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Saudi Journal of Kidney Diseases and Transplantation
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  Citation statistics : Table of Contents
   2010| May-June  | Volume 21 | Issue 3  
    Online since April 26, 2010

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Transient IgA nephropathy with acute kidney injury in a patient with dengue fever
Bala Krishna Upadhaya, Alok Sharma, Ambar Khaira, Amit K Dinda, Sanjay K Agarwal, Suresh C Tiwari
May-June 2010, 21(3):521-525
Dengue virus infection can clinically manifest as dengue fever, dengue shock syn­drome and dengue hemorrhagic fever. Acute kidney injury as a result of dengue virus infection can occur due to various reasons including hypotension, rhabdomyolysis, sepsis and rarely immune complex mediated glomerular injury. However, glomerulonephritis associated with IgA Nephropathy in dengue virus infection has not been reported previously. We report a case of 15­year-old boy who was admitted with dengue fever and dialysis dependant acute kidney injury. Urine examination showed microscopic glomerular hematuria and proteinuria. Kidney biopsy showed mesangial proliferation with mesangial IgA dominant immune complex deposits and acute tubular necrosis. A repeated kidney biopsy 6 weeks after clinical recovery showed reversal of glomerular changes as well as resolution of mesangial IgA deposits.
  7 3,658 546
Prevention of hepatitis C virus in hemodialysis patients: Five years experience from a single center
Waleed Z Mohamed
May-June 2010, 21(3):548-554
Hepatitis C virus (HCV) has been a significant problem in hemodialysis (HD) pa­tients. In general, it carries significant morbidity including liver cirrhosis, liver cell failure and hepa­toma. The study was conducted on 36 seronegative HD patients. All patients were managed with strict application of infection control guidelines as well as isolation of HCV-positive patients. None of the patients received any blood transfusions and were managed with iron and erythro­poietin. After five years of follow-up, we found that the incidence of HCV seroconversion was zero. Our study further suggests that following infection control guidelines, isolation of sero­positive patients and minimizing blood transfusions can help in prevention of HCV transmission among HD patients.
  7 4,057 767
Changes in QT intervals in patients with end-stage renal disease before and after hemodialysis
Mahmoud Malhis, Sami Al-Bitar, Saleh Farhood, Khair Al-Deen Zaiat
May-June 2010, 21(3):460-465
Increased dispersion of QT intervals is known to predispose to ventricular arrhyth­mias and sudden cardiac death. To assess the effect of hemodialysis (HD) on QT and corrected QT (QTc) intervals and their dispersions in chronic hemodialyzed patients we studied 85 patients (male/female = 48/37; mean age 44 ± 17 year) on chronic hemodialysis. Simultaneous 12-lead ECG was recorded before and after HD in a standard setting. The QT intervals for each lead were measured manually by one observer using calipers. Each QT interval was corrected for heart rate: QTc= QT √ R-R/ (in milliseconds [ms]). ECG parameters, body weight, blood pressure, heart rate, electrolytes (Na + , K + , Ca ++ , phosphate), urea, and creatinine were measured before and after HD. The mean of pre and post dialysis cycle intervals was 828 ± 132 ms and 798 ± 122 ms respec­tively; the difference was not significant. The mean of QT max intervals changed significantly from 446 ± 47 to 465 ± 72 ms (P< 0.05). The mean of corrected QT cmax intervals increased significantly from 472 ± 38 to 492 ± 58 ms (P< 0.05). The mean of QT dispersions and the corrected QT interval dispersions changed from 60 ± 29 to 76 ± 32 ms (P< 0.05) from 72 ± 46 to 98 ± 56 ms (P< 0.05), respectively. During HD, the serum potassium and phosphate levels decreased whereas the calcium levels increased. We conclude that QT and QTc interval and dispersion increase in HD patients.
  6 3,129 778
Treatment of steroid resistant nephrotic syndrome in children
Jameela A Kari, Manal Halawani
May-June 2010, 21(3):484-487
Achieving remission in children with Steroid-Resistant Nephrotic Syndrome (SRNS) could be difficult. Many immunosuppressive drugs are used with variable success rates. We have studied the response of children with SRNS who presented to our pediatric's renal unit between 2002 and 2007 to various modalities of therapy. We included patients with no response to pred­nisolone (60 mg/M 2 /day) after four weeks of therapy; all the patients had renal biopsy and follow­up duration for at least one year. We excluded patients with congenital nephrotic syndrome, lupus, or sickle cell disease. There were 31 (23 girls and 8 boys with F: M= 2.9:1; the mean age at presentation was 4.2 ± 3.2) children who fulfilled the inclusion criteria. The mean duration of follow up was 3.1 ± 1.6 years. Twenty children (65%) achieved partial (6 children) or complete (14 children) remission. There were 16 children treated with cyclophosphamide either oral or intra­venous, and only 4 of them (25%) achieved remission. Seven children received oral chlorambucil, and only2 of them (28.5%) achieved remission; none of the children experienced side effects. Fifteen children received cyclosporine, and only eight of them (53%) achieved remission. Six children developed gum hypertrophy and one had renal impairment, which was reversible after discontinuing the drug. Mycophonelate mofetil (MMF) was used as the last option in 5 children, and 2 of them achieved complete remission. One child developed a systemic cytomegalovirus (CMV) infection which indicated discontinuing the drug. Fourteen (45%) children needed more than one immunosuppressive therapy. Three children progressed to end stage renal failure and required dialysis. We conclude that SRNS in children is a difficult disease with significant morbidity. However, remission is achievable with cyclosporine and other immunosuppressive agents. Treatment should be individualized according to the underlying histopathology, and clinical and social conditions of the children.
  4 5,970 1,592
Holy month of Ramadan and increase in organ donation willingness
Katayoun Najafizadeh, Fariba Ghorbani, Sajjad Hamidinia, Mohammad Ali Emamhadi, Mohammad Ali Moinfar, Omid Ghobadi, Shervin Assari
May-June 2010, 21(3):443-446
Organ shortage is the most significant factor in restricting the activities of trans­plantation systems. We herein report the positive impact of Muslims' holy month of Ramadan on willingness to donate organs in Iran. Data were derived from the database of Donation Willing­ness Registries, affiliated to the organ procurement unit of Masih Daneshvari Hospital during March 2007 till March 2008. The number of applications for organ donation was compared bet­ween Ramadan and its previous month, and the socio-economic characteristics of the applicants were compared between those who applied in Ramadan and those who did so in the previous month. In addition, the mean number of daily applications was compared between Ramadan and the other months of the same year. A total of 11528 applications for organ donation cards were registered for the Ramadan of 2007 as opposed to 4538 applications in the previous month, sho­wing an increasing rate of 154%. The mean number of daily applications was significantly higher in Ramadan than that of the other months of the same year (P< 0.001). There was also a significant difference in terms of the socio-economic characteristics between the applicants in Ramadan and those in the previous month. The increase in organ donation willingness in Ramadan may be the result of the propagation of altruism by the mass media and religious organizations. Ramadan seems to provide a great opportunity to promote organ donation across the Muslim world.
  4 3,072 515
The role of B-Mode ultrasonography in the detection of urolithiasis in patients with acute renal colic
Azmi A Haroun, Azmy M Hadidy, Ayman M Mithqal, Waleed S Mahafza, Nusaiba T Al-Riyalat, Rasha F Sheikh-Ali
May-June 2010, 21(3):488-493
This study was conducted to assess the diagnostic yield of B-Mode Ultrasonogra­phy compared to unenhanced helical CT scan in detecting urinary stones in patients with acute renal colic. This retrospective study comprised of 156 patients who underwent unenhanced uri­nary tract CT scan and ultrasonography for suspicion of urolithiasis. Both techniques were used to determine the presence or absence, site, size, and number of urinary stones, as well as presence of any other intra-abdominal pathology. For statistical analysis, the sensitivity, specificity, predictive values, and diagnostic accuracy of ultrasonography were measured considering unenhanced CT scan as a gold standard. Unpaired two-tailed student's t-test was used for comparison between mean size of true positive, false positive, and false negative stones. There were 68 patients having 115 urinary stones. Ultrasound identified 54 stones, missed 43, and falsely diagnosed 18 stones. The mean size of true positive, false positive, and false negative stones were 4.8 ± 3.3 mm, 6 ± 1.8 mm and 4.18 ± 3 mm, respectively. There were 23 patients with other intra-abdominal patho­logies, equally detected by both techniques. Ultrasound helped in identifying the cause of acute flank pain in 62% of cases. The overall sensitivity, specificity, positive and negative predictive values, and accuracy of ultrasonography in the diagnosis of renal stone disease were 58%, 91%, 79%, 78%, and 78% , respectively. Our study suggests that, despite its limited value in detecting urinary stones, ultrasonography should be performed as an initial assessment in patients with acute flank pain. Unenhanced helical CT should be reserved for patients in whom ultrasonography is inconclusive.
  3 3,911 802
The effect of low serum bicarbonate values on the onset of action of local anesthesia with vertical infraclavicular brachial plexus block in patients with End-stage renal failure
Mahmoud M Al-mustafa, Islam Massad, Moaath Alsmady, Abdullah Al-qudah, Subhi Alghanem
May-June 2010, 21(3):494-500
Vertical infraclavicular brachial plexus block is utilized in patients with chronic renal failure at the time of creation of an arterio-venous fistula (AVF). The aim of this study is to test the effect of impaired renal function, with the resulting deranged serum electrolytes and blood gases, on the success rate and the onset of action of the local anesthetics used. In this prospective clinical study, we investigated the effect of the serum levels of sodium, potassium, urea, crea­tinine, pH, and bicarbonate on the onset of action of a mixture of lidocaine and bupivacaine administered to create infraclavicular brachial plexus block. A total of 31 patients were studied. The success rate of the block was 93.5 % (29 patients). The mean onset time for impaired or re­duced sensation was found to be 8.9 ± 4.7 mins and for complete loss of sensation, was 21.2 ± 6.7 mins. There was no significant association with serum sodium, potassium, urea, creatinine or the blood pH level (P> 0.05). The bivariate correlation between serum bicarbonate level and the partial and complete sensory loss was -0.714 and -0.433 respectively, with significant correlation (P= 0.00, 0.019). Our study suggests that infraclavicular block in patients with chronic renal failure carries a high success rate; the onset of the block is delayed in patients with low serum bicarbonate levels.
  3 3,961 500
The role of oral L-Carnitine therapy in chronic hemodialysis patients
Alaa A Sabry
May-June 2010, 21(3):454-459
To evaluate the effects of L-carnitine oral supplementation on anemia and cardiac function in patients on maintenance hemodialysis (HD), we studied 55 adult chronic HD patients at our center during the period from January 2006 to June 2006 and divided them into two groups; a group of 20 patients who received 1,500 mg/day oral L-carnitine and a control group of 35 patients. Both groups were on erythropoietin therapy. Echogardiographic studies were performed before and at the end of the study. The mean hemoglobin levels were comparable in the L-­carnitine group and the control group at the start and after 6 months of therapy (8.63 ± 1.77 and 9.39 ± 2.02 gm/dL, P= 0.18; 10.49 ± 1.65 and 10.92 ± 2.48 gm/dL, P= 0.76, respectively). The mean weekly maintenance dose of erythropoietin was not statistically significantly different in L­carnitine group (80.16 ± 35.61 units/kg) and the control group (91.9 ± 38.21 units/kg, P= 0.20). In addition no significant improvement could be observed in the echogardiographic findings in the L-carnitine group after therapy. We conclude that our study revealed no significant improvement in hemoglobin, erythropoietin dose and echocardiographic findings after six months of therapy. Long-term studies including larger number of patients are required to clarify the questionable role of L-carnitine in the HD patients.
  3 5,749 1,118
Congenital vitamin D deficiency: A rare etiology of an acute life threatening event in early infancy
Rafat Mosalli, Elsayed Yasser, Abbass Mohammad Ali, Saleh Al Harbi
May-June 2010, 21(3):511-514
Infants born to mothers with deficiency of vitamin D and/or calcium due to cultural modifications in their diets, life style and clothing habits, are at risk of developing early and fatal sequelae of hypocalcemic vitamin D deficiency. We present a 44-day-old infant with hypocal­cemia secondary to congenital vitamin D deficiency, who presented as a recurrent Acute Life Threatening Event (ALTE) resulting in an unexpectedly prolonged intensive care course. This report suggests that evaluation of vitamin D status should be included as part of the workup of ALTE and we describe evidence-based preventive measures for both mothers and infants who are at risk for vitamin D deficiency.
  2 3,513 603
Panniculitis associated with steroid use
Arvind Bagga, Sidharth Kumar Sethi, Alok Sharma
May-June 2010, 21(3):539-541
  2 2,769 429
Primary renal lymphoma: A differential diagnosis of renal mass in a young male
Ankur Gupta, Anil Bhatt, Ambar Khaira, Ashwini Gupta, Devender S Ran
May-June 2010, 21(3):544-545
  2 3,055 496
Effect of vitamin E coated dialyzers on anticoagulation requirement in hemodialyzed children
Bilal Aoun, Yuliya Janssen-Lozinska, Tim Ulinski
May-June 2010, 21(3):466-470
As hemodialysis (HD) requires extra corporal blood flow and the need for anti­coagulation, we evaluated the effect of vitamin E coated membranes (VIE) on the requirement of low molecular weight heparin (LMWH) in pediatric HD patients. Patients and methods: seven children and adolescents on regular hemodialysis were started on VIE and their LMWH dose was decreased every week. In order to monitor the requirement of LMWH we used a coagulation score to evaluate coagulation in the dialyzer, air trap and blood line. Other classical parameters (hemoglobin, erythropoietin dose, inflammatory markers) were monitored weekly while the pa­tients were on VIE dialyzers. LMWH dose during the 1st week was 110 IU/kg ± 18 (defined as 100%), in the 2nd week the dose was 77 IU/kg ± 12 (70%), in the 3 rd week the dose was 33 IU/kg ± 5 (30%), and in the 4 th week anticoagulation could be stopped in one patient, in the other six pa­tients further decrease was impossible given the increase of the clotting score. There was no in­crease in clotting score during week one and two. During week three (while on 30% of the initial LMWH dose) six patients showed mild to moderate clotting phenomena: mild coagulation phe­nomena in three patients and moderate clotting phenomena in three others. One patient did not show any clotting phenomena in week three and LMWH was totally stopped. In conclusion, use of VIE dialyzers may help to reduce the requirement of anticoagulation in pediatric HD patients reducing bleeding problems and simplify hemostasis after HD sessions.
  2 2,536 460
Factors associated with decision-making about end-of-life care by hemodialysis patients
Salim A Baharoon, Hamdan H Al-Jahdali, Abdullah A Al-Sayyari, Hani Tamim, Yaser Babgi, Saeed M Al-Ghamdi
May-June 2010, 21(3):447-453
The current cross sectional study is based on a questionnaire database on patients with end-stage renal disease (ESRD) to determine their preferences about end-of-life care and differences of certainty regarding the application of cardiopulmonary resuscitation and life sus­taining measures in case of cardiac arrest. The study was performed on 100 patients on hemo­dialysis for at least 2 years and not on the transplant list in two tertiary hospitals in Saudi Arabia; King Fahad National Guard in Riyadh and King Faisal Specialist Hospital in Jeddah in March 2007. More than two thirds of the surveyed patients were willing to make decisive decisions. Ha­ving more than 5 children was the only factor significantly associated with the ability to make de­cisive decisions; there was an insignificant association with factors such as marital status or non­Saudi nationality. Factors such as self-perception or disease curability, previous admissions to hospital or intensive care units, prior knowledge of mechanical ventilation, or cardiopulmonary resuscitation did not have any influence on making certain decisions on end-of-life care. There was a significant lack of knowledge in our study patients of cardiopulmonary resuscitation, me­chanical ventilation, and disease outcome.
  2 3,042 797
Laparoscopic right donor nephrectomy: Endo TA stapler is safe and effective
Amit K Devra, Suhag Patel, Shailesh A Shah
May-June 2010, 21(3):421-425
Although laparoscopic donor nephrectomy is now a well-accepted alternative to traditional open donor nephrectomy at many transplantation centers, there are always concerns regarding quality of graft and vessels after laparoscopic harvest, especially with right donor nephrectomy. Several methods of graft retrieval have been explored to achieve acceptable graft outcome. We share our initial experience at the Institute of Kidney Diseases and Research Center, Amedabad, India of laparoscopic right donor nephrectomy performed by subcostal open, and pure laparoscopic approach with the use of Endo TA stapler. Nine laparoscopic right donor nephrec­tomies were performed by the trans-peritoneal approach at our centre from January 2006 to March 2007. In the first five cases, the grafts were retrieved through subcostal incision (Group A) and the last four cases were performed purely laparoscopically by using Endo TA stapler device (Group B). None of the patients needed open conversion. The mean operative time and hospital stay were comparable in each group. The warm ischemia time was longer in pure laparoscopic group (415 seconds) than the subcostal open approach group (176 seconds). The serum creatinine of the recipients on day seven was comparable in both the groups. The recipient surgery was effectively performed with graft retrieved using Endo TA stapler device (Group B) without any compromise to the renal vein length. Our study suggests that the Endo TA stapler device is safe and provides all the benefits of minimally invasive surgery to the donor.
  2 2,826 715
Safe conversion to cicloral, a generic cylosporine, in both stable and De Novo renal transplant recipients
Delawir Kahn, Elmi Muller, Michael Pascoe
May-June 2010, 21(3):426-432
Several generic cyclosporine (CsA) formulations have been developed over the last decade and are now widely available. In 2003 our local Health Department replaced Neoral with CicloHexal for the cost benefits, and we were compelled to convert all our renal transplant reci­pients to the generic CsA formulation. All renal transplant recipients were converted from Neoral to CicloHexal on a 1:1 dose basis in August/September 2003. Study 1 constitutes the retrospective review of all stable renal transplant patients and the CsA dose, CsA level and serum creatinine were noted. Study 2 constitutes the review of the records of de novo transplant patients inititated on CicloHexal compared to matched patients transplanted on Neoral before the conversion and the CsA dose, CsA level and serum creatinine noted (Study 2). There was no difference in the mean CsA dose, CsA level or serum creatinine at one month before conversion (on Neoral) com­pared to one month after conversion (on CicloHexal) in the 117 stable renal transplant recipients. Similarly, the mean CsA dose, CsA level and serum creatinine in de novo renal transplant reci­pients on Neoral (n= 26) were similar to those on CicloHexal (n= 23) at about seven and ten days postoperatively. In conclusion both stable and de novo renal transplant patients can be safely converted from Neoral to CicloHexal on a 1:1 dose basis.
  2 2,178 431
Assessment of sleep disturbance in renal transplant recipients and associated risk factors
Vahid Pourfarziani, Saeed Taheri, Mir Mohsen Sharifi-Bonab, Maqsud Mohammadzadeh
May-June 2010, 21(3):433-437
Sleep disturbances are highly prevalent in ESRD patients. In this study we sought to evaluate the associations of poor sleep with several genetic, laboratory, treatment and de­mographic factors in renal allograft recipients using a validated sleep quality questionnaire. A cross-sectional study was conducted on renal transplant patients over 18 years of age with stable current stable graft function. All patients completed PSQI and Ifudu questionnaires for assessment of sleep quality and morbidity measures. Kolmogorov-Smirnov test was used for evaluation of distributions besides Student's t-test, and Fisher's exact test for analyses. Mean total PSQI score for the whole patients was 6.5 ± 2.6. Overall 26 (67%) of patients were diagnosed as "poor sleepers" (PSQI total score ≥ 5) and the reminding 13 (33%) were "good sleepers". Compared to "good sleepers", "poor sleepers" significantly had higher serum phosphate levels and ESRD duration (P= 0.05). Hematological disorders were more seen in "poor sleepers" and musculo­skeletal disorders had a significant worsening impact on PSQI total score (β= 0.28, P= 0.05). In conclusion our study showed that sleep disturbance is common in renal transplant patients is sur­prisingly common, and ESRD duration prior to transplant was significantly associate with sleep quality. Future studies with larger sample sizes are necessary for confirming our results.
  2 2,395 526
Renal transplantation in Nepal: The first year's experience
Pawan R Chalise, Dibya S Shah, Uttam K Sharma, Prem R Gyawali, Guna K Shrestha, Bhola R Joshi, Mukunda P Kafle, Mahesh Sigdel, Kanak B Raut, David M.A. Francis
May-June 2010, 21(3):559-564
A successful renal transplantation service was started in Nepal at the Tribhuvan Univer­sity Teaching Hospital in August 2008, and a continuing regular service is being provided currently to needy people. We report here our experience in thirty five end stage renal disease patients who re­ceived kidneys from close relatives during a one year period. The mean age of donors was 46.7 years. Seventeen (49%) donations were from parents, 13 (37%) from spouses, four (11%) between siblings and one (3%) between mother and daughter in law. Although the left kidney was given preference, right sided donor nephrectomy was needed in five (14%) cases. Six (17%) donors had minor post­operative problems. The mean age of recipients was 33.2 years, four (11%) of whom had pre-emptive renal transplantation. Recipients were immunosuppressed with dacluzimab, prednisolone, mycophena­late, and cyclosporine or tacrolimus. The average time taken for graft implantation was 137 minutes. The mean cold ischemia time and second warm ischemia time were 133 and 36 minutes respectively. Four (11%) patients developed urinary tract infection, three (9%) had significant hematuria, one (3%) developed a peri-transplant abscess, and one (3%) had ureteric ischemia and urine leak which required re-exploration in the early post-operative period. Four patients (11%) developed acute rejection of which three were cell- mediated rejection and one was antibody-mediated. There were two (6%) deaths, one due to transplant-related sepsis and the other due to subarachnoid hemorrhage following rupture of a posterior communicating artery aneurysm. No kidney has been lost otherwise.
  2 4,227 488
Pattern of lipid profile in patients on maintenance hemodialysis
Narinder Maheshwari, Muhammad Rafique Ansari, Muhammad Shahzad Laghari, Darshana , Kumar Lal, Kamran Ahmed
May-June 2010, 21(3):565-570
This hospital-based cross-sectional comparative observational study was performed to determine the pattern of lipid profile in patients on maintenance hemodialysis. The study was performed at the Department of Nephro-Urology, Liaquat University Hospital, Hyderabad, Pakistan from April 2008 to June 2008. Fifty patients with end-stage renal disease on maintenance hemo­dialysis (MHD) were studied. They comprised of 31 males and 19 females, the mean duration on HD was 7.58 ± 2.05 yrs, with frequency of two to three sessions per week and each session las­ting for four hours. Additionally, 25 healthy volunteers (16 male, 9 female) were also studied. Af­ter obtaining informed, written consent, general information of each patient was recorded on the proforma. After 12-hours fasting, blood samples were drawn from the arterio-venous fistula before starting dialysis. The total cholesterol, triglyceride (TG) or low density lipoprotein (LDL) levels more than 95 th percentile for age and gender or high density lipoprotein (HDL) less then 35 mg/dL was defined as dyslipidemia. Descriptive and inferential statistical analysis were performed using SPSS version 16.0. The age among MHD and control groups was 47.88 ± 13.92 and 54.56 ± 11.16 years respectively. Serum TG and lipoprotein-a (LPa) were significantly increased (P= < 0.001 for each) while HDL-c was significantly lower (P= < 0.001) in MHD patients than in the control group. The serum cholesterol, LDL-c, VLDL-c and chylomicron levels were not signi­ficantly different in the two groups. Our study suggests that patients on MHD show abnor­malities of lipid metabolism like hypertriglyceridemia, elevated lipoprotein-a and low HDL-c, which could contribute to atherosclerosis and cardiovascular disease that may increase the mor­bidity and mortality in these patients.
  2 5,300 915
Ramadan fasting and transplantation: Current knowledge and what we still need to know
Hossein Khedmat, Saeed Taheri
May-June 2010, 21(3):417-420
Ramadan fasting is one of the most appreciated Islamic rituals in Islamic culture. Although non-healthy as well as weak people are allowed not to fast in this month, some trans­plant recipient patients are willing to fast but are concerned about adverse effects on their health. Due to answering this question, a number of studies have been conducted. In this literature review we review the existing data on this issue and attempt to reach to a conclusion on what we know and what we still need to know.
  2 4,817 976
Xanthogranulomatous pyelonephritis in a Horse-Shoe kidney
Ritesh Mongha, Arindam Dutta, Mukesh Vijay, Uttara Chatterjee, Sudip C Chakraborty
May-June 2010, 21(3):515-517
Xanthogranulomatous pyelonephritis (XGPN) represents an unusual suppurative gra­nulomatous reaction to chronic infection, often in the presence of chronic obstruction from a calculus. We present a case of XGPN in a horse shoe kidney in an adult. Hemi-nephrectomy of the involved side was followed by clinical improvement. The case highlights the importance of early hemi-nephrectomy in XPGN with horse shoe kidney.
  1 2,366 357
Renal thrombotic microangiopathy revisited: When a lesion is not a clinical finding
Sacha A De Serres, Paul Isenring
May-June 2010, 21(3):411-416
Despite advances in the field of thrombotic microangiopathy (TMA) and associated syndromes such as thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS), they still leave several issues unresolved. For instance, actual diagnostic criteria on which therapeutic decisions rely are relatively narrow and focused on TTP-HUS, with the consequence that non-idiopathic and atypically-presenting TMA are overlooked. In addition, nosologic classifi­cations of TMA disorders have varied substantially over the years, but are still devised from historical rather than mechanistic data. As such, it is perhaps not surprising that even today TMA is erroneously used as an interchangeable term with TTP-HUS, and missed or inappropriately diagnosed on various occasions. Yet, recognizing TMA is of crucial importance given that this lesion often manifests with potentially reversible renal failure. In this editorial, which is presented from a Nephrologist's perspective, we propose that TMA disorders need to be reclassified to include most types of presentations and confirmed or excluded through more elaborate diagnostic approaches.
  1 5,267 1,226
Impact of cardiovascular risk factors on the outcome of renal transplantation
Mehrdad Moghimi, Kianoosh Falaknazi, Nazila Bagheri
May-June 2010, 21(3):438-442
Cardiovascular diseases are common in renal transplant recipients and renal insuf­ficiency has been shown to be a risk factor for cardiovascular disease. Some studies have reported that cardiovascular risk factors may contribute to the outcome of renal transplantation. This study was performed to determine the impact of cardiovascular risk factors on the outcome of renal transplantation in Iranian subjects. This is a retrospective, observational study including patients of 20­85 years of age who had undergone renal transplantation. Parameters documented and analyzed included demographics, cardiovascular risk factors, past medical history, date of last transplan­tation, the outcome of transplant, last measured serum creatinine, cause of graft failure, rejection, and death. A total of 192 patients were analyzed including 152 in the case group (with identifiable cardiovascular risk factors) and 40 controls (transplant recipients without identifiable risk factors). The mean serum creatinine in the case and control groups were 1.33 ± 0.13 and 1.29 ± 0.36 mg/dL respectively (P= 0.493). Response to transplantation was categorized based on a report from the World Health Organization. Complete response to grafting occurred in the control group more than the case group (P= 0.009), while frequency of partial response to grafting was higher in the case group (0.008). A history of chronic obstructive pulmonary diseases (COPD) could significantly predict the outcome of grafting (P= 0.008) as could the occurrence of renal failure (P= 0.022). Results were consistently reproduced using multivariate cumulative log it model. Our study indicates that the measured cardiovascular risk factors do not significantly influence the outcome of renal transplantation.
  1 2,057 415
Electrocardiographic manifestations of hyperkalemia in hemodialysis patients
Eghlim Nemati, Saeed Taheri
May-June 2010, 21(3):471-477
This study was performed to evaluate whether any electrocardiogram (ECG) para­meter can predict the presence of hyperkalemia in patients on maintenance hemodialysis (HD). In January 2006, we conducted a cross-sectional study of 80 stable patients with end-stage renal disease from four university-based HD units of Tehran, Iran, receiving conventional thrice-weekly HD. Pre-HD serum electrolyte values and conventional 12-lead ECG were obtained from each pa­tient. Bivariate linear regression was used for assessing relationship of the study variables with hyperkalemia (K + > 5.2 mg/dL). Multivariable logistic regression was used for evaluating inde­pendent relationship between decreased T wave duration (≤ 170 ms) and other variables. Bivariate correlation analysis showed a significant inverse correlation between serum potassium concentra­tion and T wave duration (P<0.05). None of the patients with serum potassium of ≥ 5.6 mg/dL had T wave duration > 200 ms. Multivariate logistic analysis, after adjustment for other factors, also showed a significant relationship between decreased T wave duration (≤ 170 ms) and hyper­kalemia. We conclude that although hyperkalemia does not induce the usual ECG changes in HD patients, decreased T wave duration was found to be a good indicator of this lethal condition.
  1 5,068 1,181
Comparative study of anticoagulation versus saline flushes in continuous renal replacement therapy
Amit P Nagarik, Sachin S Soni, Gopal Kishan Adikey, Anuradha Raman
May-June 2010, 21(3):478-483
Systemic heparinization during continuous renal replacement therapy (CRRT) is associated with disadvantage of risk of bleeding. This study analyses the efficacy of frequent saline flushes compared with heparin anticoagulation to maintain filter life. From January 2004 to November 2007, 65 critically ill patients with acute renal failure underwent CRRT. Continuous venovenous hemodialfiltration (CVVHDF) was performed using Diapact Braun CRRT machine. 1.7% P.D. fluid was used as dialysate. 0.9% NS with addition of 10% Ca Gluconate, Magnesium Sulphate, Soda bicarbonate and Potassium Chloride added sequentially in separate units were used for replacement, carefully monitoring their levels. Anticoagulation of extracorporeal circuit was achieved with unfractionated heparin (250-500 units alternate hour) in 35 patients targeting aPTT of 45-55 seconds. No anticoagulation was used in 30 patients with baseline APTT > 55 seconds and extracorporeal circuit was maintained with saline flushes at 30 min interval. 65 pa­tients including 42 males. Co-morbidities were comparable in both groups. HMARF was signifi­cantly more common in heparin group while Sepsis was comparable in both the groups. CRRT parameters were similar in both groups. Average filter life in heparin group was 26 ± 6.4 hours while it was 24.5 ± 6.36 hours in heparin free group ( P=NS). Patients receiving heparin had 16 bleeding episodes (0.45/patient) while only four bleeding episodes occurred in heparin free group (0.13/patient, P< 0.05). Mortality was 71% in heparin group and 67% in heparin free group. Frequent saline flushes is an effective mode of maintainance of extracorporeal circuit in CRRT when aPTT is already on the higher side, with significantly decreased bleeding episodes.
  1 4,080 1,109
Isolated non diabetic renal disease in diabetic patients: A moroccan report
Intissar Haddiya, Hakim Hamzaoui, Zitouna Al Hamany, Aicha Radoui, Hakima Rhou, Loubna Benamar, Rabia Bayahia, Naima Ouzeddoun
May-June 2010, 21(3):555-558
The occurrence of non-diabetic renal disease (NDRD) in diabetic patients is well established, with different frequencies from all around the world. We report 13 cases of isolated NDRD in diabetic patients diagnosed in our unit and present our biopsy criteria in these patients. From January 2000 to December 2008, 13 diabetic patients with suspected NDRD underwent renal biopsy. The case records of these patients were retrospectively analysed. Nine were males and the mean age was 51 years (10-75). Two had a type I diabetes and 11 had a type II diabetes. The mean duration of diabetes was 36 and 30 months in type I and II respectively. Indications for renal biopsy included: absent retinopathy in 11 cases (84%), heavy proteinuria in four cases (30%), acute renal failure (ARF) in three cases (23%), rapidly progressive renal failure (RPRF) in one case (7%), hematuria in five cases (38%), extra-renal signs in four cases (30,7%), short duration of diabetes in all cases. In conclusion, NDRD was observed in our study in patients with a short duration of diabetes and atypical clinical or biological findings.
  1 2,623 503
Cystic nephroma: A diagnostic dilemma
Debajyoti Mohanty, Bhupendra Kumar Jain, Vivek Agrawal, Arun Gupta
May-June 2010, 21(3):518-520
Cystic nephroma (CN) is a rare benign neoplasm of kidney with excellent prog­nosis. An accurate pre-operative diagnosis differentiating CN from other cystic renal malignan­cies may be impossible by clinical and radiological examination, and histopathological exami­nation provides the final diagnosis. This report describes two adult patients with large multi-locular cystic renal masses on imaging and the diagnosis of CN was clinched post-operatively by the ho­neycomb appearance of the cut specimen and the finding of multiple, non-communicating fluid filled cysts lined by cuboidal or flattened epithelial cells and absence of blastemal cells on mic­roscopy. Tumor diameter on cross sectional imaging remains the key parameter for treatment de­cisions in renal neoplasms, with nephrectomy being preferred for larger lesions.
  - 3,777 462
ANCA-Positive Pauci-Immune rapidly progressive glomerulonephritis and the nephrotic syndrome
Wael Latif Jabur, Hareth M Saeed
May-June 2010, 21(3):526-530
We herewith report a case of biopsy proven crescentic glomerulonephritis (GN) due to vasculitis, whose sole presentation was the nephrotic syndrome. Our case raises the possibility of whether the disease initially was a primary GN, upon which crescentic GN was superimposed, or was it vasculitis from initial stages with an atypical presentation. The various points for both these possibilities are discussed.
  - 5,110 795
Relapsing peritonitis in a malnourished female with rheumatoid arthritis on continuous ambulatory peritoneal dialysis
Varun Sundaram, Georgi Abraham, Santosh Kumar Mohanraj, Yogesh NV Reddy, Vijaiaboobbathi Sathiah
May-June 2010, 21(3):501-503
  - 2,097 385
Post transplant ureteric stenosis causing allograft hydronephrosis and calyceal rupture: Salvage side to side ureteroneocystostomy
Mirza Anzar Baig, Taqi Khan, Dujana Mousa
May-June 2010, 21(3):504-506
A 26 years old lady with End Stage Renal Disease who received a cadaveric renal trans­plant, presented with ureteral stenosis as well as calyceal rupture due to hydronephrosis that was unresponsive to balloon dilation and the allograft was salvaged by a side to side ureteroneo­cystostomy. The symptoms and renal function improved and patency of the side to side uretroneo­cystostomy was confirmed post operatively and also at seventeen month follow-up. It may be rea­sonable to treat post-transplant ureteral stenosis resistant to balloon dilation with this technique. However, long-term follow-up is required to evaluate the efficacy of this treatment.
  - 3,795 372
Conservative treatment of processus vaginalis hernia in two peritoneal dialysis patients
Hamed Al-Wadani, Abdulaziz Ali Alqahtani, Noora Al-Dossari, Ayat Alsawad, Myasaar Al-Atiqu, Iraheem Saad, Abdullah K Al-Hwiesh
May-June 2010, 21(3):507-510
Dialysate leakage represents one of the major noninfectious complications of peri­toneal dialysis (PD). In some instances, dialysate leakage may lead to discontinuation of the technique. Despite its importance, the incidence, risk factors, management, and outcome of dia­lysate leakage are poorly characterized in the literature. Here, we report two PD patients who pre­sented with painless scrotal swelling. Computerized peritoneography confirmed the diagnosis of processus vaginalis hernia that was treated conservatively.
  - 2,199 212
Delayed presentation of traumatic renal AV fistula managed by coil embolization
John Samuel Banerji, Karthikeyan Aswathaman, Sunithi Elizabeth Mani
May-June 2010, 21(3):531-532
  - 2,045 380
Regional citrate anticoagulation for hemodialysis: A safe and efficient method
Faical Jarraya, Khaled Mkawar, Khawla Kammoun, Abdelhamid Hdiji, Somaya Yaich, Mahmoud Kharrat, Khaled Charfeddine, Mohamed Ben Hmida, Hichem Mahfoudh, Fatma Ayedi, Jamil Hachicha
May-June 2010, 21(3):533-534
  - 3,221 649
Computerization of hemodialysis records: A new era explored
Ashar Alam
May-June 2010, 21(3):535-537
  - 1,993 368
An unusual cause for Post-Renal transplant hematuria and proteinuria: A retained Double-J catheter
Manouchehr Amini, Gholam Hossain Naderi
May-June 2010, 21(3):538-538
  - 2,495 353
Retroperitoneal mass and burned out testicular tumor
Salim Jaber
May-June 2010, 21(3):542-543
  - 2,244 431
Renal artery embolization in a patient with severe nephrotic syndrome
Yalcin Solak, Huseyin Atalay, Ilker Polat, Kultigin Turkmen, Osman Koc, Suleyman Turk
May-June 2010, 21(3):546-547
  - 2,197 417
Outcome of Iranian children with mild post streptococcal glomerulonephritis
Alaleh Gheissari, Taj Saadat Adjodani, Maryam Hashemi, Arghavan Mokhtarian, Mehri Sirous
May-June 2010, 21(3):571-574
We studied the long-term outcome of children with mild acute post streptococcal glomerulonephritis (APSGN) APSGN hospitalized at St Al Zahra hospital, Isfahan, Iran from 1993-1998. The patients were subdivided into two groups according to the duration of follow-up. Group A consisted of 15 patients and group B consisted of 12 patients, followed up for 4 and 8 years, respectively. The male to female ratio was 1.45/1. The mean GFR in group A and B was 127.7 ± 26 mL/min/1.73 m2; and 128.57 ± 7 mL/min/1.73 m2, respectively. There was no statis­tically significant difference between GFRs in two groups. Comparing the mean systolic blood pressure in two groups did not demonstrate a significant difference; 95.33 ± 7.1 mmHg in group A and 102.5 ± 14.06 mmHg in group B. However the mean diastolic blood pressure in group B was significantly higher than group A; 65.4 ± 11.71 mmHg vs 61.33 ± 3.51 mmHg. Our study found that even mild APSGN may lead to some degree of renal impairment, and rising diastolic blood pressure maybe an early clinical sign of renal impairment in APSGN.
  - 2,671 685
Hospital activities in organ donation program in Saudi Arabia

May-June 2010, 21(3):575-580
  - 1,510 228
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