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Saudi Journal of Kidney Diseases and Transplantation
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   2002| January-March  | Volume 13 | Issue 1  
 
 
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CASE REPORT
Post Transplant Acute Tubular Necrosis - How Long you can Wait?: A Case Report
Sameer Huraib, W Al Khudair, G Al Ghamdi, A Iqbal
January-March 2002, 13(1):50-54
PMID:18209413
Delayed graft function (DGF) is a common clinical problem occurring after cadaveric renal transplantation. Acute tubular necrosis (ATN) is one of the main causes of the DGF. Protracted recovery from ATN may continue for several weeks. We describe a case of prolonged oliguric ATN that lasted for more than three months with complete recovery of renal function. We discuss the contributing factors to the lengthy course of ATN and the known prophylactic and treatment strategies.
  12,154 610 -
EDITORIAL
The Role of the Clinical Pharmacist in the Care of Renal Transplant Patients
Monica Zolezzi
January-March 2002, 13(1):14-17
PMID:18209406
  8,486 1,119 -
CASE REPORT
Acute Renal Failure After Cardiac Catheterization and Coronary Artery Bypass Graft in an Elderly Patient
Muna Al Nimri, Maan Hadidi
January-March 2002, 13(1):55-59
PMID:18209414
We report the occurrence of atheroembolic disease in an elderly patient with coronary artery disease who had cardiac catheterization followed by coronary artery bypass graft. The patient developed acute renal failure and extra-renal manifestations with biochemical and clinical evidence of deep organ involvement which ended in death due to severe cardiac failure despite improvement of renal function.
  7,272 335 -
Visual Loss in Uremic Patients on Dialysis: A Case Report and Review of Literature
Nawal Ahmed Basri, Faissal AM Shaheen
January-March 2002, 13(1):45-49
PMID:18209412
We report a 40-year-old female patient who was on maintenance hemodialysis for end-stage renal disease. She was initially noted to have severe hypertension necessitating use of four anti-hypertensive drugs. Gradually, and with regular dialysis, her blood pressure normalized without any medications, and subsequently she was noted to have pre- and post-dialysis blood pressure respectively of 90/60 mm Hg and 70/40 mm Hg which was asymptomatic. Following one session of dialysis during which she had severe hypotension associated with dizziness and headache, corrected by saline infusion, she noticed loss of vision affecting both eyes. Detailed evaluation including fundoscopy, magnetic resonance imaging, fluorescein angiography, color doppler and electroretinogram was performed. Empirical treatment with pulse methyl prednisolone and plasma exchange did not help. A diagnosis of anterior ischemia optic neuropathy due to hypotension was arrived at. Our case suggests that intra-dialytic hypotension can be problematic and should be treated aggressively.
  6,103 445 -
EDITORIAL
Blood Pressure on Dialysis: An Ongoing Controversy
Eberhard Ritz, Jutta Pablick-Deetjen, Martin Zeier, Kerstin Amann
January-March 2002, 13(1):1-13
PMID:18209405
Based on apparently conflicting epidemiological data there has recently been considerable uncertainty and controversy concerning optimal blood pressure (BP) levels in patients on maintenance hemodialysis. It has also become obvious that it is not only the mean arterial pressure, but also the arterial pulse pressure profile, which impacts on hemodynamic stress and outcome. Epidemiological surveys document that, in the pre-dialysis state, up to 53% of chronically dialyzed patients have systolic BP above 140 mm Hg, but only 17% have diastolic BP values above 90 mm Hg. In other words, the systolic BP tends to be elevated, while the diastolic BP remains within normal limits. This constellation reflects the reduced elasticity of central arteries leading to increased pulse wave velocity and larger BP amplitude. Recent retrospective surveys created much uncertainty: they indicated that short-term survival was optimal when predialysis systolic BP values were between 130 and 180 mm Hg, higher values conferring little additional risk. In contrast, the risk of death was increased dramatically for BP values below 120 mm Hg. According to epidemiological studies in the general population, patients with low systolic BP are characterised by poor cardiac function and high cardiac risk. It has been observed that after such high-risk patients have died, in the long run, a continuous positive relationship exists between BP and survival. These observations are in agreement with what has also been observed in dialysis patients by Charra (Tassin, France). We are of the opinion that, in general, a pre-dialysis systolic BP in the low normal range is optimal for survival. This goal may not be achieved in all patients and may cause side effects so that it is necessary to individualize the approach. Rapid ultrafiltration carries the risks of sympathetic activation and intradialytic hypotension, which must be avoided. Relatively simple measures are effective in lowering blood pressure, e.g. low salt intake, reduction of dialysate sodium concentration, long slow and possibly more frequent dialysis sessions.
  5,402 546 -
CASE REPORT
Ischemic Monomelic Neuropathy: A Complication of Vascular Access Procedure
Malik Anas Rabbani, Aasim Ahmad, Syed Mansoor Ahmed Shah, Tahseen Mozzaffar, Mahesh Moolani, Syed Sohail Ali
January-March 2002, 13(1):60-62
PMID:18209415
Ischemic monomelic neuropathy (IMN) is an infrequently recognized type of ischemic neuropathy produced by shunting blood or acute occlusion of a major proximal artery in the extremities. IMN predominantly occurs in diabetic patients with evidence of peripheral atherosclerotic vascular disease and neuropathy. We report a case of ischemic monomelic neuropathy occurring in a diabetic patient with end-stage renal disease following the placement of polytetrafluoroethylene (PTFE) graft as a vascular access in the proximal upper arm for chronic hemodialysis.
  4,880 457 -
REVIEW ARTICLE
Anticoagulation for Hemodialysis and Hemofiltration
E Nigel Wardle
January-March 2002, 13(1):40-44
PMID:18209411
  4,252 499 -
ORIGINAL ARTICLE
Urinary Tract Infection and Vesicoureteral Reflux in Saudi Children
Alia Abdulrahim Al-Ibrahim, Rohin Dhar Girdharilal, Muhammad Akhter Chawdhry Jalal, Abdulaziz Hamed Alghamdy, Yosief Kamal Ghazal
January-March 2002, 13(1):24-28
PMID:18209408
This is a retrospective study of 82 children with urinary tract infection (UTI) evaluated for the prevalence of vesicoureteral reflux at a community hospital in Riyadh, Saudi Arabia from 1997 to 2000. There were 73 (89%) girls and nine (11%) boys; 58 (71%) were at an age between 1-5 years, 15 (18%) were between 0-1year and nine (11%) were more than 5 years of age. All patients were documented to have UTI by history and laboratory investigations. There were 29 patients (35%) who had acute pyelonephritis at the initial clinical presentation and 53 (65%) had recurrent UTI. Escherichia coli was the isolated bacterium from urine in 79(96.4%) patients. Thirty-four (41.5%) patients had vesicoureteral reflux (VUR); 17 (50%) had it bilaterally and 14 (41%) had renal scarring. There were 9/82 (11%) patients who had renal scarring without reflux. Twenty-six (77%) of the VUR patients had mild to moderate reflux (grade 1-3) and eight (23%) had severe reflux (grade 4-5). Two patients with bilateral reflux had mild to moderate reflux on one side and severe reflux on the other. The age of the patients with VUR was below one year in 11 (32%), between 1 year and 5 years in 21(62%), and between 6 and 12 years in two (6%) patients. There were 11/ 29 (38%) patients with acute pyelonephritis who had reflux. Follow-up of the VUR patients showed that reflux disappeared without surgical intervention in 15 (44%), improved in two (6%) to lower grade and worsened in two (6%) to higher grade. Seven (20.5%) patients underwent ureteral reimplantation; all of them had recurrent UTI and were more than one year of age. While on chemoprophylaxis, two (28%) of the reimplanted patients developed breakthrough infections and the remaining five (72%) had a radiological picture of chronic pyelonephritis. None of the study patients developed new scars, hypertension or renal failure during follow-up; the duration of follow­up was from 5 months to 3 1/2 years and only seven (20.5%) patients had less than one-year follow-up. We conclude that Saudi children with UTI below 7 years of age have high incidence of reflux and scarring especially in patients presenting with acute pyelonephritis. A multi center study is needed to evaluate the size of the problem and its complications in the Saudi children besides screening of the siblings of patients with reflux.
  3,600 383 -
Vascular Access Related Septicemia in Hemodialysis: A Focus on Bacterial Flora and Antibiotic Access Salvage
Anil K Saxena, BR Panhotra, Mohammed Naguib, DS Sundaram, CK Venkateshhappa, Wahid Uzzaman, Khalifa Al-Mulhim
January-March 2002, 13(1):29-34
PMID:18209409
A good vascular access is the lifeline of patients on long-term hemodialysis (HD) and anteriovenous fistula is considered the ideal access. Vascular access related septicemia (VARS) is the second most common cause of mortality among HD patients. Such infections could also lead to loss of vascular access unless specific measures are taken to preserve the accesses. The present study was designed to determine the incidence of septicemia, common bacterial flora involved, and impact of early, empirical antibiotic therapy on vascular access salvage among HD patients. This prospective study, involved 209 patients, undergoing long-term HD, from June 1996 to June 2000. A total of 85 (40.6%) developed VARS with predominance in females (63.7%), patients above 50 years of age (37.0%) and those having diabetes mellitus (25.1%). A total of 124 episodes of septicemia were recorded with an average of 1.23 episodes per 100 patient-months during the four year (10032 patient-months) study period. Peripheral blood samples for culture and sensitivity were collected and the patients were started empirically on amikacin-vancomycin combination which was modified after obtaining culture and sensitivity results. A cure was defined as 45 days symptom-free interval after antibiotic therapy was completed. Staphylococcus aureus was the commonest (29.0%) organism associated with VARS, followed by Pseudomonas aeruginosa (15.3%). The temporary vascular access group recorded maximum number of VARS episodes; [femoral catheter (FC) group, (43.5%), followed by subclavian (SC) group, (28.2%)] and the lowest (8.8%) was seen in the AVF group. Vascular access salvage rate of 48/85 (56.4%) and mortality of 22/85 (25.9%) was observed in the present study. Antibiotic access salvage with Amikacin­Vancomycin combination has an advantage of preserving vascular access sites in at least, 50% of cases.
  3,253 408 -
RENAL DATA FROM THE ARAB WORLD
Acute Renal Failure in Moroccan Children
Amal Bourquia, Fatima Chakib, Abdessadek Jennah, Amal Boughnama
January-March 2002, 13(1):66-70
PMID:18209418
To evaluate the etiology and prognosis of acute renal failure (ARF) in Moroccan children, we retrospectively studied 120 cases of ARF that presented to two centers in Casablanca, Morocco between 1982 and 1999. There were 72 (60%) boys and 48 (40%) females with age that ranged between six months and 15 years with a mean of 6.8 ± 5.0 years. All patients received appropriate medical treatment, while 76 (74%) patients required dialysis; peritoneal dialysis in 31 (40%) patients and hemodialysis in 45 (60%). Emergency dialysis was performed in 37 (48.7%) patients due to severe sodium and water overload and/or severe hyperkalemia, while dialysis was initiated in 39 (51.3%) because of high blood urea and creatinine levels. Predialysis serum urea nitrogen (BUN) exceeded 33 mmol/l in all of these cases and the mean was 51 mmol/l. The causes of ARF included acute glomerulonephritis (GN) in 61 (50.8%), hemolytic uremic syndrome (HUS) in 18 (15%), renal hypoperfusion in 12 (10%), acute interstitial nephritis in 9 (7.5%), urinary tract obstruction in 7 (5.9%) and the cause was not identified in 13 (10.8%). Mortality rate was 17%; recovery rate was higher in the non-oliguric patients. Outcome was favorable in 65% of the patients with glomerular disease. Most patients in this study did not require intensive care and none had neonatal ARF, which is known to carry poor prognosis.
  3,060 305 -
BRIEF COMMUNICATION
Use of Vascular Clipping System in Kidney Transplantation in Syria: A Study of 30 Cases
Mohammed Mustafa Al-Habash, Mohammed Bassam Al-Shaer
January-March 2002, 13(1):35-39
PMID:18209410
The aim of this study is to report our experience in the use of vascular clipping system (VCS) in kidney transplantation (KT), and to discuss its potential clinical benefits for the patients compared with the traditional anastomosis method (suture method). Between October 1985 and December 2000, 350 cases of KT from living related donors (LRD) were performed in the Kidney Transplantation Unit at the Al-Mouassat University Hospital in Damascus, Syria. Between October 1999 and December 2000, 30 cases (21 males and 9 females) of KT were performed using VCS. The mean age of the patients was 32.7 years (14-52). HLA typing showed HLA haplo­identical matching in 22 patients and HLA identical matching in eight. Twenty left kidneys and 10 right kidneys were resected from LRD. VCS was used in 22 arterial and 30 venous anastomosis. We used the Vascular Clip Applier/large 2.0-Auto suture Company-Connecticut-USA. Vessel anasto­mosis was performed end to end between renal and hypogastric arteries and end to side between renal and external iliac vein for all 30 patients. Immunosuppression treatment was with cyclosporine, azathioprine and prednisolone in all patients. The follow-up period was 5-16 months. All the patients were alive at the end of the follow-up period. The other cases of KT (320 patients) were performed by traditional anastomosis method (suture). The time of arterial anastomosis was 12-20 minutes (mean 16) for the suture method versus 7-10 minutes (mean 7.5) for the VCS method The time of venous anastomosis was 15-25 minutes (mean 20) for the suture method versus 7-9 minutes (mean 8.5) for the VCS method. The number of transfused packed red cell units per operation was 1-2 units in the suture method versus 0-1 unit in the VCS method. We observed 17 cases of acute tubular necrosis (ATN) in the 320 cases in whom the suture method was used versus no case in the 30 patients receiving VCS. Vascular anastomosis using VCS shortens the warm ischemia time, reduces packed red cell units transfused and the occurrence of ATN, and thus improves the function of kidney graft.
  3,051 281 -
ORIGINAL ARTICLE
The Biochemical Status of Vitamin A and Alpha-tocopherol during Different Stages of Renal Disease and its Relationship to Diabetes
Monira A Abahusain, Nora N Al-Nahedh
January-March 2002, 13(1):18-23
PMID:18209407
The status of vitamin A, α-tocopherol and retinol binding protein (RBP) was investigated in 34 type 2 diabetic patients with renal impairment (mean serum creatinine 176 µmol/L), 26 type 2 diabetic patients with chronic renal failure (CRF) (mean serum creatinine 629 µmol/L) and 19 non-diabetic patients with CRF. In renal failure patients, the change in response to the dialysis procedure over the time for all the measured parameters was evaluated. Fasting plasma retinol, α-carotene, β-carotene and α-tocopherol were determined by high-pressure liquid chromatography. The concentrations of RBP in plasma were determined by a double antibody sandwich enzyme linked immunosorbent assay. Concentrations of retinol, RBP and β-carotene were significantly higher in diabetic patients with CRF than in diabetic patients with renal impairment or in non-diabetic patients with CRF. A significant decrease was found for the concentrations of β-carotene (p<0.003) and RBP (p<0.003) in response to the dialysis procedure. Retinol/RBP ratio significantly increased with time (p<0.0004). Serum creatinine concentrations were associated with the increased plasma RBP indicating that RBP may be dependent on renal function and changes in levels of RBP in serum may be used in the assessment of renal function.
  2,645 416 -
LETTER TO EDITOR
Chronic Hypotension in Hemodialysis Patients: Is it a Contra-indication to Renal Transplantation?
Khaled Charfeddine
January-March 2002, 13(1):63-64
PMID:18209416
  2,431 233 -
RENAL DATA FROM THE ARAB WORLD
Renal Transplant Pathology: Bahrain Experience
KS Ratnakar, Sara George, BN Datta, Al Hilli Fayek, S Rajagopalan, Eman Fareed, Mohammed Al Tantawi, Sameer Al Arrayed, Ahmed Al Arrayed
January-March 2002, 13(1):71-76
PMID:18209419
A ten-year retrospective study on renal transplant biopsies performed at the Salmaniya Medical Complex, Bahrain was performed. The histological changes were classified according to Banff 1997 working classification of renal allograft pathology. A semi quantitative scoring was also given as per the guidelines. Out of a total of 26 cases, 10 belonged to hyperacute and acute forms, while 11 could be categorized to chronic sclerosing allograft nephropathy. In the remaining five, the graft pathology was unrelated to the rejection process. Despite effective management, four cases underwent nephrectomy due to severe vascular rejection. An interesting feature was recorded in two cases in whom transmural arteritis followed chronic histological changes. Presence of tubular atrophy and interstitial matrix increase were considered useful parameters for assessing the severity in cases with chronic allograft nephropathy.
  2,305 285 -
LETTER TO EDITOR
Treatment of Progressive IgA Nephropathy
E Nigel Wardle
January-March 2002, 13(1):63-63
PMID:18209417
  1,355 254 -
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