Thymoquinone (TQ), 2-Isopropyl-5-methyl-1, 4-benzoquinone, is one of the most active ingredients of Nigella Sativa seeds. TQ has a variety of beneficial properties including anti­oxidative and anti-inflammatory activities. Studies have provided original observations on the role of oxidative stress and inflammation in the development of renal diseases such as glomerulo­nephritis and drug-induced nephrotoxicity. The renoprotective effects of TQ have been demons­trated in animal models. Also, TQ has been used successfully in treating allergic diseases in humans. The aim of this review is to highlight the importance of reactive oxygen species in renal pathophysiology and the intriguing possibility for a role of TQ in the prevention of and/or protection from renal injury in humans.

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To evaluate the smoking and khat chewing habits in male Aden University medical students and correlate them with blood pressure (BP), body mass index (BMI), and year of training, we randomly selected 100 students of different levels of training and measured their BP, height, and weight, and evaluated their cigarette smoking and khat chewing habits. The mean age of the whole group was 31.8 years. The mean BMI was 23.24 with a range from 22.6 in the in first year medical students to 24.7 (4.4) in 5 ^th year medical students (P= 0.127). The mean SBP, DBP, and MBP were 120.35, 70.47 and 87.1 mmHg, respectively, and did not change over the years of training. Preva­lence of smoking increased from 20% to 40% and khat chewing from 35% to 90% over the 5 years of training (P= 0.0003). There was a tendency for positive correlation between age and weight, BMI and frequency of khat chewing, and BMI and MBP. We found high prevalence of smoking and khat chewing among the medical students at Aden University and their prevalence increases with student seniority with no significant changes in BMI, SBP, DBP or MBP. There was a weak positive correlation between BMI with SBP, MBP and frequency of Khat chewing.

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Steroid resistant nephrotic syndrome (SRNS) remains a challenge facing pediatric nephrologists. The underlying histopathology usually affects the course of the disease and the response to treatment. We studied the pattern of histopathology in children with SRNS who presented to the King Abdul Aziz University Hospital (KAUH), Jeddah, Saudi Arabia. The records of all children with primary SRNS, who were seen between 2002 and 2007 were reviewed. Only patients who had undergone a renal biopsy were included in the study. The histopathology slides were reviewed by two renal pathologists independently. Patients with congenital nephrotic syndrome, lupus or sickle cell disease, were excluded from the study. Thirty­six children fulfilled the inclusion criteria, and included 25 girls and 11 boys with female to male ratio of 2.3:1. Fifty percent of the children (n=18) were Saudi and the remaining 50% were from various other racial backgrounds (9 Asians, 4 Arabs, 2 Africans and 3 from the Far East). Their mean age at presentation was 4.3 ± 3.0 years (range 1-12 years). The mean serum albumin at presentation was 15.6 ± 7.1 g/L and all of them had 4+ proteinuria on urinalysis. Five children had elevated serum creatinine at presentation while the mean serum creatinine was 50.4 ± 45.6 µmol/L. Three children had low serum complement levels at presentation and none were positive for hepatitis B surface antigen or antinuclear antibody (ANA). The renal histopathology was compatible with focal and segmental glomerulosclerosis (FSGS) in 39% (n=14), IgM nephro­pathy in 28% (n=10), mesengioproliferative glomerulonephritis (MesPGN) in 17% (n=6), mini­mal change disease (MCD) and C1q nephropathy (C1qNP) in 8% each (n=3 + 3) and IgA nephro­pathy in 3% (n=1). Our retrospective review shows that FSGS was the commonest underlying histopathology in children who presented with SRNS followed by IgM nephropathy and other variants of MCD such as MesPGN. C1qNP was the underlying cause in some children.

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Granulomatous interstitial nephritis (GIN) is an uncommon form of acute interstitial nephritis. We report a young male who presented to us with a rapidly progressing renal failure and massive proteinuria. A renal biopsy revealed GIN, and we were able to demonstrate the presence of tuberculous DNA in the biopsy specimen. The patient was started on anti-tuberculous therapy and steroids besides 11 sessions of hemodialysis. He recovered and is currently doing well. This case highlights an uncommon manifestation of renal tuberculosis, namely massive proteinuria, acute renal failure, and granulomatous interstitial lesions.

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Although the pathogenesis of systemic lupus erythematosus (SLE) might now seem very complicated, various aspects are coming together to make a coherent story. Firstly, there is a loss of tolerance by the T and B lymphocytes, so accounting for the formation of autoantibodies that characterize this autoimmune disease. Failure of methylation of vital genes could underlie this aspect. Secondly, as much emphasized in recent years, poor clearance of apoptotic cells on account of de­fective phagocyte receptors and complement deficiencies involves stimulation of Toll like Receptors (TLRs) 7 and 9 on plasmacytoid dendritic cells (pDCs) and results in release of type I interferon alpha (IFNa). Thirdly, the familiar Th-1 lymphocytes produce interleukins 12 and 18 and inter­feron gamma (IFNy)), along with chemokines, but now Th-17 lymphocytes are recognized to play an important role.

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In this study, we aimed to evaluate the incidence, features and outcome of post trans­plant KS among Iranian recipients of living kidney allograft. We studied 2211 kidney allograft reci­pients who underwent living renal transplantation at our center between January 1984 and August 2007. All patients in our study received cyclosporine based immunosuppressive agents. The diagno­sis of KS was confirmed with pathological evaluations of tissue biopsy specimens. There were 10 of 2211 (0.45%) incident cases of KS kidney transplant population at our center during a mean follow up of 57 ± 38 months. Of the 10 KS patients, 8 were males and two were females with a median age of 52 years. The median time from transplantation to the development of KS was 8 months. Overall, two (20%) patients developed visceral involvement (one eye, one bladder), and eight patients mani­fested only KS restricted to the skin. Immunosuppression was reduced in 5 patients and thoroughly withdrawn in the remainder (including two cases of visceral involvement); KS did not abate in the patient with bladder involvement. All the KS patients remained alive after a mean of 35.6 ± 39.3 months of follow up; two patients lost their allograft and underwent dialysis (one after 3 months and one another after 4 months of KS diagnosis). The KS patients were significantly older at their transplantation time (P= 0.008; [Table 1]). Survival analysis using Kaplan Meier method and log-rank test revealed no difference in graft and patient survival between both groups. In conclusion, we found low incidence of KS in our living renal transplant recipients. The outcome of the KS patients was excellent with low morbidity and mortality. The incidence of KS was significantly associated with an older age at transplantation time for the allograft recipients. Further studies with larger pa­tient population are warranted to confirm our results.

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Cyclosporine is the main immunosuppressive drug used for renal transplant reci­pients in order to prevent transplant rejection. Although the drug has increased the survival of patients and grafted organ, it has some side effects independent of its effect on the immune system. This study was done to evaluate the effect of cyclosporine on serum Mg level and its metabolic side effects in renal allograft patients. 157 (62 female and 95 male) renal transplant recipients treated with cyclosporine to prevent transplant rejection were included in the study. Clinical and biochemical data along with cyclosporine levels was documented. Mean serum Mg level was 196 ± 0.31 mg/dL and mean serum cyclosporine level was 371 ± 192 µg/dL. Hypomagnesemia was detected in 16 (10.2%) with a negative significant correlation with cyclosporine levels, serum creatinine, plasma LDL, fasting Blood sugar and uric acid. In conclusion according to the results of this study there is a significant correlation between cyclosporine and hypomagnesemia. Therefore, routine measurement of serum Mg and its treatment seems necessary to prevent its complications.

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This study was aimed at determining the median survival and most frequent causes of death in patients with the Autosomal Dominant Polycystic Kidney Disease (ADPKD). A retrospective, observational analysis was made on patients registered with a diagnosis of ADPKD, in the computer records of the Sheffield Kidney Institute (SKI), United Kingdom, during the years 1981 to 1999. Data on 363 patients were analyzed from these computer records and further infor­mation, if any, was obtained from the patients' clinical notes. During this period, 88 patients died. The median age of the patients who died was 60.5 years, with the youngest being 37 years old and the oldest being 82 years. The major causes of death in this study group were cardiovascular (46.6%), infection (15.9%), central nervous system (CNS) disorders (11.36%), and miscellaneous causes (11.36%). Our study suggests that the major cause of death in patients with ADPKD was cardiovascular followed by infection, of which 42% of the deaths were due to septicemia. CNS causes of death comprised 11.36% of whom 60% had cerebrovascular events including sub­arachnoid hemorrhage in 20% of the patients. Uremia was the cause of death in only 2.2% of the patients in this series.

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The arterio-venous fistula (AVF) remains the ideal vascular access for patients on maintenance hemodialysis (HD). The aim of this study was to evaluate the complications associated with AVF and was conducted at the Ekbatan Hospital dialysis center in the years 2006 and 2007. In this descriptive cross-sectional study, 90 patients with AVF were enrolled. For each patient, data related to age, gender, time of AVF surgery, duration of renal failure, duration on dialysis, number of fistulas and their sites and, data related to complications of AVF were entered in a check list and analyzed with SPSS software (version :11). Majority of the study patients were in the age-group of 41-60 years and there was a male preponderance (56.7%). The mean duration from the time AVF surgery was performed was 26 ± 29.8 months, the mean duration of ESRD was 48.1 ± 45.52 months and the mean duration on dialysis was 28.6 ± 30.81 months. Most of the patients (75.6%) had undergone AVF surgery only once and in the majority (61.1%), the fistula was in the left arm. The most frequent complication seen in our patients was aneurysm (51%), followed by venous hyper­tension (16.7%), infection (4.4%), thrombosis (3.3%) and arterial steal syndrome (1.1%). Our study indicates that the prevalence of complications of AVF is high and greater attention should be paid to the prevention of these complications. Early diagnosis and appropriate treatment is essential to improve the quality of life in patients on HD.

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Acute renal failure (ARF) is a rare but potentially fatal complication of diabetic ketoacidosis (DKA). Early recognition and aggressive treatment of ARF during DKA may im­prove the prognosis of these patients. We present a case report of a 12 year old female admitted to the hospital with severe DKA as the 1s ^t manifestation of her diabetes mellitus. She presented with severe metabolic acidosis, hypophosphatemia, and oliguric ARF. In addition, rhabdomyolysis was noted during the course of DKA which probably contributed to the ARF. Management of DKA and renal replacement therapy resulted in quick recovery of renal function. We suggest that early initiation of renal replacement therapy for patients with DKA developing ARF may improve the potentially poor outcome of patients with ARF associated with DKA.

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The increased risk of cancer after renal transplantation is well documented; however there is less agreement about the prevalence and risk of cancer in patients on dialysis. Although, certain cancers such as those of the kidney and urinary tract are more common among dialysis patients, the extremely high mortality rate of dialysis patients when compared to the normal popu­lation makes cancer screening ineffective both from the cost perspective as well as the survival benefit that is conferred by pre-emptive screening However, with newer improvements in dialysis techniques and better survival of the dialysis population, this issue needs to be addressed.

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To evaluate the efficacy of supplementation with high dose folic acid with and with­out vitamin B ₁₂ in lowering plasma total homocysteine (tHcy) concentrations in hemodialysis (HD) patients, we studied 36 HD patients randomized into four groups according to the received thera­peutic regimen: group I (only folic acid (FA), 5 mg/day), group II (FA, 5 mg/day + vitamin B ₁₂ , 1 mg/day) group III (only FA, 15 mg/day), group IV (FA, 15 mg/day, vitamin B ₁₂ , 1 mg/day) for a period of 8 weeks. Plasma tHcy and serum FA and vitamin B ₁₂ levels were measured at baseline and after the supplementation period. Dietary intakes were assessed during the study period. At baseline, 27.8% of the patients had normal levels of tHcy and 72.2% had hyperhomocysteinemia. After supplementation, plasma tHcy increased by 1.35% in group I and decreased by 6.99%, 14.54% and 30.09% in groups II, III and IV respectively, which was only significant in group IV (P= 0.014). The patients did not show any significant changes in serum folic acid, but a significant change in serum vitamin B ₁₂ in group IV (P= 0.006). Percentage of patients reaching normal levels of plasma tHcy was 5.6 fold higher in group IV than in the reference group (group I). No corre­lations were found between changes of plasma tHcy levels and dietary intakes. We conclude that oral supplementation with 15 mg/day folic acid together with 1 mg/day of vitamin B ₁₂ is effective in reducing tHcy levels in HD patients. These supplements also have a desirable effect on serum folic acid and vitamin B₁₂.

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Adult Wilms' Tumor (AWT) is a rare entity arising from the metanephric blastema. There are only about 200 cases reported in world literature. The staging of AWT is done in the same way as in children according to the National Wilms' Tumour Stage Group (NWTSG). Defini­tive treatment plans for AWT are undefined but surgical treatment has the highest priority. There is also consensus on the need for multimodality approach. We report a case of AWT who remains disease free, three years after undergoing multimodality treatment.

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Systemic lupus erythematosus (SLE) is a multisystem disease. This study was under­taken to assess the outcome of pregnancies in patients with inactive SLE. We prospectively studied 20 female patients with diagnosis of stable class IV Lupus nephritis followed up at King Abdul Aziz University Hospital, in Jeddah, Saudi Arabia between 1998 and 2008. Before each pregnancy all the patients had their blood pressure, serum creatinine, creatinine clearance, serology for SLE and 24-hour urine protein excretion measured and then repeated at monthly intervals during the pregnancy. Statistical analysis was performed using the Wilcoxon signed-rank test. Despite having negative antinuclear antibody (ANA) significant complications were observed during pregnancy. The daily proteinuria during 34-36 weeks' gestation was significantly higher (P< 0.05) than during 32 weeks. Two patients had abortions one stillbirth and 2 required termination of the pregnancy; one due to severe hypertension, and other due to renal impairment. One patient developed HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. 14 patients had a successful preg­nancy, including 4 requiring a cesarian section. In conclusion, although no clinical evidence of lupus disease activity was demonstrated pre-conception proteinuria significantly increased during pregnancy along with maternal and fetal complications. Pregnant females with diagnosis of SLE need a multidisciplinary care during the pregnancy and post-partum period.

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The aim of this study was to look for correlation between the markers for malnu­trition and inflammation, and atherosclerosis in pre-dialysis chronic kidney disease (CKD) patients. This observational study involved 100 pre dialysis patients (age 57 ± 12 years) from the out-patient and in-patient departments over a span of two years. Informed consent was obtained from all the study patients. Highly sensitive C-reactive protein (hsCRP) was assayed as a marker of chronic inflammation. Nutritional status was assessed using serum albumin and body mass index (BMI). Clinical and laboratory data were collected and a carotid doppler study was performed using duplex ultrasonography method to look for carotid artery stenosis. Renal function was assessed by cal­culating the estimated glomerular filtration rate (GFR) by the MDRD-2 formula. These data were later analyzed using descriptive statistics, Chi-square test and the students' t test. The mean GFR was 28.3 ± 16.4 mL/min/1.73m ² . The mean value of CRP was 14.3 ± 11.4 mg /L. Sixty-seven percent of patients had elevated CRP (> 6 mg/L) levels. Patients with higher CRP levels showed lower mean serum albumin levels (3.2 ± 0.7 gm/dL) (P < 0.01). Only three patients had evidence of hemodynamically significant carotid disease (lumen diameter < 50%) with no statistical signifi­cance. Low serum albumin levels were associated with low hemoglobin levels (< 10 gm/dL), low GFR and presence of diabetes mellitus. Our results indicate that a high degree of inflammation and malnutrition exists in pre-dialysis patients as seen by high CRP values and low serum albumin levels. Synergism of these factors could contribute to atherosclerosis in CKD apart from the classic risk factors. To our knowledge, this is the first study, which has compared these markers of infla­mmation in pre-dialysis patients in developing countries.

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Almost all forms of glomerular diseases have been reported in diabetics. In a recent series, 12% of those with type I and 27% of those with type II diabetes were found to have non diabetic renal disease. We studied 80 adult diabetic Iraqi patients who were diagnosed with glo­merular disease on native kidney biopsies from January 2000 to April 2008. Membranoproliferative GN was seen in 32 patients (40%), Focal and Segmental glomerulosclerosis in 16 patients (20%), Membranous nephropathy in 20 patients (25%), Minimal change disease in 8 patients (10%), Renal amyloidosis in 4 patients (5%). In conclusion Membranoproliferative GN was the most common histological diagnosis in our diabetic patients undergoing renal biopsy.

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To determine the prevalence of urological and vascular complications in renal trans­plant recipients (RTx) at Tabriz Renal Transplant Center, we studied 55 recipients of renal allo­grafts (25 male and 29 female patients with a mean age of 38.3 ± 13.4 years) from October 2005 to November 2006. The surgical complications in our study included hematomas: 20.4%, renal artery stenosis: 20.4%, calculi: 7.4%, hydronephrosis or ureteral stricture: 5.6%, urinary leakage: 5.6%, lymphoceles: 1.9%, and renal vein thrombosis: 1.9%. We conclude that the most common urologic complications in our center were ureteric strictures and urine leaks, and the most common vascular complication was renal artery stenosis.

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The use of imaging modalities and endovascular procedures has escalated phenol­menally in the last two decades. In view of increasing number of elderly patients, rising incidence of chronic kidney disease and diabetes along with the complication of nephrogenic systemic fibrosis with gadolinium, a large patient population will be at risk of developing iodinated contrast induced acute kidney injury (ICI-AKI) which is associated with significant morbidity and mortality and increased health care costs. Hence a search for more effective ways to prevent ICI­AKI continues to be a focus within the medical community.

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Spontaneous rupture of the spleen usually occurs secondary to infection, hematolo­gical disorders or infiltrative lesions of the spleen. In patients with positive human immuno­deficiency virus (HIV) antibodies and the acquired immunodeficiency syndrome (AIDS) who pre­sent with acute abdomen, splenic rupture should be considered as a possible cause and should addi­tionally be investigated for co-infection with tuberculosis. Spontaneous rupture of spleen in asymp­tomatic patients requires a high index of suspicion for diagnosis. We herein report on a HIV-positive patient on maintenance hemodialysis, who presented with spontaneous rupture of a tuberculous spleen.

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Renal hemodynamics were studied using duplex Doppler ultrasonography in forty (33 females and 7 males; mean age: 12.1 ± 5.3 years) normotensive patients with recurrent urinary tract infection and with no evidence of obstructive uropathy and age matched control group of 24 healthy children and adolescents. Resistivity index (RI) and pulsatility index (PI) in both arcuate (AA) and interlobar (IA) arteries were significantly higher in patients as compared to controls (P= 0.001, 0.01 respectively). Diastolic/systolic ratio (D/S) at the same levels of renal vasculature (AA and IA) was significantly lower in study patients as compared to their controls (P= 0.01, 0.001 respectively). Moreover, scarred renal units had higher RI and PI values as well as lower D/S ratio as compared to non scarred units (p= 0.01, 0.001, 0.001 respectively).). In conclusion, intra renal vascular resistivity is significantly increased in recurrent UTI patients particularly in those sus­taining renal scarring. Further follow up studies are recommended to determine if duplex assess­ment of intrarenal vasculature could be useful as an ancillary diagnostic and/or prognostic technique in the evaluation and follow up of recurrent UTI.

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Transplantation is accepted therapy for chronic kidney disease. However the essential immuno­suppressive agents for graft survival have their own side-effects. Renal biopsy is a reliable tool for diagnosing cyclosporine (CsA) nephrotoxicity. To present our observations on CsA toxicity in renal allograft biopsies, we studied prospectively 207 renal allograft biopsies performed for graft dysfunction as per Ahmedabad Tole­rance Induction Protocol (ATIP) and compared them to 50 controls from January to October 2007. The ATIP comprised donor specific leucocyte infusions, low dose target specific irradiation; non-myeloablative condi­tioning with Anti-T ± B cell antibodies followed by intraportal administration of cultured donor bone marrow (BM) ± adipose tissue derived mesenchymal stem cells. Renal transplantation was performed following nega­tive lymphocytotoxicity cross-matching. The post-transplant immunosuppressive agents included CsA 2.5 ± 0.5 mg/kg BW/day and prednisone 0.2 mg/kg BW/day. The controls were transplanted using standard triple immunosuppressive agents including CsA 5 ± 1 mg/Kg BW/day, prednisone 0.6 mg/kg BW/day, and MMF/ Azathioprine. The Institutional Review Board approved the ATIP. The biopsies were categorized into 2 groups; group A (N=97): performed < 6 months, group B (N= 160), > 6 months posttransplant. Acute CsA toxicity was observed in group A: 2.5% ATIP and 11.1% controls; group B: 16.2% ATIP and 8.8% controls. Chronic CsA toxicity was observed in group B: 10.8 % ATIP and 17.6 % controls. Acute toxicity was more in the ATIP, while chronic toxicity was more in the controls. CsA doses were reduced post-biopsy and resulted in improved graft function evaluated by serum creatinine. We conclude that CsA nephrotoxicity evaluated by allograft biopsy resulted in allograft function recovery by decreasing the cyclosporine dose, and the ATIP decreased the incidence of CsA nephrotoxicity.

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Overall and cardiovascular mortality are significantly higher in hemodialysis patients with elevated C-reactive protein (CRP). The aim of study was to determine whether CRP, low albumin and troponin are markers of overall and cardiovascular mortality in hemodialysis patients. 138 stable hemodialysis patients were divided into 2 groups n= 66 patients with coronary disease equivalent (known coronary or peripheral vascular disease or diabetes mellitus) and n= 72 patients without it. The two groups were then stratified by biomarkers [cardiac troponin T and Albumin and highly sensitive CRP (hs-CRP)] and followed for 30 months. The primary outcome was all causes mortality. Patients with coronary disease equivalents had 3.5 fold greater annual mortality compared to controls (24%% vs 6.9%, P value = 0.005). Elevated troponin T had a further increase in the risk for death while hs-CRP and low albumin were not associated with risk of death In conclusion, circu­lating cardiac troponin-T was associated with poor prognosis especially in hemodialysis patients with coronary risk factors.

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One fifth of the inserted dialysis catheters in the internal jugular or subclavian veins may be misplaced. Appropriate positioning of the catheter tip is sometimes difficult. We attempted to use intravenous electrocardiography (ECG) to guide catheter tip positioning in 30 hemodialysis patients (17 (57%) were men, and the mean age was 43 ± 12 years). who required vascular accesses for dialysis by insertion of double lumen temporary catheters via the jugular veins. Before cathe­terization, standard ECG on the long lead D II was performed and P-wave height was recorded. P­wave voltage was also measured via the blue (venous) and red (arterial) lumens, using the guide wire as an electrical conductor. After confirmation of the appropriate position of the catheter tip at the superior vena cava (SVC)-right atrial junction using chest radiography, the ECG lead corres­ponding to the right hand was connected to the guide wire lodged inside the lumen of the blue catheter. P-wave height in the long lead D II was recorded. The guide wire was withdrawn so as to bring its tip tangent to the tip of the red catheter. ECG was performed on the long lead D II in a similar manner, and the P-wave height was recorded. The mean P-wave voltage in normal ECG and intravenous ECG (red and blue catheter tips) measured 1.27 ± 0.38 mm, 3.10 ± 0.95 mm, and 5.42 ± 1.76 mm, respectively. The difference between the mean P-wave voltages measured in standard and intravenous ECG (blue and red catheter tips) was statistically significant (P< 0.05). We conclude that the dialysis catheter tip can be positioned appropriately via the measurement of the P-wave height by intravenous ECG and using the sinoatrial node as an accurate landmark. This method can complement the chest radiography in the appropriate placement of the central vein catheters.

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Chronic infection with hepatitis C virus (HCV) is a serious public health problem affecting an estimated 2% of the world's population. The natural history of HCV infection in hemodialysis patients remains incompletely understood and the management is difficult. HCV infection in hemodialysis patients is usually asymptomatic. Given the diminished life expectancy of hemodialysis patients, complications such as decompensated cirrhosis and hepatocellular carcinoma may not have time to develop. The frequency of advanced fibrosis or cirrhosis ranges from 0% to 28 %. We discuss in this presentation several aspects of HCV infection in chronic kidney disease (CKD) patients such as relationship with glomerulopathy, renal allograft outcome, prevalence in hemodialysis patients in the kingdom of Saudi Arabia, treatment of HCV in hemo­dialysis patients in the kingdom of Saudia Arabia, and finally our experience at Prince Salman Center for kidney disease (PSCKD) in the management of HCV infected hemodialysis patients.

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We present two cases that developed clinical, biochemical and radiological evidences of primary and secondary hyperparathyroidism. In the first case the adenoma was removed through a transcervical incision and in the second case the supernumerary adenoma was removed through sternotomy. Post operatively, patients had normal serum calcium and iPTH with complete disappearance of symptoms.

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Emphysematous pyelonephritis (EPN) is an acute necrotizing parenchymal and peri­renal infection caused by gas-forming uropathogens. The predisposing factors are diabetes mellitus and ureteric obstruction. E. coli is the most frequently identified pathogen. The overall mortality is 43%. Computerized tomography (CT) is the imaging procedure of choice in determining the extent of infection and guiding management. Management of EPN has evolved from aggressive surgical intervention to conservative management. Although there are reports of improved renal function after medical therapy combined with relief of obstruction, most of the patients still require neph­rectomy. We present a case of EPN and also evaluate the radiological features, prognosis, and current management of this disease.

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Mesangial IgG glomerulonephritis (MesIgGN) is recently recognized as a distinct type of glomerulonephritis. In our renal biopsy series, two patients with MesIgGN were identified. The morphologic criteria detected in these patients included mesangial dense deposits by ultra­structural studies, which were predominantly positive for IgG by immunofluorescence. Both patients were young boys, one presented with hematuria and the other with the nephrotic syndrome. Similar cases have been reported in other studies from around the world; however, this is the first report of MesIgGN from Saudi Arabia.

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