The pharmacology of the perioxisome proliferators activated receptor PRAR ligands is summarized. The alpha, delta (beta) and gamma receptors occur in vascular walls and on macrophages suggesting that their ligands can be used to modify atherosclerosis and other forms of vascular disease. Furthermore, gamma-ligands exert an anti-inflammatory effect on macrophages. Troglitazone has been used to protect against glomerulosclerosis in rats. The thiazolidinediones (TZDs) could be important adjunct therapy for lupus glomerulonephritis.

This survey was performed on children with renal diseases admitted to Shiraz Pediatric Nephrology Unit from October 1993 to March 2000. There was a total of 1358 children, of whom 709 (52%) were boys, with age range of 1 month to 16 years and a mean of 6.5 ± 4.7 years. Thirty percent of children were below age of 2 years. Admission diagnosis was acute nephritis in 312 (23%) patients, urinary tract infection in 259(19.1%), nephrotic syndrome in 252 (18.6%), chronic renal failure in 202 (14.9%), urologic problems in 101 (7.5%), acute renal failure in 99 (7.3%), metabolic disorders in 47 (3.5%) and hypertension in 39 (2.9%). Acute poststreptococcal nephritis was the most common disease in the acute nephritis group. Minimal change nephrotic syndrome was the most common in the nephrotic syndrome group (64.2%). Chronic renal failure was mainly due to congenital urological malformations (46%). Acute renal failure (ARF) was caused mainly by gastroenteritis. There were six cases of ARF due to scorpion sting and 12 cases due to various malignancies and associated tumorlysis syndrome. Persistent hypertension was caused mainly by reflux nephropathy (50%). We conclude that the patterns of renal diseases found in the Iranian children were similar to those reported from other developing countries with predominance of infection related diseases.

There is a high prevalence of diabetes mellitus in the population of Saudi Arabia with the majority having non-insulin dependent diabetes mellitus (NIDDM). Random mid-day urine samples were obtained from 100 male [37 insulin dependants DM (IDDM) and 63 NIDDM] and 100 female (51 IDDM and 49 NIDDM) diabetic patients. Eighty-four patients were hypertensive (46 males and 28 females). One hundred and fifty­five subjects, not under medication and without clinical evidence of renal disease, hypertension, or diabetes mellitus were used as controls. Two urinary enzymes, N-acetyl-β­D-glucosaminidase (NAG) and alanine amino-peptidase (AAP) were measured in the urine, together with total protein and creatinine concentration. Microalbuminuria, glucose and pH were measured using test strips. Increased levels of both NAG and AAP were found in the diabetic subjects. Increased excretion of both these enzymes as well as microalbuminuria was found in the hypertensive groups. The high levels of urinary enzymes found, suggest that renal complications were prevalent in the groups studied. Because of the high incidence of diabetes in Saudi Arabia, a screening program should be established which would include urinary biomarkers for the early detection of renal damage.

To evaluate the incidence of tubulopathies in the long-term follow-up of children post renal transplantation, we reviewed the records of 43 patients from 1987-1996. There were 24 (56%) boys. The age of patients at the time of transplant ranged from 2.7 to 15 years. Eighteen children (78%) had transplantation from cadaver donors (CAD). Thirty-two (74%) patients were transplanted in Saudi Arabia and 11(26%) were transplanted abroad. Significant tubular dysfunction developed in 72% of patients. Renal Tubular Acidosis (RTA) occurred in 23/43 (53%) patients. The patients who received CAD grafts required higher mean dose of bicarbonate and longer duration of therapy compared to living related donors (LRD) recipients ( mean dose of 1.7 Vs 0.5 meq/kg/day and mean duration of 18 Vs 3 ½ months, respectively). Hypophosphatemia of various degrees of severity (0.4-0.8 mmol/1) was detected in 12 (28%) patients. Those who received CAD grafts required higher mean dose of phosphate and longer period of therapy than those who received LRD grafts. Hypomagnesemia requiring supplemental magnesium therapy occurred in 4 (9%) patients, all received tacrolimus therapy. In four patients with hypomagnesemia, this was mild and transient. Hypokalemia was found in 5 (11.5%) patients; all had CAD grafts. We conclude that tubulopathies were a frequent complication post renal transplantation in our population. They were more severe in the patients who received CAD grafts. However, the defects were controllable and transient.

Hepatitis C Virus (HCV) infection constitutes a major health issue in many hemodialysis (HD) units all over the world, including Saudi Arabia. Despite the isolation policy practiced in many dialysis units, the prevalence is still high. Current literature does not support isolation policy and actually points to the role of health care providers in transmitting the disease. This study has been conducted in a questionnaire format to investigate the nurses' knowledge about HCV and their practice inside the HD units. Structured questionnaires were distributed among 36 nurses in units with high prevalence for HCV (Group I) and 34 nurses in units with low prevalence (Group II). Comparison was made between the two groups. In both groups, 54% of nurses received their HCV education by nurse educator, 13% by physicians, 10% by both and 23% had no targeted education. There is no statistical difference in the providers of education between the two groups. Most nurses in both groups isolate patients on the line of HCV serostatus. The difference was observed in the method of isolation and the use of dedicated machines. Twenty-five nurses (69%) of group I practice ward isolation while 16 nurses (47%) of group II use this practice (P = .04). Twenty-five nurses (69%) of group I reported using HCV-dedicated machines in comparison to only seven nurses (20.5%) of group II (P = .001). All nurses in group II cleaned the machine surfaces and HD tables after each patient, while only 58% of nurses in group I did so after each patient, 39% at the end of the day and three percent never cleaned the surfaces (P <. 001). The number of dialysis patients cared for by a single nurse at a time in group I was 3.4 while in group II, it was 1.7 (P < .001). A mean of 2.5 gloves per patient were used by nurses from group I in contrast to eight gloves per patient used by those from group II (P > .003). In conclusion, HCV infection in high prevalence units is probably related to poor application of standard health precautions and that isolation does not prevent spread of the disease inside HD units. Improving the nurse: patient ratio and encouraging the liberal use of gloves, together with well implemented policies and practices, will result in a better control of HCV transmission in dialysis units.

A 50-year-old woman who was being treated with hemodialysis was admitted for severe neuropsychiatric symptoms. She tested positive for antibody to hepatitis C virus. Her medical history revealed ophthalmic herpes zoster four days before her admission for which she was started on oral acyclovir (800 mg three times daily). Four days later, she became disoriented and agitated. She had visual hallucinations and myoclonus. She was diagnosed as having acyclovir toxicity and was instituted on vigorous dialysis. The serum acyclovir levels normalized and the patient became asymptomatic with three dialysis sessions. Our case further reinforces that the dose of acyclovir should be reduced in patients with renal failure and that dialysis is a good form of treatment for over dosage.

Oligomeganephronia represents a distinct subgroup of renal hypoplasia in which there is a marked reduction in the number of nephrons with hypertrophy of those that are present. It can only be recognised on renal biopsy. We describe a 14-year-old boy who presents with a history of dysuria and some blood in his pants. Urinalysis showed no hematuria but persistent heavy proteinuria. The size of the kidneys on ultrasound was between -1 to -2 SD for height (right 9.3; left 9.6cm) and both kidneys showed a diffuse increase in echogenicity. The pathological features were diagnostic with a reduced number of greatly enlarged glomeruli indicating oligomeganephronia. No focal segmental glomerulosclerosis was identified but there was subcapsular fibrosis. Hyperfiltration in the small number of nephrons initially maintains the glomerular filtration rate at an acceptable level but by adolescence these children typically have progressive proteinuria, glomerulo­sclerosis and renal failure.

Renal amyloidosis (RA) is known to be one of the many complications of Behcet's disease (BD) but its frequency has been often underestimated. In this paper, we report on three cases of RA in a series of 105 patients with BD. RA was clinically suspected in our patients by the presence of edema and/or hypotension. The nephrotic syndrome was present in all of them and one patient had associated renal failure. Renal biopsy showed amyloid deposits type AA in all cases.Our patients received Colchicine at doses of 1 mg per day but with disappointing results. Their prognosis was significantely impaired with our three patients dying at ten years, six months and four weeks after diagnosis of RA. We will try, through this clinical experience and based on the relevant literature to better understand this kind of morbid association.

We report a 53 years old Saudi man a known diabetic for more than 15 years. He presented with lower abdominal pain, diarrhea and vomiting. He had symptoms and signs of sepsis. He had pancytopenia, renal failure, and his blood culture grew E.Coli. He remained febrile despite antibiotics administration for one week and developed crepitation over both thighs. Radiologically, plain-x ray, ultrasound and CT scan of the abdomen confirmed the presence of air in the left kidney involving the renal parenchyma and the collecting system and extensive gas in subcutaneous tissue of the thighs with abscesses. Repeated surgical drainage of the renal and the extra renal abscesses helped the antibiotic that was continued for several weeks to control the infection. Emphysematous pyelonephritis is a rare but life threatening condition that can be difficult to treat especially if the gas forming organism extends outside the kidney.

We evaluated retrospectively the etiology and outcome of acute renal failure (ARF) in 84 patients in Rasheed Renal Center in Baghdad, Iraq from June 1998 through March 1999. They were 82 males and 2 females with ages that ranged between 5 and 80 years. Prerenal ARF was the commonest type found in 45 (53.6%) patients followed by renal ARF in 33 (39.3%) patients and acute obstructive uropathy in six (7.1%) patients. Clinically, 74 patients presented with oligo-anuria, while 10 patients presented with non­oliguria. Of the oligo-anuric group, 61 (82.4%) patients required renal replacement therapy (RRT) and 50 (67.6%) patients had complete recovery. The mortality rate was 25.67% in the oliguric group, while none in the non-oliguric group required RRT and the complete recovery rate was 100%. The overall survival in both groups was (77.4%). The patterns of ARF in our center were mostly compatible with the previous reports from the region.

In a retrospective survey, 75 children with chronic renal failure (CRF) referred to our renal unit during 1989-2002 were studied. Their ages ranged from 10 days to 14 years (male to female ratio 1.7:1) and 64% of the cases were under one year of age. The mean annual incidence of CRF was 7.14%. All the patients had irreversible levels for creatinine corresponding approximately to a glomerular filtration rate less than 50 ml/min/1.73 m ² . The main etiological groups of primary renal disease were malformation of the urinary tract (45.3%), renal hypoplasia/dysplasia (18.7%), hereditary disorders (9.3%), glomerulopathies (6.7%), nephrotic syndrome (5.3%), while urinary system anomalies only made up 2.5% of the cases. The remaining (12%) had CRF of unknown etiology. Twenty-eight patients were treated for CRF of whom 13 patients were started on ambulatory peritoneal dialysis and five, on hemodialysis. Seven patients have undergone transplantation and three died.

To evaluate the patterns of chronic renal failure in children in our center, we studied prospectively the etiology and outcome of all the cases referred to us as renal disease between 1997-2002. There were 24 children;14 (58.3%) males and 10 (41.7%) females with a mean age of 11.2 + 0.97 years (range; 0.08-16.0 years). The estimated incidence was 1.7 new cases per million-child population and the prevalence was 4 per million populations. The leading causes of renal failure were glomerulonephritidis in 14 (58.3%) children and posterior urethral valve in 8 (33.3%). Most of the patients came from poor socio-economic background. Generalized body swelling 11 (45.8%), abdominal swelling 9 (37.5%) and paleness 7 (29.2%) were the commonest presenting complaints. Late presentation and severely compromised renal function were common features. The mortality rate was 58.3%. We conclude that there is an increased mortality rate in children with renal disease in our country due to the dearth of facilities for renal replacement therapy coupled with poverty and late referrals.