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Saudi Journal of Kidney Diseases and Transplantation
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   2015| July-August  | Volume 26 | Issue 4  
    Online since July 8, 2015

 
 
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CASE REPORTS
Nephrogenic ascites - Still an intractable problem?
Shobhana Nayak-Rao
July-August 2015, 26(4):773-777
DOI:10.4103/1319-2442.160214  PMID:26178555
Nephrogenic ascites or ascites associated with renal failure is seen in end-stage renal disease in-patients on hemodialysis but has been described occasionally in earlier stages of renal failure. The cause can be multifactorial and a combination of inadequate dialysis and ultrafiltration, poor nutrition and increased peritoneal membrane permeability in uremia. Generally, the onset of nephrogenic ascites is insidious and portends a grim long-term prognosis. We describe herein three patients who presented with refractory ascites of nephrogenic origin and review this entity.
  17,667 1,180 -
BRIEF COMMUNICATIONS
Cost-effectiveness of kidney transplantation compared with chronic dialysis in end-stage renal disease
Diego Rosselli, Juan-David Rueda, Carlos Eduardo Diaz
July-August 2015, 26(4):733-738
DOI:10.4103/1319-2442.160175  PMID:26178546
To estimate the costs and effectiveness measured in quality-adjusted life years (QALY) of kidney transplantation compared with dialysis in adults suffering from end-stage renal disease from the perspective of the Colombian healthcare system, we designed a Markov model with monthly cycles over a five-year time horizon and eight transitional states, including death as an absorbing state. Transition probabilities were obtained from international registries, costs from different local sources [case studies, official tariffs (ISS 2001 + 35%) for procedures and SISMED for medications]. Data were validated by an expert panel and we performed univariate, multivariate and probabilistic sensitivity analyses. Effectiveness indicators were months of life gained, months of dialysis averted and deaths prevented. The annual discount rate was 3% and the cost-utility threshold (willingness to pay) was three times gross domestic product (GDP) = USD 20,000 per QALY. The costs were adopted in US dollars (USD) using the 2012 average exchange rate (1 USD = COP$ 1798). The discounted average total cost for five years was USD 76,718 for transplantation and USD 76,891 for dialysis, with utilities 2.98 and 2.10 QALY, respectively. Additionally, renal transplantation represented 6.9 months gained, 35 months in dialysis averted per patient and one death averted for each of the five patients transplanted in five years. We conclude that renal transplantation improves the overall survival rates and quality of life and is a cost-saving alternative compared with dialysis.
  6,211 1,077 -
LETTERS TO THE EDITOR
Prevalence of hepatitis C and B virus infections among hemodialysis patients in Karaj, Iran
Ramin Tajbakhsh
July-August 2015, 26(4):792-796
DOI:10.4103/1319-2442.160219  PMID:26178560
  2,905 1,437 -
CASE REPORTS
Liddle's syndrome: A case report
Pranav Patel, Reena Kuriacose
July-August 2015, 26(4):769-772
DOI:10.4103/1319-2442.160211  PMID:26178554
Liddle's syndrome or pseudoaldosteronism is a rare autosomal dominant disease mimicking primary hyperaldosteronism, characterized by early-onset hypertension, hypokalemia and hypoaldosteronism, caused by excessive salt and water reabsorption in the distal nephron. As of 2008, there are <30 pedigrees or isolated cases that have been reported worldwide. We present an isolated case of a Liddle's syndrome in a 48-year-old female. A 48-year-old female presented to the clinic with palpitation and a three to four-year history of low potassium level and hypertension. She was initially treated with a high potassium diet and potassium supplements. Her cardiac work-up including echocardiography, stress test and Holter monitoring were all negative. After a few months, she was admitted to the hospital with an acute hypertensive episode and hypokalemia. On evaluation, she was found to have low renin and aldosterone levels. Liddle's syndrome was considered with the clinical picture of hypokalemia, hypertension and low renin/ aldosterone level. The patient was successfully treated with a high potassium diet, triamterene and atenolol. Liddle's syndrome should be considered as the differential diagnosis in patients presenting with the clinical picture of hypokalemia, hypertension and low renin/aldosterone level.
  3,306 464 -
ORIGINAL ARTICLES
Nutritional assessment and its correlation with anthropometric measurements in hemodialysis patients
Behrooz Ebrahimzadeh Koor, Mohammad Reza Nakhaie, Saied Babaie
July-August 2015, 26(4):697-701
DOI:10.4103/1319-2442.160146  PMID:26178540
One of the most important problems in patients on hemodialysis (HD) is chronic malnutrition. This study is aimed to assess the prevalence of malnutrition using a subjective global assessment (SGA) in HD patients referred to the Valie ASR Hospital, Arak, Iran. In this descriptive analysis study, 190 HD patients were selected with random sampling. SGA and anthropometric and biochemical measurements were assessed in all patients. Data were analyzed with the Chi-square and t-tests and Pearson correlation coefficient. P <0.05 was considered statistically significant. Of the 190 patients studied, 78 patients (41.1%) were male and 112 patients (58.9%) were female. Sixteen patients were detected to have adequate nutritional status (8.4%), 90 (47.4%) had mild malnutrition and 84 patients (44.2%) had moderate malnutrition. We found a significant negative correlation of SGA score with patient's weight (r = -0.147) and patient's body mass index (BMI) (r = -0.238). Also, it correlated significantly with duration of dialysis treatment (years) (r = 0.404). The SGA score showed a significant negative correlation with mid-arm circumference (MAC) (r = - 0.152). No significant correlation was found between SGA score and mid-arm muscle area. Our study showed that >50% of patients on maintenance HD had mild or moderate malnutrition. There was no case of severe malnutrition. Duration of dialysis treatment and some anthropometric indices (weight, BMI and MAC) also showed a significant correlation with SGA score, which are important to determine the nutritional status of HD patients.
  2,933 620 -
Prevalence of oral lesions in kidney transplant patients: A single center experience
Sumita Kaswan, Santosh Patil, Sneha Maheshwari, Richa Wadhawan
July-August 2015, 26(4):678-683
DOI:10.4103/1319-2442.160128  PMID:26178537
Kidney transplant patients (KTPs) have a potential tendency to develop oral lesions due to the administration of immunosuppressive drugs, but their prevalence is still obscure. The aim of the present study was to investigate the oral clinical findings in a group of renal transplant patients in comparison with ageand sex-matched healthy controls (HCs). Three hundred KTPs who underwent transplantation at least six months earlier and 296 HCs were examined clinically for the presence of any oral lesions. Demographic and additional details regarding medications, systemic diseases and duration after transplantation were recorded. Statistical analysis was performed using the Chi-square test, with significance set at P <0.05. The prevalence of oral lesions in KTPs was 56.8% as compared with 29.7% in HCs. The most common lesion observed in KTPs was gingival overgrowth (21.8%), followed by candidiasis (17.1%). Coated tongue (15.9%), followed by leukoplakia (11.3%), were common in HCs. Both gingival hyperplasia and coated tongue were significantly related to poor oral hygiene (P <0.05), but were not significantly related to the immunosuppressive therapy (P >0.05). The findings of the present study indicate the need for a routine and regular oral health check-up, with emphasis on maintenance of oral hygiene for renal transplant patients.
  2,831 508 -
RENAL DATA FROM THE ARAB WORLD
Retroperitoneal fibrosis: A retrospective review of clinical presentation, treatment and outcomes
Jannet Labidi, Yosra Ben Ariba, Soumaya Chargui, Najeh Bousetta, Bassem Louzir, Saleh Othmani
July-August 2015, 26(4):816-822
DOI:10.4103/1319-2442.160226  PMID:26178567
Retroperitoneal fibrosis (RPF) is a rare disease and has a high risk of developing chronic kidney disease (CKD). This retrospective study was carried out with the objective to study the epidemiological, clinical and therapeutic characteristics of RPF and identify the risk factors associated with its progression to CKD. All 30 cases (24 males and five females) of RPF admitted from January 1985 to December 2013 in the Military Hospital of Tunis were included in this study. The mean age was 50.5 years. Presentation was with lower back pain, acute renal failure and inflammatory syndrome in 93%, 56% and 43% of the cases, respectively. Sixteen patients (54%) had a creatinine clearance <60 mL/min at the time of diagnosis. Erythrocyte sedimentation rate and C-reactive protein of >30 mm/h and 10 mg/L were observed in 56% and 53% of cases, respectively. The abdominal computed tomography scan showed ureterohydronephrosis in 63% of the cases. Classes I, II and III according to Scheel's radiological classification were found in, respectively, 16%, 13% and 70% of cases. Biopsy of RPF was performed in 20% of the cases, and all showed an inflammatory infiltrate without signs of vasculitis. RPF was idiopathic in 85% of the cases. Oral corticosteroid therapy was started for all patients. After a mean follow-up time of 53.2 months, an initial favorable response was noted in 76% of the cases. Fifty-three percent of the patients have presented one or more relapses during follow-up and 20% progressed to CKD. Most relapses were successfully treated by corticosteroids; only five patients had required additional immunosuppressive therapy. Two patients died. Elevated creatinine at diagnosis, high urea, clearance of creatinine lower than 60 mL/min and the use of ureteral stents were identified as risk factors for development of CKD.
  2,650 560 -
Causes of chronic kidney disease in Egyptian children
Hesham Safouh, Fatina Fadel, Rascha Essam, Ahmed Salah, Abdallah Bekhet
July-August 2015, 26(4):806-809
DOI:10.4103/1319-2442.160224  PMID:26178565
There are very few published reports on the causes of chronic kidney disease (CKD) in Egyptian children. We reviewed the records of 1018 (males 56.7%, age ranged from 1 to 19 years) Egyptian patients suffering from CKD and followed-up at the pediatric nephrology units (outpatient clinics and dialysis units) of 11 universities over a period of two years. The mean of the estimated glomerular filtration rate was 12.5 mL/min/1.73 m 2 . Children with CKD stage I and stage II comprised 4.4% of the studied group, while those with stage III, IV and V comprised 19.7%, 18.3% and 57.6%, respectively. The most common single cause of CKD was obstructive uropathy (21.7%), followed by primary glomerulonephritis (15.3%), reflux/urinary tract infection (14.6%), aplasia/hypoplasia (9.8%) and familial/metabolic diseases (6.8%); unknown causes accounted for 20.6% of the cases. Of the 587 patients who had reached end-stage renal disease, 93.5% was treated with hemodialysis and only 6.5% were treated with peritoneal dialysis.
  2,643 502 -
Indications and results of renal biopsy in children: A single-center experience from Morocco
Fatima Zohra Souilmi, Tarik Sqalli Houssaini, H Alaoui, T Harmouch, S Atmani, M Hida
July-August 2015, 26(4):810-815
DOI:10.4103/1319-2442.160225  PMID:26178566
The contribution of renal biopsy (RB) is of major importance in the management of many renal diseases in children. Specific indications for performing biopsy in children include steroid-resistant nephrotic syndrome (NS) and secondary nephropathies. The aim of our study was to report the common histological varieties of kidney diseases in children in Morocco. In this retrospective and descriptive study, we included all renal biopsies performed in patients under 16 years in the Department of Pediatrics of Hassan II University Hospital, Fez, Morocco from July 2009 to December 2013. Biopsy samples without glomeruli and those with less than five glomeruli or repeat biopsies on the same patient were excluded from our study. We performed 112 RBs during this period; the average age at the time of RB was 10.05 ± 4 years and the sex-ratio was 1.07. The indications for RB were NS with hematuria and/or renal failure (RF) in 32.1%, active urinary sediment in 21.4%, isolated NS in 15.2%, RF in 13.4% and steroid-resistant NS in 10.7% of cases. Primary nephropathies represented 59.8% of cases, with a predominance of minimal change disease (MCD) seen in 40.2% of the cases. Secondary nephropathies accounted for 27.7% of the cases, with a predominance of lupus nephritis (11.6%), followed by Henoch-Schonlein purpura nephritis (6.2% of cases) and post-streptococcal glomerulonephritis (3.6%). There was one case of hepatitis B virus-associated membranous glomerulonephritis. Chronic glomerulonephritis accounted for 12.5% of the cases. Vascular and tubulo-interstitial nephritis were rare. Our study confirmed that primary glomerular nephropathy was the most common renal disease in children. The most common lesion was MCD. Secondary nephropathies were less frequent, with a predominance of lupus nephritis.
  2,615 457 -
ORIGINAL ARTICLES
Robotic-assisted versus laparoscopic partial nephrectomy: An experience with a novel technique of suturing
Tanveer Iqbal Dar, Vipin Tyagi, Ajay Sharma, Sachin Kathuria, Sudhir Chadha, Abdul Rouf Khawaja
July-August 2015, 26(4):684-691
DOI:10.4103/1319-2442.160129  PMID:26178538
This study was conducted to evaluate whether robotic-assisted laparoscopic partial nephrectomy (RALPN) is superior to laparoscopic partial nephrectomy (LPN) with regard to warm ischemia time and complications and, in addition, to report our novel technique of suturing in partial nephrectomy (PN). This was a prospective study carried out over a period of six years at our institute. A single surgeon performed PNs laparoscopically (17) and with robotic assistance (16). Only exophytic tumors were included and a novel technique of knotless and bolster-less suturing using Hem-o-loc clips was used to close the renal defect. There was no difference in intra-operative and post-operative blood loss between the two groups. However, LPN patients had significantly longer mean warm ischemia time (24.1 vs. 30.1 min, P <0.001) and operating time (157.5 vs. 192.5 min, P <0.001). Also, hospital stay was comparable between the two groups. RALPN is technically easier and also safer than LPN because of its advanced degrees of freedom, decreased warm ischemia time and reduction in the total operating time. However, these observations need further validation by larger and randomized trials. Based on our study, we recommend RALPN wherever there is availability of robot and if cost is not an issue.
  2,369 417 -
CASE REPORTS
Retained fragmented double J ureteric stent: A report of four cases with review of the literature
Hemant Kumar Goel, Anup Kumar Kundu, Tapas Kumar Maji, Dilip Kumar Pal
July-August 2015, 26(4):747-750
DOI:10.4103/1319-2442.160199  PMID:26178549
Polyurethane double-J ureteral stents are widely used in the field of urology. Postoperatively, patient education about the ureteral stent and making sure it is removed at the prescribed time is an utmost necessity. Forgotten ureteral stent is not only disastrous for the patient but also fraught with serious medico-legal implications for the urologist. Herein, we present four cases of long-term retained part of ureteral stent with its varied presentation and subsequent management.
  2,488 267 -
ORIGINAL ARTICLES
Sequential changes in bone biochemical parameters and bone mineral density after renal transplant
Manish Rathi, Deepak Kumar, Sanjay Kumar Bhadada, Niranjan Khandelwal, Harbir S Kohli, Vivekanand Jha, Vinay Sakhuja
July-August 2015, 26(4):671-677
DOI:10.4103/1319-2442.160127  PMID:26178536
To evaluate sequential changes in biochemical bone parameters, parathyroid hormone (iPTH), vitamin D levels and bone mineral density (BMD) over a period of 24 weeks after renal transplantation, we studied 75 patients (58 males, with a mean age of 35.4 years) who underwent their first renal transplantation without a past history of parathyroid surgery or fractures. Serum calcium, phosphorus and albumin were measured before transplant, then weekly for four weeks and monthly for the following 20 weeks. Serum iPTH and vitamin D levels and BMD were measured at baseline and 24 weeks after transplantation. After transplantation, there was a significant fall in serum calcium in the first week, followed by a gradual rise. At 12 and 24 weeks, respectively, 17.5% and 8% patients had hypercalcemia. Serum phosphorus decreased after transplant and at 24 weeks; 25% patients had hypophosphatemia. The iPTH levels declined significantly from 251 ± 218.2 pg/mL before transplant to 97 ± 142.8 pg/mL at the end of the study period. At 12 and 24 weeks, 42.7% and 51.3% patients, respectively, had persistent hyperparathyroidism (HPT). Elevated baseline iPTH levels and graft dysfunction were the risk factors for HPT at 12 weeks, while low vitamin D levels were the risk factor at 24 weeks. The BMD showed a significant decline of 2.7% after transplant, and it negatively correlated with the pre-transplant iPTH levels; the patients who received tacrolimus immunosuppression had a lower decline in BMD than the rest of the patients. No fractures were reported during the study period. We conclude that, after renal transplantation, hypercalcemia and hypophosphatemia are common, while a significant proportion of patients have persistent HPT and decline in bone mineral density.
  1,993 503 -
SCOT DATA
Dialysis in the Kingdom of Saudi Arabia

July-August 2015, 26(4):839-848
  2,132 344 -
ORIGINAL ARTICLES
Serum cystatin-C and BETA 2-microglobulin as accurate markers in the early diagnosis of kidney injury in neonates: A single center study
Mohamed S El-Frargy, Ahmed M El-Refaey, Riham Eid, Mokhtar A Hussien
July-August 2015, 26(4):712-717
DOI:10.4103/1319-2442.160151  PMID:26178543
Early detection of kidney injury in neonates is very important for appropriate management and prevention of serious complications; however, commonly used detectors as creatinine and blood urea nitrogen (BUN) do not directly reflect early renal cell injury. Serum cystatin-C (Cys-C) and beta 2-microglobulin (Β2M), serum creatinine and BUN were assessed in 20 neonates who developed renal impairment after admission to the neonatal intensive care unit and 10 healthy neonates. The means of serum Cys-C, Β2M and creatinine on Day 1 of admission in the cases and control groups were 2.15 ± 0.52 vs 0.45 ± 0.19, 7.18 ± 2.36 vs 1.92 ± 0.41 and 0.81 ± 0.07 vs 0.53 ± 0.20, respectively, with P-value <0.05 in only Cys-C and Β2M. We conclude that serum Cys-C and Β2M are suggested as simple and accurate markers for the early diagnosis of kidney injury in neonates than serum creatinine.
  2,018 377 -
RENAL DATA FROM ASIA-AFRICA
Pattern of glomerular disease in Nepal: A single-center experience
S Khakurel, RK Agrawal, R Hada
July-August 2015, 26(4):833-838
DOI:10.4103/1319-2442.160249  PMID:26178570
Glomerulonephritis (GN) is the most common cause of end-stage renal disease in Nepal. The aim of the present study is to determine the clinical presentation and histological pattern of GN with and without immunofluorescence (IF). It is a retrospective analysis of all GN patients with kidney biopsy at the Bir Hospital from January 2000 to April 2009. The clinical presentation, blood pressure, urine analysis, 24-h urinary protein, biochemistry, hemoglobin, antinuclear antibody, anti-ds DNA, light microscopy (LM) and IF findings of kidney biopsies were computed from hospital records. SPSS package was used for analysis. A total of 398 patients [LM 204 (51%) and LM plus IF 194 (49%] were analyzed. The mean age of the study patients was 28 ± 13.6 years (range 7-74); males comprised 52.8% and females 47.2% of the patients; 51% were between 16 and 30 years of age. The common clinical presentations included nephrotic syndrome (NS), seen in 69% of the patients, followed by acute nephritic syndrome, seen in 14.4% of the patients. Kidney biopsy without IF showed mesangial proliferative GN (MesPGN) in 21.1%, membranoproliferative GN (MPGN) in 18.6%, membranous nephropathy (MN) in 14.2%, minimal change disease (MCD) in 12.3% and focal and segmental glomerulosclerosis (FSGS) in 9.8% of the cases. With IF, MCD was seen in 23.2%, FSGS in 18%, MN in 11.9%, IgA nephropathy in 9.8%, MesPGN in 8.2%, MPGN in 4.1% and crescentic GN in 3.1% of the cases. Lupus nephritis in the cases GN was most common in young adults, with the majority presenting with NS. MCD and FSGS were the most common glomerular lesions; over-diagnosis of MesPGN and MPGN by LM could be due to exclusion of IgA nephropathy.
  2,003 364 -
ORIGINAL ARTICLES
Comparison of C-reactive protein levels with delivered dose of Kt/V in patients with end-stage renal disease on maintenance hemodialysis
Humayun Rashid, Rizwan-ul-Haq , Abad-ur-Rehman
July-August 2015, 26(4):692-696
DOI:10.4103/1319-2442.160130  PMID:26178539
The objective of our study is to compare the C-reactive protein (CRP) levels with the delivered dose of dialysis in terms of Kt/V in patients undergoing maintenance hemodialysis (HD). This is a comparative, cross-sectional survey. The study was conducted at the HD unit of the Shaikh Zayed Hospital, Lahore, Pakistan. Patients who fulfilled the inclusion and exclusion criteria were enrolled in this study. The delivered dose of HD (Kt/V) was assessed by an online clearance module (OCM) in Fresenius machines at the end of every dialysis session and the weekly Kt/V was determined by adding all three Kt/V values. The serum CRP sample was taken after each session of HD and the mean CRP was calculated and considered elevated if it was >6 mg/dL. Both weekly Kt/V and CRP values were entered in a pre-designed proforma. Data were analyzed by using statistical software SPSS and P-value £0.05 was considered significant. Of 100 patients on maintenance HD, high serum CRP level (>6 mg/dL) was found in 38 patients. When the Kt/V was compared with the CRP level, there was a negative correlation between the two parameters (r = 0.212, P = 0.032). Low Kt/V means dialysis inadequacy, which is associated with chronic inflammatory state, resulting in high CRP levels. We suggest that the quality of life of dialysis patients can be improved by offering an adequate dose of HD reflected by Kt/V ≥3.6/week.
  1,903 340 -
RENAL DATA FROM ASIA-AFRICA
Solute clearance measurement in the assessment of dialysis adequacy among African continuous ambulatory peritoneal dialysis patients
Aliyu Abdu, Sagren Naidoo, Shirin Malgas, Jocelyn T Naicker, Graham Paget, Saraladevi Naicker
July-August 2015, 26(4):827-832
DOI:10.4103/1319-2442.160228  PMID:26178569
Solute clearance measurement is an objective means of quantifying the dose of peritoneal dialysis (PD). Despite continued debate on the interpretation and precise prognostic value of small solute clearance in PD patients, guidelines based on solute clearance values are common in clinical practice. There is limited information on the solute clearance indices and PD adequacy parameters among this predominantly low socioeconomic status PD population. We investigated the solute clearance among continuous ambulatory peritoneal dialysis (CAPD) patients at the Charlotte Maxeke Johannesburg Academic Hospital and its relationship with other parameters of PD adequacy. Seventy patients on CAPD were studied in this cross-sectional study. Solute clearance was assessed using urea clearance (Kt/V). Linear regression analysis was used to determine factors associated with solute clearance, while analysis of variance was used to test the influence of weekly Kt/V on blood pressure (BP), hemoglobin (Hb) and other biochemical parameters. The mean age of the study population was 37.9 ± 12.4 years, 43% were females and 86% were black Africans. The mean duration on CAPD was 19.7 ± 20.8 months. Mean systolic and diastolic BP were 144 ± 28 and 92 ± 17 mm Hg, respectively. The mean Hb was 11.1 ± 2.2 g/dL and the mean weekly Kt/V was 1.7 ± 0.3. Factors like systolic BP, Hb level, serum levels of cholesterol, calcium, phosphate, parathyroid hormone and albumin were not significantly associated with the weekly Kt/V. We conclude that the dose of PD received by the majority of our patients in terms of the weekly Kt/V is within the recommended values and that this finding is significant considering the low socioeconomic background of our patients. There is no significant association between Kt/V and other indices of dialysis adequacy.
  2,004 223 -
BRIEF COMMUNICATIONS
Hemodiafiltration using pre-dilutional on-line citrate dialysate: A new technique for regional citrate anticoagulation: A feasibility study
Radhouane Bousselmi, Anis Baffoun, Zied Hajjej, Mohamed Ben Saleh, Iheb Labbene, Mustapha Ferjani, Mohamed Jalel Hmida
July-August 2015, 26(4):739-742
DOI:10.4103/1319-2442.160195  PMID:26178547
A prospective, observational, feasibility study was carried out on four patients with end-stage renal failure undergoing bicarbonate hemodialysis to study the feasibility of an on-line hemodiafiltration technique using a citrate dialysate with pre-dilutional infusion of citrate as a technique for regional citrate anticoagulation. All patients had contraindication to systemic heparin anticoagulation. The dialysis technique consisted of an on-line hemodiafiltration with a citrate dialysate without calcium using a Fresenius 4008S dialysis machine and Fresenius Polysulfone F60 dialyzers. The infusion solution was procured directly from the dialysate and was infused into the arterial line. To avoid the risk of hypocalcemia, calcium gluconate was infused to the venous return line. The study was carried out in two stages. During the first stage, the citrate infusion rate was 80 mL/min and the calcium infusion rate was 9 mmol/h. At the second stage, the rates were 100 mL/min and 11 mmol/h, respectively. The primary endpoint of this study was the incidence of thrombosis in the extracorporeal blood circuit and/or the dialyzer. A total of 78 sessions were conducted. All the sessions were well tolerated clinically and there were no major incidents in any of the four patients. At the first stage of the study, there were five incidences of small clots in the venous blood chamber, an incidence of extracorporeal blood circuit thrombosis of 12.5%. At the second stage of the study, no cases of extracorporeal blood circuit or dialyzer thrombosis were noted. Hemodiafiltration with on-line citrate dialysate infusion to the arterial line is safe and allows an effective regional anticoagulation of the extracorporeal blood circuit without the need for systemic anticoagulation.
  1,712 422 -
ORIGINAL ARTICLES
Clinical outcomes of acute kidney injury patients treated in a single-center, sub-urban satellite hospital
Fariz Safhan Mohd Nor, Che Rosle Draman, Mohd Ramli Seman, Norasmiza Abd Manaf, Azril Shahreez Abd Ghani, Khairul Anuar Hassan
July-August 2015, 26(4):725-732
DOI:10.4103/1319-2442.160273  PMID:26178545
Acute kidney injury (AKI) is a common diagnosis among critically ill patients. Although the etiology of AKI will determine the appropriate initial management, the definitive management of established AKI is still debatable. This is a retrospective, observational, single-center analysis of a cohort of patients referred to the nephrology unit for AKI from 1st August 2010 to 31st January 2011. Those patients with indications for dialysis were treated with continuous renal replacement therapy, intermittent hemodialysis or stiff-catheter peritoneal dialysis as determined by their hemodynamic status and the technical availability of the method. The 30-day mortality rate, renal outcomes and independent prognostic factors were analyzed statistically. Seventy-five patients were reviewed. The mean age was 52.9 ± 14.5 years. Two-thirds were males and 75% were Malays. 53.3% were referred from intensive wards. Pre-renal AKI and intra-renal AKI were diagnosed in 21.3% and 73.3% patients, respectively. Sepsis was the most common cause (n = 59). The pathogens were successfully cultured in 42.3% of the cases. The median urea and creatinine were 30.4 [interquartile range (IQR) 20.3] mmol/L and 474 (IQR 398.0) μmol/L, respectively. Seventy-six percent had metabolic acidosis. Oliguria was only noted in 38.7% of the patients. Sixty percent (n = 45) of the referrals were treated with conventional, intermittent hemodialysis and 22.7% (n = 17) with continuous veno-venous hemofiltration. The 30-day mortality rate was 28%, and was higher in intensive wards (37.5% versus 17.1%). Thirty-one percent (n = 20) had complete recovery, 17 (26.6%) had partial recovery without dialysis and seven (10.9%) became dialysis dependent. The 30-day mortality rate was 28%. Referral from intensive wards was the only significant poor prognostic factor in our patients and not the dialysis modalities.
  1,797 327 -
CASE REPORTS
Renal artery stenosis: An unusual etiology of hypertensive encephalopathy in a child with fanconi anemia
Radheshyam Purkait, Aritra Mukherji, Sucharita Datta, Ramchandra Bhadra
July-August 2015, 26(4):778-782
DOI:10.4103/1319-2442.160215  PMID:26178556
A 9-year-old girl, diagnosed case of Fanconi anemia, presented with generalized convulsion with altered sensorium. She had fever, severe pallor, sinus tachycardia, blood pressure of 180/120 mmHg in both upper and lower limb, pan-systolic murmur of grade 2/6, abdominal bruit and bilateral papilledema. A provisional diagnosis of hypertensive encephalopathy was made and managed with continuous labetalol infusion. Detailed evaluation including magnetic resonance angiography of renal artery detected underlying atrophic and non-functioning right kidney secondary to severe renal artery stenosis on the same side. She was started with multiple antihypertensives, but her blood pressure was maintained poorly. Later on, she underwent rightsided nephrectomy. Following surgery, she was doing well and maintaining normal blood pressure without any antihypertensives. Our child is the second reported case of Fanconi anemia associated with renal artery stenosis presenting with hypertensive encephalopathy.
  1,860 207 -
ORIGINAL ARTICLES
Improvement in glomerular filtration rate may decrease mortality among type-2 diabetics with chronic kidney disease lacking proteinuria: A retrospective study
Bijin Thajudeen, Pooja Budhiraja, Edward Meister, Mordecai Popovtzer
July-August 2015, 26(4):702-707
DOI:10.4103/1319-2442.160148  PMID:26178541
Twenty percent of patients with type-2 diabetes mellitus without albuminuria progress to chronic kidney disease (CKD). The various factors related to development of CKD, the natural course of renal dysfunction as well as mortality in this sub-group of diabetics has not been studied in detail. The medical records of 121 patients (all males) above the age of 40 years with type-2 diabetes mellitus and CKD, and without proteinuria, were reviewed in this retrospective study. The outcomes measured included: (a) all-cause mortality, (b) need for hemodialysis (HD), (c) appearance of proteinuria and (d) trend in kidney function. The all-cause mortality was 33%, with mean age at death being 75.9 years. Sixty-three percent of the patients had improvement in estimated glomerular filtration rate (eGFR) at the end of the follow-up period. The mortality was higher in patients with worsening eGFR compared with those with improvement in eGFR (61% vs 39%, P = 0.040). 5.8% of the patients ended up on HD and 16.51% developed proteinuria at the end of the follow-up period. Patients who developed proteinuria showed a higher tendency for progression of renal failure. Multivariate logistic regression for trend toward improving versus worsening of the eGFR revealed no statistically significant predictors. This observational study suggests that in type-2 diabetic patients with CKD, a substantial number of patients will have improvement in eGFR over time. Careful search for potential reversible causes of kidney damage could help in reducing mortality.
  1,826 226 -
Cystatin C is an early marker of contrast-induced nephropathy in patients with sepsis in the intensive care unit
Fatima I Al-Beladi
July-August 2015, 26(4):718-724
DOI:10.4103/1319-2442.160170  PMID:26178544
Contrast-induced nephropathy (CIN) is becoming an increasingly common cause of acute kidney injury in hospitalized patients. To evaluate the prevalence of CIN in critically ill patients, we conducted a prospective study on intensive care unit patients who had undergone diagnostic computed tomography scan or non-coronary angiography with intravenous administration of iodinated contrast media. Patient demographics, disease characteristics and biochemical markers, including cystatin C, creatinine and urea, were compared between the patients who developed and those who did not develop CIN. A total of 42 patients were diagnosed with sepsis, 52 were diagnosed with diabetes mellitus, 18 with ischemic heart disease and 49 with hypertension. We found a similar incidence of CIN among the groups (28.6-36.8%). There was no association of patient age, gender or body mass index with the development of CIN. In sepsis patients, cystatin C levels were significantly raised at baseline in patients who developed CIN (P = 0.020) and also on the day before CIN was detected (P = 0.035) and the day of CIN detection (P = 0.012). No associations with cystatin C or other serum or urinary biomarkers were detected in any of the other disease groups. In conclusion, a relatively high prevalence of CIN was found in all disease groups. No demographic or disease factors were found to be associated with the development of CIN. Cystatin C may be a useful early marker of CIN in sepsis patients, but further work is required to understand the difference in cystatin C expression levels in patients with different underlying pathologies.
  1,609 392 -
CASE REPORTS
Kidney involvement in Crow-Fukase syndrome
Karim Zouaghi, Lilia Ben Fatma, Saida Hajri, Rania Khedher, Madiha Krid, Wided Smaoui, Soumaya Béji, Lamia Rais, Fatma Ben Moussa
July-August 2015, 26(4):751-756
DOI:10.4103/1319-2442.160201  PMID:26178550
Crow-Fukase syndrome, also known as POEMS syndrome, is a rare plasma dyscrasia characterized by monoclonal gammopathy and various combinations of polyneuropathy, organomegaly, endocrinopathy and dermatological changes, and their initials stand for the acronym POEMS. Substantial kidney involvement is rarely related to this disease. Our report is about five patients suffering from the POEMS syndrome with kidney involvement that rapidly progressed to end-stage renal disease. Our report is about three females and two males with a mean age of 60.6 years. Neuropathy was noted in all the cases. Endocrinopathy included hypothyroidism and/or diabetes. Skin changes were noted in one case, and included peri-orbital hyperpigmentation. Monoclonal gammopathy was present in all the cases and was related to multiple myeloma in three cases. Kidney involvement presented in all the five cases. Treatment included Melphalan, Thalidomid, steroids and hemodialysis. Survival was short for three patients, from five to 34 months.
  1,550 355 -
RENAL DATA FROM ASIA-AFRICA
CKD-MBD spectrum at the time of initiation of hemodialysis in Pakistani chronic kidney disease patients
Ehtesham Hafeez, Hammad Raza, Rahmat Ullah Khan, Muhammad Asim Anwar, Tariq Hussain, Muhammad Atif Beg
July-August 2015, 26(4):823-826
DOI:10.4103/1319-2442.160227  PMID:26178568
Chronic kidney disease (CKD) is associated with mineral and bone disorder (MBD), which results in significant morbidity and mortality. To determine the spectrum of CKD- MBD in the Pakistani population, we performed a retrospective review of the medical records of 63 native Pakistani CKD stage-5 patients at our unit at the initiation of hemodialysis from March 2009 to September 2011. The cohort included 28 males and 35 females, with an age range of 18- 87 years (mean age 51 years). We reviewed the serum parathormone (PTH) levels along with other serum biochemical markers according to the KDIGO 2009 guidelines. There were 25 (40%) patients who had PTH <150 pmol/L, 15 (22%) patients who had PTH from 150 to 300 pmol/L and 24 (38%) patients who had PTH >300 pmol/L. Subgroup analysis and follow-up of patients with initial PTH >300 pmol/L (n = 24) showed treatment response in nine patients (38%). We conclude that at initiation of hemodialysis, a significant number of patients had low PTH and a similar percentage of high PTH in our population states. Therefore, we recommend early assessment of renal bone disease spectrum to prevent morbidity and mortality associated with mineral bone disorder in CKD patients.
  1,561 259 -
CASE REPORTS
Sodium stibogluconate-associated acute interstitial nephritis in a patient treated for visceral leishmaniasis
Sanjay Vikrant, Dalip Gupta, Satinder Singh Kaushal
July-August 2015, 26(4):757-760
DOI:10.4103/1319-2442.160203  PMID:26178551
The spectrum of side-effects of sodium stibogluconate is well described. Patients treated with sodium stibogluconate can develop varied manifestations of renal toxicity, ranging from renal cell casts, proteinuria, renal tubular acidosis and acute tubular necrosis, resulting in acute kidney injury (AKI). We describe a 32-year-old male patient who was treated for visceral leishmaniasis with sodium stibogluconate. The patient was readmitted two weeks after completion of the treatment for evaluation of AKI. Kidney biopsy revealed marked acute interstitial nephritis. The renal dysfunction reversed totally after a course of corticosteroids. Antimonials should be recognized as a new class of agents as a possible cause of drug-induced acute interstitial nephritis.
  1,586 233 -
Effective ultrafiltration with acute peritoneal dialysis in a child with diuretic-resistant nephrotic edema
Himesh Barman, Rokoloukho Sirie, Sourabh Gohain Duwarah
July-August 2015, 26(4):743-746
DOI:10.4103/1319-2442.160197  PMID:26178548
Edema is a cardinal feature of the nephrotic syndrome and sometimes merits independent treatment. The use of diuretics is usually sufficient in the treatment of edema. Ultrafiltration (UF) may sometimes be needed in diuretic-resistant states. The use of UF for steroid-resistant nephrotic edema is scarce in children. We report a child with steroid-resistant nephrotic syndrome with diuretic-resistant nephrotic edema treated successfully using acute peritoneal dialysis as a means of UF.
  1,466 278 -
ORIGINAL ARTICLES
Spectrum of clinico-pathological profile and treatment response in children with nephrotic immunoglobulin a nephropathy
Subal Kumar Pradhan, Pradeep Sivaraj, Leena Das, Arakhita Swain
July-August 2015, 26(4):708-711
DOI:10.4103/1319-2442.160149  PMID:26178542
Immunoglobulin A nephropathy (IgAN) is one of the most common types of primary glomerulonephritis in the world. Nephrotic syndrome is an uncommon presentation of IgAN. To evaluate the clinico-pathological features and treatment response of nephrotic IgAN, we prospectively studied 20 nephrotic children with biopsy-proven IgAN at our center from August 2009 to December 2012. The histopathological characterization of IgAN was carried out with the HAAS classification. The demographic profile, clinical presentation, initial laboratory, biopsy findings and treatment response were analyzed. The mean age was 6.7 years. The most common indication of renal biopsy was steroid-dependent nephrotic syndrome associated with microscopic hematuria (65%) and hypertension (25%). The majority of cases were classified as HAAS-III stage. Fifteen cases responded to oral cyclosporine-A, four cases to oral cyclophosphamide and one to mycophenolate mofetil. Complete remission of the nephrotic syndrome was achieved in 90% (18/20) cases within 3 months of initiation of therapy. Two cases that had partial remission were in the HASS-II and III stages. We conclude that the majority of children with nephrotic IgAN responded to oral cyclosporine-A. However, a larger cohort and longer duration follow-up are required to confirm our results.
  1,423 247 -
LETTERS TO THE EDITOR
A case of acute kidney injury and calcium oxalate deposition associated with synthetic cannabinoids
Mahmoud Kamel, Bijin Thajudeen
July-August 2015, 26(4):802-803
DOI:10.4103/1319-2442.160222  PMID:26178563
  1,411 241 -
CASE REPORTS
Emphysematous pyelonephritis presenting as a sonologically absent kidney
Chirag Patel, Urmila Anandh, Ankit Shah, Raghu Malghan
July-August 2015, 26(4):764-768
DOI:10.4103/1319-2442.160209  PMID:26178553
Emphysematous pyelonephritis is an acute necrotizing infection of the kidney caused by gas-producing organisms. It is being increasingly recognized as an underlying cause of sepsis. We present a case of emphysematous pyelonephritis where the affected kidney was filled with extensive gas. This made the detection of the kidney difficult by ultrasound. Also, this case presents the dilemma of managing a septic patient medically and the risks entailed in surgical intervention in such cases. Most often, these patients have underlying diabetes mellitus with underlying co-morbidities, making indicated surgical management difficult as illustrated by our patient.
  1,419 210 -
LETTERS TO THE EDITOR
Mediastinal malposition of a left jugular tunneled hemodialysis catheter with bilateral hemothorax and pneumo-hemo-mediastinum
Georgios Kosmadakis, Enrique Da Costa Correia, Odette Carceles, Frederic Somda, Christian Bros, Didier Aguilera
July-August 2015, 26(4):786-789
DOI:10.4103/1319-2442.160217  PMID:26178558
  1,421 187 -
Corticosteroids in IgA nephropathy: Daily oral or intravenous pulses followed by every other day oral administration
Revela Ioanna, Kalliakmani Pantelitsa, Zerbala Sinodi, Gerolymos Miltiades, Goumenos Dimitrios, Iatrou Christos
July-August 2015, 26(4):804-805
DOI:10.4103/1319-2442.160223  PMID:26178564
  1,368 209 -
Primary hyperoxaluria type 1 diagnosed after kidney transplantation: The importance of pre-transplantation metabolic screening in recurrent urolithiasis
GholamHossein Naderi, Firouzeh Tabassomi, AmirHossein Latif, MohammadReza Ganji
July-August 2015, 26(4):783-785
DOI:10.4103/1319-2442.160216  PMID:26178557
  1,330 215 -
The role of peri-operative doppler ultrasound in creation and maintenance of arteriovenous fistula: A single-center experience
Rajendra Prasad Basavanthappa, Chandrashekar Anagavalli Ramswamy, Sanjay Channappa Desai, Vinay Kothathi Khivaswamy
July-August 2015, 26(4):790-791
DOI:10.4103/1319-2442.160218  PMID:26178559
  1,249 199 -
CASE REPORTS
Retro-aortic, left inferior renal capsular vein
Umberto G Rossi, Maurizio Gallieni, Paolo Rigamonti, Maurizio Cariati
July-August 2015, 26(4):761-763
DOI:10.4103/1319-2442.160206  PMID:26178552
In our case report, abdominal multi-detector computed tomography was used for the pre-operative anatomy evaluation in a living kidney donor. The early phase of the test revealed normal kidneys in the donor. The vascular phase detected a venous variant on the left side: An inferior renal capsular vein, which had a loop and a retro-aortic course. This preoperative knowledge was crucial for the laparoscopic nephrectomy as a surgical procedure for harvesting kidney from the living donor.
  1,249 152 -
LETTERS TO THE EDITOR
An unreported association in a case with chronic microscopic hematuria
Kaan Demiroren, Saadet Demiroren
July-August 2015, 26(4):800-801
DOI:10.4103/1319-2442.160221  PMID:26178562
  1,213 167 -
Renal trauma in horse shoe kidney causing pseudoaneurysm of the right middle renal artery and large peri-nephric hematoma
Sanjeet Kumar Singh, Rakesh Kapoor
July-August 2015, 26(4):797-799
DOI:10.4103/1319-2442.160220  PMID:26178561
  1,124 163 -
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