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Saudi Journal of Kidney Diseases and Transplantation
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   1998| April-June  | Volume 9 | Issue 2  
    Online since February 27, 2008

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Post-dialysis Solutes Rebound: Comparison of Two Protocols for Hemodialysis
Jamal S Al-Wakeel
April-June 1998, 9(2):139-143
The blood urea concentration is artificially low immediately following high­efficiency dialysis. Post-dialysis urea rebound correlates with hemodialysis efficiency, and is inversely correlated with dialysis treatment time. We evaluated the effect of variation in the length of hemodialysis treatment on urea, creatinine and other solutes rebound. We used two protocols for hemodialysis, using 500-ml dialysate/min and similar dialyzed blood volume. Protocol A: hemodialysis with blood flow of 300 ml/min for four hours; protocol B: hemodialysis with blood flow of 400 ml/min for three hours. Fifteen stable anuric patients with end- stage renal disease (ESRD) were hemodialysed using each protocol, three sessions a week, for a period of two weeks. The mean dialyzed blood volume in protocol A and B was 66 ± 4 and 67 ± 4.8 liters/session, respectively. The mean blood flow in protocol A was 286 ± 22 ml/min, and in protocol B was 395.3 ± 13 ml/min. The mean urea pre and immediately post dialysis in patient using protocol A was 20.5 ± 5.4 and 5.55 ± 2.2 mmol/L, respectively. While in protocol B it was 19.8 ± 4.6 and 6 ± 1.68 mmol/L. The mean urea, one hour post dialysis, in protocol A was 6.51 ± 1.9 Vs 8.04 ± 2.6 mmol/L in protocol B (P value < 0.003). The percent rebound of mean blood urea concentration in protocol A and B one hour post dialysis was 17.3% vs 34%, respectively. Predialysis creatinine in protocol A and B was 894 ± 156.8 vs 907.9 ± 163 umol/L, respectively (P= 0.4). The immediately post-dialysis creatinine in protocol A and B, was 317± 98.4 vs 331 ± 72.0 µmol/L (P = 0.4), while one hour later it was 398.6 ± 104.0 vs 442.6 ± 107.2 µmol/L, respectively (P value < 0.007). The percent rebound of creatinine was 25.6% in protocol A vs 33.5% in protocol B. These results show significant difference between the two protocols, and confirm increased rebound of urea and creatinine one hour post dialysis with shorter time of dialysis treatment.
  4,857 379 -
Paroxysmal Nocturnal Hemoglobinuria and Renal Failure
Ali Al-Harbi, Osman Alfurayh, Mohammed Sobh, Mohammed Akhtar, Mohammed Amin Tashkandy, Ahmed Shaaban
April-June 1998, 9(2):147-151
In this report we present two cases of acute renal failure in paroxysmal nocturnal hemoglobinuria (PNH) patients, who both eventually recovered their renal function. We also highlight some of the possible pathophysiological changes, which may contribute to renal failure in patients with PNH.
  4,710 491 -
Extraction of Urinary Stone
Rabeih Al Saeed Abdul Haleem, Ali Sulaiman Altwaijiri, Salah Rashid Alfaquih, Ahmad Hasan Mitwalli
April-June 1998, 9(2):157-168
  3,479 226 -
Spectrum of Renal Osteodystrophy in Dialysis Patients at a Tertiary Hospital, Riyadh, Saudi Arabia
Ahmed H Mitwalli
April-June 1998, 9(2):128-133
To evaluate renal osteodystrophy (ROD), bone biopsies were performed in 57 patients with end-stage renal failure (ESRF) on dialysis, 46 on hemodialysis (HD) and 11 on peritoneal dialysis (PD). There were 29 males (mean age of 42 years) and 28 females (mean age of 39 years). Relevant presenting clinical features were pruritis in 46 cases, bone pains in 32, acute pseudogout in three, bone deformities in two, conjunctiva! calcification in two, cutaneous calcification in two, and corneal calcification in one. The mean value of predialysis blood investigations were as follows: urea 33.9 mmol/L, creatinine 913 umol/L, bicarbonate 18 mmol/L, calcium 2.36 mmol/L, albumin 40 g/L, phosphorus 1.69 mmol/L, alkaline phosphatase 178 U/L, parathyroid hormone 543 pmol/L, magnesium 1.06 mmol/L and aluminum 1.81 mmol/L. Skeletal survey showed no changes in 24 patients (42%), hyperparathyroid cystic changes of bones in seven, osteoporosis as the predominant features in seven, mixed picture of ROD in 12, subperiosteal resorption of the metacarpals in two, osteosclerosis (Rugger Jersey Spine) in two and osteomalacia in two patients. Bone mineral density (BMD) was measured by dual x-ray absorptiometry in the lumbar spine (LS) and femoral neck (FN). All patients had low BMD (both LS and FN). Bone biopsy (BBX) revealed mixed picture in 30 cases, predominantly secondary hyperparathyroid changes in 10, mild hyperparathyroid changes in five, predominant osteoporosis in three, osteomalacia in four, aplastic (adynamic) bone in four, and aluminum deposition in one. All of the patients who showed evidence of bone involvement on BBX had abnormal BMD suggesting that BMD is a good non-invasive screening test for ROD but indiscriminative for the type of bone disease. BBX still remains the diagnostic tool to differentiate and classify different types of bone disease.
  3,021 369 -
Incidence and Types of Malignant Tumors in Renal Transplant Recipients: A Single Center Experience
Atallah A Shaaban
April-June 1998, 9(2):116-122
We reviewed the incidence and types of de novo malignancies which developed in 792 renal transplant recipients who received their grafts between 1979 and 1996 and followed up for an average period of 5.6 years. There were 56 malignant tumors detected in 54 patients, representing an overall incidence of 6.8%. These tumors occurred in a relatively young group of patients whose average age was 33.4 years at the time of transplantation and 40 years at the time of diagnosis of malignancy. The average latency period between transplantation and malignant disease was 7.4 years for solid tumors and 16 months for Kaposi's sarcoma. Tumors included 39 Kaposi's sarcomas, four malignant lymphomas, three hepatomas, two bladder cancers, one renal cell carcinoma of the allograft, two colorectal cancers, two thyroid cancers, one adenocarcinoma of unknown primary, one nasopharyngeal carcinoma and one leiomyosarcoma of the uterus. Kaposi's sarcoma was the most common malignancy and comprised 70% of all tumors in this study. It is imperative for renal transplant recipients to have diligent follow-up at regular intervals for early detection of cancer.
  3,007 311 -
Chyluria Associated with Renal Vasculitis
Kamel Abdulmohsen El-Reshaid, John Patrick Madda, Mahmoud Fuad Sherif
April-June 1998, 9(2):152-156
Chyluria is usually associated with abnormal retrograde or collateral flow of lymph from intestinal lymphatics into lymphatics of the kidney, ureter or bladder. Chyluria has been described in patients with lymphoma, carcinoma, trauma, abscess, tuberculosis, filariasis, pregnancy and stenoses of the thoracic duct. In this case report we describe a patient who presented with chyluria associated with severe hyperlipidemia due to nephrotic syndrome induced by microscopic polyangiitis. Laboratory, histological and radiological examination did not show evidence of filarial infestation, tuberculous infection or malformation of the lymphatic system. Treatment with corticosteroids and cyclophosphamide resulted in improvement of hyperlipidemia and disappearance of chyluria.
  2,825 346 -
Genetically Transmitted Renal Diseases in Children: A Saudi Perspective
Tej K Mattoo
April-June 1998, 9(2):105-109
A significant number of renal diseases in children occur as a result of genetic susceptibility. It is believed that such diseases, particularly those with an autosomal recessive transmission, may be more common in places with a high rate of consanguineous marriages as in the Middle East including the Kingdom of Saudi Arabia (KSA). Although a comparison of the published literature from the KSA with that from other countries outside the region support such a possibility, too few studies have been published from the region to definitely answer the question. Preliminary observations indicate that the children in the Kingdom probably have a higher incidence of polycystic kidney disease, familial juvenile nephronophthisis, congenital urological anomalies and familial nephrotic syndrome. It is reasonable to speculate that whereas some diseases may be common, others may be rare because of a low gene frequency in the local population.
  2,652 320 -
Adequacy of Hemodialysis: It is not Only Urea we Have to Monitor
Osman Alfurayh
April-June 1998, 9(2):110-115
  1,990 281 -
Survey of the Current Status of Renal Transplantation in the Arab Countries
Faissal A.M Shaheen, Muhammad Ziad Souqiyyeh
April-June 1998, 9(2):123-127
To evaluate the current status of renal transplantation in the Arab world, a questionnaire was mailed to prominent renal transplant physicians and surgeons in the Arab countries to get information related to number, donor type, immunosuppressive therapy used and survival of graft and patients who received renal transplantation. Furthermore, data about rehabilitation and legislation in the Arab countries were also included. The cost of renal transplantation was estimated from historical data. There were replies from 14 out of 22 (70%) countries with a total population of approximately 210 million (84%). Renal transplantation started in most of these countries in the late seventies and early eighties. In all but one, the renal transplant programs started with live related donations, and continued over the past 1 5-20 years with this type of donation. There have been 5,680 such operations, performed in a growing number of transplant centers. Legislation organizing donation from cadaveric donors has been established in only seven of the fourteen countries (50%) and, to date, there are only five countries with specialized centers to organize organ donation. The overall average graft survival is 87%, 80%, 60%, while patient survival is 96%, 85%, 70%, during one, five and ten years respectively. Full rehabilitation averaged 50%, partial rehabilitation averaged 40% and complete dependence averaged 10% after renal transplantation in the Arab countries. We conclude that there is still a need for more efforts to increase the number of renal transplantation, passing legislations that organize organ donation, and increase utilization of cadavers in renal transplantation in the Arab countries.
  1,814 259 -
Treatment of Post-transplant Erythrocytosis with Enalapril
N Akash, I Smadi, M El-Lozi
April-June 1998, 9(2):144-146
This prospective study was carried out to estimate the efficacy and safety of Enalapril therapy in post-transplant erythrocytosis. Thirteen long-term renal allograft recipients (11 males and two females) with increased hematocrit values (>51%) and elevated red cell mass were treated with Enalapril for 12 weeks; their age ranged from 18 to 54 years. At the end of the study period the mean hematocrit values decreased from 53.9% to 46.7%, red cell mass significantly decreased from 50.8 ml/kg to 40.5 ml/kg. During the following six months without Enalapril treatment, an increase in hematocrit was observed reaching a mean of 47.5%. In conclusion, enalapril can be safely and efficiently used to treat post-transplant erythrocytosis.
  1,757 212 -
Radionuclide Assessment of Patients with Urinary Tract Infection and Vesico-Ureteric Reflux Using Tc-99m-Dimercaptosuccinic Acid
Hussam Al-Kaylani
April-June 1998, 9(2):134-138
The purpose of this study was to evaluate pediatric patients with urinary tract infection and to identify the risk of developing renal scarring and its relationship to the presence of vesico-ureteric reflux. The subjects in this study were 29 pediatric patients between two months and 11 years of age with a history of urinary tract infection among which 69% were females. All the patients underwent radio-isotope scanning using Technetium-99-m-dimercaptosuccinic acid, 4-6 weeks after the eradication of the acute infection. Micturating cysto-urethrography and renal ultrasound examinations were performed before the radio-isotope scanning. Isotope scanning showed evidence of scarring in 34% of the kidneys, while ultrasound scanning was positive in only 29% of the kidneys. The agreement between the results of the two examinations was in 88% of the kidneys. Reflux was noted in 53% of the kidneys of which 62% showed scarring by isotope scanning. Only 11% of the kidneys with no reflux showed evidence of scarring, while 92% of kidneys with severe reflux had renal scarring. In patients with reflux, 57% of the kidneys in female patients and 50% of the kidneys in male patients developed renal scarring evident on DMSA scanning. Absence of reflux had a high predictive value for absence of renal scarring, while the presence of reflux did not necessarily imply the presence of renal scarring but the possibility increased with the severity of reflux.
  1,692 198 -
Acquired Cystic Renal Disease and Hemodialysis
Wahid Bhat, Sabita Desai, Ebeid Abdul
April-June 1998, 9(2):172-172
  1,190 194 -
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