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Saudi Journal of Kidney Diseases and Transplantation
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   2016| September-October  | Volume 27 | Issue 5  
    Online since September 22, 2016

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Gitelman's syndrome presenting with hypocalcemic tetany and hypokalemic periodic paralysis
Kunal Gandhi, Dharmendra Prasad, Vinay Malhotra, Dhananjai Agrawal
September-October 2016, 27(5):1026-1028
DOI:10.4103/1319-2442.190881  PMID:27752015
Gitelman's syndrome is an autosomal recessive renal tubular disorder characterized by hypomagnesemia, hypokalemia, hypocalciuria, and metabolic alkalosis. Hypocalcemic tetany as a presentation of Gitelman's syndrome has rarely been reported in literature. We report a rare case of Gitelman's syndrome presenting with hypocalcemic tetany along with hypokalemic periodic paralysis. A 17-year-old female was admitted to our hospital with a history of perioral numbness and carpal spasms of five days duration with progressive quadriparesis developing over a period of few hours. Past history was significant for three episodes of transient lower limb weakness. On examination, blood pressure was 110/70 mm Hg. Chvostek's sign and Trousseau's sign were positive. Neurologically, she was fully oriented. She had Grade 3 power in all the four limbs with intact sensation. Laboratory tests showed hypocalcemia (7.8 mg/dL), hypokalemia (2.2 mEq/L), hypomagnesemia (0.9 mEq/L), and hypocalciuria (104 mg/day). Arterial blood gas showed mild metabolic alkalosis with respiratory compensation. Thus, a clinical diagnosis of GS was made. The patient made a remarkable recovery after the correction of electrolyte imbalance. The aim of this case report is to re-emphasize the fact that hypocalcemia can rarely occur in Gitelman's syndrome.
  5,817 491 -
Organ trade using social networks
Waleed Alrogy, Dunia Jawdat, Muhannad Alsemari, Abdulrahman Alharbi, Abdullah Alasaad, Ali H Hajeer
September-October 2016, 27(5):971-976
DOI:10.4103/1319-2442.190866  PMID:27752006
Organ transplantation is recognized worldwide as an effective treatment for organ failure. However, due to the increase in the number of patients requiring a transplant, a shortage of suitable organs for transplantation has become a global problem. Human organ trade is an illegal practice of buying or selling organs and is universally sentenced. The aim of this study was to search social network for organ trade and offerings in Saudi Arabia. The study was conducted from June 22, 2015 to February 19, 2016. The search was conducted on Twitter, Google answers, and Facebook using the following terms: kidney for sale, kidneys for sale, liver for sale, kidney wanted, liver wanted, kidney donor, and liver donor. We found a total of 557 adverts on organ trade, 165 (30%) from donors or sellers, and 392 (70%) from recipients or buyers. On Twitter, we found 472 (85%) adverts, on Google answers 61 (11%), and on Facebook 24 (4%). Organ trade is a global problem, and yet it is increasingly seen in many countries. Although the Saudi Center for Organ Transplantation by-laws specifically prohibits and monitors any form of commercial transplantation, it is still essential to enforce guidelines for medical professionals to detect and prevent such criminal acts.
  5,242 488 -
Systemic immunologic and inflammatory response after transperitoneal versus retroperitoneal laparoscopic donor nephrectomy: A prospective observational study
Debojit Gogoi, Dilip Kumar Pal, Malay K Bera
September-October 2016, 27(5):985-991
DOI:10.4103/1319-2442.190868  PMID:27752008
Laparoscopic donor nephrectomy (LDN) can be performed via either transperitoneal or retroperitoneal approach. Very few studies have been carried out till now, comparing immunologic and inflammatory responses in donors after these two approaches. This is a prospective observational study. Selection of approach was decided by the operating surgeon. All patients underwent peripheral venous blood sampling preoperatively and 24 h postoperatively for the measurement of C-reactive protein (CRP), interleukein-6 (IL-6), total leukocyte count (TLC), blood urea nitrogen (BUN), and serum creatinine (SCr). Operative time, warm ischemia time, hospital stay, requirement of analgesia, and complications were also recorded. From February 2013 to January 2015, we performed 54 LDNs (38 transperitoneal and 16 retroperitoneal). There were 49 females and five males. Mean operative time was not significantly different in these two approaches, but warm ischemia time was significantly less in the retroperitoneal laparoscopic donor nephrectomy (RLN) group. Postoperative inflammatory markers' (IL-6, CRP, and TLC) levels, BUN, and SCr rise in both of these approaches, but there was no significant difference observed between these two approaches. RLN is a safe and effective approach to preserve a longer right renal vein. It combines the benefit of both hand assistance and retroperitoneal approach. Warm ischemic time is significantly less in RLN group.
  4,277 276 -
Total parathyroidectomy in patients with chronic kidney disease: Avoiding repeat surgery
Thomas Hanna, Jacob A Akoh
September-October 2016, 27(5):950-957
DOI:10.4103/1319-2442.190858  PMID:27752003
Renal hyperparathyroidism (RHPT) is a common complication of renal failure and it is associated with significant morbidity and mortality. The aim of this study was to determine the patient characteristics which might predict persistent or recurrent hyperparathyroidism after surgery and to assess the long-term effect of unsuccessful surgery. This is a retrospective study of all chronic kidney disease patients who required a total parathyroidectomy (TP) because of failed medical management from January 1999 to December 2014. Patient characteristics, preoperative imaging, operative findings, and patient outcome were all studied. Differences between groups (dialysis-dependent and nondialysis-dependent; preoperative imaging and no imaging) were tested by the Chi-square statistic test and P <0.05 was regarded statistically significant. Eighty-eight patients underwent TP during this period and were followed up for a median of 35.5 months (range 1-119 months). Seventy (80%) had removal of all parathyroid glands with associated fall in parathyroid hormone level. There were no statistically significant differences in surgical success rates in neither the dialysis-dependent versus nondialysis-dependent groups nor the preoperative imaging versus no imaging groups. Two patients underwent repeat parathyroid surgery for persistent hyperparathyroidism and 16 were followed up without surgery. Preoperative imaging did not direct surgical management nor reduce surgical failure rate in this series. The long-term effects of pharmaceutical developments in this area are unknown but are likely to change indications for initial parathyroidectomy and reoperation. An agreed protocol is essential for the management of patients with RHPT.
  3,328 417 -
Prevalence and presentation of tuberculosis among hemodialysis patients in Khartoum, Sudan
Amin S. I. Banaga, Nihad K Siddiq, Randa T Alsayed, Rasha Babiker, Khalifa Elmusharaf
September-October 2016, 27(5):992-996
DOI:10.4103/1319-2442.190873  PMID:27752009
Tuberculosis (TB) is a major health problem in the developing countries. There are limited data about the prevalence of TB patients on maintenance hemodialysis (HD) in Sudan. The aim of this study is to identify the prevalence and presentation of TB among Sudanese maintenance HD patients. This is a hospital-based descriptive study. The participants of the study are all HD patients distributed in 13 HD centers in Khartoum and Khartoum North Provinces in Sudan. All patients attended the HD centers from November 1, 2014 to February 1, 2015, were interviewed by a questionnaire focused on personal and clinical data. Those who were diagnosed as having active TB were studied regarding their clinical presentation, presence of comorbidities, site of TB, and methods used on diagnosis. The total number of HD patients during the study period was 1328 patients. We found 19 patients who already diagnosed and treated for TB infection. The prevalence rate of TB among HD patients is 1.4%. The mean age of patient was 44.53±8.69 years, 89.5% of them were males. The majority of them have comorbidities: 31.6%% have hypertension and 21.1% have diabetes. Extrapulmonary TB was the major presentation (57.9%) mainly tuberculous lymphadenitis (26.3%). The pulmonary presentation was found to be 42.1%. The diagnosis of TB was supported by microbiological evidence of alcohol acid-fast Bacilli present in sputum smear (21%), histological diagnosis (31.6%), polymerase chain reaction (21%), and imaging in (26.3%). Patients on maintenance HD are at an increased risk of TB and diagnosis of TB among HD patients need a high index of suspicion. There is a great need for establishing a screening scheme for TB among HD patients and further epidemiological studies are needed to fully evaluate this problem.
  3,310 410 -
Severe metastatic calcifications in a hemodialysis patient
Jannet Labidi, Yosra Ben Ariba, Abdelkader Ben Gabsia, Faida Ajili, Riadh Battikh, Bassem Louzir, Nadia Ben Abdelhafidh, Saleh I Othman
September-October 2016, 27(5):1037-1042
DOI:10.4103/1319-2442.190884  PMID:27752018
Tissue calcification is a common complication in patients on continuous hemodialysis (HD) for chronic renal failure; however, severe calcification is unusual. Three distinct clinical types of extraosseous calcifications are found in uremic patients: vascular calcification, periarticular (tumoral) calcification, and visceral calcification (heart, lung, and kidney). We report a case of a young chronic HD patient who presented with extensive metastatic calcifi cations both vascular, visceral specially localized in the lungs, and periarticular with progressively increasing multiple subcutaneous swellings. This evolution was secondary to noncompliance of the patient to the treatment of a malignant hyperparathyroidism with a marked elevation of phosphocalcium product.
  3,333 384 -
Prevalence of hypovitaminosis D and the different-dose cholecalciferol supplementation effects on renal transplant recipients
Sergio Mazzola Poli de Figueiredo, Andrea Olivares Magalhães, Patrícia Malafronte, José Ferraz de Souza, Yvoty Alves Santos Sens
September-October 2016, 27(5):929-935
DOI:10.4103/1319-2442.190839  PMID:27752000
High prevalence of hypovitaminosis D has been observed in patients with chronic kidney disease. However, there is not much data about its prevalence in kidney transplant recipients (KTRs). The study included 83 adult KTRs at a single center to calculate the prevalence of hypovitaminosis D. Among the 83 patients, those with incomplete data were excluded leaving 22 patients available for study. The demographic and biochemical data were analyzed retrospectively. Serum concentrations of 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), phosphorus, calcium, and creatinine were evaluated. The 22 selected patients were divided into two groups: (1) those who received 10,000 IU of cholecalciferol orally per week, and (2) those who received 10,000-20,000 IU/week. The Vitamin D level rate was calculated to evaluate the time necessary to reach serum values ≥30 ng/mL. Hypovitaminosis D was present in 80.7% (67/83) of the patients. Eleven patients received 10,000 IU/week of cholecalciferol, and the other 11 patients received 10,000-20,000 IU/week (approximately 64,000 IU/month). The calcium, phosphorus, and PTH values did not show any differences between the two groups. We estimate that a dose of approximately 64,000 IU/month of cholecalciferol was sufficient to reach values of ≥30 ng/mL of 25(OH)D in approximately 2.1 months in the insufficient and 4.3 months in Vitamin D-deficient patients. The prevalence of hypovitaminosis D was high among Brazilian KTR, and low-level doses of cholecalciferol (approximately 64,000 IU/month) were sufficient to control hypovitaminosis D.
  3,268 352 -
Prevalence of proteinuria in school children (aged 12-14 years) in Kashmir valley, India, using dipstick method
Hilal Ahmad Malla, Ashraf M Bhat, Bashir Shazia, Fayaz A Rather, Saleem M Najar, Imtiyaz A Wani
September-October 2016, 27(5):1006-1010
DOI:10.4103/1319-2442.190877  PMID:27752011
Screening for kidney diseases by urinalysis in school children is being conducted in many parts of the world with inexpensive tools such as urinary dipsticks. We conducted this study to know the prevalence of asymptomatic proteinuria in school children (age group 12-14 years) in Kashmir valley as no previous study is available. After applying exclusion criteria, 2068 children were screened for proteinuria by dipstick method. Another test was performed in the children with abnormal findings in the first sample with dipstick of the same brand, after a period of one-month. These children were also assessed by timed urine collection (i.e., 24 h urinary protein). In the first dipstick test, the prevalence of proteinuria in the studied population was 6.2% which persisted in 2.17% after second dipstick examination. No child in the studied group was found to have glycosuria. In our study, no statistically significant association was found between proteinuria and gender, body mass index, or hypertension. In our study, the prevalence of persistent proteinuria in school children (age group 12-14 years) in Kashmir valley was almost similar to the studies conducted in different parts of the world.
  3,255 329 -
The triad of kidney, obesity, and bariatric surgery
Talha H Imam, Karen J Coleman
September-October 2016, 27(5):875-884
DOI:10.4103/1319-2442.190772  PMID:27751993
There is an epidemic of obesity in the USA. Obesity significantly increases the risk of developing chronic kidney disease. Multiple studies have shown overall health and mortalityrelated benefits of medical and surgical weight loss. Renal benefits of bariatric surgery include decrease in proteinuria and hyperfiltration. There have only been a few small studies in patients with abnormally low glomerular filtration rate (GFR) that have shown improvements in GFR postsurgery over a short term. Long-term and larger scale studies are needed to see if renal benefits of weight loss are sustained in post-bariatric surgery patients.
  2,723 621 -
Pathophysiology of central sleep apnea in chronic kidney disease
Gaurav Nigam, Muhammad Riaz
September-October 2016, 27(5):1068-1070
DOI:10.4103/1319-2442.190907  PMID:27752026
  2,676 355 -
Risk factors for chronic kidney disease in Urban Uyo, South-South, Nigeria
Effiong Ekong Akpan, Udeme Ekpenyong Ekrikpo, Aniema Isaac Assam Udo
September-October 2016, 27(5):1011-1017
DOI:10.4103/1319-2442.190878  PMID:27752012
The prevalence of chronic kidney disease (CKD) is increasing the world over, and it is now regarded as a public health problem. The prevalence of CKD in Nigeria remained largely unknown with hospital-based data of 2-8%. However, emerging community studies show a prevalence of 10-26.8%. This study was conducted during the 2013 world kidney day activities in Uyo, Akwa Ibom, State of Nigeria, with an estimated population of 554,906 people. Sensitizations of members of the public were ensured through the media. Trained nurses of the dialysis unit were recruited for the exercise. A well-structured questionnaire was used to collect demographic data and medical history. Subjects also had measurements of their blood pressure, random blood sugar, urinalysis, serum creatinine, and anthropometric data. Five hundred and two adults (70.6% females and 29.4% males) aged 18-78 years participated in the study. A family history of CKD was found in 4.3% of the study participants. The risk factors for CKD investigated in this population included hypertension, diabetes mellitus, obesity, proteinuria, and hematuria. The prevalence of hypertension in this sample was 30.16% [95% confidence interval (CI) 26.14-34.18%]. Only 12.58% (95% CI 9.54-15.61%) were aware of their hypertension status. There was an increasing trend in the proportion of individuals with hypertension in each higher 10 years age group (P = 0.03). The independent predictors of hypertension in this cohort were age and body mass index. The proportion of those with diabetes mellitus in the study population was 5.8% (95% CI 3.7-7.8%). Obesity was found in 31.8% individuals' proteinuria in 23.5% and hematuria in 3.0%. There is a high prevalence of risk factors for CKD in our population. Therefore, screening for early detection should be encouraged.
  2,596 377 -
Delayed clearance of hepatitis B surface antigen and development of hepatitis B surface antibody in a chronic hemodialysis patient
Richard Treger, Ramy M Hanna, Brian M Lee, Eduardo A Lopez, James Wilson, Dalila Corry
September-October 2016, 27(5):1047-1051
DOI:10.4103/1319-2442.190886  PMID:27752020
The introduction of hepatitis B vaccination and infection control in 1977 has greatly decreased the prevalence of hepatitis B. Currently, approximately 2.8% of the end-stage renal disease population is hepatitis B positive with a presence in 27.7% of the USA hemodialysis (HD) units according to the Dialysis Outcomes and Practice Patterns Study data. The behavior of hepatitis B infection differs significantly between immunocompetent and immunosuppressed hosts. Immunosuppressed hosts present more subtly with complications of chronic hepatitis B infection, being more challenging to detect. It is also well known that patients with chronic infection on HD have a small chance of clearing the virus. We report here a case of a hepatitis B positive HD patient who underwent spontaneous delayed serological clearance of hepatitis B surface antigen and development of immunity via appearance of hepatitis B surface antibody. This is a rare occurrence, and the few similar reported cases will be discussed.
  2,677 277 -
Green urine and extrapyramidal symptoms
K Jayasree, B Sangeetha, V Chaitanya, BV Subramanyam, R Ram, V Siva Kumar
September-October 2016, 27(5):1055-1056
DOI:10.4103/1319-2442.190888  PMID:27752022
  2,618 263 -
Cyclosporine therapy in steroid-dependent or steroid-resistant idiopathic focal and segmental glomerulosclerosis
Imen Gorsane, I Helal, I Yacoub, F Ben Hamida, E Abderrahim, T Ben Abdallah
September-October 2016, 27(5):958-965
DOI:10.4103/1319-2442.190864  PMID:27752004
Focal and segmental glomerulosclerosis (FSGS) is a heterogeneous entity. Previous few studies have evaluated the efficacy of calcineurin inhibitors in primary FSGS and have suggested positive benefit. In this single-center, retrospective study (1975-2014), we report our experience in Tunisian adults with primary FSGS treated with cyclosporine A (CsA). It includes patients histologically proven FSGS and managed in the Charles Nicolle Hospital at Tunis, Tunisia. The dose of CsA was adjusted to maintain a whole blood trough level of 80-150 ng/mL. The observation period was 6.8 ± 3.7 years after CsA treatment. Twenty-three patients with idiopathic FSGS, treated with CsA, were studied. The mean age was 26.69 ± 10.1 years, and the sex ratio was 2.83. Eight patients (35%) had a steroid-dependent nephrotic syndrome (NS), and 15 patients (65%) had for steroid-resistant NS. After a median follow-up of 16.5 months on CsA, we noticed complete remission of the NS in eight cases (35%) after 12.12 ± 8 months, partial remission in five (22%) after 3 ± 0.7 months, dose-dependent remission to CsA (2.87 mg/kg/day) in four (17%), and a no response in six patients (26%). Eleven patients (48%) showed improvement of renal function, while eight (35%) developed end-stage renal disease (ESRD) after 35.7 ± 20.9 months. Predictive factors of progression to ESRD were creatinine clearance <90 mL/min before introduction of CsA (P = 0.0054) and CsA-resistance (P = 0.053). Our study suggests that CsA is effective in the treatment of patients with idiopathic FSGS. Initial renal function and cyclosporineresistance are the predictive factors of ESRD in steroid-resistant or -dependent FSGS.
  2,402 380 -
Relationship between anemia, quality of life, and laboratory indices in hemodialysis patients
Mahdi Sadeghi, Hossein Ebrahimi, Mohammad Abbasi, Reza Norouzadeh
September-October 2016, 27(5):1063-1067
DOI:10.4103/1319-2442.190905  PMID:27752025
  2,327 387 -
Chemerin: A biomarker for cardiovascular disease in diabetic chronic kidney disease patients
Farag E Salama, Qasem A Anass, Abdelnaem A Abdelrahman, Elsayed B Saeed
September-October 2016, 27(5):977-984
DOI:10.4103/1319-2442.190867  PMID:27752007
Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). The carotid intima-media thickness (CIMT) and arterial stiffness are useful markers of subclinical atherosclerosis and significantly correlate with various metabolic risk factors. Chemerin is one of the adipokines that may represent a link between obesity and inflammation and may be a potential candidate playing a role in the pathogenesis of atherosclerosis and cardiovascular complications. Therefore, we studied the relationship of chemerin levels with atherosclerosis as measured by CIMT in diabetic CKD patients, either predialysis or on hemodialysis (HD). In addition, we studied its correlation with other cardiovascular risk factors such as interleukin-6 (IL-6) and insulin resistance (IR). Fifty-eight patients were enrolled in the study; 23 patients with CKD (11 are diabetic) on conservative treatment and 35 (18 are diabetic) on maintenance HD. Serum concentrations of chemerin and IL-6 were determined by ELISA. All participants underwent measurements of CIMT by highresolution ultrasonography. A stepwise increase in serum chemerin levels was found depending on the glomerular filtration rate: 286.6 ± 10.02 ng/mL in the control group, 332.1 ± 21.54 ng/mL in the predialysis group, and 355.7 ± 20 ng/mL in the HD group. A significant rise of serum chemerin level was observed in diabetic CKD patients either on conservative therapy or on HD when compared with nondiabetic CKD patients. Moreover, there was a significant difference in serum levels of chemerin, IL-6, CIMT, serum insulin, and homeostasis model assessment of IR (HOMA-IR) between diabetic and nondiabetic patients in both groups. Chemerin showed a significant positive correlation with HOMA-IR, serum insulin, and C-reactive protein. In conclusion, serum chemerin level was found to be an independent predictive marker of the presence of atherosclerosis in patients with CKD either on conservative treatment or on HD.
  2,269 435 -
A study of the main determinants of sexual dysfunction in women aged 15-45 years on chronic hemodialysis
Reza Hekmat, Faeze Maghsudloo, Mahmood Mohebi, Sayed Abdolrahim Rezaee, Rosita Vakili, Hoshang Rafat Panah
September-October 2016, 27(5):916-920
DOI:10.4103/1319-2442.190816  PMID:27751998
Sexual dysfunction (SD) is a common problem in patients with the end-stage renal disease. In contrast to SD in males, relatively little work has been performed in the field of SD in females. In this study, we tried to identify the main determinants of SD in women aged 15-45year-old on chronic hemodialysis (HD). One hundred-forty female patients aged 15-45-year-old on chronic HD were studied in the winter of the year 2013. Healthy relatives of the patients were chosen as controls and matched for age, level of education, marital status, and income. Both cases and controls were interviewed by the same female interviewer. The Arizona Sexual Experiences Scale (ASEX) was used as a questionnaire. A significant correlation was found between the total ASEX score and age and duration on HD (r = 0.599, P = 0.003 and r = 0.434, P = 0.043, respectively). No correlation was found between serum hemoglobin, parathormone, creatinine, iron, calcium, phosphorus, and urea reduction ratio and the ASEX score. Moreover, the correlation between the ASEX score and socioeconomic parameters like level of education and monthly income was not significant (all P >0.1). There was a significant difference in the total ASEX score between cases and controls (16.31 ± 2.50 vs. 9.80 ± 4.21, P <0.001). Our study suggests that sexual function in chronic hemodialyzed female patients is mainly impacted by age and duration on HD.
  2,353 313 -
A clinicopathologic study of glomerular disease: A single-center, five-year retrospective study from Northwest India
Pankaj Beniwal, Lalit Pursnani, Sanjeev Sharma, RK Garsa, Mohit Mathur, Prasad Dharmendra, Vinay Malhotra, Dhanajai Agarwal
September-October 2016, 27(5):997-1005
DOI:10.4103/1319-2442.190876  PMID:27752010
Studies published from centers across India have reported different and contradicting patterns of glomerular disease. In this retrospective study, we report our experience from a Tertiary Care Center in Northwest India. A total of 702 renal biopsies performed between 2008 and 2013 were reviewed of which 80 were excluded from the study because of having insufficient records or if the biopsies were taken from an allograft. The study included 411 males (66.1 %) and 211 females (33.9%) with an age range of 12-70 years (mean 30.34 ± 7.04 years). Majority of the biopsies (93.9%) showed some form of glomerulonephritis (GN), either primary (79.4%) or secondary glomerular disease (SGD) (14.5%). Minimal change disease (MCD) was the most common type of primary GN (26.5% of primary GN), followed by membranous nephropathy (MN; 18.8%) and focal and segmental glomerulosclerosis (FSGS; 13.2%). Lupus nephritis (LN) was the most frequent SGD (52.2% of secondary GN). Amyloidosis was found in 41.1% and diabetic glomerulosclerosis in 4.4%. LN was also the second most common diagnosis in females after MCD, seen in 19.4% of females. MCD followed by membranoproliferative GN and diffuse proliferative GN were the most common entities in individuals <20 years of age. In the 20-39 years age group, MN was the most common pathology seen. MN was again the most common pathology seen in patients aged above 40 years followed by amyloidosis and FSGS. In this study, MCD was the most common primary GN observed overall from this part of India. MN was the most common GN in individuals above 20 years of age presenting with the nephrotic syndrome. The geographical and regional differences in the pattern of GNs point to the necessity of having a central biopsy registry.
  2,239 418 -
Triple confusion: An interesting case of proteinuria in pregnancy
Pramod K Guru, Devon M Ramaeker, Arundhathi Jeybalan, Nirav A Shah, Sheldon Bastacky, Kelly V Liang
September-October 2016, 27(5):1029-1032
DOI:10.4103/1319-2442.190882  PMID:27752016
Pregnancy-related renal diseases are unique and need special attention, both for diagnosis and management. The major confounding factors for diagnosis are the physiological multiorgan changes that occur throughout the gestational period. Proper diagnosis of the renal disease is also important, given the impact of varied management options both on the maternal and fetal health. A young middle-aged female with a long-standing history of diabetes presented to the hospital with worsening proteinuria in her second trimester of pregnancy. Clinical history, examinations, and laboratory analysis did not give any clues for diagnosis of a specific disease entity. This led us to take the risk of renal biopsy for a tissue diagnosis. The odds of renal biopsy favored the management decision in her case, thereby avoiding the confusions prior to biopsy. The pathological diagnosis is a surprise though not a unique entity on its own (minimal change disease in pregnancy). The case illustrates the disparity of clinical presentations and the pathology in patients, and the importance of renal biopsy in pregnant patients in particular.
  2,315 295 -
Emergency ligation of external iliac artery for control of bleeding following allograft nephrectomy
Afshar Zomorrodi, Shakeri Abolhassan, Abbas Jabbari, Sahar Zomorrodi, Monazzah Farzin Sheikh
September-October 2016, 27(5):1043-1046
DOI:10.4103/1319-2442.190885  PMID:27752019
Renal transplantation is the best treatment for end-stage renal disease. Vascular complications of renal transplantation can be hazardous. Bleeding from the anastomotic site in external iliac artery is a nightmare for kidney transplant surgeons. Ligation of the external iliac artery might possibly lead to the loss of the lower limbs. We present two cases of postallograft nephrectomy bleeding, in which the external iliac artery was ligated without consequent ischemia.
  2,370 208 -
Orientation of university students about brain-death and organ donation: A cross-sectional study
Ali A Al Bshabshe, Javed Iqbal Wani, Imran Rangreze, Mohammed Ali M Asiry, Haitham Mansour, Alhassan Gaba'n Ahmed, Jabber Madi Assiri
September-October 2016, 27(5):966-970
DOI:10.4103/1319-2442.190865  PMID:27752005
The gap between demand and supply of organs continues. No country has found a concrete solution for tackling this problem. We attempted to evaluate the general information and attitude of university students in their primary basic science stage, when they did not receive special education regarding brain death and organ donation in Saudi Arabia. Since they were from different cities with different cultures and values, we believe that we could assess the educational needs of future doctors and paramedical staff, to help them gain enough competence for solving the concerns of the population at large. The present study is a secondary analysis of a survey conducted at the King Khalid University, Abha, Saudi Arabia, from March to May 2014, about the knowledge of and attitudes toward brain death, organ donation, and transplantation in a sample of university students. A total of 873 university students participated in the survey and 93% from the cohort had heard about brain death. Eighty-five percent got their information about brain death from the media. Seventy-three percent of the cohort had the impression that there is no difference between brain death and natural death. An organized educational program about all aspects of organ donation, particularly from deceased donors, seems necessary in the curriculum, which can be started at an early level and built up gradually to impart a gradual comprehensive knowledge on beliefs and practices about brain death, organ donation, and transplantation. The Saudi Center for Organ Transplantation in collaboration with other regional societies and regional professional organizations has to work together to achieve this long-term goal to save the precious lives of people, awaiting transplantation.
  2,200 367 -
VKORC1 gene (vitamin K epoxide reductase) polymorphisms are associated with cardiovascular disease in chronic kidney disease patients on hemodialysis
Noha A Osman, Nevine El-Abd, Mohamed Nasrallah
September-October 2016, 27(5):908-915
DOI:10.4103/1319-2442.190782  PMID:27751997
Vitamin K is necessary for the carboxylation of clotting factors and matrix Gla protein (MGP). Vitamin K epoxide reductase (VKOR) is the enzyme responsible for recirculation of Vitamin K increasing its tissue availability. Polymorphisms of VKOR may alter the function of MGP, thereby influencing vascular calcification. We conducted this study to investigate the relationship of VKORC1 gene single nucleotide polymorphisms (SNP's) to vascular calcification and clinically overt cardiovascular disease in chronic kidney disease (CKD) patients on hemodialysis (HD). The study included 54 CKD patients on HD. We excluded those with diabetes or on anticoagulant therapy. Vascular calcifications were measured using computerized tomography scans and roentgenograms. Prevalent clinically overt cardiovascular disease was reported based on the evidence of documented preexisting major cardiovascular events. Genotype detection for the gene VKORC1 C1173T and G-1639A polymorphisms was carried out by polymerase chain reaction. We found a significant association between C1173T polymorphisms and vascular calcification (odds ratio [OR] = 43, P = 0.001). The mutant T allele was also linked with higher odds of vascular calcification (OR = 8.880, 95% confidence interval [CI] = 3.1-25.4, P = 0.001) and clinically overt cardiovascular disease (OR = 4.7, 95% CI = 1.5-14.7, P = 0.005). VKORC1 G-1639A polymorphisms were not associated with vascular calcification and had lower prevalence of clinically overt cardiovascular disease (OR = 0.07, 95% CI = 0.01-0.4, P = 0.001). In patients with CKD on HD, we found that VKORC1 gene polymorphisms did have an association with prevalent cardiovascular calcification and clinically overt cardiovascular disease, C1173T polymorphisms with higher risk for disease, and G-1639A with lower risk.
  2,176 352 -
Hypertension in hemodialyzed children
Shatha Hussain Ali, Salman Hussain Assi, Fadhil S Hussien
September-October 2016, 27(5):942-949
DOI:10.4103/1319-2442.190849  PMID:27752002
Hypertension (HTN) is one of the most common sequelae of chronic kidney disease (CKD) in children. Dialysis-related HTN is predominantly caused by chronic volume overload, and as such the blood pressure (BP) can be reduced and/or brought down to normal in a sizable number of patients with improved salt and fluid balance. This study was conducted to assess the prevalence of HTN among children on hemodialysis (HD) and to evaluate the correlation of HTN with some demographic data. This is a prospective study performed on forty pediatric patients with CKD receiving maintenance HD in three centers in Baghdad. HTN was defined as BP ≥95 th percentile for age, height, and sex or use of antihypertensive medications. HTN was recorded in 27 patients on HD (67.5%), while the BP was normal in the other 13 patients (32.5%). There was no significant correlation between HTN and gender, age, or etiology of CKD. Duration of the HD session, number of sessions per week, total duration on HD, and blood flow rate also had no statistical correlation with HTN. Only serum albumin showed a significant correlation with BP.
  2,200 284 -
Fractional excretion of magnesium, a marker of aminoglycoside induced nephrotoxicity in neonates
Sheikh Farjana Sonia, Mohammad S Hassan, Ferdous Ara, Mohammed Hanif
September-October 2016, 27(5):902-907
DOI:10.4103/1319-2442.190781  PMID:27751996
Aminoglycoside is a widely used antibiotic in neonatal age group at hospital setting in Bangladesh. It has underlying side effect and toxicity which is mostly unseen and ignored. The aim of the study was to evaluate the nephrotoxic effect of aminoglycoside in neonates. This study was conducted in fifty hospital admitted neonates of Dhaka Shishu Hospital from January 2012 to December 2013. Serum creatinine, blood urea nitrogen, and fractional excretion of magnesium (FEMg) were measured before starting and after seven days of aminoglycoside treatment. Statistical analyses of the results were obtained by window-based computer software devised with Statistical Packages for Social Sciences (SPSS version 16). Statistical tests for significance of difference were done using Student's paired t-test. Serum creatinine and blood urea nitrogen were not significantly changed after drug administration (P = 0.092, P = 0.247, respectively). None of the neonates in our study group had abnormal serum creatinine and blood urea nitrogen after aminoglycoside therapy. FEMg was significantly increased (P <0.001) after aminoglycoside treatment. In this study, conventional renal function test such as blood urea and serum creatinine did not reflect the nephrotoxicity of aminoglycoside. However, a biomarker of tubular damage, FEMg detected nephrotoxicity of aminoglycoside therapy.
  2,201 270 -
Renal transplantation: Assessment of "at risk" diabetic foot and recommendations for mitigation
OP Prajapati, AK Verma, RK Sharma, M Sabaretnam
September-October 2016, 27(5):893-901
DOI:10.4103/1319-2442.190780  PMID:27751995
We conducted a prospective study (between November 2013 and January 2015) to identify "foot at risk" in the diabetic renal transplant patients at a Tertiary Care Hospital in India. Patients (151) were divided into three groups: diabetic transplant recipients (n = 42), new onset diabetes after transplantation (NODAT) (n = 59), and controls (nondiabetic renal transplant recipients) (n = 50). Foot neuropathy and vasculopathy were assessed by standard methods. Patients with "at risk" feet were given foot care advice. Of the 151 patients, 144 patients were male and seven were female with a male:female ratio of 20:1. Peripheral neuropathy was present among 42.9% of diabetic transplant patients, 35.6% of NODAT patients, and 12% of control patients. Vasculopathy was present in 28.6% of diabetic transplant patients, 23.7% of NODAT patients, and 2% of control patients. On multivariate analysis, patient's age, mean time interval since transplantation, and HbA1c levels were significantly associated with neuropathy, whereas the duration of diabetes and vibration perception threshold was associated with vasculopathy. After undergoing renal transplantation, a significant number of diabetic and NODAT patients has their "feet at risk" who in future may develop full-blown lesions of the diabetic foot. Proper advice to patients and information to the treating doctor helps to mitigate the risk.
  2,146 310 -
Posterior reversible encephalopathy syndrome in a 5-year-old boy with steroid-dependent nephrotic syndrome
Md. Habibur Rahman, Md. Abdul Qader, Syed Saimul Haque, Md. Abdullah Al Mamun, Golam Muin Uddin
September-October 2016, 27(5):1021-1025
DOI:10.4103/1319-2442.190880  PMID:27752014
Posterior reversible encephalopathy syndrome (PRES) is a rare clinical and radiological phenomenon is encountered in children compared to adults. In our center, a 5-yearold boy with steroid-dependent nephrotic syndrome (SDNS) presented with headache and blurring of vision during relapse after a long course of immunosuppressive therapy. Evaluation by computed tomography scan of the brain showed that the child had hypodense areas throughout the occipital region of the brain. All signs of PRES, except papilledema, resolved after seven days of supportive treatment evidenced by subsequent radiological evaluation. PRES should be kept in mind in any nephrotic child who is on prolonged immunosuppressive therapy.
  2,117 299 -
Pathological interstitial vascular proliferation adjacent to glomeruli in immunoglobulin a nephropathy
Honami Mori, Shinichi Nishi, Mitsuhiro Ueno, Naofumi Imai, Susumu Ookawara, Yoshiyuki Mirishita, Ichiei Narita, Kaoru Tabei
September-October 2016, 27(5):885-892
DOI:10.4103/1319-2442.190779  PMID:27751994
We detected an increase in small arterioles around glomeruli, particularly adjacent to tuft adhesive lesions in immunoglobulin A nephropathy (IgAN), for the 1 st time, as far as we know. We labeled these as periglomerular microarterioles (PGMAs). This study aimed to clarify the pathological significance of PGMAs. Sixty-two patients with IgAN and 19 controls with minor glomerular abnormalities without proteinuria were evaluated in this study. The number of PGMAs located between the Bowman's capsule and the adjoining tubules was counted for each glomerulus. The mean number of PGMAs per glomerulus in cases of IgAN was significantly higher than those of the controls (0.530 ± 0.477 vs. 0.240 ± 0.182, P <0.05). Serial sections showed that most of the PGMAs were in contact with adjacent glomeruli (71.8%), through tuft adhesive lesions (52.1%), or the vascular pole (19.7%). By single regression analysis, the number of PGMAs was found to be positively correlated with the incidence of glomerular tuft adhesion, glomerular sclerosis, or the area of interstitial fibrosis in IgAN. By multiple regression analysis, the incidence of glomerular tuft adhesion was found to be the only independent pathological feature to correlate with the number of PGMAs (P = 0.0006). We have noticed the existence of PGMAs around glomeruli as a pathological finding of IgAN. Furthermore, the number of PGMAs was associated with the incidence of tuft adhesive lesion in glomeruli of IgAN although there was no relationship between the presence of PGMAs and clinical parameters including urinary protein excretion or creatinine clearance in the present study.
  1,937 326 -
Acute kidney injury in Hemiscorpius lepturus scorpion stung children: Risk factors and clinical features
Ehsan Valavi, Parisa Amuri, Ali Ahmadzadeh, Bahman Cheraghian, Ehsan Ahankoob
September-October 2016, 27(5):936-941
DOI:10.4103/1319-2442.190841  PMID:27752001
Acute kidney injury (AKI) is frequently seen in Hemiscorpius lepturus scorpion stung children. We have previously reported several victims with hemolytic uremic syndrome (HUS) and a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 deficiency. Hence, we conducted this study to identify predictive factors and clinical features of AKI in H. lepturus scorpion stung patients. We included all 215 H. lepturus scorpion stung children with no previous renal diseases in two groups (with and without AKI) and compared them based on their clinical and laboratory findings. AKI was found in 27.4% of patients, they were significantly younger and with lower body weight (P = 0.006, P = 0.011, respectively). There was a significant difference between groups with and without AKI in findings such as fever (P = 0.003), hypertension (P <0.001), hemolytic anemia (P <0.001), thrombocytopenia (P <0.001), massive proteinuria (P <0.001), hemoglobinuria (P <0.001), pyuria (P <0.001), and hematuria (P = 0.004). HUS was in 5.5% and disseminated intravascular coagulation in 14.6% which had a significant association with AKI (P <0.001).There were several independent predictors for AKI in a multivariate regression model including thrombocytopenia (P = 0.002), pyuria (P = 0.01), proteinuria (P =0.01), and fever (P = 0.02). Hemodialysis was performed in four patients but kidney function improved in all patients and there was no findings of renal impairment after three months follow-up. We found several predictors for AKI in children following H. lepturus scorpion sting including younger age, delay in receiving medical care, pigmenturia, microangiopathic hemolytic anemia, proteinuria, and pyuria.
  1,954 294 -
Transient distal renal tubular acidosis following hump nosed viper bite: Two cases from Sri Lanka
Ranga M Weerakkody, Pushpa N Lokuliyana, Ruchika D Lanerolle
September-October 2016, 27(5):1018-1020
DOI:10.4103/1319-2442.190879  PMID:27752013
Hump-nosed viper (Hypnale hypnale; HNV) is one of the six major snake species in Sri Lanka that cause envenomation. Nephrotoxicity, coagulopathy, and neurotoxicity are wellrecognized features of its envenomation. Type 4 renal tubular acidosis (RTA4) has only once been described previously in this condition, and we report two further cases. Two patients aged 53 and 51 presented following HNV bites with acute kidney injury and microangiopathic hemolytic anemia. Both underwent multiple cycles of hemodialysis until the polyuric phase was reached. Despite polyuria, both patients developed resistant hyperkalemia that needed further hemodialysis. The urinary pH, arterial pH, delta ratio, and transtubular potassium gradient confirmed RTA4. HNV venom has been shown to damage the proximal convoluted tubules in animal studies, but not the distal convoluted tubule, and hence the mechanism of our observation in these two patients is unclear. Unexplained hyperkalemia in recovery phase of HNV bite should raise suspicions of RTA4.
  1,826 239 -
An unusual complication of malposition of left internal jugular catheter in a patient with chronic kidney disease
Manjusha Yadla, Manjusha Jalli, Dasari Prasad Rao
September-October 2016, 27(5):1052-1054
DOI:10.4103/1319-2442.190887  PMID:27752021
  1,749 237 -
Primary hyperparathyroidism causing putty kidney with brown tumor located in the pubic ramus
Abdussamet Batur
September-October 2016, 27(5):1033-1036
DOI:10.4103/1319-2442.190883  PMID:27752017
Primary hyperparathyroidism (pHPT) is a condition caused by excessive and uncontrolled secretion of parathyroid hormone. The classical presenting symptoms in primary hyperparathyroidism are renal stones, hypercalcemic crisis, soft tissue calcifications, and cystic bone disease. Although most cases of pHPT are detected early and before symptomatic lesions appear, some patients may present late in the course of their disease. In this report, we present a patient with extensive parenchymal calcifications forming a cast of the right kidney which is called as "putty kidney" with Brown tumor located in the pubic ramus.
  1,709 236 -
Chronic renal allograft dysfunction in Egyptian population: Histopathological and immunohistochemical study
Wael M Hamza, Hanan H Ali, Samia M Gabal, Sawsan A Fadda
September-October 2016, 27(5):921-928
DOI:10.4103/1319-2442.190818  PMID:27751999
The chronic dysfunction stands as the most common cause of renal allograft loss. During the nineties of the past century, this condition was referred to as chronic allograft nephropathy (CAN). Since 2005, CAN has been assigned by the eighth Banff schema to four main categories via histopathological and immunohistochemical findings including chronic antibodymediated rejection (CAMR), chronic T-cell-mediated rejection (CTMR), chronic cyclosporine toxicity (CNITOX), and "interstitial fibrosis (IF)/tubular atrophy; not otherwise specified (NOS)" to eliminate the term CAN. We conducted a retrospective study of renal allograft cases with biopsy-proven chronic damage diagnosed at our nephropathology units, between January 2007 and September 2013, to assign them to the defined categories. Differences between groups were tested using one-way analysis of variance. The frequencies of the diagnostic categories were as follow: CNITOX (43.1%), CAMR (27.5%), CTMR (17.6%), and NOS (11.8%). The serum creatinine level, time posttransplant, and global sclerosis frequency were insignificant among the categories. Nine categorized cases showed transplant glomerulopathy; five of them were seen in association with CAMR. There was a positive relationship between the number of interstitial CD8 + T cells and the degree of IF in CTMR cases. Two cases showed combined features of CAMR and CTMR. Protocol renal allograft biopsy starting 3 months after transplantation with proper monitoring and adjustment of the calcineurin inhibitors level may reduce the potential risk of chronic damage in renal allograft.
  1,615 227 -
Risk factors for chronic kidney disease among patients admitted to the medical wards in Conakry
ML Kaba, M Camara, M Béavogui, AO Bah, D Fousény, ML Kourouma, A Camara, A. A. S. Diallo, YI Touré
September-October 2016, 27(5):1073-1075
DOI:10.4103/1319-2442.190916  PMID:27752028
  1,564 203 -
Mucocutaneous and visceral leishmaniasis in renal transplant patient from nonendemic region
E Mahesh, P Rakesh Madhyastha, Vijay Varma, KC Gurudev
September-October 2016, 27(5):1059-1062
DOI:10.4103/1319-2442.190903  PMID:27752024
  1,506 201 -
Malaria vaccine: Good news for African nephrologists
Mohammed Asserraji, Merouane Belarbi, Nadir Zemraoui
September-October 2016, 27(5):1071-1072
DOI:10.4103/1319-2442.190909  PMID:27752027
  1,451 203 -
Beta-blockers control pulse rate during hemodialysis
Kiyonori Ito, Susumu Ookawara, Yuichiro Ueda, Kaoru Tabei
September-October 2016, 27(5):1057-1058
DOI:10.4103/1319-2442.190901  PMID:27752023
  1,451 186 -
Organ Donation and Transplantation in the Kingdom of Saudi Arabia 2015

September-October 2016, 27(5):1076-1081
  1,056 134 -
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