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Saudi Journal of Kidney Diseases and Transplantation
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   2004| October-December  | Volume 15 | Issue 4  
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Ethics of Organ Transplantation: An Islamic Perspective
Khaja H. Mujtaba Quadri
October-December 2004, 15(4):429-432
  7,954 681 -
Assessment of the Nutritional Status of End-Stage Renal Disease Patients on Maintenance Hemodialysis
Huda O Basaleem, Saeed M Alwan, Amel A Ahmed, Khaled A Al-Sakkaf
October-December 2004, 15(4):455-462
We assessed the nutritional status of 50 patients on maintenance hemodialysis by performing anthropometric measurement (pre and post dialytic weight, height, mid-upper arm circumference (MUAC) and related biochemical analysis. The malnutrition score was calculated from the body mass index (BMI), MUAC, hemoglobin, clinical signs of nutritional deficiencies and gastrointestinal manifestations. Stepwise multiple logistic regression analysis was carried out with malnutrition as a dependent variable. There was equal number of men and women in the study with a mean age of 39.5±12.1 years. The main cause of renal failure was arterial hypetension (30%), followed by glomerulonephritis (22%). The mean period of hemodialysis was 1.2 ± 0.9 years. The mean total knowledge score about avoidable food was 2.86±1.59 (Total=6) and only 14% have a satisfactory knowledge score. A significant difference between men and women was found in the mean predialytic (52.1±9.6 kg) and post dialytic weight (50.0±9.7 kg) P<0.05, while there was insignificant difference in the mean MUAC (22.6±3.3 centimeters) and BMI (20.3±2.9 kg/meter 2 ). The malnutrition score showed 70% of moderately malnourished patients and 20% severely malnourished. Abnormal biochemical parameters were encountered in the majority of patients. Old age (≥50 years) was significantly associated with malnutrition. All the patients received only six hours of dialysis a week, which was inadequate dose and had the major impact on the patient's nutritional status. We conclude that poor nutritional status was detected among a significant number of patients with poor dietary knowledge and practices. Increased risk of malnutrition was significantly associated with older age (≥50 years) and inadequate dialysis dose.
  6,048 878 -
Varicella-Induced Remission of Steroid-Resistant Nephrotic Syndrome in a Child
Mohamad Bassam A Saeed
October-December 2004, 15(4):486-488
We report a Syrian boy aged three years and four months, a known case of the nephrotic syndrome (NS) diagnosed 18 months earlier. In view of non-response to steroid therapy administered according to the ISKDC regimen, a kidney biopsy was performed which showed features compatible with minimal change disease. While on alternate-day steroid therapy, he developed a typical rash of very severe varicella. Steroid therapy was stopped and intravenous acyclovir was administered for five days, followed by oral acyclovir. The child made a full recovery from chickenpox which was associated, in addition, with a complete remission of the NS. His remission has been sustained after a follow-up of six months. In conclusion, to the best of our knowledge and following an extended search, this case is the probably first ever published about varicella-induced remission of steroid-non responsive NS.
  5,747 377 -
Bladder Instability and Upper Renal Tract Damage
Abbas Abdul Aal, Ayman Khalil
October-December 2004, 15(4):463-467
Bladder instability simulating neurogenic bladder disease is one of the commonest causes of dysfunctional voiding in children. We studied 100 cases with such problem over a five-year period; the peak age incidence was between 4-8 years. The gender distribution was 3:2 with female preponderence. Urgency and urge incontinence occurred in 80% of cases, recurrent acute cystitis in 50%, characteristic-holding postures in 15% and nocturnal enuresis in 40%. Variable degrees of bladder wall thickening and significant residual urine were seen on ultrasound examination. The patients were given anticholinergic therapy and antibiotic prophylaxis. All the patients went into complete remission within five years, many of them earlier. None needed surgical intervention although few patients had undergone surgical vesicoscopy and urethral dilation before they were referred to us. We conclude that recognition of the children with bladder instability is paramount to successful management and this will help to avoid upper renal damage and reduce the discomfort from unnecessary investigations and surgical procedures.
  4,852 277 -
Successful Bone Marrow Transplantation in a Child with X-Linked Hyper-IgM Syndrome
Haddadin Isam, A Al-Wahadneh
October-December 2004, 15(4):489-493
A 13-year-old boy was diagnosed at the age of three years as having hyper IgM Immunodeficiency syndrome (HIgM). It is a rare congenital disease characterized by recurrent infections and very low level of serum immunoglobulin (IgG, IgA) and elevated IgM. Conservative treatment with antibiotics and regular intravenous immunoglobulin (IVIG) was not satisfactory. At the age of five, the patient developed Hodgkin's lymphoma, which was treated successfully with chemotherapy. Experience with Bone Marrow Transplantation (BMT) in such cases is limited as a definitive treatment for this kind of syndromes. He was transplanted from his HLA-matched sister, and three years post BMT follow-up he showed good clinical recovery and immunoreconstitution.
  3,771 397 -
Post-Transplant Erythrocytosis: A Review of 47 Renal Transplant Recipients
Mohamed Abdelrahman, Ali Rafi, Reda Ghacha, Tahir Qayyum, Ayman Karkar
October-December 2004, 15(4):433-439
Post-transplant erythrocytosis (PTE) is a well known phenomenon occurring in 5-17% of renal transplant recipients (RTR). In this retrospective study, we studied 47 RTR which included 39 males and eight females. They were divided into two groups according to the presence or absence of PTE, which was defined as a hematocrit of more than 51%. Nine of the 47 patients (19%) developed PTE all of whom were males. The mean age of patients with PTE was 44 ± 9 years versus 40 ±11 years for patients without PTE. The mean follow-up period was 113 ± 26 months and 93 ± 58 months for the PTE and non­PTE groups respectively. The mean period after transplant when PTE developed was 9.8 ± 9 months and it lasted for 37 ± 3 months. Thromboembolic complications in the form of lower limb deep vein thrombosis occurred in one patient. Most patients were treated with phlebotomies, and one received an angiotensin converting enzyme inhibitor. There were no apparent predisposing factors in any but one patient, who had autosomal dominant polycystic kidney disease and developed hydronephrosis of the transplanted kidney. This might have caused excessive production of erythropoietin resulting in PTE. The serum creatinine values were higher, although statistically insignificant in patients with PTE. Chronic rejection was more commonly seen in patients with PTE (44%) than those without PTE (11%). Our findings suggest that PTE is a benign condition affecting males more than females. It may have an association with chronic rejection. Most cases can be controlled using phlebotomy.
  3,768 387 -
Spectrum and Outcome of Primary Glomerulonephritis
Jamal S Al Wakeel, Ahmed H Mitwalli, Nauman Tarif, Awatif A Alam, Durdana Hammad, Hassan Abu-Aisha, Nawaz Memon, Fathia Sulimani, Akram Askar, Abdo Qudsi
October-December 2004, 15(4):440-446
Glomerulonephritis (GN) is a major cause of chronic renal failure (CRF). To evaluate the trends and outcome with modern improved treatment strategies, we retrospectively reviewed the clinical records of 120 patients with biopsy proven primary GN at our center from January 1990 to June 2001. All the biopsy specimens were subjected to light, electron and immunofluorescent microscopy. The recorded clinical parameters included the presenting symptoms, blood pressure readings, complete blood count, urinalysis, 24-hr urinary protein excretion, creatinine clearance besides rendered therapy and the outcome. Focal segmental glomerulosclerosis was the most common GN and accounted for 56 (47.6%) cases. The frequency of other GN cases in our study included IgA GN in 21 (17.5%) patients, membranous GN in 20 (16.7%), minimal change disease (MCD) in 13 (10.8%), membranoproliferative GN in 4 (3.3%), post infection in 4 (3.3%) and rapidly progressive glomerulonephritis (RPGN) in 2 (1.7%). The type of nephropathy had great influence on outcome and response to therapy. The deterioration of patients with FSGS was the fastest of the glomerulopathies, and nine (16.1%) patients developed end-stage renal failure (ESRD). MCD and post infection GN had the best outcome. Corticosteroids alone along with supportive medication conferred good results in MCD, while combined therapies of mycophenolate mofetil (MMF) and/or cyclophosphamide with corticosteroids provided better outcomes in the rest of the GN. RPGN responded well to the cyclophosphamide and the patients did not develop ESRD. Hyperuricemia, high serum creatinine and hypertension predicted worse outcomes. The control of blood pressure and glucose, and treatment of hyperuricemia and hypoalbuminemia had salutary effect on the outcome. We conclude that due to the better delivered care the outcome of primary GN has improved over the years. However, FSGS is still the most frequently encountered primary GN and has the worst outcome. In the present study, combined therapies with corticosteroids and cytotoxic drugs and supportive therapy were associated with better outcome.
  3,353 572 -
Cytokines and Glomerulonephritis
Ayman Karkar
October-December 2004, 15(4):473-485
  3,508 356 -
Iranian Experience with the Non-Related Renal Transplantation
Behzad Einollahi
October-December 2004, 15(4):421-428
Kidney transplantation is the treatment of choice for most uremic patients. However, organ shortage remains the central problem in kidney transplantation. To deal with the widening gap between supply and demand of organs for renal transplantation, efforts to expand the organ donor pool have received increased attention. To solve this problem, we have initiated a living unrelated donor (LURD) program using emotionally related persons, friends and well-motivated volunteers as organ donors. A controlled transplant program, now known as the "Iran model", supported by the government for LURD renal transplantation was launched, which resulted in eliminating the waiting list. A charity founded by patients with end-stage renal disease, acts as a liaison agency and the altruistic volunteers have to register with the foundation for being introduced to the potential recipient referred by transplant centers. This review deals with the history of renal transplantation in Iran and describes the "Iran model" protocol and our experience of the non-related renal transplantation. Our results indicate that proper selection and pre-operative management of potential living donors lead to promising results in kidney transplantation. The health of the living donors is not impaired by the donation. The rate of early post-operative complications is low. Living donor kidney transplantation, in our geographical area with a low-rate of cadaveric donor transplants, is an alternative to expand the donor pool, yielding better results in terms of patient and graft survival.
  3,311 451 -
Incidence and Etiology of End-Stage Renal Disease in Madinah Munawarah Area: Any Changing Trends?
Abdelrahman Osman Mohamed, Irshad Ahmed Sirwal, Javid Ahmed M Vakil, Mohammed Ashfaquddin
October-December 2004, 15(4):497-502
In this prospective study, we show that the incidence of treated end-stage renal disease (ESRD) in Madinah Munawarah Area-Saudi Arabia (KSA) increased from 65.2 per million population (PMP) in 1988 to 137.5 PMP 2001. The highest incidence (40.6 %) was in the age group 40 to 59 years with predominance of males (61.6 %). Diabetes mellitus was the major etiology of ESRD in this area (42.5 %) and remained as such over the past 11 years; this is the highest figure for this etiology in KSA. Hypertension as a co-morbidity is very common (74.5 %). All diabetics were hypertensive at the start of renal replacement therapy (RRT). Ischemic heart disease is common in the chronic renal disease patients before RRT (27.4 %). Most patients presented very late with ESRD (69.9 %) without previous correction of the modifiable risk factors. The medical and general community at large should be informed of the benefits of early correction of the modifiable factors and the safety of the present RRT.
  3,117 278 -
Clinical Profiles of Chronic Renal Failure Patients at Referral to Nephrologist
AbulKashem Muneer, Ibrahim Al Nusairat, Mohd Zahangir Kabir
October-December 2004, 15(4):468-472
The quality of care of patients with chronic renal failure (CRF) in their pre­dialysis state is known to have a significant impact on the mortality and morbidity of dialysis patients. We evaluated 78 patients with chronic renal disease who were referred to our center for Follow-up of nephrologists between June 2002 and July 2003. We studied the etiology of the disease and the different biological parameters at the time of first nephrology clinic visit. The mean age of the patients was above 52 years. Diabetes mellitus was the leading cause of CRF found in 28% of patients, followed by hypertension in 24% cases. Seventy percent of the patients were in a state of moderate and severe renal failure at referral with mean blood urea nitrogen (BUN) of 22 ± 13 mmol/L, serum creatinine of 390 ± 180 µmol/L and creatinine clearance of 16.8 ± 14.2 ml/min. Our study suggests that the referring physicians should be more aware of the timing of referral of patients with CRF to nephrologists so that optimum pre-dialysis care can be ensured to improve the quality of life and better outcome of CRF patients.
  2,876 312 -
Effect of Age on Pituitary Gonadal Hormonal Responses of Saudi Male Patients on Hemodialysis
Samia H Sobki, Hala Al-Etah, Amina El Gezeery, Abdullah Al Khader
October-December 2004, 15(4):447-454
The pituitary gonadal axis of men with chronic renal failure is disturbed even when there is moderate reduction of the glomerular filtration rate. This axis is also disturbed in the ageing male. The present investigation was undertaken to study the pituitary gonadal hormonal response in Saudi male patients, belonging to two different age-groups, on regular hemodialysis (HD). Male patients on HD were divided into two groups. Group one included 24 individuals under 45 years of age and group two had 50 subjects > 45 years. Age­matched healthy individuals were used as controls. Serum levels of total and free testosterone were significantly reduced in patients >45 years of age when compared to patients <45 years of age. Also, the levels of follicle stimulating hormone (FSH) and leutenizing hormone (LH) were significantly increased in both the groups when compared with their age-matched controls. However, the serum levels of FSH, LH and sex hormone binding globulin (SHBG) were not significantly different between patients >45 years and those <45 years of age. Similarly, there was no significant difference in the hemoglobin levels between the two groups. The results of this study, suggest that disturbances in the pituitary gonadal hormonal responses in men on HD and >45 years of age may be more severe than men <45 years of age. Further studies are warranted to understand this observation.
  2,760 219 -
Renal Biopsy Findings in the Kingdom of Bahrain: A 13-Year Retrospective Study
Ahmed Al Arrayed, Sara M George, AK Malik, Sameer Al Arrayed, S Rajagopalan, Aziz Al Arrayed, Salah Eldin Sharqawi, KS Ratnakar, Eman Fareed, Fadhel Al Sabag
October-December 2004, 15(4):503-507
Glomerular diseases continue to be the leading cause of end-stage renal disease globally. Hence, it is important to recognize the pattern of these diseases in any given geographical area. A total of 498 renal biopsies performed on patients with proteinuria, hematuria and mild to moderate renal impairment during a period of 13 years (between January 1990 and December 2002) at the Salmaniya Medical Complex (a tertiary care hospital of the Kingdom of Bahrain), were reviewed and categorized. Primary glomerular disease accounted for two-third of the glomerular diseases, which in turn constituted 44.8% of all renal biopsies. The most common histological lesion was minimal change disease (30%). Focal and segmental glomerulosclerosis was the second most common lesion (23.8%) followed by membranoproliferative glomerulonephritis (14.3%). Secondary glomerular disease comprised 33.6% of glomerular diseases (22.7% of all the renal biopsies) with lupus nephritis forming the commonest lesion (38.9%) followed by diabetic nephropathy (31.9%) and hypertension (20.4%). Tubulointerstitial diseases accounted for 13.1% of all renal biopsies whereas transplant diseases were noted in 12.2%. The miscellaneous group including inadequate biopsies constituted 7.2% of all the biopsies. The results of this analysis were compared with surveys from other parts of the World.
  2,360 370 -
Nephron Sparing Surgery in a Transplanted Kidney Renal Cell Carcinoma
Mohammad Ali Amirzargar, Mahnaz Yavangi
October-December 2004, 15(4):494-496
Renal cell carcinoma (RCC) of the transplanted kidney is rare. In Iran, until 2004, 15000 kidney transplantations were performed, mostly from living donors. We report the first case of renal cell carcinoma in transplanted kidney, four years after transplantation, which was treated with nephron sparing or partial nephrectomy.
  1,900 233 -
Early Scary Days in Medical Practice
Abdullah A Al-Khader
October-December 2004, 15(4):513-514
  1,161 179 -
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