS is possible, but requires attention to the quantity data used in the projection method.
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Effect of lymph leakage on renal allograft outcome from living donors
Abolfazl Bohlouli, Nariman Nezami, Afshar Zomorrodi, Sedigeh Abdollahifard, Bahram Hashemi
July-August 2012, 23(4):701-706
DOI:10.4103/1319-2442.98113  
Lymph leakage is a cause of prolonged fluid discharge in renal transplant patients. Lymph leakage during early post-transplantation is responsible for extracting immune substances; therefore, it may play a role in prognosis of the transplanted kidney. In this study, we aimed to investigate the effects of lymph leakage on different factors that play significant roles in renal allograft outcome. During the present case-control study, we evaluated 62 renal allograft recipients in which 31 subjects were complicated with lymph leakage and enrolled as the study group. The other 31 subjects were included in the control group who did not experience any lymph leakage during their post-transplantation period. All kidneys were transplanted from living donors. We investigated and compared the renal allograft rejection rate, hospitalization duration, serum urea, creatinine (Cr) and cyclosporine (CsA) levels, antithymoglobin (ATG) administration and treatment duration between the study and the control groups. There were no significant difference in the urea and Cr levels between the two groups (P >0.05). Early (one week) and late (one month) serum CsA levels of the study group were significantly higher than in the control group (P = 0.005 and P = 0.006). The number of days in which ATG receivers responded to therapy was significantly lower for the control group (P = 0.008). 21.93% of the study group subjects experienced allograft rejection, while this rejection probability was 28.38% for the control group (P = 0.799). Lymph leakage has no prominent role in renal function, which is estimated by Cr and urea levels in patients' serum during the days after transplantation. CsA level was higher in patients with lymph leakage, and all cases of allograft rejection were in the subjects with lymph leakage.
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Graft survival rate following renal transplantation in diabetic patients
AR Rajaeefard, A Almasi-Hashiani, J Hassanzade, H Salahi
July-August 2012, 23(4):707-714
DOI:10.4103/1319-2442.98143  
Diabetic nephropathy is the most common cause of kidney failure needing dialysis in most countries of the world. Kidney disease occurs in one-third of diabetic patients, and signi­ficantly increases the mortality rates and treatment costs. The aim of the present study was to investigate the survival rate and to determine factors that influence survival among diabetic patients who underwent transplantation at the Shiraz Namazi Hospital Transplant Center during the years 1999 to 2009. This study is a historical cohort study, which examined the graft survival rate among 103 kidney transplant patients with diabetes. The Kaplan-Meier method was used to determine the survival rate and the log-rank test was used to compare survival curves; P-value of less than 0.05 was considered significant. The mean follow-up period of patients was 48.15 ± 31.05 months (range: 3.07-118.03 months), and the estimated nine-year graft survival rate was 84.2% (±0.045). Based on the results of the Cox regression model, age of the donor was a contributing factor to graft survival rate. In summary, the graft survival rate in our cohort is satisfactory and comparable with reports from other larger centers in the world.
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Neuropathy in type 1 diabetic renal transplanted patients
Hamid Noshad
July-August 2012, 23(4):719-723
DOI:10.4103/1319-2442.98146  
This study was undertaken to study the changes in neuropathy in type 1 diabetic patients with end-stage renal disease (ESRD) after renal transplantation. From April 2007 to June 2010, 30 renal transplanted patients with type 1 diabetes mellitus (RT) and 30 type 1 diabetic patients with ESRD were enrolled in this study. Electroneurodiagnostic tests of peroneal, sural, ulnar, and median nerves were performed. Nerve conduction velocity (NCV), compound motor action potentials (CMAPs), and sensory nerve action potentials (SNAPs) were analyzed at 6, 12, and 18 months after renal transplantation. The NCV improved in the RT group in 18 months of the follow-up period (P <0.01 versus baseline). This parameter worsened significantly in the control group throughout the study period (P = 0.03), but in the cross-sectional analysis between the groups, we could not find any remarkable differences (P = 0.07). Both SNAP and CMAP amplitudes improved in the RT (SNAP Sural = 0.04, SNAP Median = 0.01 and CAMP Peroneal = 0.03, CAMP Ulnar = 0.02) but worsened in the control group (SNAP Sural < 0.001, SAP Median < 0.01 and CAMP Peroneal < 0.01, CAMP Ulnar < 0.01). Comparison of both groups did not show any significant statistical changes. Electroneurodiagnostic values improved after renal transplantation in type 1 diabetic patients with ESRD, but cross-sectional analysis did not reveal statistically significant differences between the studied groups.
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The perception of organ donation among health-care providers in the intensive care units at a tertiary center
Mohammad Alsultan
July-August 2012, 23(4):724-728
DOI:10.4103/1319-2442.98147  
The growing demand for organs continues to outpace the supply. The aim of our study was to evaluate the knowledge, attitude and awareness of organ donation procedures among the health-care providers in the Intensive Care Units (ICUs) at a tertiary hospital. This was a questionnaire-based study conducted in December 2011 among the health-care providers at five ICUs in a tertiary teaching hospital in Riyadh, Saudi Arabia. A total of 154 participants completed the questionnaire. Eighty percent of the participants acknowledged that organ donation is a legal practice in Saudi Arabia, but only 73% knew that the hospital had an organ donation policy. However, only 34% were willing to participate in a training program for organ donation. Interes­tingly, only 57% were willing to donate their organs. Our results suggest that more measures should be taken to educate the health-care providers regarding the concept of organ donation and the ethical and religious beliefs. Also, the policy of the hospital and the Saudi Center for Organ Transplantation regarding the process of organ donation should be strongly emphasized.
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RENAL DATA FROM THE ARAB WORLD
Risk factors associated with albuminuria in Kuwaiti adults with type 2 diabetes
Afaf Al-Adsani
July-August 2012, 23(4):860-865
DOI:10.4103/1319-2442.98189  
There are no available data about the factors associated with diabetic nephropathy (DN) in Kuwaiti individuals with type 2 diabetes. This study was conducted on 154 consecutive Kuwaiti adults with type 2 diabetes who attended the diabetic out-patient clinic at Al-Sabah Hospital to determine the factors associated with albuminuria among them. Albuminuria was considered to be present if the urinary albumin:creatinine ratio test or 24-h collection was positive on two occasions. There were 102 (66.2%) women and 52 (33.8%) men, with a mean age of 49.1 ± 10.1 years and a median duration of diabetes for 6 years. Hypertension was found in 60.8% of the patients and 16.3% had an HbA 1c <7%. Albuminuria was found in 43.5% of the patients. The prevalence of microalbuminuria and macroalbuminuria was 27.3% and 16.2%, respectively. In the univariate analysis, the factors that were significantly associated with albuminuria were hypertension - both systolic and diastolic blood pressure levels, HbA 1c , retinopathy, duration of diabetes, and modality of treatment. Multiple logistic regression analysis indicated that hyper­tension was the main independent risk factor associated with albuminuria (OR 4.1, 95% CI 1.1- 15.0; P = 0.03). In conclusion, although albuminuria is common among Kuwaiti adults with type 2 diabetes, the prevalence is lower than that reported for other populations in spite of the poor glycemic control and the high prevalence of hypertension. Factors associated with albuminuria appear to be similar to other populations, and hypertension was the most independent factor. Early recognition and treatment of hypertension is an important strategy to prevent or delay DN as well as cardiovascular morbidity and mortality. A population-based study is warranted to confirm these findings and to search for genetic linkage for the development of DN.
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A five-year analysis of the incidence of glomerulonephritis at Cairo University Hospital-Egypt
Salwa Ibrahim, Ahmed Fayed, Sawsan Fadda, Dawlet Belal
July-August 2012, 23(4):866-870
DOI:10.4103/1319-2442.98191  
Our study aimed to obtain a comprehensive review of the incidence of biopsy-proven glomerulonephritis (GN) at the Cairo University Hospitals, Egypt, over the last five years. We analyzed the clinical and pathological data of all renal biopsy samples that were performed during the period from July 2003 to July 2008. Renal biopsy samples of 924 patients were referred for pathological assessment during the period of the study [437 male and 487 female patients; their mean age was 26.5 ± 14.6 years (range: 2.5-71 years)]. Focal segmental glomerulo-nephritis was the most frequent cause of primary GN (21.21%), followed by mesangial proliferative GN (18.93%), diffuse proliferative GN (13.96%), focal proliferative GN (12.77%) and membranous GN (10.93%). The results could be explained by the high incidence of lupus nephritis among the study subjects as well as the relatively young age of the study group.
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RENAL DATA FROM THE ASIA - AFRICA
Renal involvement in childhood lupus: A study from Kolkata, India
Madhumita Nandi, Rakesh Mondal
July-August 2012, 23(4):871-875
DOI:10.4103/1319-2442.98194  
Systemic lupus erythematosus (SLE) is a multi-system disease of autoimmune origin. The relative incidences of the various manifestations in children with SLE are significantly different from adults and among different age-groups of children. To analyze the characteristics of childhood lupus nephritis (LN), we prospectively followed-up 23 cases of pediatric LN, diag­nosed over a period of five years, in the pediatric rheumatology clinic at the Institute of Post Graduate Medical Education and Research, Kolkata, India. The resultant database was analyzed using standard statistical methods. Of all childhood lupus cases treated in our clinic over the last five years (n = 42), 54.7% (n = 23) had renal involvement. This study has tried to delineate the disease trends of childhood lupus from Eastern India. Certain important trends have emerged that are different from other contemporary Indian and International observations.
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SCOT DATA
Dialysis in the Kingdom of Saudi Arabia

July-August 2012, 23(4):881-889
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