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Table of Contents
July-August 2012
Volume 23 | Issue 4
Page Nos. 677-889
Online since Monday, July 9, 2012
Accessed 236,535 times.
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ORIGINAL ARTICLES
Intestinal fungal and parasitic infections in kidney transplant recipients: A multi-center study
p. 677
Afsoon Emami Naeini, Mehran Sharifi, Shahrzad Shahidi, Shahram Taheri, Shiva Seirafian, Dyana Taheri, Mahdi Tazhibi, Sayyed Hosein Hejazi, Pardis Emami Naini, Asghar Amini Harandi
DOI
:10.4103/1319-2442.98110
Kidney transplant recipients are susceptible to various infections due to the use of immunosuppressive drugs. The present study was performed as studies on the prevalence of intestinal fungal and parasitic infections in kidney transplant recipients are limited. A total of 150 kidney transplant recipients and 225 matched immunocompetent outpatients, who were referred to the laboratory of Noor Hospital, Isfahan, were studied. After recording demographic characteristics, direct test and specific laboratory cultures were carried out on the stool specimens. Patients were instructed on sanitary rules and, during each medical visit, they were reminded of the same. The overall prevalence of intestinal parasitic and fungal infections was 33.3% and 58.7%, respectively, in transplant recipients and 20% and 51%, respectively, in the control group; the difference was not statistically significant. The most prevalent intestinal parasite was
Entameba coli,
which was seen in 9.3% of the study patients and 6.7% of the controls. The most prevalent fungus was Candida sp
.
, which was seen in 22% of the study patients and 24.4% of the control group. Coexisting infection with two or more fungi was seen in 14.8% and 3.4% in the case and control groups, respectively;
P
<0.001. Interestingly, there was no significant difference in the prevalence of infection by a single organism between the two groups. However, co-existing infection with two or more species was more prevalent in transplant recipients. We conclude that further investigations are needed to evaluate the pathogenesis of infection with these microorganisms.
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Graft outcomes in pediatric kidney transplantation: Focus on the role of race
p. 684
Ibrahim F Shatat, David J Taber, Sheetal Shrivastava, Nicole A Weimert, David J Sas, Kenneth D Chavin, John K Orak, Prabhakar K Baliga
DOI
:10.4103/1319-2442.98111
While significant racial disparities in graft outcome persist among adult and pediatric kidney transplant recipients in the US, some international studies do not show these differences. The aim of this study is to examine predictors of graft outcomes and the impact of race in our pediatric kidney transplant cohort. Records of 109 pediatric kidney transplant recipients performed at our institution between 7/99 and 4/07 were studied. Patients were grouped based on race: African-American (AA) vs. non-AA. Fifty-five AA (12 ± 5 years) and 54 non-AA patients (11 ± 6 years) were studied. There were more females, pre-emptive transplants and living donors in the non-AAs. Survival analysis showed significantly higher rejection rates in AAs,
P
= 0.02, and lower unadjusted graft survival (
P
= 0.09). Cox Proportional Hazards Survival Regression Analysis revealed biopsy-proven acute rejection and delayed graft function contributed to worse graft survival, while pre-emptive transplantation had a favorable effect. Race was not an independent risk factor for decreased graft survival in the final model. In conclusion, our cohort showed several modifiable risk factors that can partially account for poorer graft survival in pediatric AA kidney transplant recipients.
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Predicting long-term graft survival in adult kidney transplant recipients
p. 693
Brett W Pinsky, Krista L Lentine, Patrick R Ercole, Paolo R Salvalaggio, Thomas E Burroughs, Mark A Schnitzler
DOI
:10.4103/1319-2442.98112
The ability to accurately predict a population's long-term survival has important implications for quantifying the benefits of transplantation. To identify a model that can accurately predict a kidney transplant population's long-term graft survival, we retrospectively studied the United Network of Organ Sharing data from 13,111 kidney-only transplants completed in 1988- 1989. Nineteen-year death-censored graft survival (DCGS) projections were calculated and compared with the population's actual graft survival. The projection curves were created using a two-part estimation model that (1) fits a Kaplan-Meier survival curve immediately after transplant (Part A) and (2) uses truncated observational data to model a survival function for long-term projection (Part B). Projection curves were examined using varying amounts of time to fit both parts of the model. The accuracy of the projection curve was determined by examining whether predicted survival fell within the 95% confidence interval for the 19-year Kaplan-Meier survival, and the sample size needed to detect the difference in projected versus observed survival in a clinical trial. The 19-year DCGS was 40.7% (39.8-41.6%). Excellent predictability (41.3%) can be achieved when Part A is fit for three years and Part B is projected using two additional years of data. Using less than five total years of data tended to overestimate the population's long-term survival, accurate prediction of long-term DCGS is possible, but requires attention to the quantity data used in the projection method.
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Effect of lymph leakage on renal allograft outcome from living donors
p. 701
Abolfazl Bohlouli, Nariman Nezami, Afshar Zomorrodi, Sedigeh Abdollahifard, Bahram Hashemi
DOI
:10.4103/1319-2442.98113
Lymph leakage is a cause of prolonged fluid discharge in renal transplant patients. Lymph leakage during early post-transplantation is responsible for extracting immune substances; therefore, it may play a role in prognosis of the transplanted kidney. In this study, we aimed to investigate the effects of lymph leakage on different factors that play significant roles in renal allograft outcome. During the present case-control study, we evaluated 62 renal allograft recipients in which 31 subjects were complicated with lymph leakage and enrolled as the study group. The other 31 subjects were included in the control group who did not experience any lymph leakage during their post-transplantation period. All kidneys were transplanted from living donors. We investigated and compared the renal allograft rejection rate, hospitalization duration, serum urea, creatinine (Cr) and cyclosporine (CsA) levels, antithymoglobin (ATG) administration and treatment duration between the study and the control groups. There were no significant difference in the urea and Cr levels between the two groups (
P
>0.05). Early (one week) and late (one month) serum CsA levels of the study group were significantly higher than in the control group (
P
= 0.005 and
P
= 0.006). The number of days in which ATG receivers responded to therapy was significantly lower for the control group (
P
= 0.008). 21.93% of the study group subjects experienced allograft rejection, while this rejection probability was 28.38% for the control group (
P
= 0.799). Lymph leakage has no prominent role in renal function, which is estimated by Cr and urea levels in patients' serum during the days after transplantation. CsA level was higher in patients with lymph leakage, and all cases of allograft rejection were in the subjects with lymph leakage.
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Graft survival rate following renal transplantation in diabetic patients
p. 707
AR Rajaeefard, A Almasi-Hashiani, J Hassanzade, H Salahi
DOI
:10.4103/1319-2442.98143
Diabetic nephropathy is the most common cause of kidney failure needing dialysis in most countries of the world. Kidney disease occurs in one-third of diabetic patients, and significantly increases the mortality rates and treatment costs. The aim of the present study was to investigate the survival rate and to determine factors that influence survival among diabetic patients who underwent transplantation at the Shiraz Namazi Hospital Transplant Center during the years 1999 to 2009. This study is a historical cohort study, which examined the graft survival rate among 103 kidney transplant patients with diabetes. The Kaplan-Meier method was used to determine the survival rate and the log-rank test was used to compare survival curves;
P
-value of less than 0.05 was considered significant. The mean follow-up period of patients was 48.15 ± 31.05 months (range: 3.07-118.03 months), and the estimated nine-year graft survival rate was 84.2% (±0.045). Based on the results of the Cox regression model, age of the donor was a contributing factor to graft survival rate. In summary, the graft survival rate in our cohort is satisfactory and comparable with reports from other larger centers in the world.
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The use of micro pulse oximetery as a new detector of tissue perfusion in solid organ transplantation
p. 715
Alireza Rasekhi, Maryam Sharifian, Koroush Kazemi, Seyed Ali Malek Hosseini
DOI
:10.4103/1319-2442.98144
Vascular complications are a frequent cause of transplant failure; angiography, duplex sonography, computerized tomography (CT) scan, CT-angiography and microdialysis are the methods that were suggested for the detection of arterial obstruction after transplantation. In this study, we suggest a new method. Eight healthy adult dogs were included in the trial. All cases were operated by the same surgeon and the liver, pancreas, spleen, kidney and bowel tissue were exposed. The probes of the device, which were designed for this study, were inserted on the organ parenchyma. The device, a neonatal pulse oximeter, has two probes that were fixed by a holder in front of each other; the distance between the probes was changeable via a spring. The pulse and the oxygen saturation of the tissue were measured initially. Following this, by inducing ischemia with vessel clamping, the pulse and the oxygen saturation were measured again. The collected data were analyzed under the supervision of a statistician. In the liver and spleen, we could not detect a clear pulse wave and oxygenation. On the other hand, in the pancreas, kidney and bowel, we detected a clear curve of oxygenation and pulse in all cases. Obstruction caused significant changes: the pulse was not detected and the oxygenation decreased significantly. Our study suggests that with early diagnosis, the surgeons can detect arterial occlusion immediately and early intervention may decrease parenchymal damage. This study is the first experience in this field, and these findings need to be validated with further studies.
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Neuropathy in type 1 diabetic renal transplanted patients
p. 719
Hamid Noshad
DOI
:10.4103/1319-2442.98146
This study was undertaken to study the changes in neuropathy in type 1 diabetic patients with end-stage renal disease (ESRD) after renal transplantation. From April 2007 to June 2010, 30 renal transplanted patients with type 1 diabetes mellitus (RT) and 30 type 1 diabetic patients with ESRD were enrolled in this study. Electroneurodiagnostic tests of peroneal, sural, ulnar, and median nerves were performed. Nerve conduction velocity (NCV), compound motor action potentials (CMAPs), and sensory nerve action potentials (SNAPs) were analyzed at 6, 12, and 18 months after renal transplantation. The NCV improved in the RT group in 18 months of the follow-up period (
P
<0.01 versus baseline). This parameter worsened significantly in the control group throughout the study period (
P
= 0.03), but in the cross-sectional analysis between the groups, we could not find any remarkable differences (
P
= 0.07). Both SNAP and CMAP amplitudes improved in the RT (SNAP
Sural
= 0.04, SNAP
Median
= 0.01 and CAMP
Peroneal
= 0.03, CAMP
Ulnar
= 0.02) but worsened in the control group (SNAP
Sural
< 0.001, SAP
Median
< 0.01 and CAMP
Peroneal
< 0.01, CAMP
Ulnar
< 0.01). Comparison of both groups did not show any significant statistical changes. Electroneurodiagnostic values improved after renal transplantation in type 1 diabetic patients with ESRD, but cross-sectional analysis did not reveal statistically significant differences between the studied groups.
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The perception of organ donation among health-care providers in the intensive care units at a tertiary center
p. 724
Mohammad Alsultan
DOI
:10.4103/1319-2442.98147
The growing demand for organs continues to outpace the supply. The aim of our study was to evaluate the knowledge, attitude and awareness of organ donation procedures among the health-care providers in the Intensive Care Units (ICUs) at a tertiary hospital. This was a questionnaire-based study conducted in December 2011 among the health-care providers at five ICUs in a tertiary teaching hospital in Riyadh, Saudi Arabia. A total of 154 participants completed the questionnaire. Eighty percent of the participants acknowledged that organ donation is a legal practice in Saudi Arabia, but only 73% knew that the hospital had an organ donation policy. However, only 34% were willing to participate in a training program for organ donation. Interestingly, only 57% were willing to donate their organs. Our results suggest that more measures should be taken to educate the health-care providers regarding the concept of organ donation and the ethical and religious beliefs. Also, the policy of the hospital and the Saudi Center for Organ Transplantation regarding the process of organ donation should be strongly emphasized.
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Fatigue and depression and sleep problems among hemodialysis patients in a tertiary care center
p. 729
Bincy Joshwa, Deepika C Khakha, Sandeep Mahajan
DOI
:10.4103/1319-2442.98149
High prevalence of sleep problems, fatigue and depression are reported in maintenance hemodialysis (MHD) patients. To assess fatigue, depression, sleep problems and their co-relates among MHD patients in a tertiary care center in India, we studied 47 patients on MHD for >3 months. Patients demographic, medical and co-morbidity profile were recorded. Pittsburgh Sleep Quality Index (poor sleeper if score >5) and Epworth Sleepiness Scale (EPSS, abnormal daytime sleepiness if score >13) were used to assess sleep abnormalities and quality. Beck Depression Inventory (BDI) was used to screen for depression. Depression was classified on BDI scores as mild-moderate (score 11-30) and severe (score >30). Fatigue Severity Scale was used to assess fatigue (score ≥36 indicates fatigue). The correlations of these parameters among themselves and with social and demographic parameters were also analyzed. The mean age of the study population was 37.1 ± 13.1 (range 19-65 years) years, with 89.3% being males. The majority (68.1%) of the MHD patients was poor sleepers, but only five (10.6%) patients had borderline or abnormal daytime sleepiness. Of the patients, 44.7% reported fatigue and (72.3%) had depression (mild to moderate in 59.7% and severe in 12.6%). Fatigue scores were found to be significantly associated with lesser frequency of dialysis (
P
< 0.05). There was higher daytime sleepiness in patients who were working (mean EPSS score 6.2 ± 3.7) than who were unemployed (mean EPSS score 3.9 ± 2.7). Depression was found to be higher in those who were paying for the treatment themselves (mean BDI score 20 ± 11.8) as compared with those who were getting medical expenditure reimbursed (mean BDI score 12.9 ± 8.8). Fatigue positively correlated with that of daytime sleepiness (
P
= 0.02), poor nighttime sleep (
P
= 0.02) and depression (
P
=0.006). In the present study, there was no correlation (
P
<0.05) found between daytime and night time sleep and depression. We found a high prevalence of fatigue, depression and poor sleep quality in our MHD patients. These abnormalities are closely related to each other and to the socioeconomic and demographic profiles of the population.
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Association of adiponectin with cardiovascular events in diabetic and non-diabetic hemodialysis patients
p. 736
Amir Elokely, Amira Shoukry, Tarek A Ghonemy, Mrwan Atia, Ghada Amr
DOI
:10.4103/1319-2442.98151
Adiponectin is a novel collagen-like protein synthesized by white adipose tissue. Its levels are decreased in obesity, type-2 diabetes and insulin-resistant states, and are increased in chronic renal failure. It has anti-inflammatory and anti-atherogenic properties. This study was planned to evaluate the levels of adiponectin in uremic patients with and without diabetes and to find any relationship between adiponectin levels and some cardiovascular risk factors, and to determine the possible predictive value of adiponectin for cardiovascular complications (CVC). The study included 100 subjects, 20 of them were healthy subjects and served as the control group (group I), 40 were uremic non-diabetic patients (group II) (half of them were without CVC, group IIA, and the other half were patients with CVC, group IIB) and, lastly, 40 uremic diabetic patients (group III) (half of them were without CVC, group IIIA, and the other half were patients with CVC, group IIIB). All subjects were subjected to complete clinical examination, including determination of mean arterial blood pressure (MABP), body mass index (BMI), waist to hip ratio, routine laboratory investigations, fasting plasma glucose, fasting plasma insulin, lipid profile (cholesterol, TG, LDL, HDL), determination of insulin resistance by homeostasis model assessment index (HOMA-IR) and estimation of serum levels of adiponectin. There was a significant increase in serum adiponectin levels in all the uremic patients (group II and group III) when compared with the control (group I) group,
P
<0.01; also, serum adiponectin levels were significantly decreased in uremic diabetic patients (group III) when compared with uremic non-diabetic patients (group II),
P
<0.01; but this was still higher than in the controls. The patients with CVC, whether uremic non-diabetic (group IIB) or uremic diabetic (group IIIB), had a significant decrease in serum adiponectin levels when compared with patients without CVC (group IIA and group IIIA),
P
<0.01. Serum adiponectin has a significant positive correlation with HDL and a significant negative correlation with MABP, BMI, plasma insulin, HOMA-IR, LDL, TG and cholesterol in all the patients. Therefore, it can be concluded that adiponectin levels in uremic patients, whether diabetic or non-diabetic, may be a good indicator of cardiovascular disease risk.
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Cefotaxime-heparin lock prophylaxis against hemodialysis catheter-related sepsis among
Staphylococcus aureus
nasal carriers
p. 743
Anil K Saxena, Bodh R Panhotra, Abdul Aziz Al-hafiz, Dasappan S Sundaram, Bassam Abu-Oyun, Khalifa Al Mulhim
DOI
:10.4103/1319-2442.98154
Staphylococcus aureus
nasal carriers undergoing hemodialysis (HD) through tunneled cuffed catheters (TCCs) form a high-risk group for the development of catheter-related bloodstream infections (CRBSI) and ensuing morbidity. The efficacy of antibiotic-locks on the outcomes of TCCs among
S. aureus
nasal carriers has not been studied earlier. Persistent nasal carriage was defined by two or more positive cultures for methicillin-susceptible (MSSA) or methicillin-resistant (MRSA)
S. aureus
of five standardized nasal swabs taken from all the participants dialyzed at a large out-patient HD center affiliated to a tertiary care hospital. Of 218 participants, 82
S. aureus
nasal carriers dialyzed through TCCs (
n
= 88) were identified through April 2005 to March 2006 and randomized to two groups. Group I comprised of 39 nasal carriers who had TCCs (
n
= 41) "locked" with cefotaxime/heparin while group II included 43 patients with TCCs (
n
= 47) filled with standard heparin. The CRBSI incidence and TCC survival at 365 days were statistically compared between the two groups. A significantly lower CRBSI incidence (1.47 vs. 3.44/1000 catheter-days,
P
<0.001) and higher infection-free TCC survival rates at 365 days (80.5 vs. 40.4%,
P
<0.0001) were observed in the cefotaxime group compared with the standard heparin group. However, no significant difference in MRSA-associated CRBSI incidence was observed between the two groups. Cefotaxime-heparin "locks" effectively reduced CRBSI-incidence associated with gram-positive cocci, including MSSA, among
S. aureus
nasal carriers. There remains a compelling requirement for antibiotic-locks effective against MRSA.
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Results of recombinant growth hormone treatment in children with end-stage renal disease on regular hemodialysis
p. 755
Doaa Mohammed Youssef
DOI
:10.4103/1319-2442.98157
Children with chronic kidney disease are at high risk for growth retardation and decreased adult height. Growth hormone (GH) treatment is known to stimulate growth in children with short stature suffering from chronic kidney disease. However, the extent to which this therapy affects final adult height is not known. This study was performed on 15 patients with endstage renal disease (ESRD) on regular hemodialysis to detect the effect of using recombinant human growth hormone (rhGH) on growth of patients with ESRD on regular hemodialysis and comparing this effect with the growth velocity in the same group without using rhGH in the year before therapy. There were eight females and seven males with mean age 10.6 ± 2.8 (range 5-14 years). For each patient, recombinant GH was given for one year, three-times weekly. The data of these 15 patients was compared with the year before treatment versus data of the same group of patients after six months and after one year of rhGH therapy. Our results showed that, in the year before therapy, height of these patients increased from a mean of 112.1 ± 11.6 cm to 112.7 ± 11.5 cm, which is a non-significant increase statistically (
P
>0.05) as well as clinically (mean growth velocity 0.6 cm/year), while height of these patients increased from a mean of 112.7 ± 11.5 cm at the start of therapy to 116.8 ± 11 cm after therapy for one year, which, although statically not significant (
P
>0.05), was of clinical significance as it makes rate of increase, i.e. the mean growth velocity, 4.1 cm/year close to the normal growth velocity, which is 5 cm/year, before puberty. rhGH therapy for patients with ESRD on regular hemodialysis is helpful in height gain and catch-up growth even when given three-times per week instead of five- or six-times per week. We recommend giving rhGH therapy as a routine supplementation to pediatric patients before epiphyseal closure.
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Matricaria chamomilla
attenuates cisplatin nephrotoxicity
p. 765
Ragaa H.M. Salama
DOI
:10.4103/1319-2442.98158
Matricaria chamomilla
is extensively consumed as a tea or tonic. Despite its widespread use as a home remedy, relatively few trials evaluated its benefits in nephro protection. Hence, this study evaluates the protective role of
M. chamomilla
in cisplatin nephrotoxicity rat model. The study was conducted on 32 rats divided into four groups. The first group (G1) was injected with saline intra-peritoneally (IP); G2 was injected with 5 mg/kg cisplatin on day 0 of the experiment and repeated four times, with five days free interval. G3 and G4 were injected daily with
M. chamomilla
(50 mg/kg) IP, starting five days before the experiment (-5 day); in addition, G4 was injected with cisplatin. On day 16, animals were scarified and serum and/or kidney tissue was used to determine: (a) kidney function tests (serum urea, creatinine, gamma glutamyl transferase (GGT), NAG, β-gal), (b) oxidative stress indices (NO, LPO), (c) antioxidant activities (SOD, GSH, total thiols), (d) apoptotic indices (Cathepsin D, DNA fragmentation) and (e) mineral (calcium).
M. chamomilla
significantly increased the body weight, normalized the kidney functions, improved the apoptotic markers, reduced the oxidative stress markers and corrected the hypo-calcemia that resulted from cisplatin nephrotoxicity.
M. chamomilla
is a promising nephro-protective compound reducing cisplatin nephrotoxicity most probably by its antioxidant activities and inhibition of gamma glutamyl transferase activity.
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Nephroprotective effect of Kabab chini (
Piper cubeba
) in gentamycin-induced nephrotoxicity
p. 773
Qazi Zaid Ahmad, Nasreen Jahan, Ghufran Ahmad, Tajuddin
DOI
:10.4103/1319-2442.98159
Kabab chini (KC) (
Piper cubeba
) is an important drug in Unani Medicine, widely described to be effective in renal diseases, and physicians are using it as a protective and curative agent in various renal disorders from ancient times. The present study was designed to evaluate the nephroprotective effect of KC against gentamycin-induced nephrotoxicity in Wistar rats. This was studied in two different sets of tests, in which both the protective as well as the curative effects were evaluated in groups of albino rats. The powder of the test drug was administered orally in a dose of 810 mg/kg and 1220 mg/kg, in suspension form, in the pre- and post-treated models. The nephroprotective effect was assessed on the basis of biochemical estimation of serum urea and creatinine levels and histopathological examination of the treated kidney. The effect observed in the pre-treated and post-treated groups was compared with plain as well as negative control groups using one-way ANOVA with Dunnett's multiple pair comparison test. The findings of the two tests demonstrated that KC produced a significant nephroprotective effect in both pre-treated and post-treated groups. The results of our study indicate that KC possesses significant benefit against gentamycin-induced nephrotoxicity.
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The effect of sublingual isosorbide dinitrate on acute urinary retention due to benign prostatic hyperplasia
p. 782
Farhad Tadayyon, MohammadHossein Izadpanahi, Saeed Aali, Hamid Mazdak, Mohammad-Hatef Khorrami
DOI
:10.4103/1319-2442.98160
Acute urinary retention (AUR) is one of the most important long-term complications of benign prostatic hyperplasia (BPH). Nitric oxide (NO) as a transmitter can relax smooth muscles of the bladder neck and external sphincter. Several studies have reported that sublingual isosorbide dinitrate (ISDN), as a NO donor, can lead to significant decrease in resting pressure of the external sphincter, and its rapid onset of action may be useful in the treatment of AUR. This study was designed to asses the effect of ISDN on AUR in patients with BPH. In this clinical trial, 60 men with BPH-induced AUR were randomly selected via a simple sampling method. Participants were randomly divided into case and control groups. Patients in the case group received 200 mg of sublingual ISDN and participants in the control group received placebo. After 20 min, participants were asked to void spontaneously and the urine was collected in scale containers. Following this, urethral catheterization was done on all the participants and the residual urine was measured. Data were analyzed using SPSS version 15. There was no significant difference in the mean age of the two groups (
P
-value = 0.28). The mean voided urine volume in the case group was 201 mL and, in the control group, it was 18 mL (
P =
0.004). About 30% in the case group and 3.3% in the control group could void spontaneously after receiving ISDN or placebo (
P
= 0.006). In the case group, there was a significant correlation between voided urine volume and total urine volume in the bladder (
P
= 0.03) and in the size of the prostate (
P =
0.001). Our study shows that ISDN can be effective in the treatment of BPH-induced AUR with decrease in bladder outlet resistance. ISDN is more effective in younger men and in those with smaller prostates.
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CASE REPORTS
Synchronous primary cancers of urinary bladder and kidney and prostate
p. 786
Punit Tiwari, Astha Tripathi, Punit Bansal, Mukesh Vijay, Aman Gupta, Anup Kumar Kundu
DOI
:10.4103/1319-2442.98161
Synchronous occurrence of two or more than two primary cancers of the urinary tract is quite rare, and poses a difficult treatment challenge. Here, we present a case of synchronous renal cell carcinoma, transitional cell carcinoma of urinary bladder and adenocarcinoma of prostate diagnosed within a short period. To the best of our knowledge, this is the first case reported from India and the youngest patient reported in the literature having this combination of urinary cancers.
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Mycophenolate mofetil associated with progressive multifocal leukoencephalopathy with successful outcome
p. 790
Driss El Kabbaj, Mohammed Hassani, Mouncif Kadiri, Jamal Mounach, Hamid Ouhabi, Charki Haimeur, Zouhir Oualim
DOI
:10.4103/1319-2442.98162
The use of mycophenolate mofetil (MMF) is known to be associated with progressive multifocal leukoencephalopathy (PML). We report a case of PML in a patient receiving MMF, who showed improvement upon discontinuation of the drug. He was restarted on MMF, following which he went into coma. He showed prompt recovery upon stopping the drug again and made full recovery without any residual neurological deficit. This case is being reported to further highlight this neurological side-effect of MMF.
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Simultaneous hemorrhage in intracranial aneurysms and in renal cyst in a case of polycystic kidney disease
p. 794
Amit Agrawal, Sankalp Dwivedi, Brij Raj Singh, Pankaj J Banode
DOI
:10.4103/1319-2442.98163
We report an unusual case of simultaneous hemorrhage in intracranial aneurysms and in renal cyst in a case of polycystic kidney disease. A 27-year-old gentleman presented with progressive headache and intermittent vomiting of one month duration. Initial computerized tomography (CT) scan and magnetic resonance imaging/angiography revealed a large mass lesion in the right temporal fossa. Over the previous 15 days, he developed progressive weakness in his left upper and lower limbs, and the headache worsened in severity. A repeat of CT scan showed an evidence of aneurysmal bleed and a large temporal lobe hematoma. The patient underwent urgent evacuation of the intracerebral of hematoma and excision of the redundant aneurysmal sac. The patient made excellent recovery in the post-operative period; however, for him, the pain abdomen was persisting. Detailed work-up with contrast-enhanced abdominal CT scan revealed bilateral multiple cysts in the kidneys with evidence of intracystic hemorrhage on the left side. An extensive search of the literature revealed that this kind of presentation has not been reported previously.
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Dural sinus thrombosis - A rare manifestation of internal jugular venous occlusion
p. 799
Pooja Binnani, MM Bahadur, Kuldeep Dalal
DOI
:10.4103/1319-2442.98164
The dural sinus thrombosis is an uncommon complication of a commonly done procedure of central venous catheterisation. We present a case of massive hemorrhagic venous infarct with gross cerebral edema due to dural sinus thrombosis along with right internal jugular vein thrombus. A 21-year-old male patient presented to the emergency department with fever and swelling of the right neck four days following discharge after his prior hospitalization two weeks ago for acute renal failure due to severe gastroenteritis, when he underwent hemodialysis through right internal jugular access. On presentation, he was conscious, with swelling on right side of the neck, which was diagnosed as right internal jugular vein occlusion. However, he rapidly deteriorated and developed signs of raised intracranial pressure despite being on treatment with heparin. He was diagnosed as having massive hemorrhagic cerebral venous infarct with gross cerebral edema complicated with shift of the ventricles to the left due to dural sinus thrombosis. Despite emergency decompressive craniotomy, he succumbed in the next two days due to coning. Asymptomatic catheter-related thrombosis is frequent in the intensive care units, but major complications like retrograde extension into dural sinus causing thrombosis is rare. A high index of suspicion is required to diagnose this major catastrophe for an early and meaningful intervention.
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ARC syndrome with complex renal problems: Nephrocalcinosis, proximal and hyperkalemic distal RTA and nephrogenic diabetes insipidus
p. 804
Majid Malaki, Rafeei Mandana, Shamsi Ghaffari
DOI
:10.4103/1319-2442.98165
We present a female neonate with arthrogryposis, renal tubular abnormalities and cholestasis syndrome and complex renal structural and functional abnormalities that include medullary nephrocalcinosis, hydronephrosis, nephrogenic diabetes insipidus, Fanconi syndrome, proximal and distal hyperkalemic renal tubular acidosis, near-nephrotic range proteinuria, hypercalciuria and severe hypovitaminosis D.
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Collecting duct carcinoma: A rare renal tumor
p. 810
Punit Bansal, Suresh Kumar, Neeru Mittal, Anup K Kundu
DOI
:10.4103/1319-2442.98166
The most common primary malignant renal tumor is renal cell carcinoma (RCC), which accounts for 3% of all adult malignancies. Bellini duct carcinoma or collecting duct carcinoma is an unusual rare variant of RCC. This histologically distinct tumor is very rare, with less than 100 cases reported in the literature, and accounts for approximately 1% of all malignant renal epithelial tumors. We report two cases of collecting duct carcinoma and highlight the rarity of these tumors and their similarity to RCC.
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Pheochromocytoma of the urinary bladder: A rare cause of severe hypertension
p. 813
Abhinandan M Hanji, Vinayak S Rohan, Jayesh J Patel, Rajena A Tankshali
DOI
:10.4103/1319-2442.98167
Paraganglioma of the urinary bladder is a rare entity, and accounts for less than 0.5% of all bladder tumors. In the genitourinary tract, the urinary bladder is the most common site for paragangliomas. These tumors commonly present with hematuria and intermittent hypertension during micturition along with generalized symptoms due to raised catecholamines. Surgical removal is the treatment of choice, with most of the patients requiring at least a partial cystectomy. We herewith report a 38-year-old lady who presented with a two month history of pain abdomen, burning micturition, headache and uncontrolled hypertension. Detailed investigations revealed a pheochromocytoma of the urinary bladder, which was treated with partial cystectomy, following which her blood pressure stabilized.
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SPECIAL ARTICLE
Organ transplantation: A Sunni Islamic perspective
p. 817
Mohammed Albar
DOI
:10.4103/1319-2442.98169
This paper reviews the standpoints of Muslim jurists within the Sunni tradition on organ transplantation. Muslim jurists allowed different forms of bone grafts (autograft, allograft and xenograft) for widely broken bones. Ibn Sina in 1037 discussed this subject in Al-Kanoon 1000 years ago. In 1959, the Muftis of Egypt and Tunisia allowed, under specific conditions, corneal transplants from dead persons. Thereafter, many fatwas (jurisprudence) on organ transplantation have been issued from different parts of the Muslim world. In Amman, Jordan, the International Islamic Jurist Council recognized brain-death as a recognized sign of death in Islam in October 1986. This paved the way for organ transplantation from brain-dead persons, which started immediately in Saudi Arabia. In 1990 and 2003, the International Islamic Fiqh Academy (IIFA) and the Islamic Fiqh Academy (IFA) issued important fatwas on organ transplantation. By the end of 2008, more than 3600 organs were transplanted from brain-dead persons in Saudi Arabia.
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BRIEF COMMUNICATIONS
Comparison of 5 IU and 10 IU tuberculin test results in patients on chronic dialysis
p. 823
H Tayebi Khosroshahi, E Akhtari Shojaie, D Habibzadeh, B Hajipour
DOI
:10.4103/1319-2442.98171
Immunocompromised patients such as those with end-stage kidney failure undergoing hemodialysis (HD) are at increased risk of developing tuberculosis (TB). For this reason, routine TB screening of HD patients with tuberculin test has been recommended. The Center for Disease Control and Prevention (CDC) has recommended that patients with chronic renal failure should undergo annual skin testing for TB with tuberculin [purified protein derivative (PPD)], with an induration of ≥10 mm at 48 h depicting a positive reaction. The aim of this study was to compare the results of two different doses of PPD in dialysis patients. This descriptive and comparative multicenter study was performed on 255 patients on chronic dialysis in Tabriz, Iran. These patients did not have the PPD test done within the preceding one year. Patients were divided into two groups randomly and conventional or double-dose tuberculin test was performed using the Mantoux technique with 5 IU (group 1) and 10 IU (group 2) of PPD. Results were interpreted 48-72 h after injection. Patients were divided into those with less than 10 mm and those with ≥10 mm duration. Mean age was 44.6 ± 15 years (M/F = 1.5/1). The mean duration on dialysis was 39 ± 7 months. There was no significant difference regarding the age, gender, duration on dialysis, causes of chronic kidney disease, erythrocyte sedimentation rate, C-reactive protein and serum albumin between the two groups. The mean induration was 4.6 mm and 7.7 mm in groups 1 and 2, respectively. There was induration ≥10 mm in 19.6% and 25.5% of group 1 and 2, respectively, which showed a significant difference (
P
<0.05). In conclusion, because of the high frequency of TB in dialysis patients, an annual tuberculin test may be recommended. Our study showed that the double-dose tuberculin test may be a better substitute to the conventional test in dialysis patients.
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Evaluation and applicability of predictive equations of the glomerular filtration rate in chronic kidney disease
p. 827
Manian Raghul, Manickavasagam Kannapiran, Ambarkar Madhusudhana Rao
DOI
:10.4103/1319-2442.98173
Prediction equations of glomerular filtration rate (GFR) may facilitate early detection, evaluation and management of chronic kidney disease (CKD). However, the reliability of these equations was not extensively studied in our CKD population. Hence, the present study was aimed to determine the performance of modification of diet in renal disease (MDRD) and Cock-croft Gault formulas in predicting GFR in CKD patients and their relationship with the measured GFR. A total of 104 subjects (71 male and 33 female, aged 26-68 years) with different stages of CKD were recruited for this study; we excluded 51 patients due to improper collection of 24-h urine. The GFR was measured using 24-h creatinine clearance and predicted by the Cockcroft Gault, the 4-variable MDRD and the 6-variable MDRD equations. Prediction equations correlated well with the measured GFR. However, the predicted GFR using the 4-variable MDRD equation revealed a highly significant positive correlation with the GFR measured by creatinine clearance (r = 0.86,
P
< 0.001), followed by the 6-variable MDRD and Cockcroft-Gault equations with r = 0.85 and 0.77,
P
< 0.001, respectively. In conclusion, the present study predicts that the 4-variable MDRD is the best available equation for predicting GFR in our CKD population.
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LETTERS TO THE EDITOR
Urinary tract infection in the kidney allograft recipients
p. 832
NK Rathnamalala
DOI
:10.4103/1319-2442.98174
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Pregnancy desire unmasks a MYH9 syndrome in a kidney transplant woman
p. 834
Gisella Vischini, Fabio Farneti, Pasquale Niscola, Ada Stefoni
DOI
:10.4103/1319-2442.98175
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Does zinc supplementation help in the treatment of anemia in patients on hemodialysis?
p. 836
Maryam Sharifian, Jamshid Roozbeh, Mohammad Mahdi Sagheb, Sanaz Shabani, Alireza Hamidian Jahromi, Raha Afsharinai, Oveis Salehi, Ghanbarali Raais Jalali
DOI
:10.4103/1319-2442.98177
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Endovascular management of iatrogenic renal artery aneurysm and arteriovenous fistula
p. 838
Yesilkaya Yakup, Peynircioglu Bora, Cil Barbaros, Gulek Bozkurt, Demirbas Burak, Bilen Yucel Cenk
DOI
:10.4103/1319-2442.98180
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Classical laboratory and point of care tests for screening for microalbuminuria
p. 841
Viroj Wiwanitkit
DOI
:10.4103/1319-2442.98181
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Increased urinary frequency: An unusual presentation of
Plasmodium falciparum
malaria
p. 844
Syed Ahmed Zaki, Preeti Shanbag
DOI
:10.4103/1319-2442.98182
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Distal renal tubular acidosis associated with non-autoimmune hypothyroidism
p. 846
Bashir Ahmad Laway, Imran Ali, Mir Iftikhar Bashir, Shahnaz Ahmad Mir, Mohd. Ashraf Ganie, Imtiyaz Ahmad Wani
DOI
:10.4103/1319-2442.98185
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A rare presentation of an enlarged isthmus of a horse shoe kidney composed of a well-differentiated renal architecture
p. 850
Anup Shyamal, Pradeep Bokariya, Aaditya Tarnekar, Indira V Ingole
DOI
:10.4103/1319-2442.98186
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RENAL DATA FROM THE ARAB WORLD
Short- and long-term outcomes of kidney donors: A report from Tunisia
p. 853
Imed Helal, Taieb Ben Abdallah, Monder Ounissi, Gargah Tahar, Mejda Cherif, Karima Boubaker, Cyrine Karoui, Fethi Ben Hamida, Ezzedine Adberrahim, Fethi El Younsi, Adel Kheder, Mohamed Sfaxi, Amine Derouiche, Mohamed Chebil, Jamil Hachicha, Mohamed Nabil Mehiri, Habib Skhiri, Mezri Elmay, Kais Harzallah, Mezri Jamel Elmanaa, Jalel Hmida
DOI
:10.4103/1319-2442.98187
Kidney transplantation remains the best treatment option of end-stage renal disease. Kidney donations are of particular interest with the currently increasing practice of living-donor transplantation. The purpose of this study was to analyze retrospectively the general health status as well as renal and cardiovascular consequences of living-related kidney donation. A total of 549 living-related kidney donors had donated their kidneys between 1986 and 2007. We attempted to contact all donors to determine short- and long-term outcome following kidney donation. All kidney donors who responded underwent detailed clinical and biochemical evaluation. The data were compared with age-matched health tables of the Tunisian general population. In all, 284 donors (52%) had a complete evaluation. They included 117 men and 167 women with a mean age of 42 ± 12 years. The major perioperative complications that occurred in these donors included four cases of pneumothorax, six cases of surgical site infection, one case of phlebitis and one case of pulmonary embolism. None of the study cases died. The median length of hospital stay after donor nephrectomy was 6.5 days (range: 3-28 days). The median follow-up period was eight years. The mean creatinine clearance after donation was 90.4 ± 25 mL/min in men and 81.5 ± 27.2 mL/min in women. Proteinuria was >300 mg/24 h in 17 cases (5.9%). Fifty-eight (20.4%) donors became hypertensive and 19.6% of the men and 37.2% of the women became obese. Diabetes mellitus developed in 24 (8.4%), and was more common in patients who had significant weight gain. Our study suggests that kidney donors have minimal adverse effects on overall health status. Regular follow-up identifies at-risk populations and potentially modifiable factors. Creation of a national registry of living donors and their monitoring are an absolute necessity.
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Risk factors associated with albuminuria in Kuwaiti adults with type 2 diabetes
p. 860
Afaf Al-Adsani
DOI
:10.4103/1319-2442.98189
There are no available data about the factors associated with diabetic nephropathy (DN) in Kuwaiti individuals with type 2 diabetes. This study was conducted on 154 consecutive Kuwaiti adults with type 2 diabetes who attended the diabetic out-patient clinic at Al-Sabah Hospital to determine the factors associated with albuminuria among them. Albuminuria was considered to be present if the urinary albumin:creatinine ratio test or 24-h collection was positive on two occasions. There were 102 (66.2%) women and 52 (33.8%) men, with a mean age of 49.1 ± 10.1 years and a median duration of diabetes for 6 years. Hypertension was found in 60.8% of the patients and 16.3% had an HbA
1c
<7%. Albuminuria was found in 43.5% of the patients. The prevalence of microalbuminuria and macroalbuminuria was 27.3% and 16.2%, respectively. In the univariate analysis, the factors that were significantly associated with albuminuria were hypertension - both systolic and diastolic blood pressure levels, HbA
1c
, retinopathy, duration of diabetes, and modality of treatment. Multiple logistic regression analysis indicated that hypertension was the main independent risk factor associated with albuminuria (OR 4.1, 95% CI 1.1- 15.0;
P
= 0.03). In conclusion, although albuminuria is common among Kuwaiti adults with type 2 diabetes, the prevalence is lower than that reported for other populations in spite of the poor glycemic control and the high prevalence of hypertension. Factors associated with albuminuria appear to be similar to other populations, and hypertension was the most independent factor. Early recognition and treatment of hypertension is an important strategy to prevent or delay DN as well as cardiovascular morbidity and mortality. A population-based study is warranted to confirm these findings and to search for genetic linkage for the development of DN.
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A five-year analysis of the incidence of glomerulonephritis at Cairo University Hospital-Egypt
p. 866
Salwa Ibrahim, Ahmed Fayed, Sawsan Fadda, Dawlet Belal
DOI
:10.4103/1319-2442.98191
Our study aimed to obtain a comprehensive review of the incidence of biopsy-proven glomerulonephritis (GN) at the Cairo University Hospitals, Egypt, over the last five years. We analyzed the clinical and pathological data of all renal biopsy samples that were performed during the period from July 2003 to July 2008. Renal biopsy samples of 924 patients were referred for pathological assessment during the period of the study [437 male and 487 female patients; their mean age was 26.5 ± 14.6 years (range: 2.5-71 years)]. Focal segmental glomerulo-nephritis was the most frequent cause of primary GN (21.21%), followed by mesangial proliferative GN (18.93%), diffuse proliferative GN (13.96%), focal proliferative GN (12.77%) and membranous GN (10.93%). The results could be explained by the high incidence of lupus nephritis among the study subjects as well as the relatively young age of the study group.
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RENAL DATA FROM THE ASIA - AFRICA
Renal involvement in childhood lupus: A study from Kolkata, India
p. 871
Madhumita Nandi, Rakesh Mondal
DOI
:10.4103/1319-2442.98194
Systemic lupus erythematosus (SLE) is a multi-system disease of autoimmune origin. The relative incidences of the various manifestations in children with SLE are significantly different from adults and among different age-groups of children. To analyze the characteristics of childhood lupus nephritis (LN), we prospectively followed-up 23 cases of pediatric LN, diagnosed over a period of five years, in the pediatric rheumatology clinic at the Institute of Post Graduate Medical Education and Research, Kolkata, India. The resultant database was analyzed using standard statistical methods. Of all childhood lupus cases treated in our clinic over the last five years (
n
= 42), 54.7% (
n
= 23) had renal involvement. This study has tried to delineate the disease trends of childhood lupus from Eastern India. Certain important trends have emerged that are different from other contemporary Indian and International observations.
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Pattern of glomerular diseases among adults in Rajshahi, the Northern Region of Bangladesh
p. 876
MA Habib, SM Badruddoza
DOI
:10.4103/1319-2442.98195
To obtain a recent and comprehensive insight into the pattern of glomerular diseases in the Bangladeshi population, we studied 95 adequate renal biopsies done during July 2008 to June 2009, by light and direct immunofluorescence microscopy in the Department of Pathology, Rajshahi Medical College, Northern Region of Bangladesh. Of these, 38 (40%) were males and 57 (60%) were females, with a male to female ratio of 1:1.5. The most frequent clinical presentation was nephrotic syndrome (67.37%). Primary glomerular disease accounted for 91.25% of all glomerular disease and, of them, focal and segmental mesangial proliferative glomerulonephritis was the most common histological lesion in 29.47%. Diffuse mesangial proliferative glomerulonephritis (GN) was the second most common lesion (15.79%), followed by focal segmental GN (11.58%), minimal change disease (10.53%), membranous GN (7.37%), IgA nephropathy (6.85%), chronic sclerosing GN (2.11%) and crescentic GN (2.11%). Lupus nephritis was the most prevalent among secondary GN.
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SCOT DATA
Dialysis in the Kingdom of Saudi Arabia
p. 881
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© 2007 - Saudi Journal of Kidney Diseases and Transplantation | Published by Wolters Kluwer -
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Online since 20
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April, 2007