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Saudi Journal of Kidney Diseases and Transplantation
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   2003| April-June  | Volume 14 | Issue 2  
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Intravenous Iron Saccharate Complex: Guidelines for its use in the Management of Anemia of Renal Disease
Monica Zolezzi
April-June 2003, 14(2):129-133
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Snake Bites and Acute Renal Failure
HS Kohli, V Sakhuja
April-June 2003, 14(2):165-176
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Unusual Presentations of Wegener's granulomatosis: Pitfalls in Early Diagnosis
Syed Mansoor Ahmed Shah, Malik Anas Rabbani, Ambreen Gul, Aasim Ahmad
April-June 2003, 14(2):177-185
Wegener's Granulomatosis (WG) is a disorder characterized by necrotizing granulomatous vasculitis that primarily affects the upper and lower respiratory tracts and the kidneys. Although the cause is unknown, there is strong evidence that this is an autoimmune disease and immunosuppressive therapy with cyclophosphamide and corticosteroids efficiently relieves the symptoms and, prevents relapses. We report on four cases of WG that presented with unusual features. The first patient presented with vague joint pain, blackish discoloration of the skin and leg ulcers. The second patient presented as fever of unknown origin and gingival hyperplasia. The third patient presented with hearing loss while the fourth presented with arthritis, conjunctivitis and painful swelling of the ear. It is emphasized that WG is a complex disease and can involve multiple organ systems. Early recognition and institution of proper treatment are crucial for optimal outcome.
  6,183 458 -
Systemic Lupus Erythematosus with Distal Renal Tubular Acidosis Presenting as Hypokalemic Paralysis with Respiratory Failure
Parvaiz Ahmad Koul, Abdul Wahid, Bashir Ahmad Shah
April-June 2003, 14(2):190-193
An eighteen-year-old woman presented with hypokalemic respiratory failure. She was found to have distal renal tubular acidosis (dRTA) as the underlying cause for hypokalemia. This was treated successfully, and no apparent etiology for the dRTA was discovered. Three years later she presented with full-blown picture of systemic lupus erythematosus (SLE) together with features of persistent dRTA complicated, this time, with bilateral renal calculi and nephrocalcinosis. It is very likely that the dRTA was an early feature that preceded the other markers of SLE. The moral of this case is that patients with dRTA should be followed-up carefully as a primary cause for the dRTA may show up in-due-course and to monitor the treatment so as to prevent long-term complications of the RTA.
  5,864 612 -
The Superior Vena Cava Syndrome: Late Presentation after Hemodialysis Catheter Removal
Nabieh Al-Hilali, Mangalathillam RN Nampoory, Vadakethu T Ninan, Fawzia MY Hussein, Jaber H Ali, Mahmoud Samhan, Kaivilayil V Johny
April-June 2003, 14(2):186-189
The superior vena cava (SVC) syndrome is due to obstruction of the SVC and may present by dyspnea, chest pain, cough, headache, dysphasia, and symptoms of increased intracranial pressure; however, the affected patients can be asymptomatic. Numerous collateral veins are often seen on the upper chest, arms and neck. The syndrome may be caused by prolonged use of indwelling catheters, but is an infrequently reported complication in the hemodialysis patients. We report two patients who developed SVC syndrome several months after removal of hemodialysis indwelling catheters. The causes of this syndrome in our patients were stenosis in one patient and thrombosis in the other; venous endothelial injury and subnormal levels of protein C and S were possible contributory factors. These cases illustrate that SVC syndrome is a possible late complication after removal of hemodialysis indwelling catheters.
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Brachiocephalic Vein Stenosis in a Patient with End-Stage Renal Disease Without Prior Central Vein Cannulation
AR Fauzi, V Jeyabalan, Norella CT Kong, Tamil Selvam
April-June 2003, 14(2):194-196
Central vein stenosis is usually associated with previous cannulation or trauma to the affected vein. This pathology may present as ipsilateral arm swelling in patients in whom a recent arteriovenous fistula has been prepared for chronic hemodialysis. The presence of central vein stenosis without prior trauma or cannulation is not hitherto reported to the best of our knowledge. We herewith report a patient with end-stage renal disease who was initiated on chronic dialysis using an arteriovenous fistula, who was noted to have central vein stenosis. This was despite her never having had any central vein cannulation or previous known trauma. Venogram confirmed the presence of brachiocephalic vein stenosis. The patient underwent venographic stenting of the involved vein with good success.
  5,163 347 -
Levamisole Therapy as a Second-line Immunosuppressive Agent in Corticosteroid-sensitive Nephrotic Syndrome in Children
Alia Abulrahim Al-Ibrahim, Salah Mohammad Al-Kharraz, Dalal Meshari Al-Sadoon, Ahmad Jamil Al -Madani, Suleiman Abdulkarim Al-Musallam
April-June 2003, 14(2):153-157
To evaluate the effect of levamisole therapy combined with corticosteroid in children with nephrotic syndrome and frequent relapses (FR) or steroid dependence (SD), we studied retrospectively 24 children (18 boys and six girls) with a mean age of 32 months. Eleven (46%) patients had FR and 13 (54%) had SD. Levamisole was used for a mean period of 8.5 months. The relapse rate decreased from a mean of 4 relapses/year during steroid therapy alone to 1.3 relapses/ year during the combined therapy in 17 (71%) of the patients. Remission was sustained, after discontinuing levamisole, for more than six months in 11 of the 17 responders (65%), and six patients relapsed after discontinuing levamisole. Seven of the 24 study patients (29%) had no response to levamisole. The seven patients who failed to respond to levamisole and the six initial responders who could not maintain remission after discontinuing the drug were treated with cyclophosphamide for 12 weeks. Eight of these patients (61.5%) had remission sustained for a mean duration of 10 months. The FR patients sustained remission for a longer period of time than SD patients in both groups. Levamisole was more effective than cyclophosphamide in patients with the age of onset of the disease above 2 years (10 patients out of 11 (91%). The side effects of levamisole and cyclophosphamide in our patients were transient and manageable. We conclude that levamisole is a safe and effective drug if combined with corticosteroid therapy in children with nephrotic syndrome. Further studies may be required.
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The Use of Alphacalcidol Intravenously in Hemodialysis Patients: Experience from Bahrain
Sameer Al-Arrayed, Rajagopalan Seshadri, Sivamohandas Nagalla, Mohammed Hussain Al- Khayyat
April-June 2003, 14(2):158-164
While the effects of vitamin D, one-alphahydroxycholecalciferol (alphacalcidol) administered intravenously on the serum levels of parathormone (PTH) and calcium in dialysis patients have been well studied in the past few years, no detailed studies were conducted in patients from this part of the world. We studied nine patients (four men and five women) who received this drug for 12 weeks. The mean age of the patients was 54.4 ± 19.8 (range: 23-81) years and the duration on dialysis was 40.1 ± 15.6 (range: 18-62) months. The patients were selected on the basis of baseline serum intact PTH values of more than twice the upper limit of normal; all of the patients were on oral alphacalcidol, which was stopped before the study. Alphacalcidol was administered during the last fifteen minutes of each dialysis session, three times per week. The dose of the drug was upregulated weekly to a maximum of 6µg per session according to the degree of suppression of PTH and/or the development of hypercalcemia. The results showed a significant decrease of the mean serum PTH from baseline of 77.58 ± 49.13 to 41.87 ± 48.87 pmol/L (p<0.02). Serum phosphate 2.01 ± 0.27 and calcium 2.38 ± 0.25 did not change significantly from baseline . None of the patients developed local or systemic adverse reaction to the injection; only one patient developed hypercalcemia requiring short interruption of the vitamin D with later resumption at a lower dose. In conclusion, alphacalcidol administered intravenously is effective and safe in hemodialysis patients.
  3,719 263 -
Vesicoureteric Reflux
Issa Hazza, Edward Saca
April-June 2003, 14(2):123-128
  3,661 239 -
Spectrum of Tuberculosis in Dialysis Patients in Saudi Arabia
Ghulam Hassan Malik, Suleiman Ali Al-Mohaya, Ali Swaid Al-Harbi, Mohammad Kechrid, Osman Azhari, Sabry Shetia, Mohammad Amin Tashkandy, Khursheed Ahmad, Abdul Waheed Bhat, Mohammad Ashraf Want, PT Subramanian, Nussrullah Abutaleb, Ayman Karkar
April-June 2003, 14(2):145-152
Data from different regional hospitals of Saudi Arabia were collected to know the prevalence, clinical features and results of therapy of tuberculosis, in patients on dialysis. Eight hospitals located in five different provinces of Saudi Arabia were involved. There were 132 patients with TB on dialysis of whom 75 were males (mean ages in different hospitals ranging 42­58 years) and 57 were females (mean ages ranging 38-58 years). The prevalence of TB in these patients varied from 2.4 to 14.5% with an average of 7%, which is 12 times commoner than in the general population of Saudi Arabia. The presenting clinical features were fever (65%), cough (17%), weight loss (59%) and anorexia (58%). The organs/systems involved by TB were pulmonary in 73 (55.3%), lymphadenopathy in 30 (22.7%) peritoneal in 27 (20.4%) and bone in seven (5.3%). The diagnosis of TB was made by X-ray chest in 73, positive acid fast bacilli in sputum in 38, lymph node biopsy in 30, ascitic fluid examination in 20 and other tests in 17 patients. Four anti-TB drugs namely, isoniazid (INH), rifampicin (Rif), ethambutol (Eth) and pyrazinamide (Pyra) were used in 58 patients (44%) for six months; three drugs namely, INH, Rif, and Eth or Pyra were used in 61 patients (46%) for a variable period of six to 12 months. A total of 28 (21%) patients expired, eight while on therapy, one before starting the therapy and 19 after they were cured of TB. The main causes of death were sepsis in eight (28.5%), cardiovascular in seven (25%) and sudden death in six (21%). TB was not the direct cause of death in any of the patients except one, in whom it could be contributory.
  3,505 375 -
Histopathological Profiles of Nephropathies in Senegal
Niang Abdou, Diouf Boucar, KA El Hadj Fary, Mbengue Mouhamadou, Leye Abdoulaye, KA Mamadou Mourtala, Diallo Saidou, Pouye Abdoulaye, Moreira-Diop Therese
April-June 2003, 14(2):212-214
Few data from West Africa are available on the prevalence of the different kidney diseases. One hundred fifteen patients underwent renal biopsy in the nephrology department in Dakar from 1993 to 1998. Nephrotic syndrome was the main indication of biopsy (67%). The primary nephropathies were found in 69.5% of the patients, the secondary nephropathies in 23.5% and unclassified nephropathies in 7%. Of the primary nephropathies, focal segmental glomerulosclerosis was found in 47% of the patients followed by membranous glomerulopathy in 12.5%. Secondary nephropathies were dominated by lupus nephritis followed by tubulo-interstitial toxic nephritis, misnamed as "tropical nephropathy", due to the intake of local home remedies.
  3,239 377 -
Hepatitis C Virus Among Hemodialysis Patients in Najran: Prevalence is More Among Multi-Center Visitors
Abul Kashem, Ibrahim Nusairat, Mirvat Mohamad, Mohamad Ramzy, Jaisimha Nemma, Mohd. Rezaul Karim, MP Divakaran, Abdul Shakoor Tayaab
April-June 2003, 14(2):206-211
We studied a population of hemodialysis (HD) patients in the Najran region of Saudi Arabia to assess the prevalence of hepatitis C virus (HCV) and to evaluate the possible risk factors associated with this infection. The records of 90 patients undergoing dialysis in two centers of this region were reviewed. Blood samples were screened for anti­HCV antibodies by enzyme linked immunosorbent assay (ELISA) and positive samples were tested for confirmation by recombinant immunoblot assay. Liver transaminases were measured to assess the activity of the virus. In this study, an overall HCV prevalence of 46.7% was found among the HD patients. Statistical analysis showed that the number of previous blood transfusions, duration of dialytic age and dialysis treatment in multi-centers were associated significantly with HCV seropositivity. Although the mean levels of liver enzymes were significantly higher in HCV-positive than in HCV-negative patients, enzyme levels were raised above normal in only 29% of the patients.
  3,201 324 -
Attitude of Physicians Towards Iron Supplementation in Hemodialysis Patients Treated with Erythropoietin
Muhammad Ziad Souqiyyeh, Faissal AM Shaheen
April-June 2003, 14(2):134-144
This study was performed to evaluate the attitude of the physicians in Saudi Arabia towards iron supplementation in hemodialysis patients treated by recombinant human erythropoietin (r-HuEPO). A questionnaire was sent to 174 physicians in the 133 active dialysis centers in Saudi Arabia; 99 (74.5%) centers in Ministry of Health (MOH), 14 (10.5%) in governmental non-MOH institutions and 20 (15%) in the private sector, who collectively looked after more than 7300 chronic hemodialysis patients of whom 4745 (65%) were on erythropoietin therapy. A total of 149 out of 174 (85.6%) physicians answered the questionnaire. Of them, 90 (60.4%) had a protocol for intravenous (i.v.) iron administration, 117 (78.5%) utilized serum ferritin and 75 (50.3%) utilized transferrin saturation (TS) ratio for the evaluation of iron stores in their patients. There were 97 respondents (88%) who would initiate i.v. iron during the induction therapy of r-HuEPO in case of absolute iron deficiency, 44 (54.3%) in case of borderline iron deficiency, 38 (48.1%) in case of functional iron deficiency and only eight (10.6%) in case the values of the ferritin and TS were higher than normal. There were 100 respondents (76.3%) who believed that i.v. iron supplements could decrease the dose of r-HuEPO and 123 (91.1%) believed that i.v. iron could improve the hematocrit response to r-HuEPO. Furthermore, there were 95 (87.2%) respondents who would use iron saccharate as the iron preparation of choice, 70 (52.2%) believed that iron saccharate caused less hypersensitivity than iron dextran while 84 (75%) had no idea about the cost of i.v. iron preparations. There were 74 (55.6%) respondents who would administer high iron loading dose over a short period and 87 (66.9%) would follow the guidance of the lab tests during the maintenance phase of the r-HuEPO replacement therapy. Our study suggests that a protocol for i.v. iron supplementation is lacking in many centers. There is a need to increase awareness of the physicians working in those centers to the importance of i.v. iron therapy.
  2,511 297 -
A Database for the Management of Histocompatibility and Immunogenetics Results of Renal Transplantation Patients
Ali Hajeer, Samir Issa, Hana Fakhoury, Samir Huraib, Ghormallah Al Ghamdi, Ahamad Flaiw, Abdulmajeed Alabdulkareem
April-June 2003, 14(2):197-201
To establish a multi-relational database to include data on renal transplantation patients' HLA results, panel reactive antibodies (PRA), antibody crossmatching, blood transfusions and cytokine gene polymorphisms, we designed a database using a Microsoft office application, Access®. Accordingly, any combination of the results' tables can be obtained in one single table. We believe that Access® is a good tool to organize the collected data on renal transplant patients and may serve to obtain fast reports on patients and enhance research.
  2,366 268 -
Telmisartan in Hemodialysis
Julen Ocharan-Corcuera, J Montenegro, R Sracho, I Martinez
April-June 2003, 14(2):202-204
  2,237 295 -
How Harmless are Herbal Remedies on Human Kidneys?
Anil K Saxena
April-June 2003, 14(2):205-206
  2,120 283 -
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