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Saudi Journal of Kidney Diseases and Transplantation
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   2013| November-December  | Volume 24 | Issue 6  
    Online since November 13, 2013

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Novel troponin-like biomarkers of acute kidney injury
Emad Abdallah, Emam Waked, Bassam Al-Helal, Reem Asad, Malak Nabil, Tarek Harba
November-December 2013, 24(6):1111-1124
DOI:10.4103/1319-2442.121267  PMID:24231472
Acute kidney injury (AKI) is a common and serious condition in both the inpatient and outpatient settings, and its diagnosis depends on serum creatinine measurements. Unfortunately, creatinine is a delayed and unreliable indicator of AKI. The lack of early biomarkers has limited our ability to translate promising experimental therapies to human AKI. Fortunately, understanding the early stress response of the kidney to acute injuries has realized a number of potential biomarkers. For example, neutrophil gelatinase-associated lipocalin is emerging as an excellent stand alone troponin-like biomarker in the plasma and urine for predicting and monitoring clinical trials and in the prognosis of AKI. In recent years, a number of new biomarkers of AKI with more favorable test characteristics than creatinine have been identified and studied in a variety of experimental and clinical settings. This review will consider the most well-established biomarkers of AKI.
  3,936 4,759 -
The role of erythrocyte enzyme glucose-6-phosphate dehydrogenase (G6PD) deficiency in the pathogenesis of anemia in patients on hemodialysis
Elshazali Widaa Ali, Emad Eldean Mohammed Ahmed
November-December 2013, 24(6):1153-1156
DOI:10.4103/1319-2442.121271  PMID:24231476
Anemia is a common feature among patients with chronic renal failure (CRF). Low activity of the erythrocyte enzyme glucose-6-phosphate dehydrogenase (G6PD), which plays a major role in protecting red blood cells against oxidative agents, has been described as one of the contributing factors to anemia in patients with CRF treated with hemodialysis (HD). In this study, blood samples were randomly collected from 65 patients on HD and investigated for G6PD deficiency using the methemoglobin reduction test. The hemoglobin (Hb) concentration, packed cell volume (PCV), red blood cells (RBCs) count and reticulocyte count were determined in all the samples. Our results showed that 39 of 65 patients (60%) on HD had low G6PD activity and 26 (40%) patients had normal activity; 59% of the patients with low G6PD activity were males. The mean Hb, PCV and RBCs counts were lower in patients with low G6PD activity than in those with normal G6PD activity, but the difference was not statistically significant. Likewise, no statistically significant difference was found in the reticulocyte count in patients with low G6PD activity and in those with normal G6PD activity. The low G6PD activity that was found in a large proportion of patients on HD seems to be the result of enzyme inhibition rather than deficiency. No statistically significant difference was found in anemia parameters between patients with and without G6PD deficiency.
  4,447 612 -
The impact of CYP3A5 and MDR1 polymorphisms on tacrolimus dosage requirements and trough concentrations in pediatric renal transplant recipients
Sireen Shilbayeh, Rawan Zmeili, Reham Issa Almardini
November-December 2013, 24(6):1125-1136
DOI:10.4103/1319-2442.121268  PMID:24231473
Previous international studies demonstrated significant heterogeneity in the tacrolimus (TAC) dose required to attain target blood concentrations, attributed to both genetic and ethnic factors. While the majority of previous reports on adult recipients of renal, heart and liver transplants have shown a significant effect of CYP3A5*3 single nucleotide polymorphisms (SNPs) on TAC pharmacokinetics (PKs), the impact of multidrug resistance protein 1 (MDR1) and SNPs remains controversial. Yet, similar data of TAC in pediatric populations, in whom the intra- and inter-subject variations are likely to be even greater, is currently limited. We aimed to examine the influence of various CYP3A5 and MDR1 genotypes on TAC dose requirements and PKs in the Jordanian pediatric renal transplant population. Thirty-eight patients were genotyped for CYP3A5*1 and *3 and MDR1 C3435T. Dose-adjusted trough concentrations (C 0 /D) and daily doses (D) were compared among different CYP3A5 and MDR1 genotypes in the early and maintenance phases post-transplant. Surprisingly, there were no significant differences in D, C 0 or C 0 /D among the genotypes of CYP3A5 or MDR1 polymorphisms in either the early or the maintenance phase after transplantation, whereas after combining the C 0 /D levels of MDR1 C allele expressers, noticeably lower TAC levels were observed as compared with the TT genotype. However, the difference became not significant beyond 3 months. Based on a pharmacogenetic evaluation, the independent impact of CYP3A5 SNPs on TAC PKs was not evident, demonstrating the need for further large-scale studies.
  3,003 2,045 -
Nocturnal enuresis among primary school children
Hasan Mohamed Aljefri, Omer Abdullah Basurreh, Faisel Yunus, Amen Ahmed Bawazir
November-December 2013, 24(6):1233-1241
DOI:10.4103/1319-2442.121312  PMID:24231492
To determine the prevalence and personal and family risk factors for nocturnal enuresis (NE) among primary school children in Al-Mukalla City, Yemen, we conducted a cross-sectional survey using a self-administered, three-part structured questionnaire involving 832 school children aged 6 - 15 years between 2007 and 2008. We assessed participants' socio-demographic factors, family characteristics and factors related to the presence of NE. The mean age of the children was 11.5 (±2.7) years. The overall prevalence of NE was 28.6%, with a predominance of girls, and the prevalence decreased with increasing age (P <0.001). Factors likely to be associated with NE were pattern of sleeping (P <0.001), stressful social and psychological events (P <0.01), positive family history of enuresis (P <0.001), large family size (P >0.002) and a higher number of siblings (P = 0.01). Our findings reveal a high prevalence of NE among children in Al-Mukalla City, Yemen, with a higher prevalence in girls than in boys compared with the other studies. Sleep pattern, stressful life events, family history of NE, large family size and more children in the household may act as a risk factor for NE.
  3,563 641 -
Predictors of early post-operative hypocalcemia after parathyroidectomy for secondary hyperparathyroidism
M Hamouda, N Ben Dhia, S Aloui, S El Mhamedi, H Skhiri, M Elmay
November-December 2013, 24(6):1165-1169
DOI:10.4103/1319-2442.121273  PMID:24231478
We sought to identify predictors of development of early post-operative hypocalcemia after parathyroidectomy for secondary hyperparathyroidism. The patients were divided into two groups according to their serum calcium (Ca) levels within 24 hours of undergoing para-thyroidectomy: the hypocalcemia group (22 patients) with post-operative serum Ca levels of 2 mmol/L or less, and the normocalcemia group (48 patients), with post-operative serum Ca levels higher than 2 mmol/L. By using multivariate stepwise logistic regression analysis, high pre-operative serum Ca level had the strongest predictive value of development of early hypocalcemia with an adjusted odds ratio (aOR) of 3.01, followed by hypo-albuminemia (aOR = 2.72), younger age (aOR = 2.56), and high pre-operative alkaline phosphatase (ALP) levels (aOR = 2.28). We conclude that among patients with secondary hyperparathyroidism, age, levels of pre-operative serum Ca, ALP and albumin correlate positively with the development of early post-operative hypocalcemia. Patients with one of these factors should be monitored more closely in the early post-parathyroidectomy period.
  3,271 606 -
Risk factors and management of diabetic nephropathy
Mohamed Akheel Ahmed, Githa Kishore, Hafeez Abdul Khader, Meera Neelathahalli Kasturirangan
November-December 2013, 24(6):1242-1247
DOI:10.4103/1319-2442.121310  PMID:24231493
To determine the risk factors for nephropathy in diabetic patients and to study the management of diabetic nephropathy (DN), we conducted a hospital-based prospective study in the Internal Medicine department of our hospital on 60 patients with DN and 60 diabetic patients without DN. An odds ratio (OR) disclosed the following risk factors: Hypertension (OR = 2.06), family history of diabetes (OR = 1.23), family history of DN (OR = 2.86), uncontrolled hyperglycemia (OR = 11.80), obesity (OR = 1.07), duration of diabetes between 11 and 20 years (OR = 4.69), smoking (OR = 2.79), alcohol consumption (OR = 3.75), other complications (OR = 2.03), lack of physical activity (OR = 1.51) and anemia (OR = 2.29). According to these risk factors, we suggest that improving patient's knowledge on diabetes and its treatment, life style modifications and aggressive management of the disease may delay the progression of disease to advanced stages.
  2,673 686 -
Renal function, urinalysis abnormalities and correlates among HIV-infected cameroonians naive to antiretroviral therapy
Francois FolefackKaze, Andre-Pascal Kengne, Eric Walter PefuraYone, Nelly Sandra NdamFemben, Gloria Ashuntantang
November-December 2013, 24(6):1291-1297
DOI:10.4103/1319-2442.121280  PMID:24231506
As per guidelines and recommendations, screening for renal diseases should be performed at the time of diagnosis of human immuno-deficiency virus (HIV) infection; however, this remains largely unimplemented in many settings across Sub-Saharan Africa. We evaluated the renal function, urinalysis abnormalities and their correlates in HIV-infected individuals who were naïve to highly active antiretroviral therapy (HAART). This was a cross-sectional study of 2 months' duration involving 104 HIV-infected outpatients naive to HAART (71 women, 68%) attending the HIV clinic of the Yaoundé General Hospital in Cameroon. Renal and urinalysis parameters were measured and the Student t-test and Fischer exact test were used to compare the groups of participants. The mean age and CD4 count were, respectively, 35 ± 10.7 years and 305 ± 202/mL. Fifty-six (54%) patients presented with stages 3 and 4 of HIV infection. Forty-three (41%) patients had urinalysis abnormalities, including proteinuria (36%), leukocyturia (13%) and hematuria (12%). Proteinuria was associated with increased age, advanced stage of HIV infection, decreased CD4 count, hematuria and renal failure (P <0.04). Hematuria and leukocyturia were associated with decreased CD4 count and advanced stage of HIV infection, respectively (P = 0.04). The mean estimated glomerular filtration (eGFR) rate was100.2 ± 32.7 mL/min; three (3%) patients had renal failure (eGFR <60 mL/min) and 45 (43%) patients had reduced kidney function 60 ≤eGFR ≤90 mL/min. There was a high prevalence of decreased kidney function and proteinuria among Cameroonian HIV-infected patients naïve to HAART. Indicators of the severity of HIV infection, including advanced stage and low CD4 count, were associated with urinalysis abnormalities.
  2,818 466 -
Refeeding syndrome in a patient with advanced Kidney failure due to Nephronophthisis
Kamel El-Reshaid
November-December 2013, 24(6):1217-1222
DOI:10.4103/1319-2442.121304  PMID:24231489
Refeeding syndrome (RS) is a serious and potentially fatal disorder. It is caused by a shift of fluids, sodium, potassium, magnesium and phosphorus as well changes in the metabolism of glucose, protein, fat and vitamins following the refeeding of malnourished patients, whether enterally or parenterally. RS has rarely been reported in patients with advanced kidney disease probably due to the pre-existing hyperphosphatemia, hypermagnesemia and hyperkalemia in these patients. In the following report, we present a patient with nephronophthisis type 1 deletion syndrome in whom her main previous nutrition was limited to simply rehydration to avoid renal replacement therapy. On presentation, she was cachectic and dehydrated with advanced kidney failure. She was treated with medical nephrectomy using non-steroidal anti-inflammatory drugs and then placed on maintenance hemodialysis. Percutaneous endoscopic gastrostomy was used for her initial feeding. Care was exercised during her early refeeding with regard to correction of fluids and essential electrolytes, viz. potassium, phosphorus and magnesium, as well as multivitamins to avoid the cardiovascular and neurological complications of RS. However, the changes in the gut, pancreas and liver as well as her hyperlipidemia were a clear obstacle. Fortunately, the ileus and pancreatitis she developed on refeeding improved dramatically with a decrease of the feeding dose to half; however, the liver abnormalities and hyperlipidemia were severe and slow to recover. These improved after addition of ursodeoxycholic acid and permitted successful increase of the dose of feeding subsequently.
  2,741 437 -
The relationship between the antioxidant system, oxidative stress and dialysis-related amyloidosis in hemodialysis patients
Gulperi Celik, Irfan Capraz, Mustafa Yontem, Murat Bilge, Mustafa Unaldı, Idris Mehmetoglu
November-December 2013, 24(6):1157-1164
DOI:10.4103/1319-2442.121272  PMID:24231477
End-stage renal disease (ESRD) is associated with several complications that are partly due to excess amounts of reactive oxygen species and/or decreased antioxidant activity. Dialysis-related amyloidosis (DRA) has also been linked to increased oxidative stress. The aim of this study was to investigate the relationships between the antioxidant system, including superoxide dismutase (SOD), malonyldialdehyde (MDA), various biochemical parameters and shoulder amyloidosis, in hemodialysis patients. We studied 107 non-diabetic chronic dialysis patients. The SOD levels correlated with right and left biceps tendon thickness (r = -0.219, P = 0.048 and r = -0.236, P = 0.031, respectively), MDA (r = -0.429, P = 0.000) and albumin levels (r = -0.319, P = 0.001). MDA levels correlated with right and left biceps thickness (r = 0.291, P = 0.006 and r = 0.337, P = 0.001, respectively) and β2 microglobulin levels (r = 0.455, P = 0.000). We also identified the statistically significant relationships between MDA levels and supraspinatus tendon thickening (greater than 7 mm) and right and left biceps tendon thickness (P = 0.022, P = 0.040 and P = 0.005, respectively). Our data suggest the complex relationship between antioxidants and oxidative stress and further support the roles of oxidative stress and antioxidants in DRA.
  2,477 502 -
Successful elimination of hemodialysis-related bacteremia and vascular access infection
Jafar Al-Said, Aimee Pagaduan, Soni Murdeshwar
November-December 2013, 24(6):1228-1232
DOI:10.4103/1319-2442.121313  PMID:24231491
Hemodialysis (HD) related bacteremia and dialysis induced infection constitute major risk factors for mortality and morbidity among patients with end stage renal disease. In this retrospective study, we attempted to assess the impact of the infection control protocol introduced in our center on the prevalence of HD related bacteremia and vascular access infection. All the HD sessions performed over 8 years, from January 2004 till the end of December 2011, were included in this study. Over 108 months of the study period, 6161 HD sessions were performed on 118 patients. Demographic data of all the study patients were collected. The type of vascular access as well as the presence of diabetes and hypertension were recorded. During the study period, 15 episodes of dialysis related bacteremia were noted in nine patients. Three of them required hospitalization for administration of parenteral antibiotics. Blood cultures in 93% of the infection episodes (14/15) grew Sphingomonas paucilomobilis. One patient had methicillin resistant Staphylococcus aureus grown on blood culture. The prevalence of HD related bacteremia and vascular access infection in our unit were lower than international published data. The infection control protocol used seems to have been successful in reducing HD related bacteremia and eliminating vascular access infection.
  2,299 595 -
Kaposi's sarcoma with HHV8 infection and ANCA-associated vasculitis in a hemodialysis patient
Lilia Ben Fatma, Lamia Rais, Amel Mebazza, Haifa Azzouz, Somaya Beji, Madiha Krid, Wided Smaoui, Hedi Ben Maiz, Karim Zouaghi, Moncef Zitouna, Amel Ben Osmane, Fatma Ben Moussa
November-December 2013, 24(6):1199-1202
DOI:10.4103/1319-2442.121285  PMID:24231484
The association between Kaposi's sarcoma (KS) and human herpes virus eight (HHV-8) infection is rarely reported in hemodialysis (HD) patients. We report here the rare association of KS, HHV-8 and hepatitis C virus (HCV) infection as well as syphilis in a HD patient. We report the case of a 72-year-old woman who presented with microscopic polyangiitis with alveolar hemorrhage and pauci-immune necrosing and crescentic glomerulonephritis as well as renal failure requiring HD. Biological tests showed positive HCV and syphilis tests. The patient was treated by HD and intravenous pulse, followed by oral corticosteroids and six cyclophosphamide monthly pulses with remission of the alveolar hemorrhage, but without renal functional recovery as the patient remained HD dependent. Five months after the first treatment administration, she developed extensive purpuric lesions on her lower limbs, abdomen face and neck. A skin biopsy showed KS. The HHV-8 test was positive, with positive polymerase chain reaction-HHV8 in the serum and skin. After immunosuppression withdrawal, the KS skin lesions regressed rapidly without relapse after 12 months of follow-up, but alveolar hemorrhage relapsed after 16 months of follow-up. Our case showed that the immunosuppressed state related to multiple factors such as aging, vasculitis, HHV-8, HCV, syphilis, immunosuppressive therapy and HD may all have contributed to the development of KS in our patient.
  2,419 380 -
Occurrence of microalbuminuria among children and adolescents with insulin-dependent diabetes mellitus
Abdulmoein E Al-Agha, Ali Ocheltree, Amr Hakeem
November-December 2013, 24(6):1180-1188
DOI:10.4103/1319-2442.121276  PMID:24231481
Microalbuminuria precedes the onset of diabetic nephropathy in insulin-dependent diabetes mellitus (IDDM) pediatric patients. Its prevention is among the most important challenges in managing IDDM. We attempted to determine the occurrence of microalbuminuria among IDDM Saudi children and adolescents and its associated risk factors. This is a retrospective cross-sectional study conducted on 409 IDDM children and adolescents attending the pediatric clinic at King Abdul-Aziz University Hospital from 2006 to 2010. Their ages ranged from 1 to 18 years and the mean ± standard deviation (mean ± SD) was 12.3 ± 4.1 years. Twenty-four-hour urinary albumin excretion (on two separate occasions or more, 3 - 6 months apart each), HbA1c, duration of IDDM, Tanner staging and body mass index (BMI) were reviewed. Prevalence of microalbuminuria in our cohort was 11.3%. IDDM duration was ≥2 years in 55.8% of our patients; of them, 15.6% had microalbuminuria while 45.2% had IDDM duration <2 years (6% had microalbuminuria) (P <0.01). The prevalence of microalbuminuria was higher among the post-pubertal subjects (50%) than that among the pre-pubertal (8.7%) and pubertal (41.5%) subjects. Furthermore, microalbuminuria was present in 16.7% of those with elevated blood pressure, but only in 8.5% among those with normal blood pressure (P <0.05). The enrolled overweight and obese subjects showed a higher prevalence of microalbuminuria (14%) when compared with that among those with a normal BMI (6.6%) (P <0.05). In our cohort, duration of IDDM, pubertal status, hypertension and BMI affected the prevalence of microalbuminuria. Annual screening for microalbuminuria in IDDM children and adolescents is imperative.
  2,227 504 -
Effects of oral enalapril and verapamil on dialysis adequacy and solute clearance in chronic ambulatory peritoneal dialysis
Shahnaz Atabak, Omolbanin Taziki, Hassan Argani, Rozita Abolghasemi, Hooman Farhang Zangneh, Leila Rahmani
November-December 2013, 24(6):1170-1174
DOI:10.4103/1319-2442.121274  PMID:24231479
Peritoneal dialysis offers several advantages such as better clearance of intermediate/large molecules and better preservation of renal residual function when compared with hemodialysis. However, dialysis adequacy is one of the subjects of concern of this modality. There are some drugs that are capable of influencing solute transport in the peritoneum, such as acetyle co-enzyme inhibitors (ACE-I) medications and calcium channel blockers. Captopril and Verapamil are often mentioned, but their use has shown varying conclusions and initial studies were performed with the intra-peritoneal administration of these drugs and there are only a few studies on the effect of the oral administration of these drugs. This study was undertaken with the aim to evaluate the effects of oral administration of Verapamil and Enalapril among continuous ambulatory peritoneal dialysis (CAPD) patients. The results of this study showed that Verapamil and Enalapril do not have any effects on glucose, creatinine, sodium, potassium and urea clearance (during the 4-h peritoneal equilibration test (PET) test). However, it was shown that Enalapril significantly increased the peritoneal urea Kt/V and caused a meaningful decrease in the diastolic and mean blood pressures. Therefore, we feel that Enalapril may be administered as an anti-hypertensive medication of choice in CAPD patients, which can also result in better dialysis adequacy. However, further studies with larger sample sizes are needed in the future.
  2,200 531 -
Pattern of glomerular disease in the Saudi population: A single-center, five-year retrospective study
Z Nawaz, F Mushtaq, D Mousa, E Rehman, M Sulaiman, N Aslam, N Khawaja
November-December 2013, 24(6):1265-1270
DOI:10.4103/1319-2442.121288  PMID:24231502
Glomerular diseases continue to be the leading cause of end-stage renal disease (ESRD) globally. Hence, it is important to recognize the pattern of glomerular diseases in different geographical areas in order to understand the patho-biology, incidence and progression of the disorder. Published studies from different centers in Saudi Arabia have reported contradicting results. In this retrospective study, we report our experience at the Armed Forces Hospital, Riyadh, Saudi Arabia. A total of 348 native renal biopsies performed at our center on patients with proteinuria >1 g, hematuria and/or renal impairment during a period of 5 years (between January 2005 and December 2009) were studied by a histopathologist using light microscopy, immunofluorescence and electron microscopy, and were categorized. Results showed that primary glomerular disease accounted for 55.1% of all renal biopsies. The most common histological lesion was focal and segmental glomerulosclerosis (FSGS) (27.6%), followed by minimal change disease (MCD) (17.7%) and membrano-proliferative glomerulonephritis (MPGN) (13.0%). Secondary glomerular disease accounted for 37.9% of the glomerular diseases, with lupus nephritis (LN) being the most common lesion (54.5%), followed by hypertensive nephrosclerosis (22%), post-infectious glomerulonephritis (7.5%), diabetic nephropathy (DN) (6.8%) and vasculitides (4.5%). Four percent of all biopsies turned out to be ESRD while biopsy was inadequate in 2.8% of the cases. In conclusion, our study showed that FSGS was the most common primary GN encountered, while LN was the most common secondary GN. We encountered 14 cases of crescentic glomerulonephritis. Also, the prevalence of MPGN, MCD, IgA nephropathy and membranous GN was many folds higher in males when compared with the Western data. We believe that it is mandatory to maintain a Saudi Arabian Renal Biopsy Registry to understand better the pattern of glomerular disease in the Saudi population and to follow any change in trend.
  2,024 633 -
Celiac disease a rare cause of nephrogenic ascites
Jwaher Al-bderat, Issa Hazza, Rana Haddad
November-December 2013, 24(6):1262-1264
DOI:10.4103/1319-2442.121309  PMID:24231501
  2,328 323 -
Mismatched related hematopoietic stem cell transplantation in primary immunodeficiency
Adel M Wahadneh, Haifa A Bin Dahman, Mohammed E Abu Shukear, Zeyad M Habahbeh, Mohammad A Ajarmeh, Raed M Zyood, Mueen S Habashneh
November-December 2013, 24(6):1137-1143
DOI:10.4103/1319-2442.121269  PMID:24231474
Hematopoietic stem cell transplantation (HSCT) is the definitive therapy for a variety of primary immunodeficiency syndromes (PIDs). However, no more than 30% of the patients will have a human leukocyte antigen (HLA)-identical sibling. We retrospectively analyzed our results of ten patients with PID; severe combined immunodeficiency (SCID) (n = 7), hyper IgM (HIgM) (n = 1) and combined immunodeficiency (CID) (n = 2), who lacked a fully matched donor and underwent mismatched related HSCT during the period from 2008 to 2010. The median age at the time of transplantation ranged between 3 and 84 months (median 6.5 months). Peripheral blood stem cells (PBSC) were used in all HSCTs. The mean value of the peripheral CD34+ cells infused was 9.19 × 10 6 /kg recipient weight. Patients received different conditioning protocols. All patients received anti graft versus host disease (GVHD) prophylaxis and all were engrafted. Mixed chimerism (5-55%) was noticed. GVHD was observed in 50% of the patients. Post-transplant follow-up ranged from 3 weeks to 36 months (median 15 months). Five patients are still alive while one patient developed engraftment syndrome followed by graft slippage for which a second transplant with CD34+ stem cells 5.8 × 10 6 /kg recipient's weight was infused. The others died from sepsis and transplant-related complications. Immune reconstitution was noticed in four patients. In conclusion, HLA-haploidentical stem cell transplantation may be feasible, with appropriate GVHD prophylaxis, for patients with PID who lack a fully matched donor.
  2,124 449 -
Risk factors of chronic Kidney disease influencing cardiac calcification
Hariharan Iyer, Georgi Abraham, Yuvaram N. V. Reddy, Ulhas M Pandurangi, U Kalaichelvan, S Balashankar Gomathi, Milly Mathew, Roy Santhosham
November-December 2013, 24(6):1189-1194
DOI:10.4103/1319-2442.121279  PMID:24231482
We sought to determine the influence of risk factors of chronic kidney disease (CKD) on cardiac calcification. We studied the correlation between coronary artery calcium score (CACS) and the type and duration of dialysis as well as the presence of diabetes mellitus and hypertension. The relation between calcium score and mortality was also analyzed. Patients with CKD attending the outpatient department or admitted in our hospital were included. They were subjected to high-resolution computerized tomography of the thorax to determine their CACS. Serum levels of intact parathyroid hormone (iPTH), highly sensitive C-reactive protein (hCRP), homocysteine, calcium, phosphorus, and calcium × phosphorus product were measured. Out of the 50 patients studied, 39 were hypertensive (78%), 32 were diabetic (64.4%), 20 were on hemodialysis, and 13 were on continuous ambulatory peritoneal dialysis. The mean CACS was 388.6. Twenty-nine patients had high iPTH levels and 92.9% of them had calcium score >400 (P = 0.013). Twenty-eight patients had high hCRP and 85.7% of these patients had calcium score >400 (P = 0.048). Patients on dialysis for more than two years had higher calcium score >400 (P = 0.035). 43% of diabetics had calcium score >400 (P = 0.008). All the six patients who died had calcium score >400 (P = 0). There was statistically no significant association noted between hypertension, high calcium x phosphorus product, and high homocysteine levels, and high calcium score. Our study suggests that higher values of iPTH, hCRP, and longer duration on dialysis are associated with accelerated cardiac calcification. Calcification scores >400 are associated with increased mortality.
  1,861 522 -
Immunological aspects of biopsy-proven lupus nephritis in Bahraini patients with systemic lupus erythematosus
Eman M Farid, Adla B Hassan, Ali A Abalkhail, Amgad E El-Agroudy, Sameer Al-M Arrayed, Sumaya M Al-Ghareeb
November-December 2013, 24(6):1271-1279
DOI:10.4103/1319-2442.121286  PMID:24231503
Lupus nephritis (LN) is a frequent and potentially serious complication of systemic lupus erythematosus (SLE) that may influence morbidity and mortality. Immunological investigations are aiding tools to the kidney biopsy findings in early diagnosis, in addition to monitoring the effect of therapy. The aim of the present study is to highlight the role of these investigations in a group of Bahraini patients and to determine whether there is any positive association between these findings and the outcome of LN. The current study is a retrospective case-control study of randomly selected 88 SLE patients, 44 with biopsyproven LN and 44 without, acting as controls. All renal biopsies performed during the period from 1996 to 2012 were classified according to the World Health Organization classification. Immunological investigations analyzed are: Antinuclear antibodies (ANA), anti-ds DNA, anti-ENA, anti-cardiolipin antibodies (abs) and complement components C3, C4. Human leukocyte antigen (HLA) typing class II was performed on selected cases. All patients had positive ANA (100%). A significantly high frequency of anti-Smith abs among the non-LN group (43.18%) compared with the LN group (18.18%) was found (P <0.001). On the other hand, the anti-Ro/SSA abs in the non-LN group was also found at a statistically higher frequency (20.45%) compared with that in the LN group (4.54%) (P <0.01). Anti-ds-DNA abs were found to be higher in the LN group (84.09%) compared with the non-LN group (70.45%), but the difference was not statistically significant (P = 0.082). There was a positive association of ANA positivity and low C3 and or C4 in the studied group. In our study, 88.2% of the HLA typed patients had HLADR2, DR3 or both. In conclusion, in our Arabic Bahraini SLE patients, the presence of anti-Smith, anti-Ro/SSA and anti-RNP antibodies and the absence of anti-dsDNA antibodies are independent predictive markers for renal involvement. However, more prospective studies with a larger number of patients are essential to ascertain those findings.
  1,917 435 -
Renal failure in Hay-Wells syndrome
Dhanya Mohan, Dileep K Sugathan, Mohammed Railey, Mona Alrukhaimi
November-December 2013, 24(6):1214-1216
DOI:10.4103/1319-2442.121301  PMID:24231488
Ectodermal dysplasia (ED) is a group of disorders involving developmental defects of the ectodermal structures, with abnormalities in the skin, hair, nails and sweat glands. Ankyloblepharon - ectodermal defects-cleft lip/palate (AEC) syndrome, also known as Hay-Wells syndrome, is characterized by eyelid fusion, ED and cleft lip/palate. We report a 15-year-old Omani boy with AEC syndrome who presented with end-stage renal disease (ESRD) requiring renal replacement therapy. Genitourinary anomalies including hypospadiasis, posterior urethral stricture and bilateral vesicoureteric reflux were noted. These led to secondary focal segmental glomerulosclerosis and ESRD. Screening for genitourinary anomalies and renal function tests must be performed in all patients with ED to facilitate early detection of renal disease and appropriate management.
  2,041 281 -
The renal recovery of critically ill patients with acute renal failure requiring dialysis
Mohammed A Alsultan
November-December 2013, 24(6):1175-1179
DOI:10.4103/1319-2442.121275  PMID:24231480
The incidence of acute renal failure (ARF) is increasing and will nearly double over the next decades as the population ages. As a result of ARF, patients will have longer hospital stays and may require dialysis as outpatients. The aim of this cohort study was to examine the renal recovery after the hospital discharge of surviving critically ill patients who developed ARF that required dialysis. During the 3-year study, there were 2574 patients admitted to the intensive care unit; 308 (12%) patients developed ARF and needed dialysis, 86 (28%) patients survived to hospital discharge and 40 (47%) patients continued to require dialysis after discharge. There were no differences of age or gender in the dialysis group from the non-dialysis group. In addition, there were no differences between the groups in terms of the severity of illness, use of mechanical ventilation, history of hypertension, creatinine levels, urine output or use of inotropes. It was not uncommon for surviving patients with ARF that required dialysis to be dialysis dependent upon hospital discharge, which represents an important cause of chronic kidney disease.
  1,719 513 -
Non-hemorrhagic dengue fever with rhabdomyolysis
Ratan Jha, Dilip Gude, Sashidhar Chennamsetty
November-December 2013, 24(6):1207-1209
DOI:10.4103/1319-2442.121296  PMID:24231486
Acute kidney injury occurs in 33-50% of patients with rhabdomyolysis and infections remain one of the major contributing factors. The incidence of rhabdomyolysis in non-hemorrhagic dengue virus infection is quite low and may go unnoticed, especially if the presentation is not florid. We report a case of a young male patient, sero-positive for dengue, with no hemorrhagic manifestations or hypotension, who developed rhabdomyolysis complicated by renal failure. The patient eventually needed dialysis support and later recovered fully. Clinicians need to be aware of the occurrence of rhabdomyolysis even in patients without the hemorrhagic manifestations of dengue viral infection and should employ early preventive strategies in such cases.
  1,804 375 -
Ultra-early onset post-transplantation Lymphoproliferative disease
Hossein Khedmat, Saeed Taheri
November-December 2013, 24(6):1144-1152
DOI:10.4103/1319-2442.121270  PMID:24231475
Post-transplant lymphoproliferative disease (PTLD) can present as early as days to as late as several decades after transplantation. This study, however, tries to research PTLD characteristics including histopathological and clinical features, predictors and prognosis of the disease when occurring within the first month post-transplantation. We conducted a comprehensive search for the available data using the Pubmed and Google scholar search engines for reports indicating presentation time in PTLD patients. Data from 25 previously published studies were included in the analysis. Finally, we found 355 recipients of organs presenting with "ultra-early onset PTLD." Transplant recipients with ultra-early onset PTLD were significantly more likely to have kidney allografts (P = 0.032). Transplant recipients with ultra-early onset PTLD were comparable to their counterparts in the control group in their demographics, histopathological findings and survival. Patients with ultra-early onset PTLD were significantly more likely to receive induction therapy (100% vs. 49%, respectively; P = 0.013). Pancreas transplant recipients were at a significantly higher risk for development of ultra-early onset PTLD (20% vs. 1%, respectively; P <0.001). Our findings emphasize the importance of immunosuppression potency as well as the type of allograft transplanted on the incidence of PTLD in the early stages after transplantation. However, we found no histopathological or outcome disparities for patients with ultra-early PTLD compared with controls. Further prospective studies with more comparable approaches to the patients are needed to confirm our findings.
  1,699 387 -
Organ transplantation in Saudi Arabia- 2012

November-December 2013, 24(6):1298-1308
  1,815 222 -
Encapsulating peritoneal sclerosis
MM Cisse, D Dia, SM Seck, M Cisse, EF Ka, S Gueye, A O.L. Tall, A Niang, B Diouf
November-December 2013, 24(6):1203-1206
DOI:10.4103/1319-2442.121291  PMID:24231485
Encapsulating peritoneal sclerosis (EPS) is a rare but potentially lethal complication of peritoneal dialysis (PD). Peritoneal tuberculosis is considered an etiologic factor. We report a case of EPS in a 40-year-old man who was switched to hemodialysis because of peritoneal tuberculosis after 2 years of PD. Because of the persistence of gastrointestinal symptoms and cachexia, laparoscopic exploration was performed, which revealed an important thickening of the peritoneal membrane sheathing the intestinal loops. Accordingly, a diagnosis of EPS was made. Anti-tuberculosis treatment associated with a low dose of corticosteroids stabilized the disease.
  1,564 394 -
Does NPHS1 polymorphism modulate P118l mutation in NPHS2?
Nida Dincel, Sevgi Mir, Afig Berdeli, Ipek Kaplan Bulut, Betul Sozeri
November-December 2013, 24(6):1210-1213
DOI:10.4103/1319-2442.121300  PMID:24231487
Nephrotic syndrome (NS) in the first year of life is uncommon and makes up a heterogeneous group of disorders. Subsequent studies have further defined the phenotype associated with mutations in the NPHS2 gene, revealing that patients usually develop NS from birth to 6 years of age. We report a child aged 4 months with steroid-resistant NS who had polymorphism of NPHS1 (E117K) and mutation of NPHS2 (P118L). Our patient was carrying a polymorphic NPHS1 mutation, while phenotypically she had a poor prognostic NPHS2 mutation. However, it must be questioned whether this polymorphic change (E117K) alters the signaling pathways of the podocytes and leads to P118L mutation, thus making it behave differently. Perhaps, this would be called a genetic modifier in future.
  1,600 342 -
Pauci-immune crescentic glomerulonephritis in the Down's syndrome
Mejda Cherif, Hafedh Hedri, Mondher Ounissi, Taher Gergah, Rim Goucha, Samia Barbouch, Ezzedine Abderrahim, Hedi Ben Maiz, Adel Kheder
November-December 2013, 24(6):1223-1227
DOI:10.4103/1319-2442.121311  PMID:24231490
Kidney disease is a rare complication in patients with the Down's syndrome. However, with increased survival, it appears that a growing number of these patients present with glomerulonephritis. Most cases have been reported as case reports and include lesions such as mesangiocapillary glomerulonephritis with hypo-complementemia, crescentic glomerulonephritis with anti-neutrophil cytoplasmic antibodies (ANCA), amyloidosis and immunotactoid glomerulopathy. We report the observation of a 38-year-old man with the Down's syndrome who presented with severe renal failure, proteinuria and microscopic hematuria evolving over two months. There was no history of congenital heart disease or urinary symptoms. Percutaneous renal biopsy revealed fibrous crescents, rupture of Bowman's capsule and peri-glomerular granuloma; there were no deposits on immunofluorescence study. Thoracic computerized tomography scan showed alveolar congestion. The patient tested negative for ANCA. At the time of reporting, the patient is on regular chronic hemodialysis. Our case illustrates a distinct entity that further expands the spectrum of renal disease known to occur in the Down's syndrome. Early detection of the renal disorders may prevent or slow down the progression.
  1,454 330 -
Fathoming uric acid nephropathy
Dilip Gude, Sashidhar Chennamsetty, Ratan Jha
November-December 2013, 24(6):1259-1261
DOI:10.4103/1319-2442.121307  PMID:24231500
  1,512 270 -
Symptoms of anxiety among patients with chronic kidney disease in Sri Lanka
Chaturaka Rodrigo, Anupama de Silva, Rushika Lanerolle
November-December 2013, 24(6):1256-1257
DOI:10.4103/1319-2442.121302  PMID:24231498
  1,482 267 -
Kidney disease in the elderly: A Sri Lankan perspective
Chaturaka Rodrigo, Lasitha Samarakoon, Senaka Rajapakse, Rushika Lanerolle, Rezvi Sheriff
November-December 2013, 24(6):1285-1290
DOI:10.4103/1319-2442.121282  PMID:24231505
Renal disease in the elderly in Sri Lanka is a largely neglected area in the literature with hardly any publications. We carried out a hospital-based survey of elderly patients (elderly is defined in this article as patients aged 65 years or above) with renal disease. This prospective study included all patients aged 65 years or above admitted to the University Medical Unit, National Hospital of Sri Lanka, over a period of 1 year with a primary renal-related illness as the reason for hospitalization. This hospital-based survey is the first of its kind to look into the nephrological disease profile of elderly patients in Sri Lanka. Based on our findings, we have made several pertinent recommendations regarding the care of the elderly with renal disease in Sri Lanka that may be relevant to other developing nations as well.
  1,474 266 -
Pre-emptive treatment of Hepatitis B infection by lamivudine in two tunisian renal transplant recipients
Kais Harzallah, Wafa Haddad, Mondher Haloues, Imene El Kossai, Nabil Ben Romdhane, Hatem Ben Abdallah, Riadh Bouali, Mohamed Nabil Abdelli, Jalel Hmida, Jamel Manaa
November-December 2013, 24(6):1195-1198
DOI:10.4103/1319-2442.121281  PMID:24231483
Infection with hepatitis B virus has a major implication for transplant recipients due to the risk of reactivation under immunosuppression, progression to chronic liver disease, development of liver cirrhosis and hepatocellular carcinoma. We report two cases of renal transplantation patients who were hepatitis B surface antigen positive before transplantation and were treated by Lamivudine.
  1,427 298 -
Intercity deceased donor renal transplantation: A single-center experience from a developing country
TR Mehta, VR Shah, BP Butala, GP Parikh, BK Parikh, KS Vora, MP Modi, GP Bhosale, PG Kadam, PR Shah, MR Gumber, HV Patel, VB Kute, PR Modi, SJ Rizvi, AV Vanikar, HL Trivedi
November-December 2013, 24(6):1280-1284
DOI:10.4103/1319-2442.121283  PMID:24231504
In a developing country such as India, deceased donor renal transplantation (DDRTx) accounts for only about 1% of all renal transplants (RTx). Our institute initiated an intercity DDRTx in the year 2006, which significantly increased the number of RTx. We retrieved 74 kidneys from 37 deceased donors from various cities of Gujarat from January 2006 to December 2009. We transplanted the allografts in 66 recipients and a retrospective analysis of the donor profile and management and recipient outcome was performed. The mean age of the donors was 43.3 ± 18.8 years. The causes of death included road traffic accident in 51.35% of the donors and cerebrovascular stroke in 48.65% of the donors; 83.78% of the donors required ionotropes for hemodynamic stability in addition to vigorous intravenous fluid replacement. The average urine output of the donors was 350 ± 150 mL. The organs were perfused and stored in HTK solution. The mean cold ischemia time (CIT) was 9.12 ± 5.25 h. The mean anastomosis time in the recipient was 30.8 ± 8.7 min. 57.6% of the recipients established urine output on the operating table and 42.4% developed delayed graft function. At the end of 1 month after transplantation, the mean serum creatinine was comparable to the Ahmadabad city DDRTx, although the CIT was significantly longer in the intercity patients. Intercity organ harvesting is a viable option to increase the donor pool. Distance may not be an impediment, and good recipient outcome is possible in spite of prolonged CIT in case of proper harvesting and preservation.
  1,262 243 -
Acute renal failure associated with malaria in children
Mahmood Dhahir Al-Mendalawi
November-December 2013, 24(6):1255-1255
DOI:10.4103/1319-2442.121298  PMID:24231497
  1,160 290 -
Ultrasound findings in urinary schistosomiasis infection in school children in Gezira State, Central Sudan
Mahmood Dhahir Al-Mendalawi
November-December 2013, 24(6):1252-1253
DOI:10.4103/1319-2442.121295  PMID:24231496
  1,162 282 -
Cytomegalovirus infection following renal transplantation: An analysis of 21 cases in an endemic area
Beuy Joob, Viroj Wiwanitkit
November-December 2013, 24(6):1248-1249
DOI:10.4103/1319-2442.121290  PMID:24231494
  933 244 -
Dialysis access technology, the next generation
Alan S Coulson
November-December 2013, 24(6):1250-1251
DOI:10.4103/1319-2442.121293  PMID:24231495
  923 197 -
Major flooding in Central Thailand: The problem related to availability of dialysis fluid
Beuy Joob, Viroj Wiwanitkit
November-December 2013, 24(6):1258-1258
DOI:10.4103/1319-2442.121305  PMID:24231499
  858 177 -
Author's reply
Syed Ahmed Zaki
November-December 2013, 24(6):1255-1255
  593 160 -
Author's Reply
Nagla Gasmelseed
November-December 2013, 24(6):1253-1254
  565 126 -
Forthcoming conferences

November-December 2013, 24(6):1309-1309
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  356 151 -
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