Home About us Current issue Ahead of Print Back issues Submission Instructions Advertise Contact Reader Login  

Search Article 
Advanced search 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 2202 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
Export selected to
Reference Manager
Medlars Format
RefWorks Format
BibTex Format
  Citation statistics : Table of Contents
   2012| March-April  | Volume 23 | Issue 2  
    Online since February 28, 2012

  Archives   Previous Issue   Next Issue   Most popular articles   Most cited articles
Hide all abstracts  Show selected abstracts  Export selected to
  Cited Viewed PDF
Primary hyperoxaluria type 1 in Tunisian children
Tahar Gargah, Nourchene Khelil, Gharbi Youssef, Wiem Karoui, Mohamed Rachid Lakhoua, Jaouida Abdelmoula
March-April 2012, 23(2):385-390
To determine the clinical, biological, and radiological futures of primary hyper-oxaluria type 1 in Tunisian children, we retrospectively studied 44 children with primary hyper-oxaluria type 1 who were treated in our center from 1995 to 2009. The diagnosis was established by quantitative urinary oxalate excretion. In patients with renal impairment, the diagnosis was made by infrared spectroscopy of stones or kidney biopsies. The male-to-female ratio was 1:2. The median age at diagnosis was 5.75 years. About 43% of the patients were diagnosed before the age of five years with initial symptoms dominated by uremia. Four patients were asymptomatic and diagnosed by sibling screenings of known patients. Nephrocalcinosis was present in all the patients; it was cortical in 34%, medullary in 32%, and global in 34%. At diagnosis, 12 (27%) children were in end-stage renal disease. Pyridoxine response, which is defined by a reduction in urine oxalate excretion of 60% or more, was obtained in 27% of the cases. In the majority of patients, the clinical expression of primary hyperoxaluria type 1 was characterized by nephrocal-cinosis, urolithiasis, and renal failure; pyridoxine sensitivity was associated with better outcome.
  3 3,318 558
Peritonitis caused by Mycobacterium abscesses in patients on continuous ambulatory peritoneal dialysis
Nauman Siddiqi, Iftikhar Sheikh
March-April 2012, 23(2):321-324
Nontuberculous mycobacteria are an uncommon cause of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. We report two cases of peritonitis caused by Mycobacterium abscesses from a single center, which were successfully treated. In endemic areas of tuberculosis, Zeil Neilsen staining should be part of the initial evaluation to allow early detection. Treatment requires removal of Tenckhoff catheter and second-line antibiotics until cultures become negative.
  2 3,307 460
A randomized trial of saline hydration to prevent contrast-induced nephropathy in patients on regular captopril or furosemide therapy undergoing percutaneous coronary intervention
Hassan Shemirani, Masood Pourrmoghaddas
March-April 2012, 23(2):280-285
Contrast-induced nephropathy (CIN) is characterized by acute deterioration of renal function that occurs after parenteral administration of contrast media in the absence of other causes. Although no definite proof has been obtained yet, the risk of diuretics or angiotensin-converting enzyme inhibitors (ACEI) to exacerbate CIN has been reported because of their effects on renal perfusion. This study was conducted to assess the protective effect of hydration alone in the prevention of CIN after percutaneous coronary intervention (PCI) in patients on diuretics or ACEI. This randomized clinical trial was conducted at the Chamran Hospital, Isfahan University of Medical Sciences, Iran, during the years 2006-2007. The study patients were divided into four groups, each group containing 60 patients. Patients in groups A and B were on regular treatment with ACEI (captopril) and patients in groups C and D were on regular diuretic (furosemide) the­rapy. About 36 h before PCI, captopril in group A and furosemide in group C were discontinued. The serum creatinine (Cr) levels were measured at the time of performing PCI and 24 h and 48 h after PCI in all patients. All patients received 1 mL/kg/h normal saline (0.9%) 12 h before and 24 h after PCI. The occurrence of CIN after PCI was diagnosed based on the following formula: Cr level after PCI - Cr level before PCI. If this value was greater than 0.5 mg/dL, it was coded as one and if the value was less than 0.5 mg/dL, it was coded as zero. The mean difference was analyzed and compared among the four groups by the ANOVA test. Three patients (5%) in group A, two patients (3.3%) in group B, two patients (3.3%) in group C and one patient (1.6%) in group D had a >0.5 mg/dL difference in serum Cr. The difference seen between these groups was not statistically significant (P > 0.05). This study shows that although furosemide and captopril can exacerbate CIN by impairment of renal perfusion, this can be prevented by hydration and discontinuation of furosemide and captopril may not be required.
  2 3,779 942
Frequency of Chlamydia trachomatis among male patients with urethritis in northeast of Iran detected by polymerase chain reaction
Kiarash Ghazvini, Hassan Ahmadnia, Javad Ghanaat
March-April 2012, 23(2):316-320
Planning for appropriate preventive measures against Chlamydia trachomatis, a common cause of sexually transmitted disease, requires knowledge of prevalence of infection so that interventions can be targeted in a cost-effective manner. This study was performed on 178 male patients presenting with urethritis in the Mashhad province to determine the prevalence of chlamydial infection in Northeast Iran. A cotton swab and first voided urine specimen were collected according to standard procedures. Polymerase chain reaction (PCR) tests were used for the detection of C. trachomatis in the specimens collected and the results were analyzed using SPSS program. Results showed that 10.6% of male patients in this group were infected with C. trachomatis. This study provides strong evidence that prevalence of Chlamydia in the Northeast Iran is high and suggests that Chlamydia screening as a routine part of STD investigations is highly necessary in this area.
  1 3,625 449
Joubert syndrome presenting as unilateral dysplastic kidney, hypotonia, and respiratory problem
Majid Malaki, Masood Nemati, Maryam Shoaran
March-April 2012, 23(2):325-329
An 8-month-old girl with a history of asphyxia and respiratory distress immediately after birth was hospitalized at her fourth month of age with the diagnosis of kidney infection and it was revealed that she had a unilateral multicystic dysplastic kidney. In recent admission, she presented to emergency room with fever, hyperpnea, and apnea. In appearance, she was a hypotonic girl with broad forehead, hypertelorism, depressed nasal bridge and bitemporal regions, rapid vertical and horizontal nystagmus, and open mouth with salivation. In spite of normal physical growth, she had delayed developmental milestones. Blood gas O 2 saturation dropped after she received phenobarbital. Her urinary and blood tests were normal; however, her cranial magnetic resonance imaging (MRI) revealed vermis agenesis and molar tooth sign. These physical and para-clinical findings suggested Joubert syndrome.
  1 4,302 496
Urofacial syndrome
Kamal F Akl, Hashem M Al Momany
March-April 2012, 23(2):346-348
The urofacial syndrome is characterized by functional obstructive uropathy asso­ciated with an inverted smile. The importance of the subject is that it sheds light, not only on the muscles of facial expression, but also on the inheritance of voiding disorders and lower urinary tract malformations. We report a 10-year-old-male patient who had the urofacial syndrome. Early diagnosis of the urofacial syndrome is important to avoid upper urinary tract damage and renal failure.
  1 2,971 428
The Global Role of Kidney Transplantation
Guillermo Garcia Garcia, Paul Harden, Jeremy Chapman
March-April 2012, 23(2):215-222
World Kidney Day on March 8 th 2012 provides a chance to reflect on the success of kidney transplantation as a therapy for end stage kidney disease that surpasses dialysis treatments both for the quality and quantity of life that it provides and for its cost effectiveness. Anything that is both cheaper and better, but is not actually the dominant therapy, must have other drawbacks that prevent replacement of all dialysis treatment by transplantation. The barriers to universal transplantation as the therapy for end stage kidney disease include the economic limitations which, in some countries place transplantation, appropriately, at a lower priority than public health fundamentals such as clean water, sanitation and vaccination. Even in high income countries the technical challenges of surgery and the consequences of immunosuppression restrict the number of suitable recipients, but the major finite restrictions on kidney transplantation rates are the shortage of donated organs and the limited medical, surgical and nursing workforces with the required expertise. These problems have solutions which involve the full range of societal, professional, governmental and political environments. World Kidney Day is a call to deliver transplantation therapy to the one million people a year who have a right to benefit.
  1 3,213 659
Co-administration of albumin and furosemide in patients with the nephrotic syndrome
Pankaj Hari, Arvind Bagga
March-April 2012, 23(2):371-372
  1 4,616 1,057
Successful percutaneous continuous ambulatory peritoneal dialysis catheter insertion in a patient with past abdominal surgeries
Santosh Varughese, Vinoi George David, Gopal Basu, Anjali Mohapatra, Madhivanan Sundaram, Tamilarasi Veerasamy
March-April 2012, 23(2):353-354
  1 2,895 351
Transplantation with positive complement-dependent microcytotoxicity crossmatch in contemporary kidney transplantation: Practice patterns and associated outcomes
Ralph J Graff, Huiling Xiao, Brian Duffy, Mark A Schnitzler, David Axelrod, Krista L Lentine
March-April 2012, 23(2):234-245
We analyzed clinical factors and graft survival associated with complement-dependent microcytotoxicity (CDC) crossmatch (XM) positive (+) kidney transplants in 1995 to 2009 United Network of Sharing (UNOS) registry data. CDCXM negative (-) transplants were selected from centers and years in which at least one CDCXM+ transplant was performed at a given center in a given year. CDCXM+ and CDCXM- results were compared with bivariate and multivariate survival analysis. Our observations are as follows: (1) The risk of graft loss with CDCXM+ vs. CDCXM- results was markedly lower than the risk observed historically, e.g., living donor (LD)-CDCXM+ absolute all-cause graft survival reductions were 0.7% at 24 hours (P=0.007), 2.9% at one year (P <0.0001), 3.7% at five years (P<0.0001); deceased donor (DD)-CDCXM+ absolute graft survival reductions were 0.7% at 24 hours (P=0.02), 3.5% at one year (P <0.0001), 2.7% at five years (P=0.0009). On covariate adjustment, the only significant association of CDCXM+ vs. CDCXM- results was with one-year graft loss risk: LD aHR 1.44 (95% CI 1.05-1.96), DD aHR 1.33 (CI 1.10-1.61). (2) CDCXM+ transplantation was more commonly performed among groups disadvantaged with respect to transplant access, including sensitized, previously transplanted women and black recipients. (3) In CDCXM+ recipients, there was a high percentage of flow cytometry (FC) XM- and autoXM+ results. After removing these groups, outcomes with CDCXM+ results were relatively good. (4) CDCXM+/FCXM+ vs. CDCXM-/FCXM- graft loss risk was observed only in LD recipients transplanted at centers performing fewer than 10 such transplants during the study period: 11.0% reduction (P<0.0001) and aHR of 2.86 (CI 1.18-6.94) at one year; 14.7% reduction (P<0.0001) and aHR of 1.77 (CI 0.88-3.58) at five years. Although using CDCXM+ as a contraindication to transplantation has been associated with virtual elimination of hyperacute rejection, the negative effect of a CDCXM+ in contemporary practice is relatively small, questioning the value of the CDCXM as a standalone test.
  1 3,551 669
Renal transplantation in allografts with multiple versus single renal arteries
Koosha Kamali, Mohammad Amin Abbasi, Alireza Ani, Mohammad Ali Zargar, Hossein Shahrokh
March-April 2012, 23(2):246-250
Allograft with multiple renal arteries (MRA) is considered to have an increased post-transplantation risk due to vascular and urologic complications. The aim of this study is to inves­tigate the outcome of living donor kidney transplantation using allograft with a single artery and recipients of allografts with multiple arteries. Seven hundred and eighteen consecutive adult kidney transplants done between 1998 and 2007, with living unrelated kidney donors, were enrolled in this retrospective analysis. Data from the group with MRA (n = 60) were compared with those from the group with single renal artery (SRA) (n = 658). Delayed graft function (DGF) was more frequent in recipients' allografts with more than 2 arteries when compared with SRA recipients (Odds Ratio: 1.2; 95% CI:1.08-1.9, P = 0.02), but there was no difference between SRA and allograft with two arteries. The incidence of acute rejection (AR) was not statistically greater in recipients with MRA. Renal artery stenosis (RAS) occurred more frequently in patients with MRA (8.3% vs. 5.9% and P = 0.02), but other vascular complications such as renal artery thrombosis and hematoma revealed no differences (P > 0.05). Urologic complications such as UVJ obstruction, urinary leakage and ureteropelvic obstruction were not statistically different between the groups. The actuarial 1-year allograft survival rate was comparable in both groups (93.6% vs 96.8%, P = 0.22). Allografts with more than two arteries were associated with increased DGF and RAS, but no surgical or urological complications were detected in our series. Our findings demonstrate that renal allograft transplantation with multiple arteries could be performed with reasonable complications and acceptable outcomes.
  1 3,222 603
Evaluation of high sensitivity creactive protein and glycated hemoglobin levels in diabetic nephropathy
MS Roopakala, HR Pawan, U Krishnamurthy, CR Wilma Delphine Silvia, Mahesh Eshwarappa, KM Prasanna Kumar
March-April 2012, 23(2):286-289
Diabetic nephropathy (DN) is one of the major long-term complications of diabetes mellitus (DM). Type 2 DM is frequently associated with an inflammatory status, but limited information is available on the relationship between low-grade inflammation and DN. The aim of the study is to determine the serum level of high sensitivity C-reactive protein (hsCRP) in DN patients and to compare with that of normal subjects and to study the association between serum hsCRP levels and glycated hemoglobin (HbA1c) levels. Fifty DN patients in the age group of 50- 60 years with more than ten years of duration of diabetes were recruited for this study and 25 age-and sex-matched healthy subjects were included in this study as controls. Serum hsCRP levels were measured by turbidometry method. There was a statistically significant increase in serum hsCRP levels in DN cases as compared to normal controls. The hsCRP levels showed a positive correlation with HbA1c in DN. These results suggest that estimation of serum hsCRP levels and aiming at good glycemic control help in early intervention and prevention of further com­plications in diabetic patients.
  1 4,031 756
Cardiovascular disease in patients with end-stage renal disease on hemodialysis in a developing country
Leila S. V. Silva, Rodrigo A Oliveira, Geraldo B Silva, Jose Wellington O Lima, Ricardo P Silva, Alexandre B Liborio, Elizabeth F Daher, Carlos Roberto R. M. Sobrinho
March-April 2012, 23(2):262-266
Cardiovascular disease is the main cause of death among patients with end-stage renal disease (ESRD). The present study was undertaken to identify the main cardiovascular diseases and their risk factors in 160 patients with ESRD on hemodialysis (HD) in Brazil. Their mean age was 47 ± 39 years. The main risk factors for cardiovascular diseases were arterial hypertension (89.4%), dyslipidemia (78.3%), low high-density lipoprotein levels (84.2%) and low physical activity (64.1%). Family history of coronary insufficiency and high low-density lipoprotein levels were significantly associated with coronary artery disease (P = 0.005 and P = 0.029, respectively). Sedentary life style, diabetes mellitus, secondary hyperparathyroidism and hyperglycemia also showed a significant association with the underlying vascular disease (P = 0.017, P = 0.039, P = 0.037 and P = 0.030, respectively). Hypercalcemia, hypertension and black race were factors significantly associated with left ventricular systolic dysfunction (P = 0.01, P = 0.0013 and P = 0.024, respectively). Our study shows that the most prevalent cardiovascular diseases in patients with ESRD were left ventricular hypertrophy, atherosclerotic disease, valvular disease and coronary artery disease. Hypertension and dyslipidemia were the common risk factors associated with cardiovascular diseases. The present study was undertaken to identify the main cardiovascular diseases and their risk factors in 160 patients with ESRD on HD in a single center in Brazil.
  1 3,942 779
Clinical features and outcomes of ANCA-associated renal vasculitis
Sidy Mohamed Seck, Bertrand Dussol, Philippe Brunet, Stephane Burtey
March-April 2012, 23(2):301-305
To determine the patterns and outcomes of the pauci-immune vasculitis in the nephrology department at hospital La Conception in Marseille, we conducted a retrospective study including all patients with diagnosis of pauci-immune renal vasculitis between January 1, 2000 and December 31, 2007. Among 33 cases, 25 were diagnosed as Wegener granulomatosis (WG), seven as microscopic polyangitis (MPA) and one as Churg-Strauss syndrome (SCS). The median age of the patients was 57.7 years and the sex-ratio (M/F) was 1.6. The visceral mani­festations included kidneys (100% of patients), lungs (75%), ENT (52% of WG), and nervous system (57% of MPA). The mean serum creatinine at admission was 3.3 mg/dL. Renal biopsies revealed a pauci-immune crescentic gromerulonephritis in 96% of the cases. Two patients with WG received plasmapheresis and seven patients required emergency hemodialysis. Induction therapy comprised cyclophosphamide IV and corticosteroids, while maintenance therapy included azathioprine for the majority of patients. Eighty four percent of the patients experienced complete remission after induction therapy. During maintenance therapy relapses were more frequent among patients with MPA (28%) compared to WG cases (12%). After 35 months of follow-up, eight patients ended on chronic hemodialysis, and five patients died. ANCA associated vasculitis are frequent in our patients. Long-term outcomes are relatively good despite a mortality rate of 15% and 25% of the patients entering dialysis after three years of follow-up.
  1 4,767 1,080
Factors influencing hemodialysis and outcome in severe acute renal failure from Ilorin, Nigeria
A Chijioke, AM Makusidi, MO Rafiu
March-April 2012, 23(2):391-396
The epidemiology of acute renal failure (ARF) varies between nations and even within the same country because of differences in diagnostic criteria, causes, mode of pre­sentation, and cost of therapy. To determine the factors influencing hemodialysis and outcome of severe ARF in Ilorin, Nigeria, we studied ARF patients on hemodialysis in our center between January 1989 and December 2009. There were 138 (58 males and 80 females) patients with age range between 18 and 69 years and a mean of 29.4 ± 11.9 years. Major etiologies of ARF included septicemia, acute glomerulonephritis, septic abortion, herbal remedies, post-partum bleeding, and gastroenteritis. The mean duration of illness and waiting time before dialysis was 11.7 ± 8.14 days and 3.28 ± 1.86 days, respectively. The mean number of dialysis was 2.24 ± 1.13 sessions and 89% of the patients received a maximum of three sessions before recovery. Hypotension, twitching of muscles, and back pains were common intradialysis complications. The factors that influenced hemodialysis and outcome were late presentation, severity of ARF, and financial constraints. The etiological agents are preventable and treatable conditions. The short duration of hospital stay, waiting time before dialysis, and total duration of illness influenced the outcome positively. We strongly recommend early referral of patients with severe ARF to nephrologists for proper management in a bid to reduce mortality from this disease.
  1 4,753 618
Ambulatory blood pressure monitoring in children and adolescents with type-1 diabetes mellitus and its relation to diabetic control and microalbuminuria
Mitra Basiratnia, Saeed Fotooh Abadi, Gholam Hossein Amirhakimi, Zohreh Karamizadeh, Hamdollah Karamifar
March-April 2012, 23(2):311-315
Diabetes mellitus (DM) is now considered as the major cause of end-stage kidney failure, and hypertension (HTN) is one of the main determinants of progression of renal disease. The aim of this study was to assess the role of blood pressure (BP) by ambulatory blood pressure monitoring (ABPM) in children and adolescents with type-1 DM and its correlation with micro-albuminuria (MA) and diabetic control. Eighty-one patients with type-1 DM (mean age 13 ± 4 years), whose duration of DM was at least two years, were enrolled in this study. The prevalence of HTN based on ABPM was 28.4%, while by casual method it was 32.1%. The pattern of HTN was as follows: mean systolic HTN 27.2%, mean diastolic HTN 11.2%, daytime systolic HTN 17.3%, daytime diastolic HTN 6.2%, night systolic HTN 30.9%, and night diastolic HTN 29.7%. The systolic and diastolic BP loads were 33.4 and 27.2%, respectively. About 70.4% of the patients were non-dippers, 12.4% had masked HTN, and 3.7% had white coat HTN. The pre­valence of MA was 34.6% and that of abnormal HbA 1 c was 82.7%. There was no correlation bet­ween HTN and both MA and HbA 1 c; also, no correlation was found between the duration of dia­betes and HbA 1 c. Moreover, no significant correlation was found between the duration of diabetes and MA (P = 0.080). Despite the high prevalence of abnormal BP profile among diabetic children, prospective longitudinal studies considering the other major risk factors, particularly genetic factors, which have an impact on the progression to diabetic nephropathy, are recommended.
  - 3,042 724
A case of exorbitism in association with Wegener's granulomatosis with renal involvement
S Beji, L Ben Fatma, A Chebbi, L Rais, M Krid, W Smaoui, H Ben Maiz, K Zouaghi, F Ben Moussa
March-April 2012, 23(2):330-333
Wegener's granulomatosis (WG) is a necrotizing granulomatous vasculitis invol­ving the nose, paranasal sinuses, lungs, and kidneys. Ocular involvement can occur in about 50% of cases. There are very few reports of WG with orbital inflammation and exorbitism. We report a case of a female patient who presented with exorbitism related to orbital inflammation secondary to WG, with renal involvement. A 29-year-old woman with a previous history of recurrent pan-sinusitis presented with bilateral exophthalmos and renal failure with rapidly progressive glo-merulonephritis. Computed tomography showed extensive bilateral soft tissue in the retro-orbital area. Immunologic tests showed the presence of type-C anti-neutrophil cytoplasmic antibodies and renal biopsy revealed pauci immune crescentic glomerulonephritis. The patient was treated with corticosteroids and pulses of cyclophosphamide followed by azathioprine and trimethoprim-sulfamethoxazole. After a follow-up of 10 months, the renal outcome was favorable with improvement of renal function but there was persistence of exorbitism and loss of visual function. Our case suggests that WG should be considered in the differential diagnosis of persistent bila­teral exophthalmos. Prompt recognition of this early manifestation is important for the institution of early treatment.
  - 3,833 423
Rituximab in the treatment of refractory lupus nephritis with vasculitis
Huseyin Kadikoy, Waqar Haque, Salman Ahmed, Abdul Abdellatif
March-April 2012, 23(2):334-337
Dysfunction of the B lymphocyte, an important component of adaptive immunity, is thought to be important in the pathogenesis of lupus nephritis (LN). There are several novel strategies emerging including B-cell depletion by the monoclonal antibodies to B-cell markers, rituximab. We describe an unusual clinical response of a 22-year-old Hispanic woman with class IV LN with vasculitis while on dialysis to cyclophosphamide (CY) and adjunct rituximab. The patient had a history of class III/V LN and was treated with nine months of CY and maintenance therapy with mycophenolate mofetil (MMF) for three years. While on MMF, the patient deve­loped class IV LN with vasculitis leading to end-stage renal disease (ESRD). While the patient was on peritoneal dialysis, the patient was treated with two doses of rituximab and six doses of intravenous CY. The patient responded to this regimen and recovered kidney function within four months. The kidney function remained stable nine months after discontinuing peritoneal dialysis.
  - 5,223 838
Familial prune belly syndrome in a Nigerian family
Michael Okoeguale Ibadin, Ade Adeyekun Ademola, Gabriel Egberue Ofovwe
March-April 2012, 23(2):338-342
A case of Prune Belly Syndrome in an infant, the second in a middle class family with both parents in their late thirties, is presented because of its rarity. Constraints in the manage­ment are discussed and relevant literature reviewed. This is intended to awaken interest and sharpen indices of suspicion that would facilitate early diagnosis, enhance management, and mitigate prejudices.
  - 3,553 456
Diffuse proliferative crescentic lupus nephritis with normal renal function
Vibhanshu Gupta, Sandeep Sachdeva, Anwar Salamat Khan, Shahzad Faisul Haque
March-April 2012, 23(2):343-345
Crescentic nephritis can be a manifestation of Lupus Nephritis. It usually presents with rapid deterioration of renal functions over days to weeks with an active urinary sediment and confers a poor prognosis. Nephrotic range proteinuria is rare in crescentic nephritis. We present an interesting case of (crescentic) Diffuse Proliferative Lupus Nephritis (DPLN) with remarkably preserved renal function and nephrotic range proteinuria. Also noteworthy was the patient's excellent response to immunosuppressive therapy despite the high frequency of cellular crescents on biopsy.
  - 3,211 445
Management of obstructive uropathy with cutaneous ureterostomy in posterior urethral valve
Abdulmalik M.S. Tayib, Ahmed J Alsayyad
March-April 2012, 23(2):355-357
  - 2,966 517
Renal angiomyolipoma
SM Badruddoza, RA Jahan
March-April 2012, 23(2):358-360
  - 2,500 468
Concerns regarding laboratory analysis of urine protein: A brief comment
Viroj Wiwanitkit
March-April 2012, 23(2):361-362
  - 4,705 346
Acute cortical necrosis and collapsing glomerulopathy in an HIV-infected patient: A rare clinical scenario
Bakshsish Singh, Ankur Gupta, Sandeep Mahajan, Ruchika Gupta
March-April 2012, 23(2):363-366
  - 2,342 290
Nanotechnology in nephrology
Rajiv Saini, Santosh Saini, Sugandha R Saini
March-April 2012, 23(2):367-367
  - 2,851 507
Necrotic crescentic glomerulonephritis and IgA nephropathy: Lee-hass classification revisited
Muhammed Mubarak
March-April 2012, 23(2):368-369
  - 2,340 422
Author's Reply
Wael Latif Jabur
March-April 2012, 23(2):369-370
  - 1,551 207
Author's Reply
Nariman Sepehrvand
March-April 2012, 23(2):372-373
  - 1,311 250
Bilateral renal infarction due to thromboembolism
Riyazuddin S Ansari, Fatima M Domfu, Mohammad Al-Barrak, Basim Felemban, Wael H Mutair
March-April 2012, 23(2):374-376
  - 2,235 345
Neurotoxicity due to cefepime in patients on maintenance hemodialysis
Nauman Siddiqi, Iftikhar Sheikh
March-April 2012, 23(2):349-349
  - 2,243 502
Author's Reply
Manjusha Yadla
March-April 2012, 23(2):350-350
  - 1,410 212
The trauma of the thoracic duct is a rare complication of jugular catheterization with fistula lymphatico-cutaneous
Zouakou Djamel
March-April 2012, 23(2):351-352
  - 2,837 290
Evaluation of the effects of simvastatin in reduction of panel-reactive antibody (PRA) levels in patients with end-stage renal disease awaiting renal transplantation
Nargesosadat Zahed, Fatemeh Nazemian, Massih Naghibi
March-April 2012, 23(2):306-310
This study was undertaken to assess the effect of simvastatin in the reduction of panel-reactive antibody (PRA) levels in patients with end-stage renal disease (ESRD) awaiting renal transplantation. During the 1-year period from September 2007 to August 2008, 60 ESRD patients with PRA levels more than 30% were enrolled into the study. Each patient was given oral simvastatin 10 mg/day as the initial dose. After one month, in those patients who did not respond, the dose was increased to 20 mg/day. Again, at the end of two months, if there was no response, the dose was further raised to 40 mg/day of simvastatin. The appropriate response to the treatment was defined as serum PRA levels getting reduced to less than 30%. Among the 60 patients who were enrolled in the study, three cases were excluded due to side-effects of the drug and 57 patients remained in our study. The mean age was 42.8 ± 28.2 years (range 18-75). Among these, 34 (59.6%) were females. Before the study, the PRA levels were between 30 and 100 (mean ± SD: 60.4% ± 20%). After the administration of simvastatin, a significant decrease in PRA levels was seen in our patients (P < 0.0001). In patients who had baseline PRA less than 40%, the PRA dropped to below 30% in 69.2% of the cases with 10 mg simvastatin. In those who had baseline PRA more than 40%, a similar reduction was seen only in 15.9% of the cases. However, in those who did not respond initially to 10 mg of simvastatin, statistically significant reductions were seen after the administration of 20 mg and, if needed, 40 mg of simvastatin (P = 0.001). In conclusion, simvastatin can be a useful drug in ESRD patients to lower the PRA levels.
  - 2,667 439
Assessment of immune status in relation to vitamin D levels in children on regular hemodialysis
Doaa M Youssef, Amal S Elshal, Abeer A Abo Elazem
March-April 2012, 23(2):267-273
The two most common causes of death in patients with chronic kidney disease (CKD) are cardiovascular diseases and infections, and both have been linked to impaired vitamin D levels and dysregulated immune response. The aim of this work is to study the relation between vitamin D levels in children with end-stage renal disease (ESRD) on regular hemodialysis (HD) and their immune status. This case-control study was conducted at the Nephrology Unit, Department of Pediatrics, the Zagazig University Hospital, from April 2010 to August 2010. We studied 27 children with ESRD on regular HD (group-A) whose mean age was 8 ± 1.3 years; there were 15 males and 12 females. The study patients were divided into two groups depending on the degree of vitamin D deficiency; group-A1 had 12 patients, all of whom had vitamin D deficiency defined as serum concentration of 25-hydroxy vitamin D3 [25(OH) D3] of 15-30 ng/mL. Group-A2 had 15 patients with more severe vitamin D deficiency (<15 ng/mL). Twenty healthy age- and sex-matched children served as the control group (group-B); their mean age was 7.8 ± 1.6 years and they included 12 males and eight females. All subjects underwent thorough history taking, clinical examination and the following investigations: complete blood count, lymphocyte count, blood urea, serum creatinine, total serum calcium, ionized calcium, serum phosphorus, plasma 25(OH)D3, intact para-thormone (iPTH), serum interleukin-10 (IL-10) and soluble IL-2 receptor (SIL-2R). We found that the vitamin D level was significantly lower in the patient group (group-A) than in the control-group (group-B). The IL-10 level was significantly lower in group-A than in group-B, and the SIL-2R level was significantly higher in group-A than in group-B. We found a significant positive correlation between serum 25(OH)D3 levels and serum IL-10, while there was a negative correlation between 25(OH)D3 levels and SIL-2R; this correlation was not significant. Our findings suggest that 25(OH)D3 levels affect the immune state in patients through their effect on both limbs of immunity, the anti-inflammatory and the pro-inflammatory, but the effect was higher on the anti-inflammatory IL-10. We conclude that the serum levels of vitamin D are lower in children with ESRD than in age-matched controls, and that it is significantly positively related to the anti-inflammatory IL-10 and negatively related to the pro-inflammatory SIL-2R. Further studies are required to throw more light on the role of vitamin D supplementation in children with ESRD in maintaining immune balance.
  - 3,023 604
Evaluation of lipid peroxidation and erythrocyte glutathione peroxidase and superoxide dismutase in hemodialysis patients
Farzaneh Montazerifar, Mohammad Hashemi, Mansour Karajibani, Houshang Sanadgol, Madhurima Dikshit
March-April 2012, 23(2):274-279
Oxidative stress often occurs in chronic hemodialysis (HD). The aim of the present study was to determine plasma malondialdehyde (MDA) level for lipid peroxidation product and erythrocyte superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities as enzy­matic antioxidants. Thirty-one HD patients (aged 50.3 ± 14.9 years) who were dialyzed three times per week and 31 healthy subjects (aged 47.8 ± 13.9 years) were enrolled. The results showed lower enzymatic antioxidants activity (GPx, SOD) and higher MDA levels in comparison with control subjects. In addition, SOD and GPx activities significantly decreased and MDA increased after HD. We also found that there was a significantly negative correlation between SOD and GPx with MDA. The results suggest that elevated level of plasma MDA and reduced activities of SOD and GPx can be caused oxidative stress, which may play a critical role in HD complications.
  - 3,512 642
Assessment of nitrogen radicals and their scavenging activity in patients with end-stage renal failure
Marwan S.M. Al-Nimer, Nidham A Jaleel
March-April 2012, 23(2):290-295
Reactive oxygen species are implicated in cardiovascular disease in patients with chronic renal failure (CRF). This study is aimed to assess the nitrogen radicals in patients with end-stage renal failure (ESRF) referred for peritoneal dialysis. A total of 36 patients with estimated creatinine clearance ≤ 15 mL/min were recruited from the Dialysis Unit at Al-Yarmouk Teaching Hospital in Baghdad, Iraq during 2009, and enrolled into the study. The main causes of CRF were hypertension and diabetes mellitus. The median levels of serum nitric oxide and peroxynitrite were 300 and 152 μmol, respectively. Nitric oxide was not detected in the sera of 10 patients. The sera of 12 patients showed ability to scavenge in vitro, the nitric oxide released by sodium nitroprusside. Significant inverse correlation was found between serum peroxynitrite and either systolic (r = -0.402) or diastolic (r = -0.387) blood pressure. Our study shows that production of nitrogen radicals is enhanced in ESRF and it is accompanied by limited activity of scavenging nitric oxide.
  - 2,500 377
Acute renal failure in falciparum malaria: Clinical characteristics, demonstration of oxidative stress, and prognostication
Ch. Venkata Rama Krishna, P.V.L.N. Srinivasa Rao, GC Das, V Siva Kumar
March-April 2012, 23(2):296-300
In this prospective study, we aimed to assess the clinical characteristics of acute renal failure (ARF), determine oxidative stress, as well as to predict the outcome in patients with severe falciparum malaria (FM). The study included a total of 75 subjects; there were 25 adult patients with acute severe FM and ARF, 25 adult patients with uncomplicated FM without ARF, and 25 age- and sex-matched healthy subjects who served as controls. In patients with severe FM and ARF (n = 25), renal failure was non-oliguric in 28% and oliguric in 72%. The average duration of renal failure was 10.53 ± 4.0 days. Sixty percent recovered and 40% died. All patients with non-oliguric presentation recovered. The mean serum malondialdehyde (MDA) levels were 0.82 ± 0.43 μmol/L, 2.97 ± 1.11 μmol/L, and 6.86 ± 2.62 μmol/L, respectively, in healthy con­trols, in patients with uncomplicated FM, and in those with severe FM with ARF. The Acute Physiology Age and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, and the Acute Tubular Necrosis-Individual Severity Index (ATN-ISI) score were all significantly higher in the expired group (19 ± 5.49) when compared to the survivor group (14.4 ± 3.15) (P = 0.014). Kaplan-Meier survival analysis showed that survival was low in patients with delayed hospitalization and longer duration of symptoms. Also, we observed a high occurrence of acute respiratory distress syndrome and central nervous system involvement among the patients who expired.
  - 3,086 634
Prevalence of sleep apnea and excessive day time sleepiness in patients with end-stage renal disease on dialysis
Hamdan Al-Jahdali
March-April 2012, 23(2):251-261
Sleep apnea (SA) and excessive daytime sleepiness (EDS) are common sleep disorders among patients with end-stage renal disease (ESRD). This cross-sectional study, carried out in two dialysis centers in Saudi Arabia, assessed the prevalence of sleep apnea and sleepiness in Saudi patients with ESRD who are on maintenance dialysis with either peritoneal or hemodialysis. We used questionnaires to assess the prevalence of SA and EDS. The association between sleep apnea, EDS, and other sleep disorders, the underlying causes of renal failure, and other demo­graphic data were also examined. Among 227 enrolled patients, the mean patient age was 55.7 years ΁ 17.2 years; 53.7% were male, and 46.3% were female. The overall prevalence of SA as defined by the Berlin questionnaire (BQ) was 37% in males and 34% in females, which was not a statistically significant difference (P = 0.459). Sleep apnea was significantly associated with age, neck size, afternoon and evening hemodialysis shift, obesity, diabetes, and hypertension (P-values, 0.001, 0.029, < 0.0001, < 0.0001, < 0.008, 0.002, and < 0.001, respectively). Sleep apnea was also significantly associated with other sleep disorders such as restless leg syndrome, insomnia, habitual snoring, and EDS (P-values, < 0.001, < 0.001, < 0.001, and < 0.001, respectively). The prevalence of EDS was 44%, and EDS was significantly more prevalent in patients undergoing peritoneal dialysis (P < 0.001); it was also associated with older age, diabetes mellitus, and other sleep disorders. SA and EDS are common in dialysis patients and are significantly associated with other sleep disorders.
  - 3,870 1,062
Histopathological pattern of pediatric renal diseases: A study from a university hospital in western Saudi Arabia
Layla Saleh Abdullah
March-April 2012, 23(2):377-384
To study the clinical indications and histopathological pattern of renal biopsies and renal resection specimens in the pediatric age group (birth to 17 years) in a large academic center in western Saudi Arabia. A retrospective review of the computerized database of the Pathology Department at King Abdul Aziz University Hospital (KAUH) was carried out on the final patho­logy reports of all children of the age of 17 years and below who either had ultrasound-guided renal biopsies or partial or total renal resections during the period between January 1995 and December 2008. All the specimens were reported by our pathology department. The most common clinical indication in the study group (242) is nephrotic syndrome (117, 48.3%), fol­lowed by systemic lupus erythromatosis for staging (30, 12.4%), nephritic syndrome (27, 11.1%) and renal mass for histological diagnosis (17, 7.0%). The most frequently reported pathological diagnosis was renal glomerulopathies, constituting 183 cases (n = 183, 75.6%) of the total number of pathology reports reviewed. Primary glomerulopathies were more common (n = 155, 88.4%) than the secondary ones (n = 28, 11.6%). The second most common pediatric renal pathology in this study was renal neoplasms (14, 5.7%). Vascular renal diseases and renal glomerulosclerosis ranked as the third pathological diagnosis in order of frequency in this study, with ten cases (10, 4.1%). The most common clinical indication for renal tissue sampling in this study is nephrotic syndrome and the most frequently detected pathology is glomerulonephritis. Larger multicentre studies are needed to further study pediatric nephropathies.
  - 2,899 519
Interstitial nephritis with moderate-to-heavy proteinuria: An unusual combination
Biplab Ghosh, Rana Gopal Singh, Usha , Sanjeev Kumar Behura, Ashutosh Soni, Lou Krakpam Sharatchandra, Shivendra Singh
March-April 2012, 23(2):397-402
Interstitial nephritis with proteinuria >1 g/day is uncommon and almost always the result of drug-induced ATIN with an associated minimal change glomerulonephritis (GN). Here, we present a series of five unusual cases of interstitial nephritis without GN but with proteinuria >1 g/day, and they were identified from renal biopsies done from February 2008 to March 2009. Out of 236 patients who underwent renal biopsy, only five met the inclusion criteria. Three patients presented with edema and two with oliguria, while none had frank hematuria, fever, arthralgia, skin rash or history of exposure to nonsteroidal antiinflamatory drugs, analgesics, anti­biotics, allopurinol, or Chinese herb before presentation. Urinalysis revealed hematuria in two patients, pyuria in three and nephrotic range proteinuria in two. All had normal complement levels and were negative for antinuclear antibodies, Anti-dsDNA antibody, and antineutrophil cyto-plasmic antibodies. Clinical diagnosis was nephrotic syndrome in two patients, the third had diagnosis of rapidly progressive GN, the fourth had HIV associated nephropathy, and the fifth had unexplained advanced renal failure. Though three patients had renal dysfunction only one required dialysis. Light microscopy of renal biopsies revealed granulomatous interstitial nephritis in three patients and small vessel vasculitis in two of them. One patient had nongranulomatous interstitial nephritis along with vasculitis. Acute interstitial nephritis was the only finding in one patient. In conclusion, patients with interstitial nephritis can present with moderate-to-heavy proteinuria probably due to cytokine-like permeability increasing factor secreted by inflammatory cells in the interstitium.
  - 4,624 751
Medication prescribing patterns among chronic kidney disease patients in a hospital in Malaysia
Rowa Al-Ramahi
March-April 2012, 23(2):403-408
To determine the medication prescribing patterns in hospitalized patients with chronic kidney disease (CKD) in a Malaysian hospital, we prospectively studied a cohort of 600 patients in two phases with 300 patients in each phase. The first phase was carried out from the beginning of February to the end of May 2007, and the second phase was from the beginning of March to the end of June 2008. Patients with CKD who had an estimated creatinine clearance ≤ 50 mL/min and were older than 18 years were included. A data collection form was used to collect data from the patients' medical records and chart review. All systemic medications prescribed during hospitalization were included. The patients were prescribed 5795 medications. During the first phase, the patients were prescribed 2814 medication orders of 176 different medications. The prescriptions were 2981 of 158 medications during the second phase. The mean number of medications in the first and second phases was 9.38 ± 3.63 and 9.94 ± 3.78 res­pectively (P-value = 0.066). The top five used medications were calcium carbonate, folic acid/vitamin B complex, metoprolol, lovastatin, and ferrous sulfate. The most commonly used medication classes were mineral supplements, vitamins, antianemic preparations, antibacterials, and beta-blocking agents. This study provides an overview of prescription practice in a cohort of hospitalized CKD patients and indicates possible areas of improvement in prescription practice.
  - 5,155 851
Analysis of 88 nephrectomies in a rural tertiary care center of India
Biswajit Datta, Tapas Moitra, Dhiraj Nundy Chaudhury, Biswajit Halder
March-April 2012, 23(2):409-413
Nephrectomy is not an uncommon surgery in day-to-day practice of urology. Trauma is the most common cause of emergency nephrectomy. On the other hand, elective nephrectomy is done for both benign and malignant diseases of the kidney. This study has been performed to know the different causes of nephrectomy in a rural, tertiary care center of India. In our series, we have studied all the elective nephrectomies done in our hospital during a period of eight years. We have analyzed 88 cases of nephrectomies regarding their age, sex, laterality of disease, and histopathologic report of the nephrectomy specimens. Out of 88 cases, 61 were males and 27 were females. In our series, 62.5% cases of nephrectomies were done for benign causes and 37.5% cases for malignant causes. Among the benign causes, neglected pelviureteric junction obstruction was the leading cause, followed by calculus disease resulting in obstruction. On the other hand, renal cell carcinoma was the most common malignant pathology requiring nephrectomy.
  - 2,778 413
Prehypertension - Time to Act
Preeti Gupta, Shankar Prasad Nagaraju, Ankur Gupta, Kiran B Mandya Chikkalingaiah
March-April 2012, 23(2):223-233
The term "prehypertension" defined as systolic blood pressure between 120 and 139 mmHg and/or diastolic pressures between 80 and 89 mmHg has now gained general acceptance. Prehypertension is associated with ~3-fold greater likelihood of developing hypertension, and roughly twice the number of cardiovascular events, than BP < 120/80 mmHg. When compared with normotensive individuals, prehypertensive individuals are more likely to be overweight and obese, to have other cardiovascular risk factors, to progress to established hypertension, and to experience premature clinical cardiovascular disease. The major unresolved issue is the appropriate manage­ment of such patients. Lifestyle modification is recommended for all patients with prehypertension as it effectively reduces rate of cardiovascular events. Presently pharmacological therapy is indicated for some patients with prehypertension who have specific comorbidities, including diabetes mellitus, chronic kidney disease, and coronary artery disease.
  - 8,574 1,264
Deceased heart beating donor and organ transplantation in Saudi Arabia

March-April 2012, 23(2):414-419
  - 1,822 257
  My Preferences