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Saudi Journal of Kidney Diseases and Transplantation
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   2007| July-September  | Volume 18 | Issue 3  
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Gabapentin: A Promising Drug for the Treatment of Uremic Pruritus
Afsoon Emami Naini, Ali Amini Harandi, Saeid Khanbabapour, Shahrzad Shahidi, Shiva Seirafiyan, Masood Mohseni
July-September 2007, 18(3):378-381
Despite advances made in treatment, uremic pruritus remains a common and distressing symptom in patients on hemodialysis (HD). Gabapentin is an effective drug in the management of neuropathic pain. Considering that neuropathic pain and pruritus share similar pathogenic mechanisms, we conducted this study to evaluate the efficacy of gabapentin in controlling uremic itch. In a double blind, placebo-controlled trial, 34 adult patients on maintenance HD were enrolled. The patients were assigned to receive four weeks of treatment with either gabapentin (400 mg) or placebo administered twice weekly after HD sessions. Pruritus scores were measured using a visual analogue scale and compared between the two groups.After four weeks of treatment, the mean decrease in pruritus score in gabapentin and placebo groups was 6.7 ± 2.6 and 1.5 ± 1.8, respectively (p<0.001). None of the patients was forced to drop out of the study due to side effects of the treatment. Our study suggests that gabapentin is a safe and effective treatment for uremic itch.
  15 10,479 1,692
Fasting the month of Ramadan by Muslims: Could it be injurious to their kidneys?
Hala S El-Wakil, Iman Desoky, Nashaat Lotfy, Ahmed G Adam
July-September 2007, 18(3):349-354
Ramadan is the ninth lunar month of the Islamic calendar. During Ramadan, Muslims abstain from food and drink from dawn to sunset (fasting) to express their gratitude to God; eating and drinking is permitted only at night. Muslims typically consume two meals each day, one after sunset, and the other just before dawn. The effect of fasting during the month of Ramadan on patients with renal impairment is still a matter of controversy. This is a prospective study performed on 15 predialysis chronic kidney disease (CKD) patients and six healthy volunteers as control. They were studied during two phases: when the subjects were drinking and eating freely before the start of Ramadan, and a second phase toward the end of Ramadan. We estimated glomerular filtration rate (GFR) using DTPA dynamic renal scan, and tubular cell damage by measuring the level of N-acetyl-B-D- glucosaminidase (NAG). The change in glomerular filtration rate was -6.56 ± 31.10 in the CKD group compared to 9.58 ± 30.10 in the control group with no significant difference between them (p= 0.43). However, the urinary NAG percentage change was found to be significantly higher in the CKD patients compared to the control group (236 ± 332, -49.1 ± 60.1 respectively p= 0.03). There was a significantly positive correlation between the NAG values and the change in the blood glucose level (p=0.001), hence diabetic CKD patients should be meticulously followed during Ramadan fasting. In conclusion, fasting Ramadan may have injurious effect on the renal tubules in CKD patients. Larger studies are recommended to determine the extent of tubular injury and renal function in CKD patients during Ramadan fasting.
  6 7,914 1,077
Congenital Adrenal Hyperplasia: Problems with Developmental Anomalies of the External Genitalia and Sex Assignment
Hussein Al-Maghribi
July-September 2007, 18(3):405-413
A retrospective study was performed on all patients with congenital adrenal hyperplasia (CAH) who were followed up at the King Hussein Medical Center (KHMC), Amman, Jordan, during the period from January 1996 to June 2006. The aim was to evaluate the clinical features, special problems, and corrective interventions for these patients. The records of 73 children (39 were genetic females and 34 were genetic males) with CAH were reviewed in the study. The age of the patients at last follow-up was between five months and 18 years. Diagnostic criteria for CAH were typical clinical features of the illness (salt loss, dehydration, virilization, macrogenitosomia, ambiguous genitalia, and accelerated growth) and typical hormonal abnormalities (decreased serum cortisol and elevated serum 17-hydroxyprogesterone). There were 62 patients with classical presentation; among them, salt-wasting (SW) form was seen in 41 patients (66%). There were 5 patients with the nonclassic form, while 6 others had cryptic presentation. Seven patients (9%) had hypertension, mostly due to salt-retaining CAH. Among the 39 females with CAH, 27 had developed mental anomalies of the external genitalia; 20 of them underwent surgical interventions of their external genitalia. Fourteen genetically female patients were wrongly diagnosed as 'male sex' at birth due to severe virilization. Seven of them were reassigned 'female sex' socially, legally, and surgically; the parents of one of them (a four-year-old girl) wanted the surgical intervention postponed for two to three years. Hysterectomy and gonadectomy were carried out for 6 of the other 7 patients who chose to keep the male gender. Our study indicates that newborns with developmental anomalies of the external genitalia should be diagnosed as early as possible so that medical, psychological, and social complications are minimized. A neonatal screening program for such a disorder can identify infants at risk for the development of life-threatening adrenal crisis and prevent incorrect sex assignment of affected female infants with intersex.
  3 8,164 1,123
Non-Hodgkin's Lymphoma in Autosomal Dominant Polycystic Kidney Disease, 12 Years after Renal Transplantation
Mohammad Ali Amirzargar, Farahnaz Dadras, Farhad Khoshjoo, Mahnaz Yavangi, Mohammad Jafary, Seyed Habib Musavi Bahar, Nasibeh Amirzargar
July-September 2007, 18(3):419-421
Autosomal dominant polycystic kidney disease (ADPKD) is a systematic disease which accounts for 10-15% of patients receiving dialysis or renal transplantation. It has a statistically significant association with malignancy in renal transplant recipients. We report a 47­year-old ADPKD female who developed a large renal tumor in the right kidney 12 years after kidney transplantation. During the follow-up, her ultrasound and laboratory tests were within normal limits. Bilateral nephrectomy of the native kidneys was performed, and followed by radiotherapy on the right side because pathology of the tumor suggested Non-Hodgkin's Lymphoma (NHL).
  2 2,952 363
Renal Tamponade Secondary to Subcapsular Hematoma
Nasrulla Abutaleb, Abdulmunaem Obaideen
July-September 2007, 18(3):426-429
We report the occurrence of renal biopsy induced subcapsular (SC) hematoma in two patients. The first was a recently transplanted elderly man, while the second was a woman with class IV lupus nephritis. Though hematoma size was initially small, early significant renal dysfunction was noted in both patients followed by eventual recovery of renal function in both patients; the first recovered within one day, while the second case within 10 days.
  2 4,214 385
Kidney Transplantation in Elderly Iranian Patients
Fatemeh Nazemian, Massih Naghibi, Ehsan Farazi
July-September 2007, 18(3):391-396
The population of elderly people with chronic renal insufficiency is increasing around the world. It has been shown that renal transplantation (RT) may be the best treatment for these patients. However, it has been observed that older patients who have received a RT have a higher mortality rate than those who are younger. The aim of this study was to evaluate the outcome of RT in recipients over 50 years of age. During the period between 1988 and 2002, 650 renal transplantations were performed at the Imam Reza Hospital in Mashad, Iran, of which 83 were performed in patients older than 50 years (50 to 66 years). We studied the one, three, and five-year patient and graft survival rates as well as the prevalence of urinary tract infection (UTI) after transplantation in these patients. We also evaluated the effect of the recipient's age and sex and the type of donor (related or unrelated) on patient survival as well as the prevalence of UTI. Patient survival at one, three, and five years after RT were 92.4%, 84.7%, and 75.6%, respectively. The graft survival at one, three, and five years after RT were 91.1%, 79.7%, and 66.7%, respectively. UTI occurred in 67.1% of patients after transplantation. The patient and graft survival rates were not related to the age and sex of the recipients and the type of donors. Also, there was no correlation between the prevalence of UTI and the age and sex of the recipients. Our study suggests that RT can be performed safely and with acceptable prognosis in elderly patients after appropriate clinical evaluation.
  2 2,790 296
Assessment of Nutritional Status in Patients Undergoing Maintenance Hemodialysis: A Single-Center Study from Iran
Reza Afshar, Suzan Sanavi, Akram Izadi-Khah
July-September 2007, 18(3):397-404
Malnutrition is a relatively common problem in patients on hemodialysis (HD) and is associated with increased morbidity and mortality in affected patients. With the aid of subjective global assessment (SGA), a semi-quantitative scale for estimating nutritional status, the malnutrition score (MS), has been developed. The MS incorporates advantages of the SGA while extending the reliability and precision. This study was performed to assess the nutritional status in patients on HD at the Mostafa Khomeini Hospital, Tehran, Iran. Based on the MS, which consists of seven components - - weight change, dietary intake, gastrointestinal (GI) symptoms, functional capacity, comorbidity, subcutaneous fat, and muscle wasting - - we conducted a cross-sectional descriptive-analytic study on 54 HD patients (35 males, 19 females) with age range of 18 to 82 years (mean 44.2 ± 19.8 years). Each component of the MS has a score from one (normal) to five (very severe). Anthropometric measurements including triceps skin-fold thickness (TSF), mid-arm circumference (MAC) and mid-arm muscle circumference (MAMC) were taken on all patients. Also, the body mass index and TSF/MAC ratio were calculated. Relevant laboratory parameters were checked. The duration of HD of the study patients ranged between 5 and 36 months (mean 19.5 ± 1.5 months). Data analysis was carried out using the SPSS, Pearson correlation, 't' test and regression. Based on the MS, 40.7% of patients had malnutrition (mean score 13.8 ± 2.8). There were statistically significant correlations between TSF (p < 0.01), MAC (p = 0.02), MAMC (p = 0.01), TSF/MAC ratio (p < 0.001), BMI (p = 0.028), serum albumin concentration (p = 0.021) and MS. No statistically significant correlation was found between the MS and urea reduction ratio, protein catabolic rate, age, gender, or duration of dialysis. After 1 year, 20.4% of patients died because of dialysis-related complications. The mortality rate did not show significant correlation with age, presence of diabetes mellitus, biochemical parameters, and anthropometric measures. A significant correlation was found between the protein catabolic rate (nPCR) and the mortality rate (regression analysis, p = 0.016); lower values of nPCR were associated with increased mortality. Our study suggests that the MS is a reliable, precise, and rapid method for estimating the nutritional status in patients on HD. The nPCR can be used as a predictor of increased mortality. Further studies with larger sample size and longer duration are required to confirm this observation.
  2 9,808 1,249
Nutritional Status in Renal Transplant Recipients
Sonali Mantoo, Georgi Abraham, Girija Balaji Pratap, V Jayanthi, S Obulakshmi, S Shanmuga Bhaskar, Nancy Lesley
July-September 2007, 18(3):382-386
We performed this study to observe the nutritional status in our renal transplant recipients using serum parameters, body mass index (BMI), and dual energy x-ray absorptiometry (DEXA) that measured the fat distribution. We studied 109 patients who had chronic kidney disease due to different etiologies, and received mean hemodialysis before they underwent successful renal transplantation. The body mass index and the prevalence of type 2 diabetes mellitus revealed a significantly positive correlation with older age (p<0.05). The mean values of serum sodium, chloride, potassium, calcium, and phosphorous were found to be within the normal range. There were no significant differences in these parameters according to age distribution. However, the mean serum creatinine was elevated, 154 ± 18 µmol/L, which was compatible with a significant but stable renal dysfunction. iPTH levels in most of our patients were within two times the normal values (101± 81 pg/ml). The mean hemoglobin levels were low in all our patients (91.6 ± 19.4 g/L). The mean bicarbonate levels were within normal limits (23 ± 3.5 mmol/L), however there were some patients below normal. The plasma proteins and albumin were lower than normal; 62.2 ± 8.6 g/L, and 36.1 ± 5.1gms/L, respectively. We conclude that the BMI, fat distribution and percentage as measured by DEXA scan, as well as the prevalence of type 2 diabetes mellitus in our transplant population revealed a significantly positive correlation with older age. The elevated mean plasma iPTH levels, decreased mean serum bicarbonate, albumin, and hemoglubin levels are most likely related to renal allograft dysfunction which is usually inherent with the grafts and may eventually affect the nutritional status of the patients. Subsequently, the initial weight gain may be hampered by the graft dysfunction. Prospective long-term studies are required to confirm our findings on larger transplant populations.
  2 4,350 610
New technique for allograft ureteroneocystomy for better transvesical endoscopic handling of allograft urological complications
Afshar Zomorrodi, Abulfazl Buhluli
July-September 2007, 18(3):365-369
We studied a new ureteroneocystostomy technique for the anastomosis of the transplanted ureter and the native bladder that involves the change of the position of the neoureteral orifice during renal graft transplantation to the posterio-lateral aspect of the bladder's dome. We applied the technique on 30 consecutive renal transplant recipients (25 males and five females with ages between 15-50 years). Mucosa to mucosa anastomosis was performed, and all of the patients had double J (DJ) stents inserted in the ureters. The patients were followed for one year. At the time of removing the DJ stents, we evaluated the ureters by inserting ureteral catheters and by performing ureteroscopy transvesically and the results were compared with another group of 30 patients who underwent the conventional anterio-lateral ureteroneocystostomy. The retrograde stenting of the ureters was much more easily performed in the study group than the controls. During the follow-up of the study patients, renal ultrasound and renal function tests did not disclose any urological complications. We conclude that the new technique is effective and safe and enabled better retrograde handling of the allograft ureter than the conventional ureteroneo-cystostomy. Advantages of the new technique included the need for a shorter ureter, the normally appearing orifice of the allograft ureter in the bladder, and the unproblematic retrograde vesical approach for the posterolateral ureter.
  2 3,059 355
Characteristics of Kidney Transplantation in Baghdad: An Epidemiological Study
Hareth M.M. Saeed Al-Jebory, Kais Hasan Abd, Saja Mahmood, Wael Lateef Jabur, Qusay J Al Khyat
July-September 2007, 18(3):432-438
Kidney transplantation remains the optimal therapy for patients with end-stage renal failure. The kidney transplantation program in Iraq has finished its third decade, and this study was performed to assess the characteristics of this program. This study was performed, from early 2004 to mid-2005, on all patients who underwent renal transplantation and were residing in Baghdad. All the subjects were subjected to full examination and detailed investigations at the Al-Karamah Hospital, Baghdad. A total of 512 patients (males, 69.7%), all of whom were residing in Baghdad, underwent kidney transplantation from 1979 to 2005. The donor source was living donors in 55.7% of these patients, living unrelated donors in 42.6% and emotionally related donors in 1.7%. The recipients' age range was from 7 to 64 years with a mean age of 41 years. The patient survival rates at 6, 12 and 18 months were 91, 91 and 89% respectively, while the graft survival rates in the same periods were 89, 89 and 82% respectively. The annual incidence of renal transplant in our study was 15.4 per million people. About 55% of the transplants were performed in private hospitals and 41% in Government hospitals; the others (3.5%) were performed abroad. We conclude that this study is an initial step to assess the renal transplant activities in Iraq, and we hope that this will act as a launching pad for future studies.
  2 2,195 286
Acute Renal Failure in a Patient with Non-fulminant Hepatitis A Infection
RT Parakkadavathu, SV Pisharath, AP Chekkura, A Khandekar, SS Soni, RM Parameswaran, A Melothvalapil
July-September 2007, 18(3):422-425
Acute viral hepatitis A is a common cause of jaundice with a very low mortality. Acute renal failure occurs very rarely in hepatitis A. We report a case of non-fulminant hepatitis A in a 45-year-old man complicated by acute renal failure. The patient was treated successfully with hemodialysis resulting in complete recovery. Kidney biopsy was not performed in view of improving clinical picture.
  1 5,978 474
Resistant Hypertension: A Methodological Approach to Diagnosis and Treatment
Nihad A.M Tamimi
July-September 2007, 18(3):337-345
Resistant hypertension affects approximately 10% of the hypertensive patient population. It should be differentiated from white-coat hypertension and pseudo-resistant hypertension. Non-compliance to anti-hypertensive therapy remains the most common cause of resistant hypertension. Primary hyperaldosteronism is not as uncommon as previously thought, but its prevalence depends on the selected population. Low-renin resistant hypertension responds to aldosterone blockade when other drugs are apparently inadequately effective. Sleep apnea syndrome can also contribute to the development of resistant hypertension by stimulating aldosterone secretion, which leads to vascular damage and may promote scarring through more direct actions. Normal blood levels of potassium in resistant hypertension do not exclude the possible presence of hyperaldosteronism.
  1 5,170 947
Optimizing Hypertension Control in Hemodialysis Patients: A Proposed Management Strategy
Faissal Tarrass, Karima Addou, Meryem Benjelloun, Mohamed Zamd, Ghislaine Medkouri, Khadija Hachim, Mohamed Gharbi Benghanem, Benyounes Ramdani
July-September 2007, 18(3):355-360
Objective: The purpose of the study was to assess the efficiency of a goal-oriented therapeutic strategy in lowering blood pressure and reducing the need for antihypertensive medications in 168 patients undergoing long-term hemodialysis. Methods: Patients were managed initially by achieving optimal dry weight. After reduction of the dry weight, patients with uncontrolled arterial hypertension were dialyzed using a 1.25 mmol/L calcium concentration buffer. Results: The predialysis mean arterial blood pressure (PDBP) was 127.4/74.2 mmHg for the total population. Fifty (29.76%) of the total study population were hypertensive. Of them, 88% (44 patients) were receiving antihypertensive drugs, while the others were not on such medications. Twenty patients (40% of the hypertensives) were receiving one antihypertensive drug, 17 (34%) were receiving two antihypertensive drugs, while 7 patients (14%) were receiving three or more drugs. There was a significant increase in the number of patients with good control of PDBP in the second data collection [45 patients (90%)] compared to the first data collection of 40 patients (80%). Similarly, there was a significant reduction in the number of patients with uncontrolled PDBP in the second data collection (5 patients (10%) compared to the first data collection of 10 patients (20%). The average blood pressure in the first data collection was 137.2/76.3 and 167.4/87.1 mmHg in the controlled and uncontrolled blood pressure groups respectively. In the second data collection, the average blood pressure was 136.4/75.1 and 161.6/86.3 mmHg in the controlled and uncontrolled groups respectively. Conclusion: Therapeutic approach using combination of dry weight reduction and dialysis with low calcium dialysate provides acceptable long-term results in patients with arterial hypertension and reduces the need for antihypertensive medication.
  1 5,032 587
Comparison of prevention methods of intradialytic hypotension
H Rezki, N Salam, K Addou, G Medkouri, MG Benghanem, B Ramdani
July-September 2007, 18(3):361-364
Our study evaluates the effectiveness of the different methods of prevention of intradialytic hypotension (IDH). We studied 16 hemodialysis patients who developed IDH at Ibn Rochd University Hospital. Each patient underwent three standard sessions with cellulose diacetate dialysers and bicarbonate dialysate with calcium concentration of 1.75mmol/L and sodium (Na) concentration of 140 mmol/L, with dialysate temperature (T) of 37° C. Then the patients were subjected to five successive sessions, each time using one of the following protocols: fixed Na dialysate concentration at 144 mmol/L, Na ramping from 152 to 138 mmol/L, one hour of ultrafiltration (UF) alone followed by three hours of standard dialysis session, dialysis with standard dialysate at T < 37 o C, or a combination of Na ramping and cold dialysate. Twelve (78%) patients underwent two sessions of HD per week of five hours each. The mean systolic blood pressure (SAP) in the interdialytic period was 110.7 (100.1-125.5) mmHg; two patients underwent anti-hypertensive treatment. The combination of ramping Na and cold dialysate as well as the cold dialysate were associated with fewer episodes of hypotension in comparison with the standard dialysate. We conclude that the combination modulation of Na and cold dialysate as well as the cold dialysate are the most effective techniques to decrease the number of IDH episodes and the average number of interventions.
  1 4,262 736
Outcome and Survival of Temporary Hemodialysis Catheters: A Prospective Study From a Single Center in Iraq
Kais Hasan Abd Altaee, Omar Abdulwahid Theeb, Saja Mahmood Al-Timimi, Harth M Mohammed Saeed, Ihsan Alshamma
July-September 2007, 18(3):370-377
Background: The use of temporary hemodialysis catheters (THC) has facilitated the delivery of hemodialysis to patients lacking functional vascular access. However, the use of these catheters is often associated with infections or mechanical complications. Methods: A review of experiences at a tertiary referral center in Iraq with the use of 128 THC catheters in 103 patients was undertaken over one year, to identify indications for use and outcomes and issues limiting survival. Results: The indications for insertion of THC included the following: as acute dialysis access for patients with chronic renal failure (CRF) in 42.1%, failed arteriovenous fistulae in 14%, acute renal failure in 18%, failed prior THC in 18.7%, absent vascular access in patients with transplant rejection in 6.2% and severe anasarca in one patient (0.78%). The site of insertion was the right internal jugular vein in 101 patients, the right subclavian vein in 23 patients, and the left internal jugular vein in four patients. During follow-up, 86 catheters were removed: 62 in patients with end-stage renal disease (ESRD), 23 in patients with acute renal failure and one patient with severe anasarca. The reasons for removal of THC in ESRD patients were elective removal (44%), catheter related sepsis (CRS) in 30%, mechanical complications (19%) and others (7%). The subclavian site was associated with infection in 20% of patients, while the internal jugular site was associated with infection in 22.7% of patients. For patients in whom THC removal was for infection, a post removal culture of the catheter tip showed Staphylococcus aureus in 57.8%, Klebsiella in 15.7%, Psuedomonas in 15.7% and Streptococcus hemolyticus in 10.5% of the cases. Conclusions: THC is advantageous for vascular access in patients with acute renal failure. Infections and blockage significantly reduce the survival of THC in patients with ESRD. Approaches to minimize these complications are likely to lead to improved clinical outcomes with THC use.
  1 4,970 616
Tuberculosis After Renal Transplantation: A Case Report
Omar Salem Khattab, Omar Abdulwahid Theeb
July-September 2007, 18(3):414-418
Renal transplant recipients are susceptible to a variety of infections with both common and opportunistic pathogens as a result of immunosuppressive therapy. We report herein a case of a 32-year-old female renal transplant recipient who developed pulmonary tuberculosis with supraglotic mass causing suffocation, 1.7 years after undergoing renal transplantation. She responded well to a combination of tracheostomy and antituberculous therapy. Although tuberculosis is a common infection in transplant recipients, its presentation as a supraglotic mass is unusual.
  - 2,883 344
Diagnostic Decision Making in Medicine
Abdullah A Al Sayyari
July-September 2007, 18(3):448-451
Medical diagnostic decision making, like all decision making instances, involves a cognitive process. It starts with internalizing data, structuring it and generating hypotheses. In simple cases very often the experienced physician utilizes pattern recognition, intuition and retrieval in reaching a diagnostic decision. In more complicated cases more complex cognitive process takes place including the balancing of probabilities and the weighing of evidence. Apart from knowledge and experience, personal traits and perceptions and prejudices play some part in some situations.
  - 2,728 350
Interferon-Beta for Glomerulonephritis?
E Nigel Wardle
July-September 2007, 18(3):333-336
Interferon beta (IFNβ) is used in the therapy of multiple sclerosis (MS), which develops from the activation of autoreactive T lymphocytes against peptides of myelin basic protein. IFNβ was demonstrated to have beneficial effects in experimental models of glomerulonephritis (GN), such as decreasing proteinuria via Il-10 release. T helper (Th-1) lymphocyte responses are reduced, the actions of metalloproteinase (MMP9) are suppressed, and the functions of regulatory T cells are promoted. In concept, IFNI3 therapy might be beneficial in patients with life threatening forms of GN, such as Goodpasture's syndrome or vasculitis. Further research is warranted to study the effect of IFNβ on GN in clinical settings.
  - 2,047 350
Organ Sharing in Saudi Arabia: A Proposal
Ali H Hajeer
July-September 2007, 18(3):346-348
  - 2,118 292
Rhabdomyolysis-Induced Acute Renal Failure in a Patient with Leptospirosis
John Droulias, Dimitrios Anestis Moutzouris, Theodore Kassimatis, Kyriaki Kollia, Theofanis Apostolou, Valsamakis Hadjikonstantinou
July-September 2007, 18(3):430-431
  - 4,248 574
Infertility among Female Renal Transplant Recipients
S Ghazizadeh, M Lessan-Pezeshki, MR Khatami, M Mahdavi-Mazdeh, MR Abbasi, J Azmandian, E Razeghi, S Seifi, F Ahmadi, S Maziar
July-September 2007, 18(3):387-390
We studied 122 women with renal allograft transplantation to evaluate their reproductive systems. The patients were recruited from the three main kidney transplant surgery centers in Tehran, from September to October 2005. Fifteen (12%) patients were either in the menopausal stage or had hysterectomies, and the other 33(27%) were unmarried. Of the 76(62%) married women at the reproductive age, 10 (13.1%) had infertility that was defined as the failure of a married woman to conceive after 12 months of frequent intercourse without contraception. Three patients had male factor infertility, three others had ovulatory problems, and four cases were undefined. Only six cases were actively treated by ovulation induction ± an intrauterine inducer (IUI); two patients became pregnant, while the other four refused infertility treatment. The reasons of unwillingness for infertility treatment included old age (40 years) in one patient, positive HBsAg in one, renal retransplantation in one, and previous clomiphene therapy failure in another. We conclude that the prevalence of infertility among female renal transplant recipients is the same as the general population, and the causes are mostly treatable. However, many are less motivated to be treated for this problem.
  - 3,147 329
The Comparison of Clinical and Biochemical Parameters among 1200 alive and dead Renal Transplant Recipients
Heshmatollah Salahi, Hamed Jalaeian, Saman Nikeghbalian, Hamid Reza Davari, Ali Bahador, Jamshid Roozbeh, Mohammad Mehdi Sagheb, Ghanbar Ali Rais-Jalali, Saeed Behdazi, Seyed Ali Malek-Hosseini
July-September 2007, 18(3):439-442
With increasing long-term graft survival and life-long immunosuppression, cardiovascular disease and infectious complications are major causes of morbidity and mortality. We retrospectively evaluated 1200 consecutive kidney transplant patients at Shiraz Organ Transplant Center from December 1988 to December 2003. Data on demographic profile, donor source, blood pressure, rejection episodes, cause of death, and hematological and biochemical serum profiles were collected to compare alive and dead recipients. One hundred fifty six patients (13%) died in the post transplant period. Patient death was more prominent during the first years after transplantation. Most common causes of death were cardiovascular (28.3%), graft loss (20.7%), and infection (19.6%). Post transplant systolic and diastolic blood pressures, BUN, creatinine, fasting blood sugar, and total cholesterol were higher, and serum HDL lower in the dead recipients than those who remained alive (P<0.05). No significant difference was found in LDL, hemoglobin, and triglyceride values between the two groups. The one- and three-year patient survival rates were 94% and 91.5%, respectively. We conclude that the patients who died after transplantation had more risk factors than stable patients who remain alive. A multidisciplinary approach to control the co-morbid factors could be beneficial to decrease the mortality of patients after renal transplantation.
  - 2,172 304
Chronic Kidney Disease and Stiff Hands
Rafat Bukhari, Dujanah Mousa
July-September 2007, 18(3):443-447
  - 4,699 315
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