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2015| March-April | Volume 26 | Issue 2
Online since
March 3, 2015
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ORIGINAL ARTICLES
Study of non-compliance among chronic hemodialysis patients and its impact on patients' outcomes
Salwa Ibrahim, Mohammed Hossam, Dawlat Belal
March-April 2015, 26(2):243-249
DOI
:10.4103/1319-2442.152405
PMID
:25758870
Non-adherence to prescription is common among hemodialysis (HD) patients and has been associated with significant morbidity. At least 50% of HD patients are believed to be non-adherent to some part of their treatment. We aimed to assess the prevalence of non-adherence to dialysis prescription among 100 chronic HD patients. We explored the relationship between non-adherence on one hand and socioeconomic profile, depression scores and cognitive function on the other hand. The impact of patients' non-adherence on nutritional status, quality of life and dialysis adequacy was also assessed. The mean age of the study group was 50.51 ± 12.0 years. There were 62 females and 38 males in the study. Thirty-six patients (36%) were non-compliant to their dialysis prescription. No significant differences were detected between compliant and non-compliant patients in their education level and employment status. Inter-dialytic weight gain, serum phosphorus and depression scores were significantly higher in non-compliant patients compared with compliant patients, whereas body weight, serum albumin, serum calcium, quality of life scores and nutrition scores were significantly higher in compliant patients (
P
<0.05). In conclusion, non-adherence is highly prevalent among chronic HD patients and is associated with poor quality of life, depression and malnutrition.
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13
Coping methods to stress among patients on hemodialysis and peritoneal dialysis
Kobra Parvan, Ronak Ahangar, Fahimeh Alsadat Hosseini, Farahnaz Abdollahzadeh, Morteza Ghojazadeh, Madineh Jasemi
March-April 2015, 26(2):255-262
DOI
:10.4103/1319-2442.152409
PMID
:25758872
Dialysis patients need to deal and cope with various aspects of their disease. Identifying the adaptation methods provides valuable information for planning specific treatment and medical care delivery and improving the performance of medical teams. The present study aims to evaluate the coping strategies to stress among patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) at the Imam Reza Educational-Medical Hospital, Tabriz, West Azarbaijan, Iran. This descriptive and analytical study was conducted on 70 patients in the year 2012. The subjects were selected through census method and simple random sampling method. Data were collected using a customized questionnaire and consisted of demographic information and the Jalowiec Coping Scale (JCS) through a structured interview. Descriptive and inferential statistics were used to analyze the data in SPSS (version 13). The mean score of frequency of use of the coping strategy as "sometimes used" for the HD patients was 70.94 ± 18.91 and also for PD patients as "seldom used" was 58.70 ± 12.66. The mean score of helpfulness of coping strategies in the HD group was 49.57 ± 19.42 as "slightly helpful", whereas in the PD group it was 37.21 ± 14.38 as "slightly helpful" Furthermore, both groups used the emotion-oriented coping styles more frequently than the problem-oriented methods. HD patients used coping methods more frequently than the PD patients. The majority of patients used emotion-oriented coping strategies to deal with stress factors. Use of educational, counseling and supportive programs to assist in coping techniques can facilitate the coping process with stress factors in dialysis patients.
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4
The impact of pediatric nephrotic syndrome on parents' health-related quality of life and family functioning: An assessment made by the PedsQL 4.0 family impact module
Kirtisudha Mishra, Smita Ramachandran, Saima Firdaus, Bimbadhar Rath
March-April 2015, 26(2):285-292
DOI
:10.4103/1319-2442.152420
PMID
:25758876
The multi-dimensional impact on the quality of life (QOL) of families of children with the nephrotic syndrome (NS) has not been studied sufficiently in the literature. We aimed to study this aspect and the predictors of poor QOL among Indian families having children with NS. A cross-sectional study was conducted to compare the parents of children with chronic NS on treatment for at least one year with parents of a matched healthy control group. The parents of both groups were asked to complete the standard self-administered multi-dimensional questionnaire of Pediatric Quality of Life Inventory 4 (PedsQL
TM
) Family Impact Module (FIM). Descriptive and analytical statistics were performed to compare scores between the two groups. Possible predictors of poor outcome in each of the summary scales among the cases were assessed by both univariate and multivariate analysis. The parents of 61 cases and 72 controls completed the PedsQL
TM
FIM questionnaire. The scores in each of the categories, namely FIM Total Scale Score, Parent HRQOL Summary Score, Family Functioning Summary Score and eight individual domains, were found to be significantly higher among controls. Female gender of the affected child was an independent risk factor for poor Family Functioning Summary Score. Also, presence of serious complications during the course of the disease independently predicted poor Total FIM and Parent HRQOL Summary Scores. Even a relatively benign and potentially curable chronic disorder in children, like the NS, can disturb the QOL of parents in multiple domains of functioning.
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17
BRIEF COMMUNICATIONS
Effects of fasting during Ramadan on renal function of patients with chronic kidney disease
Houda Mbarki, Nada Tazi, Adil Najdi, Nabil Tachfouti, Mohamed Arrayhani, Tarik Sqalli
March-April 2015, 26(2):320-324
DOI
:10.4103/1319-2442.152494
PMID
:25758882
Fasting during Ramadan is prohibited when an individual's health is endangered. Little work has been published in this direction in patients with chronic kidney disease (CKD). We aimed to evaluate the impact of fasting during Ramadan on the renal function of patients with CKD, adjusting for the initial degree of renal impairment. We prospectively studied 60 patients with CKD (35 females; mean age 45.6 ± 15.8 years). All study patients were older than 15 years, being followed-up at the nephrology clinic for more than six months, having a stable CKD during the preceding six months and who had fasted during Ramadan the previous year. Patients who had a medical contra-indication for fasting were excluded from the study [severe or resistant arterial hypertension, insulin-requiring diabetes, acute renal failure (ARF), active renal disease, repetitive urolithiasis or terminal chronic renal failure]. Statistical analysis was performed in collaboration with the epidemiology lab at the Fez Medical School using the SPSS software version 17. Three of the study patients developed ARF in the first week and four of them at the end of the month of the study period. The risk of developing ARF was significantly higher for patients with baseline creatinine clearance of <60 mL/min/1.73 m
2
. However, the small sample size does not allow us to draw any firm conclusions on fasting during Ramadan in stable CKD patients. Studies on larger numbers of patients are recommended.
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8,769
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10
ORIGINAL ARTICLES
Gabapentin versus levodopa-c for the treatment of restless legs syndrome in hemodialysis patients: A randomized clinical trial
Nazanin Razazian, Hamid Azimi, Jafar Heidarnejadian, Daryoush Afshari, Mohammad Rasoul Ghadami
March-April 2015, 26(2):271-278
DOI
:10.4103/1319-2442.152417
PMID
:25758874
To compare the efficacy of gabapentin and levodopa-c (Levodopa/Carbidopa) in reducing restless leg syndrome (RLS) symptoms and sleep problems in hemodialysis patients with RLS in a four-week randomized clinical trial. The diagnosis of RLS was made using the criteria of the International Restless Legs Study Group. Each subject completed three questionnaires: IRLS questionnaire, Pittsburgh Sleep Quality Index and Epworth sleepiness scale. After four weeks of washout period for previous treatments for RLS, subjects were randomly assigned to four weeks of gabapentin (200 mg) or levodopa-c (110 mg). After four weeks of therapy, the questionnaires administered at the outset of the study were re-administered. Both drugs were found effective for the management of RLS. But, the effect of gabapentin was more significant. Gabapentin significantly improved the IRLS total score (change from baseline to post-treatment ≈-17) compared with levodopa-c (change from baseline to post-treatment ≈-13)
(P:
0.016). Regarding sleep parameters, levodopa improved sleep quality, sleep latency and sleep duration (
P
<0.0001). Gabapentin was also effective with respect to sleep parameters (
P
<0.0001). Our study shows that gabapentin is a safe effective therapy for RLS among hemodialysis patients. This medication may be considered as an alternative or additive treatment to current therapeutic remedies for hemodialysis patients with RLS.
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RENAL DATA FROM THE ARAB WORLD
Epidemiology of urolithiasis with emphasis on ultrasound detection: A retrospective analysis of 5371 cases in Saudi Arabia
Farid Ahmad, Medhat O Nada, Afsan Bin Farid, MA Haleem, S. M. A. Razack
March-April 2015, 26(2):386-391
DOI
:10.4103/1319-2442.152557
PMID
:25758899
This retrospective study was conducted to determine the prevalence of urinary calculi in the indigenous population of Saudi Arabia and compare it with expatriates of different nationalities working in Saudi Arabia with emphasis on the anatomic location of the calculi and the role of ultrasound in the detection and management. The study included 5371 patients (both sexes, mean age 36.6 years) examined by us from September 2004 to February 2008. The patients hailed from 30 countries, which included Bangladesh (42.3%), Pakistan (18.3%), Yemen (17.5%), India (6.5%), Sudan (3.4%), Saudi Arabia (2.8%), Egypt (2.3%) and Eritrea (1.7%). All patients were referred for abdominal/renal ultrasonography. Urinary calculi were detected in 1029 patients. The distribution of calculi was as follows: Renal 73.3%, pelviureteric junction 2.3%, proximal, middle and distal thirds of the ureter 13%, vesicouretic junction 9.8%, vesical 1.1% and urethral 0.5%. The prevalence of urinary calculi according to ethnic origin in descending order of frequency was Egyptians (29.5%), Pakistani (24.9%), Indian (23.3%),Yemeni (20.5%), Sudanese (17.6%), Bangladeshi (16.2%), Eritrean (15.4%) and Saudi Arabian (7.4%). Urinary calculi were found in 19.1% of the studied population. Approximately three-quarters of the calculi were located within the kidney. The nationalities with the highest prevalences were Egyptian, Pakistani and Indian.
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7,522
842
5
BRIEF COMMUNICATIONS
Continuous ambulatory peritoneal dialysis: Nurses' experiences of teaching patients
Amnah Shubayra
March-April 2015, 26(2):309-313
DOI
:10.4103/1319-2442.152491
PMID
:25758880
Nine nurses were interviewed to determine nurses' experiences of teaching patients to use continuous ambulatory peritoneal dialysis (CAPD). The material was analyzed using content analysis. Data were sorted into four themes and ten subthemes. The themes were presented as follows: Importance of language, individualized teaching, teaching needs and structure of care in teaching. The findings highlighted important insights into how nurses experience teaching patients to perform CAPD. The study revealed some barriers for the nurses during teaching. The major barrier was shortage of Arabic speaking nursing staff. Incidental findings involved two factors that played an important role in teaching, retraining and a special team to perform pre-assessments, including home visits. In conclusion, the findings of this study showed several factors that are considered as barriers for the nurses during teaching the CAPD patients and the need to improve the communication and teaching in the peritoneal dialysis units, including the importance of individualized teaching.
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6,584
870
2
CASE REPORTS
Metformin-associated lactic acidosis in a peritoneal dialysis patient
Najlaa Almaleki, Mohammad Ashraf, Majdi M Hussein, Syed A Mohiuddin
March-April 2015, 26(2):325-328
DOI
:10.4103/1319-2442.152498
PMID
:25758883
Metformin is one of the commonly used drugs in type-2 diabetes mellitus. It reduces glucose levels by increasing insulin sensitivity, reducing hepatic glucose release and increasing muscle uptake. One of the serious complications associated with metformin use is lactic acidosis, and it is associated with high morbidity and mortality. This is more likely to happen in patients with renal failure due to reduced clearance. International guidelines recommend discontinuing metformin in advanced renal failure. We report a case of metformin-associated lactic acidosis in a patient with end-stage renal disease on peritoneal dialysis. The patient presented with severe lactic acidosis, which was successfully treated with hemodialysis.
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2
RENAL DATA FROM ASIA-AFRICA
Comparison of survival in patients with end-stage renal disease receiving hemodialysis versus peritoneal dialysis
Seyed Seifollah Beladi Mousavi, Fatemeh Hayati, Ehsan Valavi, Fazlollah Rekabi, Marzieh Beladi Mousavi
March-April 2015, 26(2):392-397
DOI
:10.4103/1319-2442.152559
PMID
:25758900
Although the life expectancy of patients with end-stage renal disease (ESRD) has improved in recent years, it is still far below that of the general population. In this retrospective study, we compared the survival of patients with ESRD receiving hemodialysis (HD) versus those on peritoneal dialysis (PD). The study was conducted on patients referred to the HD and PD centers of the Emam Khomini Hospital and the Aboozar Children's Hospital from January 2007 to May 2012 in Ahvaz, Iran. All ESRD patients on maintenance HD or PD for more than two months were included in the study. The survival was estimated by the Kaplan-Meier method and the differences between HD and PD patients were tested by the log-rank test. Overall, 239 patients, 148 patients on HD (61.92%) and 91 patients on continuous ambulatory PD (CAPD) (38.55%) with mean age of 54.1 ± 17 years were enrolled in the study. Regardless of the causes of ESRD and type of renal replacement therapy (RRT), one-, two- and three-year survival of patients was 65%, 51% and 35%, respectively. There was no significant difference between type of RRT in one- (
P
-value = 0.737), two- (
P
-value = 0.534) and three- (
P
-value = 0.867) year survival. There was also no significant difference between diabetic and non-diabetic patients under HD and CAPD in the one-, two- and three-year survival. Although the three-year survival of diabetic patients under CAPD was lower than that of non-diabetic patients (13% vs. 34%), it was not statistically significant (
P
-value = 0.50). According to the results of the current study, there is no survival advantage of PD during the first years of initiation of dialysis, and the one-, two- and three-year survival of HD and PD patients is also similar.
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6,111
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5
BRIEF COMMUNICATIONS
Geriatric nutritional risk index: A mortality predictor in hemodialysis patients
Mahnaz Edalat-Nejad, Fatemeh Zameni, Mahdi Qlich-Khani, Fatemeh Salehi
March-April 2015, 26(2):302-308
DOI
:10.4103/1319-2442.152445
PMID
:25758879
Recently, the Geriatric Nutritional Risk Index (GNRI) has been introduced as a valuable tool to assess the nutritional status of hemodialysis (HD) patients. To determine the predictive value of the GNRI score for death in HD, we studied 145 chronic HD patients (%53 men, mean age 60 ± 16 years). The GNRI score was estimated by an equation involving serum albumin and individual's weight and height. According to the highest positive likelihood and risk ratios, the cut-off value of the GNRI for mortality was set at 100. The survival of patients on HD was examined with the Cox proportional hazards model. Mortality was monitored prospectively over an 18-month period, during which 35 patients died. The GNRI (mean 102.6 ± 5.5) was significantly positively correlated with lean body mass, hematocrit, serum lipids and presence of metabolic syndrome. Multivariate Cox proportional hazards analysis demonstrated that the GNRI <100, serum ferritin ≥ 500 μ g/L and age 65 years or older were significant predictors for mortality (hazard ratio 3.691, 95% CI 1.751-7.779,
P =
0.001; hazard ratio 3.105, 95% CI 1.536-6.277,
P =
0.002; and hazard ratio 2.806, 95% CI 1.297-6.073,
P =
0.009, respectively), after adjustment to gender and vintage time. It can be concluded that, in addition to old age, malnutrition (low GNRI) and inflammation (high ferritin) are identified as significant independent risk factors that predict all-cause mortality in HD patients.
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ORIGINAL ARTICLES
The effect of regular hemodialysis on the nutritional status of children with end-stage renal disease
Hala M Lotfy, Samar M Sabry, Emad E Ghobrial, Samer A Abed
March-April 2015, 26(2):263-270
DOI
:10.4103/1319-2442.152416
PMID
:25758873
Growth failure is one of the most common and profound clinical manifestation of chronic kidney disease (CKD) in infants, children and adolescents. The aim of this study was to assess the nutritional status of Egyptian children with end-stage renal disease (ESRD) on regular hemodialysis (HD). The study included 50 Egyptian children with ESRD on regular HD, following-up at the Pediatric Nephrology unit, Cairo University. History, including dietary history, was taken for all patients and clinical examination was performed on all of them. Body weight, standing height, height or length SD score, the skin fold thickness, mid-arm circumference, mid-arm muscle circumference and mid-arm muscle circumference area were also assessed. The height of the patients was the most affected anthropometric parameter, as 78% of the patients were shorter (height SDS below -3). Body weight is less affected than height, as body weight SDS of 34% of patients was less than -3 SDS. In addition, the body mass index of 16% of the patients was <3
rd
percentile, while only 4% of the patients were >97
th
percentile. Although most ESRD patients received adequate protein and caloric intake, their growth was markedly affected, especially with longer period on HD. We suggest that assessment of growth parameters should be performed at a minimum period of every six months in children with CKD stages 2-3. For children with more advanced CKD (stages 4-5 and 5D), more frequent evaluation may be warranted due to the greater risk of abnormalities.
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5,690
970
2
LETTERS TO THE EDITOR
A patient with hemodialysis intolerance and hypereosinophilia
Shobhana Nayak-Rao
March-April 2015, 26(2):366-367
DOI
:10.4103/1319-2442.152520
PMID
:25758892
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5,953
439
1
CASE REPORTS
Microscopic polyangiitis associated with primary biliary cirrhosis, Sjogren's syndrome and Hashimoto's thyroiditis
I Ben Ghorbel, Nabil Belfeki, T Ben Salem, A Hamzaoui, M Khanfir, M Lamloum, M Miled, MH Houman
March-April 2015, 26(2):359-362
DOI
:10.4103/1319-2442.152515
PMID
:25758890
The association between microscopic polyangiitis (MPA) and primary biliary cirrhosis (PBC) has seldom been reported. We describe here a patient who presented with sensorimotor neuropathy along with hypothyroidism, renal failure and liver dysfunction. Detection of antinuclear antibodies at a titer of 1/800, anti-SSA, anti-SSB, anti-GP210, anti-microsomial and p-ANCA anti-myeloperoxydase antibodies along with renal, salivary and liver biopsy led to a diagnosis of MPA associated with PBC, Sjogren's syndrome and Hashimoto's thyroiditis.
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5,345
804
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BRIEF COMMUNICATIONS
Pediatric systemic lupus erythematosus in a single nephrology unit
Doaa Mohammed Youssef, Doaa Mostafa Tawfek, Abdelsalam Mohammed Mohammed, Rania Mohammed, Naglaa Ahmed Khalifa
March-April 2015, 26(2):314-319
DOI
:10.4103/1319-2442.152493
PMID
:25758881
Clinical manifestations of systemic lupus erythematosus (SLE) are widely variable, and its course is unpredictable. SLE that begins in childhood has been considered more severe than SLE with onset during adulthood. Our aim was to determine the presentation and the outcome of SLE of 26 children (20 females and 6 males, with a female to male ratio of 3.8:1) with SLE in our center, their ages ranging from 5 - 18 years and followed from 2005 till October 2011. They were diagnosed according to the American Rheumatism Association's revised criteria. Complete blood count, erythrocyte sedimentation rate, C3, urine analysis, 24-h urinary protein, antinuclear antibodies, anti-ds DNA and renal biopsy were obtained for the patients. We found that the most extra-renal manifestation of SLE was fever (57.7%), while lupus nephritis (LN) was the most commonly affected organ (50%). Hemolytic anemia was the most common hematological abnormality (80.8%), while immunological characteristics were positive in all the patients. Remission in patients without LN was more than 5.3-times the remission in LN patients. The outcome of the patients without LN was better than the patients with LN.
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5,123
641
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CASE REPORTS
Multiple sites of calciphylaxis in a patient with chronic renal failure
Ramy Magdy Hanna, Joseph Riad Nabil, Eduardo A Lopez, Dalila B Corry, James Wilson
March-April 2015, 26(2):344-348
DOI
:10.4103/1319-2442.152506
PMID
:25758887
Calciphylaxis has seldom been reported in patients with acute renal failure or in pre-dialysis patients. It also has been reported at lower calcium phosphorous products and in patients with adynamic bone disease. We report a pre-hemodialysis (HD) patient with acute renal failure and biopsy-proven calciphylaxis involving multiple cutaneous sites with calcification of the perineal area resulting in dry gangrene of the penis that necessitated a partial penectomy. The patient had elevated serum calcium, phosphorous and parathyroid hormone level of 612 pg/mL. The same patient suffered subsequently from a calcium embolus that occluded his left ophthalmic artery and resulted in left eye blindness. Calciphylaxis is a devastating phenomenon and physicians should have a high clinical suspicion for it in HD patients as well as in patients with late stages of chronic kidney disease.
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5,158
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2
RENAL DATA FROM THE ARAB WORLD
Prevalence and associated factors of hepatitis C virus infection among renal disease patients on maintenance hemodialysis in three health centers in Aden, Yemen: A cross sectional study
Khadija Aman, Sami AbdoRadman Al-Dubai, Reema Aman, Aamenah Hawash, Mustafa Alshagga, Saba Kassim
March-April 2015, 26(2):380-385
DOI
:10.4103/1319-2442.152555
PMID
:25758898
We aimed to assess the prevalence and factors associated with positive anti-hepatitis C virus (HCV) antibodies among patients on maintenance hemodialysis (HD) in three centers in Aden, Yemen. The data from 219 patients and their records over the period between 2000-2013, was extracted and analyzed. The mean ± SD age of the patients was 47.08 ± 13.9 years; 74.4% of them were married and 14.6% were employed. The prevalence of validated anti-HCV-positive cases was 40.2% (95%CI 33.64%-46.73%). The mean ± SD duration on HD of all the patients was 35.09 ± 38 months. On bivariate analysis, the duration on HD and attending more than one center for HD associated significantly with anti-HCV positivity (
P
<0.05). On multivariate fully adjusted Poisson regression modelling, controlled for age, Patients attending more than one center and those who underwent HD for longer durations were more likely to be positive for anti- HCV antibodies [
P
= 0.004, adjusted prevalence rate ratio (APRR) = 1.87, 95% confidence interval (CI): 1.22-2.88;
P
= 0.0005, APRR = 1.01, 95% CI: 1.00-1.02. In this study sample, the prevalence of HCV was significant. Patients attending more than one center and those who underwent HD for longer durations were found to be more likely to contract HCV. Enhancing existing infection control measures and allocating more resources to HD centers therefore warrants consideration.
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5,089
613
3
ORIGINAL ARTICLES
A meta-analysis of potential relationship between Epstein-Barr-Encoded-RNA (EBER) and onset time of post-transplant lymphoproliferative disorders
Hossein Khedmat, Reza Karbasi-Afshar, Shahram Agah, Mohammad Ebrahim Ghamar-Chehreh, Mohsen Amini
March-April 2015, 26(2):232-237
DOI
:10.4103/1319-2442.152398
PMID
:25758868
Epstein-Barr virus (EBV) encodes two non-polyadenylated RNAs termed EBV-encoded RNAs (EBERs). In this study, we tried to find series in which data of EBER and onset time of post-transplant lymphoproliferative disorder (PTLD) for patients have been documented to conduct a meta-analysis. A comprehensive search of the literature was performed by Pubmed and Google scholar to find reports indicating test results for EBER and PTLD onset in transplant patients. PTLD was considered "early onset" when it develops within the first post-transplant year. Finally, 265 patients from 15 studies have been included in the meta-analysis. The overall meta-analysis also showed a significant relation between EBER test positivity and early-onset PTLD development [relative risk (RR): 1.36; 95% CI: 1.16-1.59;
P
<0.001]. The i2 index was 49.8%. Our study suggests that PTLD lesions with positive EBER test are more likely to develop within the early post-transplant period. Since early-onset PTLD is supposed to have better prognosis, having a positive EBER test might not be a bad news. However, for having a precise conclusion, prospective studies are needed to be conducted.
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4,841
749
4
LETTERS TO THE EDITOR
The efficacy of dipyridamole in the treatment of hypophosphatemia- hypocalcemia for hungry bone syndrome in a hemodialysis patient
Bulent Kaya, Eda Altun, Saime Paydas, Mustafa Balal
March-April 2015, 26(2):363-365
DOI
:10.4103/1319-2442.152518
PMID
:25758891
[FULL TEXT]
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[PubMed]
4,715
469
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ORIGINAL ARTICLES
Diagnostic value of color doppler ultrasonography in detecting stenosis and occlusion of central veins in patients with chronic kidney disease
Masoud Pezeshki Rad, Gholam Hosain Kazemzadeh, Masood Ziaee, Ghodsieh Azarkar
March-April 2015, 26(2):279-284
DOI
:10.4103/1319-2442.152418
PMID
:25758875
Venography is an invasive diagnostic test that uses contrast material that provides a picture of the condition of the veins. But, complications, including adverse effects on the kidney, do occur. On the other hand, with the current technological development, application of ultrasound in the diagnosis of obstructive diseases of the veins is gaining popularity, being non-invasive, easy to perform and cost-effective. The aim of this study was to evaluate the diagnostic value of Doppler sonography in the diagnosis of central vein stenosis. In this descriptive-analytical study, 41 hemodialysis patients who had been referred for 50 upper limb venographies to the radiology department of Imam Reza (AS) were included. Patients with chronic kidney disease with a history of catheterization of the vein, jugular or subclavian, and who had established fistulas or synthetic vascular grafts were targeted. Central venous ultrasound was performed on both sides to evaluate stenosis or occlusion. Venography was performed by the radiologist the next day or the day before hemodialysis. Data on demographic characteristics, findings of clinical examination and findings of ultrasound as well as venography were recorded by using the SPSS software, Chi-square test and Spearman correlation, and Kappa agreement was calculated for sensitivity, specificity and predictive values. Twenty-three (56%) patients were male subjects and 18 patients (44%) were female. Twenty-three (56%) patients of the study population were aged <60 years and 18 (43/9%) patients were aged >60 years. The overall sensitivity, specificity and positive predictive value and negative predictive value of Doppler sonography in the proximal veins in hemodialysis patients compared with venography were, respectively, 80.9%, 79.3%, 73.9% and 85.1%. Color Doppler sonography, as a non-invasive method, could be a good alternative for venography in the assessment of the upper limb with central vein stenosis and occlusion.
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4,551
573
1
Albuminuria prediction of kidney function outcome in kidney transplant recipients
Osama El Minshawy, Eman El-Bassuoni
March-April 2015, 26(2):227-231
DOI
:10.4103/1319-2442.152397
PMID
:25758867
To investigate the association of albuminuria and kidney function outcome in kidney transplant recipients, we studied 161 kidney transplant recipients; 95 (59%) of them were males and the mean age of the patients was 46 ± 13 years (range 18-70 years). All the patients received allografts from living related kidney donors. The mean body mass index of the patients was 25 ± 4 kg/m
2
. Forty (25%) patients were diabetic and 72 (45%) patients were hypertensive. All the patients had glomerular filtration rate (iGFR) determination by (
99m
Tc-DTPA) clearance and albumiuria was assessed using the first voided morning urine samples. According to the results of albuminuria, the patients were subdivided into three groups: One group of 90 (56%) patients with normoalbuminuria (<30 mg albumin/g. creatinine), a second group of 52 (32%) patients with microalbuminuria (30-300 mg albumin/g. creatinine) and a third group of 19 (12%) patients with macroalbuminuria (>300 mg/g. creatinine). There was a significant increase in the time post transplantation in the patients with macroalbumiuria in comparison with microalbuminuria and normoalbuminuria (90 ± 28, 60 ± 22 and 18 ± 6 months, respectively),
P
<0.05. There was a significant decrease of iGFR in the macroalbumiuria group as compared with the microalbumiuria and normoalbuminuria groups (57 ± 24, 74 ± 20 and 74 ± 28 mL/min/1.73 m
2
, respectively),
P
<0.05. We conclude that there was an association between albuminuria and the status of the renal function in our transplant population, which may reflect renal injury due to proteinuria. Prospective studies are warranted to evaluate the effect of albuminuria on the prognosis of the kidney allografts.
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4,475
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3
Nutritional knowledge following interventional educational sessions in children on regular hemodialysis
Doaa Mohammed Youssef, Mohammad Nagib Abo Al Fotoh, Rabab Mohamed Elibehidy, Shreen Magdy Ahmad Ramadan, Ehab Mohammady Mohammad
March-April 2015, 26(2):250-254
DOI
:10.4103/1319-2442.152407
PMID
:25758871
To evaluate the impact of nutritional knowledge following interventional educational sessions in chronic dialysis patients, we studied 40 children on chronic regular hemodialysis (HD) at the beginning and after six months of nutrition educational sessions using a predesigned questionnaire. We also measured the anthropometric parameters of nutrition to evaluate the impact of this education on the health of patients. We found a highly statistically significant increase in patients' scores and in adequate knowledge using the questionnaire after the educational sessions. Our results showed a statistically significant decrease in body mass index and weight after educational sessions for six months. Moreover, there were no significant decreases in serum phosphorus, ferritin, iron and creatinine, in contrast with no significant increase in hemoglobin, serum calcium, blood urea nitrogen and serum albumin. We conclude that nutritional education is significantly effective with regard to the level of knowledge, but not with regard to the attitude and practice in children on chronic HD.
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4,478
591
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BRIEF COMMUNICATIONS
Non-tolerability of double-filtration plasmapheresis in antibody-incompatible kidney transplant candidates
Hadia Hebibi, Hugo Weclawiak, Lionel Rostaing, Séverine Beaudreuil, Asma Allal, Hélène François, Antoine Durrbach, Nassim Kamar
March-April 2015, 26(2):297-301
DOI
:10.4103/1319-2442.152435
PMID
:25758878
Few studies have reported the use of double-filtration plasmapheresis (DFPP) in antibody-incompatible kidney transplantation. To assess the efficiency and tolerability of DFPP, we prospectively studied four chronic hemodialysis patients from two centers undergoing antibody-incompatible kidney transplantation. DFPP was used for ABO-incompatible transplantation (n = 1), for high human leukocyte antigen (HLA) immunization levels (n = 2) or for the presence of a donor-specific antibody (DSA) against a potential living donor (n = 1). In all the patients, the DFPP program was discontinued because of the adverse effects. Low blood pressure occurred during the first hour of the session in all the patients. A significant loss of plasma proteins, clotting factors and immunoglobulins also occurred during this treatment. In addition, fistula thrombosis was diagnosed in two patients. Three patients experienced gastrointestinal symptoms. The DFPP reduced the titers of the anti-B antibodies and reduced the levels of DSA in one patient, but had no effect on anti-HLA antibodies in the remaining two patients. Our study highlights the non-tolerability and poor efficacy of DFPP prior to antibody-incompatible kidney transplantation that limit its extensive use in the desensitization protocols.
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4,330
471
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CASE REPORTS
Intrathoracic kidney in a child with literature review
Abdul-Wahab M Al-Saqladi, Saleh A Akares
March-April 2015, 26(2):349-354
DOI
:10.4103/1319-2442.152509
PMID
:25758888
Intrathoracic kidney (ITK) is an extremely rare congenital anomaly, often asymptomatic and discovered incidentally on chest radiography. Diagnosis in children is less frequent than in adults. It affects males more than females and is more common on the left side. Symptoms can be present if it is associated with diaphragmatic defect, herniation of abdominal contents or respiratory compromise. We report a case of a three-year-old boy with right ITK, diagnosed incidentally by chest radiography during treatment of lower respiratory tract infection and confirmed by chest computerized tomography scan.
[ABSTRACT]
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[CITATIONS]
[PubMed]
4,147
522
3
Spontaneous peri-nephric hematoma in a patient with acute kidney injury following Russell's viper envenomation
Vishal Golay, Arpita Roychowdhary, Rajendra Pandey
March-April 2015, 26(2):335-338
DOI
:10.4103/1319-2442.152500
PMID
:25758885
Snake bite envenomation is a common cause of acute kidney injury (AKI) in the tropics and severe coagulopathy with bleeding manifestations is usually seen, especially with viperine bites. We present a case of a 34-year-old male who had developed AKI following Russell's viper envenomation along with disseminated intravascular coagulation. The patient was seemingly improving during the course of his treatment but subsequently developed a spontaneous unilateral peri-nephric hematoma and finally succumbed to this complication. This is a rare presentation that can be clinically innoccuous in a disease where there are multiple bleeding manifestations and, carries a very poor outcome.
[ABSTRACT]
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4,131
352
4
ORIGINAL ARTICLES
Comparison of renal function following donor nephrectomy versus radical nephrectomy for renal tumor
Mohamed Etafy, Fatma Saleh, MA Abdel Aal, Maher Gawish, Gamal Morsy
March-April 2015, 26(2):238-242
DOI
:10.4103/1319-2442.152401
PMID
:25758869
In this study, we compared renal function in patients after donor nephrectomy (DN) and radical nephrectomy (RN). We retrospectively reviewed 68 patients (mean follow-up 15 months), including 30 patients who had undergone DN and 38 patients who had undergone RN. The study was performed between April 2006 and July 2010 at a single institute. Patients were matched for age and co-morbidities (hypertension and diabetes mellitus). We calculated the estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease study group equation. Parameters studied included GFR (≥60 to <60 mL/min/1.73 m
2
), serum creatinine (>2.0 mg/dL), metabolic acidosis (serum bicarbonate <22 mmol/L) and proteinuria (>30 mg). There were no significant demographic differences between the two study groups. After a mean follow-up of 15 months, low eGFR (<60 mL/min/1.73 m
2
) was seen in 28% and 6.7% of patients in the RN and DN groups, respectively (
P
= 0.03). Similarly, proteinuria was seen in 21% vs 0%,
P
= 0.007, and
de novo
elevated creatinine was seen in 13% vs 0%, respectively
P
= 0.04; thus the changes were greater in the RN group. Our study shows that undergoing RN had a significantly greater risk of developing renal insufficiency and proteinuria compared with age-and co-morbidity-matched patients undergoing DN. We concluded that patients undergoing RN show a significantly greater risk of developing renal insufficiency and proteinuria compared with the patients undergoing DN.
[ABSTRACT]
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3,975
460
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RENAL DATA FROM ASIA-AFRICA
C1q nephropathy in India: A single-center study
KV Kanodia, AV Vanikar, RD Patel, KS Suthar, HV Patel, MA Gumber, PR Shah, HL Trivedi
March-April 2015, 26(2):398-403
DOI
:10.4103/1319-2442.152562
PMID
:25758901
C1q nephropathy (C1qN) is defined by conspicuous C1q deposits in the glomerular mesangial regions of patients who do not have any evidence of systemic lupus erythematosus (SLE). We present our experience with C1qN over the last three years. In total, 1775 native renal biopsies were reviewed and dominant/co-dominant C1q mesangial deposits in patients with absence of clinical and/or serological evidence of SLE were considered as C1qN. Their clinical profile and renal function status were studied and correlated. C1qN was observed in 11 patients (0.61%), and included eight males and three females; the mean age was 36.6 years. The most common presentation was nephrotic syndrome. Hematuria was noted in eight patients (72%). The mean serum creatinine was 2.78 mg/dL. Hypertension was seen in two patients (18%). Mesangial proliferative glomerulonephritis (MePGN) was the most common histological pattern, followed by focal and segmental glomerulosclerosis and other lesions. The common codeposits along with C1q were IgM, followed by C3 and others. MePGN had better prognosis than others. To conclude, C1qN was noted in 0.61% of all renal biopsies with bimodal age distribution and may present as podocytopathy or non-podocytopathy. The prognosis depends on the morphological pattern and C1q deposits
per se
are not prognostic indicators.
[ABSTRACT]
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[CITATIONS]
[PubMed]
3,953
478
2
EDITORIAL
Chronic kidney disease in disadvantaged populations
Guillermo Garcia-Garcia, Vivekanand Jha, World Kidney Day Steering Committee
March-April 2015, 26(2):221-226
DOI
:10.4103/1319-2442.152395
PMID
:25758866
[FULL TEXT]
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[CITATIONS]
[PubMed]
3,778
576
1
CASE REPORTS
Encapsulating peritoneal sclerosis: Presentation without preceding symptoms
Petros Yiannoullou, Kavitha Kanesalingam, David van Dellen, Titus Augustine
March-April 2015, 26(2):329-334
DOI
:10.4103/1319-2442.152499
PMID
:25758884
Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of peritoneal dialysis (PD), resulting in malnutrition and ultimately overt intestinal obstruction. We present the case of a 71-year-old man diagnosed with EPS incidentally at laparotomy for removal of PD catheter following an episode of PD peritonitis. He had been treated with continuous ambulatory PD for 18 months. He presented with anasarca and did not exhibit persistent symptoms of gastrointestinal dysfunction to suggest the EPS. Computed tomography scanning obtained 18 days prior to confirmation of the diagnosis did not demonstrate any features suggestive of EPS, highlighting a deficiency in the sensitivity of the diagnostic investigations. Management of the EPS is typically complicated by late diagnosis and concomitant malnutrition. This case highlights both the insidious nature of the EPS and a management problem to the surgeon faced with an unexpected abdominal cocoon. It further accentuates the necessity for increasingly sensitive diagnostic investigations to allow earlier diagnosis, thereby facilitating successful treatment.
[ABSTRACT]
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3,962
389
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Visceral phaeohyphomycosis caused by
Alternaria alternata
offering a diagnostic as well as a therapeutic challenge
H Raza, RU Khan, K Anwar, K Muhammad
March-April 2015, 26(2):339-343
DOI
:10.4103/1319-2442.152503
PMID
:25758886
Phaeohyphomycosis is a heterogeneous group of opportunistic infections caused by dematiaceous molds, which are distributed worldwide as plant pathogens but rarely cause human diseases. However, due to the growing populations of immunocompromised patients, these fungi are frequently recognized as important human pathogens. We are reporting this very rare, unique case for the first time from Islamabad, Pakistan, describing the association of visceral Phaeohyphomycosis caused by the opportunistic fungus
Alternaria alternata,
affecting the left kidney, with the immunocompromised state in a young incidentally detected patient with insulin-dependent type I diabetes. The case was diagnosed on the basis of a high index of clinical suspicion, microbial cultures, microscopy, imaging studies and endourological procedures. The patient did not respond well to the highly sensitive Amphotericin B, resulting in loss of the kidney. Therefore, we suggest that clinicians involved in treating immunocompromised patients should have a high degree of clinical suspicion for such opportunistic pathogens to allow timely initiation of the correct diagnostic and therapeutic work-up.
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3,919
380
1
ORIGINAL ARTICLES
Comparison of measured glomerular filtration rates with isotope infusion and with the modification of diet in renal disease equation in cancer patients with raised serum creatinine
Amrah Javaid, Saghir Ahmed Jaffri, Iqbal Munir, Muhammad H Qazi, Muhammad Khalid Nawaz
March-April 2015, 26(2):293-296
DOI
:10.4103/1319-2442.152422
PMID
:25758877
To compare the measured glomerular filtration rate (rGFR) using [99mTc] diethylene triamine pentacetic acid (DTPA) clearance or estimated GFR (eGFR) by the Modification of Diet in Renal Disease (MDRD) equation in cancer patients with raised serum creatinine level, we studied 100 cancer patients; 50 patients with normal serum creatinine (control group) and 50 patients with abnormal serum creatinine (study group). History of patients, including site of cancer, chemotherapy regime and dose of chemotherapy, was recorded. The rGFR and eGFR were increased in the study group as compared with the control group, but the GFR recorded by the MDRD formula or DTPA revealed similar values. It is therefore concluded that the MDRD equation may be recommended for eGFR estimation even with abnormal creatinine, without the need for exposure to radiation.
[ABSTRACT]
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3,653
311
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CASE REPORTS
An unusual presentation of venous thrombosis in a child with idiopathic membranous nephropathy
Sreekanth Burri, Manjusha Yadla, Pradeep Deshpande, Rama Enaganti, Ramesh Chada, Nimmagadda Laxmi NarasimhaMoorthy, Nethikoppula Anil Kumar
March-April 2015, 26(2):355-358
DOI
:10.4103/1319-2442.152512
PMID
:25758889
Venous thrombosis is one of the major complications associated with nephrotic syndrome. Among the primary glomerular diseases, membranous nephropathy is associated with a high incidence of thrombotic events. Although this is well described in adults, there is paucity of the literature regarding venous thrombosis in children. Herein, we report such a thrombotic event involving both the lower limb veins and the inferior vena cava in a child with membranous nephropathy.
[ABSTRACT]
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3,479
390
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LETTERS TO THE EDITOR
The effect of serum fetuin-A on atherosclerosis in hemodialysis patients
Fevzi Nuri Aydin, Mehmet Agilli, Tuncer Cayci, Yasemin Gulcan Kurt
March-April 2015, 26(2):370-372
DOI
:10.4103/1319-2442.152537
PMID
:25758894
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
3,194
344
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Occult hepatitis C virus infection in dialysis patients: Does it need special attention?
Mohammad Saeid Rezaee-Zavareh, Mahdi Ramezani-Binabaj, Behzad Einollahi
March-April 2015, 26(2):368-369
DOI
:10.4103/1319-2442.152523
PMID
:25758893
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[PubMed]
3,162
351
2
Sleep quality and C-reactive protein
Sora Yasri, Viroj Wiwanitkit
March-April 2015, 26(2):378-379
DOI
:10.4103/1319-2442.152546
PMID
:25758897
[FULL TEXT]
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[PubMed]
3,092
314
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Age and gender distribution of primary and secondary glomerulonephritis obtained by renal biopsy: A study from Hamadan, a great province in Western Iran
Mohammad Jafari, Alireza Monsef, Bahram Soleimani
March-April 2015, 26(2):375-377
DOI
:10.4103/1319-2442.152542
PMID
:25758896
[FULL TEXT]
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[PubMed]
3,057
288
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Occurrence of microalbuminuria among children and adolescents with insulin-dependent diabetes mellitus
Mahmood Dhahir Al-Mendalawi
March-April 2015, 26(2):373-374
DOI
:10.4103/1319-2442.152540
PMID
:25758895
[FULL TEXT]
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[EPub]
[PubMed]
2,753
287
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SCOT DATA
Deceased heart beating donor and organ transplantation in Saudi Arabia
March-April 2015, 26(2):404-409
[FULL TEXT]
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[EPub]
2,295
162
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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