Stress is a well known and identified problem within the nursing profession. Dialysis nurses are exposed to high level of stress. Increasing workload can aggravate stress and cause burnout and exhaustion. Stress and burnout are capable of having a detrimental impact on organizational productivity and pose serious health and safety hazards on the job. We aimed in this study to determine the type and level of stress and the amount of burnout among our dialysis nurses, and to evaluate the managing skills and the impact of stress on their work performance. There were 93 nurses (19 national and 74 expatriate nurses) who answered modified questionnaires to the aims of our prospective and descriptive correlational study. Our results show that most nurses involved in the study (national and expatriate) experienced a mild level of stress (79% and 68%, respectively) and moderate level of burnout (42% and 38%, respectively). The most common stressor among the national nurses was technical breakdowns of machines (15.9%) and that among expatriates was job insecurity (16.9%). The majority of the national nurses (21%) coped with this by increased sick leaves, whereas the majority (25%) of the expatriates responded by becoming easily frustrated. The most utilized coping skill among both groups was the relaxation methods (20.8% versus 24.9%) and the least utilized was denial (3.9% versus 0.5%). In conclusion, our results suggest the exposure of dialysis nurses to different types of stress and demonstrate the different experienced coping skills. These results may have implications for nursing management and hospital administration.

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Hemodialysis (HD) is one of the important modalities of renal replacement therapy in acute renal failure (ARF) as well as chronic renal failure (CRF). This study was performed to evaluate the various intradialytic complications that occur during HD and their management. This is a retrospective study performed in patients who underwent conventional HD during the period of 1 January 2000 to 31 December 2011 at our center. Clinical details, various complications faced and their management were retrieved from dialysis case sheets. A total of 2325 patients of renal failure (790 ARF and 1535 CRF patients) were assessed for the intradialytic complications of HD. During the study period, there were 12,785 bicarbonate dialyses performed on these patients. In the ARF patients, the common intradialytic complications were: Hypotension, seen in 1296 sessions (30.4%), nausea and vomiting seen in 1125 sessions (26.4%), fever and chills seen in 818 sessions (19.2%), headache seen in 665 sessions (15.6%), cramps seen in 85 sessions (2.0%), chest pain and back pain seen in 82 sessions (1.92%), hypoglycemia seen in 77 sessions (1.8%), first-use syndrome seen in 72 sessions (1.7%) and femoral hematoma seen in 31 sessions (0.73%). In the CRF group, common complications were hypotension in 2230 sessions (26.1%), nausea and vomiting in 1211 sessions (14.2%), fever and chills in 1228 sessions (14.4%), chest pain and back pain in 1108 cases (13.0%), hypertension in 886 sessions (10.4%), headache in 886 sessions (10.4%), cramps in 256 sessions (3.0%), hematoma in 55 sessions (0.64%), intracerebral hemorrhage in three sessions (0.03%) and catheter tip migration in three sessions (0.03%). There is a need for special attention for the diagnosis and management of intradialytic complications of HD because such complications could be managed successfully without the need for termination of the dialysis procedure.

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Acute kidney injury (AKI) is an important cause of morbidity and mortality in severe acute pancreatitis (SAP). We aimed in our study to explore the risk factors of AKI in patients with SAP and assess the prognosis of patients with SAP and AKI. This is a retrospective study consisting of analysis of outcome and complications encountered in 72 severe acute pancreatitis patients admitted to a tertiary care center at Indore, India, from May 2011 to April 2012. We encountered 14 AKI cases in the SAP study patients. There was a significant association of diabetes and alcohol with AKI in patients with SAP. Alcohol was found to be an independent significant risk factor for AKI in SAP. All the eight patients with SAP who expired had AKI. None of the patients of SAP without AKI expired during the study. We conclude that the patients with SAP with AKI have a greater mortality rate as compared with the SAP patients without AKI.

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The aim of this work is to study the incidence of acute kidney injury (AKI) in neonates admitted to the neonatal intensive care unit (NICU) over a six-month period from September 2011 to March 2012. This prospective study was performed on 250 neonates admitted to the NICU at the Children's Hospital, Faculty of Medicine, Zagazig University. All neonates were subjected to detailed history taking, including pre-natal, natal and post-natal history, with stress on symptoms suggestive of AKI. All neonates were examined thoroughly and the following investigations were performed: Blood urea nitrogen (BUN), serum creatinine, sodium, potassium, calcium, complete blood count, C-reactive protein, arterial blood gases, urine sodium and urine creatinine. AKI was diagnosed in 27 cases (10.8%), including 12 females and 15 males. 40.7% of the AKI cases were born after full-term pregnancy while 59.3% were pre-term babies. 29.6% of the AKI cases had oliguria, and there was male sex predominance, with a male-female ratio of 1.3:1. The cause of AKI was pre-renal in 96.3% and intrinsic renal in 3.7% of the cases. The predisposing factors for AKI were sepsis in 63% of the cases, respiratory distress syndrome in 55.6%, mechanical ventilation in 51.9%, peri-natal asphyxia in 18.5%, dehydration in 14.8%, surgical operation in 11.1%, congenital heart disease in 7.4%, sub-galeal hematoma in 3.7%, polycythemia in 3.7% and intra-ventricular hemorrhage in 3.7% of the cases. Our data suggest that pre-renal failure was the most common form of AKI in our patients. Early recognition of risk factors such as sepsis, peri-natal asphyxia or peri-operative problems and rapid effective treatment of contributing conditions will reduce the incidence of AKI in the neonatal period.

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Patients on hemodialysis (HD) are usually anemic because of defective erythropoeisis. Hepcidin is a polypeptide that regulates iron homeostasis and could serve as an indicator of functional iron deficiency in patients with end-stage renal disease (ESRD); this may also aid in the assessment of patient's response to erythropoietin (EPO). The present study was directed to investigate serum levels of hepcidin, iron status and inflammation markers such as C-reactive protein (CRP) in patients with ESRD on maintenance HD and to observe the correlation of serum hepcidin with conventional iron and inflammatory markers. A total of 42 patients of both sexes on maintenance HD and EPO therapy were enrolled; 42 ageand sex-matched healthy subjects were included as controls. Laboratory tests including complete blood count, serum hepcidin, total iron binding capacity (TIBC), serum ferritin, serum iron and CRP were performed. Serum hepcidin levels were significantly higher in patients with ESRD than in the control group (18.2 ± 2.8 ng/mL and 8.5 ± 2.3 ng/mL, respectively P = 0.000). The hemoglobin, hematocrit, serum iron, TIBC and transferrin saturation levels in the patient group were significantly lower than in the control group. Higher hepcidin levels were found in EPO non-responders (19.6 ± 2.4 ng/mL) while lower levels (16.9 ± 2.5 ng/mL) were seen in responders (P = 0.001). A positive and significant correlation was observed between the values of serum hepcidin and CRP. Our study indicates that higher hepcidin levels are found in ESRD patients on HD and in those not responding to EPO. Our findings suggest that hepcidin might play a role in the pathophysiology of anemia associated with chronic diseases as well as EPO resistance.

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To evaluate the use of rituximab in the treatment of severe glomerulonephritis (GN) in order to prevent progression of kidney disease toward the end stage, we designed a multicenter, retrospective study in Saudi Arabia about the efficacy and safety of the use of "off label" rituximab in a variety of severe refractory GN to conventional treatment and the progression of kidney disease for at least one year of follow-up. All the patients had kidney biopsies before treatment with rituximab, and proteinuria and glomerular filtration rate (GFR) were followed-up for the period of the study. The immediate side-effect at the time of administration of rituximab included itching in three patients, hypotension in one patient and anaphylaxis in one patient (dropped out from the study). After the administration of rituximab in 42 patients and during the first six months of therapy, 16 (38%) patients had complete remission (CR), 13 (31%) patients had partial remission (PR) and 13 (31%) patients had no remission. The mean follow-up period for the patients was 19.0 ± 6.97 months (median 18.0 months). The long-term follow-up during the study period disclosed a good hospitalization record for almost all of the patients. Membranous GN (MGN) was the largest group in the cohort (58% of the patients), and we observed CR and PR in 40% and 28% of them, respectively, which was comparable with the previous experience with rituximab in MGN patients with more CR than PR in our cohort. We conclude that our study suggests the safety and efficacy of the use of rituximab in patients with refractory GN and that larger and long-term prospective studies are required to define the role of rituximab in the different categories of these diseases.

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Focal and segmental glomerulosclerosis (FSGS) is a clinicopathological entity. The following five FSGS variants: Collapsing, cellular, glomerular tip, peri-hilar and not otherwise specified (NOS) are recognized, which may have prognostic value. The aim of this study was to highlight the clinical course and outcome in the different pathological variants of FSGS and to evaluate the predictive risk factors of end-stage renal disease (ESRD). It was a retrospective analysis of biopsy-proven primary FSGS patients who presented over a period of three years. The data were collected from the clinical and biopsy records of the Nephrology Unit. There were 116 patients with biopsy-proven FSGS. The frequency of occurrence of FSGS among all cases of the nephrotic syndrome seen in our unit was 35.47%. NOS was the most common pathological variant (62.2%), followed by peri-hilar (11.2%), cellular (9.4%) and glomerular tip (7.7%), and the least common variant was collapsing (4.3%). Majority of patients with collapsing, NOS and glomerular tip variants had nephrotic range proteinuria. However, the amount of proteinuria was highest in the glomerular tip and collapsing variants. A higher percentage of patients with the collapsing and cellular variants had renal failure at the time of presentation. A higher rate of tubular and interstitial changes was seen in the collapsing and cellular variants. The collapsing and cellular variants showed lower response rate and higher rates of ESRD, while the glomerular tip lesion had the highest remission rate and the lowest rate of ESRD. Poor prognostic factors for ESRD in FSGS were initial renal insufficiency, severe tubulo-interstitial change, initial nonresponsiveness to steroids and collapsing histopathological variant. Our study suggests that histopathological classification of FSGS is of paramount importance in the management and in predicting the prognosis.

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A 65-year-old gentleman was referred to our hospital with encephalopathy and renal failure. His medications included lithium for the treatment of bipolar disorder. The clinical examination and the laboratory investigations that followed revealed findings classical of lithium overdose. The patient was successfully managed and discharged from the hospital on Day 9 of admission. Clinicians should be aware of this rather unusual and relatively rare differential cause of acute on chronic renal failure with encephalopathy.

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We attempted in this study to determine the thyroid hormone levels in 45 adult chronic kidney disease (CKD) patients and 45 ageand sex-matched healthy subjects as controls. The serum thyroid hormone levels were measured by a radioimmunoassay. Serum concentrations of creatinine, urea, electrolytes and total proteins and albumin were measured as well. There was a significant decrease in the levels of serum total T3, total T4 and total protein and albumin levels in CKD patients when compared with the controls. There was a significant increase in the level of thyroid stimulating hormone in the CKD patients compared with the controls. Our study suggests that CKD leads to significant changes in the thyroid hormone levels, which need to be interpreted carefully in these patients.

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Venous thromboembolic events (VTEs) are a major cause of post-operative morbidity and mortality. Our objective is to establish the prevalence of VTEs in kidney transplant recipients and assess its impact on graft survival. Data regarding renal transplant patients with VTEs from 1985 to 2010 were identified and analyzed. After excluding recipients of combined grafts and late VTE development, 1596 recipients were included in this analysis. The prevalence of post-operative VTEs and graft survival were determined. Cox regression was used to analyze the survival data and data on prognostic (confounding) variables. The observed prevalence of VTEs in kidney transplant recipients was 1.6%. Of the 1596 kidney recipients, 25 recipients who developed VTEs had a mean graft survival of 12.3 years (compared with 20.5 years in patients without). The hazard ratio was 1.1 (95% confidence interval: 0.4-3.0, P = 0.447). The prevalence of VTEs post kidney transplantation is small. Although it did not reach statistical significance, it increased the risk of graft failure by 30%.

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Bicarbonate dialysis is the treatment modality of choice for correction of metabolic acidosis in chronic renal failure. However, improper selection of dialysate concentrate can result in life-threatening human errors. We report a case of iatrogenic severe hypernatremia (sodium 207 mEq/L) and severe metabolic acidosis (pH 6.65) that resulted due to accidental use of inappropriate bicarbonate concentrate for hemodialysis treatment. There was successful recovery in this patient with no neurological sequelae. To the best of our knowledge, this is the first case report in adults of severe hypernatremia along with severe metabolic acidosis due to error in the preparation of dialysis fluid.

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Anemia is a frequent complication in patients with chronic kidney disease. However, human recombinant erythropoietin (rHu-EPO) has revolutionized the management of anemia in chronically dialyzed patients. Epomax ^® is a new rHu-EPO alfa manufactured in Tunisia (Medis Laboratories). The aim of this study was to evaluate the efficacy and tolerance of Epomax ^® in chronic hemodialysis (HD) patients in a phase-III, multicenter, clinical trial. Fiftythree HD patients (mean age 47.7 ± 13 years) who received a stable dose of rHu-EPO (Hemax ^® , a rHu-EPO alfa manufactured by Biosidus Laboratories) subcutaneously were switched to Epomax ^® via the same route of administration. At baseline, the mean systolic pressure was 132 ± 18 mm Hg and the mean diastolic pressure was 79 ± 8 mm Hg. The mean blood hemoglobin was 10.2 g/dL and the median ferritin level was 667 ng/mL. After a follow-up of 43 days, the mean blood hemoglobin was 10.5 g/dL under the effect of Epomax ^® . There was no significant difference in the mean hemoglobin levels between the treatments with both drugs. Few adverse events were reported during the study. We conclude that Epomax ^® was effective at maintaining the hemoglobin levels at target concentrations and was well tolerated in HD patients.

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Tuberculosis (TB) is a frequently encountered infection among organ transplant recipients in developing countries, and the incidence of infection after the first year of transplantation is considerably high. In this study, the impact of rifabutin treatment on organ transplant recipients with TB infection was evaluated with respect to the trend of infection, management and outcome. The medical records of 26 post-transplant patients who received an organ transplant between 2004 and 2012 and later diagnosed with TB of different organs were reviewed retrospectively. We retrieved data regarding clinical features as well as treatment and outcomes. The median time interval between transplantation and TB was 36 months (IQR 12-101 months). The most common form of infection was pulmonary/pleural TB. All our subjects received rifabutin instead of rifampin in the anti-TB treatment regime as rifabutin is a less-potent inducer of cytochrome P-450. All patients responded satisfactorily to the treatment and maintained excellent allograft function. Moreover, we did not have any mortality among our recipients. Drug-induced hepatitis was observed in nine (35%) patients. Rifabutin is an excellent alternative medication to rifampin in the setting of TB management. Hepatotoxicity is a potential risk for treatment because of the potential additive toxicity of immunosuppressive drugs.

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Strongyloides stercoralis is an uncommon infection in Saudi Arabia. It can establish latency and cause an autoinfection in humans that lasts for years. The infection can get reactivated during immunosuppression and can result in a life-threatening Strongyloides hyperinfection syndrome. We present three cases of renal transplant recipients who developed Strongyloides infection following transplantation. A bronchoalveolar lavage specimen, a duodenal biopsy and/or a stool specimen from these patients revealed evidence of S. stercoralis larvae. The first two patients received kidneys from the same deceased donor, a native of Bangladesh, an area that is highly endemic for S. stercoralis. The data suggest that the first two cases might be donor derived. High-risk donors and recipients should be screened for Strongyloides infection to initiate treatment before transplantation thus reducing morbidity and mortality.

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Hemodialysis (HD) patients are subjected to a number of physical and mental stresses. Physicians might be unaware of some of these problems. We assessed our patients' opinion about the service provided at the dialysis unit. Our unit has 89 patients on HD. A questionnaire exploring our patients' opinion relative to the service provided was prepared. The patients were asked to fill-in the questionnaire in a confidential manner. Questionnaires were then collected and examined while unaware of patient identities. Sixty-nine patients (77.5%) responded to the questionnaire. Eight patients (11.6%) revealed their names on the questionnaire. According to the questionnaire, the patients were asked to assess the service of each service by choosing one of the following grades: "excellent," "mediocre" or "bad." For the whole group of contributing patients, there were 563 "excellent," 85 "mediocre" and five "bad" choices in addition to 37 blank "no comment" choices. Food service had the least percentage (68%) of evaluation as "excellent," while doctor' performance got the highest excellent evaluation (85.5%). Thirty-five patients (50.7%) added further comment(s). An audit meeting was conducted to discuss these results. Exploring the opinion of patients on HD might uncover some areas of dissatisfaction and help in improving the provided service. We recommend widespread usage of questionnaires to assess patient satisfaction as well as to assess other health-care aspects.

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The present study is aimed to evaluate the effect of the herbal drug Salacia oblonga on reduction of cardiovascular risk factors in patients with chronic kidney disease (CKD). Sixty patients were randomized in four groups; group A1 = non-diabetic CKD given trial drug Salacia oblonga for six months, group A ₂ = non-diabetic CKD intended to receive placebo, group B1 = diabetic CKD treated with Salacia oblonga for six months and group B ₂ = diabetic CKD patients intended to receive placebo. Estimation of renal function tests including blood urea, serum creatinine and creatinine clearance was performed at baseline and after that at monthly intervals. Lipid profile, interleukin-6 (IL-6) and C-reactive protein (CRP) were measured at baseline and were repeated at three months and six months. After six months of treatment, Salacia oblonga could reduce the triglyceride levels by 23.66% (P = 0.008) in non-diabetic and by 17.45% (P = 0.01) in diabetic CKD patients. In comparison with placebo, both non-diabetic and diabetic CKD patients treated with Salacia oblonga showed significant reduction in CRP levels (P = 0.002 and 0.03, respectively), while significant reduction in IL-6 (P-value = 0.0003) and serum cholesterol levels (P-value = 0.0001) was seen only in diabetic CKD patients treated with Salacia oblonga. Stabilization of creatinine clearance with Salacia oblonga was observed in both non-diabetic (P = 0.05) and diabetic CKD (P = 0.04) patients in comparison with placebo. Salacia oblonga has significant beneficial effects on lipid profile and markers of inflammation and endothelial dysfunction in CKD patients. Salacia oblonga also seems to have a reno-protective effect, as reflected by stabilization of creatinine clearance at six months in this study.

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The excessive cardiovascular mortality seen in patients with end-stage renal disease seems to be closely related to accelerated coronary atherosclerosis. Some echocardiographic parameters such as left ventricular mass and diastolic dysfunction are implicated in ventricular dysfunction and mortality. The aim of the present study was to evaluate the effect of duration on dialysis on some echocardiographic parameters. We enrolled 75 patients on hemodialysis, including 34 women, in our prospective study. The mean age was 42.5 ± 13.8 years. The echocardiographic parameters were all measured within 2 h after a dialysis session. The study population was divided into two groups: Group-1 consisted of patients on dialysis for < 5 years and group-2 included patients on dialysis for >5 years. The two groups were similar regarding demographic characteristics and cardiovascular risk factors. On univariate analysis, a statistically significant difference was seen in the left ventricular end-diastolic diameter (P = 0.002), left ventricular end-syslotic diameter (P = 0.008), left ventricular mass (P = 0.006), inter-ventricular septum (P = 0.024), mitral flow deceleration time (P = 0.03), tricuspid anteroposterior systolic excursion (P = 0.01), inferior vena cava diameter (P = 0.04), left atrial size (P = 0.02), valvular calcification (P = 0.01) and pericardial effusion (P = 0.01) between the two groups. We conclude that the duration on dialysis is associated with changes in several echocardiographic parameters. Frequent follow-up with echocardiogram is recommended in the management of these patients.

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Behcet's disease (BD) is a multisystem vasculitis with protean manifestations. It is characterized by a heightened state of inflammation, although the factors that initiate and sustain this inflammation are not clear. We report some cases of BD-associated amyloidosis and have similar features. The patients developed nephrotic syndrome due to secondary amyloidosis, which was refractory to the immunosuppressive agents. Two patients expired and the third was lost to follow-up during the course. The BD complicated with amyloidosis is associated with high mortality despite the current aggressive therapy.

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The cardiovascular disease is an important cause of morbidity and accounts for almost 50% of deaths in patients undergoing maintenance dialysis. Many harmful molecules of the uremic milieu, such as the middle molecules, are difficult to remove by conventional hemodialysis (HD). On-line hemodiafiltration (OL-HDF) can achieve a considerable clearance of middle molecules and, together with its sterile ultrapure infusate, may have favorable effects on inflammation and cardiovascular complications. We aimed in this study to assess the effect of OL-HDF on improving the chronic inflammatory state associated with chronic kidney disease and the possible impact of these changes on myocardial function in chronic HD children. Thirty pediatric patients [12 (40%) males and 18 (60%) females with a mean age of 11.3 ± 3.2 years] on conventional HD for at least six months were switched to OL-HDF for six months. Variables for comparison at the end of each period included the levels of serum C-reactive protein and Kt/V as well as electrocardiography and echocardiographic measurements, including left ventricular mass index (LVMI). On changing from HD to OL-HDF, there was a significant decrease in hs-CRP (from 7.9 ± 8.9 to 3.4 ± 3 μ g/mL) (P = 0.01) and frequency of diastolic dysfunction (P = 0.04), while systolic function (FS and EF) improved significantly (P = 0.007 and 0.05, respectively), while LVMI did not change. We conclude that OL-HDF was well tolerated in children with improvement of the systolic function of the myocardium and the overall frequency of diastolic dysfunction.

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Metformin is a first-line oral anti-hyperglycemic agent. It decreases insulin resistance, decreases hepatic glucose output and enhances peripheral glucose uptake. Metformin is used as a monotherapy in combination with other oral hypoglycemic agents. A major side-effect of metformin is lactic acidosis. The elimination of metformin is mainly through the kidneys, and raised plasma concentrations can cause lactic acidosis. Provided there is no overdose, metforminassociated lactic acidosis rarely develops in patients without co-morbidities such as renal or hepatic insufficiency, acute infection or severe dehydration. Herein, we report a case of metformin-induced metabolic acidosis occurring in a woman who was severely dehydrated after performing Haj and treated conservatively.

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Left ventricular hypertrophy (LVH) and left ventricular dysfunction are highly prevalent in patients with end-stage renal disease (ESRD). Several studies suggest that left ventricular mass and function is strongly modulated by the nitric oxide (NO) system. Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of endothelial-based NO synthase, is emerging as an important cardiovascular risk factor in ESRD patients. Our objective is to evaluate the relationship between plasma ADMA level and LVH among hemodialysis (HD) patients. Plasma ADMA measurements by enzyme-linked immunesorbent assay and echocardiographic evaluation were performed for 40 patients on regular HD, 20 patients with pre-dialysis chronic kidney disease, 20 hypertensive patients with left ventricular hypertrophy and normal kidney function and 20 healthy age and sex-matched subjects as a control group. Residual renal function (RRF) was measured in HD patients by urea clearance from a urine collection. Mean values of plasma ADMA level were significantly high in all patient groups when compared with the control group (P < 0.001). However, there was no significant difference between groups I, II and III as regards mean values of plasma ADMA (P >0.05) and between ADMA and RRF in HD patients (r = -0.20, P = 0.60). It was also seen that plasma ADMA was not correlated with left ventricular mass index; however, there could be an association between ADMA level and diastolic dysfunction. The plasma ADMA level was found to be high in the three studied patient groups in comparison with the control group. HD is not an effective procedure for adequate removal of ADMA.

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Hepcidin prevents absorption of iron from the intestine and inhibits release of iron from macrophages and hepatocytes. For this reason, it seems that high levels of hepcidin are a predisposing factor for anemia in chronic inflammatory conditions such as chronic kidney disease and dialysis patients. This study was designed to determine the role of changes in the level of serum hepcidin in the management of hemodialysis patients. This study included 44 dialysis patients and 44 controls. The hepcidin and pro-hepcidin levels were measured by the enzymelinked immunosorbent assay method. The serum ferritin level was measured by the chemiluminescence method. The mean hepcidin level was 999.3 ± 996.7 ng/mL in the case group and 770.4 ± 815.9 ng/mL in the control group (P = 0.25). The mean pro-hepcidin level was, respectively, 186.1 ± 220.3 pg/mL and 150.87 ± 207.7 pg/mL, in the case group and control groups (P = 0.45). The mean (standard deviation) ferritin level was 816.4 ± 379.4 ng/mL in the case group and 193 ± 171.8 ng/mL in the control group (P < 0.001). In the case group, the correlation between serum ferritin and hepcidin was not significant (r = 0.6, P = 0.08). Also, there was no significant correlation between serum ferritin and pro-hepcidin levels (r = 0.6, P = 0.08). A positive correlation was seen between pro-hepcidin and hepcidin levels (r = 0.92, P < 0.01). In this study, the results showed that the serum hepcidin levels are high in dialysis patients and that there was no correlation with the serum ferritin levels.

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In the treatment of end-stage renal disease, kidney transplantation (KT) is the best and most cost-effective alternative with regard to both prognosis and quality of life. To identify the proportion and the characteristics of kidney transplant candidates who can be considered eligible, a total of 2066 hemodialysis patients were investigated as part of the ARTEMIS (Attitude toward Renal Transplantation and Eligibility among dialysis patients in a Moroccan Interregional Survey) study. We investigated all patients receiving hemodialysis in the 39 centers of four Moroccan departments. The mean age was 52.9 years and the mean duration of hemodialysis was 55.3 months. Fifty-eight percent of our patients were considered eligible for KT; 18.2% had an absolute contraindication and 23.8% had one or more relative contraindications. When compared with eligible patients (n = 1200) in the univariate analysis, those ineligible were significantly older (61 years vs. 51, P < 0.0001), had no residual diuresis (59.8% vs. 49.1%, P < 0.0001), were more often diabetic (25.1% vs. 11.9%, P < 0.0001) and hypertensive (54.5% vs. 45.8%, P < 0.0001), and their median dialysis duration was longer (61 months vs. 51, P < 0.0001). In the multivariate models, eligibility remained associated with young age, less term of dialysis and residual diuresis. Adequate control of cardiovascular risk factors before dialysis and early referral for transplantation might help to improve eligibility of the renal transplant candidates.

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Current immunosuppression improved long-term outcome of transplant patients, but it also increased the incidence of de novo malignancy. Organ transplant recipients have a threeto four-fold increased risk of developing carcinoma in comparison with the general population. Common malignancies encountered after transplantation include cancer of the skin, lips, post-transplant lymphoproliferative disease, ano-genital carcinoma and Kaposi sarcoma. Squamous cell carcinoma of the tongue is very rare. We report here a case of squamous cell carcinoma of the tongue in an adult male patient who developed it 11 years post-transplant. He underwent right hemiglossectomy and his graft function remained stable.

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To evaluate the prevalence, risk factors, possible etiology, prognosis and management of proteinuria in renal transplant recipients, we studied 435 adult renal transplant recipient patients randomly selected from our center; 394 patients were reviewed retrospectively and 41 patients were followed-up prospectively for a period of one year. The patients were classified into three groups according to the results of urinalysis and spot urinary albumin creatinine ratio: Group A patients with normoalbuminuria; Group B patients with microalbuminuria; and Group C patients with macroalbuminuria. Persistent post-transplantation proteinuria was detected in 125 (28.8%) patients. The etiology of post-transplantation proteinuria included chronic allograft dysfunction in 44 (35.2%) patients, acute rejection in 40 (32%) patients, transplant glomerulopathy in eight (6.4%) patients, glomerular disease in 16 (12.8%) patients and other etiology in 17 (13.6%) patients. Proteinuric patients demonstrated significantly lower graft survival rates than did those without proteinuria (48.3% versus 51.7%, respectively; P = 0.017; Risk Ratio = 0.403; 95% confidence interval 0.188-0.862). We conclude that proteinuria is prevalent after kidney transplant in our population, and that it is most commonly associated with chronic allograft nephropathy, transplant glomerulopathy, glomerulonephritis and acute rejection. Post-transplant proteinuria is associated with decreased allograft survival.

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Autosomal recessive distal renal tubular acidosis (dRTA) is associated with mutation in the ATP6B1 gene encoding the B1 subunit of H ⁺ -ATPase, one of the key membrane transporters for net acid excretion of α-intercalated cells of medullary collecting ducts. Sensori-neural deafness frequently accompanies this type of dRTA. We herewith describe a patient who had distinct features of dRTA with bilateral sensori-neural hearing loss and ATP6B1 mutation. This is a rare entity.

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Fertility is markedly reduced in dialysis patients. Estimates of the frequency of conception in dialysis patients range from 1.4% per year in Saudi Arabia to 0.5% in the United States. The reasons for the rarity of pregnancy in dialysis patients are not well understood. In addition, there is a marked increase in the risk of pre-eclampsia, hydramnios, hypertension crisis, early uterine contractions and pre-term delivery. Herein, we report a 38-year-old Saudi woman with chronic renal failure who completed the full term of pregnancy uneventfully on peritoneal dialysis. Using a biocompatible dialysate solution, adequate metabolic and blood pressure control were achieved during pregnancy. The delivered infant was small for gestational age and was born with a ventricular-septal defect. To the best of our knowledge, this is the first case report in the literature of ventricular-septal defect in an infant born to a mother on peritoneal dialysis.

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Kimura's disease is a rare chronic eosinophilic inflammatory disorder of unknown etiology. Majority of cases have been reported from South East Asia, while sporadic occurrences have been reported worldwide, including the Indian subcontinent. Nephrotic syndrome may be the presenting manifestation of Kimura's disease, and a variety of renal lesions are observed histologically in such patients. We herein describe a case of steroid-responsive mesangioproliferative glomerulonephritis related to kimura's disease.

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Eosinophilic peritonitis (EP) is an uncommon complication of peritoneal dialysis, which happens usually secondary to either an underlying bacterial, fungal or tubercular infection or as a reaction to intraperitoneal drugs or constituents of the dialysis system like tubings or solution. We report a case of a middle aged male who was initiated on continuous ambulatory peritoneal dialysis. Because of inadequate inflow and outflow of dialysis fluid, he was given two doses of intraperitoneal streptokinase after ruling out other causes. After the use of intraperitoneal streptokinase, there was turbid effluent with culture showing Staphylococcus aureus. Even after the successful treatment of bacterial peritonitis with intravenous antibiotics, he continued to have turbid effluent, with a predominance of eosinophils in the effluent cell count. A diagnosis of EP was made and he was managed with the antihistaminic drug loratidine, with complete resolution.

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Infection with polyomavirus (BK virus) is the cause of renal graft losses in more than 50% of the infected cases. There should be a high index of suspicion about this disease, although the incidence is only between 2% and 5% as the future of renal graft depends on the early and appropriate management of the same. Herein, we describe three clinical cases: Two were those of kidney transplant and the third, a combined kidney-pancreas transplant. In these cases, by reducing immunosuppression and, in one case, replacing the calcineurin inhibitor by MTOR (mammalian target of rapamycin) in addition, we were able to preserve of the normal function of the transplanted organs.

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