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January-March 2000 Volume 11 | Issue 1
Page Nos. 1-83
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EDITORIALS |
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Renal Complications of the Human Immunodeficiency Virus Infection |
p. 1 |
Tejinder S Ahuja, Mahendra Agraharkar PMID:18209292 |
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Vesicoureteral Reflux - an Update |
p. 13 |
Baroukh Maurice Assael, Clara Bellosta PMID:18209293 |
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ORIGINAL ARTICLES |
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Diabetes and Renal Transplantation: Saudi Experience |
p. 25 |
Muhammad Ziad Souqiyyeh, Faissal A.M Shaheen, Iftikhar A Shiek, Abdulla A Al-Khader, Halima Fedhail, Mohammed Al-Sulaiman, Dujana Mousa, Fahd Al-Hawas PMID:18209294We conducted this study to evaluate the prevalence and risk factors of diabetes mellitus (DM) in our renal transplant population. We retrospectively reviewed the records of the active renal transplant patients at two large transplant centers in Riyadh and Jeddah in Saudi Arabia, transplanted between 1979 and November 1998. The recipients were grouped according to the diagnosis of diabetes; group I: diabetes developed before transplantation (BTDM), group II: diabetes developed only after transplantation (ATDM) and group III: did not have diabetes (NDM). There were 1112 patients' records included in the study. The mean age was 38.2 years and the mean duration of transplantation was 66.9 months. There were 113(10.2%) patients in BTDM group, 134 (12.1%) patients in the ATDM group and 865 (77.8%) patients in the NDM group. There was no significant difference in the prevalence of hypertension among the study groups. In comparison to the other groups, the BTDM group had significantly more males (78.8%), more patients who were transplanted after 1990 (pre-cyclosporin era), more patients with grafts from living non-related donors (46%), higher incidence of acute rejection episodes (39%), higher mean serum creatinine and more patients treated with azathioprine (71%). The ATDM group had significantly higher mean age (46.4 years), higher mean duration of transplantation (91.5 months), higher rate of retransplantation (8.2%), higher mean serum cholesterol level (6.0mmol/L) and more frequently abnormal electrocardiogram (24.6%) than the other two groups. The ATDM group had comparable mean weight (70.2 kg) to the BTDM group but significantly higher than the NDM group (66.1kg). The NDM group had significantly higher mean dose of cyclosporine (3.3 mg/kg/day) and higher mean dose of prednisone (0.16 mg/kg/day) than the other groups. The only independent risk factor for developing DM after transplantation was advancing age. The currently used low-dose steroid therapy was not significantly associated with development of DM after renal transplantation. Nevertheless DM is an important co-morbid condition in the transplant population and is associated with increased risk for cardiovascular and cerebrovascular events. |
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Patients on Hemodialysis Visiting Madina Munawarah: Communication Between Nephrologists |
p. 31 |
Abdelrahman O Mohamed, Irshad A Sirwal, Bassam Bernieh, Mosaddeque Ahmed PMID:18209295Two hundred and thirteen patients who were already on hemodialysis (HD) at other locations visited Al-Madina Al-Munawarah, Saudi Arabia, during the year 1996. These patients were accepted for temporary HD at the King Fahad hospital during their stay in the city. Only 29 (13.6%) patients had detailed medical reports with them. Forty-one (19.2%) patients had full serology reports with them. Those coming from within Saudi Arabia were comparable to those from other countries. Hemodialysis per se should not deter patients from leading as normal a life as possible, including visiting places for leisure or religious purposes. Full cooperation and communication between HD units would give appropriate and timesaving services to those patients at place of visit and would limit possible problems. |
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Wilms' Tumor Experience at King Hussein Medical Center |
p. 35 |
Isam Haddadin, Issa Hazza PMID:18209296This is a retrospective study designed to find out the clinical profile of children with Wilms' tumor admitted to King Hussein Medical Center over a 6.5-year period. There were 26 patients (eight males and 18 females) with a median age of three years (range 1-8 years), at the time of diagnosis. Twenty children went into complete remission for a period ranging from 4-80 months (mean 46 months). Six children relapsed locally or with distant metastasis. All the six children with relapse died because of progressive disease. The overall relapse free survival was 77% for all stages (100%, 90%, 66.6%, 0% and 100% for stage I, II, III, IV and V respectively). This is similar to the international figures for stage I & II but is still behind for stage III & IV. |
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Etiology and Outcome of Acute Renal Failure in Children in Congo-Brazzaville |
p. 40 |
Alain G Assounga, Claire Assambo-Kieli, Adolphe Mafoua, Georges Moyen, Samuel Nzingoula PMID:18209297Acute renal failure (ARF) is a common problem in the Congo. This is a sixyear retrospective study aiming at analyzing the etiology and the outcome of ARF at the Brazzaville's University Hospital from 1989 through 1994. One hundred and five cases of ARF (0.99%), including 54 boys (51.4%) and 51 girls (48.6%), out of 10,512 children admitted in the department of Pediatrics have been recorded. ARF represented 13.09% of the causes in 802 patients with renal disorder. The main etiologies of ARF included acute gastroenteritis with dehydration (25.7%), nephrotic syndrome (14.7%), sepsis (15.23%), malaria (12.38%), and acute glomerulonephritis (9.5%). Most cases were managed conservatively, while peritoneal dialysis (PD) was used in eight cases (7.62%). The outcome of ARF was recovery in 50.5 %, death in 37 % and chronic renal failure in 12.5% of cases. Preventive measures may help in reducing the high mortality rate and the need for dialysis. |
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BRIEF COMMUNICATION |
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Nail Changes in End-Stage Renal Failure Patients on Hemodialysis  |
p. 44 |
Arshad Jamal, PT Subramanian, K Shaik Anwar Hussain PMID:18209298To evaluate the fingernail changes in patients with end-stage renal failure (ESRF) on regular hemodialysis (HD), we reviewed 69 patients (male 25, female 44; age 40 ± 14.8 years) who have been on HD at Samtah General Hospital, Gizan, Kingdom of Saudi Arabia for a mean of 4.3 ± 3.06 years. They were free from congenital, systemic or primary skin disorders contributing to nail changes. The patients were also free from ornamental dyes like henna, traumatic injuries or infections in the fingernails. They were also clinically free from features suggestive of the carpal tunnel syndrome or vascular steal syndrome secondary to arteriovenous fistula (AVF) created for vascular access. Their nails were examined under bright day light by the authors independently. The findings consistent among all three observers were taken for analysis. Hemoglobin and serum albumin levels were also estimated. We compared these changes according to age, sex, and duration on chronic hemodialysis, AVF, and the levels of serum albumin and hemoglobin. One or more nail changes were observed in 44/69 (64%) patients. The commonest abnormality was the so-called "Half-and-half nail changes", which was observed in the finger nails of 18/69 (26%) of the study patients (males to female ratio was 2:1). Typically, the half-and-half nails are nails where the distal portion of the nail bed is red, pink or brown, occupies 20-60% of the total nail length and is always sharply demarcated with the proximal portion. The latter has a dull whitish ground glass appearance and when pressure is applied, the distal discoloration does not fade completely. Non-specific nail changes were observed 26/69 (38%) patients. The hemoglobin and serum albumin levels were not significantly different of those with 'half-and-half' nail, non-specific nail changes or no nail changes. We conclude that various fingernail changes are observed in ESRF patients on HD. These nail changes are independent of the age of the patient, duration on HD, AVF or hemoglobin or albumin levels. However, a gender dependent trend was noticed and the half-and-half nail seems to be characteristic of uremia. |
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CASE REPORTS |
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Granulomatous Interstitial Nephritis and Acute Renal Failure due to Renal-limited Sarcoidosis |
p. 48 |
Kamel A El-Reshaid, Eissa H Al-Khaldi, John Patrick Madda PMID:18209299Renal failure secondary to granulomatous sarcoidosis without clinical features or radiological evidence of disease is rare. In this case report, we describe a 14year old girl who developed progressive renal failure over a two-month period which was associated with weight loss and epigastric pain. Physical examination did not show any abnormality. Laboratory investigations were normal except for normocytic normochromic anemia, high serum urea, high serum creatinine (452 tmol/L) and polyclonal gammopathy. Percutaneous kidney biopsy showed severe interstitial nephritis with non-caseating granulomata. She was treated with tapered prednisone after a starting dose of 1 mg/kg. The treatment with prednisolone resulted in a complete remission that lasted up to two years of follow up. This case highlights the variable expression of sarcoidosis, which should be considered in the management of such disease. |
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Wolfram's (DIDMOAD) Syndrome and Chronic Renal Failure |
p. 53 |
Mojaly Ahmed Hasan, Issa Hazza, Abdulhamid Najada PMID:18209300Wolfram's syndrome is usually considered as an autosomal recessive condition, with wide phenotypic variation. The syndrome is commonly called DIDMOAD (diabetes insipidus, diabetes mellitus, optic atrophy and deafness), although some patients have additional clinical findings including ataxia, hypogonadism, hydronephrosis and psychiatric illnesses. We report a patient with DIDMOAD syndrome with emphasis on the urological tract and its progressive complications. Unfortunately, he developed end-stage renal failure and needed hemodialysis at the age of 14 years. The presentation, investigations and management are discussed. |
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Cerebral Venous Thrombosis in the Nephrotic Syndrome |
p. 59 |
Khalid N Al Fakeeh, Soud A Al Rasheed PMID:18209301A 4-year-old boy with idiopathic steroid responsive nephritic syndrome developed bilateral sixth-nerve palsy and lethargy secondary to cerebral sinus thrombosis. Treatment with heparin, fresh frozen plasma as source of antithrombin III and vitamin K inhibitors may have prevented further sequels. However, anti-coagulation, as assessed by partial thromboplastin and prothrombin time, was difficult to achieve. Despite these problems the child made a complete neurological recovery. |
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REVIEW ARTICLE |
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Best Practice Hospital: A Model for Cooperative Exchange of Information in the Field of Nephrology and Transplantation |
p. 64 |
Annelies Fitzgerald, Harald Thurnher, Robert D Fitzgerald PMID:18209302The rapid development of new technology in the health care system is often contrasted by the difficulties in implementing a new system or program in an existing setting. A valuable means for bypassing these difficulties is the direct transfer of knowledge and practical experience from successful users and developers to those interested in initiating the use of the same system. We describe a system of knowledge and information transfer - Best-Practice Seminars - that is successful in surpassing many of the obstacles in implementing and managing change in the health care sector. |
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LETTERS TO THE EDITOR |
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Hepatitis C in Dialysis Patients in Egypt: Relationship to Dialysis Duration, Blood Transfusion, and Liver Disease |
p. 72 |
Ahmed Adel Hassan, Rasha Khalil PMID:18209303 |
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Temporary Vascular Access for Hemodialysis Patients |
p. 74 |
Ayman Haddad, Nabil Akash, Mohammad Ghnaimat, Mohammad El-Lozi PMID:18209304 |
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RENAL DATA FROM THE ARAB WORLD |
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Early Experience of Kidney Transplantation in Yemen: The First Two Cases |
p. 82 |
Muhamed Al-Rohani, Ibrahim Al-Nunu PMID:18209305 |
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