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Saudi Journal of Kidney Diseases and Transplantation
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   2016| March-April  | Volume 27 | Issue 2  
    Online since March 11, 2016

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Influence of nutritional education on hemodialysis patients' knowledge and quality of life
Hossein Ebrahimi, Mahdi Sadeghi, Farzaneh Amanpour, Ali Dadgari
March-April 2016, 27(2):250-255
DOI:10.4103/1319-2442.178253  PMID:26997377
To determine the effects of educational instructions on hemodialysis patients' knowledge and quality of life (QOL), we studied 99 patients randomly assigned to control and experimental groups after participation in a pretest exam. The two groups were not significantly different in terms of demographic composition. The instrument used in this study was a questionnaire regarding patients' knowledge and the standard questionnaire to assess QOL for end-stage renal disease (ESRD) patients. Then, intervention (nutritional education) was conducted in the experimental group lasting for 12 weeks. After 16 weeks, a post test regarding subjects' knowledge on dietary instructions and their QOL were as conducted. There was no significant difference in QOL score and knowledge score before and after intervention in the control group, but there was a significant difference in the experimental group. In addition, after the intervention, the difference in knowledge and QOL score persisted between the two groups. The results of this study supported the positive effects of educational program on patients' knowledge and QOL among ESRD patients. It is recommended that dietary instruction be included in all educational programs to improve ESRD patients' QOL.
  7,030 1,768 -
Outcome of patients with multiple myeloma and renal failure on novel regimens
Tayebeh Soleymanian, Adel Soleimani, Asadollah Musavi, Kourosh Mojtahedi, Gholamreza Hamid
March-April 2016, 27(2):335-340
DOI:10.4103/1319-2442.178557  PMID:26997388
Renal involvement occurs in 20-40% of newly diagnosed multiple myeloma (MM) patients, and diagnosis of myeloma is frequently made after investigation for unexplained renal disease. This is a retrospective study between 2006 and 2013 in which 57 consecutive patients seen at the Nephrology Unit with diagnosis of MM were enrolled. MM was diagnosed for the first time because of renal dysfunction and/or proteinuria in these patients. The mean age of the patients (65% male) was 58.3 ± 12.7 years. The median baseline serum creatinine was 3.5 mg/dL (1.4-14.5). Anemia (hemoglobin <12 g/dL) was noted in 88% and hypercalcemia (calcium >10.5 mg/dL) in 35% of patients. Early hemodialysis was started in 28 patients (49%). Thalidomide plus dexamethasone (16% on bortezomib) were the main therapeutic regimens. Three patients (5%) underwent autologous stem cell transplantation. Twenty-six patients (45.6%) died during a median follow-up of 25 months (1-90). The mean age of patients who died was significantly higher than the age in patients who were alive (62.2 ± 12.7 vs. 55.2 ± 11.9 years, respectively; P = 0.037). Early hemodialysis had no significant effect on mortality rate. The one-, threeand fiveyear patient survival was 71%, 54%, and 41%, respectively. The median overall survival of patients was 50 months. Prolonged patient survival can be expected in myeloma patients with renal failure or on dialysis by applying novel therapeutic agents.
  6,674 913 -
Successful management of chylous ascites: A report of two cases
Shaan E Alam, Sunny M Kar, Pran M Kar
March-April 2016, 27(2):386-390
DOI:10.4103/1319-2442.178573  PMID:26997396
Chylous ascites consists of the accumulation of chyle in the peritoneal cavity. Diagnosis is established by cytochemical analysis of the fluid revealing fat globules and high triglyceride content. The majority of cases are caused by pathology that interferes with abdominal retroperitoneal lymphatic drainage. We present two cases of postoperative chylous ascites, one following a bilateral nephrectomy, the other following orthotopic heart transplantation. Treatment is typically conservative with the aim to alleviate abdominal distension and reduce the flow of lymph into the mesenteric lymph nodes. Postsurgical chylous ascites has high cure rate with conservative therapy alone. Therapeutic paracentesis, diuretics, salt restriction, a high-protein, low-fat, mediumchain triglyceride diet, and parenteral nutrition are considered in chronic cases. The effects of longterm paracentesis on patients remains to be seen. In patients requiring renal replacement therapy, removal of chyle during peritoneal dialysis is often attempted.
  5,311 648 -
A comparison of the quality of life of the patients undergoing hemodialysis versus peritoneal dialysis and its correlation to the quality of dialysis
Abdolamir Atapour, Salar Nasr, Amir Momeni Boroujeni, Diana Taheri, Shahaboddin Dolatkhah
March-April 2016, 27(2):270-280
DOI:10.4103/1319-2442.178259  PMID:26997380
Over the years, there has been a steady increase in the number of patients requiring dialysis. However, no consensus exists between choosing either hemodialysis (HD) or peritoneal dialysis (PD) as the preferred method of dialysis for patients. In this study, we have compared the quality of life of the patients undergoing either HD or PD. This cross-sectional study was performed in the dialysis center of the Noor and Saint Ali Asghar University Hospital in Isfahan, Iran in 2012. Forty-six patients who underwent PD (28 males and 18 females) and 46 similar patients undergoing HD (26 males and 20 females) were compared. A standardized Persian version of the short form-36 (SF-36) tool was used to assess the quality of life and to assess the quality of dialysis weekly Kt/V in patients undergoing PD and single random Kt/V sampling in HD patients were assessed. Patients undergoing PD reported higher scores in physical functioning. The lowest scores in both groups were reported in mental health section. In physical functioning section, physical role functioning section and overall score of the SF-36 tool, PD patients reported significantly higher scores compared to the HD patients (P <0.05). There was no significant difference between the qualities of the dialysis in the two patient groups. Aspects of quality of life such as physical functioning, physical role functioning, bodily pain, general health perceptions, and overall score were significantly different between the two groups. If these results are substantiated by subsequent longitudinal studies, then the choice of dialysis could be better guided in patients by the quality of life issues.
  4,903 1,016 -
A modified peritoneal dialysis catheter with a new technique: Farewell to catheter migration
Abdullah Khalaf Al-Hwiesh
March-April 2016, 27(2):281-289
DOI:10.4103/1319-2442.178261  PMID:26997381
To evaluate the efficacy our new, three-cuff peritoneal dialysis (PD) catheter, with the low-entry technique and to study its impact on catheter survival and mechanical and infectious complications, we prospectively used it in 36 incident PD patients and compared the results with those of conventional double-cuff PD Tenckhoff catheters with the classic approach used in 37 patients. The study was carried out at our university hospital over a period of 18 months. At the end of the study, significantly higher survival rate was observed with the use of new catheter compared with the conventional two-cuff Tenckhoff catheter, 91.7% and 73%, respectively, (P <0.01); the difference in catheter survival was due to a lower incidence (P < 0.01) of catheter-tip migration and a lower incidence (P <0.01) of peritonitis. Dialysis fill and drain times were significantly shorter and Kt/V was better with our new catheter. In conclusion, the study suggests superiority of our new catheter and our new technique over the conventional one in terms of catheter survival. This is due to less incidences of catheter tip migration in addition to lower peritonitis rates. Dialysis adequacy was better because of shortened fill and drain time.
  4,630 633 -
Pregnancy after renal transplantation: Effects on mother, child, and renal graft function
Siham El Houssni, Siham Sabri, Loubna Benamar, Naima Ouzeddoun, Rabia Bayahia, Hakima Rhou
March-April 2016, 27(2):227-232
DOI:10.4103/1319-2442.178204  PMID:26997374
The aim of this study was to report our experience of pregnancy in renal transplant (RT) patients and its medium and long-term effects on the renal graft as well as the maternal fetal complications. We studied 21 pregnancies in 12 RT patients with mean age of 29.9 ± 5.3 years. The mean duration of RT to 1 st pregnancy was 42 (21-68.5) months and the median follow-up period was 112.5 (138-165) months. The pregnancy was planned in 28.6% of the cases. At the time of the diagnosis of the pregnancy, all the patients were maintained on corticosteroids and cyclosporine, 14.3% of the patients were on mycophenolate mofetil, and 71.4% of the patients were on azathioprine. The high blood pressure was present before the pregnancy in 33.3% of the patients. During pregnancy, proteinuria appeared in 20% of the cases, urinary tract infection in 33.3%, and preeclampsia in 5%. Anemia was present in all the patients during pregnancy. The doses of cyclosporine were increased during pregnancy. The mean term of delivery was 37 ± 2 weeks. Premature delivery was observed in 19% of the cases, fetal death in utero in 10%, and abortion in 15%. The number of living children was 16, with a mean birth weight of 3014 ± 515 g; the weight was lower than 2500 g in three (15%) cases. In the long-term follow-up, we noticed two cases of acute rejection related to patients' noncompliance, and four cases of chronic allograft nephropathy, without a switch to dialysis. We conclude that pregnancy in RT patients requires multidisciplinary care because of the increased risks of maternal and fetal complications. Each pregnancy needs to be planned; all parameters have to be studied and evaluated in order to allow for optimization of outcome and minimization of complications.
  3,894 957 -
Blood pressure measurement in hemodialysis: The importance of the measurement technique
M Kubrusly, Claudia Maria Costa de Oliveira, RP Silva, MA Pinheiro, M. B. C. Rocha, RM Magalhães
March-April 2016, 27(2):241-249
DOI:10.4103/1319-2442.178251  PMID:26997376
Systemic arterial hypertension contributes to the high cardiovascular morbidity in hemodialysis (HD) patients, but the accuracy of blood pressure (BP) measurement in this population has not been well studied. To evaluate the agreement between BP measurement using the routine measurement technique (usual method) and the technique recommended by the VII Joint (standard method). This cross-sectional study enrolled 124 patients in a single center who had undergone dialysis for more than three months and were 18 years of age or older. The BP was verified at the start of dialysis by the nursing team (usual method) and by the researchers (standard method). The agreement between the systolic and diastolic BP (SBP and DBP) measurements was tested by the Bland-Altman analysis. A difference in BP measurement higher than ±5 mm Hg was considered clinically significant. The studied group had a mean age of 53.2 years. The average difference between routine and standard BP measurement was −6 mm Hg for SBP (limits of agreement: −40.1-28 mm Hg; P <0.001) and −5.6 mm Hg for DBP (limits of agreement: −33.1-21.8 mm Hg; P <0.001). A clinically significant difference in BP measured by both methods was observed in 69.4% of the patients for SBP and in 61.3% for DBP. The disagreement between the results of different BP measurement methods in HD patients was significant and the BP was underestimated using the usual BP method. BP measurement standardization should be encouraged to avoid errors in diagnosis and therapy.
  3,957 467 -
Effect of Vitamin B 12 supplementation on serum homocysteine in patients undergoing hemodialysis: A randomized controlled trial
Ali Tayebi, Vajihe Biniaz, Samira Savari, Abbas Ebadi, Mahdi Sadeghi Shermeh, Behzad Einollahi, Abolfazl Rahimi
March-April 2016, 27(2):256-262
DOI:10.4103/1319-2442.178255  PMID:26997378
Clinical studies have shown that hyper-homocysteinemia is a potent independent risk factor for cardiovascular diseases, and many different methods have been investigated for lowering it in hemodialysis (HD) patients. Our study investigated the effect of Vitamin B 12 supplementation on serum homocysteine levels in these patients. This randomized trial was conducted on 140 HD patients. They were randomly distributed by lottery method into two groups: intervention and control. In the intervention group, 100 μg/mL of Vitamin B 12 was intravenously injected two times a week, for eight weeks. No intervention was performed in the control group. Serum levels of homocysteine, hemoglobin (Hb), and hematocrit (Hct) were measured at the beginning and again after eight weeks (2 months) of treatment. About 91% of the patients had hyperhomocysteinemia (serum homocysteine >15 μmol/L). The median baseline levels of serum homocysteine in the intervention and control groups were 31.9 and 26.9 μmol/L, respectively (P = 0.1). After eight weeks, the median homocysteine level reduced significantly in the Vitamin B 12 group to 22.2 versus 28.4 μmol/L in control group (P = 0.006). The mean Hb and Hct also changed significantly during our study (12.3 vs. 11.4 g/dL; P = 0.003 and 37.9 vs. 35.3%; P = 0.02, respectively). Our results demonstrated the existence of a statistical negative relationship between Vitamin B 12 and serum levels of homocysteine. Detailed investigations with larger sample sizes and longer-term use of Vitamin B 12 are recommended.
  3,553 816 -
The effect of depression and anxiety on the performance status of end-stage renal disease patients undergoing hemodialysis
Emilda Juidth Ezhil Rajan, Somasundaram Subramanian
March-April 2016, 27(2):331-334
DOI:10.4103/1319-2442.178555  PMID:26997387
Individuals who are diagnosed with end-stage renal disease (ESRD) undergo major changes in lifestyle. The present cross-sectional study was conducted to identify the relationship between patients who undergo hemodialysis (HD) and their performance status, and how it is influenced by the presence of the level of depression and anxiety. A total of 50 patients were recruited from HD centers in and around Chennai. The patients were screened using the General Health Questionnaire to screen for co-morbid psychiatric conditions. The patients were assessed for depression and anxiety, and their performance status was assessed using Beck's Depression Inventory, Beck's Anxiety Inventory, and Karnofsky Performance Status. The study findings indicate that there is a positive correlation between anxiety and depression in ESRD patients. The findings also indicated that depression and anxiety are positively correlated with the performance status of ESRD patients. The duration on, as well as the frequency of dialysis, also correlated with the performance status of ESRD patients. It can be concluded that anxiety and depression are prevalent among ESRD patients and that they interfere with the performance status; additionally, duration on dialysis also interferes with performance status. Addressing depression and anxiety can help in enhancing the patient's performance status.
  3,287 845 -
Accuracy of GFR estimation formula in determination of glomerular filtration rate in kidney donors: Comparison with 24 h urine creatinine clearance
Abdul Rauf Hafeez, Muhammad Khalid Idrees, Syed Fazal Akhtar
March-April 2016, 27(2):320-325
DOI:10.4103/1319-2442.178551  PMID:26997385
To determine the accuracy of estimated glomerular filtration rate (eGFR) using the modification of diet in renal disease (MDRD), Cockcroft-Gault (CG), and chronic kidney disease epidemiology (CKD-EPI) formulas in potential kidney donors compared with 24-h urine creatinine clearance, we studied 207 potential live kidney donors in our center. There were 126 (60.9%) males and 81 (39.1%) females. Male:female ratio was 1.6:1. The age of the donors ranged from 18-58 years, with mean age of 35.30 ± 9.23 years and most of the individuals were below 40 years of age. The body mass index (BMI) was calculated and venous blood samples were obtained for the measurement of serum creatinine and every study participant was instructed to collect 24-h urine. GFR was calculated based on 24-h urine creatinine clearance and the formulas. The accuracy of GFR estimation formula was taken as positive if the GFR calculated by the formulas and urine creatinine clearance fell between 90-120 mL/min/1.73 m 2 . The accuracy of the MDRD formula was 48.8% and the CG formula was 41.5% whereas the accuracy of the CKD-EPI formula was 78.2%. The accuracy of the eGFR using the MDRD formula was significantly higher in males than females (57.9% vs. 33.3% P = 0.001), while there was no statistically significant difference in the eGFR between them in case of the use of the CG and the CKD-EPI formulas. BMI and obesity had no effect on the accuracy of eGFR by the use of the different formulas. The performance of GFR estimation formulas was sub optimal and these either underestimated and/or over-estimated the GFR in healthy subjects. CKD-EPI is closer to 24 -h urinary creatinine clearance in the calculation of eGFR. However, none of the eGFR formulas can be used in renal transplant donors because of their low accuracy, and 24-h urine creatinine clearance should be used for evaluation of the GFR in this population.
  3,537 589 -
Pattern of renal diseases in children: A developing country experience
Shankar Prasad Yadav, Gauri Shankar Shah, Om Prakash Mishra, Nirmal Baral
March-April 2016, 27(2):371-376
DOI:10.4103/1319-2442.178565  PMID:26997393
Spectrum of renal disease varies in different ethnic population, geographical location, and by environmental factors. The purpose of this study was to find out the clinical spectrum and occurrence of different pediatric renal diseases at a teaching hospital in the Eastern part of Nepal. All cases of renal diseases from one month to 15 years of age, attending the pediatric renal outpatient department and/or were admitted to the wards during the period of February 2012 to January 2013, were included in the study. Detailed clinical and laboratory evaluations were performed on all patients. Diseases were categorized as per standard definitions and managed with hospital protocols. Renal diseases accounted to be 206 cases (6.9%) of total annual pediatric admissions, of which (58%) were male and (42%) female. Acute glomerulonephritis (AGN) was the most common disorder (37.7%) followed by nephrotic syndrome (26.1%), urinary tract infection (21.3%), acute kidney injury (AKI) (17.9%), obstructive uropathy (1.9%), chronic kidney disease (CKD) (1.2%), and others. In AGN group, the most common cause was post-infectious glomerulonephritis (PIGN) (32.9%) followed by lupus nephritis (4%) and Henoch-Schonlein purpura nephritis (0.8%). Urine culture was positive in (9.22%) and the most common organism was Escherichia coli (57.9%). The causes of AKI were urosepsis, septicemia, and AGN (18.9%) each, followed by dehydration (13.5%). Mortality was found in 5% of cases and the etiologies were AKI in (72.7%), PIGN (18.1%), and CKD (9%). Renal diseases are a significant problem among children and are one of the common causes of hospital admission. These patients need comprehensive services for early identification and management.
  3,258 725 -
Utility of saliva as a sample to assess renal function and estimated glomerular filtration rate
Naresh Yajamanam, Kiranmayi S Vinapamula, V Sivakumar, Aparna R Bitla, P. V. L. N. Srinivasa Rao
March-April 2016, 27(2):312-319
DOI:10.4103/1319-2442.178549  PMID:26997384
Diagnosis of renal diseases by assessing renal parameters in saliva. Biochemical investigations using serum form important component of monitoring patients with renal disease. Utility of saliva, in diagnosis and monitoring of patients with renal disease and for calculation of estimated glomerular filtration rate (eGFR), was studied. Sixty patients with renal disease and sixty ageand sex-matched healthy controls were studied. Urea, creatinine, sodium, potassium, uric acid, calcium, and phosphorus were measured in both serum and saliva. eGFR was calculated using salivary creatinine. Data were expressed as mean ± standard deviation. Comparison and correlation between groups were assessed by Student's t-test and Pearson correlation, respectively. Bland-Altman plot, mountain plot, and intra-class correlation coefficient were used to test agreement. A P <0.05 was considered statistically significant. Statistical analysis was done using Microsoft excel spreadsheets, Medcalc Version 10.0, and SPSS version 11.5. Salivary levels of urea, creatinine, uric acid, sodium, potassium, and phosphorus were higher in patients compared to controls. Potassium and phosphorus levels were higher (P = 0.001) and creatinine, sodium, calcium, and uric acid levels were lower (P = 0.001) in saliva compared to serum in both patients and controls. Positive correlation was observed between serum and salivary urea and creatinine (P < 0.0001). eGFR values calculated from salivary creatinine showed good agreement with those calculated form serum creatinine. Salivary urea (>6 mmol/L) and creatinine (>14.6 μmol/L) and eGFR calculated from salivary creatinine can be used to identify patients with renal disease.
  3,264 676 -
Averting the legacy of kidney disease - Focus on childhood
Julie R Ingelfinger, Kamyar Kalantar-Zadeh, Franz Schaefer, World Kidney Day Steering Committee
March-April 2016, 27(2):219-226
DOI:10.4103/1319-2442.178201  PMID:26997373
World Kidney Day 2016 focuses on kidney disease in childhood and the antecedents of adult kidney disease that can begin in earliest childhood. Chronic kidney disease (CKD) in childhood differs from that in adults, as the largest diagnostic group among children includes congenital anomalies and inherited disorders, with glomerulopathies and kidney disease in the setting of diabetes being relatively uncommon. In addition, many children with acute kidney injury will ultimately develop sequelae that may lead to hypertension and CKD in later childhood or in adult life. Children born early or who are small-for date newborns have relatively increased risk for the development of CKD later in life. Persons with a high-risk birth and early childhood history should be watched closely in order to help detect early signs of kidney disease in time to provide effective prevention or treatment. Successful therapy is feasible for advanced CKD in childhood; there is evidence that children fare better than adults, if they receive kidney replacement therapy including dialysis and transplantation, while only a minority of children may require this ultimate intervention Because there are disparities in access to care, effort is needed so that those children with kidney disease, wherever they live, may be treated effectively, irrespective of their geographic or economic circumstances. Our hope is that World Kidney Day will inform the general public, policy makers and caregivers about the needs and possibilities surrounding kidney disease in childhood.
  3,290 600 -
Prevalence and determinants of microalbuminurea among type 2 diabetes mellitus patients, Baghdad, Iraq, 2013
Ali Abdalkader Ali, Faris Hassan Al Lami
March-April 2016, 27(2):348-355
DOI:10.4103/1319-2442.178561  PMID:26997390
Microalbuminuria (MAU) is an early marker of diabetic nephropathy (DN), which accounts for a significant reduction in life expectancy of diabetic patients. The progression of DN from the appearance of clinical proteinuria to end stage renal failure is usually irreversible. Increased levels of urinary albumin secretion may represent a more generalized vascular damage. This is the first study conducted in Iraq to determine the prevalence and potential risk factors of MAU among Type 2 diabetes mellitus (T2DM) patients. A cross-sectional study was conducted on a systematic random sample of 224 eligible T2DM patients aged 25-64 years attending a DM clinic in Baghdad. A questionnaire was developed to gather basic and clinical data, besides anthropometric measurements, and laboratory assessment of lipid profile, HbA1c, serum creatinine, albumin, and microalbumin/creatinin in urine. MAU was defined as albumin/creatinine ratio 30-300 mg/g on two occasions. Only 36 cases (16.1%) had MAU. A statistical significant association found between MAU and educational level (P = 0.009), family history of hypertension (P = 0.024) and DN (P = 0.013), history of hypertension (P = 0.001), duration of angiotensin-converting-enzyme inhibitor drug intake in hypertensive patients (P = 0.001), body mass index (BMI) (P = 0.014), and waist to hip ratio (P = 0.006). Logistic regression analyses revealed two independent risk factors influencing MAU: diastolic blood pressure [odds ratio (OR) = 1.08, 95% confidence interval (CI): 1.007-1.118] and BMI (OR = 1.17, 95% CI: 1.037-1.220). The prevalence of MAU is not low among DM patients. Mandatory screening of all DM patients and amelioration of the assigned significant risk factors are recommended.
  2,989 622 -
Takayasu arteritis associated with severe renovascular hypertension
Mohamed Hassani
March-April 2016, 27(2):402-406
DOI:10.4103/1319-2442.178581  PMID:26997400
Takayasu arteritis (TA) is an inflammatory process frequently associated with stenosis and obliteration of the aorta and its primary branches. We report a 16-year-old girl in whom TA manifested mainly with a sudden decrease in visual acuity and severe arterial hypertension in both legs. Bilateral radial pulses were absent. Ultrasound showed renal size asymmetry and raised the possibility of renal artery stenosis. The diagnosis of TA was confirmed by computed tomography angiography, which showed a thickened abdominal aortic wall and narrowing of its lumen. In addition, occlusions of left renal artery and of both left and right subclavian arteries were observed. Hypertension was hardly under control by a combination of three antihypertensive drugs. The outcome was favorable with corticosteroids alone with regression of the clinical signs, disappearance of inflammation, and control of hypertension.
  3,027 496 -
Restless legs syndrome in hemodialysis patients
Shahram Rafie, Majid Jafari, Mostafa Azizi, Mohammad Bahadoram, Shima Jafari
March-April 2016, 27(2):326-330
DOI:10.4103/1319-2442.178553  PMID:26997386
Restless legs syndrome (RLS) is a neurological disorder characterized by uncomfortable sensation of paresthesia in legs that subsequently causes involuntary and continuous movement of the lower limbs, especially at rest. Its prevalence in hemodialysis is more than that in the general population. Different risk factors have been suggested for RLS. We studied the prevalence and risk factors of RLS in 137 hemodialysis patients followed up at our center. The patients completed at least three months on dialysis and fulfilled four criteria for the diagnosis of RLS. We compared the patients with and without RLS, and the odds ratios (ORs) were estimated by the logistic regression models. The prevalence of RLS was 36.5% in the study patients. Among the variables, diabetes was the only predicting factor for the development of RLS. The diabetic patients may be afflicted with RLS 2.25 times more than the non-diabetics. Women developed severe RLS 5.23 times more than men. Neurodegeneration, decrease in dopamine level, higher total oxidant status, and neuropathy in diabetic patients may explain the RLS symptoms.
  2,892 568 -
Multinational observational study on clinical practices and therapeutic management of mineral and bone disorders in patients with chronic kidney disease stages 4, 5, and 5D: The OCEANOS study
Faissal A. M. Shaheen, Ramprasad Kurpad, Abdulla A Al-Sayyari, Muhammad Ziad Souqiyyeh, Harith Aljubori, Tarek El Baz, Waqaruddin Kashif, Saltanat Tuganbekova, Kairat Kabulbayev, Faical Jarraya, Mohsen Nafar
March-April 2016, 27(2):290-304
DOI:10.4103/1319-2442.178266  PMID:26997382
Our aim is to assess the current clinical practices in monitoring and treatment patterns of chronic kidney disease (CKD)-mineral bone disorder and the degree to which these practices met the kidney disease improving global outcome (KDIGO) guidelines. This was an international, multi-center, cross-sectional, observational study in adult patients diagnosed with CKD Stages 4, 5, and 5D. Patients were enrolled from Middle East, South Asia, Eurasia, and Africa; patients with estimated glomerular filtration rate ≥30 mL/min/1.73 m 2 or with any medical/surgical conditions precluding their participation were excluded. Frequency of measurements, levels of serum calcium (Ca), phosphorus and parathormone (parathyroid hormone [PTH], and presence vascular/valvular calcification were recorded. Of the 2250 patients enrolled, data on 2247 patients were evaluated. Overall, only a small percentage of patients met all three target KDIGO ranges of serum Ca, phosphorus, and PTH (13.7% [95% confidence interval: 12.0; 15.4], with a higher proportion among CKD Stage 5D patients (14.8%) than CKD Stage 4 and 5 (5.6%) patients. Majority (84.3%) of the patients received treatment with phosphorous binders, of whom 85.5% received Ca-based phosphate binders. Overall, 57.0% of patients received Vitamin D treatment with a similar frequency among patients with CKD Stages 4, 5, and 5D. Over half (65.7%) of the patients were screened for vascular/valvular calcification; of these, 58.8% had ≥1 calcification. Diabetes status, P, PTH, and low density lipoprotein-cholesterol had significant impact on the prescription pattern of phosphorous binders. The current practices for the management of bone and mineral metabolism in CKD patients in the study region fall far short of meeting the KDIGO target range.
  2,807 622 -
Serum magnesium level and vascular stiffness in children with chronic kidney disease on regular hemodialysis
Manal Mohamed Zaher, Manal Abdel-Salam, Ragaa Abdel-Salam, Randa Sabour, Amal Abd El-Aleem Morsy, Dina Gamal
March-April 2016, 27(2):233-240
DOI:10.4103/1319-2442.178205  PMID:26997375
Chronic kidney disease (CKD) patients have a high prevalence of vascular calcifications, and cardiovascular disease is the leading cause of death in this population. Magnesium (Mg) depletion may be the missing link between multiple cardiovascular risk factors and the development of atherosclerosis. In this study, we aimed to assess the relationship between serum Mg levels and vascular stiffness in children with CKD on regular hemodialysis (HD). The study included 25 children with CKD on regular HD in our center; the study included also 25 healthy children age-and sex-matched as a control group. Serum Mg levels were measured, and Doppler ultrasound assessment of the intima-media thickness (IMT) and the peak systolic velocities (PSVs) of the main arteries including the (aorta, carotid, and femoral) arteries were recorded in the study patients. There were significantly lower serum Mg levels in children on regular HD than in the controls (1.7 ± 0.43 mg/dL vs. 2.31 ± 0.12 mg/dL, respectively, P = 0.001). There was a significant increase in the aorta and carotid IMT in the study group than in the controls (0.45 ± 0.07 mm vs. 0.40 ± 0.09 mm; 0.98 ± 0.57 mm vs. 0.55 ± 0.1 mm, P = 0.034 and 0.001, respectively), whereas there were no significant differences regarding the PSV of the carotid, aorta, and femoral arteries between the study patients and the controls (P >0.05). A negative correlation was found between serum Mg level with aortic IMT (AIMT) (r = −0.682; P = 0.000). In addition, a significant negative correlation was found between the AIMT with systolic and diastolic blood pressure (r = 0.447, P = 0.025, 0.472, P = 0.017), respectively. We conclude that lower serum Mg levels were associated with vascular calcification in chronic HD children. Confirmation of our results warrants further study.
  2,759 632 -
Posterior reversible encephalopathy syndrome in a hypertensive patient with renal failure
T Aatif, MR El Farouki, M Benyahia
March-April 2016, 27(2):411-414
DOI:10.4103/1319-2442.178586  PMID:26997402
Posterior reversible encephalopathy syndrome (PRES) is a clinical and neuroimaging entity characterized by headache, visual field deficits, changes in mentation and seizures, and by typical neuro-imaging features such as areas of sub-cortical edema, occasionally cortical, involving predominantly the occipital and parietal lobes of both hemispheres. Hypertension, uremia, immunosuppressive drugs neurotoxicity, preeclampsia or eclampsia, renal disease, and sepsis are the most common etiologies of PRES. Less common, it has been described in the setting of autoimmune disease. We report a case of PRES which was associated with hypertensive crisis in a patient with renal failure. Antihypertensive therapy and hemodialysis resulted in complete recovery.
  2,563 573 -
Cerebral venous thrombosis and secondary polycythemia in a case of nephrotic syndrome
Shankar Prasad Nagaraju, Manohar Bairy, Ravindra Prabhu Attur, Charudutt Jayant Sambhaji
March-April 2016, 27(2):391-394
DOI:10.4103/1319-2442.178575  PMID:26997397
Cerebral venous thrombosis (CVT) and polycythemia are considered as rare and life threatening complications of nephrotic syndrome. We report an unusual combination of both these complications in a case of nephrotic syndrome due to minimal change disease that was treated successfully. There was prompt and complete remission of nephrotic syndrome with steroid therapy, concurrent with complete resolution of polycythemia and CVT.
  2,424 324 -
Early recurrence of proliferative glomerulonephritis with monoclonal immunoglobulin deposits in a renal allograft
Rohit Tewari, Kusum Joshi, Ashwani Kumar, CS Rayat, Rajaram Iyer, Vinay Sakhuja, Mukut Minz
March-April 2016, 27(2):381-385
DOI:10.4103/1319-2442.178568  PMID:26997395
Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMIDs) is a clinico-pathologic entity, the recurrence of which in the renal allograft has only recently been described. A 55-year-old male presented with rapid deterioration of renal function. Light microscopy showed membranoproliferative glomerulonephritis with kappa light chain restriction and only one sub-class of IgG. He subsequently underwent renal transplant. Two months later, he developed acute graft dysfunction. Renal biopsy showed a recurrence of the disease. Work up for multiple myeloma was positive. Membranoproliferative pattern of injury in the posttransplant setting has a wide range of differential diagnosis, PGNMID being one of them.
  2,264 444 -
Quadriparesis due to Gitelman's syndrome diagnosed with thiazide diuretic test response
Sumanto Mukhopadhyay, Suvendu Jana, Apratim Chatterjee, Manoj Roy, Anup Sarkar, Jotideb Mukhopadhyay
March-April 2016, 27(2):407-410
DOI:10.4103/1319-2442.178584  PMID:26997401
Gitelman's syndrome is characterized by hypocalciuria, severe hypomagnesemia, and prominent muscular involvements such as fatigue, weakness, cramps, and tetany. It is due to mutations in the thiazide sensitive NaCl co-transporter in the distal convoluted tubule. The administration of thiazide diuretics may induce a subnormal increase of urinary Cl excretion in patients with Gitelman's syndrome, consistent with the hypothesis that less than normal Cl is reabsorbed by the thiazide-inhibitable transporter in Gitelman's syndrome. Thus, we report a case of Gitelman's syndrome presenting with quadriparesis diagnosed by using thiazide clearance test.
  2,347 333 -
Prognostic significance of C1q deposition in serial biopsies for predicating the long-term outcome in patients with proliferative lupus nephritis
Abdulkareem Alsuwaida, Sufia Husain, Mohammed Al Ghonaim, Noura Aloudah, Anhar Ullah, Hala Kfoury
March-April 2016, 27(2):305-311
DOI:10.4103/1319-2442.178547  PMID:26997383
Lupus nephritis (LN) is characterized by a highly variable clinical course. It has been reported that histopathologic lesions are risk factors for the progression of LN. The aim of this study is to investigate the relationship among the co-deposition of C1q, clinicopathological features, and renal outcomes in patients with LN. The clinical and histological parameters were studied in patients with International Society of Nephrology/Renal Pathology Society Class III or IV LN, who underwent two kidney biopsies. The patients were divided into two groups based on the glomerular C1q deposits: C1q-positive and C1q-negative. The impact of C1q status and longterm renal outcome on the doubling of serum creatinine and the rate of remission in the two groups were further investigated. Fifty-three patients had pure proliferative nephritis and 37.7% of these had a co-deposition of C1q. Doubling of serum creatinine was observed in 25% of patients with C1q-positive and 24.2% of patients with C1q-negative deposits. There was no difference between the two groups in terms of achieving complete or partial remission. The renal survival in the two groups was similar (P = 0.75). Upon repeat biopsy, the persistence of C1qpositivity was associated with a poor outcome (P = 0.007). C1q deposition in the glomerulus in the baseline biopsy was not associated with a poor renal outcome or severe pathologic features in patients with proliferative LN. However, the persistence of C1q positivity in repeat kidney biopsy is associated with a poor renal outcome.
  2,072 411 -
Identification of high-risk population and prevalence of kidney damage among asymptomatic central government employees in Delhi, India
Himanshu Sekhar Mahapatra, Yadunanandan Prasad Gupta, Neera Sharma, Gurdeep Buxi
March-April 2016, 27(2):362-370
DOI:10.4103/1319-2442.178564  PMID:26997392
Chronic kidney disease (CKD) has attained epidemic proportions in India due to increased incidence of diabetes and hypertension (HTN). It was surmised that identification of only high-risk groups (HRGs) through a questionnaire would be sufficient to identify cases of kidney damage (KD). The study attempted to device a questionnaire to classify the subjects in to HRG and low-risk group (LRG) and assess the extent of early KD. The central government employees were classified into HRG and LRG based on "SCreening for Occult REnal Disease (SCORED)" and "EXTENDED" questionnaire formulated after addition of 10 more parameters apart from diabetes and HTN. Urine examination by dipstick, quantitative microalbumin, serum creatinine, and estimated glomerular filtration rate were assessed to determine KD. The data were analyzed for risk-group classification. Sensitivity was calculated based on the number of KD cases in the HRG. Of the 1104 employees screened, 58% and 42% were classified in HRG and LRG, respectively. There were 306 KD cases of whom, 65% were in the HRG. The sensitivity of the EXTENDED questionnaire to detect CKD was much higher (60%) compared to the SCORED questionnaire (25%). The prevalence of KD according to stage was: stage-1, 13.4%; stage-2, 9.9%; and late stages (3, 4, and 5), 4.5%. Microalbuminuria and dipstick-positive proteinuria showed statistically higher proportion in the HRG (25% and 4.1%) than in the LRG (19% and 1%, respectively) (P <0.05). Although the EXTENDED questionnaire was more sensitive in detecting KD, only screening the high-risk population will leave behind 35% of KD cases. There is, therefore, a need for mass screening at regular intervals.
  2,134 324 -
The relationship between total mass and blood supply of parathyroid glands and their secretion of parathyroid hormone in hemodialysis patients with secondary hyperparathyroidism
Farrokhlagha Ahmadi, Pegah Aghajanzadeh, Hadi Rokni Yazdi, Sima Maziar, Sayad Mansour Gatmiri
March-April 2016, 27(2):263-269
DOI:10.4103/1319-2442.178257  PMID:26997379
Characteristics of parathyroid glands usually determined by ultrasonography such as its total weight or volume might be a good indicator for the induction or suppression of parathyroid hormone (PTH) secretion from these glands. In the present study, we investigated the relationship between the volume and blood supply grade of the parathyroid glands, and its PTH secretion. Study subjects included 52 consecutive patients with the secondary hyperparathyroidism undergoing maintenance hemodialysis therapy referred to dialysis wards of the Imam Khomeini and Amiralam University Hospitals in Tehran. Serum intact PTH (i-PTH) was measured by an ELISA assay. The parathyroid glands characteristics were identified by ultrasonography that was performed simultaneously with blood collection. Parathyroid blood flows were evaluated by power-Doppler color imaging. There was no significant correlation between the total mass of the glands and serum concentration of i-PTH. No significant correlations were also observed between both total central and peripheral parathyroid glands blood flow and serum i-PTH level. Dialysis duration and serum alkaline phosphatase were significantly correlated in a positive manner with i-PTH level. Furthermore, serum level of i-PTH was not correlated with the total signals of glands blood flow in a multivariable linear regression analysis. Serum secreted i-PTH level might not be predictable by a total mass of parathyroid glands as well as their blood supply.
  2,030 400 -
Hypertension and diabetes remain the main causes of chronic renal failure in Fars Province, Iran 2013
Leila Malekmakan, Alireza Malekmakan, Arghavan Daneshian, Maryam Pakfetrat, Jamshid Roosbeh
March-April 2016, 27(2):423-424
DOI:10.4103/1319-2442.178594  PMID:26997406
  1,970 413 -
Five years renal transplantation data: Single-center experience from Iraq
Ala A Ali, Ali J Al-Saedi, Ali J Al-Mudhaffer, Kais H Al-Taee
March-April 2016, 27(2):341-347
DOI:10.4103/1319-2442.178559  PMID:26997389
Renal transplantation is the treatment of choice for patients with end-stage renal disease. In Iraq, renal transplantation started in 1973 and has continued until now with live donor transplantation, since deceased donor transplant program is not approved as yet. Long-term transplant data are still scarce. The aim of our study is to present data on transplantation and medical follow-up at one year and, survival analysis at one, three and five years. A total of 250 renal transplantations were performed at the Nephrology and Renal Transplantation Center, Baghdad between January 2009 and January 2014. It is a living donor, blood group compatible donor program. All patients received triple immunosuppression (calcineurine inhibitor, mycophenolate mofetil or mycophenolic acid, and steroid). The Kaplan-Meier method was used to determine the survival rate. There were 92 live related donors, 143 unrelated donors, and 15 spouse donors. The mean age was 34.07 ± 12.2 years. The one-year graft survival for related and unrelated donor transplants was 98.9% and 91.8%, respectively. Graft survival was lower (82.9%) in recipients with acute rejection episodes. The patient survival at one-year was 94%. The three-year graft and patient survival was 91% and 90%, respectively, and five-year survival for grafts and patients was 87.1% and 88%, respectively. The outcome of the renal transplantation in Iraq is improving. Long-term patient follow-up needs more meticulous attention. The development of renal transplant registry is critical for future planning. Moreover, renal transplantation practice in Iraq needs more social, religious, and governmental support.
  1,984 369 -
Graft function and nutritional parameters in stable postrenal transplant patients
Anita Saxena, RK Sharma, Amit Gupta
March-April 2016, 27(2):356-361
DOI:10.4103/1319-2442.178563  PMID:26997391
Bioelectrical impedance analysis (BIA) is a method for the assessment of nutritional status. We studied the effect of graft function on nutritional status in postrenal 45 transplant patients with borderline to good allograft function using BIA. The patients had a mean serum creatinine of 1.42 ± 0.42 mg% and mean glomerular filtration rate (GFR) of 45.1 ± 14.1 mL/min. Based on BIA-derived GFR, the patients were divided into two groups; group 1: borderline graft function GFR <40 mL/min and a mean of 27.34 ± 9.1 mL/min and group 2: good graft function GFR ≥40 mL/min and a mean of 51.60 ± 9.16 mL/min. The patient data were compared with 30 healthy individuals. There was a significant difference between healthy controls and the posttransplant patients. There were significant differences between the study groups in body weight (P <0.01), serum creatinine (P <0.005), body mass index (BMI) (P <0.000), fat free mass (FFM) (P <0.003), fat mass (FM) (P <0.003), body cell mass (P <0.000), and dry weight (P <0.001). Group 1 had significantly lower body weight, BMI, FFM, FM, and dry weight, indicating poorer nutritional status compared with those in group 2. Based on phase angle, there were significant differences between group A (phase angle <4.0) and group B (phase angle >4.0) in extracellular water (P <0.015), intracellular water (P <0.002), plasma fluid (P <0.016), interstitial fluid (P <0.016), and body cell mass (P <0.024). Subjective global assessment (SGA) scores showed that transplant patients had normal nutritional status, but when compared with healthy individuals as assessed by BIA, there were significant differences in FM, FFM, and body cell mass. In conclusion, BIA was more sensitive to evaluate nutritional depletion than SGA in transplant patients with borderline.
  1,960 387 -
Asymptomatic pontine and extra-pontine lesions in a patient with end-stage renal disease
Raj Kanwar Yadav, Chandan J Das, Soumita Bagchi, Sanjay Agarwal
March-April 2016, 27(2):395-397
DOI:10.4103/1319-2442.178578  PMID:26997398
Osmotic demyelination syndrome leading to central pontine/extra-pontine myelinolysis (CPM/EPM) occurs mainly in patients with history of alcohol abuse, malnourishment, following liver transplantation and less commonly, in association with other systemic diseases. Asymptomatic CPM/EPM is rare. Patients with end-stage renal disease (ESRD) who develop CPM/EPM are usually symptomatic with florid neurologic manifestations. Herein, we present a patient with ESRD on maintenance hemodialysis who was incidentally detected to have pontine and extra-pontine lesions suggestive of myelinolysis without any neurologic signs or symptoms.
  1,924 323 -
Acute renal artery spasm during live kidney transplant surgery due to iatrogenic cause
Dipika Singh, Bina P Butala, Geeta P Parikh
March-April 2016, 27(2):415-416
DOI:10.4103/1319-2442.178588  PMID:26997403
  1,973 253 -
WT1 mutations in steroid-resistant idiopathic nephrotic syndrome
Om P Mishra, Arun K Singh, Abhishek Abhinay, Gopeshwar Narayan, Rajniti Prasad, Vineeta V Batra
March-April 2016, 27(2):417-418
DOI:10.4103/1319-2442.178590  PMID:26997404
  1,656 340 -
An unusual case of hematuria in a young female: renal artery embolism, mitral stenosis, and sinus rhythm
Ashok Kumar, Aditya Kapoor, Sudeep Kumar
March-April 2016, 27(2):398-401
DOI:10.4103/1319-2442.178580  PMID:26997399
Renal artery embolism (RAE) is an uncommon entity that is most often secondary to a cardiac source. Most reported cases have been in patients with underlying atrial fibrillation (AF), and occurrence of RAE, especially in patients with valvular heart disease, and sinus rhythm is very rare. We describe an unusual case of a young female who presented with sudden onset right flank pain, vomiting, anorexia, and hematuria, and was found to have thrombotic occlusion of the distal right renal artery. Although she denied any previous cardiac history, detailed cardiovascular examination revealed the presence of severe rheumatic mitral stenosis without any evidence of AF or left atrial clot. She was initially managed conservatively using low molecular weight heparin followed by oral anticoagulation with resolution of symptoms. A successful balloon mitral valvotomy was performed six weeks later. The patient is asymptomatic at her last follow-up of six months with preserved renal function. In symptomatic patients, clinicians need to consider the possibility of RAE even in patients of valvular heart disease with underlying sinus rhythm. Appropriate management of the underlying cardiac condition is imperative since embolism may be recurrent leading to compromise of renal function, if left untreated.
  1,658 274 -
Recurrent acute kidney injury in a young female: A rare presentation of ureteral endometriosis
Pragya Pant, Suraj Prakash, AN Dwivedi, Jai Prakash
March-April 2016, 27(2):419-422
DOI:10.4103/1319-2442.178591  PMID:26997405
  1,639 281 -
Occurrence of double primary malignancies in an African renal transplant recipient
Pavithra Mohan, Anand Yuvaraj, Georgi Abraham, Abraham Kurien, Anila Abraham, Milly Mathew, S Saravanan, Sanjeev Nair
March-April 2016, 27(2):377-380
DOI:10.4103/1319-2442.178566  PMID:26997394
A 63-year-old African male with end stage renal disease who received a renal transplantation from his daughter after successful treatment of hepatitis C virus, type 1 genotype developed metastatic Kaposi's sarcoma and subsequently adenocarcinoma of the prostate. He was successfully treated with chemotherapy and reduction of immunosuppression and switch over to rapamycin.
  1,598 245 -
The need to automate urinary creatinine ratios adjusted for the predicted daily creatinine excretion
Nasrulla Abutaleb
March-April 2016, 27(2):425-427
DOI:10.4103/1319-2442.178595  PMID:26997407
  1,318 175 -
Deceased Heart Beating Donor and Organ Transplantation in Saudi Arabia

March-April 2016, 27(2):428-433
  1,035 151 -
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