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Saudi Journal of Kidney Diseases and Transplantation
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Intravenous Iron Saccharate Complex: Guidelines for its use in the Management of Anemia of Renal Disease
Monica Zolezzi
April-June 2003, 14(2):129-133
  27,963 886 -
Moral and Ethical Issues in Liver and Kidney Transplantation
Lama Saadi Taher
July-September 2005, 16(3):375-382
  21,429 1,044 -
Snake Bites and Acute Renal Failure
HS Kohli, V Sakhuja
April-June 2003, 14(2):165-176
  20,499 1,772 -
Evaluation of a Transplanted Kidney by Doppler Ultrasound
Samih Al-Khulaifat
September-October 2008, 19(5):730-736
  19,218 2,597 -
Panel Reactive Antibody test (PRA) in renal transplantation
Ali H Hajeer
January-March 2006, 17(1):1-4
  20,045 1,700 -
Which is the Best Way of Performing a Micturating Cystourethrogram in Children?
Ola Ali Al-Imam, Nareeman Moh’d Al-Nsour, Samih Al-Khulaifat
January-February 2008, 19(1):20-25
The Micturating Cystourethrogram (MCU) is a tough and stressful examination for patients and their parents as well as the radiologists and pediatric radiology nurses. Even though, it is one of the most commonly used fluoroscopic procedures in pediatric radiology practice, there is no definite agreement as to the best way to perform it, considering that this examination results in the children receiving a high dose of radiation to the gonadal region. This review was undertaken to determine the best way to perform the MCU in modern pediatric radiology practice.
  18,206 1,153 1
The Significance of Extreme Elevation of the Erythrocyte Sedimentation Rate in Hemodialysis Patients
Mohammed Al-Homrany
April-June 2002, 13(2):141-145
We conducted this study to determine the prevalence of elevated erythrocyte sedimentation rate (ESR) in chronic hemodialysis patients and to evaluate the dialytic and serum factors that might explain this elevation. ESR was measured using the Westergren method immediately before and immediately after dialysis sessions in 200 stable (i.e. with no other obvious systemic illnesses) hemodialysis patients and in 50 hemodialysis patients during concurrent acute illnesses. ESR was found to be > 25 mm/h in 180 (90%) patients, >50 mm/h in 76 (38%) and > 100 mm/h in 64(32%) patients. The mean pre dialysis ESR was not significantly different from the mean post dialysis ESR (77 ± 38 Vs 78 ± 35 mm/h, respectively). The mean ESR in the 50 patients during acute illnesses was not significantly different from the mean ESR measured during the stable state. Among all dialytic, biochemical and serum factors that were studied in this population, fibrinogen was the only factor that independently correlated significantly with ESR (P=0.015). In conclusion, this study showed that our dialysis patients had a tendency for elevated ESR and almost one third of them (32%) had ESR >100 in the absence of malignancy or other clinical factors known to cause such levels. There was a significant correlation between elevated ESR and fibrinogen level. Thus, an ESR of > 100 does not necessarily warrant extensive investigations for causes other than the renal failure/hemodialysis state unless other indicators exist to justify the search.
  18,168 715 -
Candiduria: A Review of Clinical Significance and Management
Zakeya Abdulbaqi Bukhary
May-June 2008, 19(3):350-360
Candiduria is a common nosocomial infection afflicting the urinary tract. This review is aimed at providing an updated summary of the problem in hospitalized adult patients. A review of English Medline literature published between Jan 1970 until June 2007 was performed. Reviews, clinical trials and case-controlled studies in adult patients were included. Risk factors for candiduria included urinary indwelling catheters, use of antibiotics, elderly age, underlying genitourinary tract abnormality, previous surgery and presence of diabetes mellitus. Presence of candiduria may represent only colonization and there are no consistent diagnostic criteria to define significant infection. Candiduria may not be associated with candidemia and most cases are asymptomatic. Asymptomatic candiduria is usually benign, and does not require local or systemic antifungal therapy. Physicians need to confirm the infection by a second sterile urine sample, adopt non-pharmacologic interventions and modify risk factors. Mortality rate can be high particularly in debilitated patients and awareness to validate candiduria is necessary to stratify treatment according to patient status. Appropriate use of anti fungal drugs, when indicated, should not replace correction of the underlying risk factors. Treatment of symptomatic candiduria is less controversial and easier.
  15,350 3,151 14
Acute Kidney Injury due to Rhabdomyolysis
Rafael Siqueira Athayde Lima, Geraldo Bezerra da Silva Junior, Alexandre Braga Liborio, Elizabeth De Francesco Daher
September-October 2008, 19(5):721-729
Rhabdomyolysis is a clinical and biochemical syndrome that occurs when skeletal muscle cells disrupt and release creatine phosphokinase (CK), lactate dehydrogenase (LDH), and myoglobin into the interstitial space and plasma. The main causes of rhabdomyolysis include direct muscular injury, strenuous exercise, drugs, toxins, infections, hyperthermia, seizures, meta­bolic and/or electrolyte abnormalities, and endocrinopathies. Acute kidney injury (AKI) occurs in 33-50% of patients with rhabdomyolysis. The main pathophysiological mechanisms of renal injury are renal vasoconstriction, intraluminal cast formation, and direct myoglobin toxicity. Rhabdo­myolysis can be asymptomatic, present with mild symptoms such as elevation of muscular en­zymes, or manifest as a severe syndrome with AKI and high mortality. Serum CK five times higher than the normal value usually confirms rhabdomyolysis. Early diagnosis and saline volume expansion may reduce the risk of AKI. Further studies are necessary to establish the importance of bicarbonate and mannitol in the prevention of AKI due to rhabdomyolysis.
  14,805 3,511 8
Lung Disease in Relation to Kidney Diseases
Imad Salah Ahmed Hassan, Mohammed Beshir Ghalib
July-September 2005, 16(3):282-287
  16,754 909 -
The Place of Ultrasound in Renal Medicine
Alaleh Gheissari
October-December 2006, 17(4):540-548
Today, ultrasound is one of the most commonly used diagnostic tools, the reasons being that it is non-invasive, reliable, widely available, and affordable. In this paper, we review the place of ultrasound in the diagnosis and follow-up of patients with kidney diseases. We briefly discuss a wide range of kidney diseases for which ultrasound imaging is still performed as one of the initial steps of diagnosis. To achieve this, five following categories are addressed: congenital anomalies of the kidney; renal cystic diseases; renal infections; kidney stones; and kidney tumors. The sonographic findings of these diseases are discussed.
  16,507 1,136 4
Review of Thrombotic Microangiopathy (TMA), and Post- Renal Transplant TMA
Mohammad Reza Ardalan
April-June 2006, 17(2):235-244
Thrombotic microangiopathy (TMA) is a rare but devastating disorder; it involves small vessels and is characterized by intravascular thrombi of aggregated platelets leading to thrombocytopenia and variable degrees of organ ischemia and anemia, which is due to erythrocyte fragmentation in microcirculation. Childhood cases with predominant renal involvement are referred as the hemolytic uremic syndrome (HUS), and adults with major central neurological involvement are labeled as thrombotic thrombocytopenia purpura (TTP). Endothelial damage due to toxins and/or lack of defense against complement activation have a central role. Recent discovery of the von Willebrand Factor cleaving protease (ADAMTS 13) has offered new insight into the pathogenesis of TMA. TMA is also a well-recognized serious complication of renal transplantation. Clinical features of intravascular hemolysis are not always found. It may occur as de novo or recurrent and the majority of de novo cases are related to cyclosporin therapy. Viral infections, severe renal ischemia and acute vascular rejection are less frequent causes. Recurrence is negligible in diarrhea-associated HUS in childhood, but non-diarrheal HUS recurs in majority of adults following renal transplantation. Renal transplantation is contraindicated in familial/relapsing recurrent forms of HUS.
  14,533 2,138 12
Vascular Access Related Infections in Hemodialysis Patients
Anil K Saxena, BR Panhotra, Abdulrahman S Al-Mulhim
January-March 2005, 16(1):46-71
Hemodialysis (HD) patients are at considerably high risk for vascular access­related blood stream infections (VRBSI) that result in serious complications. Such severe infections are a great deal more frequent with central venous catheters (CVCs) and polytetrafluoroethylene (PTFE) grafts than with arteriovenous fistula (AVF). Nonetheless, the CVCs, though having "undesirable" side effects, remain "unavoidable" for the patients requiring instant dialysis access, as a consequence of the unpredictable course of chronic renal disease. Although early antibiotic treatment should include the coverage for Staphylococcus aureus, the treatment of catheter-related blood stream infections (CRBSI) remains controversial. Antimicrobial- anticoagulant 'locks' have shown promising results in several recent randomized controlled trials in the treatment and prevention of CRBSI. Policy of increasing AVF prevalence beyond 50% is bound to have an enduring positive effect on HD outcomes. Standard infection control measures for hygiene and aseptic handling of CVCs cannot be overemphasized. The catheters with 'bioactive' surface with thrombo-resistant and infection-resistant properties will be available in the near future.
  14,773 1,635 -
Epidemic of Chronic Kidney Disease in India -What Can Be Done?
Murugesan Ram Prabahar, Venkatraman Chandrasekaran, Periasamy Soundararajan
September-October 2008, 19(5):847-853
The exact prevalence of chronic kidney disease in India is not clear in the absence of regular national registry data and provided only by small observational series or rely on reports from personal experience, but the quality of data is quiet uneven. There are only three population based studies in India commenting on the magnitude of chronic kidney disease. In a prevention program started at community level in Chennai, the reported prevalence is 0.86% in the project population and 1.39% in the control region. The second study is based on Delhi involving 4972 urban patients. The prevalence of chronic renal failure (defined as serum creatinine more than 1.8 mg/dL) to be 0.79 % or 7852 per million/population. The third study perhaps the only longitudinal study to identify the incidence of end stage renal disease is based on 572,029 subjects residing in city of Bhopal suggests that the average crude and age adjusted incidence rates of end stage renal disease were 151 and 232 per million population respectively. The resources and skill for taking care of this large case load, both in terms of personal and health care infrastructure do not exist currently and would need to be created. To tackle the problem of limited access to renal replacement therapy, an important method would be to try and reduce the incidence of end stage renal disease and the need of renal replacement therapy by preventive measures. It is clear that treatment of chronic kidney disease and its advanced stage end stage renal disease is expensive and beyond the reach of average Indian. Thus it is crucial that prevention of chronic kidney disease has to be the goal of medical fraternity, government of India and the general public. This article suggests a series of primary, secondary and tertiary preventive measures for prevention of chronic kidney disease. Clearly there are already many effective and attractive interventions for the treatment and prevention of chronic kidney disease exist and many more surely be developed.
  14,223 1,849 11
Use of sodium thiosulfate in the treatment of calciphylaxis
Carlos G Musso, Paula Enz, Flavia Vidal, Rodolfo Gelman, Aldana Lizarraga, Luis Di Giuseppe, Alicia Kowalczuk, Leonardo Garfi, Ricardo Galimberti, Luis Algranati
November-December 2009, 20(6):1065-1068
Calciphylaxis is an infrequent but severe entity found in chronic dialysis patients. Its clinical pattern consists of tissue ischemia with itchy and painful subcutaneous nodules and plaques, most often located on the abdomen, buttocks, thighs and/or legs. These injuries evolve to extensive superficial necrosis of the skin overlying the panniculitis, with ulceration, overinfection and consequent sepsis. Current treatment modalities used to counteract this pathology are not entirely effective. A new treatment reported for calciphylaxis, is the use of intravenous sodium thiosulfate. This inorganic salt is already used in the treatment of intoxication caused by cyanide, in patients with calcific nephrolithiasis and tumoral calcinosis, with very good and safe results. We herewith report a case of calciphylaxis that was cured using intravenous sodium thiosulphate treatment.
  14,184 1,824 12
Comparison of 24-hour urinary protein and protein-to-creatinine ratio in the assessment of proteinuria
Ayman M Wahbeh, Mohammad H Ewais, Mahamed E Elsharif
May-June 2009, 20(3):443-447
To determine the correlation between protein-to-creatinine ratio (PCR) and 24-hour urinary protein (UP), we measured proteinuria in 68 patients attending the nephrology clinic at Jordan University Hospital by 24-hour urine protein excretion and protein-to-creatinine ratio. The cutoff values for spot urine protein-to-creatinine ratio in predicting 24-hour protein "threshold" excretion of 0.5, 1.0 and 3.5 g/day were determined using receiver operating characteristic curves. A very good correlation (r= 0.832, P< 0.0001) was found between spot urine protein-to-creatinine ratio and 24-hour urine protein excretion. Bland-Altman plot showed the two tests had reasonable limits of agreement at low level of protein excretion but the limits became wider as the protein excretion increased. For protein excretion < 2.0 g/day, the limits of agreement of spot urine (PCR) and (UP) were +1.48 and -1.2 g/day. The spot urine protein-to-creatinine ratios of 0.72 (sensitivity 0.97; specificity 1.0), 1.2 (0.97; 0.89) and 3.23 (1.0; 0.86) mg/mg reliably predicted 24-hour urine total protein equivalent "thresholds" of 0.5, 1.0 and 3.5 g/day, respectively. We conclude that the protein-to-creatinine ratio in spot urine specimens is an accurate, convenient, and reliable method to estimate the protein excretion in urine. However, the protein-to-creatinine ratio will likely be within clinically acceptable limits only when proteinuria is at reasonably low levels.
  14,146 1,586 4
Infectious Complications in Kidney Transplant Recipients: Review of the Literature
Jad A Khoury, Daniel C Brennan
October-December 2005, 16(4):453-497
Since the initial successful kidney transplantation in humans, the field of renal transplantation has made significant progress. Patient survival and graft survival have improved tremendously. Our armamentarium of immunosuppressive drugs and antimicrobial agents has expanded, as our understanding of their effects and proper utilization. Enhanced surgical techniques also improved the overall survival of kidney recipients. However, infectious complications remain a major cause of morbidity and mortality in this patient population. In this article, we provide an overview of infections in kidney transplant recipients, a detailed illustration of specific infectious agents with a focus on cytomegalovirus, and finally we lay some general principles for limiting the burden of infectious complications in kidney transplants through proper infection control measures.
  13,059 1,625 -
Severe acute renal failure in a patient with diabetic ketoacidosis
Jamila Al-Matrafi, Jennifer Vethamuthu, Janusz Feber
September-October 2009, 20(5):831-834
Acute renal failure (ARF) is a rare but potentially fatal complication of diabetic ketoacidosis (DKA). Early recognition and aggressive treatment of ARF during DKA may im­prove the prognosis of these patients. We present a case report of a 12 year old female admitted to the hospital with severe DKA as the 1s t manifestation of her diabetes mellitus. She presented with severe metabolic acidosis, hypophosphatemia, and oliguric ARF. In addition, rhabdomyolysis was noted during the course of DKA which probably contributed to the ARF. Management of DKA and renal replacement therapy resulted in quick recovery of renal function. We suggest that early initiation of renal replacement therapy for patients with DKA developing ARF may improve the potentially poor outcome of patients with ARF associated with DKA.
  12,157 1,791 4
Long-term Complications in Hemodialysis
Christopher R Blagg
October-December 2001, 12(4):487-493
  13,030 892 -
Penile gangrene: A devastating and lethal entity
Vishwajeet Singh, Rahul Janak Sinha, SN Sankhwar
March-April 2011, 22(2):359-361
  13,170 423 2
The protective effect of thymoquinone, an anti-oxidant and anti­-inflammatory agent, against renal injury: A review
Ahmed Ragheb, Ahmed Attia, Walid Shehab Eldin, Fawzy Elbarbry, Sana Gazarin, Ahmed Shoker
September-October 2009, 20(5):741-752
Thymoquinone (TQ), 2-Isopropyl-5-methyl-1, 4-benzoquinone, is one of the most active ingredients of Nigella Sativa seeds. TQ has a variety of beneficial properties including anti­oxidative and anti-inflammatory activities. Studies have provided original observations on the role of oxidative stress and inflammation in the development of renal diseases such as glomerulo­nephritis and drug-induced nephrotoxicity. The renoprotective effects of TQ have been demons­trated in animal models. Also, TQ has been used successfully in treating allergic diseases in humans. The aim of this review is to highlight the importance of reactive oxygen species in renal pathophysiology and the intriguing possibility for a role of TQ in the prevention of and/or protection from renal injury in humans.
  9,716 3,873 29
Renal Failure in Multiple Myeloma "The Myeloma Kidney":State of the Art
Hartmut Goldschmidt, Heinrich Lannert, Jurgen Bommer, Anthony D Ho
April-June 2001, 12(2):145-150
Renal failure is present in about 20% of patients with multiple myeloma (MM) at diagnosis. Renal function impairment is usually caused by the so-called "myeloma kidney" and is associated with shortened survival in patients treated with conventional therapy. Renal failure is reversible in up to 50% of patients, particularly when its degree is moderate and it is related to precipitating factors such as hypercalcemia. In our experience, approximately 10% of newly diagnosed patients with MM have renal failure severe enough to require dialysis. Despite its frequency, there are few reports dealing with MM and renal failure.
  11,862 1,233 -
Infection Control and the Immunocompromised Host
Adel Alothman
October-December 2005, 16(4):547-555
  12,300 712 -
Chronic kidney disease in older people; Disease or dilemma?
Aimun K Ahmed, Siobhan H.M Brown, Ahmed H Abdelhafiz
September-October 2010, 21(5):835-841
The majority of patients diagnosed with Chronic Kidney Disease (CKD) are elderly and CKD is linked with poor cardiovascular, cognitive, and disability outcomes in these people. Only a minority of these patients will progress to end stage renal disease (ESRD) while the majority will die due to cardiovascular disease. Thus, only a small number of these patients with CKD will benefit from specialist nephrologist assessment. The priority for the remainder should be cardiovascular disease prevention. We have reviewed specific issues relevant to older people to determine high-risk groups with CKD that are likely to benefit from a more intensive risk reduction intervention and to allow identification of clinically relevant renal disease.
  11,980 926 2
Cerebral Salt Wasting in a Patient with Head Trauma: Management with Saline Hydration and Fludrocortisone
Akram Askar, Nauman Tarif
January-March 2007, 18(1):95-99
Hyponatremia secondary to the syndrome of inappropriate anti-diuretic hormone secretion is commonly observed in patients with various neurological disorders. Cerebral salt wasting (CSW), although uncommon, has also been reported to frequently result in hyponatremia. Here, we report a case of CSW in a patient with head trauma without evidence of cerebrovascular injury or brain edema. He was diagnosed on the basis of high fractional excretion of urinary sodium and uric acid along with extremely low serum uric acid. Improvements in serum sodium levels after saline hydration and fludrocortisone administration further supported the diagnosis, even in the presence of normal brain and atrial natriuretic peptide levels.
  11,528 1,375 4
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