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Saudi Journal of Kidney Diseases and Transplantation
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   2008| March-April  | Volume 19 | Issue 2  
    Online since March 1, 2008

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Comparative Evaluation of Renal Findings in Beta-Thalassemia Major and Intermedia
Derakhshan Ali, Karimi Mehran, Abdolkarim Ghadimi Moghaddam
March-April 2008, 19(2):206-209
Thalassemia is a systematic disease in which the renal involvement has not yet been scrupulously studied. In a cross-sectional study, the renal findings of 50 cases of thalassemia intermedia (group 1) were compared to 58 patients with thalassemia major (group 2). Blood urea nitrogen, serum creatinine, uric acid, calcium, phosphorus, urinalysis, and ultrasonographical findings were evaluated. Mean age was 18 ± 3.0 in group 1 and 17 ± 3.5 years in group 2. The mean of serum ferritin levels was 871 ± 81.8 ng/ml in group 1 vs. 3503 ± 201 ng/ml in thalassemia major (p < 0.05). Ninety-two percent of the patients in group 1 were on hydroxyurea at the time of evaluation. Serum uric acid was significantly higher in group 1 than group 2 patients (5.74 ± 2.95 vs. 4.12 ± 0.9 mg/dl, p < 0.05). Microscopic hematuria (red blood cell in high power field of urine microscopy > 5) was observed among 19 children (17.6%); 17 of them were in group 1. In contrast, children with thalassemia major had significantly higher serum creatinine (0.89 ± 0.18 vs. 0.59 ± 0.37 mg/dl, p < 0.05) and blood urea nitrogen values (12.14 ± 5.58 vs. 13.85 ± 3.54 mg/dl, p < 0.05). We conclude that significant renal involvement is not a frequent complication in children and young adults suffering from thalassemia. Hyperuricemia and microscopic hematuria are more common in thalassemia intermedia than thalassemia major. Microscopic hematuria in thalassemia intermedia might be related to either hypercalciuria or hyperuricosuria.
  11 8,392 1,930
Pulmonary Hypertension in Hemodialysis Patients
Mitra Mahdavi-Mazdeh, Seyed Alijavad-Mousavi, Hooman Yahyazadeh, Mitra Azadi, Hajar Yoosefnejad, Yoosef Ataiipoor
March-April 2008, 19(2):189-193
The aim of this study was to evaluate the prevalence of primary pulmonary hypertension (PHT) among hemodialysis patients and search for possible etiologic factors. The prevalence of PHT was prospectively estimated by Doppler echocardiogram in 62 long-term hemodialysis patients on the day post dialysis. PHT (> 35 mm Hg) was found in 32 (51.6%) patients with a mean systolic pulmonary artery pressure of 39.6 ± 13.3 mmHg. The hemoglobin and albumin levels were significantly lower in the PHT subgroup (11.1 ± 1.86 vs 9.8 ± 1.97 g/dL and 3.75 ± 0.44 vs 3.38 ± 0.32 g/dL, p = 0.01 and 0.02, respectively). Our study demonstrates a surprisingly high prevalence of PHT among patients receiving long-term hemodialysis. Early detection is important in order to avoid the serious consequences of the disease.
  10 5,920 1,105
Hepatitis B Infection among Patients Receiving Chronic Hemodialysis at the Royal Medical Services in Jordan
Munther Al Hijazat, Yousef M Ajlouni
March-April 2008, 19(2):260-267
Hepatitis B virus (HBV) infection is a major clinical problem in patients on maintenance hemodialysis (HD) and can lead to many serious consequences. This study was carried out in order to determine the prevalence of HBV infection and the possible risk factors for acquiring it, in patients on maintenance HD. All patients on regular HD in seven hospitals of the Royal Medical Services, Amman, Jordan, were studied during the period between July and December 2006. The medical history and records of these patients were reviewed for the presence of hepatitis B surface antigen (HbsAg), and possible risk factors for acquiring this infection. A total of 430 patients on HD with a mean age of 47.3 years were studied. Three patients, who were positive for HBsAg before starting dialysis, were excluded from the study. The remaining 427 patients, who were HBsAg negative before starting dialysis were included. Of these, 25 (5.9%) became HbsAg-positive during the study period. Being on HD for longer than two years and positive history of blood transfusion(s) were more frequently noticed in the HbsAg­positive group (88% and 60% respectively) compared with the HbsAg-negative group (43% and 56% respectively). Of 379/402 (94%) patients who remained Hbs Ag-negative and 1/25 (4%) of those who converted to Hbs Ag-positive were reportedly vaccinated. Our study suggests that the prevalence of HbsAg positivity in our HD patients was 5.9%. Dialysis for more than two years, but not history of blood transfusions, was noted to be a significant risk factor for acquiring this infection. Vaccination against the HBV gives good protection against this virus.
  6 5,088 689
Renal Abnormalities in Patients with Sickle Cell Disease: A Single Center Report from Saudi Arabia
Aamer Aleem
March-April 2008, 19(2):194-199
Patients with sickle cell disease (SCD) are at increased risk of serious morbidity and mortality. Renal abnormalities in SCD are well known but renal involvement in Saudi patients with SCD has not been studied. We sought to identify renal abnormalities in adolescent and adult Saudi patients with SCD. We prospectively studied 73 patients with SCD followed up at King Khalid University Hospital, Riyadh, Saudi Arabia from July 2005 to November 2006,. All patients underwent evaluation of kidney function and urine examination to detect proteinuria and other urinary abnormalities. In addition, 53 patients from the cohort had 24-hour urine collection to measure creatinine clearance and to quantitate proteinuria. The patient population consisted of 34 males (46.5%) and 39 females (53.5%) with a median age of 23 years (range 14-40). Proteinuria was present in 30 patients (41%). Creatinine clearance was low in 12 patients (22.5%) and seven of these patients had low or low-normal serum creatinine despite reduced creatinine clearance. Low serum creatinine was common and present in 28 patients (38%). Two patients had chronic renal failure and one of them is on regular dialysis. Other abnormalities detected include hematuria in seven patients (8.5%) and hemoglobinuria in 12 patients (14.5%). In conclusion, renal abnormalities are present in a significant number of Saudi patients with SCD and proteinuria is the most common abnormality. Serum creatinine may remain low or within low-normal range in SCD patients despite reduced creatinine clearance. As proteinuria is a risk factor for developing renal failure in future, routine screening of SCD patients is recommended for timely intervention in order to prevent or delay renal damage.
  5 7,072 904
5-year Mortality in Hemodialysis Patients: A Single Center Study in Tripoli
Mahdia A Buargub
March-April 2008, 19(2):268-273
To investigate the 5-year mortality of patients undergoing maintenance hemo­dialysis (HD) at Al-Shat center Tripoli, we reviewed during June 2007 the records of all the HD patients initiated on HD from Jun 2000 and Jan 2002.There were 124 patients in the study, 77 males (63.6%) and 47 (36.4%) females, with a mean age of 49 ± 14 years. Diabetic nephropathy (DN) was the underlying kidney disease in 34 (27.4%) patients. After 5 years; 3 patients were transferred to other centers, 18 (14.9%) patients underwent kidney transplan­tation. Out of the 103 patients who continued on hemodialysis, 53 (51.4%) expired during the 5-year follow-up. Mortality was associated with older age (p< 0.001 and odd ratio (OR) of 4.2 for age > 50 years) and DN (p< 0.002 and OR of 3.9). Mortality rate in diabetics was 74.1% and significantly associated with male sex (p< 0.0067 and OR of 2.4), older age (p< 0.004), presence of hypertension (p< 0.003 and OR of 3.9), type 1 diabetes (OR 1.6), and elevated mean body weight (p< 0.046). Mortality was also relatively higher in black patients (OR of 2.0) and smokers (OR of 1.39). In conclusion, the overall 5- year mortality for dialysis patients was elevated and higher in the diabetics.
  3 7,803 710
The Patency Rate and Complications of Polytetrafluoroethylene Vascular Access Grafts in Hemodialysis Patients: A Prospective Study from Iran
Javad Salimi, Mohammad R Zafarghandi
March-April 2008, 19(2):280-285
The objective of this study was to evaluate the patency rate as well as complications of polytetrafluoroethylene vascular grafts (ePTFE) in patients on hemodialysis (HD). In a prospective study, 84 patients who underwent implantation of vascular grafts for HD at the Sina Hospital, Tehran, Iran, between April 2001 and April 2004, were evaluated. The mean age of the patients was 55 + 12 years; and 42 patients were male. Upper and lower limb vascular access grafts were implanted in 42 patients each. The patients were followed-up for a mean of 24 months. During this period, 30 patients (35.7%) developed thrombosis and two (2.4%) had bleeding. Graft infection and pseudo-aneurysm were observed in five (6%) and two (2.4%) patients, respectively. The primary 24-month patency rate was 43%. The patency rates in patients with and without hypertension were 29.7% and 62.2%, respectively (P < 0.03). Upper extremity grafts had 60% patency rate while lower extremity grafts had a patency rate of 26% (P < 0.05). Our study indicates that ePTFE vascular graft seems to be an appropriate vascular access when arteriovenous fistulas cannot be constructed . Educating patients and maintaining proper care of the grafts will help in reducing prevalence of infection, thrombosis and other complications, can increase the patency rate of the grafts and consequently, decrease the morbidity rate in HD patients.
  3 3,897 486
Bleeding and Thrombosis in a Patient with Secondary Antiphospholipid Syndrome
Hayet Kaaroud, Soumaya Beji, Sami Guermazi, Fatma Ben Moussa, Fethi Ben Hamida, Sami Ezzine, Taieb Ben Abdallah, Fethi El Younsi, Adel Kheder
March-April 2008, 19(2):227-231
Antiphospholipid antibodies have been associated with occurrence of arterial and venous thrombotic events and fetal loss, which together constitute the antiphospholipid syndrome (APS). However, bleeding is rare in this syndrome. We report a case of systemic lupus erythematosus (SLE) with APS complicated simultaneously by thrombotic and hemorrhagic events. A 34-year-old woman was a known case of diffuse proliferative lupus nephritis associated with APS, on treatment with corticosteroids, cyclophosphamide and anticoagulants. She presented in February 2004 with severe anemia, menorrhagia, gingival bleeding and acute loss of vision in the left eye. Investigations revealed a hematoma in the psoas muscle with thrombosis of the inferior vena cava and occlusion of the retinal vein. Blood tests revealed a strongly positive lupus anticoagulant, factor XI deficiency (35%) and decrease of free protein S (44%). Factor XI inhibitor, anti-prothrombin, and anti-protein S antibodies were absent. The patient was treated with corticosteroids and six pulses of cyclophosphamide, which resulted in a rapid disappearance of bleeding, reduction of hematoma and normalization of hematological abnormalities. She was maintained on corticosteroids, azathioprine and anticoagulant agents were introduced. After a follow-up of 28 months, there was no recurrence of bleeding, the thrombosis had resolved, and there was a decrease in the levels of circulating anticoagulant as well as anticardiolipin antibodies.
  2 6,387 870
Leiomyoma of Bladder
PJ Sudhakar, Neelam Malik, Ashok Malik
March-April 2008, 19(2):232-235
A case of leiomyoma of urinary bladder, a rare benign tumor, is presented. The patient was a 45-year-old woman with long duration history of dysuria. Intravenous urography (IVU), ultrasound (US), computed tomography (CT) and biopsy diagnosed this case accurately. The clinical presentation, imaging findings and management of this benign tumor are discussed.
  2 4,234 591
Recurrent Multifocal Primary Amyloidosis of Urinary Bladder
S Patel, A Trivedi, P Dholaria, M Dholakia, A Devra, B Gupta, SA Shah
March-April 2008, 19(2):247-249
Primary localized amyloidosis of bladder is rare. We report a case of recurrence of multifocal primary amyloidosis of urinary bladder. Cystoscopy revealed a diffuse left lateral wall lesion with normal surrounding mucosa. Histopathological examination of the specimen revealed urinary bladder amyloidosis with negative surgical margins. Recurrent urinary bladder amyloidosis was confirmed 3 months after the first resection. Close follow-up is recommended.
  2 4,172 452
Pregnancy and Contraceptive Issues in Renal Transplant Recipients
Ayman Karkar
March-April 2008, 19(2):165-173
Fertility is improved within months and conception is achieved within one to six years after kidney transplantation. Pregnancy is safe and has little effect on long-term graft survival, but has increased maternal and fetal risks. Pregnancy is contraindicated in the first two years post-kidney transplantation due to increased risk of acute rejections and higher doses of immunosuppressive drugs. Poor renal function, uncontrolled diabetes mellitus and hypertension are other contraindications. Family planning and counseling, and consideration of a suitable contraceptive method are essential before transplantation. Tubal ligation and vasectomy are permanent contraceptives with the least failure results. Combined pills are highly effective and are among the lowest failure rate contraceptives, but they interact with cyclosporine, and are contraindicated in patients with thromboembolism and deep vein thrombosis. Progesterone-only minipill has the advantage of avoiding the risks associated with estrogen, but has a higher failure rate than the combined pills. The barrier methods (condom and diaphragm) are effective and safe contraceptives and can prevent sexually transmitted diseases, but require motivated couples. Intra uterine devices are convenient contraceptives, but have higher failure rate and are associated with increased incidence of pelvic infection. Pregnancy in renal transplant recipients should be managed by a multidisciplinary approach in a tertiary centre.
  2 12,179 1,276
Effect of Sevelamer on Mineral and Lipid Abnormalities in Hemodialysis Patients
Fethi Ben Hamida, Lilia Ben Fatma, Samia Barbouch, Hayet Kaaroud, Imed Helal, Hafedh Hedri, Taieb Ben Abdallah, Hedi Ben Maiz, Adel Kheder
March-April 2008, 19(2):183-188
We conducted a prospective study in hemodialysis patients to assess the safety and efficacy of sevelamer, a non-absorbable phosphate binding polymer free of calcium and aluminum, in lowering serum phosphorus, serum intact parathyroid hormone, and serum lipids. Phosphate binders were discontinued during a two-week washout period. We considered the patients with serum phosphorus levels more than 1.8 mmol/l during the washout period eligible for treatment. Sevelamer was administered to 29 hemodialysis patients for eight weeks. Sevelamer reduced the mean serum phosphorus levels to 1.8 mmol/l by the end of the eight-week treatment period (p < 0.0001). Two weeks after the completion of the sevelamer study the mean serum phosphorus levels increased to 2.09 mmol/l (p < 0.02). Mean serum calcium levels did not significantly change during sevelamer trial. Mean serum intact parathyroid hormone declined from 501 pg/ml at the start of the study to 425 pg/l at the end of the eight week treatment period (p = 0.05). In addition, sevelamer reduced the mean serum total cholesterol levels from 5.22 mmol/l to 4.26 mmol/l (p < 0.0001), and the mean serum low density lipoprotein cholesterol from 3.56 mmol/l to 2.79 mmol/l (p < 0.0001) at the end of the study. However, the mean serum levels of high density lipoprotein and triglycerides did not change during the study period. We conclude that sevelamer can control serum phosphorus and reduce the level of intact parathyroid hormone and cholesterol without inducing hypercalcemia or other side effects.
  2 4,421 750
Comparison of Right and Left Grafts in Renal Transplantation
Mehdi Salehipour, Ali Bahador, Hamed Jalaeian, Heshmatollah Salahi, Saman Nikeghbalian, Fardin Khajehee, Seyed Ali Malek-Hosseini
March-April 2008, 19(2):222-226
This study compares outcomes and graft function of right and left grafts of deceased donor. We studied 120 kidney recipients from 60 deceased donors in Shiraz organ transplantation center from 1988 to 2004. We analyzed data regarding age, gender, side of grafts, duration of pre-transplant dialysis, hospital stay, serial creatinine levels, cold ischemic time, complications, graft function, patient survival rates, and post-operative complications. Recipients were divided into two groups: group 1 consisted of 60 recipients who received right renal graft (43 males, 17 females; mean age: 33.6 ± 7.3 years), and group 2 consisted of 60 recipients who received left renal graft (45 males, 15 females; mean age: 29.2 ± 6.4 years). No statistically significant differences were found in duration of pre-transplant dialysis, cold ischemic time, acute rejection rates, post-operative surgical and vascular complications' rates, hospital stay, renal function, and one year graft survival rates. We conclude that although it is advised to use left kidney from live donors because of longer vessel length, easier surgical technique and organ handling, and shorter ischemic time, we got the same outcome in left and right deceased renal grafts.
  2 4,555 1,246
Renal Allograft in a Professional Boxer
Behzad Einollahi, Mohsen Nafar, Saeed Taheri, Eghlim Nemati
March-April 2008, 19(2):241-243
Significant health benefits result from regular physical activity for kidney transplant recipients. Nevertheless, some adverse effects also have been shown to be associated with highly intensive exercises. We report a kidney transplant professional boxer whose kidney allograft has remained in good health, despite his violent sport activities.
  1 3,583 358
Evaluation of Conner's Continuous Performance Test in Hemodialysis Patients
Mostafa Najafi
March-April 2008, 19(2):210-214
Memory and cognitive abnormalities such as decreased attention span, impulsiveness, and slow reaction are common among chronic hemodialysis patients. We studied the changes these parameters in 38 hemodialysis patients before and after hemodialysis sessions via Conner's continuous performance test. Mean age of the study patients was 38.0 ± 12.6 years. There was no significant difference before and after hemodialysis in the number of the successfully recognized matches, the number of the miss fires, and the mean of reaction time of matches. In addition, there was no significant effect of the duration of hemodialysis therapy on the number of successfully recognized matches, the number of missed matches, and the mean reaction time of matches. Educational level of patients did not significantly impact on the number of successfully recognized matches and the mean of reaction time of matches. However, this impact was significant on the number of miss fires during hemodialysis. (P = 0.04). We conclude from our results that hemodialysis did not significantly impact on the cognitive function. However, this hypothesis must be confirmed by other cognitive function tests on larger hemodialysis population.
  1 3,523 396
Variability of Acid-Base Status in Acetate-Free Biofiltration 84% versus Bicarbonate Dialysis
Kais Harzallah, Nourredine Hichri, Chakib Mazigh, Mohamed Tagorti, Ahmed Hmida, Jalel Hmida
March-April 2008, 19(2):215-221
The ultimate goal of hemodialysis (HD) treatment is to achieve the highest level of efficacy in the presence of maximal clinical tolerance. With an aim to offer good hemodynamic stability, as observed during the acetate-free biofiltration 14% (AFB 14%) to patients who are intolerant to bicarbonate dialysis (BD) and with less cost, we have developed since June 1994, a new HD technique, namely AFB 84%. This study was carried out to analyze acid-base variations during the AFB 84% in comparison to BD in hemodynamically stable patients on regular HD. This was a prospective randomized crossover study carried out on 12 patients (6 males and 6 females) for a total of 144 HD sessions (72 BD and 72 AFB 84%). Patients with decompensated cardiomyopathy, respiratory diseases or uncontrolled hypertension were not included in the trial. All the patients were treated with BD or AFB 84%; the latter is characterized by the absence of acetate in the dialysate and a complete correction of buffer balance by post-dilutional infusion of bicarbonate-based replacement solution. The comparison of pre-dialysis arterial acid-base and blood-gas parameters revealed no significant differences of pH, HCO 3 - and paCO 2 levels between the two techniques. Analysis of post-dialysis parameters showed that, among patients dialyzed with BD, there was over correction of metabolic acidosis with a tendency towards metabolic alkalosis. In contrast, in patients dialyzed with AFB 84%, we observed a significant improvement in pH and HCO 3 - levels but the increase in paCO2 level was not significant. A comparison of these parameters between the two techniques showed statistically significant difference in pH, HCO3 - and paCO2 levels, but not for paO2 level. AFB 84% can offer some important advantages with the complete absence of acetate from the substitution fluids, and permits a better correction of metabolic acidosis than BD, without causing alkalosis.
  1 5,900 591
Is Antibiotic Usage Necessary after Donor Nephrectomy? A Single Center Experience
Afshar Zomorrodi, Abulfasel Buhluli
March-April 2008, 19(2):200-205
Proper management of living kidney donors is a very important aspect of all renal transplants. To date, approximately 60,000 living donor nephrectomies have been performed worldwide and about 20 deaths directly related to the operation have been reported. The most common cause of death has been pulmonary embolism. Wound infection following surgery is the third most common nosocomial infection, and is dependent on the surgeon and his/her team, the operating room, number and virulence of contaminated bacteria, patient characteristics (immunity and defense), as well as time and duration of administration of antibiotics. Approach to the prophylaxis of wound infection in kidney donors varies in different transplant centers. This study was conducted at the Emam Hospital, Tabriz, Iran in order to delineate the protocol regarding antibiotic usage after donor nephrectomy. One hundred kidney donors were enrolled in the study. They were classified randomly in two groups: Group-1, comprising 50 donors, who received antibiotics immediately following surgery and for at least seven days thereafter. Group-2, comprised of 50 donors, in whom one gram of cephazoline was injected intravenously before anesthesia and continued for 24 hours after surgery. The patients were followed-up for one month with particular emphasis on occurrence of wound infection. One patient in Group-1, and two in Group-2 had wound infection; the difference was not statistically significant (p = > 0.5). Our study suggests that antibiotic prophylaxis started before incision and continued for 24 hours after donor nephrectomy is safe and effective in preventing wound infection.
  1 3,886 491
Hemorrhagic Fever with Acute Renal Failure: A Report from Kosova
Bejtush Ibrahim Zylfiu, Ymer Elezi, Gani Bajraktari, Ibrahim Rudhani, Murat Abazi, Emrush Kryeziu
March-April 2008, 19(2):250-253
Acute renal failure (ARF) is a well-known complication of hemorrhagic fever (HF). We studied patients with HF and ARF who were treated in our department for two years between March 2005 and the end of December 2006. The age of the patients ranged from 17 to 71 years. The incidence of complications in the study patients was acceptable and similar to that reported in the literature of Balkan region. Our study shows that the efficacy of the overall results in the treatment of these patients in our center is comparable to the published data in the country from the Balkan region.
  - 3,431 406
Retroperitoneal Cystic Metastases from Renal Cell Carcinoma
Rajul Rastogi
March-April 2008, 19(2):244-246
Many malignant tumors produce retroperitoneal nodal metastases. However, cystic nodal retroperitoneal metastases are uncommon. Renal cell carcinoma is one of the very few carcinomas that can infrequently produce cystic nodal retroperitoneal metastases. Hence, This is a case of retroperitoneal cystic nodal metastases secondary to renal cell carcinoma, which has been rarely reported in the medical literature
  - 4,237 414
A Case of Mayer-Rokitansky-Kuster-Hayser Syndrome with Absence of the Right Thumb
Ranabir Pal, Arun Manglik, Neloy Sinha
March-April 2008, 19(2):236-240
A 14-year-old feminine adolescent, presented with congenital absence of right thumb, scoliosis, severe anemia, primary amenorrhea without secondary sexual characteristics, except for normally developed breasts. In the genital area, there was a pair of ill developed labia majora fused at upper end with a whirling pattern containing inside the urethral opening. The lower end of genitalia had loose skin folds containing adequate amounts of rugae with a raphe, mimicking the texture of scrotal skin. There was no vaginal orifice. Diagnostic work-up included routine hematological studies, skeletal radiography, renal ultrasonography, and renal scan to demonstrate possible association between the congenital genitourinary and skeletal anomalies. Ultrasound imaging studies confirmed that she had structures close to uterus with hematometra, but vagina and ovary were not found. Sonologically, the left kidney could not be visualized. Renal scan confirmed agenesis of the left kidney and hypoplastic, parenchymally insufficient, right kidney. Cytogenetic karyotyping revealed a 46, XX karyotyping and the presence of Barr chromatin body. Based on the clinical examination and investigations, a diagnosis of Mayer-Rokitansky-Kuster-Hauser syndrome was established with associated limb and skeletal deformities.
  - 4,849 593
Contrast Media Nephropathy: In Depth Review
N Hussain, T Al Otaibi, M.R.N Nampoory
March-April 2008, 19(2):174-182
  - 4,629 1,120
Controversial role of Omega-3 fatty acids in Dyslipidemia
KVS Hari Kumar, Abhyuday Verma, Shekhar , KD Modi
March-April 2008, 19(2):254-255
  - 3,079 558
Hypertension in Related Living Donor Renal Allograft Recipients
Tarik Houssaini Sqalli, Asmaa Laboudi, Mouna Faik, Loubna Benamar, Yamama Amar, Naima Ouzeddoun, Rabea Bayahia, Hakima Rhou
March-April 2008, 19(2):256-259
Cardiovascular morbidity and mortality are extremely high in all stages of renal failure. Arterial hypertension remains a major problem even after renal transplantation. We studied retrospectively the hypertension patterns in recipients of renal allografts from living donors from January 1998 to December 2004. The mean age of the patients was 29.3 ± 9.4 (range 13 - 54) years, with a male predominance (62%). Among 42 of the study patients, 40 (95%) were hypertensive at 3 months after transplantation with a slightly decreasing prevalence at 6 and 12 months to 84% and 85%, respectively. During dialysis period, 59.5% of the patients were hypertensive. The allografts were left kidneys with only one artery in 40 patients and right kidneys with 2 arteries in 2 patients. Graft renal artery stenosis (RAS) was documented by Doppler ultrasound in 13 (32.5%) cases. Three patients improved following transluminal angioplasty with stenting. The control of the hypertension required the use of at least two anti­hypertensive drugs in 56% of patients. On an average follow-up of 30 (1 - 78) months, no cardio­vascular event was reported and all the allografts remained functional. We conclude that hypertension is prevalent in the living renal allografts recipients. The etiology is multifactorial and careful management is mandatory to protect the renal function and the cardiovascular system.
  - 2,262 372
Hematological Changes Post-Hemo and Peritoneal Dialysis Among Renal Failure Patients in Sudan
Mohamed Siddig Mohamed Ali, Muna Abbas Babiker, Leena Babiker Merghani, Fadl Aljabbar Al Taib Ali, Mekki Hamad Abdulmajeed
March-April 2008, 19(2):274-279
The objective of the study was to assess the changes that occur in various hematological parameters that may occur in renal failure patients after hemo and peritoneal dialysis sessions. The study was carried out at the AI Neelain University, Khartoum, Sudan. Blood samples were collected from 180 renal failure patients undergoing hemo and peritoneal dialysis (90 each) before and after dialysis sessions. The samples were tested for complete blood count, prothrombin time and activated partial thromboplastin time by the manual calibrated techniques. The study demonstrated an increase of hemoglobin, hematocrit and red cell count after both hemo and peritoneal dialysis. The mean corpuscular hemoglobin and hemoglobin concentration showed mild increase after peritoneal dialysis and slight decrease after hemodialysis. Leukocyte and platelet counts also showed mild increase after hemodialysis, while the prothrombin and activated partial thromboplastin times were significantly prolonged. Our study shows that most of the hematological parameters as well as prothrombin and partial thromboplastin times increased after a dialysis session. Therefore, it is recommended that all patients be screened appropriately before and after dialysis to avoid complications.
  - 10,787 873
The Socioeconomic Status of 100 Renal Transplant Recipients in Shiraz
Jamshid Roozbeh, Hamed Jalaeian, Mohammad Amin Banihashemi, Ghanbar Ali Rais-Jalali, Mohammad Mehdi Sagheb, Mehdi Salehipour, Hajar Faghihi, Seyed Ali Malek-Hosseini
March-April 2008, 19(2):286-290
Data regarding the socioeconomic status in Iranian kidney transplant (KT) recipients is lacking. In this cross sectional descriptive study we evaluated the socio-economic status of 100 KT recipients in Shiraz organ transplantation center. In a cross-sectional design, we randomly selected and interviewed 100 RT recipients (50 males and 50 females). Data regarding age, gender, martial status, occupation, level of education, number of children, type of insurance, monthly household income, place of residence, ownership of a personal transportation device, duration and frequency of pre-transplant dialysis, family history of CRF (Chronic renal failure), and etiology of renal disease were obtained. There were 50 (50%) patients aged between 16 and 35 years, 55 had a family history of CRF, 60 had been on dialysis for more than a year, 61 were married, 47 did not have any children, 41 had more than 3 children, and 65 were unemployed due to physical and emotional impairment as a result of their disease. The majority (73%) did not have a high school diploma, 15% were illiterate, 85% were below the poverty line, 52% were from rural areas, and 98% were covered by insurance. We conclude that patients with CKD in our study had acquired this condition possibly due to negligence and lack of basic health care in the lower socioeconomic class. In addition, KT is an available therapeutic modality to lower socio-economic level in Iran.
  - 3,857 456
Normal Non-Functioning Kidney Transplant
Abdulhakeem Al-Marwani, Ali Al-Harbi, Mohamed Kechrid, Othman Azhari
March-April 2008, 19(2):291-296
Severe form of HCV infection complicated by early liver failure was reported after solid organ transplantation and described as fibrosing cholestatic hepatitis (FCH). We highlight the need for early detection and possible treatment in this rare but often fatal complication of HCV infection.
  - 3,483 398
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