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2009| May-June | Volume 20 | Issue 3
Online since
May 1, 2009
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ORIGINAL ARTICLES
Restless legs syndrome in patients on dialysis
Hamdan H Al-Jahdali, Waleed A Al-Qadhi, Haithm A Khogeer, Fayez F Al-Hejaili, Saeed M Al-Ghamdi, Abdullah A Al Sayyari
May-June 2009, 20(3):378-385
PMID
:19414938
Restless legs syndrome (RLS) is an extremely distressing problem experienced by patients on dialysis; the prevalence appears to be greater than in the general population, with a wide variation from 6.6% to 80%. The diagnosis of RLS is a clinical one, and its definition has been clarified and standardized by internationally recognized diagnostic criteria, published in 1995 by the International Restless Legs Syndrome Study Group (IRLSSG). This study was designed to find out the prevalence of RLS in Saudi patients with end-stage renal disease (ESRD) on maintenance dialysis. This is a cross sectional study carried out between May and Sept 2007 at two centers, King Abdulaziz Medical City-King Fahad National Guard Hospital (KAMC-KFNGH), Riyadh and King Faisal Specialist Hospital and Research Centre (KFHRC), Jeddah, Saudi Arabia. Data were gathered on 227 Saudi patients on chronic maintenance hemodialysis or chronic peritoneal dialysis. The prevalence of RLS was measured using IRLSSG's RLS Questionnaire (RLSQ). Potential risk factors for RLS including other sleep disorders, underlying cause of chronic renal failure, duration on dialysis, dialysis shift, biochemical tests and demographic data were also evaluated. The overall prevalence of RLS was 50.22% including 53.7% males and 46.3% females. Their mean age was 55.7 ± 17.2 years and mean duration on dialysis 40.4 ± 37.8 months. Significant predictors of RLS were history of diabetes mellitus (DM), coffee intake, afternoon dialysis, gender and type of dialysis (P= 0.03, 0.01, < 0.001, 0.05 and 0.009 respectively). Patients with RLS were found to be at increased risk of having insomnia and excessive daytime sleepiness (EDS) (P= < 0.001 and 0.001, respectively). Our study suggests that RLS is a very common problem in dialysis population and was significantly associated with other sleep disorders, particularly insomnia, and EDS. Optimal care of dialysis patient should include particular attention to the diagnosis and management of sleep disorders
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HBV-DNA in hemodialysis patients infected by HCV
Mohammad Kazemi Arababadi, Gholamhossein Hassanshahi, Hassan Yousefi
May-June 2009, 20(3):398-401
PMID
:19414941
End-stage renal disease patients on chronic hemodialysis (HD) patients are at risk for both hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, and they may coexist. To determine the prevalence and clinical impact of HBV and HCV infection, we studied poly chain reaction (PCR) and reverse transcription (RT)-PCR on the blood samples of 90 HD patients in Kerman, Iran. ELISA test was used to detect anti-HBc, anti-HBs and HBsAg. We found that 30 out of 90 (33.3%) patients were PCR-RT-PCR positive for HCV-RNA. No HBV-DNA (0%) was detected through the PCR study in both positive and negative HCV-RNA patient groups. Though none of the samples was HBsAg positive, 10 (33.3%) HCV-RNA positive patients were anti-HBc positive, and 12 (40.7%) were anti-HBs positive. We conclude that prevalence of hepatitis C infection is high in HD patients in our region, but not associated with active HBV infection.
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Spironolactone in chronic hemodialysis patients improves cardiac function
Shahram Taheri, Mojhgan Mortazavi, Shahrzad Shahidi, Ali Pourmoghadas, Mohammad Garakyaraghi, Shiva Seirafian, Afrooz Eshaghian, Maryam Ghassami
May-June 2009, 20(3):392-397
PMID
:19414940
We performed this study to assess whether low dose spironolactone could be administered in hemodialysis (HD) patients with moderate to severe heart failure to improve cardiovascular function and reduce hospitalization without inducing hyperkalemia. We enrolled 16 chronic HD patients with moderate to severe heart failure and left ventricle ejection fraction :5 45%. In a double blinded randomized placebo controlled study, one group of 8 patients received 25 mg of spironolactone after each dialysis session within six months, and the rest received a placebo. Echocardiography was performed on all the patients to assess ejection fraction and left ventricular mass during 12 hours after completion of hemodialysis at the beginning and the end of study. Serum potassium was measured predialysis every 4 weeks. The mean ejection fraction increased significantly more in spironolactone group during the study period than in the placebo group (6.2 ± 1.64 vs. 0.83 ± 4.9, P= 0.046). The mean left ventricular mass decreased in the spironolactone group, but increased significantly in the placebo group during the period (-8.4 ± 4.72 vs. 3 ± 7.97. 95%, P= 0.021). The incidence of hyperkalemia was not significantly increased in the study or controlled groups. In conclusion, we found in this study that administration of spironolactone in chronic HD patients with moderate to severe heart failure substantially improved their cardiac function and decreases left ventricular mass without development of significant hyperkalemia.
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Concomitant macro and microvascular complications in diabetic nephropathy
Jamal S Alwakeel, Abdulkareem Al-Suwaida, Arthur C Isnani, Ali Al-Harbi, Awatif Alam
May-June 2009, 20(3):402-409
PMID
:19414942
To determine the prevalence of concomitant microvascular and macrovascular complications of diabetic nephropathy we retrospectively reviewed the medical records of all 1,952 type 2 diabetic patients followed-up at Security Forces Hospital, Riyadh, Saudi Arabia from January 1989 to December 2004. There were 626 (32.1%) patients (294 (47%) were males) who developed diabetic nephropathy. Their mean age was 66.9 ± 11.4 years, mean duration of diabetes was 15.4 ± 7.5 years, mean age at the onset of nephropathy was 61.5 ± 12.4 years, and mean duration of nephropathy was 3.9 ± 3.8 years. Concomitant diabetic complications included cataract (38.2%), acute coronary syndrome (36.1%), peripheral neuropathy (24.9%), myocardial infarction (24.1%), background retinopathy (22.4%), stroke (17.6%), proliferative retinopathy (11.7%), foot infection (7.3%), limb amputation (3.7%) and blindness (3%). Hypertension was documented in 577 (92.2%) patients, dyslipidemia in 266 (42.5%) and mortality from all causes in 86 (13.7%). There were 148 (23.6%) patients with one complication, 81 (12.9%) with two, 83 (13.3%) with three, and 61 (9.7%) with four or more. Deterioration of glomerular filtration rate was observed in 464 (74%) patients and doubling of serum creatinine in 250 (39.9%), while 95 (15.2%) developed end-stage renal disease (ESRD) at the end of study and 79 (12.6%) required dialysis. Complications were significantly more prevalent among males with greater number reaching ESRD level than females (P< 0.05). Relative risks of developing complications were significant after the onset of nephropathy; ACS (1.41), MI (1.49), stroke (1.48), diabetic foot (1.6), amputation (1.58) and death (1.93). We conclude that complications of diabetes are aggressive and progressive including high prevalence of diabetic nephropathy. Careful monitoring and proper institution of management protocols should be implemented to identify diabetic patients at high risk for complications and mitigate progression into ESRD.
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RENAL DATA FROM THE ARAB WORLD
Hepatitis C virus (HCV) infection in hemodialysis patients in the south of Jordan
Mohammed Al-Jamal, Ameen Al-Qudah, Khaldoon F Al-Shishi, Ameera Al-Sarayreh, Linda Al-Quraan
May-June 2009, 20(3):488-492
PMID
:19414962
Hepatitis C Virus (HCV) infection is a serious public health problem throughout the world. Patients with chronic renal failure are exposed to this infection. This could be due to a failure to identify carriers of this disease or because of lack of implementing truly effective safety measures in the dialysis units. This study was carried out in order to determine the prevalence of HCV infection and possible risk factors for acquiring it in patients on maintenance hemodialysis (HD). A total of 120 patients, 63 males (52%) and 57 females (42%), who were on regular HD in three military hospitals in the south of Jordan were studied during the period between January 2007 and April 2008. A total of 34 patients (28%) were HCV positive of whom, 20 were males (58%). The mean age of the study participants was 52.9 years. The means of age of HCV positive and negative patients were 51.5 and 54.4 years, respectively. Statistical analysis showed that four risk factors including history of blood transfusion, history of kidney transplantation, history of other surgeries and duration on HD, had an important role in acquiring HCV infection. Although the prevalence of HCV infection in our study patients is lower than in many other countries in the region, we believe that the prevalence is still high and reflects a serious challenge, which needs further research to identify the causes and to establish a well organized prophylactic program.
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Demographic data and hemodialysis population dynamics in Qatar: A five year survey
Omar M Fituri, Mazin M.T Shigidi, Gajaraj Ramachandiran, Awad H Rashed
May-June 2009, 20(3):493-500
PMID
:19414963
Hemodialysis was initiated in Qatar in 1981, since then the hemodialysis population has been expanding rapidly. This report describes the demographics and outcome of our hemodialysis patients during a five years study period. Data of all the patients on regular hemodialysis from January 1
st
,
2002 to December 31
st
, 2006 were included in this study was collected from the medical records and entered into an especially designed questionnaire. The prevalence of end stage kidney disease in Qatar is 624 patients per million populations with an incidence of 202 patients per million populations per year. Currently, 278 patients are on hemodialysis, 65% of them are Qatari, males represent 51%, whereas 44.6% are between 65-74 years of age. Diabetic nephropathy is the commonest cause of end stage kidney disease (48%), followed by primary glomerulonephritis and hypertensive glomerulopathy. Arteriovenous fistula was the vascular access in 57% of patients. The incidence of Hepatitis B, C and Human immunodeficiency virus had been stable throughhout the study period though our hemodialysis population had increased by 1.5 fold. The first and five years survival rates of our patients were 84 and
53%
respectively. Qatar has one of the highest rates of dialysis patients with a good long-term survival report. Peritoneal dialysis remained to be the key solution for the rapidly expanding patients' pool. Maintenance of national registry of dialysis patients and improving our organ transplant program is an essential goal.
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CASE REPORTS
Bilateral triple renal arteries
Turan Pestemalci, Ayfer Mavi, Yusuf Zeki Yildiz, Mehmet Yildirim, Erdem Gumusburun
May-June 2009, 20(3):468-470
PMID
:19414954
Knowledge of the variations of the renal artery has grown in importance with increasing numbers of renal transplants, vascular reconstructions and various surgical and radio logic techniques being performed in recent years. We report the presence of bilateral triple renal arteries, discovered on routine dissection of a male cadaver. On the right side, one additional renal artery originated from the abdominal aorta (distributed to superior pole of the kidney) and one other originated from the right common iliac artery (distributed to lower pole of the kidney). On the left side, both additional renal arteries originated from the abdominal aorta. Our observation has been compared with variations described in the literature and their clinical importance has been emphasized.
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ORIGINAL ARTICLES
Perceived illness intrusion among patients on hemodialysis
Usha Bapat, Prashanth G Kedlaya, Gokulnath
May-June 2009, 20(3):386-391
PMID
:19414939
Dialysis therapy is extremely stressful as it interferes with all spheres of daily activities of the patients. This study is aimed at understanding the perceived illness intrusion among patients on hemodialysis (HD) and to find the association between illness intrusion and patient demographics as well as duration of dialysis. A cross sectional study involving 90 patients with chronic kidney disease (CKD) stage V, on HD was performed during the period from 2005 to 2006. The subjects included were above 18 years of age, willing, stable and on dialysis for at least two months. Patients with psychiatric co-morbidity were excluded. A semi-structured interview schedule covering sociodemographics and a 13 item illness intrusion checklist covering the various aspects of life was carried out. The study patients were asked to rate the illness intrusion and the extent. The data were analyzed statistically. The mean age of the subjects was 50.28 ± 13.69 years, males were predominant (85%), 73% were married, 50% belonged to Hindu religion, 25% had pre-degree education, 25% were employed and 22% were housewives. About 40% and 38% of the study patients belonged to middle and upper socio-economic strata respectively; 86% had urban background and lived in nuclear families. The mean duration on dialysis was 24 ± 29.6 months. All the subjects reported illness intrusion to a lesser or greater extent in various areas including: health (44%), work (70%) finance (55%), diet (50%) sexual life (38%) and psychological status (25%). Illness had not intruded in areas of relationship with spouse (67%), friends (76%), family (79%), social (40%) and religious functions (72%). Statistically significant association was noted between illness intrusion and occupation (P= 0.02).
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Impact of obesity on development of chronic renal allograft dysfunction
Alireza Hamidian Jahromi, Ghanbar Ali Raiss Jalali, Jamshid Roozbeh
May-June 2009, 20(3):375-377
PMID
:19414937
Obesity in nontransplant patients has been associated with hypertension, hyperlipidemia, diabetes, and proteinuria. To determine whether renal transplant recipients with an elevated BMI have worse long term graft survival, we prospectively studied 92 patients transplanted between April 1999 and July 2000. Weight (Wt) and height of the patients were recorded prior to transplantation and two weeks, one, two and three years post transplantation. Blood urea nitrogen (BUN), creatinine (Cr) and blood pressure were checked monthly, while triglyceride, cholesterol, high density lipoprotein (HDL), and low density lipoprotein (LDL) were obtained 3 monthly for 3 years post transplantation. Graft dysfunction was defined as serum Cr > 1.8 mg/dL. While BMI and Wt of the patients before transplantation did not show any significant correlation with chronic renal allograft dysfunction (CRAD), patients with higher Wt and BMI two weeks after transplantation showed an increased risk of developing CRAD during the three year post transplant independent of other risk factors (P< 0.05). Patients with greater Wt loss in the first two weeks post transplantation showed a decreased risk of developing CRAD in the following 3 years (P< 0.001). Our study suggests that high Wt and BMI are significantly associated with worse graft survival 3 years post renal transplantation.
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Reduction of microalbuminuria by using losartan in normotensive patients with type 2 diabetes mellitus: A randomized controlled trial
Adnan Agha, Wasim Amer, Eram Anwar, Kaukab Bashir
May-June 2009, 20(3):429-435
PMID
:19414946
Type 2 diabetes mellitus (T2DM) is a worldwide pandemic that may lead to diabetic kidney disease (DKD), a complication which is the single most important and globally prevalent cause of chronic kidney disease. Microalbuminuria has been shown to be an early indicator of DKD and data suggest that angiotensin receptor blockers (ARBs) reduce urinary albumin excretion and retard the progression of renal disease in hypertensive T2DM patients. However, the effects of ARBs on preventing microalbuminuria and ensuing DKD in normotensive patients with T2DM is yet to be fully established. The objective of this study is to assess the anti-microalbuminuric effects of losartan therapy versus placebo in normotensive T2DM patients. This randomized single blinded controlled trial was performed at the Diabetic Clinic, Jinnah Hospital, Lahore over a period of 10 months. A total of 361 normotensive patients with T2DM and microalbuminuria were selected; of them, 171 patients were randomly allocated to the test group and 190 enrolled into the control group. The patients in the test group were started on losartan 50 mg/day for a six month period while those in the control group were put on vitamin B-12 500 mcg/day. The patients as well as the primary attending physicians/lab evaluators were blinded to the study. All study patients were followed up on a monthly basis. Quantitative microalbuminuria was tested at the beginning and at the end of the study. Out of the 171 patients in the test group, 149 (87.1%) had significant reduction of albuminuria by > 30% of their baseline (mean 101.9 ± 21.7 baseline and, 47.5 ± 12.9 post-therapy). The corresponding values for albuminuria in the 190 patients in the control group was mean 104.7 ± 26.3 baseline and post 6-month mean 103.9 ± 22.9, with P< 0.0001. The anti-albuminuric effect of losartan was reversible as seen on re-checking the urinary albumin two months after discontinuation of treatment. Our study shows that losartan was well tolerated and demonstrated significant anti-proteinuric effects in patients with T2DM with early nephropathy independent of hypertension.
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Comparison of 24-hour urinary protein and protein-to-creatinine ratio in the assessment of proteinuria
Ayman M Wahbeh, Mohammad H Ewais, Mahamed E Elsharif
May-June 2009, 20(3):443-447
PMID
:19414948
To determine the correlation between protein-to-creatinine ratio (PCR) and 24-hour urinary protein (UP), we measured proteinuria in 68 patients attending the nephrology clinic at Jordan University Hospital by 24-hour urine protein excretion and protein-to-creatinine ratio. The cutoff values for spot urine protein-to-creatinine ratio in predicting 24-hour protein "threshold" excretion of 0.5, 1.0 and 3.5 g/day were determined using receiver operating characteristic curves. A very good correlation (r= 0.832, P< 0.0001) was found between spot urine protein-to-creatinine ratio and 24-hour urine protein excretion. Bland-Altman plot showed the two tests had reasonable limits of agreement at low level of protein excretion but the limits became wider as the protein excretion increased. For protein excretion < 2.0 g/day, the limits of agreement of spot urine (PCR) and (UP) were +1.48 and -1.2 g/day. The spot urine protein-to-creatinine ratios of 0.72 (sensitivity 0.97; specificity 1.0), 1.2 (0.97; 0.89) and 3.23 (1.0; 0.86) mg/mg reliably predicted 24-hour urine total protein equivalent "thresholds" of 0.5, 1.0 and 3.5 g/day, respectively. We conclude that the protein-to-creatinine ratio in spot urine specimens is an accurate, convenient, and reliable method to estimate the protein excretion in urine. However, the protein-to-creatinine ratio will likely be within clinically acceptable limits only when proteinuria is at reasonably low levels.
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CASE REPORTS
Bilateral large diverticulae of urinary bladder
Sanjay Pandey, Vijay Agarwal, Shashank Mishra, SK Thakur
May-June 2009, 20(3):474-475
PMID
:19414956
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ORIGINAL ARTICLES
Association between scores in high school, aptitude and achievement exams and early performance in health science college
Ibrahim A Al-Alwan
May-June 2009, 20(3):448-453
PMID
:19414949
This retrospective study was carried out to assess the correlation between admission criteria to health science colleges, namely, final high school grade and Saudi National Aptitude and Achievement exams, and early academic performance in these colleges. The study included 91 male students studying in the two-year pre-professional program at the King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia. Records of these students were used to extract relevant information and their academic performance (based on the grade point average achieved at the end of the first semester of the pre-professional program), which were analytically studied. Pearson correlation coefficient was used to assess the associations between the different scores. SPSS statistical program (version 12.0) was used for data analyses. We found a strong correlation between the academic performance and the Achievement Exam, Aptitude Exam and high school final grade, with Pearson Correlation Coefficients of 0.96, 0.93, 0.87, respectively. The Saudi National Achievement Exam showed the most significant correlation. Our results indicate that academic performance showed good correlation with the admission criteria used, namely final high school grade, Saudi National Aptitude and Achievement Exams.
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6,637
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Nephropathic cystinosis in children: An overlooked disease
Neveen A Soliman, Ramzi El-Baroudy, Akmal Rizk, Hafez Bazaraa, Amal Younan
May-June 2009, 20(3):436-442
PMID
:19414947
Nephropathic cystinosis is rare genetic disease characterized by defective lysosomal cystine transport and increased lysosomal cystine. Corneal Cystine Crystal Scoring (CCCS) for diagnosis of nephropathic cystinosis was studied in all suspected children with renal Fanconi syndrome and siblings of diagnosed cases over a two year period. In addition to oral cysteamine, cysteamine eye drops were provided to all diagnosed patients and CCCS was followed up on a quarterly basis. Of 33 screened cases, 14 had corneal cystine crystals. Crystals were absent in two cystinotic patients under the age of 20 months. The mean age at diagnosis was 52.7 months and five patients had ERSD. After six months of treatment, the mean CCCS did not increase from the initial value of 1.81; associated with a decrease of 0.5 in two cases and a similar increase in two others. Scores decreased in two other patients after 12 months. Compliance was generally inadequate due to the high frequency of administration and the need for multi-drug regimen. CCCS is a simple and reasonably sensitive method for diagnosis of nephropathic cystinosis above two years of age. Topical treatment with cysteamine eye drops prevents progression of deposits and may decrease it with adequate compliance. Further follow up is still recommended to monitor long term effects of both systemic and topical cysteamine therapy.
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Acute rejection episodes after kidney transplantation
Fethi Ben Hamida, Samia Barbouch, Rafika Bardi, Imed Helal, Hayet Kaaroud, Lilia Ben Fatma, Hafedh Hedri, Ezzeddine Abderrahim, Taieb Ben Abdallah, Khaled Ayed, Hedi Ben Maiz, Adel Kheder
May-June 2009, 20(3):370-374
PMID
:19414936
Acute rejection episodes (AREs) are a major determinant of renal allograft survival. The incorporation of new immunosuppressive agents explains, at least partially, the improvement seen in the results of transplantation in recent years. The objectives of this study are to analyze the incidence and severity of AREs, their risk factors and their influence on graft and patient survival. We retrospectively studied 280 kidney transplants performed in adults at the Charles Nicolle Hospital, Tunis, between 1986 and 2004. The diagnosis of ARE was based on clinical data and response to treatment. Allograft biopsies were performed in ten cases. The treatment of AREs consisted of pulse methylprednisolone and antithymocyte globulin. There were 186 males (66.4%) and 94 females (33.6%), and their mean age was 31 ± 8.9 years. Overall, the 280 study patients experienced a total of 113 AREs. Of them, 85 had only one ARE, 28 had two to three and none had more than three AREs. A total of 68 AREs were completely reversible, 42 were partially reversible while three could not be reversed with treatment. The mean incidence of AREs was 40.4%. The incidence was > 45% between 1986 and 1997, decreased to 20.5% between 1998 and 2000 and to 9% between 2001 and 2004. Graft survival rates in patients with and without AREs were respectively 91% and 93% at three years, 82% and 90% at five years and 73% and 83% at 10 years. We found a decrease in the incidence of AREs in recent years in our study patients, and this was related to the introduction of sensitized cross-match and the newer immunosuppressive agents, particularly MMF. Additionally, AREs had a deleterious impact on late graft survival in our study population.
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RENAL DATA FROM THE ASIA - AFRICA
Causes of chronic renal failure among Iranian hemodialysis patients
Leila Malekmakan, Sezaneh Haghpanah, Maryam Pakfetrat, Alireza Malekmakan, Parviz Khajehdehi
May-June 2009, 20(3):501-504
PMID
:19414964
Chronic Renal Failure (CRF) is characterized by impaired renal function, which is progressive and irreversible. This study was carried out to investigate the status and causes of CRF in HD patients in Fars Province, Iran. In this cross-sectional study, HD patients were evaluated in Fars province. Information for demographic characteristics, and medical history were obtained by using a questionnaire administered by trained staff. 633 cases including 371 male and 262 female were studied. The mean KT/V was 1 0.4. KT/V > 1.2 was achieved in only 32.1% (203/633) of all patients. The mean BMI was 24 ± 4.5. The most common causes of CRF were hypertension (30.5%) and diabetes mellitus (30.1%). In conclusion most common causes of CRF in this region were hypertension and diabetes mellitus. Better management of hypertension and diabetes could prevent patients from ending up with end stage renal disease.
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CASE REPORTS
Renal carcinoid tumor
Bita Geramizadeh, Abdolaziz Khezri, Mahmoud Shariat
May-June 2009, 20(3):462-464
PMID
:19414952
Primary renal carcinoid is a rare tumor, until now less than 50 cases of this tumor has been reported, so very little is known about its presentation clinicopathologic patterns and prognosis. We report a patient with primary carcinoid tumor of kidney in a middle-aged woman treated by nephrectomy and review the literature concerning this kind of neoplasm.
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ORIGINAL ARTICLES
Correlation of kidney biopsy findings and clinical manifestations of primary focal and segmental glomerulosclerosis
Diana Taheri, Ali Chehrei, Pargol Samanianpour, Amar Hassanzadeh, Shohreh Sadrarhami, Shiva Seyrafian
May-June 2009, 20(3):417-423
PMID
:19414944
To evaluate the correlation of clinical, laboratory, and pathological features at presentation of focal segmental sclerosis (FSGS), we reviewed in a cross sectional study the pathological findings of kidney biopsies in 64 cases of primary FSGS, and correlated them with the clinical and laboratory data obtained at the time of the biopsies. The data included blood pressure, glomerular filtration rate (GFR), serum albumin, and the level of proteinuria. The mean level of serum creatinine was significantly higher in the biopsies' findings of synechiae (adhesions) in the Bowman's capsule, interstitial fibrosis, and global scars (P< 0.05), and mean level of GFR was significantly lower with the presence of interstitial fibrosis (P< 0.05). Furthermore, there was a positive correlation between the level of serum creatinine and global sclerosis (r= 2.21, P= 0.04), and a negative correlation between the level of GFR and global sclerosis(r= 2.01, P= 0.02). All the patients with renal insufficiency had interstitial fibrosis in their biopsies in comparison of only the 24 patients (48%) of the group without renal insufficiency (P< 0.05). There was no significant difference between patients with and without hypertension and nephritic-ranged proteinuria. We conclude that we found a correlation of renal insufficiency in primary FSGS patients with interstitial fibrosis, global scars and the synechiae of Bowman's capsule in their biopsies.
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CASE REPORTS
Bardet-biedl syndrome in a child with chronic kidney disease
Ehsan Valavi, Mohammad Javad Alemzadeh Ansari, Ali Ahmadzadeh
May-June 2009, 20(3):454-457
PMID
:19414950
A 4-year old boy was referred for evaluation of renal failure, posterior urethral valve (PUV) and urinary tract infection. His parents added complaints of polyuria, polydipsia, enuresis, shortness of stature, and inappropriate obesity. Serum blood urea nitrogen and creatinine levels were 45 and 3.5 mg/dL, respectively. Urine culture was positive for
Pseudomonas aeruginosa,
and abdominal ultrasound revealed bilateral small kidneys. The patient's history included mild to moderate mental retardation and postaxial polydactyly of both lower limbs amputated two years ago. The combination of mental retardation, obesity, postaxial polydactyly, and bilateral renal hypoplasia were compatible with the diagnosis Bardet-Biedl syndrome (BBS). The combination of PUV and BBS is a rare condition that caused this early onset of renal failure and inappropriate obesity guided us to the diagnosis.
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Intractable urinary tract infection in a renal transplant recipient
Renuka Satish, Gokulnath
May-June 2009, 20(3):458-461
PMID
:19414951
Urinary tract infections (UTI) are the most common bacterial infections after renal transplantation and are associated with significant morbidity and mortality. Recurrent or relapsing infections are not uncommon in the early post-transplant period and superadded fungal UTI can occur in these patients, posing a difficult therapeutic problem. Literature on recurrent UTI after transplant as well as the ideal approach to such patients is scanty. We present the case of a renal allograft recipient who presented with relapsing bacterial UTI complicated by systemic fungemia; also, a brief review of fungal UTI is attempted.
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LETTERS TO THE EDITOR
Tuberculosis in a kidney transplant recipient diagnosed by fine needle aspiration cytology of the bone marrow
Negar Azarpira, Maryam Pakfetrat
May-June 2009, 20(3):482-483
PMID
:19414959
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2,180
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SCOT FORUM
Post kidney transplant transitional cell carcinoma of bladder
Mohammed Al Ghonaim, Habib-ur-Rahman , Abdulkareem Al Suwaida, Akram Askar, Salman Imtiaz, Jamal S Al-Wakeel
May-June 2009, 20(3):505-512
PMID
:19414965
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CASE REPORTS
Vaginal tuberculosis in an elderly kidney transplant recipient
Eghlim Nemati, Saeed Taheri, Mohammad Hossein Nourbala, Behzad Einollahi
May-June 2009, 20(3):465-467
PMID
:19414953
Female genital tuberculosis (FGTB) is extremely rare in post-menopausal women. A 59-year-old woman developed vaginal tuberculosis one year after receiving a kidney transplant from a living donor. Her complaints included abdominal pain, fever, and weight loss. Furthermore, her tuberculin skin test was negative. She was successfully treated with quadruple anti-TB therapy for 6 months.
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Recurrent septicemia in a renal transplant recipient
Hossein Nejad-Gashti, Suzan Sanavi, Reza Afshar
May-June 2009, 20(3):471-473
PMID
:19414955
The incidence of infection is significantly elevated in renal transplant recipients,but native kidney infection is an uncommon event in these patients. We describe a 52-year-old renal transplant recipient with infection of the native kidneys that had atypical clinical presentation and a unusual course.
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EDITORIAL
Prognostic markers and new, innovative treatments in renal cell carcinoma
Ciprian C Secasan
May-June 2009, 20(3):355-361
PMID
:19414934
We reviewed the current medical literature to present the prognostic markers and current treatments of Renal Cell Carcinoma (RCC) and to propose new and innovative treatments for RCC. A PubMed search (
http://www.ncbi.nlm.nih.gov/PubMed/
) was performed and prognostic markers in RCC were reviewed and presented here. We hypothesize our own innovative theoretical research in new treatments for RCC. This includes a combination formed of an anticancer vaccine (VAX-x), which prevents the emergence of drug-resistance to (DRUG-x), with its corresponding anticancer drug (DRUG-x), administrated after immunological response to (VAX-x), can be employed to successfully treat and cure RCC in its various stages. We therefore propose that new treatment options of RCC are possibly VAX-x with either of the tyrosine kinase inhibitors-sunitinib or sorafenib.
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LETTERS TO THE EDITOR
CMV infection in post kidney transplant recipient
Mohammed Abdelrahman, Ayman Karkar
May-June 2009, 20(3):481-482
PMID
:19414958
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Prostate biopsy and what men should be told about the procedure
Ure Eke, Felicia Eke
May-June 2009, 20(3):484-485
PMID
:19414960
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Predicting hemodialysis access failure with the measurement of dialysis access recirculation
Alireza Hamidian Jahromi, Mohammed Morsy, Eric Chemla
May-June 2009, 20(3):486-487
PMID
:19414961
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Authors' reply
Javad Salimi, Effat Razeghi, Hossein Karjalian, Alipasha Meysamie, Moosa Dahhaz, Majid Dadmehr
May-June 2009, 20(3):487-487
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ORIGINAL ARTICLES
Survey of attitude of physicians on updates in the management of anemia in chronic kidney disease patients
Muhammad Ziad Souqiyyeh, Faissal Abdulraheem Shaheen
May-June 2009, 20(3):410-416
PMID
:19414943
We aimed in this study to assess the opinion of medical directors of dialysis centers in the Kingdom of Saudi Arabia (KSA) about updates of strategies for treatment of anemia in patients with chronic kidney disease (CKD). A questionnaire was sent to the medical directors of the 174 active dialysis centers in the KSA including centers under the Ministry of Health (MOH) (67 %), the governmental non-MOH sector (12%) and private hospitals (21 %) that together care for a population of more than 11,300 chronic dialysis patients. The study was performed between November 2008 and March 2009. A total of 143 of the 174 (82.1%) medical directors answered the questionnaire. This covered 9563 (84%) dialysis patients in the KSA. There were 95 (68.8%) respondents who believed that the mechanism of action of ESAs is due to both blood concentration and direct action on the stem cells that form red cells. Only 81 (57%) respondents believed that the half-life of the short-acting ESAs is less than one day, 67 (46.9%) believed the half-life of darbepoetin is 2-4 days, and 52 (36.6%) believed the half-life of CERA is 5-10 days; 79 (55.6%) respondents believed that the interval of dosing of darbepoetin is once biweekly, and 92 (71.9%) believed that the interval of dosing of CERA is once a month. There were 110 (76.9%) respondents who believed the CKD should receive a long-acting than short-acting ESAs for the more stable hemoglobin levels, 64 (44.8%) believed that pharmacodynamics of the CERA are better than other ESAs and warrant its use over all of them, and 115 (80.6%) believed that the target hemoglobin is 11-13 g/dL in CKD patients is well established. Finally, 65 (51.5%) respondents would request more than 30% of the stock of ESAs in the future as short-acting ESAs vs 71 (55%) for darbepoetin and 40 (37.4%) for CERA. There were no statistically significant differences among the respondents according to their affiliations (MOH, non MOH and private sector) on any of the issues in the questionnaire. We conclude that our results showed inadequate awareness of the medical directors of the dialysis centers in the KSA of the mechanisms of action of ESAs and the new agents such as the CERA. However, they were well informed about the limits of the targeted hemoglobin levels and showed a trend toward using the long-acting ESAs.
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Prognosis and predictors of convulsion among pediatric lupus nephritis patients
Fatemeh Beiraghdar, Abbas Maddani, Saeed Taheri, Mir Mohsen Sharifi-Bonab, Taher Esfahani, Yunes Panahi, Behzad Einollahi
May-June 2009, 20(3):424-428
PMID
:19414945
In this study, we aimed to analyze features and outcome of convulsion in pediatric lupus nephritis patients. We retrospectively reviewed data of 14 Iranian children with lupus nephritis who developed seizures and compared them with a group of the same number of well matched pediatric lupus nephritis patients. Higher serum creatinine levels and higher frequencies of anemia and lymphopenia were observed in the convulsion group. Multivariable logistic regression analysis revealed that the only risk factor for development of convulsion in pediatric lupus patients with nephritis was lymphopenia. Survival analysis showed that convulsion had no impact on patient and renal function outcomes in our pediatric lupus nephritis subjects. In conclusion, we found that lymphopenia is a predictive factor for convulsion occurrence in our patients and special attention to neurological status assessment may be needed in this situation.
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REVIEW ARTICLE
Complement and hyper acute rejection
Mohammed WO Al-Rabia
May-June 2009, 20(3):362-369
PMID
:19414935
Organ transplantation has been a major development in clinical medicine but its success has been marred by the immune system's capacity to respond to "non-self" cells and tissues. A full molecular understanding of this mechanism and the myriad triggers for immune rejection is yet to be elucidated. Consequently, immunosuppressive drugs remain the mainstay of post-transplant management; however, these interventions have side effects such as increased incidence of cancer, post-transplant lymphoproliferative disorders, susceptibility to infection if not managed appropriately and the inconvenience to the patient of lifelong treatment. Novel therapeutic approaches based on molecular understanding of immunological processes are thus needed in this field. The notion that factors influencing successful transplants might be of use as therapeutic approaches is both scientifically and medically appealing. Recent developments in the understanding of successful transplants are expected to provide new opportunities for safer transplantation. This article reviews the present understanding of the molecular basis of rejection and the role of complement in this process as well as the possibility of generating "intelligent" therapy that better target crucial components of hyperacute rejections.
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SPECIAL ARTICLE
Redesigning an educational assessment program
Hanan M.F Al Kadri
May-June 2009, 20(3):476-480
PMID
:19414957
Changing educational assessment program represent a challenge to any organization. This change usually aims to achieve reliable and valid tests and assessment program that make a shift from individual assessment method to an integral program intertwined with the educational curriculum. This paper examines critically the recent developments in the assessment theory and practice, and establishes practical advices for redesigning educational assessment programs. Faculty development, availability of resources, administrative support, and competency based education are prerequisites to an effective successful change. Various elements should be considered when redesigning assessment program such as curriculum objectives, educational activities, standard settings, and program evaluation. Assessment programs should be part of the educational activities rather than being a separate objective on its own, linked to students' high quality learning.
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© 2007 - Saudi Journal of Kidney Diseases and Transplantation | Published by Wolters Kluwer -
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Online since 20
th
April, 2007