To evaluate hearing acuity in chronic renal failure (CRF), we studied 48 patients of age less than 40 year as well as 15 years age and sex matched healthy subjects as controls by using the conventional pure-tone audiometry and evoked otoacoustic emission (TEOAE). Twenty-two of the study patients were treated conservatively and 26 patients by regular hemodialysis (HD). The dialyzed patients were further classified according to the duration of HD into 14 patients dialyzed for <1 year and 12 patients dialyzed for >1-year. TEOAE was applied only for patients proved to have normal pure tone thresholds. Sensorineural hearing loss was more in CRF patients treated conservatively than in those treated by dialysis (22.7%) and 15.3%, respectively), but the difference was not statistically significant. TEOAE was more sensitive than pure-tone audiometry in detecting sensorineural hearing loss in these patients (27.2% Vs 19.2%, respectively) and in the whole reproducibility of the test. However there were no significant statistical differences in the CRF subgroups and the controls. Furthermore, there was no correlation between TEOAE parameters and serum urea and creatinine. In conclusion, hearing acuity was found to be impaired in chronic renal failure patients whether treated conservatively or hemodialyzed. The transient evoked otoacoustic emission is more sensitive than the conventional pure-tone audiometry for evaluation of hearing acuity in this setting. Although the parameters of TEOAE seem to be better in hemodialyzed than in conservatively treated patients, but it did not reach statistical significance.

Hypercholesterolemia which frequently follows renal transplantation, places kidney graft recipients at an increased risk for atherosclerosis and cardiovascular diseases. We attempt in this study to determine the prevalence, and evaluate severity and treatment of hypercholesterolemia in kidney transplant recipients. We studied 78 renal transplant patients with a mean age of 42.1 years and mean transplant duration of 6.2 years (range from six months to 8.5 years). They were on triple immunosuppressive therapy and had serum creatinine level of less than 160µmol/L. Thirty-one patients (39.8%) were found to have blood cholesterol levels > 6.4 mmol/L. Significant positive correlation was found between hypercholesterolemia and cyclosporine blood levels above 200 ng/ml (p<0.0009). Furthermore, proteinuria positively correlated with hypercholesterolemia (p<0.0006). There was no significant correlation between cholesterol blood level and the patient age, sex, presence of diabetes, prednisolone, dose, or treatment with C.-blockers and diuretics. Dietary modification was not effective in reducing the blood cholesterol level in our patients, so we used fluvastatin in a dose of 20 to 40 mg daily for a period of three months. This drug was effective in lowering the mean cholesterol blood levels from 7.1 to 5.2 mmol/L (p<0.005). One out of 19-electromyogram studies showed abnormal pattern. We did not notice change in the levels of creatinine phosphokinase, serum creatinine or lover enzymes. In conclusion, hyper­cholesterolemia is common in stable renal transplant patients. The presence of proteinuria and the high level of blood cyclosporine are significantly associated with hypercholesterolemia. Low-dose fluvastatin was well-tolerated and effective cholesterol lowering treatment.

In this retrospective study, we reviewed the medical records, and histopathology findings of 191 patients who underwent renal biopsies at King Hussein Medical Center (KHMC) during a four-year period (1993-97). All were performed using Tru-Cut needles under ultrasound guidance. There were 119 males (62.3%) and 72 females (37.7%); the mean age was 29.1 years (range 5-76 years). Side effects of the renal biopsies included pain at the site of he biopsy in 17 (8.9%), gross hematuria in six (3.1%) and hematuria requiring blood transfusion in one (0.5%) patient. Nephrotic syndrome was the most common indication for biopsy followed by acute renal failure of unknown etiology. Among the nephritic patients, minimal change disease and post-infectious glomerulonephritis (GN) were the commonest findings in children below the age of 15 years, membrano-proliferative GN ranked first in adults whole membranous GN and amyloidosis were more common in the elderly. WE conclude that renal biopsy was associated with a n acceptably low rate of complications in our practice, and that the patterns of renal histology vary slightly from those reported from other countries.

Hepatitis is emerging as a common serious problem in renal transplant patients. To determine the prevalence of viral hepatic in our transplant population, we screened the patients who received renal transplants in the period from 1979-1997, inclusive, for hepatitis B virus (HBV) and for hepatitis C virus (HCV) infection. Of those patients screened for HBV infection, seven o f101 recipients (6.9%) were found positive for HbsAg. During the follow up, one patient cleared HbsAg and one from the negative group acquired it. Of the recipients screened for HCV antibodies 32 of 78 patients (41%) had positive tests. Higher incidence of chronic liver disease (37.5%) was found in the HCV positive group, compared to zero in the negative group. However, no difference in the short-term graft loss (25%), was noted between these two groups. We conclude that prevalence of hepatitis C in our transplant patients is high and may have an impact on their long-term outcome.

We describe here hydrothorax that occurred in a patient on continuous ambulatory peritoneal dialysis (CAPD) and highlight the problems of diagnosis and management. A 48 years-old man with history of obstructive uropathy secondary to urolithiasis was stared on CAPD when he reached end-stage renal failure. Two months later, he was admitted with two days history of shortness of breath on exertion and dry cough increasing in supine position. Chest examination was suggestive of right sided pleural effusion confusion confirmed by chest X-ray. Radioisotope Technetium ^99m labeled albumin instilled through the peritoneal catheter was detected in the right pleural fluid confirming the peritoneo-pleural leak. The peritoneal dialysis (PD) was discontinued and the patient was switched to hemodialysis. The pleural effusion subsided and has not recurred for the following three years.

A 38-years of Bangladeshi woman with a post medical history of treated Bancroftian Filariasis ten years before, presented with chyluria and heavy proteinuria. Percutaneous renal biopsy was consistent with membranous glomerulonephritis. The patient was treated with diethylcarbamazinc (DEC), and later, with azathioprine and prednisolone for the nephrosis. The chyluria disappeared with treatment, but recurred four months later, despite persistent drug therapy. The proteinuria dropped to 2.4 g and 0.2 g/24 hours at two and twelve weeks respectively. After two years of follow-up, the chyluria persisted but the proteinuria remained below 0.2g/24 hours, while plasma proteins remained within normal limits. The patient maintained stable body weight, good general health status, stable renal functions and normal lipid and hepatic profiles. The numerous investigations carried out to elucidate the etiology of the chyluria were not rewarding. The conservative approach for the management of chyuria adopted in this patient seems to be appropriate.

Galloway-Mowat Syndrome (GMS) has a wide variety of clinical manifestations and histologic findings. All reported cases had developed nephrotic syndrome in the first two years of life. We report a case of 12 years old boy with microcephaly, mental retardation, and typical dysmorphic features of GMS with a late onset of minimal change nephritic syndrome which first manifested at seven years of age.