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Saudi Journal of Kidney Diseases and Transplantation
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   2003| January-March  | Volume 14 | Issue 1  
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Comparison of HLA Class I and II Molecular and Serological Typing within Clinical Laboratory
Khaled Ayed, S Ayed Jendoubi, M Makhlouf, I Sfar, T Ben Abdallah
January-March 2003, 14(1):39-42
In order to develop an adequate tissue typing strategy, we performed human leukocyte antigen (HLA)-A, B and DR generic typing on 235 (120 HLA-A, B and 115 HLA-DR) routine clinical samples by polymerase -chain reaction (PCR)-SSP in parallel with conventional serological typing. At the A locus, there were two (1.7%) discrepancies between molecular and serological typing besides 25 (20.8%) serological blanks, which was defined by molecular typing. At the B locus, there were two (1.7%) discrepancies and 30 serological blanks, which were defined by molecular typing. At the DR locus there were two (1.8%) discrepancies and 44 serological blanks, which were defined by molecular typing. We conclude that molecular typing is of substantial benefit in the resolution of poorly defined serological antigens. In view of the low percentage of discrepancy between the serological and molecular typing besides the high cost of molecular typing, our policy is to perform HLA typing first by the serological method and to use PCR-SSP as an adjuvant tool.
  8,054 941 -
Development of SF-36 Questionnaire in the Measurement of Quality of Life in Patients on Renal Replacement Therapy in Iran
Darab Mehraban, Gholamhossain Naderi, Massoud Salehi
January-March 2003, 14(1):15-17
The measurement of quality of life in patients with chronic diseases such as renal insufficiency has come under increased attention recently. Many questionnaires have been developed and tested in terms of applicability, validity and reliability in different centers according to different cultural and geographical circumstances. The current study is contemplated to determine the reliability of the short form 36-item (SF-36) questionnaire related to quality of life that was translated into Farsi and modified by adding 25 specific items related to renal replacement therapy. The modified questionnaire was tested on 10 transplant patients within 6-12 months after operation. The test to retest time interval was three weeks. The answers to the questionnaire were obtained during a direct interview. The total reliability coefficient (RC) was 0.70. Deletion of items 20, 49 and 52 increased the RC to 0.75. Conclusion: this study shows that there is a considerable change of opinion in relation to the contents of the items between test-retest. Therefore, to refine this situation, there is a need to reconsider the contents of the items in the future studies.
  5,700 520 -
Tuberculous Peritonitis in Patients on Chronic Peritoneal Dialysis: Case Reports
Ghulam Hassan Malik, Ali Swaid Al-Harbi, Suleiman Al-Mohaya, Mohammad Kechrid, Mohammad Sabry Sheita, Osman Azhari
January-March 2003, 14(1):65-69
Two cases of tuberculous (TB) peritonitis on chronic peritoneal dialysis (PD) are described. The cases were diagnosed by positive acid fast bacilli (AFB) culture from the PD fluid effluent. Catheter removal and transfer to hemodialysis were needed in one, while the other remained on continuous ambulatory peritoneal dialysis. The patients recovered with antituberculous therapy. A high index of suspicion for early diagnosis and treatment is emphasized. A six-month course of anti-TB drugs for TB peritonitis is a viable option of therapy.
  4,918 383 -
Malignancy and Chronic Renal Failure
Ramon Peces
January-March 2003, 14(1):5-14
Increased incidence of cancer at various sites is observed in patients with end-stage renal disease (ESRD). Certain malignant diseases, such as lymphomas and carcinomas of the kidney, prostate, liver and uterus, show an enhanced prevalence compared with the general population. In particular, renal cell carcinoma (RCC) shows an excess incidence in ESRD patients. A multitude of factors, directly or indirectly associated with the renal disease and the treatment regimens, may contribute to the increased tumor formation in these patients. Patients undergoing renal replacement therapy (RRT) are prone to develop acquired cystic kidney disease (ACKD), which may subsequently lead to the development of RCC. In pre-dialysis patients with coexistent renal disease, as in dialysis and transplant patients, the presence of ACKD may predispose to RCC. Previous use of cytotoxic drugs (eg, cyclophosphamide) or a history of analgesic abuse, are additional risk factors for malignancy. Malignancy following renal transplantation is an important medical problem during the follow-up. The most common malignancies are lymphoproliferative disorders (early after transplantation) and skin carcinomas (late after transplantation). Another important confounder for risk of malignancy after renal transplantation is the type of immunosuppression. The type of malignancy is different in various countries and dependent on genetic and environmental factors. Finally, previous cancer treatment in a uremic patient on the transplant waiting list is of great importance in relation to waiting time and post-malignancy screening.
  4,617 665 -
Lupus Nephritis in Childhood
Abdullah A Al Salloum
January-March 2003, 14(1):43-56
The manifestations of lupus nephritis (LN) range from minor abnormalities detected on urinalysis to severe renal insufficiency requiring renal replacement therapy. In children, LN is often more severe than in adults. The female to male predominance is not as marked as in adults. The risk of progression to end-stage renal disease in children is 18 to 50%. The majority of children with LN have proteinuria, while the nephrotic syndrome is seen in approximately 50% of affected patients. Children with LN have higher frequency of hypertension which is considered as the most important prognostic clinical finding. The current practice of estimation of complement components, C 3 and C 4 does not adequately reflect disease activity. There are racial differences in renal survival and response to treatment. Arab patients with LN do not exhibit a distinctive serological profile. Lupus nephritis is classified into six groups depending on the severity of the histological lesion. Transformation between the histological classes occurs frequently. Histological outcome predictions have been significantly enhanced by the addition of activity and chronicity indices. Treatment of the LN may be guided by the severity of the renal biopsy appearances. Controversy persists as to the most effective cytotoxic treatment in LN and oral or intravenous (i.v.) cyclophosphamide, azathioprine, cyclosporin, i.v. immunoglobulin, plasma exchange and recently mycophenolate mofetil have been used in different units. Today, children with LN much less commonly go into renal failure. Outcome after renal transplantation of children with end-stage renal disease caused by LN is similar to non-lupus patients. Morbidity of the disease and the treatment remain a major problem.
  4,592 655 -
The Prevalence of Nasal Carriage of Staphylococcus aureus and Associated Vascular Access-Related Septicemia Among Patients on Hemodialysis in Al-Hasa Region of Saudi Arabia
Anil K Saxena, BR Panhotra
January-March 2003, 14(1):30-38
A high Staphylococcus aureus nasal carriage rate is frequently seen among patients on hemodialysis (HD) and consequently, these patients appear to be at a higher risk for endogenous S. aureus associated vascular access-related septicemia (VARS). The prevalence of nasal carriage of S. aureus and it's impact on VARS with particular reference to age, sex and type of vascular access was studied in an HD cohort to recognize the most susceptible group(s) and plan prophylactic strategies accordingly. This study involved 208 end-stage renal disease (ESRD) patients on long-term HD from July 1997 to July 2000. Five standardized swabs from the anterior nares were taken. Persistent nasal carriage was defined by two or more positive cultures. Peripheral blood samples for culture and sensitivity were collected on clinical suspicion of septicemia. An overall prevalence of nasal carriage of 38.0% was observed. Nasal carriage rates were 85.7% among 75-84 year's and 50.0% in 65-74 year's age-groups. Central venous catheters (CVCs) recorded nine folds greater collective risk of developing S. aureus nasal carriage­related VARS than non-carrier group. No significant difference in S. aureus related incidence of VARS between non-carrier and nasal carrier groups was observed among those dialyzed through arteriovenous fistula (AVF). Elderly (>65 years) nasal carriers dialyzed through Central Venous Catheters, formed a high-risk group for S. aureus nasal carriage related VARS. The optimization of AVF placement might offer a safer, non-phamacological approach to reduce the S. aureus nasal carriage-related VARS besides possibly much desirable improvent in the quality of life of our senior citizens through decline in the frequency of hospitalizations.
  4,020 380 -
Paralysis Episodes in Carbonic Anhydrase II Deficiency
Alia Al-Ibrahim, Mosa Al-Harbi, Sulaiman Al-Musallam
January-March 2003, 14(1):70-74
Carbonic anhydrase II (CAII) deficiency is an autosomal recessive disorder manifest by osteopetrosis, renal tubular acidosis, and cerebral calcification. Other features include growth failure and mental retardation. Complications of the osteopetrosis include frequent bone fractures, cranial nerve compression, and dental mal-occlusion. A hyper­chloremic metabolic acidosis, sometimes with hypokalemia, occurs due to renal tubular acidosis that may be proximal, distal, or more commonly, the combined type. Such patients may present with global hypotonia, muscle weakness or paralysis. We report a case of CA II deficiency with recurrent attacks of acute paralysis which was misdiagnosed initially as Guillian-Barre syndrome.
  3,691 378 -
Ochoa Syndrome: New Features
Fakherah N Al-Qahtani
January-March 2003, 14(1):61-64
  3,423 354 -
Asymptomatic Gastric Angiodysplasia in Chronic Hemodialysis Patients: Case Reports
K Charfeddine, K Kammoun, M Kharrat, S Yaich, K Mkawar, F Jarraya, H Bahloul, J Hachicha
January-March 2003, 14(1):57-60
Gastrointestinal (GI) angiodysplasia is a vascular lesion. It is a common cause of GI bleeding in chronic renal failure (CRF). We report three adult chronic hemodialysis patients with asymptomatic angiodysplasia. Over a period of four years, the hemoglobin level was stable and none of our patients received iron supplementation or erythropoietin (EPO) therapy. Incidence of angiodysplasia may be underestimated in the CRF patients. Further studies may be needed.
  2,955 296 -
The Predictors of Early Mortality in Patients Starting Chronic Hemodialysis
S Gmar-Bouraoui, H Skhiri, A Achour, A Frih, N Ben Dhia, S Hammami, M El May
January-March 2003, 14(1):23-29
To evaluate the predictors of early mortality in patients on chronic hemodialysis, we reviewed the records of 192 patients starting chronic hemodialysis at our centre between January 1996 and September 1999. The overall incident mortality within 90 days was 32 (16.7%) patients. The cardiovascular causes accounted for 50% of all the causes of mortality. By using multivariate stepwise logistic regression analysis, early mortality rate was not significantly increased in the comparison of age or gender groups but increased in patients with diabetes mellitus, as well as those with reduced dialysis frequency. The most powerful predictor of survival was serum albumin level of less than 30 g/l. Thus, the survival rates in patients with serum albumin less than 30 g/l and those with serum albumin equal to or greater than 30 g/l were 67.8% and 90.2%, respectively, (p<0.001). The odds ratio was 4.68. We conclude that these findings suggest that the important predictors of early mortality in the first 90 days of starting hemodialysis include the presence of diabetes mellitus, the decreased frequency of dialysis sessions and the presence of low serum albumin. The low serum albumin below 30 g/l was the strongest predictor of early mortality.
  2,818 398 -
Causes of Chronic Renal Failure at one Center in Yemen
Muhamed Al-Rohani
January-March 2003, 14(1):80-83
Chronic renal failure (CRF) remains a significant cause of mortality in Yemen. There are about 568 patients with end-stage renal failure (ESRD) who receive chronic hemodialysis in seven centers in Yemen. We studied 372 CRF patients admitted for evaluation at our center from June 1997 to December 2000 in order to determine the pattern of etiology of their renal disease. Of the study patients, 253 (68%) were males and the age ranged from 4 to 80 years with a mean of 42.7 ± 38 years. There were 215 (57.8%) patients who had unknown causes of CRF, followed by post-renal causes such as urolithiasis and pyelonephritis. Hyper­tension and diabetes mellitus were the least encountered etiologies in our study patients. There were 243 (66.3%) patients who required dialysis because of symptoms and signs of advanced renal failure; 60.2% of them were hypertensive, 80.3% were anemic with a mean hemo­globin of 79.6 gm/l, 26.9% were hyperkalemic, 52.6% were hypocalcemic and 61.0% had hyper­phosphatemia. We conclude that there are serious diagnostic and therapeutic problems in our health-care system that need addressing in order to improve health care.
  2,493 324 -
Hepatitis C Virus Infection Among Patients on Hemodialysis in Jeddah: A Single Center Experience
Abdulla Mohammed Y Al-Jiffri, Rehab B Fadag, Tawfik M Ghabrah, Adel Ibrahim
January-March 2003, 14(1):84-89
The aim of this study was to evaluate the prevalence of hepatitis C virus (HCV) in the hemodialysis (HD) population in Jeddah and its risk factors. We studied 248 patients on HD in the Jeddah Kidney Center, Jeddah, Saudi Arabia. The overall prevalence of HCV among these patients was 72.6%. Hepatitis C positive males (77.2%) were more than hepatitis C positive females (65.7%) (p<0.05). A significantly increasing annual prevalence of HCV infection among HD patients was found. It ranged from 16.4% among patients who were on HD for one year to 94.5% among those on HD for three or more years (p<0.05). Also, 78% of those who utilized more than one center acquired HCV infection compared to 64.3% of those who were treated exclusively at the Jeddah Kidney Center, (p<0.05). In this study, 75.8% of HCV positive patients had received blood transfusions while 61.1% of HCV positive patients had never received blood transfusion, (p<0.05).
  2,218 324 -
Impacts of Intifada on Renal Services
Faisal M Ali Abu Shahla
January-March 2003, 14(1):1-4
  2,213 175 -
Recurrent Ventricular Tachycardia-in Patients for Kidney Transplant
Parshotam Lal Gautam, Suneet Kathuria, Tej K Kaul, Gurpreet Singh Wander
January-March 2003, 14(1):75-76
  2,011 176 -
Risk Factors for Developing End­-Stage-Renal-Failure among Diabetic Patients: A Retrospective Analysis
Abdulla Mohammed Y Al-Jiffri, Rehab B Fadag, Tawfik M Ghabrah, Adel Ibrahim
January-March 2003, 14(1):77-80
  1,878 261 -
Role of Sequential Biopsy Study in the Evaluation of Renal Transplant
Kamaraju Suguna Ratnakar, Fayek Al Hilli, Sara Mathew George, Sameer Al Arrayed, Ahmed Al Arrayed
January-March 2003, 14(1):18-22
Renal biopsy is indicated in all cases of renal transplants showing renal dysfunction. This not only helps in the diagnosis but also in the institution of proper management. Study of sequential biopsies is essential for establishing the cause of renal dysfunction, evaluation of the effect of treatment and the progress of the disease. This report is based on the study of 14 samples (including three nephrectomy specimens) belonging to six patients who underwent two or more sequential renal transplant biopsies at the Salmaniya Medical Centre, Bahrain, between 1995-2000 because of deteriorating renal functions. Based on the sequential biopsies, the graft dysfunction was attributed to rejection in four cases and recurrence of primary glomerular disease in two. An important finding in this series is one case of type I membranoproliferative glomerulonephritis due to hepatitis C noticed five years after transplant and two cases of acute vascular rejection superimposed upon chronic rejection.
  1,888 218 -
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