The reported annual incidence of ESRD in the Kingdom is 100-120 patients per million population. The first dialysis unit in Saudi Arabia was set up in 1971 and since then rapid advances have been made in the Kingdom in the field of renal replacement therapy. There are currently 103 centers offering dialysis to about 4500 patients. The National Kidney Foundation was established in 1985 to implement a cadaveric organ transplant program and to co-ordinate the renal care facilities in the Kingdom. This center was renamed as Saudi Center for Organ Transplantation (SCOT) in 1993 in order to encompass transplantation of organs other than the kidney as well. A real impetus was given in the year 1982 with the approval handed over by Islamic scholars on the concept of brain-death and organ transplantation. From 1979, when the first renal transplant was performed till end of 1994, more than 1600 renal transplants have been performed in 13 transplant centers in Saudi Arabia. Also, 49 liver, 57 heart, 45 heart valve, 121 cornea, 4 pancreas, 4 lung, and 100 bone marrow transplants have been performed in the Kingdom. Despite these achievements, there is still a large gap between demand and supply and efforts are ongoing to improve the donor pool and bridge this gap.

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Thirty cases of autosomal dominant polycystic kidney disease (ADPKD) seen at King Fahd Hospital of the University, Al-Khobar over a period of eight years, were analysed with respect to clinical features, laboratory investigations, radiological findings, complications and outcome. There were 13 males and 17 females with a mean age of 45 yrs + 10.1 (range 16-65 years). There was positive family history of renal disease in 17 cases. At the time of presentation, 27 cases had abdominal pain. The other features noted were hematuria (20 cases), polyuria (10 cases), urinary tract infection (22 cases), headache (9 cases), uremia (7 cases) and nephrolithiasis (5 cases). Bilaterally palpable kidneys were present in all cases. Hypertension (17 cases) was the next common clinical finding. Other clinical features noted were hepatomegaly (5 cases) and mitral valve prolapse (5 cases). Twenty-one patients had cysts in liver and five had cysts in spleen. Varying degrees of renal failure were seen in 15 cases. Six (20%) patients progressed to end stage renal disease during the period of observation.

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The extent of aluminum related bone disease was evaluated in 41 patients on regular maintenance hemodialysis in two dialysis centers in Riyadh, Saudi Arabia. There were 22 males and 19 females aged 20 to 70 years (mean 35.5+11.2 years). Thirty eight of the patients were on aluminum based oral phosphate binders. Investigations performed included serum calcium, magnesium, aluminum and parathormone and radiological investigations including skeletal survey and dual photon absorptiometry. All the patients underwent bone biopsy and the biopsy material was subjected to morphometric studies, including staining for aluminum deposits. The patients were divided into two groups: group 1, (16 patients, 39%) with negative aluminum staining in the bone biopsy tissue, and group 2, (25 patients, 61%) with positive aluminum staining. Bone pain and its distribution as well as fractures were similarly prevalent in both groups. The levels of aluminum in the blood was significantly higher in group 2 (32.9 + 20.2 vs 17.9 + 11.2 ug/L P<0.05), though it was lower than the lowest accepted toxic level (40 ig/L). There was no significant difference between the two groups in the biochemical or hormonal data, frequency of abnormal radiological signs and pattern of bone histology. Our study indicates that increased aluminum deposition in the bone is prevalent in patients on maintenance hemodialysis using aluminum based phosphate binders, but adynamic bone disease is not prevalent. Further studies may be needed on a larger scale to assess the magnitude of the problem.

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The Gulf Co-operation Council (GCC) which has six member-countries was established in 1981 to promote mutual co-operation on various aspects including health care. Efforts are ongoing to have active co-ordination among the member-countries in the field of organ transplantation. Islamic scholars in these countries have approved organ donation from living related and cadaveric donors after obtaining consent from the families concerned. This has paved the way for the implementation of successful renal transplantation programs in many of the GCC countries. The results of the operations performed locally in these countries are encouraging and similar. However, the demand for organs is still high and only 30% of the need is being met at present. Commercial organ donation is strictly prohibited in all these countries. In Saudi Arabia, the Saudi Center for Organ Transplantation (SCOT), erstwhile National Kidney Foundation, was established in 1985. The main objective was to coordinate organ transplantation program in the Kingdom and in the last ten years, the center has gathered remarkable experience in this field. Other GCC countries need to establish cadaveric renal transplantation programs in their countries on similar lines as SCOT.

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Measuring the T-lymphocyte subsets CD4/CD8 ratio is known to be useful in the early diagnosis of acute rejection. A ratio of 1.3 or more is said to indicate the presence of acute rejection, but the sensitivity and specificity rates of the test are too low to render it of diagnostic value. We revisited this test on twenty-three renal allograft recipients who developed graft dysfunction within the first three months following transplantation. All cases were investigated thoroughly to identify the cause of graft dysfunction. Two groups of patients were identified. Group 1: patients confirmed to have acute rejection as the cause of graft dysfunction (13 patients); and group 2: patients found to have other causes of graft dysfunction (10 patients). Results of subsets with cluster of differentiation ratio CD4/CD8 were correlated with incidence of acute rejection. Of the 13 patients with acute rejection 10 revealed a CD4/CD8 ratio more than 1.7, while in the other three CD4/CD8 ratio was less than 1.7. In the second group of 10 patients in whom the cause of graft dysfunction was not acute rejection, the CD4/CD8 ratio was less than 1.7 in all cases. Our study indicates that T-lymphocyte subset ratio is useful in diagnosing acute rejection with a sensitivity and specificity of 81% and 100% respectively when the cutoff point is taken as 1.7. Studies with larger series of patients are needed to confirm this observation.

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We describe a patient who developed renal failure during antituberculous therapy. The condition was characterized by an initial phase of acute tubular necrosis and nephrotic syndrome which ultimately progressed to end-stage renal disease with severe interstitial fibrosis, despite adequate period of drug withdrawal. At that time, tuberculous infection was inactive and there was no evidence of amyloidosis or renal vein thrombosis.

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This study was conducted to determine the combined effect of Ramadan fasting and short-term use of different non-steroidal anti-inflammatory drugs (NSAIDs) on renal function in healthy volunteers. The study subjects were assigned to six different groups, five of whom took different NSAIDs (namely nabumetone, indomethacin, diclofenac, sulindac, tenoxicam) and the sixth was a control group. Data were collected on serum sodium, chloride, potassium, urea, creatinine, bicarbonate and uric acid as well as urinary osmolarity, sodium, potassium, chloride and urea. These measurements were taken before fasting, 10 days into fasting while using NSAIDs, and five days after stopping the use of NSAIDs. The results showed slight changes in serum and urine measurements during fasting while using NSAIDs. These changes, although were significant in some cases, were within the normal range and were noted in all the study groups including the control group. We conclude that short-term use of NSAIDs in healthy subjects during fasting is not associated with any major adverse effects on the renal function.

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