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Saudi Journal of Kidney Diseases and Transplantation
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   2007| October-December  | Volume 18 | Issue 4  
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Organ Transplantation in Iran
Ahad J Ghods
October-December 2007, 18(4):648-655
The first renal transplantation in Iran was carried out in 1967. Between 1967 to 1988 almost all renal transplants were from living-related donors and the number of renal transplants performed was much lower than the national demand. In 1988, a compensated and regulated living­unrelated donor renal transplantation program was adopted. As a result, the number of renal transplants performed substantially increased such that in 1999, the renal transplant waiting list was completely eliminated. By the end of 2006, a total of 21251 renal transplants were performed (3641 from living­related, 16544 from living-unrelated and 1066 from deceased-donors). In this program, many ethical problems that were associated with paid kidney donation were prevented. Currently, Iran is the only country with no renal transplant waiting lists, and >50% of patients with end-stage renal disease have functioning grafts. In April 2000, the legislation was passed by parliament accepting brain death and allowing deceased-donor organ transplantation. By the end of 2006, 18 brain death identification units, 13 organ procurement units were organized, and a total of 1546 deceased-donor organ transplantations were performed (1066 kidney, 327 liver, 122 heart, 20 lungs, 7 pancreas-kidney, 2 heart-lungs and 2 small bowel transplants). The number of deceased-donor organ transplants have slowly but steadily increased in the country. The majority of deceased-donor kidney, liver, and pancreas transplants have been performed by transplant team of Shiraz University of Medical Sciences.
  22 10,136 1,386
Crescentic Transformation in Primary Membranous Glomerulopathy: Association with Anti-GBM Antibody
Shobhana G Nayak, Renuka Satish
October-December 2007, 18(4):599-602
Crescentic transformation of primary membranous nephropathy (MN) associated with the development of anti-GBM antibody is a rare cause of acute renal failure in patients with MN. We report a 54-year-old lady, diagnosed to have MN four years earlier, who presented with acute deterioration of renal functions. Renal biopsy revealed circumferential crescents in all glomeruli. Serum anti-GBM antibodies were positive. Despite therapy with plasmapheresis, steroids and oral cyclophosphamide, she did not improve and continues to be dialysis dependent.
  7 3,421 701
Prevalence and Clinical Findings of Biopsy-Proven Glomerulonephritidis in Iran
Afsoon Emami Naini, Ali Amini Harandi, Shahrzad Ossareh, Ahad Ghods, Bahar Bastani
October-December 2007, 18(4):556-564
Epidemiological data of renal diseases is population-based and have great geographic variability. Due to the lack of a national renal data registry system, there is no information on the prevalence rate, and clinical and laboratory features of various glomerulo­nephritidis (GNs) in Iran. In a retrospective cross sectional study, we analyzed 462 adult renal biopsies in Tehran, Iran. We determined the prevalence rate and the frequency of different clinical and laboratory findings in patients with different GNs. We also compared our results with the reports from other countries. There were 267 (57.8%) males and 195 (42.2%) females. The mean (± SD) age was 33.6 ± 15.7 (range, 13-75) years. A total of 55 biopsies, which had revealed pathologies other than GNs, were excluded. Among the remaining 407 biopsies, membranous glomerulopathy (MGN) was the most common GN (23.6%), followed by IgAN (13.5%), membranoproliferative GN (MPGN) (11.5%), systemic lupus nephritis (SLE-GN) (10.6%), focal and segmental glomerulosclerosis (FSGS) (10.3%), and minimal change disease (MCD) (9.8%). Our study shows that MGN is the most common form of GN, followed by IgAN, MPGN, SLE­GN, FSGS and MCD in adult patients in Iran. A multi-center study with a larger sample size is needed for more comprehensive data in Iranian population.
  7 3,774 599
Review of the CMV in Renal Transplantation
Mark D Pescovitz
October-December 2007, 18(4):505-511
  6 5,413 1,063
The Effect of Low Dose Omega-3 on Plasma Lipids in Hemodialysis Patients
O Taziki, M Lessan-Pezeshki, O Akha, F Vasheghani
October-December 2007, 18(4):571-576
Hemodialysis (HD) patients have a high incidence of cardiovascular disease and increased premature mortality. N-3 polyunsaturated fatty acids (PUFAs) are known to decrease plasma triglyceride (TG) levels and have a cardio-protective effect in subjects with normal renal function. The aim of this study was to investigate the effect of Omega-3 on plasma lipid levels in patients on HD. We included 33 patients on HD with serum TG higher than 200 mg/dl and total cholesterol higher than 220 mg/dl, in the study and randomly assigned them to treatment with 2 gm pearls of Omega-3 per day, given in two equal doses or a control group who did not receive this drug. The study was conducted for a period of 12 weeks. Patients were evaluated by measurement of fasting plasma lipid levels before and after the use of Omega-3. There was a significant (28%) increase in high-density lipoprotein levels (P < 0.01) and a significant (23 %) decrease in serum TG levels (P < 0.02) in the group that received Omega-3 supplement. There were no changes in total cholesterol or low-density lipoprotein levels in either group. Our study suggests that supplementation with low-dose Omega-3 has a favorable effect on plasma lipid levels in patients on HD.
  6 3,740 821
Successful Treatment of Post-Renal Transplant Gastric and Pulmonary Kaposi's sarcoma with Conversion to Rapamycin Treatment
Slim Charfi, Salwa Krichen-Makni, Soumaya Yaich, Hafedh Makni, Abdelmajid Khabir, Ali Amouri, Khaled Charfeddine, Jamil Hachicha, Tahya Sellami-Boudawara
October-December 2007, 18(4):617-620
The incidence of Kaposi's sarcoma (KS) is higher in organ transplant recipients. The lesions are mainly cutaneous and isolated visceral involvement is rare. We herewith report a 38-year-old male patient, who underwent a cadaveric donor renal transplantation for chronic interstitial nephropathy. His immunosuppression protocol consisted of corticosteroids, tacrolimus and mycophenolate mofetil. Twenty-five months later, he presented with diarrhea and epigastric pain. An upper gastrointestinal endoscopy revealed an ulcer in the body of the stomach. Histological examination coupled with immunohistochemistry was suggestive of KS. Detailed examination did not show any skin lesions. Computed tomography of the chest revealed multiple bilateral lung micronodules. The patient tested positive for anti-Herpes Human Virus (HHV8) antibodies. Tacrolimus and mycophenolate mofetil were withdrawn and rapamycin was introduced. This resulted in a regression of both stomach and pulmonary KS. One-year later, the patient developed an episode of acute rejection, which was successfully treated with bolus steroids. Our case suggests that rapamycin-based immunosuppression offers a promising approach to the management of post-transplant KS, particularly with visceral involvement.
  5 2,874 463
Outpatient Percutaneous Renal Biopsy in Adult Patients
Abdulla K Al-Hweish, Ibrahim Saeed Abdul-Rehaman
October-December 2007, 18(4):541-546
To study the safety and efficacy of performing percutaneous renal biopsy in the outpatient department compared to the traditional inpatient policy, we studied 44 consecutive patients with proteinuria and other urinary sediment abnormalities, at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, during the period from September 2004 to August 2006. The patients were divided into two groups: group I, in whom kidney biopsy was performed and followed by 1-day hospital admission; and group II, in whom renal biopsy was performed in the outpatient department and followed by 6 hours' observation period and then by regular outpatient visits. All biopsies were performed with the use of real-time ultrasound and automated biopsy needle. Patients with a history of a bleeding diathesis or abnormal coagulation profile and those receiving warfarin, heparin, aspirin, or nonsteroidal anti-inflammatory drugs were excluded from the study. Only minor biopsy-related complications such as gross hematuria, perinephric hematoma that resolved without the need for blood transfusion or surgical intervention occurred in three (13.6%) patients in group I and in two (9.1%) patients in group II. The complications were apparent within 6 hours in all but one patient (97.7%). Overall, hematuria was identified in 52% of patients at :5 2 hours, 85% at :5 4 hours, and 97.7% at < 6 hours. The 24-hour hematocrit levels were not significantly different between the study groups. One (4.5%) patient from group II had a small perinephric hematoma, which was detected by ultrasound examination at 24 hours but not at 6 hours post biopsy period.; it resolved spontaneously without intervention. We conclude that in selected patients, same-day discharge after 6 hours of renal biopsy may be given safely without increased risk of complications.
  5 4,987 790
The Course and Outcome of Renal Transplant Recipients Admitted to the Intensive Care Unit at a Tertiary Hospital in Saudi Arabia
Abdulaziz Aldawood
October-December 2007, 18(4):536-540
Renal transplantation is the treatment of choice for most patients with end­stage renal disease (ESRD). This procedure provides a survival benefit compared to hemodialysis and is also cost effective. The aim of this study is to identify the types and incidence rates of complications that affect renal transplant recipients admitted to the intensive care unit (ICU) during long-term follow-up and, to examine the impact of these complications on the length of hospital stay as well as mortality, in a tertiary closed ICU in Saudi Arabia. We reviewed the data of all adult renal transplant recipients who were admitted to the ICU at the King Abdulaziz Medical City, Riyadh, between May 1999 and Oct 2006. During the study period, 80 patients had a total of 96 ICU admissions; 49% were females. The admission APACHE II score and expected mortality was 25+7 and 48+23 respectively. The hospital mortality rate was 42%. Sepsis was the major indication for ICU admission and pneumonia was the main cause of sepsis. In multivariate analysis the following variables were introduced in the model: APACHE II score, age, Glasgow Coma Score and need for hemodialysis in the ICU. We found only the need for hemodialysis during the ICU as an independent risk factor for mortality (P < 0.02). We found in this study that the main reason for ICU admissions among renal transplant recipients was infections. Mortality rates for this particular population are relatively high and are primarily linked to need for dialysis.
  4 2,723 421
Evaluation of the available anti-HCV antibody Detection Tests and RT-PCR assay in the Diagnosis of Hepatitis C Virus Infection
Mohamed Amin A Tashkandy, Yousif A Khodari, Aida Mohamed Ibrahim, Khalid O Dhafar, Zohair J Gazzaz, Badr A Azab
October-December 2007, 18(4):523-531
The aim of the present work is to evaluate the commercially available antibody tests in the diagnosis of hepatitis C virus (HCV) infection by comparing their results with the RT-PCR test. The study included 316 serum samples from three groups: blood donors, patients on maintenance hemodialysis (HD) and patients infected with the human immunodeficiency virus (HIV). Samples were subjected to HCV-antibody detection by ELISA and RIBA tests and HCV­RNA detection by RT-PCR assay. The percentage of infectivity for blood donors was 18.9% by ELISA, 20.8% by RIBA and 23.6% by RT-PCR test. For patients on HD and those positive for HIV, the test positivity was respectively 59.3% and 5.3% by ELISA, 64% and 10.5% by RIBA and, 66.3% and 21% by PCR test. The percentage of false negativity of HCV-Ab by ELISA and RIBA when compared with RT-PCR test was 3.5 and 8.1% for samples blood donors, 17.1 and 25.7% for HD patients and 5.6 and 16.7% for HIV-infected samples, respectively. The false positivity of HCV-Ab by ELISA and RIBA, when compared with RT-PCR, was 5%, 3.9% and zero for blood donors, HD patients and HIV-HCV co-infected cases, respectively. While comparing ELISA with RT-PCR, the false positivity was 10%, 5.9% and zero respectively for blood donors, HD patients and HIV-HCV co-infected cases. Thus, it is very important to screen blood donors, HD patients and HIV-infected patients by using the RT-PCR for HCV-RNA to avoid false negative results.
  4 8,026 1,322
Kidney Disease in Bahrain: A biopsy based epidemiologic study
Ahmed Al Arrayed, Shameem Shariff, Majeda Musabah Al Maamari
October-December 2007, 18(4):638-642
The aim of this study was to establish the incidence of renal diseases in Bahrain based on biopsy proven results during the period from January 2003 to October 2006. We studied a total of 145 biopsies obtained from 130 patients; glomerular diseases constituted 64.8%, renal allograft biopsies 23.4%, chronic glomerulosclerosis 8.9%, and others 4.1% of the total. Primary and secondary glomerular diseases were presented equally. The incidence of renal biopsies 5.4/100,000 per year. Minimal change disease­focal segmental glomerulosclerosis (MCD-FSGS) complex was the commonest of all primary glomerular diseases, and lupus nephritis was the commonest secondary glomerulopathy in the biopsied patients. We conclude that there was no significant change in the pattern of glomerulonephritis in Bahrain in comparison with our previous report.
  4 3,036 496
Seeking Remedy, Abstaining from Therapy and Resuscitation: An Islamic Perspective
Mohammed Ali Albar
October-December 2007, 18(4):629-637
This paper discusses the Islamic viewpoint on seeking remedy. It is imperative to seek remedy in life threatening situations or in case of highly infectious diseases. In such circumstances, the Muslim government can impose quarantine and enforcement of treatment to protect the community. In case of minors, the guardian could be appointed by the Qhadi (magistrate), to give consent to the necessary management. Otherwise, an adult competent male or female should give his free consent in order to start any medical or surgical procedure. He can abstain from treatment at any time. When treatment benefit is doubted, seeking remedy becomes facultative and if it seems that the side effects and inconvenience of treatment is more than the expected benefits, it becomes Makrooh (disliked). If the treatment is futile, then there is no need to continue such treatment. If treatment involves amulets, divination, talismans or sorcery, then it should be prohibited. Usage of prohibited materials e.g. pork or alcohol is not allowed except in certain limited situations, where there is no alternative medicine and it should be prescribed by a competent Muslim physician where it is considered as a necessity (necessity knows no law). Fatwas from the permanent committee of Religious Sciences, Research and Ifta of the Kingdom of Saudi Arabia regarding "do not resuscitate" policy will be fully discussed.
  4 16,141 1,322
Instillation of Povidone Iodine to Treat Lymphocele and Leak of Lymph after Renal Transplantation
Afshar Zomorrodi, Abulfazel Buhluli
October-December 2007, 18(4):621-624
Lymphoceles are common surgical complications of renal transplantation. Recently minimal invasive therapy has been advised. We studied the safety and efficacy of instillation of povidone iodine via transcutaneous catheter for treatment of lymphoceles and leaks of lymph. We studied 10 (four males, six females) kidney transplant recipients who developed lymphoceles after transplantation and four (three males, one female) who developed leaks of lymph. We treated these cases by povidone iodine after placement of transcutaneous catheters with guidance of ultrasound and confirmed the presence of lymph by biochemical analysis. After dilution of povidone iodine to 5% with normal saline, 20cc were instilled and dwelled in the cavity for 30 minute three times daily. The lymph was then allowed to drain by gravity. For the leaks of lymph, which occurred immediately post operation, the catheters were placed during transplantation surgery. All patients were followed up for four months. After one week of instillation, all lymph leaks were completely blocked. Furthermore, nine (90%) cases of lymphocele resolved after 15 days of therapy. We conclude that instillation of diluted povidone iodine for treatment of lymphocele and leak of lymph is safe and effective and it may be considered as first choice for these conditions.
  3 6,859 719
Euglycemic Diabetic Ketoacidosis in Pregnancy
Nauman Tarif, Wisam Al Badr
October-December 2007, 18(4):590-593
Diabetic ketoacidosis (DKA) can be a catastrophic event during pregnancy, complicating almost nine percent of diabetics in pregnancy. It induces both maternal and fetal mortality. Ketosis has been implicated in fetal distress and causes adverse neurological outcome. DKA with a relatively low blood sugar levels is called euglycemic DKA, which is a rare entity and reported usually in type I diabetic patients. A 37-year-old Saudi female patient known to have type II diabetes developed euglycemic [blood glucose level 4.3 mmol/L (78 mg/dl)] DKA while in her fifth pregnancy. She responded to intravenous dextrose and insulin with gradual improvement. Euglycemic DKA should be considered in type II diabetics during pregnancy and treated promptly.
  3 8,732 1,446
Hyperkalemia Revisited
Hashem Almukdad
October-December 2007, 18(4):577-584
  3 8,961 1,541
Multi-Drug-Resistant Tuberculosis in a Patient Presenting with Bilateral Gluteal Abscesses and Right Leg Swelling with End-Stage Renal Disease
Abdulraheem M Al-Shehri, Saeed M.G Al-Ghamdi, Abdalla Khalil, Abdullah Al-Amoudi, Abdullah Baslaim, Irfan Mamoun
October-December 2007, 18(4):603-608
This is a 40-year-old woman with end-stage renal disease (ESRD). She received empirical treatment for presumed TB of the right knee joint. The arthritis and the constitutional symptoms resolved despite the patient's poor compliance. One year later, she presented with TB abscesses involving the upper end of right tibia and bilateral gluteus muscles, which proved to be resistant to isoniazid, rifampicin and ethambutol. The patient was successfully treated with pyrazinamide, ofloxacin and amikacin.
  2 4,603 473
Post-Renal Transplant Hemolytic Uremic Syndrome following Combination Therapy with Tacrolimus and Everolimus
Balaji Pratap, Georgi Abraham, CN Srinivas, Shanmuga Bhaskar
October-December 2007, 18(4):609-612
A 34-year old male renal transplant recipient developed thrombotic microangiopathy (Hemolytic Uremic Syndrome) in the early post-transplant period following combined immuno­suppressive therapy with tacrolimus and everolimus. The management consisted of discontinuation of tacrolimus and substitution with mycophenolate mofetil. His renal functions improved, the hematological abnormalities reversed and he continues to have good graft function one year later.
  2 4,054 655
Double Urinary Bladder Voiding Technique Post Removal of Urethral Catheter in Renal Allograft Recipients
Afshar Zomorrodi, Abulfasel Bohluli
October-December 2007, 18(4):532-535
To evaluate the effect of urinary bladder double voiding technique on the incidence of urinary tract infection in the transplant patients with double J stents after the removal of the urethral catheters in the post-transplant period, we evaluated 65 recipients of live kidney transplant in whom we inserted double J stents and urethral catheters at the time of transplantation. After removing the urethral catheters on post-operation day six, we instructed a group of 30 patients to double void their bladders within five minutes after the first micturition. The rest of the patients served as controls. Urine cultures were repeated frequently before and at the time of removal of urethral catheters and double J stents to detect the incidence of urinary tract infection in both groups. All recipients received cotrimoxazol prophylactically. The group of patients who performed the double voiding technique had significantly lower incidence of positive urine cultures than the control group at the time of removing the double J stents (1 (3.3%) vs. 12 (34.2%) respectively). We conclude that double voiding may reduce risk of urine infection in patients with double J stents in renal allograft ureters.
  2 7,560 481
Correlation Between Creatinine Clearance and Transtubular Potassium Concentration Gradient in Old People and Chronic Renal Disease Patients
Carlos Musso, Vassilis Liakopoulos, Ioanis Stefanidis, Raul De Miguel, Nora Imperiali, Luis Algranati
October-December 2007, 18(4):551-555
Senescence and chronic kidney disease (CKD) reduce progressively glomerular filtration rate (GFR), which usually results in an increase in potassium renal secretion. To evaluate whether the transtubular potassium concentration gradient (TTKG) is more accurate parameter for evaluating the renal secretion of this cation than using fractional excretion of potassium as its urinary secretion marker, we studied 55 subjects, 43 of them were healthy elderly volunteers and 12 were CKD patients. Exclusion criteria were: abnormal plasma potassium level or presence of any disease or drug that could induce alteration of balance of this electrolyte levels. All the subjects were on a diet with a potassium content around 50 mmol/day. The curves, which demonstrate the relationship between creatinine clearance and TTKG and the grade of correlation between these two parameters were analyzed in both groups. We found that the transtubular potassium concentration gradient had a significant negative correlation with the creatinine clearance level in the healthy elderly group, while there was no correlation in the CKD group.
  2 4,806 580
Xanthgranulomatous Pyelonephritis Associated with Staphylococcus Aureus
Abdulla K Al- Hwiesh
October-December 2007, 18(4):613-616
A 44-year old man with xanthogranulomatous pyelonephritis presented with abdominal distention, left lumber pain, fever, loss of appetite, and loss of weight. He had been known to have diabetes mellitus type II for 20 years, and he was diagnosed to have a left renal stone three months prior to this presentation. The patient's urine and the left psous abscess grew staphylococcus aureus.
  1 3,362 437
Nephrotic Proteinuria and the Autonomic Nervous System
Marcello Camici
October-December 2007, 18(4):512-522
Nephrotic proteinuria triggers off complex neuro-endocrine mechanisms where forebrain activation results in sympathetic over activity. An attempt is made to discuss and analyze the renal sympathetic efferent nerve hyperactivity, the role played by the angiotensin/nitric oxide system during proteinuria and the nitric oxide/angiotensin imbalance in the hypothalamus. Several questions arise: further experimental and clinical studies are necessary. The answers to these questions may disclose new clinical and therapeutic perspectives for the nephrotic syndrome.
  1 6,477 541
Do we still need more data to provide renal transplantation for the CKD patients at or prior to stage 4?
Nasrulla Abutaleb
October-December 2007, 18(4):627-628
  1 1,549 237
The Status of Immunity Against the Hepatitis B Virus among Vaccinated Hemodialysis Patients: A Single Center Report from Iran
Zakieh Rostamzadeh Khamene, Nariman Sepehrvand
October-December 2007, 18(4):547-550
Patients on maintenance hemodialysis (HD) are very susceptible to infection with the hepatitis B virus (HBV). Repeated contact with factors that aid in transmission of this virus, is conceivably a reason for the high prevalence of HBV infection in patients on HD. Suppressed immunity also probably plays a role. The present study attempts to determine the level of immunity against the HBV among patients on HD at the Urmia University of Medical Sciences, Iran. A total of 141 patients were enrolled in the study and comprised of 76 males and 65 females. Their mean age was 45 years. Data such as the age, gender, blood transfusion(s) received and renal transplantation background, were collected from their medical records in order to identify the risk factors. The hepatitis B surface antibody (HBsAb) levels in the serum was measured in these patients using enzyme-linked immunosorbent assay (ELISA). Based on the levels of HBsAb, the study subjects were classified as non-immune (less than 10 IU/L), which included 56 patients (39.71%); moderately immune (between 10 and 100 IU/L) comprising 65 patients (46.09%) and fully immune (more than 100 IU/L) seen in 20 patients (14.18%). Our results suggest that the current status of vaccination of patients on maintenance HD, against hepatitis B is not satisfactory. Better training should be imparted to the relevant staff members. Also, timely kidney transplantation and avoiding blood transfusions, as far as possible, is recommended.
  1 4,041 527
Lower Genito-urinary Fistulae
Sadek Pharaon
October-December 2007, 18(4):643-647
A retrospective review of 120 patients diagnosed to have lower genito-urinary fistulae, over a period of 42 years, was performed. The patients were seen at the University Maternity Hospital or the Zahrawi Maternity Hospital, Damascus, Syria. The majority of the patients, particularly in the early part of this period, had obstetrical causes (90.5%), mainly due to obstructed labour, difficult and traumatic forceps deliveries, ruptured uterus and bladder and/or lower segment caesarean section (LSCS). Less frequently encountered gynecological causes, in the same early period, were due to total abdominal hysterectomy (TAH), Wertheim radical hysterectomy (WRH), anterior vaginal repair, sling operation and other causes (9.5%). However, in the later part of this study, the main causes became gynecological (57%) with obstetric causes contributing in only 43% of the cases. Urinary fistulae still represent a major problem in Syria and reflect a sub-optimal level of training of undergraduate and post­graduate students and poor socio-economic conditions. The overall cure rate was 77%. It is hoped that with better hospital care, improvement in the quality of medical practice and the socio-economic status in the country, the incidence of genito-urinary fistulae will be reduced.
  1 3,187 447
Fatal Hemorrhagic Intracranial TB in a Renal Transplant Recipient despite INH Prophylaxis
Nasrulla Abutaleb, Abdulmunaem Obaideen, Abdulmajeed Hamza, M Zakaria, Hisham Afifi, Sammera Fallata, Seddiq Younis, Muhalab Adem
October-December 2007, 18(4):594-598
A 50-year-old ESRD who received LUR renal graft abroad. Since transplanted, he remained dependent on hemodialysis. The patient received steroid pulse therapy twice for rejecrion. Nonspecific bilateral lung infiltrate were noted on admission CXR, which stimulated the search for TB. The patient suddenly lost consciousness during his hospital stay. Intracranial hemorrhage was drained and tissue staining revealed heavy loads of tuberculus (TB) bacilli. The patient died two weeks later from septic shock with multi-organ failure.
  - 2,848 388
A Neglected Case of Renal Tubular Acidosis
Ali Derakhshan, Mitra Basiratnia, Mohammad Hossein Fallahzadeh, Ghamar Hosseini-Al-Hashemi
October-December 2007, 18(4):585-589
In this report, we present a case of a child with distal renal tubular acidosis, severe failure to thrive and profound rickets, who was only 7.8 Kg when presented at 6 years of age. His response to treatment and his follow-up for four years is discussed. Although failure to thrive is a common finding in renal tubular acidosis but the physical and x-ray findings in our case were unique.
  - 3,589 549
It is "Only My Knee, Doctor" Syndrome
Abdullah A Al Sayyari
October-December 2007, 18(4):663-665
  - 3,969 322
Successful and Unsuccessful Humans
Sadek Pharaon
October-December 2007, 18(4):625-626
  - 1,829 236
Rates and Causes of Peritonitis in a National Multicenter Continuous Ambulatory Peritoneal Dialysis Program in Sudan: First-year Experience
Hasan Abu-Aisha, Elwaleed A Elhassan, Ammar H Khamis, Haleema Fedail, Babikir Kaballo, M Babbikir Abdelraheem, Tigani Ali, Safaa Medani, Layla Tammam, Ihsan Basheir
October-December 2007, 18(4):565-570
This is a cumulative report of all patients in six centers in Greater Khartoum, all three cities that comprise the capital of Sudan, covering the first year of operation of the National Program. This study evaluates the rates, mechanisms, causative agents and clinical outcomes of peritonitis. We included the data of all 60 patients who underwent CAPD from June 2005 to June 2006. There were 15 episodes of peritonitis in 323 patient-months, which equates to an overall peritonitis rate of one episode every 21.5 months (0.55 episodes per year at risk). The individual center rates varied. There was a statistically significant age difference, with peritonitis being more common in the youngsters. All patients presented with abdominal pain and had cloudy effluents but none had a significant exit site or tunnel infection. Fluid cultures were available in 11 out of the 15 episodes of peritonitis. The cultures were positive for organisms in only 3 out of 11 (27%) cases. Two patients were infected by Pseudomonas aerogenosa and one patient by Staphylococcus aureus. Thus, the culture-negative peritonitis rate was 8/11 (73%). Touch contamination was the likely mechanism in 7/15 (46.7%) of the episodes. There were three cases of refractory peritonitis and only one case of relapsing peritonitis. None of the patients had a catheter removed because of peritonitis. We conclude that the first year of operation of the Sudan National Multi-centered PD program has proven that it is a promising project with multifaceted success. The cumulative peritonitis incidence is acceptable although there are several areas for improvement. Standardized laboratory techniques need to be implemented and pursued, particularly in the microbiology area.
  - 4,643 692
Renal Disease Masquerading Vasculitis Crescentic Atheroembolic Renal Disease
Quaid Nadri, Wafa M Aleouni
October-December 2007, 18(4):656-662
  - 5,014 429
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