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Saudi Journal of Kidney Diseases and Transplantation
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   2014| May-June  | Volume 25 | Issue 3  
    Online since May 9, 2014

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Infection control in hemodialysis units: A quick access to essential elements
Ayman Karkar, Betty Mandin Bouhaha, Mienalyn Lim Dammang
May-June 2014, 25(3):496-519
DOI:10.4103/1319-2442.132150  PMID:24821145
Infection is the most common cause of hospitalization and the second most common cause of mortality among hemodialysis (HD) patients, after cardiovascular disease. HD patients as well as the dialysis staff are vulnerable to contracting health-care-associated infections (HAIs) due to frequent and prolonged exposure to many possible contaminants in the dialysis environment. The extracorporeal nature of the therapy, the associated common environmental conditions and the immune compromised status of HD patients are major predisposing factors. The evident increased potential for transmission of infections in the HD settings led to the creation and implementation of specific and stricter infection prevention and control measures in addition to the usual standard precautions. Different international organizations have generated guidelines and recommendations on infection prevention and control for implementation in the HD settings. These include the Centers for Disease Control and Prevention (CDC), the Association of Professionals in Infection Control (APIC), the Kidney Disease Outcomes Quality Initiative (K/DOQI), the European Best Practice Guidelines/European Renal Best Practice (EBPG/ERBP) and the Kidney Disease: Improving Global Outcomes (KDIGO). However, these guidelines are extensive and sometimes vary among different guideline-producing bodies. Our aim in this review is to facilitate the access, increase the awareness and encourage implementation among dialysis providers by reviewing, extracting and comparing the essential elements of guidelines and recommendations on infection prevention and control in HD units.
  45,740 4,435 8
Systemic lupus erythematosus in males: A case series
Krishna Kumar Agrawaal, Subodh Sagar Dhakal
May-June 2014, 25(3):638-642
DOI:10.4103/1319-2442.132222  PMID:24821166
The reported prevalence of systemic lupus erythematosus (SLE) in the general population is 20-150 cases per 100,000 population. The female to male ratio ranges from 7-15:1. An estrogen effect has been suggested by a number of observations for this difference. In children, sex hormonal effects are presumably minimal and, thus, the female to male ratio is 3:1. We report a series of three male patients who presented at the B. P. Koirala Institute of Health Sciences and were diagnosed to have lupus nephritis (LN). This is probably the first case series from Nepal on adult male LN. Male patients with SLE present mainly with renal involvement and seizures rather than photophobia and skin manifestations. The outcome also seems to be more serious in males. Thus, we believe that although male patients with lupus are not commonly seen, the manifestations are life threatening and early detection of the disease will lead to better outcome of these patients.
  7,461 918 1
A comparative study of phosphate binders in patients with end stage kidney disease undergoing hemodialysis
Viken A Prajapati, Varsha J Galani, Pankaj R Shah
May-June 2014, 25(3):530-538
DOI:10.4103/1319-2442.132167  PMID:24821148
In the present study, a comparative evaluation of the effects of calcium acetate, calcium carbonate, sevelamer hydrochloride and lanthanum carbonate was carried out in 120 patients with end stage kidney disease (ESKD) undergoing hemodialysis. Biochemical parameters, like serum phosphorous, serum calcium and serum alkaline phosphatase level and intact parathyroid hormone level, were measured. A statistically significant reduction in serum phosphorous, serum calcium, calcium × phosphorous and serum alkaline phosphatase level were observed with all phosphate binders during 3 months of treatment. Reduction in serum phosphorous were observed with calcium acetate (1.5 mg/dL), calcium carbonate (1.3 mg/dL), sevelamer hydrochloride (2.1 mg/dL) and lanthanum carbonate (1.79 mg/dL). The reduction of serum alkaline phosphatase was observed more commonly with sevelamer (107.37 IU/L) and lanthanum (104.33 IU/L) treatments than with calcium acetate (93.9 IU/L) and calcium carbonate (86.57 IU/L). There was no statistically significant change in serum calcium observed with sevelamer and lanthanum treatments, while calcium-based phosphate binders caused a significant rise in the serum calcium level. Serum intact parathyroid hormone level was significantly reduced with all phosphate binder treatments. This decline was highest with sevelamer and lowest with calcium carbonate. All treatments were well tolerated and safety profiles were consistent with previous reports in hemodialysis patients. It is concluded that all phosphate binders are safe and effective for the treatment of hyperphosphatemia in patients with ESKD undergoing hemodialysis. However, sevelamer hydrochloride seems to be superior among all with lowering incidence of hypercalcemia.
  5,896 1,226 2
Kidney transplantation: Ethical challenges in the Arab world
Hassan Chamsi-Pasha, Mohammed Ali Albar
May-June 2014, 25(3):489-495
DOI:10.4103/1319-2442.132148  PMID:24821144
There is a wide gap between organ supply and demand, which results in a very long waiting time for kidney transplantation and an increasing number of deaths of the patients while on the waiting list. These events have raised many ethical, moral and societal issues regarding organ donation, allocation and use of living donors through exploitation of the poor for the benefit of the wealthy. Success in the implementation of kidney transplantation programs in a country depends on various factors including the economic situation, religious approval, public views, medical expertise and existing legislation. The public attitude toward donation is pivotal in all transplantation programs; increasing the awareness of the leaders of religion is vital in this regard.
  5,944 875 2
Outcome of patients with acute kidney injury in severe sepsis and septic shock treated with early goal-directed therapy in an intensive care unit
Wasim Ahmed, Javed I Memon, Rifat Rehmani, Abdulmajeed Al Juhaiman
May-June 2014, 25(3):544-551
DOI:10.4103/1319-2442.132171  PMID:24821150
Acute kidney injury (AKI) in the intensive care unit (ICU) is commonly caused by severe sepsis and septic shock. There is limited data regarding the incidence and outcomes of patients developing AKI treated with early goal-directed therapy (EGDT). Our aim was to observe the incidence and outcomes of patients with AKI in severe sepsis and septic shock, treated with EGDT as compared with historic controls. Study subjects included all adults admitted to the ICU with a diagnosis of severe sepsis and septic shock prior to (historic controls) and after introduction of EGDT (intervention group). Two groups were compared for incidence of AKI, length of ICU and hospital stay, incidence and requirement for renal replacement therapy, serum creatinine at discharge, maximum RIFLE (Risk, injury, failure, loss, end stage) in each group and 28-day mortality. Two groups were well matched for age, sex, (April 16, 2014) and acute physiological and chronic health evaluation (APACHE) II scores. We found no significant difference in the incidence of AKI (51% vs. 46%). There was no statistical difference in any of the above outcomes, including 28-day mortality in historic controls versus patients treated with EGDT. Septic AKI is a complex syndrome. The incidence and outcomes have not improved despite advances in sepsis management and EGDT. Very early detection of septic AKI and targeted therapies may improve outcomes.
  5,123 1,622 1
Clinicopathologic spectrum of crescentic glomerulonephritis: A hospital-based study
Tauhidul Alam Choudhury, Rana Gopal Singh, Usha, Shivendra Singh, Takhellambam Brojen Singh, Surendra Singh Rathore, Prabhakar
May-June 2014, 25(3):689-696
DOI:10.4103/1319-2442.132241  PMID:24821180
Recent data regarding the clinical and histopathologic spectrum of crescentic glomerulonephritis (CSGN) among the Indian adult population is unknown. Our aim is to study the clinicopathological features and outcome of CSGN. It is a retrospective observational study from a tertiary care hospital in India over 3.5 years. Biopsy-proven cases of CSGN (i.e., >50% crescents in glomeruli) were included in the study. Cases with insufficient data were excluded. There were 34 cases of CSGN, accounting for an incidence of 5.5% among kidney biopsies. The mean age was 32.2 ± 16.09 years, with male to female ratio of 12:22. Clinical presentations of CSGN include rapidly progressive glomerulonephritis in 23 (67.7%), chronic renal failure (CRF) in seven (20.5%), nephrotic syndrome in two (5.8%) and acute nephritic syndrome in two (5.8%) patients. The immunological profile of CSGN showed MPO-ANCA in nine (26.4%), PR3-ANCA in one (2.9%), both PR3 and MPO-ANCA in one (2.9%), anti-GBM antibody in five (14.7%) and lupus nephritis in six (17.6%) patients. All the three antibodies were present in one patient. The percentage of glomeruli showing crescents were 100% in nine (26.4%) and ≥80% in seven (20.5%) patients. Type of crescents seen were cellular in 11 (32.3%) and fibrocellular in 22 (64.7%) patients and fibrous in one (2.9%) patient. Interstitial fibrosis was found in seven (20.5%) patients. Dialysis dependency was seen in 11 (32.3%) patients. After 3 months of follow-up, mortality was seen in three (8.8%), remission in eight (23.5%), CRF in 15 (44.1%) and ESRD in five (14.7%) patients. CSGN carries a poor prognosis. The disorder may have an insidious onset and a slowly progressive course. ANCA, anti-GBM-antibody and anti-dsDNA can coexist in CSGN.
  5,473 893 4
Epidemiology of end-stage renal disease in Iran: A review article
Seyed Seifollah Beladi Mousavi, Alireza Soleimani, Marzieh Beladi Mousavi
May-June 2014, 25(3):697-702
DOI:10.4103/1319-2442.132242  PMID:24821181
The prevalence and incidence of end-stage renal disease (ESRD) are increasing in developed and developing countries, and this will place an enormous financial burden for health-care systems. The exact reasons of the rising prevalence of ESRD patients are unknown, but it can be attributed to an increase in the prevalence of diabetes mellitus and hypertension as the most common causes of ESRD. However, in contrast to the developed countries, the etiology of ESRD in the significant percent of patients with ESRD in Iran is unknown. In our country, the patients with chronic kidney diseases present themselves to the hospital only when they have severe symptoms of uremia, and, at this time, determining the primary cause of ESRD is often not possible. In addition, although the prevalence and incidence of ESRD are also significantly increasing in Iran in recent years, they are still lower compared with developed countries, which may also be due to poor referral resulting in the under diagnosis of ESRD. The aim of this review is to evaluate the epidemiologic aspects of ESRD in Iran, including demographic data, cause of ESRD, kind of renal replacement therapies implemented and their survival.
  4,761 1,026 9
Acute post-infectious glomerulonephritis in adults: A single center report
Mouna Hamouda, I Mrabet, N Ben Dhia, S Aloui, A Letaif, MA Frih, H Skhiri, M Elmay
May-June 2014, 25(3):567-571
DOI:10.4103/1319-2442.132185  PMID:24821153
Acute post-infectious glomerulonephritis (APIGN) is uncommonly seen in adults; its incidence is progressively declining, particularly in developed countries. The aim of this study was to evaluate the epidemiological, clinical and biologic features of APIGN in a Tunisian center. A retrospective descriptive analytic study was carried out on 50 patients aged more than 15 years who were admitted to the Monastir Hospital between 1991 and 2007, with a diagnosis of APIGN. There were more males than females (66% vs. 34%), and the mean age of the patients was 36.8 ± 10 years. Only 10% had an immunocompromised background, including diabetes. The most common site of infection was upper respiratory tract, followed by skin and pneumonia. The most common causative agent was Streptococcus (66%), followed by Staphylococcus (12%). 73.8% of the patients had low C3 complement levels. The mean peak serum creatinine was 190 μmol, and 4% of patients required acute dialysis. The patients were followed-up for a mean period of 18 months (range, 0.16-97 months). During follow-up, of the 46 patients reviewed in the consultation, the majority showed complete remission, 12 patients had persisting abnormalities such as hypertension in 17%, chronic renal failure in 8% and proteinuria in 6.5%, and one patient had concomitant hypertension and chronic renal failure. Our study suggests that APIGN is still endemic in some parts of the world such as Tunisia, and our data showed a favorable prognosis in adults.
  4,422 702 1
Prevalence of anemia in patients with type II diabetes and mild to moderate chronic kidney disease and the impact of anti-RAS medications
Periklis Dousdampanis, Konstantina Trigka, Costas Fourtounas
May-June 2014, 25(3):552-557
DOI:10.4103/1319-2442.132178  PMID:24821151
Anemia is a common feature of diabetes and chronic kidney disease (CKD) mainly due to erythropoietin (EPO) deficiency and uremic toxicity. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been established as first-choice medications for the treatment of diabetic nephropathy. However, there are conflicting data regarding their impact on hemoglobin levels in patients with diabetic nephropathy. We evaluated the prevalence of anemia in 101 patients with diabetes mellitus type II and CKD at stage III-IV (group A) compared with 101 non-diabetic patients with similar renal function (group B). Moreover, we evaluated the impact of ACE inhibitors and ARBs on patients' anemia. Anemia was observed in 60 patients in group A and in 47 patients in group B (P < 0.01). Thirty-one (31) patients in group A and 19 patients in group B were receiving exogenous EPO for correction of renal anemia (P <0.05). Mean values of hemoglobin did not show significant differences (12.5 ± 1.8 vs 12.6 ± 1.7 g/dL) between the two groups. Seventy-five patients in group A and 52 patients in group B were receiving ACE inhibitors and/or ARBs (P <0.01), but, after multivariate analysis, we could not detect any association between anemia and the prescription of these medications. Anemia is more common in diabetic patients with CKD stage III-IV than in non-diabetic patients with similar renal function. Our results indicate that ACE inhibitors and ARBs are not a significant cause of anemia for both populations.
  4,056 947 3
Rhabdomyolysis and acute kidney injury after acupuncture sessions
Marios Papasotiriou, Grigoria Betsi, Maria Tsironi, Georgios Assimakopoulos
May-June 2014, 25(3):643-646
DOI:10.4103/1319-2442.132223  PMID:24821167
Rhabdomyolysis is usually caused by muscle injury, drugs or alcohol and presents with muscle weakness and pain. It is characterized by rise in serum creatine kinase, aminotransferases and electrolytes as well as myoglobinuria. Myoglobinuria may cause acute kidney injury by direct proximal tubule cytotoxicity, renal vasoconstriction, intraluminal cast formation and distal tubule obstruction. Muscle pain and weakness as well as vascular injury have been reported after acupuncture. We report a case of severe rhabdomyolysis and acute kidney injury after acupuncture sessions.
  4,468 512 -
Plasma neutrophil gelatinase-associated lipocalin (NGAL) and plasma cystatin C (CysC) as biomarker of acute kidney injury after cardiac surgery
Tarek A Ghonemy, Ghada M Amro
May-June 2014, 25(3):582-588
DOI:10.4103/1319-2442.132194  PMID:24821156
Acute kidney injury (AKI) is a common and serious condition that frequently occurs after cardiopulmonary bypass and other cardiac surgeries. The objective of this work is to evaluate the utility of new markers for kidney damage, plasma neutrophil gelatinase-associated lipocalin (NGAL) and plasma cystatin C (CysC) as early predictors of AKI after cardiac surgery. Fifty cardiac patients were recruited for this study, and they were divided into two groups of 25 patients each. Group I patients underwent coronary artery bypass graft (CABG) operation and Group II patients underwent valve replacement operation. Blood sample was taken for measurement of plasma CysC and NGAL by enzyme-linked immunosorbent assay. Plasma NGAL measurement in patients with AKI shows a highly significant rise at 3 and 6 h after surgery from its basal level (P <0.001). Plasma CysC measurement in patients with AKI is significantly higher at 6 h after surgery from its basal level (P <0.05). A statistically highly significant increase in plasma NGAL and CysC at 24 h after cardiac surgery in patients with AKI compared with patients without AKI (P <0.001). The sensitivity and specificity of NGAL at 3 h post-operative was 94.1% and 93.9% respectively, while plasma CysC sensitivity and specificity was 54.7% and 72.7%, respectively. After 6 h post-operative, NGAL sensitivity increased to 98.1% with slight decrease of the specificity to 91.9%, while CysC sensitivity and specificity increased to 75.2% and 75.8%, respectively. In conclusion, plasma NGAL and plasma CysC may be considered as early predictors of AKI after cardio-pulmonary bypass operations.
  3,810 1,114 5
Tubulo-reticular inclusions in lupus nephritis: Are they relevant?
Hala Kfoury
May-June 2014, 25(3):539-543
DOI:10.4103/1319-2442.132169  PMID:24821149
Tubulo-reticular inclusions (TRIs) are organized subcellular structures that may be found in endothelial cells of patients with systemic lupus erythematosus (SLE). This study was conducted to determine the presence or absence of TRIs and their correlation with the activity index (AI) and lupus nephritis (LN) class. A retrospective analysis of 57 cases of LN over a three-year period (2008-2011) was performed from medical records of the King Khalid University Hospital (KKUH), Riyadh. After reviewing and sorting them by class as per the International Society of Nephrology (ISN/RPS) 2004 classification of LN, the cases were divided according to the presence or absence of TRIs. The relationships between the presence or absence of TRIs and the AI were determined. Of the 57 kidney biopsies reviewed, 49 were proliferative cases (Class III and IV), of which 12 (24.5%) had TRIs. The mean AI was 6.01 ± 3.8 and the mean chronic index was 3.0 ± 1.5. Four (11.4%) class IV cases had a high AI, while no Class III cases with TRIs showed increased activity. The presence of TRIs was significantly associated with the AI (r = 9.40, P = 0.002), but not with LN class (r = 0.099, P = 0.753). Examining for TRIs in LN is still favorable and helpful in cases where the diagnosis of SLE is pending or not yet established, although the presence of TRIs is not a specific finding.
  4,475 418 1
Azotemia protects the brain from osmotic demyelination on rapid correction of hyponatremia
Murtaza F Dhrolia, Syed F Akhtar, Ejaz Ahmed, Anwar Naqvi, Adeeb Rizvi
May-June 2014, 25(3):558-566
DOI:10.4103/1319-2442.132183  PMID:24821152
Osmotic demyelination syndrome (ODS) is a dreadful, irreversible and well-recognized clinical entity that classically occurs after rapid correction of hyponatremia. However, it has been observed that when hyponatremia is rapidly corrected in azotemic patients by hemodialysis (HD), patients do not necessarily develop ODS. We studied the effect of inadvertent rapid correction of hyponatremia with HD in patients with azotemia. Fifty-two azotemic patients, who underwent HD at the Sindh Institute of Urology and Transplantation, having pre-HD serum sodium level <125 mEq/L and post-HD serum sodium levels that increased by ≥12 mEq/L from their pre-dialysis level, were studied. Serum sodium was analyzed before and within 24 h after a HD session. HD was performed using bicarbonate solution, with the sodium concentration being 140 meq/L. The duration of the dialysis session was based on the discretion of the treating nephrologist. Patients were examined for any neurological symptoms or signs before and after HD and for up to two weeks. Magnetic resonance imaging was performed in required cases. None of the 52 patients with azotemia, despite inadvertent rapid correction of hyponatremia with HD, developed ODS. This study suggests that patients with azotemia do not develop ODS on rapid correction of hyponatremia by HD, which suggests a possible protective role of azotemia on the brain from osmotic demyelination. However, the mechanism by which azotemia protects the brain from demyelination in humans is largely hypothetical and further studies are needed to answer this question.
  3,836 655 1
Viral hepatitis C and B among dialysis patients at the Rabat University Hospital: Prevalence and risk factors
Zineb Lioussfi, Zineb Errami, Aicha Radoui, Hakima Rhou, Fatima Ezzaitouni, Naima Ouzeddoun, Rabea Bayahia, Loubna Benamar
May-June 2014, 25(3):672-679
DOI:10.4103/1319-2442.132236  PMID:24821177
The aim of this study is to investigate the prevalence of hepatitis C virus (HCV) and hepatitis B virus (HBV) in maintenance hemodialysis (HD) and continuous ambulatory peritoneal dialysis patients at the Rabat University Hospital and to identify the major risk factors for transmission. A retrospective study was performed in 67 chronic HD and 36 peritoneal dialysis patients. For the screening of viral infections, we tested for anti-HCV antibodies and HBs antigen (Hbs Ag). We compared infected and non-infected patients in order to determine the risk factors for contamination. In the HD unit, the prevalence of anti-HCV was 60% and the prevalence of HBs Ag was 6%. Duration of dialysis (P = 0.001) was the only risk factor in our HD patients. In peritoneal dialysis (PD), the prevalence of anti-HCV was 8%. Hbs Ag was detected in 2.6% of our PD patients. Viral hepatitis C is the main viral infection in our HD unit. The duration of dialysis is the main risk factor for infection in our study. The transmission is essentially nosocomial, requiring a strict adherence to infection control procedures.
  3,651 654 5
Potential brain death organ donors - challenges and prospects: A single center retrospective review
Yousef Al-Maslamani, Ausama S Abdul Muhsin, Omar I Mohammed Ali, Riadh A Fadhil, Abdel Hadi R Abu Jeish
May-June 2014, 25(3):589-596
DOI:10.4103/1319-2442.132198  PMID:24821157
Organ donation after brain death (BD) is a major source for obtaining transplantable organs for patients with end-stage organ disease (ESOD). This retrospective, descriptive study was carried out on all potential BD patients admitted in different intensive care units (ICUs) of the Hamad medical Corporation (HMC), Doha, Qatar during a period from January 2011 to April 2012. Our aim was to evaluate various demographic criteria and challenges of organ donation among potential BD organ donors and plan a strategy to improve the rate of organ donation in Qatar. Various aspects of BD patients in the ICUs and their possible effects on organ donation were studied. The time intervals analyzed to determine the possible causes of delay of organ retrieval were: time of diagnosing fixed dilated pupils in the ICU, to performing the first BD test, then to the second BD test, to family approach, to organ retrieval and/or circulatory death (CD) without organ retrieval. There were a total of 116 potential BD organ donors of whom 96 (82.75%) were males and 20 (17.25%) were females. Brain hemorrhage and head injury contributed to 37 (31.9%) and 32 (27.6%) BD cases, respectively. Time interval between diagnosing fixed dilated pupil and performing the first test of BD was delayed >24 h in 79% of the cases and between the first and second BD tests was >6 h in 70.8% of the cases. This delay is not compatible with the Hamad Medical Corporation (HMC) policy for BD diagnosis and resulted in a low number of organs retrieved. BD organ donation, a potential source for organs to save patients with ESOD has several pitfalls and every effort should be made to increase the awareness of the public as well as medical personnel to optimize donation efficacy.
  3,463 638 -
Central serous chorioretinopathy following kidney transplantation
Kianersi Farzan, Leila Rezaei, Heshmatollah Ghanbari, AliReza Dehghani
May-June 2014, 25(3):615-620
DOI:10.4103/1319-2442.132208  PMID:24821161
A lesser known complication of long-term corticosteroid therapy is chronic central serous chorioretinopathy (CSCR). Although idiopathic CSCR is known to be mild with spontaneous improvement and minimal effects on the vision, chronic CSCR is different and may cause irreversible visual loss. We report four patients with CSCR on corticosteroid therapy after kidney transplant. The interesting point about these patients is that they were of a younger age group compared with classic CSCR cases, and there were two females among the patients. Organ transplantation and corticosteroid therapy are the risk factors for CSCR. We should discontinue or at least reduce corticosteroid dosage. Knowledge about this rare complication after kidney transplantation (even in unusual age and sex) is important.
  3,706 357 -
Posterior reversible encephalopathy syndrome with tactile hallucinations secondary to dialysis disequilibrium syndrome
Abdulsalam Soomro, Raiya Al Bahri, Noor Alhassan, Fayez F Hejaili, Abdulla A Al Sayyari
May-June 2014, 25(3):625-629
DOI:10.4103/1319-2442.132216  PMID:24821163
We report what we believe is the first case of posterior reversible encephalopathy syndrome (PRES) secondary to dialysis disequilibrium syndrome (DDS) in patients in whom all other possible causes of PRES were excluded and in whom a transient episode of tactile hallucination also occurred. We believe that this case of DDS was particularly severe, leading to PRES because of the late institution of dialysis therapy and the concomitant severe degree of metabolic acidosis on presentation.
  3,509 508 2
Correlation of carotid intimal-medial thickness with estimated glomerular filtration rate and cardiovascular risk factors in chronic kidney disease
Nitesh Chhajed, BJ Subhash Chandra, Manjunath S Shetty, Chandrashekhar Shetty
May-June 2014, 25(3):572-576
DOI:10.4103/1319-2442.132186  PMID:24821154
Carotid intimal-medial thickness (CIMT) predicts future vascular events in the general population. However, the correlation of traditional cardiovascular risk factors and stages of chronic kidney disease (CKD) with CIMT is not studied extensively. To determine the correlation of CIMT with traditional cardiovascular risk factors like age, body mass index (BMI), dyslipidemia and various stages of CKD patients, CIMT was measured by means of high-resolution B-mode ultrasonography in 70 CKD patients and compared with the 30 healthy controls. The mean CIMT in patients was 0.86 ± 0.21 mm vs 0.63 ± 0.17 mm in healthy age- and sex-matched controls (P <0.001). There was a significant univariate positive correlation between CIMT and age (r = 0.605, P <0.001), BMI (r = 0.377, P = 0.001), total cholesterol (r = 0.236, P ≤0.018) and serum triglyceride (r = 0.387, P ≤0.001). No statistically significant correlation was found between mean CIMT and estimated glomerular filtration rate (eGFR) (r = -0.02, P = 0.30), very low-density lipoprotein and high-density lipoprotein-cholesterol. Atherosclerotic changes very well correlate with the traditional cardiovascular risk factors like age, BMI, serum total cholesterol and serum triglyceride level in CKD patients. Even though CIMT was marginally more in the late stages of CKD patients, no statistically significant correlation was found with CIMT and eGFR.
  3,243 643 3
Statin-associated acute interstitial nephritis and rhabdomyolysis
Vidyashankar Panchangam
May-June 2014, 25(3):659-660
DOI:10.4103/1319-2442.132230  PMID:24821172
  3,251 609 1
ANCA-mediated crescentic glomerulonephritis with linear deposition of IgG along the glomerular basement membrane
Wiroon Sangsiraprapha, Luan Truong, Sreedhar Mandayam
May-June 2014, 25(3):634-637
DOI:10.4103/1319-2442.132221  PMID:24821165
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides is an important cause of rapidly progressive glomerulonephritides (RPGN), and they are classically described as pauci-immune diseases as evidenced by the absence of immune deposits on immunofluoresence microscopy of the kidney biopsy. We report two patients with RPGN, pulmonary-renal syndrome, positive ANCA serology and linear Immunoglobulin G (IgG) staining on glomerular basement membrane in the absence of detectable anti-glomerular basement membrane (anti-GBM) antibodies in the serum.
  3,307 476 -
Single nucleotide polymorphisms at erythropoietin, superoxide dismutase 1, splicing factor, arginine/serin-rich 15 and plasmacytoma variant translocation genes association with diabetic nephropathy
Maisaa Alwohhaib, Salah Alwaheeb, Nour Alyatama, Ali A Dashti, Amal Abdelghani, Naser Hussain
May-June 2014, 25(3):577-581
DOI:10.4103/1319-2442.132190  PMID:24821155
A number of genes have been identified in diabetic nephropathy. Association between diabetes-associated nephropathy and polymorphisms in the erythropoietin (EPO) gene, variants in the superoxide dismutase 1 (SOD1) gene and plasmacytoma variant translocation 1 (PVT1) gene have been identified. The EPO, SOD1:SFRS15 and PVT1 genes were genotyped using the single nucleotide polymorphism (SNP) technique in 38 diabetic nephropathy patients (Group 1) compared with 64 diabetic type 2 subjects without nephropathy (Group 2) at the Mubarak Alkabeer Hospital, Kuwait. The frequency of the risk allele T of the EPO (rs1617640) gene was high in both groups (0.96 in Group 1 and 0.92 in Group 2). Similarly, SNPs of the PVT1 (rs2720709) gene showed a higher frequency of the risk allele G in both groups (0.70 in the Group 1 and 0.68 in Group 2). Although the frequency of the risk allele A was higher than the frequency of the non-risk allele C of the SOD1:SFRS15 gene in both groups, the lowest probability value was observed in those gene SNPs (P = 0.05). We observed that the A allele of the SOD1:SFRS15 gene (rs17880135) was more frequently present in Group 1 (0.75) compared with Group 2 (0.62). Susceptibility to diabetes-associated nephropathy is partially mediated by genetic predisposition, and screening tests may open the gate for new therapeutic approaches.
  2,852 712 4
BK virus-associated hemophagocytic syndrome in a renal transplant recipient
S Yaich, K Charfeddine, D Hsairi, S Zaghdane, K Kammoun, S Makni, T Boudawara, J Hachicha
May-June 2014, 25(3):610-614
DOI:10.4103/1319-2442.132205  PMID:24821160
Hemophagocytic syndrome (HPS) is a life-threatening hematological disorder in immunocompromised patients. Reactive HPS is observed in patients with systemic infection, neoplasia or auto-immune diseases. It is a rare hematological disorder after renal transplantation and must be suspected when fever and pancytopenia are seen in association with viral infections. HPS is usually associated with infection with the Cytomegalovirus and Epstein-Barr viruses. We report here a case of BK-virus-associated HPS.
  2,994 477 3
Colorectal involvement by post-transplant lymphoproliferative disorders: A review of 81 cases
Hossein Khedmat, Mohsen Amini, Mohammad Ebrahim Ghamar-Chehreh
May-June 2014, 25(3):597-604
DOI:10.4103/1319-2442.132201  PMID:24821158
The reported number of patients representing post-transplant lymphoproliferative disorders (PTLD) within the colorectal region is quite limited. In this study, we sought to analyze and compare the characteristics, predictors and prognosis of colorectal localization of PTLDs arising in transplant recipients. A comprehensive search was performed through Pubmed and Google scholar to find case reports and series of colorectal localization of PTLD. Data of each individual patient from different studies were entered into a database and analyzed. Colorectal PTLD was significantly more prevalent in male patients (19.3% vs. 8.5%, respectively; P = 0.002) and represented a significantly shorter time to diagnosis than other localizations (P = 0.044). Multi-organ involvement (75% vs. 46%, respectively; P < 0.001) and disseminated disease (43% vs. 26%, respectively; P = 0.014) were more frequently observed in the colorectal PTLD. There was no survival difference between the two groups. Organ recipients representing colorectal involvement by PTLD are significantly at higher risk for metastasis, especially in their small intestine. Moreover, patients who underwent surgical intervention had low mortality, and, accordingly, we suggest using surgery to manage colorectal PTLD when it is applicable. Prospective studies with larger patient populations are needed to confirm these results.
  3,032 402 2
Can patients with schizophrenia undergo renal transplantation with success?
Saoussen Bouhlel
May-June 2014, 25(3):605-609
DOI:10.4103/1319-2442.132203  PMID:24821159
We report a case of a 41-year-old man suffering from paranoid schizophrenia. The patient has been consulting in our psychiatric hospital since he was 29 years old. Eight years later, he developed kidney failure and required peritoneal dialysis. After more than two years, the nephrology team indicated a renal transplantation and his brother suggested giving his kidney. There were no obstacles for transplantation in the immune and histological compatibilities; the psychiatric staff decided to check the patient's compliance with medication. The patient was compliant to all his medications and to the salt-free diet after the transplant operation. Few weeks later, he developed steroid-induced diabetes. Through the last two years, he had psychotic exacerbations with major anxiety and fear of losing the transplant. These relapses were managed by increasing doses of antipsychotics without need for hospitalization. At the present time, three years after transplantation, the nephrologists are decreasing the immunosuppressive agents and the steroids. The renal function is optimum and the diabetes is stabilized. This case exemplifies the potential for schizophrenic patients to undergo renal transplantation and to comply with follow-up medical care through a close cooperation between the patient's family, the psychiatric staff and the nephrology team.
  3,055 376 -
Effect of cyclosporine a in the treatment of proteinuric patients with immunoglobulin a nephropathy
Shahrzad Ossareh, Bahareh Madadi, Rashin Joodat
May-June 2014, 25(3):661-666
DOI:10.4103/1319-2442.132231  PMID:24821173
  3,003 402 -
Post-kidney transplant large bowel lymphoproliferative disorder
Neeraj Singh, Singh Samavedi, Amer Rajab
May-June 2014, 25(3):621-624
DOI:10.4103/1319-2442.132209  PMID:24821162
Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disorder (PTLD) is a serious complication of organ transplantation. The gastrointestinal (GI) tract is a common site involved, but non-specific signs and symptoms often delay the diagnosis. We report a case of EBV-associated GI-PTLD in a 68-year-old kidney transplant patient who received the kidney ten months earlier. He presented with chronic diarrhea and developed massive pneumo-peritoneum secondary to multiple colonic perforations.
  2,889 400 1
Spectrum of biopsy-proven kidney disease in children at a Jordanian Hospital
Reem Hadidi, May Hadidi, Ma'en alDabbas
May-June 2014, 25(3):680-683
DOI:10.4103/1319-2442.132238  PMID:24821178
To determine the patterns of renal disease among Jordanian children based on kidney biopsy results as well as correlating clinical presentation with histopathological diagnosis, we studied the medical records of 55 children who had kidney-biopsy kidney disease at the Prince Hamza Hospital from August 2006 to April 2012. The most common indication for biopsies was steroid-resistant nephrotic syndrome (25%), followed by steroid-dependent nephrotic syndrome (20%). The most common diagnosis of primary glomerular disease was minimal change disease (27%), followed by focal segmental glomerulosclerosis (21%), mesangioproliferative glomerulonephritis (12.7%) and IgA nephropathy (7.3%). The most common secondary renal disease was Henoch-Schonlein purpura (HSP) in 10.9% of the patients, followed by systemic lupus erythematosus in 9.1%. The kidney biopsy was normal in 3.6%. Cyclosporine protocol biopsy was performed in four (7.3%) patients. Gross hematuria after kidney biopsy occurred in 5.5% of cases; however, none of these patients required blood transfusion. Kidney biopsy is a safe procedure that needs to be performed once indicated and our results are comparable with those carried out elsewhere in Jordan. The study also shows the importance of establishing a national registry for pediatric renal disease.
  2,747 462 2
Comparison between spousal donor transplantation treated with anti-thymocyte globulin induction therapy and, living related donor transplantation treated with standard immunosuppression
Erkan Demir, Saime Paydas, Ugur Erken
May-June 2014, 25(3):520-523
DOI:10.4103/1319-2442.132155  PMID:24821146
The worldwide shortage of organs available for transplantation has led to the use of living-unrelated kidney donors. In this context, spouses represent an important source of organ donors. We compared the allograft outcomes of spousal donor transplantation (SDT) with anti-thymocyte globulin (ATG) induction therapy and living related donor transplantation (LRDT) with triple immonosuppression and basiliximab, in addition. Among the 335 living and deceased donor kidney transplantations performed between April 2001 and June 2010, there were 274 living donor kidney transplantations including 34 SDT and 240 LRDT. The minimum follow-up period was 36 months. All recipients of SDT received ATG (1.5 mg/kg) induction therapy, which was stopped five to seven days after surgery. Maintenance immunosuppression included tacrolimus (TAC), mycophenolate mofetil (MMF) and prednisolone. LRDT recipients received triple immunosuppressive protocol consisting of cyclosporine or TAC, MMF and prednisolone, in addition to basiliximab. There was a significant difference between the two groups in recipient age, while pre-operative duration on dialysis, recipient sex and donor age and sex were not significantly different. There was also a significant difference between the two groups in the number of human leukocyte antigen (HLA) mismatches. The 1-, 3- and 5-year graft survival rates of SDT were 94.1%, 88.2% and 79.4%, respectively, and the frequency of acute rejection episodes was 5.8% (two cases). The 1-, 3- and 5-year graft survival rates of LRDT were 95.8%, 91.6% and 83.3%, respectively, with the frequency of acute rejection being 16.2%. The graft survival rates of SDT were as good as LRDT, while the acute rejection rates in SDT were lower than in LRDT, although the difference was not statistically different (P = 0.13).
  2,507 432 -
QT dispersion in the electrocardiogram in hemodialysis and peritoneal dialysis patients
Sadraddin Rasi Hashemi, Hamid Noshad, Iman Yazdaninia, Bahram Sohrabi, Ahmad Separham
May-June 2014, 25(3):524-529
DOI:10.4103/1319-2442.132159  PMID:24821147
To evaluate QT dispersion (QTd) in dialysis patients in an analytic cross-sectional study, three groups were enrolled: Hemodialysis (HD), peritoneal dialysis (PD) and control (30 patients in each group) to study QT parameters in 12-lead electrocardiograms (ECGs). QTd was calculated (maximum QT interval minus minimum QT interval in different leads in each ECG). In dialysis patients, left ventricle mass index (LVMI) was also evaluated using the ECG of the patients. QT, corrected QT (QTc), QTd and QTc dispersion were significantly higher in the HD and PD groups than in controls, but there was no difference between the dialysis groups. There was no difference between the HD and the PD groups in LVMI and ejection fraction. In the PD group, there was a positive correlation of LVMI and QTd (r = 0.5, P = 0.004) and QTc dispersion (r = 0.54, P = 0.004). We conclude that the QT changes were more prominent in HD and PD patients than in controls, which could be due to electrolyte changes. Further studies to evaluate the causes of the QT changes in a larger population are needed.
  2,467 470 -
A family with five siblings affected with nephronophthisis
Jumana Albaramki, Kamal Akl, Radi Hamed, Ayman Wahbeh
May-June 2014, 25(3):630-633
DOI:10.4103/1319-2442.132218  PMID:24821164
Nephronophthisis is an autosomal recessive disease that leads to end-stage renal disease. These days, molecular genetic analysis is used pre-emptively for making a definitive diagnosis in patients who have clinical and radiological data suggestive of the disease. Herein, we are reporting a 12-year-old girl who was genetically diagnosed to have juvenile nephronophthisis, which explained the mystery of the chronic kidney disease in her four affected siblings.
  2,454 365 -
Focal segmental glomerulosclerosis associated with psoriasis
Subal Kumar Pradhan, Siba Shankar Beriha
May-June 2014, 25(3):670-671
DOI:10.4103/1319-2442.132234  PMID:24821176
  2,246 380 1
Mucinous cystadenocarcinoma of renal pelvis presenting as pyonephrosis
Rashmi D Patel, Aruna V Vanikar, Pranjal R Modi
May-June 2014, 25(3):647-650
DOI:10.4103/1319-2442.132224  PMID:24821168
Mucinous cystadenocarcinoma of renal pelvis is a rare epithelial tumor with poor prognosis. It is postulated to arise from metaplastic glandular mucosa in response to chronic irritation, and comprises less than 0.3% of total renal pelvic tumors. We present this case of a tumor noted in a 45-year-old lady that was diagnosed as mucinous cystadenocarcinoma on histological examination after radical nephrectomy. The patient is remaining well over a follow-up of three months.
  2,248 290 1
Distribution of pathological finding in the children with nephrotic syndrome from Guangxi
Tian-Biao Zhou, Na Lin, Yuan-Han Qin, Yun-Guang Liu
May-June 2014, 25(3):684-688
DOI:10.4103/1319-2442.132240  PMID:24821179
To identify the variations in pediatric renal biopsy pathology and clinicopathological features in Guangxi, China, in the past ten years, we studied retrospectively the kidney biopsies performed to evaluate the primary nephrotic syndrome (PNS) in 218 children at two main medical centers in Guangxi from January 1999 to January 2009. The major pathological finding was mesangial proliferative glomerulonephritis (48.2%), focal segmental glomerulosclerosis (16.5%), immunoglobulin A nephropathy (13.3%) and minimal change disease (11.0%). Patients with different pathological types yielded different response rates to glucocorticoids (P <0.001). There were statistical significant differences between prognosis for the different pathological types (P <0.05). The pathological characteristics of PNS in children were diverse and significant for guiding the grade of glucocorticoid response and predicting the prognosis of the PNS disease.
  2,163 352 1
Henna leaf ingestion and intravascular hemolysis: the missing link
Subramanian Senthilkumaran, Suresh S David, Ritesh G Menezes, Ponniah Thirumalaikolundusubramanian
May-June 2014, 25(3):667-668
DOI:10.4103/1319-2442.132232  PMID:24821174
  1,730 269 3
Multiple renal arteries in living donor kidney transplantation: Limits of recipient warm ischemia
Taqi T Khan, Basem Koshaji, Suhaib Kamal, Faheem Akhtar, Ebadur Rahman
May-June 2014, 25(3):651-654
DOI:10.4103/1319-2442.132225  PMID:24821169
  1,564 256 -
Acute renal failure and intravascular hemolysis following henna ingestion
Mahmood Dhahir Al-Mendalawi
May-June 2014, 25(3):669-669
DOI:10.4103/1319-2442.132233  PMID:24821175
  1,339 267 -
Favorable survival rate after kidney transplantation in diabetic patients
Behzad Einollahi, Zohreh Rostami
May-June 2014, 25(3):655-656
DOI:10.4103/1319-2442.132227  PMID:24821170
  1,261 264 -
New-onset diabetes after transplantation and oral glucose tolerance test
Somsri Wiwanitkit, Viroj Wiwanitkit
May-June 2014, 25(3):657-658
DOI:10.4103/1319-2442.132228  PMID:24821171
  1,261 260 -
Hospital Sharing in Organ Donation Program

May-June 2014, 25(3):703-708
  1,056 150 -
Authors reply
Manisha Sahay, Rakesh Kumar Sahay
May-June 2014, 25(3):657-658
  823 160 -
Author's reply
Behzad Einollahi
May-June 2014, 25(3):653-654
  733 136 -
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