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Saudi Journal of Kidney Diseases and Transplantation
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   2009| November-December  | Volume 20 | Issue 6  
    Online since October 27, 2009

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Use of sodium thiosulfate in the treatment of calciphylaxis
Carlos G Musso, Paula Enz, Flavia Vidal, Rodolfo Gelman, Aldana Lizarraga, Luis Di Giuseppe, Alicia Kowalczuk, Leonardo Garfi, Ricardo Galimberti, Luis Algranati
November-December 2009, 20(6):1065-1068
Calciphylaxis is an infrequent but severe entity found in chronic dialysis patients. Its clinical pattern consists of tissue ischemia with itchy and painful subcutaneous nodules and plaques, most often located on the abdomen, buttocks, thighs and/or legs. These injuries evolve to extensive superficial necrosis of the skin overlying the panniculitis, with ulceration, overinfection and consequent sepsis. Current treatment modalities used to counteract this pathology are not entirely effective. A new treatment reported for calciphylaxis, is the use of intravenous sodium thiosulfate. This inorganic salt is already used in the treatment of intoxication caused by cyanide, in patients with calcific nephrolithiasis and tumoral calcinosis, with very good and safe results. We herewith report a case of calciphylaxis that was cured using intravenous sodium thiosulphate treatment.
  22,750 2,211 12
Increasing dialysate flow rate increases dialyzer urea clearance and dialysis efficiency: An in vivo study
Ahmad Taher Azar
November-December 2009, 20(6):1023-1029
Clearance of urea depends on the dialysis solution flow rate as well. A faster dialysis solution flow rate increases the efficiency of diffusion of urea from blood to dialysate. An in vivo study was used in order to examine the effect of increasing dialysate flow rate (Q D ) on dialyzer urea clearance and dialysis efficiency expressed as Kt/V and URR. Group assignment was at the patient level rather than the facility level. The study subjects consisted of 138 hemodialysis patients on 3­times-per-week dialysis regimens. One way ANOVA test, Student's t test and Logistic regression analysis were used to analyze the data. Statistically significant increase in Kt/V and URR was noted as the dialysate flow increased from 500 to 800 mL/min when a moderate efficiency dialyzer with large surface area (1.6 m 2 ) and high flux high efficiency dialyzers were used (P< 0.05). For moderate efficiency dialyzers with large surface area, Kt/V increased by 5.86% (P= 0.022628) and URR increased by 4.31% (P= 0.02263). Low efficiency and small surface area (1.2 m 2 and 1.3 m 2 ) dialyzer did not show an improvement in Kt/V or URR with increase in dialysate flow rate. Increasing Q D from 500 to 800 mL/min is associated with a statistically significant increase in Kt/V, URR and dialyzer clearance in moderate efficiency low flux and high efficiency high flux dialyzers. Hemodialysis with Q D of 800 mL/min should be considered in selected patients not achieving adequacy despite extended treatment times and optimized blood flow rates.
  17,893 1,506 1
Supraventricular tachycardia following insertion of a central venous catheter
Onder Yavascan, Sevgi Mir, Hakan Tekguc
November-December 2009, 20(6):1061-1064
Placement of central venous catheters (CVCs) in patients is associated with several risks including endocardial injury and dysrhythmias. In addition, CVC extending into intracardiac chambers can provoke premature atrial and ventricular complexes, which have been reported to initiate supraventricular tachycardia (SVT). A 15-year-old boy with end-stage renal failure developed SVT after insertion of a CVC.
  11,817 764 3
Catheter related infection in hemodialysis patients
Zahid Nabi, Saifal Anwar, Majda Barhamein, Hachem Al Mukdad, Abdallah El Nassri
November-December 2009, 20(6):1091-1095
To determine the frequency of hemodialysis (HD) catheter related infection, causative microorganisms and predisposing factors contributing to these infections at our center, we con­ducted a prospective study in 2007 involving 57 (45.6% males) patients in whom a temporary catheter was inserted for HD. The patients were followed for one month to document any episodes of hemodialysis catheter related infection (HCRI). There were 11 (19.3%) patients who developed HCRI proven by blood culture; 5 patients were infected with more than one organism. Staphyloco­ccus Coagulase negative and Staphylococcus aureus (S. aureus) remain the most common patho­gens. All the organisms were sensitive to antibiotics administered empirically, however, 3 patients developed multiple resistant S. aureus (MRSA). All the infected patients experienced previous epi­sodes of HCRI, which formed a risk factor in addition to low albumin when compared to the non­infected group (P=0.024 and P= 0.001, respectively). We conclude that the rate of HCRI and the causative organisms found in our study is comparable to previous reports. We still need to adopt measures to minimize the use of temporary vascular accesses by creation of fistulas in a timely fashion.
  7,186 1,245 4
Current knowledge on helicobacter pylori infection in end stage renal disease patients
Hossein Khedmat, Saeed Taheri
November-December 2009, 20(6):969-974
Gastric infection with Helicobacter Pylori in end-stage renal disease patients is of rele­vance because of its potential impact on the quality of life as well as morbidity and mortality of patients. Existed data on the issue are controversial, and we attempt in this article to evaluate the available data to approach extended perception of the current knowledge on the epidemiology, relevance, and optimum therapeutic strategies.
  6,451 1,790 3
Non-dialytic management of sepsis-induced acute kidney injury
Senaka Rajapakse, Eranga S Wijewickrama
November-December 2009, 20(6):975-983
Sepsis is an important cause of morbidity and mortality. Acute Kidney Injury (AKI) often complicates sepsis, leading to greater complexity, higher cost of care and worsening prog­nosis. Despite the improved understanding of its underlying pathophysiological basis, there have been very few interventions, which have consistently been shown to be of value in the manage­ment of sepsis-induced AKI. Measures such as adequate hydration, maintenance of adequate circulating blood volume and mean arterial pressure, and avoidance of nephrotoxins, are still the mainstay of prevention. Loop diuretics, mannitol and "low dose" dopamine have been clearly shown to be of no value in the prevention or treatment of AKI and may, in fact, do harm. Among the remaining pharmacological options, N-acetylcysteine (NAC) may have a role in the preven­tion of radiocontrast induced AKI.
  5,178 2,162 -
Rituximab to treat active SLE in a hemodialysis patient
Quaid J Nadri
November-December 2009, 20(6):1085-1086
  5,151 706 2
Epstein syndrome with rapid progression to end stage renal disease
Esam Alhindawi, Samah Al-Jbour
November-December 2009, 20(6):1076-1078
The association of haematological abnormalities and hereditary nephritis is rare; it is mainly included in a spectrum of autosomal dominant macrothrombocytopenias: May-Hegglin anomaly, Fechtner, Sebastian, Epstein and Alport syndrome with macro thrombocytopenia. We are presenting a missed case of a boy who presented with epistaxis and his diagnostic work up revealed macrothrombocytopenia, sensorineural hearing loss and chronic nephropathy which constitute the Epstein syndrome, with rapid deterioration of kidney function.
  4,869 602 4
Biochemical nutritional parameters and their impact on hemodialysis efficiency
Hasan Nasir Abbas, Malik Anas Rabbani, Nilofer Safdar, Ghulam Murtaza, Qamaruddin Maria, Aasim Ahamd
November-December 2009, 20(6):1105-1109
To determine the nutritional status of chronic hemodialysis (HD) patients and the association of changes in serum albumin levels, C-reactive protein (CRP), Low Density Lipoprotein (LDL) cholesterol and body mass index (BMI) as indicators of nutritional status with the urea reduction ratio (URR) during dialysis, we studied 201 chronic HD patients (97 males and the mean age was 51 ± 15 years). Diabetes was the cause of chronic kidney disease (CKD) in 34% of the pa­tients, hypertension in 57%, chronic glomerulonephritis in 12%, and obstructive uropathy in 10%. BMI less than 18.5 (under weight) was found in 17% of patients, more 18.5 but less than 25 (nor­mal) in 56%, more than 25 but less than 30 (overweight) in 21%, and more than 30 (obese) in 6%. The laboratory investigations revealed hypercalcemia in 62% of the patients (15 patients were found to have tertiary hyperparathyroidism), total cholesterol less than 100 mg/dL in 6% (mean 152 ± 37.5 mg/dL), and URR of less than 60% in 12% of patients and greater than 60 but less than 65% in 33%. Hypoalbuminemia was associated with poor URR (P< 0.05), whereas no statistically signi­ficant correlation was found between URR and iPTH, LDL cholesterol, CRP and body mass index. We conclude that poor nutritional status was detected among a significant number of our patients with poor dietary education. Increased risk of malnutrition was significantly associated with older age and inadequate dialysis dose. Hypoalbuminemia was the single most important factor associated with poor URR.
  4,144 860 -
A study on the association between Angiotensin-I converting enzyme I/D dimorphism and type-2 diabetes mellitus
Hania Nakkash Chmaisse, Manal Jammal, Hana Fakhoury, Rajaa Fakhoury
November-December 2009, 20(6):1038-1046
Type-2 diabetes mellitus (T2DM) is a chronic disorder characterized by a varying range of predominant insulin resistance with relative insulin deficiency, to predominant insulin secretory defect with or without insulin resistance. Familial clustering as well as epidemiological studies has shown that genetic factors play a role in the development and progression of the disease. Among the genetic factors found to be associated with development of T2DM is the angiotensin-I converting enzyme (ACE) gene, which is located on chromosome 17q23. This study was conducted to study the association between ACE gene insertion/deletion (I/D) polymorphism and T2DM in a Lebanese diabetic cohort. Fifty-one patients with T2DM and 40 control subjects from different parts of Lebanon underwent genotyping for the ACE I/D, which was performed by PCR using specific primers. Chi-square and analysis of variance (ANOVA) were used for asso­ciation studies and to assess the differences in the values among the groups. The distribution of the genotypes in the patients was as follows: 15/51 (29.4%) were homozygous for deletion allele (DD genotype), 24/51 (47.1%) were heterozygous (ID genotype), and 12/51 (23.5%) were homo­zygous for insertion allele (II genotype). Among the control subjects, 16/40 (40%) were homo­zygous for deletion (DD genotype), 13/40 (32.5%) were heterozygous (ID genotype), and 11/40 (27.5%) were homozygous for insertion (II genotype). The prevalence of the D-allele in T2DM patients (52.9%) was not significantly different from that in the controls (56.3%). Thus, ACE I/D dimorphism cannot be considered a risk factor for T2DM in the Lebanese population.
  4,288 699 6
The effect of use of dates on serum potassium in nondiabetic hemodialysis patients
Nauman Siddiqi, Osama El Shahat, Ebtisam Bokhari, Haytham Roujouleh, M Hisham Hamid, Iftikhar Sheikh, Hassan El-Sayed, Ayman Saleh, Ayman Seddik
November-December 2009, 20(6):1018-1022
Hyperkalemia is common in patients with ESRD and may contribute to mortality. Dates have been reported to be high in potassium content. One of the concerns on hemodialysis (HD) is convincing patients to give up ingestion of dates as a part of their diet. To determine the effect of dates on serum potassium on patients, we studied 9 (M: F, 6:3, mean age 47.6) non diabetic patients on chronic hemodialysis, without evidence of hyperkalemia on monthly labs. Nearly all the patients had been on dialysis for an average of four years. The average monthly potassium was 4.6 mmol/L. The patients ingested 100 gm of dates (Rothana and Sukari) on two separate dialysis sessions. Serum potassium was measured at two and four hours post ingestion along with ECG monitoring. The patients underwent their regular dialysis as scheduled. The patients acted as their own controls and underwent the same protocol with 20meq of KCl on a separate session. The potassium levels did not change significantly over the four hours with either variety of dates or with potassium solution. Combining the two types of dates resulted in a trend towards higher potassium levels than with KCl, but it did not reach statistical significance. We conclude that in selected HD patients without hyperkalemia, ingestion of a few dates does not cause significant hyperkalemia and could be allowed on days of dialysis prior to their dialysis sessions.
  4,334 571 2
Can serial eGFR, body mass index and smoking predict renal allograft survival in south Asian patients
Asik Ali Mohamed Ali, Georgi Abraham, Milly Mathew, Nusrath Fathima, Saravanan Sundararaj, Varun Sundaram, Nancy Lesley
November-December 2009, 20(6):984-990
Limited data exist regarding long-term allograft survival in South Asian patients in the era of modern immunosuppressive therapy. This retrospective cohort study was undertaken to see the graft survival based on serial eGFR, immunosuppressive therapy, BMI and other confounding factors including smoking in patients who have undergone renal transplantation in a tertiary care center in south India. Three hundred and three kidney transplant recipients including live and cadaveric transplantation performed between 2001 and 2006 were included in this study. The mean graft survival after transplantation was 6.38 ± 0.11 years, graft survival at one, two, three and five years were 95.7%, 92.72%, 91.72% and 89.21%, respectively. The mean serum creatinine and eGFR in the biopsy proven acute rejection (BPAR) group were 1.74 ± 0.94 mg/dL and 43.73 ± 13.65 mL/min com­pared with 1.24 ± 0.59 mg/ dL and 61.50 ± 17.40 mL/min in the non-BPAR group (P< 0.001 and P= 0.0159) respectively. The mean BMI in the BPAR group at one year was 26.59 ± 3.18 kg/m 2 compared with 21.63 ± 2.29 kg/m 2 in the non-BPAR group (P< 0.05). The mean graft survival in patients who were smokers at the time of pretransplant evaluation was 89.3% compared with 92.5% in the non-smokers (P=0.347). This retrospective cohort study found that serial eGFR, body mass index and smoking were significant predictors of graft survival following renal transplantation in South Asian patients.
  3,353 1,259 3
Validation of predictive equations for glomerular filtration rate in the Saudi population
Jamal S Al Wakeel, Durdana Hammad, Abdulkareem Al Suwaida, Nauman Tarif, AbdulRauf Chaudhary, Arthur Isnani, Waleed Ahmed Albedaiwi, Ahmad H Mitwalli, Shaik Shaffi Ahmad
November-December 2009, 20(6):1030-1037
Predictive equations provide a rapid method of assessing glomerular filtration rate (GFR). To compare the various predictive equations for the measurement of this parameter in the Saudi population, we measured GFR by the Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault formulas, cystatin C, reciprocal of cystatin C, creatinine clearance, reciprocal of creatinine, and inulin clearance in 32 Saudi subjects with different stages of renal disease. We com-pared GFR measured by inulin clearance and the estimated GFR by the equations. The study included 19 males (59.4%) and 13 (40.6%) females with a mean age of 42.3 ± 15.2 years and weight of 68.6 ± 17.7 kg. The mean serum creatinine was 199 ± 161 μmol/L. The GFR measured by inulin clearance was 50.9 ± 33.5 mL/min, and the estimated by Cockcroft-Gault and by MDRD equations was 56.3 ± 33.3 and 52.8 ± 32.0 mL/min, respectively. The GFR estimated by MDRD revealed the strongest correlation with the measured inulin clearance (r= 0.976, P= 0.0000) followed by the GFR estimated by Cockcroft-Gault, serum cystatin C, and serum creatinine (r= 0.953, P= 0.0000) (r= 0.787, P= 0.0001) (r= -0.678, P= 0.001), respectively. The reciprocal of cystatin C and serum creatinine revealed a correlation coefficient of 0.826 and 0.93, respectively. Cockroft-Gault for­mula overestimated the GFR by 5.40 ± 10.3 mL/min in comparison to the MDRD formula, which exhibited the best correlation with inulin clearance in different genders, age groups, body mass index, renal transplant recipients, chronic kidney disease stages when compared to other GFR predictive equations.
  3,862 749 1
Drug-induced interstitial nephritis in a child with idiopathic nephrotic syndrome
Nikoleta Printza, Fotini Koukourgianni, Thaer Saleh, Chrissa Goga, Fotis Papachristou
November-December 2009, 20(6):1072-1075
Acute renal failure (ARF) is a rare but severe complication of active idiopathic nephrotic syndrome (INS) in children. It may be due to several causes with different outcomes. Both the clinical picture of the patient as well as laboratory, imaging and histopathological findings may help in the diagnosis. We present a case of drug-induced acute interstitial nephritis (AIN), complicated with ARF, in a 2 1/2 -year-old girl with active INS. The child was referred to the Hippokration General Hospital, Thessaloniki, Greece hospital with steroid-resistant NS; renal biopsy was performed, which did not show any remarkable findings and cyclosporine was admi­nistered in addition to steroid therapy. The first day after biopsy, the child developed gross hematuria and abdominal pain and an antibiotic was added to her treatment. In the following days, fever, vomiting, hypertension and ARF occurred. Ultrasound study revealed enlarged kidneys with increased echogenity and loss of corticomedullary differentiation. The antibiotic and cyclos­porine were stopped and the child was managed with furosemide, nifedipine and steroids. A second renal biopsy was performed, which confirmed the diagnosis of acute interstitial nephritis. The child did not require dialysis therapy. Her urine output improved gradually and the serum creatinine normalized one month after the initial episode. Our case re-emphasizes the need for investigation of factors precipitating ARF in children with idiopathic NS.
  3,802 778 -
The effect of ligation of the distal vein in snuff-box arteriovenous fistula
Ali Akbar Beigi, Hassan Masoudpour, Maryam Alavi
November-December 2009, 20(6):1110-1114
Arterio-venous fistula (AVF) in the snuff-box region is one of the current techniques used for creating a vascular access in patients undergoing dialysis. The aim of this study is to find out whether ligating the distal vein in AVF in the snuff-box will bring about any change in the efficiency and complications of the fistula. Sixty patients (30 males, 30 females) suffering from chronic renal failure, who had been admitted for creating an AVF, were randomly divided into two groups after having filled out consent forms. After the AVF was made, the distal vein was ligated in the first group, but not in the second group. The patients were discharged after being given the necessary advice on how to take care of their fistula. They were examined on post-surgical days 1, 30 and 90. Early efficiency in the ligated and non-ligated groups was 100% and 96.7% respectively while late efficiency in the two groups was 90% and 83.4%, respectively (P> 0.05). The most common complication in both groups was thrombosis (11.7%). Venous hypertension and edema were observed in two patients (both from the non-ligated group) and infection of the surgical site was observed in only one patient. Our study suggests that, considering the high efficiency level and low complication rate, AVF at the snuff-box region constitutes one of the best possible vascular accesses for patients undergoing hemodialysis. Ligation of the distal vein prevents the development of venous hypertension in the fistula.
  3,674 570 -
Reduction of the severity of ischemia reperfusion-induced pancreatitis by ischemic pre-conditioning of the liver
Saman Nikeghbalian, Mohsen Reza Mansoorian, Seyed Mohammad Vahid Hosseini, Parviz Mardani, Bita Geramizadeh, Seyed Ali Malek Hosseini
November-December 2009, 20(6):1010-1014
Pre-conditioning by brief exposure to ischemia does not only protect the concerned organ against subsequent severe ischemic damage, but also has protective effect on other organs, which is called remote pre-conditioning. Our aim in this study was to evaluate the protective effect of brief liver ischemia on the pancreas against severe ischemia-reperfusion-induced pancreatitis. This study was performed on 30 male wistar rats. Ischemic pre-conditioning of liver was performed by first clamping of the hepatic pedicle for 10 minutes. Following this, ischemia-reperfusion of the pancreas was performed by first clam-ping the inferior splenic artery for 30 minutes, followed by reperfusion for one hour. The rats were divided into three groups (10 rats in each group). Group­One was the sham operated group, without clamping of any artery. Group-two developed ischemia­reperfusion-induced pancreatitis, without ischemic pre-conditioning of the liver, while Group-three underwent ischemic pre-conditioning of the liver followed by ischemia-reperfusion of the pancreas. Ischemic pre-conditioning, applied prior to induction of pancreatitis, caused a reduction in plasma lipase, plasma interleukin-1β and histological signs of pancreatic damage, but plasma interleukin-10 levels were not significantly different between the three groups. Ischemic pre-conditioning of the liver did not cause any alteration of the liver enzymes. Our study suggests that ischemic pre­conditioning of the liver reduces the severity of ischemia-reperfusion-induced pancreatitis. These effects are partly related to the reduction of pro-inflammatory interleukin -1β.
  3,510 596 1
Acute renal failure associated with the rift valley fever: A single center study
Mohamed El Imam, Mohamed El Sabiq, Mustafa Omran, Abdulla Abdalkareem, Muhamadani A El Gaili Mohamed, Ahmed Elbashir, Osman Khalafala
November-December 2009, 20(6):1047-1052
Renal impairment is a frequent occurrence among patients with the rift valley fever (RVF), and is probably the result of hypovolemia and multiple organ dysfunctions in the majority of cases. This study was conducted to estimate the incidence of renal impairment in patients with RVF as well as to determine the associated mortality. Data of all patients admitted with renal impairment to the Gezira Hospital for Renal Diseases, Sudan, during the epidemic of RVF bet­ween September 2007 and January 2008 were analyzed. The total number of patients with RVF was 392 of whom, 194 were admitted to the Medani Teaching Hospital. Renal impairment was detected in 60% of the admitted patients; 90% of them needed dialysis treatment. The mortality rate was 31% in patients with acute renal failure, 25% in those with the hepatorenal syndrome and 31% in patients with primary hepatic involvement and mild renal impairment. The overall mortality was 40%. Our study suggests that RVF remains a major cause of acute renal failure with considerable mortality, although progression to chronic renal failure was not seen. Early renal substitution therapy fosters the best hope for survival
  3,488 535 4
Dissecting aortic aneurysm in maintenance hemodialysis patients
M Ounissi, R Goucha, H Hedri, F Ben Hamida, E Abderrahim, F El Younsi, T Ben Abdallah, H Ben Maiz, A Kheder
November-December 2009, 20(6):1053-1056
The dissecting aortic aneurysm (DAA) is a rare pathology that may result in fatal outcome. We report follow up of three cases of DAA patients undergoing maintenance hemo­dialysis who were managed conservatively.
  3,514 454 -
Calcific uremic arteriopathy
Pranav Dalal, Gaurav Shah
November-December 2009, 20(6):1083-1084
  3,361 574 -
Alport's syndrome
Alexander Osaretin Oni, Andrew Osayame Eweka, Peter Oghale Otuaga, James Osaretin Odia
November-December 2009, 20(6):1087-1089
  3,345 590 -
Value of serum cystatin C as a marker of renal function in the early post kidney transplant period
Bita Geramizadeh, Negar Azarpira, Maryam Ayatollahi, Ghanbar-Ali Rais-Jalali, Mahdokht Aghdai, Ramin Yaghoobi, Mehrzad Banihashemi, Zahra Malekpour, Seyed Ali Malek-Hosseini
November-December 2009, 20(6):1015-1017
Management of renal transplant patients requires periodic measurement of renal function especially in early post transplant period. This is usually assessed by measuring the crea­tinine clearance, but because of its limitations, it is not an ideal marker for assessing the renal function. Serum Cystatin C (sCyC) appears to be an endogenous marker of glomerular filtration rate (GFR). To assess the use of sCyC as a marker of renal function in kidney transplant patients, we compared it with serum creatinine (sCr) and 24-hour urine creatinine clearance (CrCl) in the first week post-transplantation. Among 60 patients (62.8% men, 37.2% women) undergoing kidney transplantation (average age: 44.87 ± 13.37 years), we determined renal function at 1, 3, 5, and 7 days after kidney transplantation using: sCr, sCyC and CrCl in a 24-hours urine specimen. During the first 5 days following transplantation, there was a progressive decline in sCr levels. In the first 5 days, post transplantation we could not find good correlation between CrC and sCyC, and the sCyC increased during these 5 days, but after that in day 7, there was a good correlation between CrC and sCyC which is coinciding with decreasing the dose of steroid (r= .625). Therefore, we recommend using sCyC may be used as a marker of renal function after one-week post kidney transplantation.
  3,312 606 2
A huge renal capsular leiomyoma mimicking retroperitoneal sarcoma
Anupam Lal, Ram Prakash Galwa, Prashana Chandrasekar, Man Updesh Singh Sachdeva, RK Vashisht, N Khandelwal
November-December 2009, 20(6):1069-1071
A huge left renal capsular leiomyoma mimicking retroperitoneal sarcoma presented in a patient as an abdominal mass. Computed tomography displayed a large heterogeneous retro­peritoneal mass in the left side of the abdomen with inferior and medial displacement as well as loss of fat plane with the left kidney. Surgical exploration revealed a capsulated mass that was tightly adherent to the left kidney; therefore, total tumor resection with radical left nephrectomy was performed. Histopathology ultimately confirmed the benign nature of the mass. This is the largest leiomyoma reported in literature to the best of our knowledge.
  3,404 488 3
Evaluation of serum tumor necrosis factor α and its correlation with histology in chronic kidney disease, stable renal transplant and rejection cases
Gyanendra Kumar Sonkar, Usha , RG Singh
November-December 2009, 20(6):1000-1004
Tumor necrosis factor alpha (TNF α) is a cytokine secreted by macrophages, helper T cells, Natural Killer cells, B lymphocytes and non lymphoid cells e.g. endothelial cells, fibroblast and tumor cell lines. Aim of the study was to find the utility of TNF α in diagnosing renal transplant rejection among the renal transplant cases (n=29), and comparison with the levels in patients on maintenance hemodialysis (n=21) and healthy controls (n=20). TNF α in healthy controls varied from 2 to 15 pg/mL. In chronic renal failure and renal transplant rejection cases TNF α was above 45 pg/mL. In stable renal transplant patients it was higher than normal (16 to 30 pg/mL). In both acute and chronic transplant rejection TNF α increase correlated well with histology. Thus our study suggests that TNF a level more than 45 pg/mL can be taken as an immunological marker of renal transplant rejection.
  3,181 604 7
Urological complications of renal transplantation: Reducing the risk
Jacob A Akoh, Abdu S Opaluwa, David Weller
November-December 2009, 20(6):1005-1009
Urological complications can have a significant effect on the outcome of renal trans­plantation including the loss of the graft. The aims of this study were to determine the incidence of urological complications occurring after kidney transplantation at our unit, and how the risk of com­plications can be reduced. All 398 renal transplantations performed at Derriford Hospital, Plymouth between August 1997 and December 2006 were reviewed. Twenty nine (7.3%) urological com­plications were noted with a median time to diagnosis of 8.5 days (range 1-950 days) following transplantation; 81% occurring within two weeks. Fourteen (48.3%) of these patients had iden­tifiable risk factors; 10 patients required ureteric reimplantation, 6 had Boari flap reconstruction, and 3 underwent transurethral resection prostatectomy. One graft was lost to severe ureteric nec­rosis. Steps to reduce the risk of complications include avoiding damage to organs during retrieval, meticulous bench preparation including hydrodilating ureters to exclude ureteric injury and vigi­lance during the transplant procedure. Prompt and appropriate corrective surgery can diminish the effect of urological complications on graft survival.
  3,042 690 1
Hydatid cyst disease in a renal allograft recipient
Tarik Houssaini Sqalli, Matthias Buchler, Azmi Al Najjar, Anne Paris, Jean-Michel Halimi, Hubert Nivet, Philippe Anthonioz, Philippe Bourlier, Thanh Hai Duong, Yvon Lebranchu
November-December 2009, 20(6):1057-1060
  3,261 457 3
Urolithiasis in Tunisian children: A study of 100 cases
Akram Alaya, Abdellatif Nouri, Mohamed Fadhel Najjar
November-December 2009, 20(6):1096-1100
The aim of this study is to assess the clinical and biological characteristics of renal stone disease among children living in the coastal region of Tunisia. This retrospective multi-center study included 100 children under the age of 16 years, who presented with urinary stones. The patients' charts were reviewed with regard to age at diagnosis, sex, history and physical exami­nation as well as laboratory and radiologic findings. Stone analysis was performed by infrared spec­trophotometry. The male/female sex ratio was 1.5 to 1. The clinical presentation of this pathology was dominated by dysuria. Stones were located in the upper urinary tract in 76 cases (76%). A total of 13% of the study subjects had positive urine cultures. Metabolic investigations were performed in all patients and were normal in 80 cases. Whewellite (calcium oxalate) was found in 77 stones (77.0%). Stone section was made of whewellite in 69.0% of cases and ammonium urate in 47.0%. Struvite stones were more frequently seen in the lower urinary tract. Our study suggests that the epidemiological profile of renal stones in Tunisia has changed towards a predominance of calcium oxalate stones and upper tract location. Also, the male predominance of pediatric urolithiasis is becoming less obvious in Tunisia
  3,074 629 2
Acute interstital nephritis associated with rifampicin therapy
Saied Aminiafshar, Masomeh Alimagham, Farhad Abbasi, Soolmaz Korooni Fard-Khani
November-December 2009, 20(6):1079-1080
  2,899 593 2
Impact of ethnicity, donor status and HLA matching on renal allograft survival: A single center study
Lakshmi Kiran Chelluri, Adavi Vasantha, Kamaraju S Ratnakar
November-December 2009, 20(6):995-997
The role of histocompatibility testing in renal transplantation is passing through an immense debate on its utility in predicting long-term graft survival. The current study, which includes fifty-one patients with end-stage renal disease, aims at evaluating the impact of the HLA matching in live related donor (LRD) (parents, siblings and near relatives) and live unrelated donor (LURD) transplants on one year graft survival rates, in a single center. Patients were followed-up for one-year after renal transplantation and observed for renal complications inclu­ding infections and rejection. The incidence of acute rejection episodes was found to be lower in LRD transplantation complying with many reports published so far. HLA matching was found to be beneficial in obtaining better graft function and one-year graft survival rate. The current study found that patients from Far East of India have lower graft survival rates as against patients from other regions of the country. India, with its vast racial distribution, has a need to look into the ethnic variation and its impact on allograft survival.
  2,815 537 1
Concomitant presence of renal cell carcinoma and adenocarcinoma of the colon
Hassan Ahmadnia, Mahmood Molaei
November-December 2009, 20(6):1081-1082
  2,532 429 -
Mycophenolate sodium increases cyclosporine blood levels in renal transplant recipients
Vahid Pourfarziani, Saeed Taheri
November-December 2009, 20(6):991-994
Cyclosporine is an immunosuppressive agent that displays a broad intra- and inter­individual pharmacokinetic variability. To evaluate the factors, which significantly influence cyclos­porine blood levels in our renal transplant recipients, we studied 611 consecutive patients trans­planted from living donors in Baqiyatallah hospital, Tehran, Iran from 1984 to 2005. The patients were divided into two groups: Group I included patients treated with mycophenolate sodium (MS) as an adjunctive immunosuppressive agent and Group II treated with azathioprine (AZA) as an adjunctive agent. Measurements of cyclosporine blood tough levels (C0) were performed 12 hours after the morning dose (just before the night dose). The mean age of the study population at time of transplantation was 38.7 ± 13.7 years and males formed 67% of it. Univariate analysis and multi­variable linear regression model showed that older age at transplantation, treatment with MS, and time interval from time of transplantation were significantly related with higher C0 levels. We conclude that there is an interaction of immunosuppressive agents in renal transplant patients with higher cyclosporine levels in the recipients of MS.
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Is short term outcome of Iranian renal transplant recipients affected by mean first 6 months C2 level?
Shervin Assari, Maryam Moghani Lankarani, Yunes Panahi, Behzad Einollahi
November-December 2009, 20(6):1101-1104
International Consensus Conference (ICC) has suggested that the whole blood level of Cyclosporine (CsA) be kept strictly at a certain level. However, it is not well understood whether failing to maintain these levels will affect the short term outcome in different patient populations or not. We aimed to assess if the short term outcome of Iranian renal transplant recipients will be affected by first 6 months C2 level. In a retrospective cohort, 265 consecutive kidney transplant recipients were categorized as group with mean C2 lower than recommended range (mean C2 levels in the first 6 month after transplantation lower than the recommended ranges; n=213) and group with mean C2 within recommended range (mean C2 levels in the first 6 month after transplantation within the recommended range; n=52). All recipients were negative for panel reactive antibody, and had received their first (living unrelated) kidney transplantation in Baqiyatallah hospital, between 2002 and 2003. The groups were similar in characteristics and 6 months, 1, 2, and 3 years patient and graft survival rates were considered as outcome. No significant difference was observed in patient and graft survival rates between the two groups (P> 0.05). The patient survival rate in group with mean C2 lower than recommended range and group with mean C2 within recommended range were: 6 months: 98% vs. 98, 1 year: 97% vs. 98%, 2 years: 97% vs. 98% and 3 years: 97% vs. 98%. The graft survival rate in the above groups were as follows: 6 months: 93% vs. 91%, 1 year: 92% vs. 91%, 2 years: 92% vs. 77% and 3 years: 89% vs. 69%, respectively. The result of our study showed that lower mean C2 levels was not necessarily accompanied with a worse short term outcome in our patients. This finding suggests that the optimal level of C2 may be different in ethnic populations.
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Survey of attitude of physicians on updates in the management of anemia in chronic kidney disease patients - An eye-opener
Pooja G Binnani
November-December 2009, 20(6):1090-1090
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