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2014| September-October | Volume 25 | Issue 5
Online since
September 2, 2014
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CASE REPORTS
Osteomalacia complicating renal tubular acidosis in association with Sjogren's syndrome
Zohra El Ati, Lilia Ben Fatma, Ghada Boulahya, Lamia Rais, Madiha Krid, Wided Smaoui, Hedi Ben Maiz, Soumaya Beji, Karim Zouaghi, Fatma Ben Moussa
September-October 2014, 25(5):1072-1077
DOI
:10.4103/1319-2442.139944
PMID
:25193912
Renal involvement in Sjogren's syndrome (SS) is not uncommon and may precede other complaints. Tubulointerstitial nephritis is the most common renal disease in SS and may lead to renal tubular acidosis (RTA), which in turn may cause osteomalacia. Nevertheless, osteomalacia rarely occurs as the first manifestation of a renal tubule disorder due to SS. We herewith describe a 43-year-old woman who was admitted to our hospital for weakness, lumbago and inability to walk. X-ray of the long bones showed extensive demineralization of the bones. Laboratory investigations revealed chronic kidney disease with serum creatinine of 2.3 mg/dL and creatinine clearance of 40 mL/min, hypokalemia (3.2 mmol/L), hypophosphatemia (0.4 mmol/L), hypocalcemia (2.14 mmol/L) and hyperchloremic metabolic acidosis (chlorine: 114 mmol/L; alkaline reserve: 14 mmol/L). The serum alkaline phosphatase levels were elevated. The serum levels of 25-hydroxyvitamin D and 1,25-dihydroxy vitamin D were low and borderline low, respectively, and the parathyroid hormone level was 70 pg/L. Urinalysis showed inappropriate alkaline urine (urinary PH: 7), glycosuria with normal blood glucose, phosphaturia and uricosuria. These values indicated the presence of both distal and proximal RTA. Our patient reported dryness of the mouth and eyes and Schirmer's test showed xerophthalmia. An accessory salivary gland biopsy showed changes corresponding to stage IV of Chisholm and Masson score. Kidney biopsy showed diffuse and severe tubulo-interstitial nephritis with dense lymphoplasmocyte infiltrates. Sicca syndrome and renal interstitial infiltrates indicated SS as the underlying cause of the RTA and osteomalacia. The patient received alkalinization, vitamin D (Sterogyl
®
), calcium supplements and steroids in an initial dose of 1 mg/kg/day, tapered to 10 mg daily. The prognosis was favorable and the serum creatinine level was 1.7 mg/dL, calcium was 2.2 mmol/L and serum phosphate was 0.9 mmol/L.
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3
ORIGINAL ARTICLES
The role of routine chest radiography for detecting complications after central venous catheter insertion
Morteza Kavanin Zadeh, Amir Shirvani
September-October 2014, 25(5):1011-1016
DOI
:10.4103/1319-2442.139895
PMID
:25193899
Chest radiographs are obtained routinely after central venous catheter (CVC) insertion in many institutions, although it consumes time and money. The purpose of this study was to evaluate the role of post-procedural chest X-ray in detecting complications of CVC insertion; we performed CVC insertion without using ultrasonography guidance. A total of 454 patients who required an emergency vascular access for hemodialysis between February 2008 and March 2010 were included in this study. In cases where three to five unsuccessful attempts were encountered to place the CVC or pierce the artery, we used another site for CVC placement or we placed the CVC under ultrasonographic guidance. Both the internal jugular and the subclavian veins were used as routes for catheter insertion. All the catheters were dual lumen and were inserted by the same vascular access surgeon. All the catheters were inserted using the same protocol. This protocol consists of five stages including position, percutaneous anesthesia, puncture, pull out and placement. Chest radiography was obtained after the procedure and patients were interviewed for the presence of any unusual symptoms. The X-rays were reviewed by a radiologist who was unaware of the patients' symptoms. Complications occurred in two patients who had unusual symptoms after the placement of the catheter. Although immediate postprocedural chest radiography is recommended for tip position confirmation, it should not be considered a reliable procedure for detecting complications in the absence of clinical symptoms. It is recommended to monitor patients after catheter insertion and perform delayed chest X-ray in the presence of any unusual symptoms.
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4
The effect of cold ischemia time on delayed graft function and acute rejection in kidney transplantation
Ismail Sert, Hulya Colak, Cem Tugmen, Sait Murat Dogan, Cezmi Karaca
September-October 2014, 25(5):960-966
DOI
:10.4103/1319-2442.139865
PMID
:25193891
The objective of this study is to evaluate the impact of cold ischemia time (CIT) on delayed graft function (DGF) and acute rejection (AR) among deceased donor kidney transplant recipients. The medical records of 111 patients who underwent kidney transplantation from deceased donors between November 1994 and July 2009 were retrospectively analyzed. DGF was observed in 54% of the patients and the prevalence of AR in the first year after transplantation was 9.9%. The incidence of DGF was higher among patients with longer CIT. There was no correlation between CIT and AR episodes. Higher body weight of recipients and donors, history of prior blood transfusion and advanced donor age were related with DGF. Patients with DGF had higher serum creatinine levels at the first, third and fifth years. There was a negative correlation between recipient body weight and creatinine clearance at the first year. CIT has an important role in the development of DGF as a modifiable risk factor. Moreover, donors with advanced age and higher body weight as well as recipients with higher body weight and history of blood transfusions are at risk for the development of DGF. Prevention of DGF may help to improve graft function at the first, third and fifth years and shorten the hospital stay.
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5
RENAL DATA FROM ASIA-AFRICA
Usefulness of renal length and volume by ultrasound in determining severity of chronic kidney disease
Muhammad Aliyu Makusidi, Adindu Chijioke, Kolawole Thomas Braimoh, Ademola Aderibigbe, Timothy Olosegun Olanrewaju, Hamidu Muhammad Liman
September-October 2014, 25(5):1117-1121
DOI
:10.4103/1319-2442.139981
PMID
:25193925
To determine the correlation of renal ultrasonic parameters and degree of kidney function among chronic kidney disease patients seen at the Nephrology unit of the University of Ilorin Teaching Hospital (UITH) Ilorin, we studied 322 patients. The results were analyzed with specific reference to socio-demography and correlating renal length and volume with estimated glomerular filtration rate. The male to female ratio was 2:1, with an age range from 20 to 80 years and mean age of 45.06 (±13.0) years. The serum creatinine levels ranged from 201 to 1205 μmol/L, with a mean of 388 ± 168 μmol/L, while the estimated glomerular filtration rate (eGFR) ranged from 3.77 to 44.32 mL/min, with a mean of 18.2 ± 7.19 mL/min. The right and left renal lengths ranged from 6.9 to 13.0 cm, with a mean of 9.11 ± 1.06, and 6.5-13.4 cm, with a mean of 9.23 ± 1.07 cm, respectively. The mean volumes of the right and left kidneys were 98.6 ± 41.9 cm
3
and 105 ± 46.2 cm
3
, respectively. The Pearson correlation of the right and left kidneys length to eGFR were -0.197 and -0.137 respectively, while that of the right and left kidney volume to eGFR were -0.122 and -0.043, respectively. Our study showed that there is a positive correlation between ultrasonic renal measurements and degree of kidney function.
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Pediatric kidney diseases in an African country: Prevalence, spectrum and outcome
Taiwo A Ladapo, Christopher I Esezobor, Foluso E Lesi
September-October 2014, 25(5):1110-1116
DOI
:10.4103/1319-2442.139976
PMID
:25193924
Insufficient data to guide the authorities responsible for resource allocation and a focus on communicable diseases increase the challenges of care of children with kidney disease in resource-constrained settings like ours. This study was performed with the aim to describe the current spectrum of pediatric nephrology disease in a tertiary hospital in Sub-Saharan Africa and highlight the challenges encountered in their care. A 4-year retrospective review of pediatric renal admissions was carried out and the overall prevalence, disease-specific prevalence and mortality rates were determined. Results were compared with nationwide data. Kidney diseases accounted for 8.9% of pediatric admissions with a prevalence of 22.3 admissions per 1000 child-admissions per year. Nephrotic syndrome, acute kidney injury and nephroblastoma accounted for almost 70% of admissions. The overall mortality was 14.4% with acute kidney injury accounting for 36% of this. Chronic kidney disease was also associated with poor outcome. The spectrum of disease nationwide is similar with a wide variation in disease-specific prevalence between geographic regions. The prevalence of genetic and hereditary conditions was low. The prevalence of pediatric renal disease in our environment is on the increase and associated with significant morbidity and mortality. Late presentation and high treatment costs were limitations to care. Preventive nephrology, training of pediatric nephrologists and strengthening of health insurance schemes are advocated.
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7
ORIGINAL ARTICLES
The relation between serum testosterone levels and cardiovascular risk factors in patients with kidney transplantation
Hulya Colak, Ismail Sert, Yusuf Kurtulmus, Cezmi Karaca, Huseyin Toz, Seyhun Kursat
September-October 2014, 25(5):951-959
DOI
:10.4103/1319-2442.139862
PMID
:25193890
The objective of the study is to evaluate the relationship between serum testosterone levels and cardiovascular risk factors (CVRF) in patients after kidney transplantation and with chronic kidney disease (CKD). Seventy-five male patients, aged between 18 and 68 years, who had kidney transplantation at least six months earlier, were enrolled into the study. Only renal transplant recipients and CKD patients with a creatinine level of <2.5 mg/dL were included in this study. Patients were divided into three groups as patients receiving calcineurine inhibitors (CNIs) and Mammalian target of rapamycin inhibitors (m-TORi) and CKD. Serum ceatinine, testosterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, high-sensitivity C-reactive protein (hs-CRP), total cholesterol (TC), triglyceride (TG) as well as left ventricle mass (LVM), left ventricle mass index (LVMI), left atrium (LA), inferior vena cava (IVC) inspiratory and expiratory diameters and collapse index (CI) and blood pressure (BP) were evaluated. Serum testosterone levels were significantly higher in the m-TORi and CNIs groups when compared with the CKD cases (
P
<0.05). When kidney recipients (both groups) were compared with CKD patients, we observed positive outcomes in serum testosterone levels and CVRF at significant levels. There was no significant difference in terms of age, serum creatinine, serum testosterone, FSH, LH, prolactin, hs-CRP, LVMI, TC and TG and between the CNIs and mTORi groups (
P
>0.05). Serum testosterone levels were independent risk factors affecting IVC collapse index, systolic BP and LA. m-TORi and CNIs drugs might have no negative effect on serum testosterone levels, and improvement of the serum testosterone levels after transplantation might have a positive contribution on cardiac risk factors.
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2
LETTERS TO THE EDITOR
Ganciclovir-induced acute liver injury in a patient with lupus nephritis
Emad Ali Abdallah, Bassam Al-Helal, Reem Asad
September-October 2014, 25(5):1084-1085
DOI
:10.4103/1319-2442.139947
PMID
:25193915
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4,701
412
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ORIGINAL ARTICLES
Hepcidin and regulation of iron homeostasis in maintenance hemodialysis patients
Dawlat Sany, Abd Elbasat Elsawy, Yasser Elshahawy
September-October 2014, 25(5):967-973
DOI
:10.4103/1319-2442.139868
PMID
:25193892
Hepcidin may play a critical role in the response of patients with anemia to iron and erythropoiesis-stimulating agent therapy. To evaluate the factors affecting serum hepcidin levels and their relation to other indexes of anemia, iron metabolism and inflammation, as well as the dose of erythropoietin, we studied 80 maintenance hemodialysis (MHD) patients treated with recombinant human erythropoietin and their serum hepcidin levels were specifically measured by using a competitive enzyme-linked immunosorbent assay. In linear regression analysis, ferritin was found to be a significant predictor of hepcidin levels in all the study patients. In the absence of apparent inflammation, serum hepcidin levels correlated exclusively with ferritin levels in MHD patients, and it was also an independent marker of inflammation as highly sensitive C-reactive protein.
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CASE REPORTS
Renal paraneoplastic vasculitis complicating lung adenocarcinoma
Besma Ben Dhaou, Fatma Boussema, Zohra Aydi, Sonia Ketari, Lilia Baili, Fatma Ben Moussa, Lilia Rokbani
September-October 2014, 25(5):1065-1067
DOI
:10.4103/1319-2442.139942
PMID
:25193910
Renal paraneoplastic vasculitis (RNPV) is rare. It can be revealed by glomerulonephritis, microaneurysms or renal failure. RPNV may precede the onset of the primary tumor, and treatment and prognosis depend on the etiology (primary tumor). A 54-year-old man who had a primary lung adenocarcinoma was admitted for nephrotic syndrome. The investigations revealed RNPV. The patient was treated with corticosteroids at high dose and cyclophosphamide with improvement of the renal condition; however, the patient died from worsening of his pulmonary neoplasia.
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ORIGINAL ARTICLES
Prevalence of vitamin D deficiency in peritoneal dialysis patients
Jamal S Alwakeel, Saira Usama, Ahmad H Mitwalli, Abdulkareem Alsuwaida, Mohammed Alghonaim
September-October 2014, 25(5):981-985
DOI
:10.4103/1319-2442.139873
PMID
:25193894
Peritoneal dialysis (PD) patients have a high risk of developing vitamin D deficiency as 25(OH) vitamin D, the precursor of active vitamin D, is lost during dialysis. This crosssectional study was conducted to investigate the prevalence of vitamin D deficiency among adult Saudi patients on regular PD The data was collected in the summer of 2010 from patients who were on PD for more than six months at the King Khalid University Hospital, Riyadh. We recorded the demographic and clinical parameters for all patients. Blood samples were taken for serum vitamin D level (25 OH), serum parathyroid hormone (PTH) levels and other necessary biochemical parameters. There were 27 patients (11 males and 16 females) with a mean age of 46 (15-78 ± 21) years. Five patients were on continuous ambulatory PD and 22 patients were using automated PD. The average time on PD was 27.5 (6-84 ± 18.5) months. The mean serum vitamin D 25 (OH) level was 16.1 (4.9-41.5 ± 8.23) nmol/L. Sixteen (59.2%) of the patients had levels below 15 nmol/L, while another eight patients (29.6%) had vitamin D levels between 15 and 25 nmol/L, indicating a marked deficiency. The mean serum calcium was 2.2 (1.7-2.6 ± 0.2) mmol/L and the mean serum phosphorous was 1.48 (0.64-2.22 ± 0.37) mmol/L. Fifteen patients (55.5%) had significant hyperparathyroidism (serum PTH levels above 30 pmol/L). Majority of the PD patients in our center had vitamin D deficiency. The possible reasons include chronic renal failure, dietary restrictions, loss of vitamin D and decreased exposure to sunlight.
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3
Association of renal failure with thyroid dysfunction: A retrospective cohort study
Maimoona Mushtaq Ahmed
September-October 2014, 25(5):1017-1025
DOI
:10.4103/1319-2442.139902
PMID
:25193900
Chronic renal failure is often associated with multiple organ co-morbidities, including thyroid dysfunction. This has been associated with poorer prognosis, particularly in patients with end-stage renal disease. This study aimed to examine the relationship between renal failure and thyroid dysfunction in an outpatient setting at the King Abdulaziz University Hospital, Saudi Arabia, from January 2011 to June 2012. Demographic and biochemical data were extracted from medical records. Differences in the levels of thyroid hormones and lipids between the four renal function groups were analyzed using the chi-square test for categorical variables and Kruskal- Wallis test for binomial variables. A total of 486 patients were included in the study population, of whom approximately half were female, and the median (range) age was 61 (17-90) years. According to creatinine measurements, renal function was normal in 48 participants, 290 had mild renal failure, 122 had moderate renal failure and 26 had severe renal failure. No significant relationships were observed between renal failure and cardiac or pulmonary dysfunction. Free triiodothyronine (FT3) levels were significantly reduced (
P =
0.005) and both free thyroxin (FT4;
P =
0.034) and parathyroid hormone (PTH;
P =
0.028) significantly increased with increasing severity of renal failure. Patients with moderate to severe renal failure displayed reduced hemoglobin levels and were significantly more likely to be anemic (
P
<0.001). Highly significant increases in alkaline phosphatase (
P
<0.001), uric acid (
P
<0.001) and low-density lipoprotein-cholesterol (
P =
0.014) levels were also observed with increasing renal dysfunction. To conclude, it was observed that renal dysfunction is associated with notable changes to other organ systems, including the thyroid. Further studies may investigate the association of multiple organ co-morbidities with prognosis in patients with chronic renal failure.
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1
RENAL DATA FROM THE ARAB WORLD
Diabetic nephropathy as a cause of end-stage renal disease in Tabuk area, Saudi Arabia: A four-year study
Osama El Minshawy, Tawfik Ghabrah, Eman El Bassuoni
September-October 2014, 25(5):1105-1109
DOI
:10.4103/1319-2442.139967
PMID
:25193923
Diabetic nephropathy (DN) as a cause of end-stage renal disease (ESRD) is increasing worldwide. In some countries, it is the most common cause of ESRD. Our objective was to assess the incidence of DN as a cause of ESRD in Tabuk, to evaluate its changes in four years, and to compare the data of Tabuk with data from the United States (US) to be aware of factors causing the difference. Data of ESRD patients with DN treated with renal replacement therapy (RRT) was evaluated from 2009 to 2012. RRT was defined as ESRD patients who were treated either with chronic regular hemodialysis (HD), renal transplantation (Tx) or continuous ambulatory peritoneal dialysis (PD). The incidence of DN as a cause of ESRD increased from 8% in 2009 to 18% in 2012. The mean age of this group was significantly higher than in patients on RRT due to other etiologies. Also, DN was more widespread in built-up areas than pastoral areas. The mortality rate decreased from 20% in 2009 to 14% in 2012. Despite this decrease, the mortality rate was still higher than that in patients on RRT due to other etiologies. When we restricted our analysis to patients treated by HD (76%), Tx (17%) or PD (7%), the results were not significantly different. DN in the Tabuk area is rising, but is less widespread than in the US possibly because of an increased occurrence of other causes of ESRD or early loss of diabetic patients. Therefore, careful management of diabetic patients is obligatory.
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2
ORIGINAL ARTICLES
Comparison of the performance of the updated Schwartz, combined Schwartz and the Grubb glomerular filtration rate equations in a general pediatric population
Alaleh Gheissari, Peyman Roomizadeh, Roya Kelishadi, Amin Abedini, Shaghayegh Haghjooy-Javanmard, Seyed-Hossein Abtahi, Bahareh Mehdikhani
September-October 2014, 25(5):1004-1010
DOI
:10.4103/1319-2442.139890
PMID
:25193898
To determine the performance of the updated Schwartz, combined Schwartz and Grubb glomerular filtration rate (GFR) equations in a relatively large number of healthy children with no known renal disease, we studied 712 students aged between seven and 18 years from the Isfahan province of Iran by random cluster sampling between 2009 and 2010. Blood investigations included blood urea nitrogen, creatinine and cystatin C. For each participant, GFR was calculated based on the three equations. We used Bland-Altman plots and weighted kappa statistics to compare the performance of the study equations. The mean age of the children was 12.2 ± 2.4 years. A high concordance in estimating GFR (mean difference: 0 ± 12.7 mL/min/1.73 m
2
) and a very good agreement in defining chronic kidney disease (CKD) and non-CKD individuals (weighted kappa: 0.85; 95% confidence intervals: 0.69-1) were observed between the updated Schwartz and the combined Schwartz equations. Poor agreement was observed between the Grubb equation and two Schwartz equations in estimating GFR and defining CKD. There was no systematic deviation between the updated Schwartz and the combined Schwartz equations in children with normal renal function. The Grubb equation was highly inconsistent with both Schwartz equations in this population. We conclude that the updated Schwartz equation is simpler and more accessible than the combined Schwartz equation in daily clinical practice and CKD screening programs.
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CASE REPORTS
Chronic graft versus host disease and nephrotic syndrome
Samia Barbouch, Hanene Gaied, Khaoula Ben Abdelghani, Rim Goucha, Amel Lakhal, Lamia Torjemen, Fethi Ben Hamida, Ezzedine Abderrahim, Hedi Ben Maiz, HafedhHedri , Khedher Adel
September-October 2014, 25(5):1062-1064
DOI
:10.4103/1319-2442.139941
PMID
:25193909
Disturbed kidney function is a common complication after bone marrow transplantation. Recently, attention has been given to immune-mediated glomerular damage related to graft versus host disease (GVHD). We describe a 19-year-old woman who developed membranous glomerulonephritis after bone marrow transplantation (BMT). Six months later, she developed soft palate, skin and liver lesions considered to be chronic GVHD. Fifteen months after undergoing BMT, this patient presented with nephrotic syndrome. A renal biopsy showed membranous glomerulonephritis associated with a focal segmental glomerulosclerosis. She was started on corticosteroid treatment with good outcome.
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1
ORIGINAL ARTICLES
Univariate and multiple linear regression analyses for 23 single nucleotide polymorphisms in 14 genes predisposing to chronic glomerular diseases and IgA nephropathy in Han Chinese
Hui Wang, Weiguo Sui, Wen Xue, Junyong Wu, Jiejing Chen, Yong Dai
September-October 2014, 25(5):992-997
DOI
:10.4103/1319-2442.139882
PMID
:25193896
Immunoglobulin A nephropathy (IgAN) is a complex trait regulated by the interaction among multiple physiologic regulatory systems and probably involving numerous genes, which leads to inconsistent findings in genetic studies. One possibility of failure to replicate some single-locus results is that the underlying genetics of IgAN nephropathy is based on multiple genes with minor effects. To learn the association between 23 single nucleotide polymorphisms (SNPs) in 14 genes predisposing to chronic glomerular diseases and IgAN in Han males, the 23 SNPs genotypes of 21 Han males were detected and analyzed with a BaiO gene chip, and their associations were analyzed with univariate analysis and multiple linear regression analysis. Analysis showed that CTLA4
rs231726
and CR2
rs1048971
revealed a significant association with IgAN. These findings support the multi-gene nature of the etiology of IgAN and propose a potential gene-gene interactive model for future studies.
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2
The evaluation of relationship between vitamin D and muscle power by micro manual muscle tester in end-stage renal disease patients
Nargesosadat Zahed, Saghar Chehrazi, Kianosh Falaknasi
September-October 2014, 25(5):998-1003
DOI
:10.4103/1319-2442.139885
PMID
:25193897
Muscle force of lower limb is a major factor for sustaining physical activity. Decreased muscle force can limit physical activity, which can increase mortality and morbidity in end-stage renal disease (ESRD) patients. Muscle force depends on several factors. One of the most important factors is 25-hydroxy vitamin D (25-OHD) that affects muscle function in both uremic and non-uremic patients. The aim of this study was to investigate the association between serum level of 25-OHD and muscle force of lower extremities in hemodialysis patients estimated by a Micro Manual Muscle Tester, a digital instrument that measures muscle force in kilograms This cross-sectional study was performed on 135 adult patients, 69 male (51%) and 66 female (69%) (mean: 1.4, standard deviation: 0.5), undergoing hemodialysis. Standard biochemistry parameters were measured before hemodialysis, including 25-OHD, calcium, albumin, parahyroid hormone and C-reactive protein (CRP). Based on the result of serum level of 25-OHD, patients were classified into the following three groups: 85 patients (63%) were 25-OHD deficient (25-OHD <30), 43 patients (32%) had a normal level of 25-OHD (30-70) and seven patients (5%) had a toxic level of 25-OHD (>70) (mean: 1.42, standard deviation: 0.59). Also, based on the result of muscle force, patients were classified into the following three groups: 84/133 patients (62%) had weak muscle force (<5 kg), 46/133 patients (34%) had normal muscle force (5-10 kg) and three patients (21%) had strong muscle force (>10 kg) (mean: 1.39, standard deviation: 0.53). There was a significant relation between 25-OHD level and muscle force (
P =
0.02), between age and muscle force (
P =
0.002) and between gender and muscle force (
P
<0.001). In our opinion, 25-OHD can be a useful drug in ESRD patients to improve muscle force and physical activity.
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5
Predictive parameters of survival in hemodialysis patients with restless leg syndrome
Radojica V Stolic, Goran Z Trajkovic, Djole Jekic, Sasa R Sovtic, Aleksandar N Jovanovic, Dragica Z Stolic, Marijana S Stanojevic-Pirkovic, Zorana Djordjevic
September-October 2014, 25(5):974-980
DOI
:10.4103/1319-2442.139869
PMID
:25193893
Restless leg syndrome (RLS) affects the quality of life and survival in patients on hemodialysis (HD). The aim of this study was to determine the characteristics and survival parameters in patients on HD with RLS. This study was a non-randomized clinical study involving 204 patients on HD, of whom 71 were female and 133 were male. Symptoms of RLS were defined as positive responses to four questions comprising the criteria of RLS. We recorded the outcome of treatment, biochemical analyses, demographic, sexual, anthropometric and clinical characteristics in all study patients. Patients with RLS who completed the study had a significantly higher body mass index and lower intima-media thickness and flow through the arteriovenous fistula. Among patients with RLS who died, there were more smokers as well as higher incidences of cardiovascular disease and diabetes mellitus. Among patients with RLS who survived, there were a greater number of patients with preserved diuresis and receiving erythropoietin therapy. Patients who completed the study had significantly higher levels of hemoglobin, creatinine, serum iron and transferrin saturation. Diabetes mellitus (B = 1.802;
P
= 0.002) and low Kt/V (B = -5.218;
P
= 0.001) were major predictive parameters for survival.
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3,351
462
4
CASE REPORTS
Unusual presentation of aortic dissection: Post-coital acute paraplegia with renal failure
Dinith P Galabada, Abdul L M Nazar
September-October 2014, 25(5):1059-1061
DOI
:10.4103/1319-2442.139940
PMID
:25193908
We report the case of a 45-year-old chronic smoker who presented with acute paraplegia occurring during coitus and subsequently developed acute renal failure (ARF) requiring dialysis. He had absent peripheral pulses in the lower limbs with evidence of acute ischemia. Doppler study showed dissecting aneurysm of thoracic aorta, thrombotic occlusion of the distal aorta from L1 level up to bifurcation and occlusion of the right renal artery by a thrombus that was confirmed by magnetic resonance imaging of the spine. He was not subjected to any vascular intervention as his lower limbs were not salvageable due to delay in the diagnosis. Post-coital aortic dissection and aortic dissection presenting with acute paraplegia and ARF are very rare. This is probably the first case report with post-coital acute aortic dissection presenting with paraplegia and ARF. This case emphasizes the importance of a careful examination of peripheral pulses in patients presenting with ARF and paraplegia.
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3,376
436
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LETTERS TO THE EDITOR
Renal forniceal rupture in pregnancy secondary to obstructive renal stone presenting with acute renal failure
Imran Khan Jalbani, MH Ather
September-October 2014, 25(5):1081-1083
DOI
:10.4103/1319-2442.139946
PMID
:25193914
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412
3
BRIEF COMMUNICATIONS
Proteinuria in patients with sickle cell disease
Ahmed M Alkhunaizi, Adil A Al-Khatti
September-October 2014, 25(5):1038-1041
DOI
:10.4103/1319-2442.139931
PMID
:25193903
Proteinuria is a complication of sickle cell nephropathy that can progress to renal insufficiency and end-stage renal disease. The magnitude of proteinuria among patients with sickle cell disease (SCD) has been reported with variable prevalence. The aim of this study was to determine the prevalence of proteinuria in a large number of patients with SCD in Eastern Saudi Arabia. The urinalyses of 940 non-diabetic patients with SCD were tested for the presence of proteinuria. The glomerular filtration rate (e-GFR) of all patients was estimated using the Cockcroft- Gault equation. Proteinuria was found in 79 of 940 patients with SCD (prevalence 8.4%). The mean age of the affected patients with proteinuria was 33 ± 15.4 years (10-76). The mean GFR was 118 mL/min/1.73 m
2
. This study indicates that patients with SCD in Eastern Saudi Arabia have a low prevalence of proteinuria and preserved GFR.
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3,262
463
2
CASE REPORTS
Subcutis calcinosis caused by injection of calcium-containing heparin in a chronic kidney injury patient
Lilia Ben Fatma, Zohra El Ati, Haifa Azzouz, Lamia Rais, Madiha Krid, Wided Smaoui, Hédi Ben Maiz, Soumaya Béji, Karim Zouaghi, Moncef Zitouna, Fatma Ben Moussa
September-October 2014, 25(5):1068-1071
DOI
:10.4103/1319-2442.139943
PMID
:25193911
Subcutis calcinosis, characterized by abnormal calcium deposits in the skin, is a rare complication of using calcium-containing heparin occurring in patients with advanced renal failure. We report the case of an 83-year-old female, a known case of chronic kidney disease (CKD) for four years with recent worsening of renal failure requiring hospitalization and hemodialysis. She developed subcutis calcinosis following injection of calcium-containing heparin. Biochemical tests showed serum parathormone level at 400 pg/dL, hypercalcemia, elevated calcium-phosphate product and monoclonal gammopathy related to multiple myeloma. She developed firm subcutaneous nodules in the abdomen and the thighs, the injection sites of Calciparin
®
(calcium nadroparin) that was given as a preventive measure against deep vein thrombosis. The diagnosis of subcutis calcinosis was confirmed by the histological examination showing calcium deposit in the dermis and hypodermis. These lesions completely disappeared after discontinuing calcium nadro-parin injections. Subcutis calcinosis caused by injections of calcium-containing heparin is rare, and, to the best our knowledge, not more than 12 cases have been reported in the literature. Pathogenesis is not well established but is attributed to the calcium disorders usually seen in advanced renal failure. Diagnosis is confirmed by histological tests. Outcome is mostly favorable. The main differential diagnosis is calciphylaxis, which has a poor prognosis. Even though rarely reported, we should be aware that CKD patients with elevated calcium-phosphorus product can develop subcutis calcinosis induced by calcium-containing heparin. When it occurs, fortunately and unlike calci-phylaxis, outcome is favorable.
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3,273
392
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ORIGINAL ARTICLES
Renal artery stenosis in patients with established coronary artery disease: Prevalence and predicting factors
Mohammad Reza Khatami, Maryam Edalati-Fard, Saeid Sadeghian, Mojtaba Salari-Far, Mina Pashang Bs
September-October 2014, 25(5):986-991
DOI
:10.4103/1319-2442.139880
PMID
:25193895
The association between renal artery stenosis (RAS) and other atherosclerotic diseases (particularly coronary artery diseases) is well known. In general, the risk factors for atherosclerosis have been clarified, but whether these risk factors operate equally in all forms of atherosclerotic diseases is not known. The aim of this study was to describe the prevalence of RAS in patients with established coronary artery diseases and then to define the most important risk factors that may help to predict the RAS in this population. In this cross-sectional study, 146 patients with established coronary artery stenosis by angiography simultaneously underwent renal angiography; RAS >50% was considered significant. We found that 25.3% of patients with coronary artery diseases had RAS. The prevalence of significant stenosis was 17.1%. Females were more vulnerable to this disorder than males (47.1% vs. 13.7%,
P
= 0.001). There was no relationship between the severity and number of stenosed coronary arteries and those of stenosed renal arteries (
P
= 0.716). Multi-variate logistic regression analysis revealed that among the risk factors for atherosclerosis, female sex (
P
= 0.001), duration of hypertension (
P
= 0.032), age (
P
= 0.046) and serum creatinine (
P
= 0.018) were strong predictors of the presence of RAS. We concluded that RAS is a common finding in patients with coronary artery disease. We suggest that all older females with deteriorating renal function and long-standing hypertension should be carefully evaluated for early detection of the RAS.
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3,101
440
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CASE REPORTS
Anesthetic management of laparoscopic dual renal transplantation
Prachi Kadam, Bina Butala, Veena Shah
September-October 2014, 25(5):1051-1055
DOI
:10.4103/1319-2442.139938
PMID
:25193906
Since the first laparoscopic nephrectomy was reported in 1991, this technique has evolved rapidly and laparoscopic donor nephrectomy has emerged as a standard of care in many institutions. However, recipient renal transplantation is still performed by the traditional open approach. There is only one case report of laparoscopic kidney transplantation (LKT) from Spain in 2009. LKT is a technically demanding surgery for a urologist and equally challenging for an anesthesiologist as he has to be vigilant because of the major perturbations in the cardiorespiratory system due to steep trendelenberg position and pneumoperitoneum; additionally, the pneumoperitoneum can have deleterious effects on blood flow and function of the transplanted kidney. We herewith present our experience with anesthesia of the first laparoscopic dual kidney transplantation from a deceased donor performed in our center.
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3,013
399
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BRIEF COMMUNICATIONS
Decreasing intra-dialytic morbid events and assessment of dry weight in children on chronic hemodialysis using non-invasive changes in hematocrit
Fatina I Fadel, Samuel H Makar, Ayman E Eskander, Ahmed H Aon
September-October 2014, 25(5):1030-1037
DOI
:10.4103/1319-2442.139916
PMID
:25193902
Achieving dry weight after hemodialysis (HD) is critical as chronic fluid over-load can result in left ventricular hypertrophy, while small fluid shifts may result in intra-dialytic morbid events (IME). In the pediatric population, estimating dry weight can be difficult due to growth while on dialysis. Continuous non-invasive monitoring of the hematocrit (NIVM) has been proposed as a more accurate method of estimating dry weight. Fifteen pediatric patients on chronic HD (6 males and 9 females; mean age 11.4 ± 2.28 years) were included in an uncontrolled prospective study involving three phases. In phase 1, patients were observed for one month for their dry weight and frequency of IME. Phase 2 consisted of using NIVM-guided ultrafiltration algorithm for rate of blood volume (BV) reduction and post-dialysis refill, recommending an intra-dialytic reduction in BV of 8% in the first hour and <4% per hour thereafter and without significant post-dialytic vascular refill. Phase 3 comprised a one month period for comparing the results. IME decreased from 33 episodes per 180 sessions in phase 1 to 4 per 180 sessions during phase 3 (
P
= 0.04), without a significant difference in pre-systolic or post-systolic or mean BP before and after the intervention (all
P
>0.1). In phase 1, 40% of patients experienced no IME, 33% experienced one or two IME while 27% experienced more than two IME; during phase 3, 80% experienced no IME, 20% experienced one or two IME while no one experienced more than two IME. NIVM can serve as an objective method for determining dry weight as well as predicting and preventing IME in the pediatric population on maintenance HD.
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2,800
419
1
CASE REPORTS
Thirty years survivor on hemodialysis: A case report
Konstantina Triga, Periklis Dousdampanis, Stamatina Aggelakou-Vaitsi, Karen Gellner
September-October 2014, 25(5):1056-1058
DOI
:10.4103/1319-2442.139939
PMID
:25193907
Hemodialysis is a widely performed and safe procedure; therefore, the numbers of long-term survivors on hemodialysis therapy have been increasing. We present a woman who had been on uninterrupted hemodialysis for 30 years and did well for much of her time on hemodialysis, despite a long-standing uneven course. The literature of extremely long-lived patients on uninterrupted hemodialysis is reviewed and the clinical characteristics and complications encountered in these patients are discussed.
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2,746
383
1
Co-existence of BKV nephropathy and disseminated tuberculosis ain transplant recipient
Sarah Al-Warthan, Abdullah Al-Hwiesh
September-October 2014, 25(5):1046-1050
DOI
:10.4103/1319-2442.139936
PMID
:25193905
Tuberculosis (TB) in renal transplant recipients presents important diagnostic difficulties because of the greater incidence of extra-pulmonary involvement, negative sputum smear results despite active disease and its atypical presentation, specifically reactivation of the latent form. BKV nephropathy was first reported in 1995, coinciding with the widespread use of immunosuppressive drugs, which can complicate the cores of 1-10% of renal transplant recipients. It is also not uncommon to find the existence of bacterial or fungal infections in the presence of an immuno-modulating virus like cytomegalovirus infection. Herewith, we describe a 67-year-old Saudi male who presented with deterioration of renal function and fever of unknown origin and was documented to have polyoma virus nephropathy and disseminated TB. To the best of our knowledge, this is the first report of such an association in the literature.
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2,737
384
1
Blastomyces dermatitidis in a renal transplant recipient
Himanshu V Patel, Vivek B Kute, Aruna V Vanikar, Pankaj R Shah, Manoj R Gumber, Hargovind L Trivedi
September-October 2014, 25(5):1042-1045
DOI
:10.4103/1319-2442.139934
PMID
:25193904
Fungal pathogens can be the source of serious and sometimes fatal infections following organ transplantation. To the best of our knowledge, we present the first case of cutaneous blastomycosis in a renal allograft recipient in India, a country outside the known endemic regions. This case, with the very rare and unexpected diagnosis of blastomycosis, not only reflects the tremendous diversity of infections in transplant recipients but also emphasizes the utility of serological methods even in the immunosuppressed host.
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2,636
378
1
RENAL DATA FROM THE ARAB WORLD
Frequency of abdominal aortic calcification in a group of Iraqi hemodialysis patients
Ali J Hashim Al-Saedi, Nawar S Jameel, Ali Qais, Abdul Hakeem A Kareem, Talib S Mohssen
September-October 2014, 25(5):1098-1104
DOI
:10.4103/1319-2442.139964
PMID
:25193922
Cardiovascular complications including abdominal aortic calcification significantly affect the mortality and morbidity in patients on a hemodialysis (HD) program. The objective of this study is to find the frequency of abdominal aortic calcification in patients on regular HD and to evaluate the effect of parameters on frequency and severity of abdominal aortic calcification. Fifty-four patients with end-stage renal disease on regular HD were studied from January 2011 to December 2011 to evaluate abdominal aortic calcification by plain abdominal X-ray. The study showed that 10 (18.5%) patients had abdominal aortic calcification. Only one (1.9%) had grade 3 calcification and among the remaining, five (9.3%) patients had grade 1 and four (7.4%), grade 2. There was a statistically significant difference (
P
<0.05) in the means of serum cholesterol among those with and without abdominal aortic calcification. Hypertension was noticed in most patients with abdominal aortic calcification. The frequency of abdominal aortic calcification is directly related to age and duration of dialysis. The only biochemical parameter with a statistically significant effect was serum cholesterol.
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2,636
352
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LETTERS TO THE EDITOR
Emphysematous pyelonephritis with air in the renal vein and septic emboli in the lungs: A rare presentation
Mukesh K Yadav, Anmol Bhatia, Ashish Bhalla, Niranjan Khandelwal
September-October 2014, 25(5):1086-1087
DOI
:10.4103/1319-2442.139948
PMID
:25193916
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2,604
303
2
Improving medication adherence among adult patients on hemodialysis
Ayman Karkar
September-October 2014, 25(5):1078-1080
DOI
:10.4103/1319-2442.139945
PMID
:25193913
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2,176
355
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BRIEF COMMUNICATIONS
Angiogenic activity in the sera of patients with post-kidney transplant erythrocytosis
Chokri Maktouf, Soumaya Yaich, Sabra Aloui, Azza Bounemra, Khaled Charfeddine, Habib Skhiri, Jamil Hachicha
September-October 2014, 25(5):1026-1029
DOI
:10.4103/1319-2442.139905
PMID
:25193901
Post-kidney transplant erythrocytosis (PTE) is one of the hematological complications in the renal transplant patients. While its pathogenesis still remains to be elucidated completely, a number of therapies are available for the management of PTE. The aim of this prospective study was to investigate whether angiogenesis may be involved in the pathogenesis of post-transplant erythrocytosis by comparing its level with those of different classes of erythrocytosis [polycythemia vera (PV), idiopathic erythrocytosis and secondary erythrocytosis]. The angiogenic activity was evaluated by the assessment of the serum vascular endothelial growth factor (VEGF) levels, as one of circulating angiogenic factor, using a standardized enzyme-linked immunosorbent assay commercial kit in 13 PTE (2 F/11 M), in 75 untreated erythrocytosis non-transplant patients and in 21 healthy subjects controls. The results indicated that VEGF was overproduced in advanced and untreated PV patients and to a lesser degree in idiopathic erythrocytosis thus confirming an increased angiogenic activity. However, there is no evidence of increased angiogenesis in PTE and in secondary erythrocytosis. The absence of angiogenesis in PTE and its presence in PV is another argument that the pathogenesis of these two entities is different.
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2,167
319
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LETTERS TO THE EDITOR
Remarks about the study on nocturnal enuresis among primary school children
Mahmood Dhahir Al-Mendalawi
September-October 2014, 25(5):1095-1097
DOI
:10.4103/1319-2442.139960
PMID
:25193921
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2,131
272
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Remarks about the study on idiopathic urolithiasis in Tunisian children
Mahmood Dhahir Al-Mendalawi
September-October 2014, 25(5):1093-1094
DOI
:10.4103/1319-2442.139954
PMID
:25193920
[FULL TEXT]
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1,779
286
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Remarks about the study on predictors of public attitude toward living organ donation in Kano, Northern Nigeria
Beuy Joob, Viroj Wiwanitkit
September-October 2014, 25(5):1091-1092
DOI
:10.4103/1319-2442.139951
PMID
:25193919
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1,632
276
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Remarks about the study on patterns of childhood nephrotic syndrome in Aljouf region, Saudi Arabia
Mahmood Dhahir Al-Mendalawi
September-October 2014, 25(5):1089-1090
DOI
:10.4103/1319-2442.139950
PMID
:25193918
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1,505
251
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Remarks about the study on renal function, urinalysis abnormalities and correlates among HIV-infected Cameroonians naive to antiretroviral therapy
Hai Err, Viroj Wiwanitkit
September-October 2014, 25(5):1088-1088
DOI
:10.4103/1319-2442.139949
PMID
:25193917
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1,504
206
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SCOT DATA
Organ Donation and Transplantation in the Kingdom of Saudi Arabia 2013
September-October 2014, 25(5):1122-1126
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1,377
205
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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