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In view of continuous controversies regarding hypertension in pregnancy and lack of reports on this subject in Saudi Arabia, we retrospectively studied 135 episodes of hypertension in pregnancy in 123 patients over a 9-years period. Fifty-one (37.8%) were primiparas, the remaining were multiparas from 2 ^nd up to 14 ¹¹ pregnancy. Of the multiparas, 44% had a history of pregnancy induced hypertension, 26% of chronic hypertension, and 13% of diabetes mellitus. ^" HELLP"-syndrome occurred in nine and eclampsia in four pregnancies. There were 10 foetal deaths, eight of them presented on admission. Chronic hypertension and diabetes mellitus approached significance as risk factors for foetal death (logistic regression analysis). For the whole group, the time of delivery was the only factor with significant impact on the Apgar score (multiple regression analysis), with an additional negative influence of diabetes mellitus and intravenous hydralazine in the multiparas. When the patients with chronic hypertension and diabetes mellitus were not included, hydralazine lost its significance. The finding suggests that intravenous hydralazine should be given in multiparas with caution, particularly in the presence of chronic hypertension and diabetes mellitus. There was a significant relation of the birth weight to the time of delivery, the serum levels of total protein and, especially in multiparas, of uric acid, confirming the importance of these factors as markers of the severity of pregnancy induced hypertension. The hypertension persisted in patients not known to have chronic hypertension in 9.6% of pregnancies during a follow-up ranging from 2 months up to 9 years.

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Three hundred and eleven patients diagnosed to have congenital hydronephrosis proven by postnatal ultrasonography in a ten-year period between 1987 and 1996 were studied retrospectively. These were classified into mild degree of hydronephrosis in H (64%), moderate in 94 (30%) and severe in 18 (6%) patients, according to first post natal sonography and depending on the measurement of the anterio-posterior transverse diameter of the pelvi-calyceal system. Significant obstructive uropathy was documented in 66 patients by Technetium-Diethylene triamine penta acetic acid renogram (Tc99m DTPA Renogram Vesicoureteric reflux was found in 22 patients by voiding cysto-urethrogram. On follow­up the hydronephrosis regressed spontaneously in 99 (31.8%), was stable in 167 (53.6%) and needed operative intervention in 45 (14.4%) patients. The types of surgical operations were pyeloplasty in 49% and ureteric re-implantation in 27%. Fifteen (83%) of the children with severe hydronephrosis and 32 (34%) of the moderate hydronephrosis group were operated o while none of the children with the mild form required operative intervention. We recommend ultrasound follow-up for mild hydronephrosis and a coordinated approach and work-up for congenital moderate and severe hydronephrosis. Surgery should only be considered if renal function is affected.

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Sarcoidosis is one of the granulomatus disorders affecting many organ systems of the body. Renal impairment in sarcoidosis is rare and occurs usually as a result of long standing hypercalcemia or hypercalciuria with nephrocalcinosis or renal stones. Sarcoid glomerulopathy and tubulo-interstitial granulomatus involvement have been described. We report two cases of sarcoidosis, the first with interstitial nephritis and anterior uveitis without evidence of granuloma. The patient was normocalcemic and normocalciuric. The second case presented with nephritic range proteinuria and severe renal insufficiency with a history of recurrent parotid swelling seven years before diagnosis. Renal biopsy showed non-caseating granulomas in the tubulo-interstitial region. Both patients showed good response to steroid therapy, however, there is still residual renal insufficiency six months after therapy. In conclusion, renal sarcoidosis although a rare presentation, should be considered in the presence of extra-renal manifestation of sarcoidosis as it is amenable to treatment.

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The charts of 175 renal transplant recipients were retrospectively reviewed. The mean duration of follow up since the transplantation was 4.17 ± 1.66 years. Apart from cyclosporin induced tremor, which occurred almost in all patients, 22 patients (12.5%) had neurological disorders during their follow up (mean annual incidence of 3%). Eight patients had epileptic seizures, seven had strokes, four had neurological infections, two developed a pseudotumor cerebri syndrome, two neuropathies, one myopathy and one conus medullaris infarction. This study demonstrates that neurological disorders are not uncommon in renal transplant recipients and that their mechanisms are variable and may be related to the underlying diseases such as hypertension and diabetes; to the operation itself; to the side effects of immunosuppression agents or rarely, they can accompany graft rejection.

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During the month of Ramadan 1417H we studied 14 patients all transplanted with live related kidneys. All the patients were transplanted between one and seven months before the month of Ramadan. All the patients were on azathioprine and prednisolone and the mean plasma creatinine level was 95 ± 15 µmol/L. They all completed fasting the month of Ramadan successfully. Medical evaluation showed that there was no clinical adverse effect. There was no significant change in serum values of creatinine, calcium, protein, sodium, potassium, chloride, HC03, or liver function tests. There was, however, a significant elevation of total plasma proteins, urea, uric acid, hemoglobin, triglycerides, cholesterol, urinary sodium and potassium, concentration (p=<0.05). Our study shows that fasting in Ramadan during the first year of transplantation is possible, nevertheless further studies with large number of patients are necessary to confirm this specially in patients receiving cyclosporine.

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Incidence of treated end-stage renal disease (t-ESRD) in Saudi Arabia is not well documented and only few reports are available. This study was conducted to determine the incidence of t-ESRD in Asir region. The study period included January 1995 to December 1995. All new cases admitted for chronic dialysis treatment in all MOH­hospitals with a diagnosis of ESRD were included. There were 114 Saudi and 10 non-Saudi Patients. Among the 114 Saudi patients, there were 64 (56.1%) males and 50 (43.9%) females. Mean age 47.86 ± 19.86 years (range 9-90 years). The overall incidence of t­ESRD was 214.9 pmp. Age adjusted incidence for males and females were 243 pmp and 186 pmp, respectively. There were no differences between males and females (X ² =2.019, p = <0.05). The majority of the patients (41.2%) did not have definitive diagnosis. Among the known causes, glomerulonephritis was diagnosed or suspected in 56.7%, diabetes was the cause of ESRD in 16.4% of the cases. This is the highest incidence of ESRD ever reported in Saudi Arabia. Geographical, environmental, genetical factors may have been contributing factors.

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