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2014| March-April | Volume 25 | Issue 2
Online since
March 11, 2014
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REVIEW ARTICLE
An update on sickle cell nephropathy
Abdullah Alhwiesh
March-April 2014, 25(2):249-265
DOI
:10.4103/1319-2442.128495
PMID
:24625990
Sickle cell disease (SCD) is a major health problem in many countries. Sickle cell nephropathy (SCN) is now a well-characterized entity with specific manifestations, risk factors and prognosis. The presence of sickled erythrocytes in the renal medullary vessels is the hallmark of the disease with a variety of renal complications. Renal manifestations of SCD include renal ischemia, microinfarcts, renal papillary necrosis and renal tubular abnormalities with variable clinical presentations. Proximal tubule dysfunction generally impairs urinary concentration, while more distal tubule dysfunction may impair potassium excretion, leading to hyperkalemia. Glomerular disease with proteinuria may develop due to ischemia and results in a compensatory increase in the renal blood flow and glomerular filtration rate; such hyperfiltration, combined with glomerular hypertrophy, probably contributes to glomerulosclerosis. Acute and chronic kidney disease are the expected outcomes of the disease. Both dialysis and kidney transplantation are effective renal replacement therapies for end-stage renal disease due to SCN, with a higher advantage for transplantation. Whether bone marrow transplantation in the early stage of the disease can halt the progression of SCN is unknown and awaits clinical studies.
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13,356
2,169
4
ORIGINAL ARTICLES
Allopurinol reduces cardiovascular risks and improves renal function in pre-dialysis chronic kidney disease patients with hyperuricemia
Siren Sezer, Sebnem Karakan, Berna Atesagaoglu, F Nurhan Ozdemir Acar
March-April 2014, 25(2):316-320
DOI
:10.4103/1319-2442.128520
PMID
:24625997
To determine the effect of hyperuricemia and allopurinol therapy on renal functions in chronic kidney disease (CKD) stage 3-4, we studied 96 patients in stage 3-4 CKD (57% male, age 65.3 ± 12.4 years). The mean estimated glomerular filtration rate (GFR) was 44.62 ± 14.38 iriL/ min/1.73 m
2
. The study patients were divided into non-allopurinol users (n = 47) and those using allopurinol (n = 49) in the last 12 months. Serum uric acid (UA) and C-reactive protein levels decreased after allopurinol therapy
(P =
0.00 and
P =
0.04, respectively), but no change was observed in the control group during the study period. In the allopurinol group, the mean GFR increased 3.3 ±1.2 mL/min/1.73 m
2
/year, while it decreased 1.3 ± 0.6 mL/min/1.73 m
2
in the control group during the follow-up period
(P =
0.04); the patients in the allopurinol group exhibited lower levels of serum potassium, serum low-density lipoprotein (LDL) and renal resistance index (RRI) (P-values were <0.05). The patients with stable renal functions or GFR change <10% (n = 25) at the end of 12 months had significantly lower LDL and RRI values and more allopurinol users than the group with deceasing GFR (74% vs. 48%,
P
<0.05). In the regression analysis, UA and RRI were found as independent variables (r
2
= 0.68,
P
<0.01; r
2
= 0.25,
P
<0.01) that affected loss of renal function. We conclude that our study suggests a role for allopurinol, an effective agent in lowering serum UA levels, as a reliable therapeutic option in controlling renal progression in pre-dialysis CKD patients.
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8,801
1,235
4
RENAL DATA FROM ASIA-AFRICA
Acute renal failure in pregnancy: Our experience
Rohina S Aggarwal, Vineet V Mishra, Anil F Jasani, Manoj Gumber
March-April 2014, 25(2):450-455
DOI
:10.4103/1319-2442.128621
PMID
:24626025
Acute renal failure (ARF) is a serious medical complication during pregnancy, and, in the post-partum period, is associated with significant maternal morbidity and mortality as well as fetal loss. The objective of our study is to find the etiology and maternal outcome of ARF during pregnancy. The study was conducted at the Obstetrics and Gynecology Department of the Institute of Kidney Disease and Research Center, Ahmedabad, India from January 2009 to January 2011. Fifty previously healthy patients who developed ARF, diagnosed on oliguria and serum creatinine >2 mg%, were included in the study. Patients with a known history of renal disease, diabetes and hypertension were excluded from the study. All patients were followed-up for a period of six months. Patient records, demographic data, urine output on admission and preceding history of antepartum hemorrhage (APH), post-partum hemorrhage (PPH), septicemia, operative interventions and retained product of conception were noted and need for dialysis was considered. Patients were thoroughly examined and baseline biochemical investigations and renal and obstetrical ultrasound were performed on each patient and bacterial culture sensitivity on blood, urine or vaginal swabs were performed in selected patients. The age range was 19-38 years (mean 26 ± 3.8). The first trimester, second trimester and puerperal groups comprised of four (8%), 25 (50%) and 21 patients (42%), respectively. Hemorrhage was the etiology for ARF in 15 (30%), APH in ten (20%) and PPH in five (10%) patients. Eleven (22%) patients had lower segment cesarian section (LSCS) while 36 (78%) patients had normal vaginal delivery. In 20 (40%) patients, puerperal sepsis was the etiological factor, while pre-eclampsia, eclampsia and HELLP syndrome accounted for 18 (36%) patients. Two (4%) patients had disseminated intravascular coagulation on presentation while one (2%) patient was diagnosed with hemolytic uremic syndrome. Maternal mortality was 12% (n = 6). Of the 38 (88%) surviving patients, 21 (42%) had complete recovery of renal function, eight (16%) patients had partial and 15 (30%) patients required dialysis on a long-term basis. ARF in pregnancy is associated with poor maternal and renal outcome if not detected and treated in time.
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10
ORIGINAL ARTICLES
A clinical study of bilateral non-obstructive acute pyelonephritis with acute kidney injury in patients of type 2 diabetes mellitus
Manjusha Yadla, Sriramnaveen Parvithina, Krishna Kishore Chennu, Sandeep Reddy, A. V. S. S. N. Sridhar, B Vijayalakshmi, AY Lakshmi, Tek Chand Kalawat, V Sivakumar
March-April 2014, 25(2):338-342
DOI
:10.4103/1319-2442.128532
PMID
:24626001
The aim of our study was to study the clinical profile of type 2 diabetes mellitus patients admitted with the diagnosis of acute kidney injury (AKI) due to bilateral acute non-obstructive pyelonephritis. The bilateral involvement was identified on various imaging modalities (ultrasound, computed tomography, nuclear scintigrapy). All the patients had AKI. Those with severe AKI underwent hemodialysis. The factors associated with the severity of illness were identified. Twenty-five patients of type 2 diabetes mellitus admitted with the diagnosis of AKI due to bilateral acute non-obstructive pyelonephritis were identified. On ultrasound, bilateral involvement was found in 12 patients and in 17 patients on computed tomography and eight patients on nuclear scintigraphy. Fourteen of them needed dialysis support. Bilateral acute pyelonephritis needs to be considered while evaluating the AKI in type 2 diabetes mellitus patients.
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728
3
Utility of color doppler ultrasound in the evaluation of renal artery stenosis in comparison with contrast-enhanced magnetic resonance angiography
Elnasri M Abuagla, Tan Sook Pei
March-April 2014, 25(2):309-315
DOI
:10.4103/1319-2442.128518
PMID
:24625996
Renal artery stenosis (RAS) is one of the main correctable causes of secondary systemic arterial hypertension. Color Doppler ultrasound (DUS), a non-invasive imaging modality, has been used to diagnose RAS in hypertensive patients. This study was conducted in the period between June 2008 and March 2010 to compare the sensitivity, specificity, accuracy and predictive values of DUS using contrast-enhanced magnetic resonance angiography (CEMRA) as the gold standard for the diagnosis of RAS. Fifty-seven consecutive patients with clinical findings suggestive of RAS (32 males and 25 females) with a mean age of 56 years (±7.92 years) were referred to the University Kebangsaan Medical Center to be screened for RAS using DUS and CEMRA. RAS was considered significant if the reduction in diameter was >60%. A total of 114 arteries were assessed, 65 in males (57%) and 49 in females (43%). On DUS, the parameters measured were the peak systolic velocity at the proximal main renal artery (PSV-P), distal main renal artery (PSV-D) and the suprarenal aorta (PSV-A) at the level of the renal hila and the acceleration time (AT) at the main renal artery. The renal-renal ratio (RRR), which is the value of PSV-P/PSV-D, and the renal-aortic ratio (RAR), which is the value of PSV-P/PSV-A, were then calculated. The accuracy, sensitivity, specificity and positive and negative predictive values of DUS in the detection of significant RAS were determined. All measured DUS parameters were positive for the detection of RAS, with an accuracy of 98.3%. On retrospective review, all the arteries that showed significant stenosis on CEMRA demonstrated an irregular outline on DUS. We conclude that DUS is accurate in the diagnosis of significant RAS but is not very sensitive as a screening tool.
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6,256
763
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Nephrocalcinosis in pre-term neonates: A study of incidence and risk factors
Gamal B Mohamed, Mohamed A Ibrahiem, Waleed M Abdel Hameed
March-April 2014, 25(2):326-332
DOI
:10.4103/1319-2442.128524
PMID
:24625999
The objective of this study was to determine the incidence and risk factors of nephrocalcinosis (NC) in pre-term neonates in the neonatal intensive care unit (NICU) at the Al-Minya University, Egypt. The study included 97 pre-term neonates with a gestational age 34 weeks. Data on duration of hospitalization, sex, gestation, birth weight, family history of renal stone, need for respiratory support, intake of calcium and use of total parenteral nutrition (TPN) and nephrotoxic drugs were collected. Blood urea nitrogen, serum creatinine, sodium, potassium, calcium and phosphate were measured within the first week of life and again at term. Blood gases, urinary pH, urinary calcium/creatinine (U Ca/Cr) ratio and urinary oxalate/creatinine (U Ox/Cr) ratio were measured once at term. Three renal ultrasound (US) scans were performed; one before the first week of life, the second at term and the third at a corrected age of one year. Of the 97 infants studied, 14 (14.4%) developed NC diagnosed by renal US at term. NC was bilateral in 11 infants. Factors significantly associated with NC were gestational age, need for respiratory support, high calcium intake, TPN, use of post-natal dexamethasone, furosemide, theophylline, and/or aminoglycosides and U Ca/Cr ratio and U Ox/Cr ratio (all
P <
0.05). Low gestational age
(P =
0.004), use of respiratory support
(P =
0.005), furosemide therapy
(P =
0.002) and increased U Ca/Cr ratio
(P =
0.001) were the strongest independent risk factors after logistic regression analysis. Eight of the 14 infants (57.1%) with NC had spontaneous resolution of calcification at a corrected age of one year. Screening at term with a renal US scan and long-term follow-up of renal function is needed for early diagnosis and better management of NC. Future research pertaining to prevention of NC in pre-term neonates is required.
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4
CASE REPORTS
Sodium hypochlorite-induced acute kidney injury
Brandon W Peck, Biruh Workeneh, Huseyin Kadikoy, Abdul Abdellatif
March-April 2014, 25(2):381-384
DOI
:10.4103/1319-2442.128553
PMID
:24626008
Sodium hypochlorite (bleach) is commonly used as an irrigant during dental procedures as well as a topical antiseptic agent. Although it is generally safe when applied topically, reports of accidental injection of sodium hypochlorite into tissue have been reported. Local necrosis, pain and nerve damage have been described as a result of exposure, but sodium hypochlorite has never been implicated as a cause of an acute kidney injury (AKI). In this report, we describe the first case of accidental sodium hypochlorite injection into the infraorbital tissue during a dental procedure that precipitated the AKI. We speculate that oxidative species induced by sodium hypochlorite caused AKI secondary to the renal tubular injury, causing mild acute tubular necrosis.
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4,883
540
1
RENAL DATA FROM THE ARAB WORLD
Assessment of adequacy of hemodialysis dose at a Palestinian hospital
Heba Adas, Rowa Al-Ramahi, Nidal Jaradat, Rand Badran
March-April 2014, 25(2):438-442
DOI
:10.4103/1319-2442.128615
PMID
:24626023
Adequacy of hemodialysis improves patient survival, quality of life and biochemical outcomes and minimizes disease complications and hospitalizations. This study was an observational cross-sectional study that was conducted in July 2012. Blood tests, weight and blood pressure were measured before and after hemodialysis. Single-pool Kt/V and urea reduction ratio (URR) were calculated. The targets based on the National Kidney Foundation Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines were Kt/V ≥ 1.2 and URR ≥ 65%. Of the 64 patients, 41 (64.1%) were males. The mean age of the patients was 58.13 ± 17.2 years. The mean body mass index (BMI) was 25.04 ± 5.01 kg/m
2
. The mean Kt/V and URR were 1.06 ± 0.05 and 54.4 ± 19.3, respectively. There was no significant difference between men and women (1.06 ± 0.47 versus 1.04 ± 0.55,
P =
0.863) and (54.7 ± 19.59 versus 53.81 ± 19.17,
P =
0.296). Only 25 (39.1%) patients achieved the Kt/V goal and only 22 (34.4%) had target URR, and there was no significant association between hemodialysis adequacy and any of the variables such as sex, age, presence of chronic diseases or BMI. Serum potassium levels post-dialysis were significantly lower in patients who reached the target Kt/V (mean = 3.44 ± 0.48 versus 3.88 ± 0.48,
P =
0.001). Most patients were inadequately dialyzed and a large percentage of the patients did not attain the targets. Attempts to achieve the desired goals are necessary. It is important to calculate Kt/V or URR and individualize the dialysis doses for each patient.
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4,716
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Impact of demographic and comorbid conditions on quality of life of hemodialysis patients: A cross-sectional study
Qusay Mohammed Mandoorah, Faisal Abdulraheem Shaheen, Sohaib Mohammed Mandoorah, Salem Ali Bawazir, Saad Saleh Alshohaib
March-April 2014, 25(2):432-437
DOI
:10.4103/1319-2442.128613
PMID
:24626022
To assess the quality of life (QOL) of Saudi Arabian patients undergoing hemodialysis (HD) and to determine the impact of gender, age, education and comorbidities on the QOL of these patients, we conducted a cross-sectional study and used the short form-36 (SF-36) questionnaire, a generic instrument for measuring QOL. This questionnaire is composed of eight scales that summarize the physical component scale (PCS) and mental component scale (MCS) of health status. We calculated the PCS and MCS scores for each patient. We studied 205 HD patients (123 men; ages 18-75 years) from the King Fahd General Hospital, Jeddah, Saudi Arabia. The mean SF-36 score was 59.4 ± 21.7 in men and 41.9 ± 20.9 in women
(P
<0.0001). Patients older than 60 years had the worst score (41.5 ± 21.2), followed by patients aged 40-59 years (53.6 ± 22.8); patients aged 18-39 years had the best SF-36 score (57.5 ± 22.5;
P
<0.0001). Education had a positive impact on QOL
(P
<0.0001), whereas comorbid conditions had a negative impact. Peripheral vascular disease was associated with the worst outcome (SF-36 score, 40.4 ± 23.0;
P
<0.0001), followed by dyslipidemia (42.9 ± 22.4;
P =
0.001) and diabetes mellitus (45.0 ± 22.0;
P =
0.012). Among the comorbid conditions, hypertension was associated with the best SF-36 score (50.6 ± 22.7;
P =
0.034). We conclude that old age, female gender, poor education and comorbid conditions have a negative impact on the QOL of HD patients in Saudi Arabia. These findings indicate a general need for social support for female patients on HD and early diagnosis and management of comorbid conditions.
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4,542
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6
ORIGINAL ARTICLES
Oral manifestations of allograft recipients before and after renal transplantation
Gita Rezvani, Mehdy Davarmanesh, Mohammad Reza Azar, Mehdy Salehipour, Razieh Sedaghat, Fatemeh Karimi, Neda Pazhoohi, Elham Ansari, Ali Dehghani Nazhvani
March-April 2014, 25(2):278-284
DOI
:10.4103/1319-2442.128505
PMID
:24625992
Renal transplantation is considered the best treatment option for patients with end-stage renal disease. In this study, the prevalence of oral lesions was studied in a cohort of renal transplant recipients before and after transplantation. Fifty-nine kidney transplant recipients were examined one week before and four months after transplantation. The information gathered included age, sex, smoking history, duration on dialysis, drugs and their doses. There were 41 males (69.5%) and 18 females (30.5%) with a mean age of 37 years. Before surgery, two patients had non-specific lesions and two other patients had leukoedema. Following transplantation, 24 patients (40.7%) did not have any specific lesion. In six patients, we observed non-specific erythematous lesions (10.2%). Other recorded observations are as follows: Gingival hyperplasia in five patients (8.5%), oral candidiasis of the erythematous type in five patients (8.5%), hairy leukoplakia in four patients (6.8%) and leukoedema in seven patients (11.9%). In our study patients, the prevalence of oral lesions increased after transplantation, although it was lower than that reported in other studies. This could be due to the differences in sample size, differences between Iranian race and other races and different pharmaceutical formulation of the drug produced in Iran.
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4,361
698
3
CASE REPORTS
Giant renal artery pseudoaneurysm caused by rupture of renal angiomyolipoma following pregnancy: Endovascular treatment and review of the literature
Ilkay S Idilman, Sanela Vesnic, Barbaras Cil, Bora Peynircioglu
March-April 2014, 25(2):385-389
DOI
:10.4103/1319-2442.128570
PMID
:24626009
Renal angiomyolipoma is a hamartomatous, benign tumor composed of blood vessels, fatty tissue and smooth muscle cells, and is often detected incidentally. It can also be associated with the tuberous-sclerosis complex (TSC). Pregnancy and use of oral contraceptives are known to be associated with an increased risk of tumoral rupture and bleeding. Herein, we report a unique case of renal angiomyolipoma associated with TSC who presented with hypovolemic shock as a result of spontaneous rupture of a giant renal pseudoaneurysm, immediately after pregnancy. Emergency endovascular treatment was successful with sparing of most of the affected kidney as demonstrated by follow-up computed tomography imaging.
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4,157
784
3
ORIGINAL ARTICLES
The protective effect of theophyline in cisplatin nephrotoxicity
Seyed Seifollah Beladi Mousavi, Mehran Hossain Zadeh, Heshmatollah Shahbazian, Abdullah Khanzadeh, Fatemeh Hayati, Ali Ghorbani, Khadijeh Golzari, Ehsan Valavi, Farzad Motemednia, Marzieh Beladi Mousavi
March-April 2014, 25(2):333-337
DOI
:10.4103/1319-2442.128528
PMID
:24626000
Cisplatin is a potent and a major anti-neoplastic drug in the treatment of a broad spectrum of malignancies. However, its clinical use is limited by renal tubular dysfunction that occurs in a significant percent of patients. The aim of the present study was to evaluate the possible protective effect of theophyline in the prevention of cisplatin-induced nephrotoxicity. The trial design was prospective, randomized, double-blinded and placebo controlled. Chemotherapeutic patients who received cisplatin at a dosage of at least 50 mg/m
2
alone or in combination with other chemotherapy agent(s) were included in the study. There were a total of 76 patients who were randomly divided into two groups. In group 1 (n = 38), placebo was advised; in group 2 (n = 38), patients received 4 mg/kg aminophyline as an intravenous loading dose, followed by theophyline in a dose of 200 mg three times daily orally for four consecutive days. The placebo group had 22 males and 16 females and the theophyline group had 26 males and 12 females. The mean age was 51 ± 17.6 years and the mean dose of cisplatin was 86.71 ± 43.18 mg. The prevalence of cisplatin nephrotoxicity in groups 1 and 2 was 7.9 and 5.3%, respectively, and the difference was not significant
(P =
1). In addition, there was no significant association of cisplatin nephrotoxicity with age
(P =
0.1), gender
(P =
0.64) and mean dose of cisplatin
(P =
0.8). These results indicate that prophy-lactic application of aminophyline and theophyline does not have a protective effect against cisplatin nephrotoxicity.
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4,245
606
5
Protective effect of everolimus on renal ischemia reperfusion injury in rats
Tamer Sagiroglu, Atakan Sezer, Nese Torun, Tulin Yalta, Mehmet Ali Yagci, Gonul Sagiroglu, Elif Copuroglu
March-April 2014, 25(2):294-302
DOI
:10.4103/1319-2442.128512
PMID
:24625994
The aim of this study was to determine the effect of everolimus and tacrolimus pretreatments on renal morphology and function in a rat ischemia reperfusion (I/R) model. Twenty-eight male Sprague-Dawley rats were randomly assigned to saline + sham operation, saline + I/R (IR), tacrolimus + I/R (TRL + I/R) and everolimus + I/R (ERL + I/R) groups. Saline and active treatments were administered intraperitoneally for seven consecutive days before the surgery. The suprarenal aorta was clamped to achieve warm ischemia, except in the sham group. Right nephrectomy was performed in all animals and histology was examined. Renal function was assessed on post-operative Day 7 by Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy, glomerular filtration rate (GFR) and serum biochemistry. Both everolimus and tacrolimus preserved serum creatinine and blood urea nitrogen levels, but only everolimus preserved GFR (0.74 ± 0.36, 1.20 ± 0.37 and 2.24 ± 0.32 mL/min for I/R, TRL + I/R and ERL + I/R, respectively,
P
< 0.001). %ID values for sham, I/R, TRL + I/R and ERL + I/R were 55 ± 3, 47 ± 4, 45 ± 6 and 62 ± 7 (
P
< 0.001). On histologic evaluation, ERL + I/R showed less tubular damage and necrosis than I/R, as well as TRL + I/R. Within the confines of this rat warm ischemia model, everolimus pre-treatment was useful in preserving renal function following I/R injury. The possibility of using everolimus as a pre-conditioning agent for I/R injury in kidney transplantation should be further explored.
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3,866
594
2
BRIEF COMMUNICATIONS
Effect of kidney transplantation on early and late post-transplant prostate-specific antigen levels
Reza Mahdavi, Abbasali Zeraati, Mahmoud Tavakkoli, Keivan Aghamohammadpour, Alireza Ghoreifi
March-April 2014, 25(2):362-366
DOI
:10.4103/1319-2442.128545
PMID
:24626004
The aim of this study was to determine the effect of kidney transplantation on serum prostate-specific antigen (PSA) levels. Forty patients who were on peritoneal dialysis or hemodialysis underwent kidney transplantation at our department. The immunosuppressive protocol was uniform during the study period. The creatinine and prostate specific antigen (PSA) levels, both free and total, were measured by immunofluorometric assays immediately before transplantation and on post-transplant Days 1, 7, 90 and 180. The mean age of the patients was 49.97 ± 4.4 years. After transplantation, there was a significant decrease in free PSA, but there was no correlation between total PSA and serum creatinine. Free PSA levels were significantly decreased after kidney transplantation but total PSA remained unchanged. This was observed in post-transplant patients irrespective of whether they had delayed graft function, slow graft function or immediate graft function during the observed period. Therefore, total PSA can be used as a marker for prostate cancer screening after kidney transplantation.
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3,869
416
1
CASE REPORTS
Chronic tubulo-interstitial nephritis in common variable immunodeficiency: A rare association
Sumantra Sarkar, Rakesh Mondal, Madhumita Nandi, Parasar Ghosh
March-April 2014, 25(2):394-397
DOI
:10.4103/1319-2442.128582
PMID
:24626011
Common variable immunodeficiency (CVID) is characterized by reduced serum immunoglobulin levels and repeated serious bacterial infections involving different organ systems. Chronic kidney disease (CKD) is an uncommon association with CVID. Chronic tubulo-interstitial nephritis in a case of CVID that progressed to CKD is distinctly rare.
[ABSTRACT]
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[PubMed]
3,685
439
1
Intussusception in two pediatric patients associated with nephrotic syndrome
Reham I Al-Mardini, Rana E Haddad
March-April 2014, 25(2):398-401
DOI
:10.4103/1319-2442.128584
PMID
:24626012
We report two cases of intussusception in two Jordanian boys during a relapse of nephrotic syndrome. The first patient had minimal change disease and the second patient had diffuse mesangial sclerosis. The most prominent symptom was abdominal pain, but the other classic sign of currant jelly stool was absent. In spite of the fact that both patients could have had other causes of abdominal pain, intussusception was suspected and confirmed by ultrasound and was treated successfully. Intussusception should be considered in the differential diagnosis in nephrotic patients presenting with abdominal pain.
[ABSTRACT]
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[PubMed]
3,672
421
1
Neonatal adrenal hematoma with urinary tract infection: Risk factor or a chance association?
Abdelhadi M Habeb, Mohamed A Zulali, Abdulkarim S Yamani, Saddine M Yassine
March-April 2014, 25(2):376-380
DOI
:10.4103/1319-2442.128552
PMID
:24626007
Neonatal adrenal hematoma is a rare finding that can be discovered incidentally or presents with various symptoms. However, urinary tract infection (UTI) has not been reported in association with this condition. We report on a 4-week old child with massive unilateral adrenal hematoma discovered incidentally during a routine abdominal ultrasound scan for UTI. The mass resolved spontaneously after several months with no complications. The diagnosis and management of infantile suprarenal mass and the possible link between this child's UTI and the adrenal hematoma are discussed.
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3,711
355
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ORIGINAL ARTICLES
The impact of genetic polymorphisms on time required to attain the target tacrolimus levels and subsequent pharmacodynamic outcomes in pediatric kidney transplant patients
Sireen Shilbayeh
March-April 2014, 25(2):266-277
DOI
:10.4103/1319-2442.128501
PMID
:24625991
Recent pharmacogenetic studies involving various transplant recipients in diverse ethnic populations revealed contradictory findings regarding the impact of CYP3A5 and multidrug resistance-1 (MDR1) single nucleotide polymorphisms (SNPs) on the pharmacodynamics of tacrolmius (TAC). The aim of the current study was to evaluate the impact of these SNPs on the time required to attain target TAC levels and subsequent pharmacodynamic outcomes in pediatric kidney transplant patients. Thirty-eight patients were genotyped for CYP3A5*1 and *3, and MDR1 C3435T. Notably, none of the patients expressing CYP3A5 *1*1 or *1*3 achieved the target concentration of 10-20 ng/mL within the first 2 weeks or even the first month after transplant. However, 34.4% of CYP3A5 *3*3 achieved and maintained the target goal within the first and second weeks (
P
<0.05). In contrast, C3435T polymorphism had no significant influence on the proportion of patients achieving target TAC levels. An examination of the impact of genotype combinations on clinical outcomes revealed an increased incidence of acute, chronic rejection and graft loss in patients carrying heterozygous MDR1 C3435T alleles (CT); this indicates the possibility of an additive effect of this SNP on its concurrent combination with a *3*3 SNP. In conclusion, our study revealed trends toward unwanted outcomes in CYP3A5 non-expressers with an unexplained correlation with MDR1 C3435T polymorphisms. Recommending routine pharmacogenetic testing of the individual SNPs in renal transplant patients is not yet feasible as the relationship of cost-effectiveness to ultimate impact on graft or patient survival must be justified by further prospective clinical trials.
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3,378
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1
CASE REPORTS
Piperazine side-effects in a patient with pre-existing renal insufficiency
Majid Malaki
March-April 2014, 25(2):390-393
DOI
:10.4103/1319-2442.128573
PMID
:24626010
Piperazine as an antihelminth has many adverse effects, especially on patients with renal insufficiency. We report the use of piperazine in a girl with a moderately severe kidney disease due to Biedl Bardet syndrome. She developed coma and acute kidney injury due to acute interstitial nephritis (AIN), anemia and thrombocytopenia. The presence of fever, proteinuria, acidosis, anemia, sterile pyuria and non-oliguric renal failure strongly suggested AIN. Her problems abated mostly by discontinuing of piperazine and supportive therapy, except anemia and thrombocytopenia.
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3,712
302
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ORIGINAL ARTICLES
Occurrence of the polyomavirus among kidney transplant recipients: A single-center study
Nagwa F Abdelsalam, Doaa I Hashad, Mona A Salem, Hala S El-Wakil, Ahmed G Adam
March-April 2014, 25(2):285-293
DOI
:10.4103/1319-2442.128509
PMID
:24625993
Polyoma virus-associated nephropathy is an increasingly recognized cause of graft dysfunction among kidney transplant recipients and could be the result of use of potent immunosuppression following transplantation. Because there is no safe and effective anti-viral therapy available presently, screening-based prevention and pre-emptive strategy are recommended. This study, which was conducted at the Nephrology Unit, Internal Medicine Department, Alexandria University, consisted of two phases: Phase 1 was a cross-sectional study and phase 2 was a 6-month follow-up study only for polyoma virus-positive cases. Phase 1 included 75 renal allograft recipients from living donors. Urine cytology for decoy cells and quantitative real-time blood polymerase chain reaction (PCR) for the BK virus (BKV) were performed on all the study patients. Renal biopsy was performed only in patients with deteriorating renal function associated with positive urine cytology. Patients who showed positive urine cytology for decoy cells and/or positive quantitative BKV PCR assay were followed-up for six months. During follow-up, the serum creatinine level, with or without urine cytology for decoy cells, and BKV PCR viral load assay were performed. Among the 75 kidney transplant recipients studied, eight were positive for decoy cells (11%), three showed viremia by quantitative PCR for BKV (4.1%), while two others showed nephropathy (2.7%) in the form of tubulointerstitial nephritis with intra-nuclear inclusions in the tubular cells. Cases with stable renal function and positive decoy cells or viremia cleared the virus spontaneously during follow-up without any intervention. Only one case with biopsyproven nephropathy and deteriorating graft function, with undetectable BKV in blood, lost the graft while another case with viremia died during follow-up due to septicemia. Our study suggests that polyoma virus should be considered as a cause of nephropathy in renal transplant recipients. Further research is required to understand this entity better.
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3,450
539
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Obesity and urologic complications after renal transplantation
Ashkan Heshmatzadeh Behzadi, Koosha Kamali, Mohammad Zargar, Mohammad Amin Abbasi, Pirouz Piran, Bahar Bastani
March-April 2014, 25(2):303-308
DOI
:10.4103/1319-2442.128516
PMID
:24625995
Although obesity has been associated with improved survival on dialysis, its short-and long-term effects on renal transplantation outcomes remain unclear. Herein, we evaluate the short-term and intermediate long-term effects of obesity on first-time renal transplant patients. A retrospective analysis was performed on 180 consecutive renal transplant recipients from living unrelated donors during 2006-2008 in a major transplantation center in Tehran, Iran. Among these, 34 (18%) patients were found to be obese (body mass index ≥30 kg/m
2
). Obese patients were more likely to develop post-transplant renal artery stenosis (RAS) (17.6% vs. 2.8%,
P
<0.001), hematoma (47.9% vs. 17.6,
P
= 0.009), surgical wound complications (64.7% vs. 9.6%,
P
<0.001) and renal vein thrombosis (2% vs. 0%,
P
<0.001). However, the incidence of delayed graft function, lymphocele, urologic complications of ureterovesical junction stenosis or urinary leakage, surgical complications of excessive bleeding or renal artery thrombosis and duration of hospitalization were similar between the two groups. The two-year patient and graft survival were also statistically not different. Renal transplantation in obese recipients is associated with a higher incidence of post-transplant RAS, hematoma, surgical wound complications and renal vein thrombosis, but similar two-year patient and graft survival.
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3,257
610
6
CASE REPORTS
Renal transplantation in a child with thrombosed inferior vena cava
Surjeet Kumar, Yashwant Rathore, Sandeep Guleria, Virinder Kumar Bansal
March-April 2014, 25(2):367-369
DOI
:10.4103/1319-2442.128546
PMID
:24626005
The external iliac vein is commonly used in renal transplantation for vascular anastomosis of the allograft renal vein. However, there are rare instances when the transplant surgeon may encounter thrombosis of the ilio-caval vein during surgery, making renal transplantation a challenge. Often, these patients are considered unsuitable for renal transplantation. We report a case of thrombosis of the inferior vena cava in an asymptomatic pediatric patient in whom the splenic vein was used, at transplantation, for venous drainage. This case highlights that pre-operative Doppler screening should be performed in all potential renal transplant recipients.
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3,417
389
2
Renal allograft tuberculosis with infected lymphocele transmitted from the donor
Maryam Ali Al-Nesf, Omar Isam Al-Ani, Ahmed Abdul-Rahman Al-Ani, Awad Hamed Rashed
March-April 2014, 25(2):370-375
DOI
:10.4103/1319-2442.128549
PMID
:24626006
Transmission of tuberculosis (TB) from a donor through renal transplantation is a rare incident. We are reporting a 53-year-old Qatari woman diagnosed with renal allograft TB infection. The disease was confirmed by isolation of
Mycobacterium tuberculosis
from fluid from the lymphocele and demonstration of caseating granuloma in graft biopsy with acid-fast bacilli seen on Ziehl-Neelsen staining. The diagnosis was made quite early post-transplantation. The presence of the granuloma, which is unusual with patients on intensive immunosuppressant medications, suggests that transmission of the infection occurred from the donor rather than from the activation of latent infection. In reviewing the literature, we found ten case reports of TB in transplanted kidney with transmission of TB infection from the donor. The presence of TB in lymphocele in association with the infected transplant by TB, to the best of our knowledge, was reported only once in the literature. Our case had unfavorable outcome and ended by renal allograft nephrectomy and hemodialysis. We are presenting this case of TB infection of renal allograft and lymphocele diagnosed early post-transplantation transmitted from the donor and pertinent review from the literature.
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3,176
524
3
Crescentic glomerulonephritis in non-asthmatic Churg-Strauss syndrome
Anupma Kaul, Raj Kumar Sharma, Krishna Swamy Jaisuresh, Vinita Agrawal
March-April 2014, 25(2):402-407
DOI
:10.4103/1319-2442.128580
PMID
:24626013
A 58-year-old male presented with sensory motor polyneuropathy and rapidly progressive renal failure. Investigations revealed marked peripheral eosinophilia and elevated perinuclear antineutrophil cytoplasmic antibody titers. Renal biopsy showed pauci-immune crescentic glomerulonephritis with interstitial eosinophil infiltrates. He had no history of asthma. Computed tomography of the chest and X-ray of the paranasal sinuses were normal. On Day 1, the patient developed ileal perforation. Resected ileal segments showed small vessel vasculitis with extravascular eosinophils. A diagnosis of non-asthmatic variant of Churg-Strauss syndrome was made. Renal recovery was achieved in 12 weeks with a combination therapy of corticosteroid and cyclophosphamide. The patient has been relapse-free for 12 months on oral prednisolone therapy.
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3,189
470
1
RENAL DATA FROM ASIA-AFRICA
Clinico-pathological study of glomerular diseases in patients with significant proteinuria in North India
Irneet Mundi, Sanjay D'Cruz, R. P. S. Punia, Ravinder Kaur, Atul Sachdev
March-April 2014, 25(2):443-449
DOI
:10.4103/1319-2442.128617
PMID
:24626024
Proteinuria is a common manifestation of renal disease. The present study was carried out to analyze the clinic-pathological correlation, assess the value of histopathology and immunofluorescence (IF) as well as note the spectrum of renal diseases in patients with significant proteinuria. Fifty consecutive patients having proteinuria >1 g/24 h underwent ultrasound-guided percutaneous renal biopsy. Clinical information was correlated with the pathological findings and the results were analyzed. The patients were in the age range of 12-79 years. Males (60%) outnumbered females (40%) in all the disease categories except lupus nephritis and IgA nephropathy. The most common clinical presentation was the nephrotic syndrome, seen in 31 cases (62%). Primary glomerular diseases (72%) were more common than secondary glomerular diseases (24%) and tubulointerstitial diseases (4%). Overall, the most common pathological diagnosis was focal and segmental glomerulosclerosis (FSGS) (20%), followed by membranous glomerulonephritis (MGN) (18%). In young patients (age <20 years), minimal change disease (36.4%) was the most common diagnosis while in adults it was MGN (23.5%) and in elderly patients (age >60 years) it was FSGS (60%). IF modified the diagnosis in 12% of the cases. The concordance between clinical diagnosis and pathological diagnosis was 66%. The difference between clinical diagnosis and final diagnosis was statistically significant. Our study further reinforces the knowledge that renal biopsy helps in accurate diagnosis and, thus, helps in appropriate management of the patients. IF provides additional information that can make the morphologic diagnosis considerably more precise.
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3,026
519
1
LETTERS TO THE EDITOR
Aluminum overload: Still as a source of concern in hemodialysis patients
Mahnaz Edalat-nejad, Reza Ghasemikhah, Mostafa Delavar
March-April 2014, 25(2):412-414
DOI
:10.4103/1319-2442.128602
PMID
:24626016
[FULL TEXT]
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[PubMed]
3,032
421
3
ORIGINAL ARTICLES
Comparison of slope-intercept with single plasma sample methods in estimating glomerular filtration rate using radionuclides
Abdelbagi Omer Osman, Ahmed Elkhidir Elmadani
March-April 2014, 25(2):321-325
DOI
:10.4103/1319-2442.128521
PMID
:24625998
To evaluate the accuracy of different single plasma sample methods (SPSM)
99m
Tc-DTPA clearances and to test whether the SPSM can replace the dual plasma samples method (DPSM) in the measurement of glomerular filtration rate (GFR), we studied 430 subjects counting renal patients and donors (240 male, 190 female; mean age 43.40 ± 16.30 years). All the subjects underwent dynamic renal scintigraphy after injection of
99m
Tc-DTPA; the GFR was calculated by seven SPSMs in addition to DPSM as a reference. Each of the SPSM clearance was compared with the DPSM measurement. There was a high correlation of all the SPSMs and the DPSM. The limits of agreement (95%) were found between the DPSM and all the SPSMs. Overall, the best method among the SPSMs, which is closest to the DPSM, is Fleming's single method as it has a statistically significant low mean difference (bias), low standard error, close mean ± SD to the reference method, good limits of agreement and high correlation co-efficient. This study concludes that, among the SPSMs, Fleming can reflect GFR more accurately than other methods, particularly when the expected serum creatinine is normal.
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2,834
362
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LETTERS TO THE EDITOR
Frequency and prognosis of acute kidney injury in burned patients
Hamid Noshad
March-April 2014, 25(2):423-424
DOI
:10.4103/1319-2442.128608
PMID
:24626019
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2,692
475
1
BRIEF COMMUNICATIONS
Localization of post-transplant lymphoproliferative disorders to the stomach might be associated with favorable outcome: A systematic review
Hossein Khedmat, Mohammad Ebrahim Ghamar-Chehreh, Mohsen Amini, Shahram Agah, Saeed Taheri
March-April 2014, 25(2):353-361
DOI
:10.4103/1319-2442.128543
PMID
:24626003
Gastric localization of post-transplant lymphoproliferative disorders (PTLDs) is very rare. In this study, we aimed to accumulate existing data in the current literature to reveal the clinical, histopathological and prognostic specificities associated with gastric PTLDs and to find the best treatment strategies in this patient population. A comprehensive search was conducted for the available data in the current literature using Pubmed and Google scholar search engines for reports on gastric PTLD in renal transplant recipients. Data of different studies were standardized and entered into a database and analyzed. No statistically significant difference was found between gastric and non-gastric PTLD. Gastric PTLD was relatively more prevalent in female patients
(P =
0.08) and showed a trend toward better outcome
(P =
0.1) and less metastasis
(P =
0.07). Surgical intervention and rituximab therapy were associated with a more favorable outcome (17% mortality). Our study showed that organ transplant recipients having gastric PTLD develop metastasis less frequently and tend to have a relatively more favorable outcome. Prospective studies with larger patient populations are needed to confirm or modify our results.
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[PubMed]
2,742
419
2
LETTERS TO THE EDITOR
Pulmonary tuberculosis in patients with chronic renal failure
Roghieh Golsha, Leila Kashani, Mahya Okhly, Abbas Ali Keshtkar, Elham Golshah, Narjes Sadr Momtaz
March-April 2014, 25(2):428-431
DOI
:10.4103/1319-2442.128611
PMID
:24626021
[FULL TEXT]
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2,490
526
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EDITORIAL
Chronic kidney disease and the aging population
Marcello Tonelli, Miguel Riella
March-April 2014, 25(2):243-248
DOI
:10.4103/1319-2442.128493
PMID
:24625989
[FULL TEXT]
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[PubMed]
2,421
586
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ORIGINAL ARTICLES
Incidence and predictive factors of Balkan Endemic Nephropathy: A longitudinal study
Kesinee Hanjangsit, Plamen S Dimitrov, Hongmei Zhang, Vecihi Batuman, Jim Burch, Svetla D Tzolova, Wilfried J Karmaus
March-April 2014, 25(2):343-352
DOI
:10.4103/1319-2442.128539
PMID
:24626002
Balkan endemic nephropathy (BEN) is a chronic kidney disease that progresses slowly. There are no known clinical markers to identify an early disease development. We evaluated the relationship between parental history of BEN and clinical markers as predictors of new occurrences of BEN. A 5-year prospective study in the offsprings of BEN and control patients was conducted in Vratza, Bulgaria, between 2003 and 2009 using markers in years one and three to predict new cases of BEN in the year five. We defined incident cases of BEN based on parental history, reduced kidney size and reduced kidney function, distinguishing probable and definite BEN, both combined as total incidence. The data were analyzed by Cox regression models using age as time scale and controlling for gender. We estimated hazard ratios and their 95% confidence intervals. The incidence of BEN was 17.4%. Paternal history was strongly associated with all three incidence groups (hazards ratio: 27-68,
P
<0.05). A reduction of kidney size of 1 mm resulted in a 5% increased hazard. However, taking parental history of BEN into account, these associations lost their significance. No kidney function measures were associated with new onset of BEN. A parental history of BEN is more important than clinical markers predicting the incidence of BEN. Without this information, kidney length forecasts probable BEN and the total incidence, while none of any clinical markers was related to definite BEN.
[ABSTRACT]
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2,498
395
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LETTERS TO THE EDITOR
Encapsulating peritoneal sclerosis in a patient with
Alport's syndrome
on long-term peritoneal dialysis
Zerrin Bicik Bahcebasi, Ozger Akarsu, Mehmet Yildirim, Hasan Kucuk
March-April 2014, 25(2):419-422
DOI
:10.4103/1319-2442.128607
PMID
:24626018
[FULL TEXT]
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2,441
285
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Successful management of recurrent atrio-ventricular nodal re-entrant tachycardia with radiofrequency ablation in a patient on maintenance hemodialysis
Manjusha Yadla, Sriramnaveen Parvathina, Krishnakishore Chennu, Rajasekhar Durgaprasad, V Vanaja, Sivakumar Vishnubotla
March-April 2014, 25(2):415-418
DOI
:10.4103/1319-2442.128604
PMID
:24626017
[FULL TEXT]
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[EPub]
[PubMed]
2,239
322
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Urinary cytopathologic findings in renal allograft recipients in Sudan: Trends, outcome and challenges
Ahmed O Almobarak, Mohammed H Mohammed, Alaa O Ahmed, Tarig H Hag Ali, Mohamed H Ahmed
March-April 2014, 25(2):410-411
DOI
:10.4103/1319-2442.128599
PMID
:24626015
[FULL TEXT]
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[EPub]
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2,172
290
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Use of a pelvic kidney for living transplantation
Soumaya Yaich, Khaled Charfeddine, Sawssen Zaghdhane, Salma Toumi, Ali Bahloul, Mohamed Nabil Mhiri, Jamil Hachicha
March-April 2014, 25(2):408-409
DOI
:10.4103/1319-2442.128596
PMID
:24626014
[FULL TEXT]
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[EPub]
[PubMed]
2,175
262
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Renal histopathological study of Human Immunodeficiency Virus - Positive patients with clinical evidence of renal disease in Benin City, Nigeria
AB Odonmeta, Efosa Oviasu, LI Ojogwu
March-April 2014, 25(2):425-427
DOI
:10.4103/1319-2442.128609
PMID
:24626020
[FULL TEXT]
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1,855
243
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SCOT DATA
Deceased heart beating donor and organ transplantation in Saudi Arabia
March-April 2014, 25(2):456-461
[FULL TEXT]
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1,252
184
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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