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Saudi Journal of Kidney Diseases and Transplantation
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   2001| April-June  | Volume 12 | Issue 2  
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Acute Renal Failure due to Rhabdomyolysis Caused by Hypokalemia
Reda Ghacha, Ajit Kumar Sinha
April-June 2001, 12(2):187-190
Rhabdomyolysis is not an uncommon cause of acute renal failure (ARF). It is usually caused by severe traumatic crush injury, severe exercise, septicemia, drug abuse, alcoholic intoxication, heat stroke and myopathy. In this case, we present a patient who developed rhabdomyolysis after severe hypokalemia (serum potassium 1.9mmol/L). This is an unusual cause of rhabdomyolysis even though hypokalemia is a common medical problem. This patient developed acute oliguric renal failure that required daily hemodialysis for 12 days, before start of recovery. This case demonstrates that hypokalemia is a preventable cause of rhabdomyolysis and ARF.
  14,112 834 -
Renal Failure in Multiple Myeloma "The Myeloma Kidney":State of the Art
Hartmut Goldschmidt, Heinrich Lannert, Jurgen Bommer, Anthony D Ho
April-June 2001, 12(2):145-150
Renal failure is present in about 20% of patients with multiple myeloma (MM) at diagnosis. Renal function impairment is usually caused by the so-called "myeloma kidney" and is associated with shortened survival in patients treated with conventional therapy. Renal failure is reversible in up to 50% of patients, particularly when its degree is moderate and it is related to precipitating factors such as hypercalcemia. In our experience, approximately 10% of newly diagnosed patients with MM have renal failure severe enough to require dialysis. Despite its frequency, there are few reports dealing with MM and renal failure.
  12,652 1,336 -
Simplified Surgical Placement of Tenckhoff Catheter under Local Anesthesia: The Dammam Central Hospital Experience
TJ Youmbissi, A Al Amir, QT Malik, AS Al Joaeb, I Al Khursany, R Ghacha, S Ajit Kumar, A Rafi, F Al Ahmed, MR Abdul Rahman, A Karkar
April-June 2001, 12(2):175-178
Many methods are used for the placement of Tenckhoff catheters. Eighteen consecutive Tenckhoff catheters were placed under local anesthesia through a mini laparotomy with a reduced operating team. There were only three total catheter failures. Complications were infrequent and operating time was less than one hour on average. This simple procedure should be a part of the training program of all junior surgeons and nephrologists.
  12,918 725 -
Renal Infarction - Presentation and Causes: A Case Report and Literature Review
Ali Al-Harbi, Abdulhamed Shahat, Mahmoud Zakaria
April-June 2001, 12(2):179-182
Renal infarction usually occurs in patients with severe atherosclerosis or heart disease. We report a 68-year-old lady who presented with total occlusion of the left renal artery of acute onset. Detailed work up did not reveal any specific cause and the infarction was considered to be idiopathic. The patient presented two-and-half years later with atrial fibrillation, which was managed with anti-arrhythmic drugs. Retrospectively, we believe that the cause of renal infarction was embolization secondary to paroxysmal atrial fibrillation. She is doing well on anti-coagulants and anti-arrhythmic drugs and was maintaining sinus rhythm when last seen.
  9,586 652 -
Value of Doppler Ultrasound Hemodynamics in the Assessment of Renal Artery Stenosis in Transplanted Kidneys: An Assessment of Patients after Percutaneous Transluminal Angioplasty
Sameer Huraib, Danlami Tanimu, Waldemar Gorka
April-June 2001, 12(2):157-163
Doppler ultrasound (USS) may allow a non-invasive early diagnosis of transplant renal artery stenosis (TRAS). Adequate Doppler sampling of the transplant renal artery is difficult, time consuming and highly operator dependent. As a result, there has been increased attention focused on the intrarenal vessels and downstream changes that occur secondary to TRAS. We evaluated Doppler USS parameters in nine patients with TRAS confirmed on angiography (significant stenosis defined as > 60% diameter narrowing). Doppler USS correctly identified all the nine stenoses. Mean peak systolic velocity (PSV) was 3.6 m/s + 1.09. Mean end-diastolic velocity (EDV) was 1.75 m/s + 0.25 with an acceleration time (AT) of 0.14 + 0.04 sec and resistivity index (RI) of 0.42 + 0.12. Early systolic peak (ESP) was lost in all cases. Percutaneous transluminal angioplasty (PTA) was successfully done in five patients with significant improvement in Doppler parameters. PSV decreased from 4.04 m/s + 1.35 to 0.76 m/s + 0.42 (p = 0.01). Similarly EDV improved from 1.71 m/s + 0.28 to 0.30 m/s + 0.17 (p = 0.001). AT improved from 0.13 + 0.01 to 0.05 + 0.01 sec (p = 0.001). RI normalized from 0.34 + 0.07 to 0.73 + 0.09 (p = 0.008). ESP was restored in all the patients. In conclusion: our results show that the Doppler USS analysis of segmental arteries is an excellent tool for the diagnosis of TRAS and follow-up of patients post PTA.
  5,216 473 -
Evaluation of Plasma Beta-2-microglobulin in Patients with the Nephrotic Syndrome
Edward O Adeyemi, Enyioma N Obineche, Abdul-Shakur Abdulle, Abdul-Rahman Osman
April-June 2001, 12(2):151-156
In patients with the nephrotic syndrome, it is often desirable to assess the disease process, not only by proteinuria but also by indices of glomerular inflammatory process. We investigated the importance of β-microglobulin (βM) as a means of assessing renal function in patients with the nephrotic syndrome with normal or abnormal values of creatinine clearance. There were 46 patients (mean age, 42.2 + 10.4 years; male/female (M/F) ratio = 31/15) and 35 healthy controls (mean age 39 + 4.5 years, M/F ratio 25/10). We subdivided the study patients into group A (n = 18, mean age 39.6 + 10.6 years, M/F ratio 8/10) and group B patients (n = 28, mean age 45.6 + 8.9 years, M/F ratio 23/5) who had normal and abnormal values of creatinine clearance respectively. An enzyme-linked-immunosorbent assay (ELISA) was used to quantitate plasma β2M in the study patients and controls. The median 132M levels of the study patients and controls were 44.0 and 1.7 mg/l respectively (p < 0.0001). Beta-2-M levels correlated significantly with serum creatinine (r = 0.56, p < 0.0001), and creatinine clearance (r = -0.6, p < 0.0001). In group A patients, the median β2M level was significantly higher than normal (4.1 vs. 1.7 mg/1, p < 0.01). Plasma β2M levels did not correlate well with any other parameter measured in group A patients. When groups A and B were compared, the median plasma β2M level in group B was significantly higher than group A (20.3 vs. 4.1 mg/1, p < 0.0001). The urinary β2M (expressed per mg urine creatinine) was also higher in group B than group A patients (6.8 vs. 0.7 p < 0.05). We conclude that elevation of β2M-microglobulin in patients with the nephrotic syndrome who have normal creatinine clearance suggests early abnormal renal function in these patients. It may be used to assess the rate of normalisation of renal function or progression to chronic renal failure.
  4,652 464 -
Recommended Standards for Peritoneal Dialysis
Ibrahim Hassan Fahal
April-June 2001, 12(2):191-212
  4,019 399 -
Psycho-social Features of Chronic Dialysis Patients in Saudi Arabia: Experience of one Centre
Mohammed A AL-Homrany, Ali M Bilal
April-June 2001, 12(2):164-171
The goals of chronic dialysis treatment for end-stage renal disease (ESRD) patients include restoration of the highest achievable state of personal physical health and preservation as well as restoration and development of the highest level of psychological and social functions. We conducted this study to evaluate factors influencing the process of adaptation such as religious faith, economic status and extended family-tribal system. It was hoped that studying these factors might provide further dimension to our understanding of the psychopathology of ESRD patients, and to help offer new ideas to improve the quality of their lives. A sample comprising 54 patients with ESRD was studied in Abha hemodialysis centre in Southern Saudi Arabia. The socio-demographic characteristics, clinical and laboratory data were collected. The psychiatric status of the patients was evaluated using a structured "The Comprehensive Psychiatric Rating Scale" (CPRS) clinical interview. The result indicated that the major co-morbidity (in 60% of these patients) was a depressive illness due to renal failure diagnosable according to DSM-IV criteria. Our study suggests the need for specific anti-depressant treatment in order to ameliorate many distressing symptoms, which may affect the quality of these patients' life. Concomitant social problems of poverty, absence of spouse and illiteracy, dictate a more prompt attitude in initiating support systems and attention to providing leisure activities.
  3,765 504 -
Factors Affecting Successful use of Erythropoietin in the Treatment of Anemia in Patients on Hemodialysis: Experience in Hajjah Region, Yemen
Muhamed AL-Rohani
April-June 2001, 12(2):220-223
The use of recombinant human erythropoietin (rHuEpo) became an essential part of the treatment of anemia in patients with end stage renal failure (ESRF). Our experience at the Hajjah region, Yemen, confirms that the use of rHuEpo significantly increases the level of hemoglobin (HB) and hematocrit (Hct), improves work tolerance and overall quality of life of patients on hemodialysis. The observable improvement occurred in 87.5% of patients. The most prominent factors that caused deterioration in the increment of HB and Hct were infection with malaria and chronic infection. Failure of patients' compliance, largely due to lack of education, was another important factor effecting the results. Many of our patients did not understand the importance of diet and drug regime. It is very important to spend more time on educating such patients.
  3,519 380 -
Partial Lipodystrophy and Rapidly Progressive Nephritis
Mjalli A Hasan, Mohammad Al Raqad
April-June 2001, 12(2):183-186
We report the association of partial lipodystrophy (PL) and nephritis in an 11-year-old boy. He had symmetric absence of facial fat with retention of adipose tissue in the arms, chest, abdomen and hips associated with macroscopic hematuria, proteinuria combined with depression of the complement C3 level. The patient had rapidly progressive glomerulonephritis (RPGN) and the histopathological study showed findings of mesangio­capillary glomerulonephritis (MCGN) and crescents. We managed and followed up this patient for three years. At the last follow-up visit, he still has mild proteinuria and microscopic hematuria and stable renal function.
  3,137 369 -
Stretch Polytetrafluoroethylene Grafts for Hemodialysis Angioaccess: Three-year Experience
Adel G Al Dayel, Ibrahim Al Oraifi, Mamun Y Ezzibdeh, Siddig A Egail, Essam El Sayed, Ali Abou Zallat, Saeed Al Zahrani
April-June 2001, 12(2):172-174
We report the results of 90 stretch polytetrafluoroethylene (PTFE) grafts in 78 chronic renal failure patients over a 3-year period from 1995-1998. The grafts were used as primary access in 15% of the patients. The cumulative patency was 63.3% and there were no complications in 48.8% of the cases. Infection was encountered in 15.5% and thrombosis in 31.1% of the grafts. Intimal hyperplasia, venous anastomotic stenosis, improper puncture technique and subclavian vein stenosis were the major causes of failure of grafts. We conclude that stretch PTFE grafts as angioaccesses may provide good patency and durability.
  2,605 290 -
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