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Saudi Journal of Kidney Diseases and Transplantation
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   2006| October-December  | Volume 17 | Issue 4  
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Diabetic Nephropathy
Eberhard Ritz
October-December 2006, 17(4):481-490
In most Western countries, diabetic nephropathy (DN) has become the single most common condition found in patients with end-stage renal disease (ESRD). This is to some extent due to better survival of diabetic patients with renal failure, but mostly due to the dramatic increase in the prevalence of type 2 diabetes. The majority of type 2 diabetic patients with renal failure suffer from nodular glomerulosclerosis (Kimmelstiel-Wilson); but ischemic nephropathy, irreversible acute renal failure (mostly acute on chronic) and diabetes co-existing with primary renal diseases are common as well. Classical DN evolves in a sequence of stages. After a period of glomerular hyperfiltration, increased urinary albumin excretion [microalbuminuria (MA)] i.e. 30-300 mg/day or 20 - 200 µg/minute indicates the onset of overt DN. Risk factors for development of DN are positive family history, hyperglycemia in the mother during pregnancy, high blood pressure, obesity and insulin resistance. Poor glycemic control (HbA1c) and elevated systolic blood pressure (> 135 mm Hg) interact in enhancing the risk of DN. Proteinuria and smoking are major promoters of progression. The risk of onset of microalbuminuria can be reduced by lowering of blood pressure and specifically by blockade of the renin angiotensin system (RAS). In patients with established DN, the target systolic blood pressure should be <130 mm Hg and RAS blockade is obligatory. Treating all cardiovascular risk factors is a high priority. Antihypertensive management is rendered difficult by extreme volume sensitivity, pronounced activation of the RAS and autonomic neuropathy. Cardiac events are excessively frequent, glycemic control becomes difficult and autonomic diabetic neuropathy with gastroparesis and diabetic foot are additional problems. Hemodialysis or continuous ambulatory peritoneal dialysis should be started relatively early. In the absence of contraindications, transplantation (renal transplantation, combined kidney/pancreas transplantation or pancreas after kidney transplantation) is the treatment of choice.
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Knowledge and Attitudes of High School Students Related to Organ Donation and Transplantation: A Cross-Sectional Survey in Turkey
Ibrahim Tokalak, Altug Kut, Gokhan Moray, Remzi Emiroglu, Rengin Erdal, Hamdi Karakayali, Mehmet Haberal
October-December 2006, 17(4):491-496
We have very little information about the knowledge and attitude of high school students towards organ donation and transplantation. The aim of this study was to identify student-related factors that might affect organ donation, and then use this information to develop some essential strategies and policies. Two hundred students from one urban high school were surveyed with a questionnaire. After completing the first interview, the students underwent a training program on organ donation and transplantation. Once this was complete, the students filled out the same questionnaire in a second interview session. We then analyzed the changes from before to after the educational program in order to assess the program's effectiveness. Concerning brain-death, 66.1% of the respondents identified the correct definition of this concept before training, and 92% did so after training (p<0.001). The correct definition of transplantation was chosen by 68.3% of the respondents before training, and by 90.6% after training (p<0.001). It is clear that this educational program greatly enhanced the students' level of knowledge related to many aspects of organ donation and transplantation and significantly expanded awareness. By leading to changes in opinion, such training programs will significantly increase the number of donors and the rate of transplantation in Turkey.
  5 6,935 900
Analysis of Vascular Access in Hemodialysis Patients: A Report From a Dialysis Unit in Casablanca
Ghislaine Medkouri, Rachid Aghai, Aabdelkbir Anabi, Asma Yazidi, Mohamed G Benghanem, Khadija Hachim, Benyounes Ramdani, Driss Zaid
October-December 2006, 17(4):516-520
Vascular access (VA) for patients needing maintenance hemodialysis (HD) remains a major obstacle in the management of patients with end-stage renal disease (ESRD). We retrospectively analyzed 190 patients, (92 males and 98 females) who had been on HD for a period ranging from 12 to 240 months. Their mean age was 42.8 years (range: 13 to 83 years). The study was carried out to analyze the VA, including the management of its complications. The cause of renal failure was chronic glomerulonephritis in 34.2% and unknown in 30.5% of the study cases. In 164 patients (86.3%), HD was initiated through a temporary catheter inserted in the internal jugular vein. Each patient had, on an average, two catheters inserted that lasted for a mean duration of 29 days. All patients had a native arteriovenous fistula (AVF) as the permanent VA. A primary radial-cephalic AVF was created in 96.3% of the patients. The median period before cannulation was 15 days. Failure of AVF function occurred in 18.4% of cases while the median survival of the primary AVF was 54.8 months. Thrombosis, seen in 26.4% of the patients, was the predominant complication, and this event seemed to be causally related to prior insertion of temporary catheters. Ten patients had arterio-venous grafts (AVG) placed due to recurrent thrombosis of the AVF. The AVG was brachial-cephalic in five patients. A tunneled cuffed catheter was placed in four patients who had no other possible access sites available. These catheters were placed in the right internal jugular vein in all of these patients. The success of VA in patients on HD requires a multi-disciplinary approach and early referral to a vascular surgeon.
  5 3,294 544
Ectopia Vasa Deferentia Inguinal Hernia, Vesicourteric Reflux, Imperforate Anus, and Recto-Vesical Fistula: A Case Report
Ibrahim Daradka, Issa Hazza
October-December 2006, 17(4):572-575
Urologic congenital anomalies are frequently associated with anorectal abnormalities. Vas deferens anomalies in the general population are estimated to be less than 0.05%. Many of the abnormalities can be explained by events in early fetal life. Urosepsis and epididymitis are the usual presenting signs and symptoms in such patients. We describe an infant who was discovered after birth to have an association of high imperforate anus with recto-vesical fistula, right inguinal hernia, left vesicoureteral reflux, and bilateral dilated vasa deferentia ectopically terminating in the posterior urethra, which caused recurrent epididymo-orchitis.
  4 4,761 411
Pediatric End-Stage Renal Disease: Single Center Analysis
Edward Sacca, Issa Hazza
October-December 2006, 17(4):581-585
Data describing end stage renal disease in Jordan is very limited, due to the absence of internal center as well as national registry systems. In this retrospective analysis, we define the etiology, prevalence, incidence as well as other demographic features of pediatric end stage renal disease and renal replacement therapy at King Hussein Medical Center. All children who entered the chronic dialysis program in our center from January 2001 to December 2005 were included in the study. Children who were transplanted pre-emptively were also included. A total number of 42 patients were included. The mean age at time of dialysis initiation was 11.10 ± 2.25 years; 19 (45.2%) were males. The prevalence of ESRD in Jordan children was calculated to be 14.5 patients per million. Hemodialysis (HD) was the primary modality of therapy in 40 (95.2%) patients. The most common cause of ESRD in our children was acquired glomerulopathy in 13 (31%) patients, followed by oxalosis in seven (16.7%), and neurogenic bladder in six (14.3 %). Thirteen patients were transplanted; the one and three year graft survival rates were 87.5% and 72.5%, respectively. We conclude that there are some peculiar features for pediatric ESRD in Jordan including the high incidence of oxalosis and neurogenic bladder. A national registry for children with ESRD should be established as this may have serious implications on the choice of renal replacement therapy.
  4 2,382 417
The Place of Ultrasound in Renal Medicine
Alaleh Gheissari
October-December 2006, 17(4):540-548
Today, ultrasound is one of the most commonly used diagnostic tools, the reasons being that it is non-invasive, reliable, widely available, and affordable. In this paper, we review the place of ultrasound in the diagnosis and follow-up of patients with kidney diseases. We briefly discuss a wide range of kidney diseases for which ultrasound imaging is still performed as one of the initial steps of diagnosis. To achieve this, five following categories are addressed: congenital anomalies of the kidney; renal cystic diseases; renal infections; kidney stones; and kidney tumors. The sonographic findings of these diseases are discussed.
  4 23,944 1,384
Bone Marrow Transplantation for Leukocyte Adhesion Deficiency-I: Case Report
Adel Mohammed Al-wahadneh, Issam Haddadin, Mufeed Hamouri, Khalifah Omari, Faten Aejellat
October-December 2006, 17(4):564-567
Leukocyte adhesion deficiency type I (LAD-I) is a rare autosomal recessive immunodeficiency syndrome leading to recurrent bacterial and fungal infections. Bone marrow transplantation offers the only cure. In this report, we describe the course and outcome of bone marrow transplant in a 4 month-old female infant with LAD-I at King Hussein Medical Center, Jordan. A successful matched HLA- related allogeneic bone marrow transplantation was performed. Engraftment was demonstrated on the 12 th day. The patient developed Grade III grafts versus host disease (GVHD), veno-occlusive disease of the liver, and late onset hemorrhagic cystitis. She recovered with appropriate immune reconstitution.
  3 4,464 363
The Diagnostic Utility of Self-Reporting Questionnaire (SRQ) as a Screening Tool for Major Depression in Hemodialysis Patients
Abdulkareem Alsuwaida, Fahad Alwahhabi
October-December 2006, 17(4):503-510
There is overwhelming evidence that individuals with Major Depressive Disorder (MDD) are being seriously under diagnosed and under treated. The Self-Reporting Questionnaire (SRQ) is a good screening instrument for the detection of psychiatric disorders. However, the clinical significance of SRQ as a screening test for MDD in patients on hemodialysis (HD) has yet to be elucidated. The purpose of this study was to evaluate the diagnostic utility of the SRQ in detecting MDD in a cohort of patients with end-stage renal disease (ESRD) on maintenance HD. Twenty-six patients on maintenance HD were randomly recruited and were asked to complete the SRQ. The participants were, in addition, interviewed by a psychiatrist, who had been blinded to the SRQ score. We examined the ability of SRQ to detect patients who were diagnosed to have MDD based on psychiatric assessment. Among the 26 patients assessed, four patients were diagnosed to have MDD based on current diagnostic criteria. Logistic regression analysis showed that SRQ could predict patients with MDD with adjusted odds ratio of 1.9 (CI, 1.06- 3.42). Being a female was the most important variable for having a high SRQ (F=16.9, P=0.0004). The limitations of this study include a relatively small sample size and a high rate of somatic symptoms reported in the non-depressed population that limited the positive predictive value of the SRQ. Thus, although the SRQ has a high sensitivity, the positive predictive value of the SRQ is poor at low cut offs. In conclusion, our study suggests that an ideal screening tool in patients on HD should have minimal emphasis on the somatic symptoms of MDD. Until such a tool is available, clinical assessment remains the best screening tool for MDD.
  3 6,488 641
Retrospective Analysis of Factors Affecting the Progression of Chronic Renal Failure in Adult Polycystic Kidney Disease
Ebadur Rahman Ahmed, Muhammed A Tashkandi, Sahpar Nahrir, Abdurrahim Maulana
October-December 2006, 17(4):511-515
Autosomal dominant polycystic kidney disease (ADPKD) is the commonest congenital cystic renal disease. Factors such as hypertension, urinary tract infection, hematuria, and proteinuria may affect the progression to chronic renal failure in ADPKD patients. Therapeutic interventions, such as the use of angiotensin converting enzyme inhibitors (ACEI) or diet modification, may impact the natural progression of the disease. We aim in this study to review a registry of ADPKD patients in order to compare the slow and fast progressors and identify possible predictors of progression and interventions that slow the progression of this disease. Sheffield Kidney Institute (SKI), one of the largest kidney institutes in Northern Europe, has registered a large number of ADPKD patients since 1981. SKI's computer network contains a wide range of information on these patients. We selected 94 adult polycystic patients from the SKI for retrospective analysis of factors affecting progression to chronic renal failure. Patients who doubled their s. creatinine in 0 36 months were considered fast progressors (FP), while those who doubled their s. creatinine in > 36 months were regarded as slow progressors (SP). There were 70 patients in the FP group and 24 patients in the SP group. A third group of 137 patients consisted of non-progressors (NP) who had stable s. creatinine levels during the same period. We found that the incidence of hypertension, UTI, macroscopic and microscopic hematuria, and overt proteinuria in the FP group was higher than in the SP and NP groups. Modification of some factors, such as hypertension and UTI, may decrease the rate of the deterioration of renal function.
  3 4,802 545
Pyoderma Gangrenosum in a Renal Transplant Recipient: A Case Report
Abdullah K Al-Hwiesh
October-December 2006, 17(4):559-563
Pyoderma gangrenosum (PG) is an ulcerative disease of the skin of unknown etiology. Its association with infection, autoimmune disease, inflammatory bowel disease, malignancy, and certain drugs suggests a hypersensitivity reaction. We herewith present a renal transplant recipient who developed PG. The patient presented with multiple necrotizing skin ulcers on both the upper and lower extremities associated with malaise, myalgia, arthralgia, weight loss and low-grade fever. To our knowledge, the association between PG and renal transplant has not been reported previously.
  2 3,300 410
Renal Angiomyxoma
Mehdi Salehipour, Bita Geramizadeh, Valiallah Azizi, Mohammad Javad Rajabi, Roshanak Boub
October-December 2006, 17(4):576-577
  2 2,075 300
Pre-emptive Pediatric Renal Transplantation
Edward Sacca, Issa Hazza
October-December 2006, 17(4):549-558
  2 3,809 410
Cyclosporine Utilization in Idiopathic Nephrotic Syndrome in Children
Bassam Saeed, Mohd Imad Ossman, Shaaban Sheriff
October-December 2006, 17(4):497-502
The treatment of steroid-resistant focal segmental glomerulosclerosis (FSGS) imposes one of the most perplexing and frustrating problems on nephrologists. Cyclosporine A (CsA) is widely considered as the treatment of choice for steroid-resistant or dependent nephrotic children. We reviewed the clinical outcome in children with idiopathic nephrotic syndrome (INS) under CsA treatment. A total of 22 children presented with either steroid­resistant nephrotic syndrome (SRNS) (14 children), or steroid-dependent nephrotic syndrome (SDNS) (8 children) during the period from August 2002 to February 2005; the mean age for both groups was 7.6 years (range: 23months -15 years). Renal histology showed FSGS in 14(63%) patients, minimal change disease (MCD) in 4(18%), diffuse mesangial glomerulonephritis (MesGN) in three (13.6%), and membranous glomerulonephritis (MGN) in two (6.8%). Treatment with CsA in combination with alternate-day prednisolone induced remission in 15(68%) patients; 9(60%) patients had complete remission and six (40%) had partial remission. Seven (50 %) patients in the SRNS group responded to CsA treatment; two (14.2%) patients had complete remission and 5 (35.7%) had partial remission. Seven (87.5%) children in the SDNS group had complete remission and one (13.5%) had partial remission. We conclude that this study demonstrates the efficacy of CsA in inducing remission in the steroid dependent is higher than in the steroid resistant nephrotic children We believe that CsA is probably a good alternative therapy in this population.
  1 3,772 599
Association of Serum Leptin with Anemia in Maintenance Hemodialysis Patients
Hamid Nasri
October-December 2006, 17(4):521-525
To evaluate the relationship between hyperleptinemia and anemia in hemodialysis patients, we investigated the reverse epidemiological role of leptin in 36 patients (males: 21, diabetics: 11) under regular chronic hemodialysis. The patients had complete blood counts, iron profile, serum leptin, and adequacy of hemodialysis measured. We found a significant positive correlation of serum leptin with hemoglobin level and body mass index (BMI). A trend between serum leptin and total iron binding capacity was observed, however, no correlation was observed with serum ferritin. No differences in these correlations were observed in any subgroup related to gender or diabetes. Our data support previous findings showing that greater serum leptin levels are associated with greater hemoglobin levels.
  1 3,176 453
The Attitude of Physicians towards Education and Rehabilitation of Patients on Chronic Dialysis: A Questionnaire Survey
Muhammad Ziad Souqiyyeh, Faissal AM Shaheen
October-December 2006, 17(4):526-534
In this study, we aimed to evaluate the attitude of physicians in the Kingdom of Saudi Arabia (KSA) towards the education and rehabilitation of chronic dialysis patients. Questionnaires were sent to 155 physicians working in 148 dialysis centers. They included 109 centers (73.6 %) in the Ministry of Health (MOH), 18 (12.2%) in governmental non-MOH sector and 21 centers (14.2 %) in private hospitals that together care for a population of more than 7,900 chronic dialysis patients. The study was performed between January and March 2006. Responses were received from 141 physicians (90.9%) from 140 (94.5%) dialysis centers. There were 134 (97.1%) respondents who believed that the ideal ratio of patients per dialysis nurse should be < 3, 132 (97.1%) believed that the ideal ratio of patients per physician should be < 25, 120 (88.9%) believed that the ideal ratio of patients per dietitian should be < 50, and 102 respondents (81.0%) believed that the ideal ratio of patients per social worker should be < 50. There were 46 respondents (32.6%) who always and 53 (37.6%) who mostly found time to educate the patients about the various options available for renal failure treatment. Educational tools, such as reading materials and audiovisuals, were only available to 56 respondents (42.7%). There were 88 (63.3%) respondents who always discussed results of laboratory tests in detail with their dialysis patients, while 48 (34.5%) informed patients when any abnormality was discovered. There were 130 respondents (94.9%) who believed that their patients were satisfied with services of the physicians, 53 (39.0%) with the dietitian's, 57 (42.5%) with the social worker's, and 131 (94.9%) with the nurses' services. Our survey suggests that that the current practices concerning education and rehabilitation of patients in the dialysis centers in the KSA may not be satisfactory. More studies are needed to explore these issues.
  1 2,919 345
An Accelerated Method for the Detection of Extended-Spectrum β-Lactamases in Urinary Isolates of Escherichia Coli and Klebsiella pneumoniae
Abdulrahman A Kader, Angamuthu Kumar, Ananth Krishna, Mohamed Nassimu Zaman
October-December 2006, 17(4):535-539
We prospectively studied an accelerated phenotypic method by incorporating the double disk synergy test in the standard Kirby-Bauer disk diffusion susceptibility testing, to evaluate a protocol for the rapid detection of extended-spectrum B-lactamases (ESBL) in urinary isolates of Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae). All ESBL-positive isolates were confirmed by the standard Clinical Laboratory Standards Institute (CLSI) confirmatory disk diffusion method. Between November 2004 and December 2005, a total of 6988 urine specimens were analyzed of which, 776 (11%) showed significant growth. They included E. coli in 577 cases (74%) and K. pneumoniae in 199 (25.6%). Of these, 63 E. coli (8%) and 15 K. pneumoniae (7.5%) were positive for ESBL by the accelerated and CLSI methods. Compared to the standard CLSI method, the accelerated method reduced the ESBL detection time from two days to one day. We conclude that the accelerated ESBL detection technique used by us in this study is a reliable and rapid method for detecting ESBL in urinary isolates of E. coli and K. pneumoniae.
  1 5,030 844
Massive Gastrointestinal Bleeding and Intestinal Perforation in a Renal Transplant Recipient: A Case Report
Omar S Khattab, Saja M Al-Timimi
October-December 2006, 17(4):568-571
Gastrointestinal (GI) hemorrhage is a problem, the management of which needs the right decision at the right time and close cooperation between physicians and surgeons. We herewith report a renal transplant recipient who developed severe GI bleed and intestinal perforations seven months after renal transplantation. Despite extensive investigations, the exact cause of the problem could not be identified.
  - 5,267 306
Why Patients Get Upset by their Doctors
Abdulla A Al-Sayyari
October-December 2006, 17(4):586-588
  - 1,540 206
Importance of Modulating the Renin-Angiotensin System in Preventing Renal Complications of Hypertension
Brian Rayner
October-December 2006, 17(4):469-480
Chronic kidney disease (CKD) is a major problem worldwide. It threatens the lives and health of many people and places severe financial burdens on health economies of even the wealthiest countries. It is clear that the approach to prevention is multifaceted including prevention of cardiovascular disease. Inhibitors of the RAS are the drugs of initial choice in preventing progressive CKD, and may be used cautiously in advanced renal insufficiency. In addition blood pressure must be optimally controlled to < 130/80 mm Hg. Treatment of late CKD results only in a risk reduction and not a prevention of end stage renal disease. It is vital that patients at risk for CKD should be identified early before overt renal damage. Screening for microalbuminuria in patients with hypertension, metabolic syndrome and diabetes is particularly important.
  - 3,619 534
Transplantation of a Lump or Cake Kidney: A Case Report
Heshmatollah Salahi, Mehdi Salehipour, Ali Bahador, Hamidreza Davari, Saman Nikeghbalian, Korosh Kazemi, Sayyed Ali Malek-Hosseini
October-December 2006, 17(4):577-578
  - 1,811 231
Helicobacter Pylori Infection in Dialysis Patients Undergoing Kidney Transplantation
Christos Zavos, Jannis Kountouras, Dimitrios Chatzopoulos
October-December 2006, 17(4):579-580
  - 1,840 225
Tumorlysis by Dialysis
Abdulnaser Mohammed Al-Abadi, Ali Swaid Al-Harbi, Suliman Ali Al-Mohaya, Mohammed Kechrid, Osman Azhari, Sabry Shetia
October-December 2006, 17(4):589-595
  - 3,030 250
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