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Saudi Journal of Kidney Diseases and Transplantation
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   2008| November-December  | Volume 19 | Issue 6  
    Online since October 20, 2008

 
 
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ORIGINAL ARTICLES
Impact of treatment with oral calcitriol on glucose intolerance and dyslipidemia(s) in hemodialysis patients
Shokoufeh Bonakdaran, Hossein Ayatollahi, Mohammad Javad Mojahedi, Farzaneh Sharifipoor, Mohammad Shakeri
November-December 2008, 19(6):942-947
PMID:18974581
This study was conducted to assess the effect of oral calcitriol on glucose metabolism in patients on hemodialysis (HD). A total of 27 patients on HD at the Mashhad University of Medical Sciences, Iran, none of whom had received calcitriol or had history of diabetes, were selected. The patients were randomly divided into two groups; Group I: patients who received oral calcitriol for eight weeks and, Group II: patients who received placebo. In all cases, levels of fasting glucose, insulin, lipid profile, calcium, phosphorous, parathormone (PTH), HbA1C and blood sugar after administration of 75 grams of glucose, insulin resistance and beta cell function were measured, before and after the treatment period. The two sets of results were then compared with one another. In Group l patients, the levels of the parameters studied before and after the study period were as follows: blood sugar after 75 grams of glucose (88.67 ± 8.68 versus 99.83 ± 34.42 mg/dL, p = 0.045), HOMA-IR (2.05 ± 1.42 versus 2.42 ± 1.33, p = 0.035), HbA1C (5.99 ± 1.00 versus 6.14 ± 1.19, p = < 0.001), total cholesterol (153.3 ± 43.80 mg/dL versus 157.0 ± 52.62, p = 0.037) and triglycerides (175.30 ± 99.65 versus 214.9 ± 117.7 mg/dL, p = 0.036). Thus, there was a significant decrease after the study period. In Group II, fasting blood sugar (110.7 ± 26.12 versus 81.14 ± 13.31 mg/dL, p = 0.002), HbA1C (6.99 ± 1.44 versus 6.17 ± 1.66, p = 0.004) and HOMA-IR (5.85 ± 5.11 versus 3.20 ± 2.39, p = 0.036) significantly increased and beta cell function significantly decreased (149.5 ± 90.57 versus 355.7 ± 299.3, p = 0.032) after the study period. In conclusion, our results show that vitamin D has a significant influence on glucose metabolism. Similar studies on larger sample size are required to confirm this observation.
  13 4,072 857
Detection of acute renal allograft rejection by analysis of renal tissue proteomics in rat models of renal transplantation
Yong Dai, Tianyu Lv, Kang Wang, Yuanshuai Huang, Deping Li, Jianjun Liu
November-December 2008, 19(6):952-959
PMID:18974583
At present, the diagnosis of renal allograft rejection requires a renal biopsy. Clinical management of renal transplant patients would be improved if rapid, noninvasive and reliable biomarkers of rejection were available. This study is designed to determine whether such protein biomarkers can be found in renal-graft tissue proteomic approach. Orthotopic kidney transplantations were performed using Fisher (F344) or Lewis rats as donors and Lewis rats as recipients. Hence, there were two groups of renal transplant models: one is allograft (from F344 to Lewis rats); another is syngrafts (from Lewis to Lewis rats) serving as control. Renal tissues were collected 3, 7 and 14 days after transplantation. As many as 18 samples were analyzed by 2­D Electrophoresis and mass spectrometry (MALDI-TOF-TOF-MS). Eleven differentially expressed proteins were identified between groups. In conclusion, proteomic technology can detect renal tissue proteins associated with acute renal allograft rejection. Identification of these proteins as diagnostic markers for rejection in patients' urine or sera may be useful and non­invasive, and these proteins might serve as novel therapeutic targets that also help to improve the understanding of mechanism of renal rejection.
  8 3,387 671
Correlation of urinary monocyte chemo-attractant protein-1 with other parameters of renal injury in type-II diabetes mellitus
Salwa Ibrahim, Laila Rashed
November-December 2008, 19(6):911-917
PMID:18974575
Diabetic nephropathy (DN) is the leading cause of end-stage renal disease in the western world. Increased number of interstitial macrophages has been observed in biopsies from patients with DN. Monocyte chemo-attractant protein-1 (MCP-1) is the strongest known chemo­tactic factor for monocytes and is upregulated in DN. We examined urinary levels of MCP-1 in patients with type-2 diabetes mellitus (DM) to assess its possible correlation with other para­meters of renal injury. The urinary MCP-1 level was assessed in 75 patients with type-2 DM (25 patients each with no microalbuminuria, with macroalbuminuria and, with renal impairment) and compared them with matched healthy control subjects. The HbA1c and estimated glomerular fil­tration rate (eGFR) derived from the abbreviated Modification of Diet in Renal Disease (MDRD) equation were examined in the study groups in relation to the urinary MCP-1. The urinary MCP-1 level was significantly higher in patients with micro and macroalbuminuria (167.41 ± 50.23 and 630.87 ± 318.10 ng/gm creatinine respectively) as compared with normoalbuminuric patients and healthy controls (63.85 ± 21.15 and 61.50 ± 24.81 ng/gm creatinine, p< 0.001). MCP-1 correlated positively with urine albumin/creatinine ratio (ACR) (r= 0.75, p< 0.001), HbA1c (r= 0.55, p< 0.001) and inversely with eGFR (r=-0.60, p< 0.001). Our findings suggest that hyperglycemia is associated with increased urinary levels of MCP-1 that is closely linked to renal damage as reflected by proteinuria and eGFR levels. Collectively, these findings suggest that MCP-1 is in­volved in the pathogenesis of diabetic nephropathy through its various stages.
  7 2,957 811
Patency rate and complications of vascular access grafts for hemodialysis in lower extremities
Javad Salimi
November-December 2008, 19(6):929-932
PMID:18974578
Placement of thigh grafts is an option in hemodialysis (HD) patients who have exhausted all upper extremity sites for permanent vascular access. To determine patency rate and complications of lower extremity grafts used for vascular access in patients on chronic HD in our center we studied prospectively the outcomes of 41 thigh grafts placed at a single institution during a 4-yr period (January 2000 and July 2003). Information was recorded on surgical complications and date of graft failure. The mean patient age was 55 ± 12 years and 54% of the patients were males. The primary patency rates were, 76%, 67%, and 60% at 3, 9, and 12 months, respectively. There were 10 (24.4%) patients with thrombosis and 2 (4.8%) patients with bleeding. Graft infec­tion and pseudoaneurism were observed in 2 patients each. No significant differences in infection rate or graft patency rates were found by patient age and gender. In our experiences, lower extremity vascular access graft is not associated with higher morbidity. Lower extremity polytetrafluoroethylene vascular graft (ePTFE) seems to be an appropriate vascular access when arteriovenous fistulas and upper extremity grafts cannot be constructed.
  6 4,077 586
RENAL DATA FROM THE ARAB WORLD
Clinical and immunological manifestations of systemic lupus erythematosus: A study on 146 south Tunisian patients
Moez Jallouli, Makram Frigui, Mohamed Ben Hmida, Sameh Marzouk, Neila Kaddour, Zouheir Bahloul
November-December 2008, 19(6):1001-1008
PMID:18974596
The objective of this study was to determine the main clinical and laboratory features as well as the morbidity and mortality of systemic lupus erythematosus (SLE) in a population of patients predominantly from the south of Tunisia. A retrospective review of a well documented population of 146 patients with SLE was undertaken. All patients fulfilled four or more criteria defined by the American College of Rheumatology. The mean age at presentation was 29.2 years (range 6-55) and the mean duration of follow-up was 62 months (range 0.25-374). Musculoskeletal (84.2%) and mucocutaneous (75.3%) were the most frequent clinical mani­festations. Antinuclear antibodies were detected in 97.3%, anti-DNA antibodies in 69.2% and anti-Sm in 39.2% of the patients. Anti-cardiolipin antibodies and lupus anticoagulant were ob­served respectively in 71.6% and 37.8% of the patients. The five-year survival rate in our series was 92%. Renal involvement and thrombocytopenia were associated with poor prognosis (p< 0.05). The clinical and immunological characteristics of our SLE patients are largely comparable to most major studies. Main differences included prominent major organ damage and high pre­valence of anti-Sm and anti-cardiolipin antibodies.
  5 4,554 910
CASE REPORTS
Computed tomographic scan in the diagnosis of bilateral renal lymphangiectasia
Rajul Rastogi, Vaibhav Rastogi
November-December 2008, 19(6):976-979
PMID:18974588
Renal lymphangiectasia is a rarely reported disorder of lymphatic malformation. Although benign, it may lead to hypertension and renal failure in undetected or undiagnosed cases. Adult polycystic kidney disease is a close mimic. We herewith present a rare case of bilateral renal lymphangiectasia that was strongly suspected on Computed tomographic (CT) scan and confirmed by aspiration cytology. Awareness about this condition will result in early diagnosis, early treatment and reduced morbidity.
  4 3,596 531
EDITORIALS
Biofeedback systems and adaptive control hemodialysis treatment
Ahmad Taher Azar
November-December 2008, 19(6):895-902
PMID:18974573
On-line monitoring devices to control functions such as volume, body temperature, and ultrafiltration, were considered more toys than real tools for routine clinical application. However, bio-feedback blood volume controlled hemodialysis (HD) is now possible in routine dialysis, allowing the delivery of a more physiologically acceptable treatment. This system has proved to reduce the incidence of intra-HD hypotension episodes significantly. Ionic dialysance and the patient's plasma conductivity can be calculated easily from on-line measurements at two different steps of dialysate conductivity. A bio-feedback system has been devised to calculate the patient's plasma conductivity and modulate the conductivity of the dialysate continuously in order to achieve a desired end-dialysis patient plasma conductivity corresponding to a desired end­dialysis plasma sodium concentration. Another bio-feedback system can control the body tempe­rature by measuring it at the arterial and venous lines of the extra-corporeal circuit, and then modulating the dialysate temperature in order to stabilize the patients' temperature at constant values that result in improved intra-HD cardiovascular stability. The module can also be used to quantify vascular access recirculation. Finally, the simultaneous computer control of ultrafiltration has proven the most effective means for automatic blood pressure stabilization during hemo­dialysis treatment. The application of fuzzy logic in the blood-pressure-guided biofeedback con­trol of ultrafiltration during hemodialysis is able to minimize HD-induced hypotension. In con­clusion, online monitoring and adaptive control of the patient during the dialysis session using the bio-feedback systems is expected to render the process of renal replacement therapy more physiological and less eventful.
  4 6,586 1,419
ORIGINAL ARTICLES
Association between diabetic nephropathy and other diabetic microvascular and macrovascular complications
Anila Chandy, Basant Pawar, Mary John, Rajesh Isaac
November-December 2008, 19(6):924-928
PMID:18974577
Diabetic nephropathy is found to be significantly associated with diabetic retino­pathy and coronary artery disease. Few studies have also shown an association between diabetic nephropathy and neuropathy, and peripheral vascular disease. A cross sectional study was done among consecutive type 2 diabetics presenting to Christian Medical College and Hospital, Ludhiana from June 2004 to May 2005. Patients were subjected to the clinical and laboratory investigations 174 patients were studied over a period of one year. Diabetic nephropathy was found to be associated with proliferative diabetic retinopathy, neuropathy and cardiovascular disease by univariate analysis. In multivariate analysis, diabetic nephropathy was again significantly asso­ciated with proliferative diabetic retinopathy and coronary artery disease. We conclude that close association between diabetic nephropathy and other micro and macrovascular complications exists in our Indian patients also.
  4 6,299 1,188
CASE REPORTS
Wasp sting: An unusual fatal outcome
Pratish George, Basant Pawar, Nalini Calton, Pradeep Mathew
November-December 2008, 19(6):969-972
PMID:18974586
Wasp stings are not uncommon especially in populations living in proximity of forested areas all over the world. Local manifestations following stings are common and un­usually life threatening anaphylaxis may occur, requiring prompt treatment. Multi organ failure and acute renal failure following wasp stings are rare and histological evaluation suggest acute tubular necrosis secondary to hemolysis, rhabdomyolysis and direct venom toxicity. A rare com­plication of a patient following multiple wasp stings with disseminated intravascular coagulation, acute renal failure and thrombotic microangiopathy is presented.
  3 5,288 872
RENAL DATA FROM THE ARAB WORLD
Hypertension care at primary health care centers: A report from Abha, Saudi Arabia
Mohammed A Al-Homrany, Mohd Yunus Khan, Yahia Mater Al-Khaldi, Khalid S Al-Gelban, Hasan Saed Al-Amri
November-December 2008, 19(6):990-996
PMID:18974594
It is well known that effective management of hypertension reduces the incidence of myo­cardial infarction, stroke and vascular complications. The Ministry of Health, Kingdom of Saudi Arabia, introduced the Quality Assurance Guidelines with the hope to improve the management of hypertension in its centers. We conducted an audit of two Primary Health Care Centers namely, Al-Manhal (MPHCC) and Al-Numais (NPHCC), to evaluate how well hypertension was managened at these centers. A check list was derived from the Quality Assurance Manual to audit the process and to assess the health outcome. A retrospective study on a chosen sample of 120 files of hypertensive patients, out of 256 from both the Primary Health Care Centers was performed, during the last three months of the year 2000. Results showed that 61% of the patients were between 45-64 years of age, 56% were females, 85% were married, 54% were illiterate and 7.5% were smokers. A total of 92% of the patients had primary hypertension and 25% had a positive family history of hypertension. Beta-blockers were the most commonly used drugs in both the centers. Although the recording of the information was not perfect, there was no statistical difference in the socio-demongraphic data and also the means of the total score in both the centres. On the other hand, carrying out the important procedures for hypertensive patients was found to be better at MPHCC in com­parison to NPHCC (p < 0.05). The commonly missed procedures were chest x-rays, electrolytes and ECG. Hypertension was well controlled in 63% of the patients, 58% were found to have obesity, 9% suffered from hypertension-related complications while almost 50% had good compliance to appointment in both the centers. Our study reveals that the process of hypertension care at the two Primary Health Care Centres in Aseer region was not in accordance with the recommended national standards. The reasons include lack of updating systems, recall system and provision of laboratory services and all these factors need to be addressed to improve care.
  3 6,819 675
CASE REPORTS
Tumoral calcinosis with vitamin D deficiency
Subramanian Kannan, Latha Ravikumar, Shiraam Mahadevan, Mayilvahanan Natarajan, Anjali Satya, Rekha Bhat, Usha Sriram
November-December 2008, 19(6):960-963
PMID:18974584
A 50-year-old woman presented with recurrent calcified mass in the left gluteal region. The clinical, radiological, and biochemical profile confirmed the diagnosis of tumoral calcinosis. She also had associated vitamin D deficiency. The patient underwent surgical removal of the mass to relieve the sciatic nerve compression and was managed with acetazolamide, calcium carbonate, and aluminium hydroxide gel with which she showed significant improve­ment. The management implications and effect of vitamin D deficiency on phosphate metabolism in the setting of tumoral calcinosis is discussed.
  2 3,663 559
LETTERS TO THE EDITOR
Protective effect of pentoxifylline on contrast induced nephropathy
Jamshid Roozbeh, Alireza Hamidian Jahromi, Maryam Sharifian, Maryam Pakfetrat, Raha Afshariani
November-December 2008, 19(6):985-986
PMID:18974592
  2 2,129 615
ORIGINAL ARTICLES
Effect of intravenous ascorbic acid in hemodialysis patients with anemia and hypeferritinemia
Keyhanian Shahrbanoo, Omolbanin Taziki
November-December 2008, 19(6):933-936
PMID:18974579
Hemodialysis (HD) patients with functional iron deficiency (FID) often develop resistance to recombinant human erythropoietin (Epo). The contributory role of chronic infla­mmation and oxidative stress in its pathogenesis is poorly understood. We assessed the effect of vitamin C, an antioxidant, on Epo-hyporesponsive anemia in hemodialysis patients with un­explained hyperferritinemia levels. Thirty-one of 132 with Hb < 11 g/dL were prospectively fo­llowed up after exclusion of reasons for Epo hyporesponsiveness. Patients were randomly divided into two groups: 15 patients received standard care and 300 mg of intravenous vitamin C with each dialysis session (group 1) and 15 patients received standard care (group 2). After 3 months, Hb and transferrin saturation levels significantly increased in group 1 but not in group 2 (p < 0.05%). Hemoglobin content in reticulocyte and serum ferritin decreased significantly in group 1 but not in control group. In conclusion, hemodialysis patients with refractory anemia and ade­quate iron stores, vitamin C improved responsiveness to Epo by augmenting iron mobilization and possibly via antioxidant effect.
  2 4,479 1,125
RENAL DATA FROM THE ARAB WORLD
Spectrum of glomerulonephritis in adult Jordanians at Jordan university hospital
Ayman M Wahbeh, Mohammad H Ewais, Mohamed E Elsharif
November-December 2008, 19(6):997-1000
PMID:18974595
We retrospectively reviewed the records and histopathological findings of 64 ade­quate native kidney biopsies performed at the Jordan University Hospital from January 2002 through December 2006. The nephrotic syndrome (NS) was the main reason for biopsy in 51.6% of the cases and deterioration of kidney function in 31%. Primary glomerulonephritis (GN) was diagnosed in 59.4% of the biopsies, and focal segmental glomeulosclerosis (FSGS) was the most common pathology detected (17.2%). Systemic lupus erythematosis was found in 17 patients (26.6%), and it was the commonest secondary GN pathology.
  2 2,187 387
RENAL DATA FROM THE ASIA - AFRICA
Etiology of acute renal failure in a tertiary center
Malik Anas Rabbani, Haseeb Bin Habib, Bilal Karim Siddiqui, M Hammad Tahir, Bushra Ahmad, Ghulam Murtaza, Qamaruddin Maria, Aasim Ahmad
November-December 2008, 19(6):1009-1014
PMID:18974597
Acute renal failure (ARF) occurs commonly in developing countries. Our aim was to assess the etiologies and outcomes of ARF in a tertiary care hospital in Pakistan and compare them with data from developed and developing countries. All patients admitted to the Aga Khan University Hospital, Karachi from January 1991 to December 2000 fulfilling the criteria of acute renal failure were reviewed retrospectively. Acute renal failure for the purpose of this study was defined as persistent elevation of serum creatinine to above 2 mg/dL (177 umol/L) on two consecu­tive occasions despite correction of any abnormal hemodynamic or mechanical factors. We studied 898 patients fulfilling the criteria of ARF, 61% (551) were males, and the mean age was 53% ± 17.6 (range 15-91) years. Medical causes accounted for (88%) of ARF cases and surgical causes for (11%). Majority of the patients had pre-renal ARF, and 5% had drug related ARF. The base line creatinine was 1.9 ± 1.8 mg/dL, while 27% of the patients had pre-existing chronic kidney disease. The mean rise in creatinine was 7.18 ± 3.8 mg/dL. We conclude that ARF resulted from pre-renal etiologies in majority of the patients and early recognition and management may improve the prognosis of these potentially preventable causes.
  2 4,569 643
Iranian kidney transplantation society seeks to answer its questions through a link between scientists and young researchers
Behzad Einollahi, Saied Bahaeloo-Horeh, Shervin Assari, Mostafa Ghanei
November-December 2008, 19(6):1015-1019
PMID:18974598
The Iranian Society of Organ Transplantation (ISOT), in an effort to further invest in transplantation-related research, established a scientific link with Baqiyatallah University of Medical Sciences (BUMS) at the beginning of the year 2006. BUMS instituted a network encom­passing 1) Nephrology and Urology Research Center (NURC), directed by prominent nephro­logists and urologists, 2) Clinical Research Unit (CRU), managed by qualified and competent young researchers, and 3) Medicine and Health Promotion Institute (mhpinstitute.ir ), which is a private research and development institute. Study titles were then extracted in discussion sessions between the NURC and CRU, the latter also being responsible for writing research protocols to be reviewed by the University ethical board for research grants. The CRU has hitherto carried out several research grants based on the following criteria: 1) accommodating the main objectives of the ISOT, i.e. the improvement in survival rates and well-being standards as well as the mini­mization of costs, 2) conducting low-budget yet cutting-edge research, and 3) ensuring publi­cation-worthy study titles. This is a review of the tie between scientists and research and metho­dological assistants, which has already come to realization in the face of financial constraints.
  2 2,273 368
CASE REPORTS
Renal tubular dysfunction with nephrocalcinosis in a patient with beta thalassemia minor
Murugesan Ram Prabahar, Manish Jain, Venkatraman Chandrasekaran, Elayaperumal Indhumathi, Periasamy Soundararajan
November-December 2008, 19(6):964-968
PMID:18974585
Thalassemia is a hereditary anemia resulting from defect in hemoglobin production. Beta thalassemia is due to impaired production of beta globin chains, leading to a relative excess of alpha globin chains. The term beta thalassemia minor is used to describe heterozygotes, who carry one normal beta globin allele and one beta thalassemic allele. The vast majority of these patients are asymptomatic. However, a variety of renal tubular abnormalities including hypercalciuria, hypo­magnesemia with renal magnesium wasting, decreased tubular absorption of phosphorus, hypo­uricemia with renal uric acid wasting, renal glycosuria and tubular proteinuria have been described even in patients with beta thalassemia minor. We here in report a 24-year old female patient who was found to have thalassemia minor and nephrocalcinosis with evidence of renal tubular dysfunction. Investigations revealed normal renal function, hypercalciuria, reduced tubular reabsorption of phos­phorus, hypomagnesemia and renal magnesium wasting. Screening for aminoaciduria was found to be negative. An acid loading test revealed normal urinary acidification. Ultrasonogram of the abdomen revealed nephrocalcinosis and splenomegaly. Detailed work up for anemia showed normal white cell and platelet count while peripheral smear showed microcytic hypochromic anemia with few target cells. Hemoglobin electrophoresis revealed hemoglobin A of 92%, hemoglobin A2 of 6.2% and hemo­globin F of 1.8% consistent with beta thalassemia minor. Her parental screening was normal. A diag­nosis of beta thalassemia minor with renal tubular dysfunction was made and the patient was started on thiazide diuretics to reduce hypercalciuria and advised regular follow-up.
  1 5,475 804
EDITORIALS
Post transplantation diabetes mellitus in kidney allograft recipients: Current concepts
Emeka A Nwankwo, Abubakar A Bakari, Aloy C Ene
November-December 2008, 19(6):904-910
PMID:18974574
The number of kidney allograft recipients has been increasing worldwide and along with that is a proportional rise in the number of individuals who develop post­transplantation diabetes mellitus (PTDM). It is therefore necessary that physicians who render care to transplant recipients, be conversant with the current issues that relate to this relatively common complication. We searched the Medline using the keywords diabetes, transplantation, kidney and PTDM, and retrieved all relevant articles that were published in the last 15 years up to 2008. Post-transplantation diabetes mellitus is a common complication following renal trans­plantation affecting approximately 10 to 20% of such patients. In the majority of the studies we reviewed, PTDM was similar to diabetes in non-transplant patients and the risk factors included older age at transplantation, family history of diabetes, obesity, elevated body mass index, non­white ethnicity and the use of steroids and several immunosuppressive agents. Curtailment of the heavy disease burden associated with PTDM should lay emphasis on pro-active preventive measures that are aimed at modifying the known risk factors and the individualized use of immunosuppressive agents determined by the pre-transplant risk profile of the patient.
  1 3,112 856
ORIGINAL ARTICLES
Polymorphism in methylenetetrahydrofolate reductase, plasminogen activator inhibitor-1, and apolipoprotein E in hemodialysis patients
Fahad Al-Muhanna, Samir Al-Mueilo, Amein Al-Ali, Emmanuel Larbi, Abdullah Rubaish, Mohammed Fakhry Abdulmohsen, Alhussain Al-Zahrani, Suad Al-Ateeq
November-December 2008, 19(6):937-941
PMID:18974580
The methylenetetrahydrofolate reductase (MTHFR) gene polymorphism, apolipoprotein E (apo s4) gene polymorphism and polymorphism of plasminogen activator inhibitor-1 (PAI-1) have been shown to be associated with end-stage renal disease (ESRD). To determine the prevalence of these mutations in Saudi patients with ESRD on hemodialysis, we studied the allelic frequency and genotype distribution in patients receiving hemodialysis and in a control group, all residing in the Eastern Province of Saudi Arabia. The genotypes were determined using allele specific hybridization procedures and were confirmed by restriction fragment length polymorphism. The T allele frequency and homozygous genotype of MTHFR in ESRD patients were 14% and 2.4%, respectively compared to 13.4% and 0%, respectively in the control group. The allele frequency and homozygous genotype of 4G/4G PAI-1 gene polymorphism were 46.4% and 4.8% respectively in ESRD patients compared to 57.1% and 32% respectively in the control group. The apo s4 allele frequency and homozygous genotype distribution in hemodialysis patients were 7% and 2.4%, respectively compared to 13% and 2% in the control group. Although allele frequency of C677T of MTHFR was statistically similar in the hemodialysis patients and in the control group, the homozygotes T allele genotype was over repre­sented in the hemodialysis group compared to normal. The prevalence of PAI-1 4G/4G polymorphism in ESRD patients was lower when com-pared to the control group. The prevalence of apo s4 allele did not differ significantly between the two groups. The present results demonstrate that all three studied polymorphic mutations are present in our population and that they may contribute to the etiology of the disease in our area.
  1 2,545 479
CASE REPORTS
Successful pregnancy in end-stage renal disease patient in a sub-urban area of Saudi Arabia
Salman Imtiaz, Muhammad Shams, Suhair Abdul Rauf Albably, Abdul Sattar Khan
November-December 2008, 19(6):980-982
PMID:18974589
A 36 years old female with hypertension and chronic kidney disease presented with anemia, nausea, vomiting and progressively rising serum Creatinine. She was found to be 16 weeks pregnant. Hemodialysis was initiated daily; however due to non compliance it remained at thrice weekly of 4 hours per session. She gained a weight during her pregnancy and labor was induced at 36 week and cesarean section performed delivering a healthy baby girl. She continues thrice weekly hemodialysis post partum.
  - 2,794 432
A transplant recipient with a mixed germ-cell ovarian tumor
Hafed Ketata, Mahdi Bouacida, Abdelkader Bouhlel, Ahmed Sahnoun, Ali Bahloul, Soumaya Yaich, Jamil Hachicha, Mohamed Nabil Mhiri
November-December 2008, 19(6):973-975
PMID:18974587
Immunosuppressed renal transplant recipients seem to be at significantly increased risk of developing neoplasms comparatively to nonimmunosuppressed individuals. A history of malignancy exposes the patient to a high risk for relapse after transplantation. We present a trans­plant recipient with a history of an ovarian mixed germ-cell tumor, with choriocarcinoma com­ponent, which was treated seven years prior to transplantation. After three years of follow-up, there was no evidence of tumor relapse. To our knowledge, there is no report of such case in the English literature. Regarding our case report and patients with a history of ovarian germ-cell neoplasm, waiting time before transplantation must take into consideration the stage of the tumor, its prognosis, the proportion of different tumor components, and the overall prognosis of the patient if transplantation is withheld.
  - 2,151 325
LETTERS TO THE EDITOR
Systemic lupus erythematosus understanding grows
E Nigel Wardle
November-December 2008, 19(6):986-989
PMID:18974593
  - 1,879 344
Can the principle of "LYFT" help objectively in timing renal transplantation therapy for the CKD patients?
Nasrulla Abutaleb
November-December 2008, 19(6):983-984
PMID:18974590
  - 2,616 254
Faith and fate in medical practice
Ali Al-Harbi
November-December 2008, 19(6):984-985
PMID:18974591
  - 1,291 265
ORIGINAL ARTICLES
Acute renal transplant rejections: A single center experience
Wael Latif Jabur, Hareth M Mohammed Saaed, Khalid Abdulla
November-December 2008, 19(6):948-951
PMID:18974582
We undertook this observational study to assess the incidence of acute rejections (AR) in the first six months after transplantation at Al-Karama Hospital, Iraq. Sixty eight patients (49 males and 19 females) underwent renal transplantation in 2006 and were followed up weekly. Forty six received kidneys from related donors and 22 from unrelated donors. During the first six months after transplantation AR occurred in 16 patients (23%); 11 (23%) related and 5 (23%) unrelated donor transplantation. We conclude that the incidence of acute rejection was similar in related and unrelated donor transplantation and the general incidence was comparable to that reported from most centers.
  - 2,296 380
Serum cystatin C as a marker of renal function in patients with acute renal failure
N Tarif, JS Alwakeel, AH Mitwalli, Hammad Durdana, NA Memon, A Askar, AR Chaudhary, AC Isnani
November-December 2008, 19(6):918-923
PMID:18974576
Serum creatinine level is the traditionally used tool to detect changes in renal function. Serum cystatin C (CC) has been suggested to be an equally effective marker of renal function. We measured the serum levels of creatinine and CC in 73 patients with acute renal failure (ARF) and 300 age and sex matched healthy controls. The serum CC was measured by particle enhanced nephlometric immunoassay (PENIA). As expected, the serum creatinine and CC levels were significantly higher in ARF patients than the healthy controls and serum CC levels correlated significantly with serum creatinine (r= 0.47, p < 0.0001). This correlation further increased for multiple measurements, (r = 0.51, p < 0.0001). No gender difference was noted. Serum CC also correlated significantly with calculated GFR. Correlation of serum CC with serum creatinine and calculated GFR was much greater in patients with deteriorating renal function, compared to patients with improving renal function (p < 0.0001). Our study further suggests that the serum CC is a good marker of renal function in ARF patients, especially those with worsening renal function. Further larger studies are needed to evaluate its role in detecting early ARF and institute possible intervention.
  - 4,063 869
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