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Saudi Journal of Kidney Diseases and Transplantation
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   2016| November-December  | Volume 27 | Issue 6  
    Online since November 28, 2016

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Attitudes, knowledge, and willingness to donate organs among Indian nursing students
Vijayalakshmi Poreddi, BV Katyayani, Sailaxmi Gandhi, Rohini Thimmaiah, Suresh Badamath
November-December 2016, 27(6):1129-1138
DOI:10.4103/1319-2442.194595  PMID:27900957
Globally, there is an acute shortage of organs for transplantation. Health professionals play an important role in raising awareness, motivating, and subsequently increasing the organ donation rates. Research related to nursing students' attitudes toward organ donation is limited from India. We aimed to assess undergraduate nursing students' knowledge, attitudes, and willingness to donate organs. This was a cross-sectional descriptive study carried out among conveniently selected undergraduate nursing students (n = 271) using self-reported questionnaires. All the participants were aware of organ donation. A majority (n = 251, 94%) of them were unaware of organ donation law. The mean score indicates that 66.7% of the participants had adequate level of knowledge [mean ± standard deviation (SD), 7.34 ± 1.61] and 72.3% hold positive attitudes (mean ± SD, 83.9 ± 1.01) toward organ donation. Statistically significant correlation (r = 0.265, P <0.001) was observed between knowledge and attitudes of the participants toward organ donation. The findings suggest the need for revising the nursing curricula to prepare the future nurses' competent in encountering the issues related to organ donation and fostering.
  10,447 1,078 3
Effect of vitamin C supplementation on lipid profile, serum uric acid, and ascorbic acid in children on hemodialysis
Ghada Mohamed El Mashad, Hanan M ElSayed, Nahla A Nosair
November-December 2016, 27(6):1148-1154
DOI:10.4103/1319-2442.194602  PMID:27900959
Children with end-stage renal disease (ESRD) suffer from dyslipidemia and hyperuricemia that might play a causal role in the progression of cardiovascular disease (CVD). The aim of the study is to assess the effects of Vitamin C supplementation on uric acid, ascorbic acid, and serum lipid levels among children on hemodialysis (HD). This prospective study was conducted in the pediatric nephrology unit at Menoufia University Hospital. The study included a total of 60 children with ESRD on maintenance HD therapy. They were divided into two groups: Group I (supplemented group, n = 30) received intravenous Vitamin C supplementation and Group II (control, n = 30) received placebo (intravenous saline) for three months. The results are shown as a mean ± standard deviation. Statistical evaluation was performed by SPSS software (version 11.5) using paired t-test. After supplementation with Vitamin C, the serum Vitamin C and high-density lipoprotein levels increased significantly with a significant reduction in the levels of serum uric acid, cholesterol, low-density lipoproteins, and triglyceride at the end of the study period. No significant changes were observed in the control group. Vitamin C can serve as a useful urate lowering medicine in HD patients to avoid complications of hyperuricemia. Furthermore, it had favorable effects on the lipid profile. This improvement can be considered as a preventive strategy in the progression of CVD in HD patients. Vitamin C supplementation improves ascorbic acid deficiency in these patients.
  5,415 737 5
Renin-Angiotensin-Aldosterone system blockade in diabetic kidney disease: A critical and contrarian point of view
Mohamed E Elrggal, Shaaban M. S. Ahmed, Meguid El Nahas
November-December 2016, 27(6):1103-1113
DOI:10.4103/1319-2442.194583  PMID:27900954
Diabetes mellitus is the most common cause of end-stage renal disease (ESRD) worldwide. Diabetic kidney disease (DKD) is associated with high morbidity and cardiovascular mortality. A number of guidelines and recommendations have been issued over the years recommending the use of renin-angiotensin-aldosterone system (RAAS) blockade in the management of DKD. This critical analysis takes a contrarian view, based on a selection of key clinical trials in the field, to argue that albuminuria should not be considered a target for treatment but instead a surrogate marker of DKD progression. The review also challenges, through a careful and critical analysis of a number of key clinical trials, the dogma that RAAS blockade's benefits in DKD is beyond mere good blood pressure control. While selective and somewhat biased the authors make compelling arguments to shed serious doubt over the strength of the evidence upon which the current guidelines favoring the use of RAAS blockade in DKD are based.
  4,306 625 -
Basic description of the dialysis population of Kuwait: The 2015 data
Ali AlSahow, Anas AlYousef, Bassam AlHelal, Monther AlSharekh, Ayaman Marzouq
November-December 2016, 27(6):1207-1210
DOI:10.4103/1319-2442.194614  PMID:27900967
Kuwait has a small, relatively young population plagued with diabetes, hypertension, and obesity, making the risk of development and progression of chronic kidney disease (CKD) very high. The total dialysis population of Kuwait in 2015 was 1720. The Ministry of Health (MOH) has divided the country into six health regions. The total number of dialysis population has been increasing slowly from 1600 in 2013 to 1650 in 2014 to 1720 in 2015, with 4% increase from 2014 to 2015. We describe some salient features among the dialysis population in Kuwait.
  3,359 281 3
Diethylene glycol poisoning-induced acute kidney injury
Natarajan Gopalakrishnan, M Kamarajan, T Balasubramaniyan, Ramanathan Sakthirajan, Jeyachandran Dhanapriya, Thanigachalam Dineshkumar
November-December 2016, 27(6):1276-1279
DOI:10.4103/1319-2442.194692  PMID:27900981
  3,254 368 1
Clinical features and histological patterns of lupus nephritis in a single center of South India
Clement Wilfred Devadass, Vijaya Viswanath Mysorekar, Mahesh Eshwarappa, Lakshminarayanan Mekala, M Gireesh Siddaiah, K Gurudev Channabasappa
November-December 2016, 27(6):1224-1230
DOI:10.4103/1319-2442.194657  PMID:27900970
Renal involvement occurs in up to 60% of patients with systemic lupus erythematosus (SLE) and signifies a poor prognosis. The class of lupus nephritis (LN), determined on renal biopsy evaluation, guides the therapeutic management and has prognostic connotations. Our aim is to determine the clinicolaboratory features and histopathological patterns of LN at presentation in our local (South Indian) population. The study was conducted in a tertiary care hospital in South India between 2009 and 2014 on SLE patients with clinical evidence of LN. The renal biopsies were examined by light and immunofluorescence microscopy and were classified according to the International Society of Nephrology/Renal Pathology Society Classification of LN. A total of 46 patients were included, with age range of 12-60 years and a female to male ratio of 8.2:1. Arthritis, dermatological manifestations, and fever occurred, respectively, in 43.5%, 39.1%, and 30.4% of the cases. Class IV LN was present in 17 (37.1%), Class III LN in ten (21.7%), Class II LN in nine (19.5%), Class V LN in eight (17.4%), Class I LN in one (2.2%), and Class VI LN in one (2.2%) patients. Antinuclear antibody (ANA) and dsDNA positivity were present, respectively, in 82.6% and 65.2% of the patients. The most common pattern of LN was Class IV LN followed by Class III LN. Relatively higher proportions of ANA and anti-dsDNA positivity were present in proliferative LN, and there was a high frequency of arthritis at presentation in our LN patients.
  3,178 419 3
Initiation of darbepoetin for management of anemia in non-dialysis-dependent patients with chronic kidney disease
Fatma Al Raisi, Issa Al Salmi, Pramod Kamble, Muna Al Shehri, Faissal A. M. Shaheen
November-December 2016, 27(6):1182-1187
DOI:10.4103/1319-2442.194607  PMID:27900963
The anemia of chronic kidney disease (CKD) is a common comorbidity seen in kidney diseases. It is also associated with increased cardiovascular morbidity and mortality and diminished quality of life. Often, patients with CKD of different stages require erythropoiesis-stimulating agents (ESAs) to maintain their hemoglobin (Hb) within the target range. Darbepoetin alfa is a newer ESA with a longer half-life than recombinant human erythropoietin (EPO). The objective of this study is to assess the efficacy and safety profile of twice-monthly (Q2W) and once a month (1QM) darbepoetin alfa in CKD patients, not on dialysis. The secondary objective was to assess the appropriate dose conversion from EPO to darbepoetin. Patients with CKD not on dialysis, receiving darbepoetin alfa every other week, or once every month, and with stable Hb levels between 10 and 12 g/dL, were enrolled in this single-center, open-label, single-arm study. In this study, 36 patients (21 female, 15 male) were enrolled with a mean age of 46.4 ± 20.12 years. About 56% of the patients (n = 20) received darbepoetin alfa 40 μg Q2W for more than three months and 36% (n = 13) were on once-monthly doses, whereas the other 8% (n = 3) were on variable doses ranging from 20 to 60 μg every two weeks. More than 80% of the patients were converted from short-acting EPO to darbepoetin corresponding to a conversion ratio of 672.2 IU:1 μg (standard deviation = 488.5). Hb levels ≥10 g/dL were maintained in 77.78% of the patients. The safety profile of darbepoetin alfa in this study was recorded, and no significant adverse effects were noted. Our study suggests that darbepoetin alfa, administered in fixed small doses and frequency of Q2W or Q1M, maintained Hb levels ≥10 g/dL in patients with CKD, not on dialysis.
  2,980 542 -
New-onset diabetes after kidney transplantation: Incidence, risk factors, and outcomes
Hassan Aleid, Ahmad Alhuraiji, Abdullah Alqaraawi, Ammar Abdulbaki, Mai Altalhi, Mohamed Shoukri, Eldali Abdelmoneim, Tariq Ali
November-December 2016, 27(6):1155-1161
DOI:10.4103/1319-2442.194603  PMID:27900960
Many patients develop new-onset diabetes after kidney transplantation (NODAT). Its incidence and epidemiology are unknown in the Saudi population. We aimed to study the incidence, epidemiology, and outcomes of kidney transplant recipients who developed NODAT. This is a retrospective study of all adults who received kidney transplant between January 2003 and December 2009. NODAT was defined according to the criteria outlined in the 2003 International Consensus guidelines. A total of 500 patients were included in this study, 54% were male patients. One hundred thirty-six patients (27%) developed diabetes (NODAT group). In the univariate analysis, patients were older in the NODAT group (P <0.001), were of higher weight (P = 0.006), and had positive family history of diabetes (P = 0.002). Similarly, more patients in this group had impaired glucose tolerance before transplant (P = 0.01) and history of hepatitis C infection (P = 0.005). In the multivariate analysis, older age [odds ratio (OR) 1.06], family history of diabetes (OR 1.09), hepatitis C infection (OR 1.92), and impaired fasting glucose (OR 1.79) were significant risk factors for the development of NODAT. Mortality was 6% in the NODAT group and 0.5% in the non-diabetic group had died (P <0.001). Graft survival was not different between the groups (P = 0.35). In conclusion, there is a significant risk of developing diabetes after renal transplantation. Patients are at higher risk if they are older, have a family history of diabetes, pre-transplant impaired fasting/random glucose, and hepatitis C virus infection.
  2,655 498 5
Serum levels of N-terminal-pro B-type natriuretic peptide as a diagnostic marker for left ventricular dysfunction in children with end-stage renal disease on hemodialysis
Amr Mohamed Zoair, Maher Ahmed Abdel-Hafez, Wegdan Mawlana, Mohamed Abdel-Rahman Sweylam
November-December 2016, 27(6):1114-1122
DOI:10.4103/1319-2442.194593  PMID:27900955
The objective of this study was to determine the diagnostic cutoff value of N-terminal-pro B-type natriuretic peptide (NT-pro BNP) as a marker of left ventricular (LV) dysfunction in children with end-stage renal disease (ESRD) on regular hemodialysis (HD). The study was carried out on thirty children with ESRD on regular HD and thirty healthy controls. Echocardiographic studies were done, including a conventional mode for ejection fraction, fractional shortening, tissue Doppler imaging, and longitudinal global strain by speckle tracking. Serum levels of NT-pro BNP were measured in venous blood samples before and about 30 min after HD by ELISA. Volume status was assessed by calculating interdialytic weight gain %. There were significant higher serum NT-pro BNP levels before HD (mean: 702.3 ± 274.3 ng/L) compared to controls (mean: 365.55 ± 76.5 ng/L) (P <0.001) and these levels decreased significantly after the HD session (mean: 625.1 ± 117.69 ng/L) (P = 0.031). Echocardiographic studies showed a significant impairment of LV function of the patients compared to controls. Patients with LV dysfunction had significant higher serum concentrations of NT-pro BNP compared to patients without dysfunction both before (P = 0.003) and after dialysis (P <0.001). Receiver operating curve demonstrated better prediction of LV dysfunction by NT-pro BNP levels after HD compared to its levels before HD (area under the curve was 0.9 and 0.73, respectively). Using a cutoff value of 630 ng/L, serum NT-pro BNP levels after dialysis were a diagnostic predictor of LV dysfunction with a sensitivity of 86.6%, specificity of 93.3%, positive predictive value of 92.8%, and negative predictive value of 87.5%. Serum NT-pro BNP levels were strongly correlated with the parameters of LV dysfunction in children with ESRD on regular HD. A postdialysis cutoff value of 630 ng/L could serve as a biochemical marker of LV dysfunction in those children regardless of chronic fluid overload.
  2,742 352 5
Incidence of pediatric acute kidney injury in hospitalized patients
Mohd. Ashraf , Naveed Shahzad, Altaf Hussain, Shafat Ahmed Tak, Syed Tariq Ahmed Bukhari, Aliya Kachru
November-December 2016, 27(6):1188-1193
DOI:10.4103/1319-2442.194608  PMID:27900964
Pediatric acute kidney injury (pAKI) is a common complication associated with high mortality in children. The objective of this study was to determine the incidence of acute kidney injury (AKI) and mortality in hospitalized (critically ill and non-critically ill) patients. This was a retrospective study conducted during the period of June 1, 2013, to May 31, 2014, at the Postgraduate Department of Pediatrics, G. B. Pant Hospital, an Associated Hospital of Government Medical College, Srinagar, Jammu and Kashmir, India. All patients between the ages of one month and 18 years were included in the study, who had AKI. In general, out of 23,794 patients, 197 developed AKI (0.8%). On subgroup analysis, 2460 were critically ill and had Intensive Care Unit (ICU) admission among whom 99 developed AKI (4%), whereas 21,334 had general pediatric ward admissions and 98 developed AKI (0.5%). Infantile age group was the most commonly 91 (46.2%) affected. The common causes of AKI were renal in 73 (37%), neurologic in 38 (19%), septicemia in 35 (18%), and inborn errors of metabolism in 30 (15.2%). Out of 197 pAKI patients, 42 (21.3%) died and all of them were critically sick (ICU admissions). The incidence of pAKI in general was 0.8%, whereas it was 4% in critically ill children and 0.5% in general ward admissions implying an eight-fold increased risk of pAKI in critically ill patients.
  2,574 358 1
Efficacy and safety of calcium acetate-magnesium carbonate in the treatment of hyperphosphatemia in dialysis patients
Imed Helal, Hanene Elkateb, Hafedh Hedri, Malika Hajri, Fethi Ben Hamida
November-December 2016, 27(6):1162-1167
DOI:10.4103/1319-2442.194604  PMID:27900961
A phosphate binder combining calcium and magnesium offers an interesting therapeutic option to control hyperphosphatemia in dialysis patients. We investigated the effectiveness and tolerance of calcium acetate-magnesium carbonate (Ca-Mg). This is a 16-week prospective study including 16 dialysis patients. After an initial two-week washout period, serum phosphorus (sPho) ≥1.8 mmol/L, serum calcium (sCa) ≤2.6 mmol/L, and serum magnesium ≤1.5 mmol/L were the main inclusion criteria. The initial dose of Ca-Mg depended on sPho level and was titrated for every two weeks to have a sPho ≤ 1.8 mmol/L. A second two-week washout period followed the 12 weeks of treatment. Ca-Mg significantly reduced the mean sPho levels from 2.14 to 1.75 mmol/L by the end of the 12-week treatment period (P <0.006). Two weeks after the completion of the Ca-Mg study, the mean sPho levels increased to 2.2 mmol/L. The mean sCa levels did not significantly change during the Ca-Mg trial. The mean serum intact parathyroid hormone declined significantly from 446 pg/mL at the beginning of the study to 367 pg/mL at the end of the 12-week treatment period (P = 0.0002). Digestive tolerance was good in all patients which allowed good compliance. There were no episodes of hypercalcemia. However, six patients had a moderate hypermagnesemia (21 episodes) requiring adjustment of treatment dose. The Ca-Mg proved to be effective in the control of hyperphosphatemia in dialysis patients with good clinical and biological tolerance. Thus, in patients with hypercalcemia or poor tolerance to calcium carbonate, Ca-Mg might be a good alternative.
  2,400 398 1
Penile calcific uremic arteriolopathy occurring postparathyroidectomy in a hemodialysis patient
Salah Omar Bashir, Mahmoud A Aamer, Hayder A Omer, Mohamed D Morsy
November-December 2016, 27(6):1265-1269
DOI:10.4103/1319-2442.194685  PMID:27900978
Calcific uremic arteriolopathy (CUA), also known as calciphylaxis, is a rare condition most frequently seen in patients with advanced chronic kidney disease. The clinical picture is characterized by painful skin lesions and ulcerations. The underlying pathology is medial calcification and intimal proliferation with microthrombi of small arteries. CUA is commonly associated with secondary hyperparathyroidism and high serum calcium and phosphate products. This article reports an atypical case where CUA developed after parathyroidectomy and in the course of treatment of hungry bone syndrome. The patient was on hemodialysis for 14 years. He had developed secondary hyperparathyroidism and severe osteodystrophy. Calcium, Vitamin-D supplements, and calcimimetics failed to control his condition. He underwent parathyroidectomy but developed hungry bone syndrome postoperatively. He was managed with large doses of calcium and active Vitamin-D analogs to maintain his serum calcium. Two weeks later, he developed a painful single lesion on the tip of the penis which was diagnosed as CUA on clinical and radiographic evidence. The patient refused surgical intervention and opted for traditional treatment with honey and herbs with an excellent outcome. The case highlights the risk of CUA complicating the aggressive management of post-parathyroidectomy hungry bone syndrome.
  2,457 311 1
Disseminated mycobacteria chelonae infection in a kidney-pancreas transplant recipient: A case report and review of the literature
Shafi Malik, Ananda Ghosh, Shahid Husain
November-December 2016, 27(6):1246-1251
DOI:10.4103/1319-2442.194681  PMID:27900974
A 40-year-old male with a long-standing history of type 1 diabetes with end-stage renal failure underwent combined kidney-pancreas (KP) transplant from a standard criteria donor. Post-operative course was uncomplicated with good primary function of both transplant grafts. Induction was with thymoglobulin and maintenance immunosuppression was with tacrolimus, mycophenolate mofetil and prednisolone. Nine weeks post-transplant, the patient developed dysfunction of both grafts. Panel reactive antibody testing revealed that the patient had developed a de novo donor-specific antibody and considering an antibody-mediated rejection the patient was treated with intravenous pulse methyl prednisone 500 mg ×3 doses, IV immunoglobulin 2 mg/kg in two divided doses, and ATG 7 mg/kg (total dose of 700 mg). In addition, his baseline immunosuppression was increased. Cr decreased to baseline levels, and blood sugars were in the range of 7-8 mmol/L, serum amylase normalized to 63 U/L, and the patient was discharged home. Nine days post-discharge, the patient presented to the hospital with a five-day history of fever, pain, and swelling in the left knee along with subcutaneous, erythematous, tender, nodular lesions in both legs and both arms. Skin biopsy showed Ziehl-Neelsen stain positive rods and biopsy culture and blood culture grew Mycobacteria chelonae. Antimicrobials were switched to azithromycin 500 mg OD, moxifloxacin 400 mg OD, and linezolid 600 mg BID and baseline immunosuppression was reduced to tacrolimus trough target 8-10 ng/mL and MMF to 250 mg BID. The patient gradually improved and was discharged after 28 days in the hospital. Six weeks following the diagnosis of nontuberculous mycobacteria infection, the patient's pancreas graft failed, presumably due to reduction in immuno-suppression and he is now back on insulin treatment. His renal graft continued to function well. Although rapidly growing mycobacterial infections are rare among transplant recipients, it should be suspected among those who have received augmented immunosuppression. Blood cultures and skin biopsy of the lesions are important to establish the diagnosis.
  2,346 402 -
Infective endocarditis in chronic hemodialysis: A transition from left heart to right heart
Y Bentata, I Haddiya, N Ismailli, N El Ouafi, A Benzirar, O El Mahi, A Azzouzi
November-December 2016, 27(6):1200-1206
DOI:10.4103/1319-2442.194612  PMID:27900966
Infective endocarditis (IE) of the left heart is the most frequent type of IE in chronic hemodialysis (CHD) (in 90% of cases) whereas involvement of the right heart is rare. The aim of this study was to determine the clinical, biological, and echocardiographic characteristics, as well as the prognosis of IE in CHD. This is a retrospective study conducted at the Center of Nephrology and Hemodialysis in Oujda, Morocco. Over a period of 56 months, we compiled data on a series of 11 CHD patients with IE. Their mean age was 40.5 ± 14 years, 72% were male and 27.3% had diabetes. All patients had native valve. All patients had bacteremia preceding the episode of IE. The tricuspid valve was the site of IE in 45% of the cases. Cardiac complications were observed in 72% of the patients and mortality was observed in 72% of cases. The period from IE diagnosis to death was 9 ± 6 days. In our study, the tricuspid valve was the most affected valve of IE in CHD.
  2,373 317 3
Chronic kidney disease stages among diabetes patients in the Cape Coast Metropolis
Richard K. D. Ephraim, Eric Arthur, W. K. B. A. Owiredu, Prince Adoba, Hope Agbodzakey, Ben A Eghan
November-December 2016, 27(6):1231-1238
DOI:10.4103/1319-2442.194658  PMID:27900971
Diabetes patients worldwide are at a high risk of chronic kidney disease (CKD) which affects their quality of life and increases the risk of early death. This study used the new kidney disease improving global outcomes (KDIGO) guidelines to establish the prevalence and also identify the factors associated with CKD among diabetes patients in the Cape Coast Metropolis. Two hundred (200) diabetes patients were randomly recruited from the diabetic clinic of the Cape Coast Teaching Hospital from January to April 2014. Blood and urine samples were collected for the estimation of serum creatinine and urine protein, respectively. The estimated glomerular filtration rate (eGFR) was calculated using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation; the 2012 KDIGO guidelines was used to assess CKD. Based on these guidelines, 37% of our participants had CKD. Sixteen percent (16%) of the participants had Stage 1 CKD and 17% had an eGFR <60 mL/min/1.73 m 2 . Albuminuria was higher among female diabetic patients compared to males (69.2% vs. 30.8%, P = 0.017). CKD was present in participants on oral hypoglycemic agents (OHAs) alone or both OHA and insulin. Duration of diabetes, systolic blood pressure, older age, and use of OHA were associated with CKD (P <0.05).
  2,338 349 1
Dengue nephropathy: Immunopathology and immune complexinvolvement
Viroj Wiwanitkit
November-December 2016, 27(6):1280-1282
DOI:10.4103/1319-2442.194693  PMID:27900982
  2,392 272 2
Renal fluid overload diagnosed by retinal optical coherence tomography scanning
Sunny M Kar, Thanh-Giao Nguyen, Sneha Rathod, Saad Shaikh, Pran M Kar
November-December 2016, 27(6):1252-1255
DOI:10.4103/1319-2442.194682  PMID:27900975
Fluid overload is one of the major findings in patients with end-stage renal disease. Common findings in fluid overload include shortness of breath, pedal edema, ascites, and pericardial effusion. Rarely, vision loss can be associated with decompensated systemic fluid status. In the following case, we report an unusual case of vision loss due to retinal edema as a result of fluid overload diagnosed and followed to resolution by optical coherence tomography testing.
  2,295 226 -
Evaluation of interleukin-2, interleukin-8, and tumor necrosis factor-like weak inducer of apoptosis in hemodialysis and renal transplant patients and healthy controls
Nasar Alwahaibi, Halima Alissaei, Amal Al-Kalbani, Nadia Alabri, Zainab Allawati, Mohammed Albalooshi
November-December 2016, 27(6):1123-1128
DOI:10.4103/1319-2442.194594  PMID:27900956
There is an increasing evidence which suggests that cytokines have an important role in hemodialysis (HD) and renal transplant patients. The aim of this study was to evaluate the levels of interleukin (IL)-2, IL-8 and tumor necrosis factor-like weak inducer of apoptosis (TWEAK) in HD and renal transplant patients and healthy controls. A total of 152 individuals participated in this study over two years including 53 HD patients, 45 renal transplant patients, and 54 healthy controls. Serum levels of IL-2, IL-8 and TWEAK were measured by enzyme-linked immunosorbent assay. The mean ages for HD, renal transplant patients, and healthy controls were 51 ± 13.6, 41.1 ± 13.0 and 40.73 ± 7.0 years, respectively. Serum levels of IL-2, IL-8 and TWEAK were significantly higher in HD patients compared to healthy controls. IL-2 concentrations were significantly higher in renal transplant patients compared to healthy controls. In conclusion, the findings of this study showed high levels of IL-2, IL-8 and TWEAK in HD patients and normal levels of IL-8 and TWEAK but high levels of IL-2 in renal transplant patients.
  2,186 285 2
Failure to thrive and nephrocalcinosis due to distal renal tubular acidosis: A rare presentation of pediatric lupus nephritis
Madhumita Nandi, Mrinal Kanti Das, Sukanta Nandi
November-December 2016, 27(6):1239-1241
DOI:10.4103/1319-2442.194679  PMID:27900972
A 9-year-old female child was initially diagnosed of having nephrocalcinosis with distal renal tubular acidosis (dRTA) while investigating for short stature. She later on developed features of nephrotic syndrome (NS) while on treatment for RTA. Investigation for the cause of NS revealed very strong serological evidence in favor of systemic lupus erythematosus (SLE). Histopathological confirmation could not be done due to bilateral severely contracted kidneys. There are a few case reports of dRTA as the presentation of SLE, but nephrocalcinosis with dRTA with subsequent manifestation of SLE has hitherto not been reported in literature.
  2,178 287 1
Renal shear wave velocity and estimated glomerular filtration rate in children with chronic kidney disease
Costanza Bruno, Milena Brugnara, Rocco Micciolo, Mariangela Cecchetto, Michele Zuffante, Alessandra Bucci, Marco Zaffanello
November-December 2016, 27(6):1139-1147
DOI:10.4103/1319-2442.194596  PMID:27900958
A shear wave velocity (SWV) value obtained by the acoustic radiation force impulse technique depends on tissue elasticity. We investigated the relationship between SWV values and the estimated glomerular filtration rate (eGFR) in children with chronic kidney disease. A total of 29 patients were enrolled in the study. There were 18 primary and 11 secondary cases of vesicoureteral reflux. eGFR was calculated using Schwartz's formulas (2012). Partial eGFR for each kidney was assessed by multiplying the eGFR by the percentage of renal function measured by means of renal (99m)Tc-dimercaptosuccinic acid scintigraphy. All ultrasound tests were done by a single qualified technician using a convex probe (frequency 4 MHz) on an S-2000 system. The mean SWV values of the two kidneys were significantly and negatively correlated with eGFR calculated with both univariate (cystatin C [Cys C] and multivariate (creatinine, Cys C, and nitrogen) equations. Of all the formulae, the strongest correlation was obtained with eGFR (Cys C). SWV of the renal cortex correlates with the eGFR of patients affected by malformative uropathies. Nevertheless, this technique needs standardization and validation.
  2,115 345 -
Analyzing the long-term survival of the patients undergoing peritoneal dialysis in the peritoneal dialysis center in Shiraz, 2002-2011
Abdolreza Rajaeefard, Sara Sarvandian, Abbas Rezaianzadeh, Jamshid Roozbeh
November-December 2016, 27(6):1211-1216
DOI:10.4103/1319-2442.194626  PMID:27900968
One of the advantages of peritoneal dialysis (PD) compared to hemodialysis is it can be performed at home. The present study aims at determining the long-term survival of patients and technique survival and investigates the risk factors affecting the mortality rate in PD patients. The study was conducted on 290 patients undergoing PD in the main PD center in Shiraz, Iran, between April 2002 and March 2012. The patients' survival rate and the factors affecting their survival were assessed using the Kaplan-Meier method. Besides, log-rank method was used to compare survival among different levels of the categorized variables. Cox regression model was used for introducing the risk factors affecting the patients' survival. The mean of the patients' survival at the end of the follow-up period was 15.42 ± 13.97 months. The patients' 1-, 2-, 3-, and 5-year survival rates were 85%, 72%, 57%, and 22%, respectively, and the median survival time was 11.64 months. Forty-three patients (14.8%) changed their treatment method to hemodialysis. The patients' 1-, 2-, 3-, and 5-year technique survival rates were 90%, 81%, 72%, and 47%, respectively. Age and hemoglobin level were the most significant factors in the patients' survival. Hemoglobin level was the most important factor in technique survival.
  2,139 285 1
Autosomal dominant polycystic kidney disease in children
Kiran Chandra Patro, R Dilip, S Ramakrishnan
November-December 2016, 27(6):1242-1245
DOI:10.4103/1319-2442.194680  PMID:27900973
Autosomal dominant polycystic kidney disease (ADPKD) presenting in adults is well documented, but the presentation in children is uncommon and is unclear why the disease presents early. Cases in children are identified usually while screening those with a strong family history and less commonly when symptomatic. We present here two children with ADPKD.
  2,104 275 1
Effect of intraperitoneal injection of sulodexide on peritoneal function and albumin leakage in continuous ambulatory peritoneal dialysis patients
Yosra Guedri, K Najla Damma, Melek Toumi, Wissal Sahtout, Awatef Azzabi, Sinda Mrabet, Safa Nouira, Dalila Saidane, Samira Amor, Anis Belarbia, Dorsaf Zellama, Abdellatif Achour
November-December 2016, 27(6):1194-1199
DOI:10.4103/1319-2442.194611  PMID:27900965
Peritoneal protein loss is one of the inevitable consequences during continuous ambulatory peritoneal dialysis (CAPD). Our objective was to study the effect of sulodexide on the protein loss and efficiency of dialysis. This study included six patients receiving CAPD treated with sulodexide at the dose of 600 IU/day given by intraperitoneal injection for 10 days. Clinical and biologic parameters were assessed before starting the treatment (D0 and after 10 days of treatment (D10. We also evaluated the benefit of therapy persisting 20 days after the end of treatment (D30. The sulodexide administration produced a significant improvement of the peritoneal function as determined by a significant increase in the following ratios measured at the 4 th h of dwell time on D0 and D30: dialysate-to plasma (D/P) creatinine from 0.63 ± 1.45 to 0.85 ± 0.073 (P = 0.028) and D/P urea from 0.63 ± 0.15 to 79 ± 0.2 (P = 0.048). A significant decrease of albumin leakage was observed, which was 0.90 ± 0.40 g/L at baseline, 0.67 ± 0.36 g/L on the 10 th day, and 0.43 ± 0.22g/L 20 days after the end of treatment. Within 10-day treatment period, use of sulodexide resulted in a reduction in the peritoneal loss of albumin, in addition to improvement of the quality of dialysis and the residual renal function among these patients.
  1,984 320 1
Organ Transplantation in Saudi Arabia - 2015

November-December 2016, 27(6):1293-1306
  2,032 205 1
Multiple visceral venous thromboses associated with oral contraceptive use
Kamel El-Reshaid, Shaikha Al-Bader, Hatem Sallam
November-December 2016, 27(6):1256-1259
DOI:10.4103/1319-2442.194683  PMID:27900976
Peripheral venous thromboembolism (VTE) is a known complication of oral contraceptive drugs (OCs), yet its association with visceral VTE is rarely reported. We describe a 21-year-old female patient who presented with sudden left loin pain. Plain computed tomography (CT) urography did not show kidney lesion but was suspicious of left renal vein thrombosis. Contrast study confirmed the diagnosis and also disclosed thrombosis of the splenic and left ovarian veins. The patient did not have a family history or laboratory evidence of hypercoagulable disorder. An OC was the only medication she had received in the previous three months. The OC was discontinued, and the patient was anticoagulated with heparin and discharged home on warfarin for a total period of six months. Subsequent CT study with contrast, one month later, showed complete resolution of the thrombosis without any visceral abnormality.
  1,889 261 -
Association of conjunctival and corneal calcification with vascular calcification among hepatitis-C-seropositive hemodialysis patients
Khaled AbouSeif, Dawlat Sany, Yasser Elshahawy, Ayman Seddik, Khedr Rahman, Moustapha Gaber
November-December 2016, 27(6):1168-1181
DOI:10.4103/1319-2442.194606  PMID:27900962
Disorders associated with the hepatitis C virus (HCV) have been reported including cardiovascular, metabolic, and central nervous system diseases. Since chronic HCV infections may be curable, their identification as causal contributors to cardiovascular risk could offer new perspectives in the prevention of cardiovascular disease. The aim of this study is to investigate the association between HCV and aortic arch calcification (AAC) and corneal and conjunctival calcification (CCC) in maintenance hemodialysis (MHD) patients; further, we assessed the correlation of CCC with vascular calcification. A total of 100 patients undergoing hemodialysis (HD) in our hospital were included in this study. Patients underwent a complete ocular examination including intraocular pressure, and CCC was looked for by slit lamp and fundoscopy. CCC was graded according to modified Porter and Crombie classification system described by Tokuyama et al. Helical computerized tomographic chest examination was used to evaluate the grading of AAC. Demographic, hematological, biochemical, and dialysis-related data were obtained. There was significant difference between seropositive (n = 51) and seronegative patients (n = 49) regarding grading of AAC and CCC (P <0.001). Significant positive correlation was found between grading of CCC, AAC, age (P <0.001), duration on HD (P <0.001), HCV-antibody positivity (P <0.001), serum calcium level (P <0.001), serum phosphorus level (P <0.001), calcium × phosphorus product (P <0.001), and i-parathormone level (P < 0.001). In addition, CCC grading positively correlated with AAC. Our results suggest that patients undergoing HD infected with the HCV have high degree of CCC, AAC, and mineral metabolism disorder. The strong correlation between CCC and AAC indicates that CCC evaluation is an easy, fast, non-invasive method, and might be used as an indirect indicator to detect vascular calcification in patients undergoing MHD.
  1,745 245 1
Unconventional strategies in the battle of focal and segmental glomerulosclerosis
Satish Mendonca, R. S. V. Kumar, Devika Gupta, Pooja Gupta, Satish Barki, ML Sharma
November-December 2016, 27(6):1260-1264
DOI:10.4103/1319-2442.194684  PMID:27900977
A 24-year-old male presented with classic features of the nephrotic syndrome. An initial renal biopsy revealed minimal change disease and thereafter, a second biopsy showed features of focal and segmental glomerulosclerosis. There was no response to conventional immunosuppression, and the patient had to be given rituximab; in spite of this, he went on to develop end-stage renal disease. He continued to have heavy proteinuria leading to severe hypoalbuminemia, thrombosis, infections, and malnutrition, placing the patient in a life-threatening situation. Bilateral renal ablation with embolization of both kidneys with coiling was done at one setting, which finally resolved the proteinuria in the patient. He then underwent a living-related renal transplant, developing recurrence immediately post-transplant. He was again given rituximab along with tacrolimus, mycophenolate mofetil, and prednisolone. There was no response to rituximab, and the patient underwent plasmapheresis, which leads to complete remission. An arteriovenous fistula was created post-transplant to facilitate regular plasmapheresis.
  1,656 323 -
Gaucher disease in a patient with focal segmental glomerulosclerosis
Jwaher Al-bderat, Nusayba Abbadi, Afrah Shammari, Amer Al-bderat
November-December 2016, 27(6):1287-1289
DOI:10.4103/1319-2442.194696  PMID:27900985
  1,719 249 -
Decreased sensitivity of anti-dsDNA antibody assay observed in a cohort of Hispanic patients with biopsy-proven lupus nephritis
Eduardo Lopez, Ramy Magdy Hanna, James Wilson
November-December 2016, 27(6):1270-1273
DOI:10.4103/1319-2442.194686  PMID:27900979
  1,733 218 -
Proteinuria, graft outcomes, and cardiovascular risk among kidney transplant recipients in a South African Public Hospital
Aminu Muhammad Sakajiki, Sagren Naidoo, P Manga, MS Nazir, S Naicker
November-December 2016, 27(6):1217-1223
DOI:10.4103/1319-2442.194655  PMID:27900969
Proteinuria is a marker of poor long-term graft survival and an independent risk factor for total and cardiovascular mortality in the transplant population. We investigated the prevalence of proteinuria and its relationship with graft function and cardiovascular risk factors in kidney transplant recipients (KTRs). Adult KTRs at the Charlotte Maxeke Johannesburg Academic Hospital were recruited. Patients' records were reviewed for information on their posttransplant follow-up. Echocardiography and carotid Doppler were performed for the assessment of cardiac status and carotid intima-media thickness (CIMT), respectively. Proteinuria was analyzed both as a categorical and continuous variable. Graft dysfunction was defined as estimated glomerular filtration rate of <60 mL/min/1.73 m 2 based on the modification of diet in renal disease formula. Framingham's risk score was used to categorize patients' cardiovascular risk. Inferential and modeling statistics were applied as appropriate using Statistical Package for Social Sciences, and P ≤0.05 was considered statistically significant. One hundred KTRs including 63% males were recruited. Proteinuria was present in 51%, the mean ± standard deviation 24 h urinary protein excretion per day was 1.67 ± 2.0 g/day with a range of 0.4-9.4 g/day. Graft dysfunction was found in 52% of patients and 36% had high cardiovascular disease (CVD) risk. Proteinuric KTRs had high CVD risk, P = 0.002. Proteinuria was associated with graft dysfunction, increased left ventricular mass index, increased CIMT, and anemia. Proteinuria is prevalent; it is a marker of graft dysfunction and is associated with markers of atherosclerosis.
  1,616 204 1
Spontaneous fracture of neck of femur as presenting manifestation of chronic kidney disease in a young patient
Manjusha Yadla, Malleshwar Bottu
November-December 2016, 27(6):1285-1286
DOI:10.4103/1319-2442.194695  PMID:27900984
  1,552 182 -
Obstructive nephropathy in a post-transplant pregnancy
Shobhana Nayak-Rao
November-December 2016, 27(6):1290-1292
DOI:10.4103/1319-2442.194698  PMID:27900986
  1,460 184 -
Primary hyperoxaluria type I importance of pre-transplant genetic screening
Ranga Migara Weerakkody
November-December 2016, 27(6):1283-1284
DOI:10.4103/1319-2442.194694  PMID:27900983
  1,371 209 -
Remarks about the study on the effect of phototherapy on urinary calcium excretion in term neonates
Mahmood Dhahir Al-Mendalawi
November-December 2016, 27(6):1274-1275
DOI:10.4103/1319-2442.194687  PMID:27900980
  1,259 166 -
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