Arab journal of nephrology and transplantation最新文献

Introduction: Hepatitis C virus (HCV) is one of the most common infections among hemodialysis (HD) patients. It continues to be exasperating problem in many HD centers, in spite of strictly following infection and quality control measures.

Methods: This is a multi-center retrospective comparative study, carried out in different HD units of Menoufia Governorate, Egypt. Patients who were HCV negative on starting HD were divided into two groups; Group-1 included patients who remained negative for HCV and group-2 included patients who seroconverted to HCV positive status during dialysis. Risk factors for seroconversion were compared between the two groups.

Results: Out of the 514 surveyed patients, 259 were negative for HCV and 255 were positive; the prevalence of HCV infection was 49.6%. A total of 303 patients who were HCV negative on starting HD were recruited in the study. Group-1 included 259 patients who remained negative for HCV and group-2 included the 44 patients who seroconverted to HCV positive status during dialysis. Patients in group-2 had significantly longer duration on dialysis compared to group-1 (71 .4 versus 33.7 months) and they had stronger family history of HCV infection (20.5% versus 6.4%).

Conclusion: There is high prevalence and high seroconversion rate of HCV in surveyed HD units. Following infection control measures and strict supervision of dialysis staff should be emphasized. More studies are needed to evaluate the possible benefits of isolation protocols of HCV patients on regular HD.

Introduction: The recognition of antibody mediated rejection has led to re-appreciation of the role of B cells in acute and chronic allograft rejection. The presence of CD20 positive lymphocytic infiltrates in acute cellular rejection has been associated with poor clinical outcomes and reduced graft survival. Recently molecular gene analysis has shown that grafts with antibody-mediated rejection (ABMR) have lower expression of CD20.

Methods: We reviewed 28 renal allograft biopsies, including 13 biopsies from patients who experienced acute ABMR and a matched group of 15 patients with acute T cell mediated rejection (TCMR) to serve as controls. All biopsies were stained by anti-CD20 and anti-CD8 antibodies.

Results: All twenty-eight biopsies were found to have CD20 positive cells within their interstitial infiltrate. The distribution of CD20 positive cells varied from sparse cells to small or dense clusters in the interstitium. We found no statistically significant differences in CD20 or CD8 cell counts between the ABMR and TCMR groups. We noticed a weak positive correlation between the numbers of CD20 positive cells and the grade/severity of rejection but it didn't reach statistical significance (r=0.37, p=0.06). However, we found a significant positive correlation between the number of CD20 positive cells and intimal artertitis score (r=0.39, p < 0.05).

Conclusion: Our findings suggest that there is a possible relation between the presence of CD20 positive lymphocytic infiltrates and a more severe histological form of rejection. However, we failed to establish a relationship between their actual presence in the interstitial infiltrate and distinct mechanisms of graft rejection.

Introduction: Central vein stenosis (CVS) is a common complication of central venous catheter (CVC) insertion. In this study we evaluated the prevalence and risk factors of CVS among hemodialysis (HD) patients in a single center in Sudan, using Doppler ultrasound as a screening tool.

Methods: The study included 106 prevalent HD patients. For every patient, we performed Duplex Doppler for the right and left jugular, subclavian and femoral veins. A patient was considered to have hemodynamically significant stenosis if the pre-stenosis to the post-stenosis velocities ratio was ≥ 2.5 or they had complete vein occlusion.

Results: Overall, 28.3% of patients had Doppler detected CVS, including 25.5% with hemodynamically significant stenosis and 2.8% with compromised flow. The prevalence of CVS was 68.4% among symptomatic patients compared to 19.5% in asymptomatic patients. The prevalence of CVS among patients with history of 0-1, 2-3 and ≥ 4 central venous catheters was 3.4%, 29.4% and 53.8% respectively (p=0.00). CVS was not more common in patients with history of previous/current jugular or femoral vein catheterization compared to no catheter placement in these veins (28.3% vs 28.6% and 35% vs 26.7% respectively; p >0.1). However, CVS was significantly more common in patients with previous/ current subclavian vein catheterization compared to no catheter placement in this vein (47.8% vs 22.9%, p = 0.02).

Conclusion: CVS is highly prevalent among studied HD patients, particularly in the presence of suggestive clinical signs. The number of HD catheter placements and subclavian vein utilization for dialysis access impose a significantly higher risk of CVS.

Introduction: The water used for dilution of hemodialysis concentrates has to meet official quality recommendations regarding microbiology and chemical parameters. To avoid chemical use and to simplify treatments, hot water has been used to control microbial contamination of water distribution systems. In this study we evaluated the efficacy of heat disinfection in maintaining the quality of dialysis water generated by reverse osmosis (RO).

Methods: During the first part of the study, we consecutively used (1) continuous water circulation, (2) daily heat disinfection and (3) a combination of daily heat disinfection and weekly chemical disinfection while checking bacterial count and endotoxin level every 4-5 weeks. During the second part of the study, we continued using daily heat disinfection while checking bacterial count and endotoxin level on weekly basis.

Results: The endotoxin levels at all sampling points of the water treatment system were lower than 0.005/ ml throughout the study. The application of heat disinfection alone reduced bacterial levels but an escape phenomenon occurred. After an interval of 21 days, an exponential increase of bacterial count was noted and cultures from the RO unit revealed growth of Pseudomonas fluorescence. The addition of chemical disinfection was successful in eliminating micro-organisms. Throughout this study, micro-organisms and endotoxins were not detectable in dialysate fluid and substitution fluid in dialysis monitors.

Conclusion: The isolation of a thermo-sensitive organism from the RO unit after a period of relying on thermal disinfection suggests the existence of dead space in the RO unit that is not adequately exposed to heat but is accessible to chemical disinfection. .

Introduction: Rare cases of association between lupus nephritis (LN) and minimal changes nephrotic syndrome (MCNS) were described. Some authors suggest that this association, taking into account the low prevalence of both diseases, may not be a simple coincidence. Several pathophysiological hypotheses have been proposed to explain this association, including a potential central role of T lymphocytes.

Case report: We describe the case of a 21 years-old female patient who initially presented with isolated nephrotic range proteinuria. She had no evidence of systemic involvement and Immunological tests were negative, including anti-neutrophil antibodies (ANA) and anti-double-stranded DNA antibodies (Anti-dsDNA). Renal biopsy showed normal glomeruli under light microscopy and no significant deposits were found in immunofluorescence studies. She was diagnosed to have MCNS and responded to a short course of steroids. She remained in remission for three years, after which she presented again with nephrotic-range proteinuria accompanied by clinical signs of systemic involvement. During her second presentation, she fulfilled the diagnostic criteria of systemic lupus erythematosus (SLE) and another kidney biopsy showed class-V lupus nephritis. She was treated with pulse steroids followed by oral prednisolone and mycophenolate mofetil, with good clinical response.

Conclusion: This case indicates that relapses of MCNS should be carefully investigated in the right setting to avoid missing a systemic disease such as SLE.

Youth, which is forgiven everything, forgives itself nothing: age, which forgives itself everything, is forgiven nothing. George Bernard Shaw The proportion of older people in the general population is steadily increasing worldwide, with the most rapid growth in low-and middle-income countries [1]. This demographic change is to be celebrated, because it is the consequence of socioeconomic development and better life expectancy. However, population aging also has important implications for society - in diverse areas including health systems, labor markets, public policy, social programs, and family dynamics [2]. A successful response to the aging population will require capitalizing on the opportunities that this transition offers, as well as effectively addressing its challenges. Chronic kidney disease (CKD) is an important public health problem that is characterized by poor health outcomes and very high health care costs. CKD is a major risk multiplier in patients with diabetes, hypertension, heart disease and stroke - all of which are key causes of death and disability in older people [3]. Since the prevalence of CKD is higher in older people, the health impact of population aging will depend in part on how the kidney community responds. March 13, 2014 will mark the celebration of the 9th World Kidney Day (WKD), an annual event jointly sponsored by the International Society of Nephrology and the International Federation of Kidney Foundations. Since its inception in 2006, WKD has become the most successful effort to raise awareness among policymakers and the general public about the importance of kidney disease. The topic for WKD 2014 is "CKD in older people". This article reviews the key links between kidney function, age, health and illness - and discusses the implications of the aging population for the care of people with CKD.

Introduction: The term hypertensive nephrosclerosis has traditionally been used to describe a clinical syndrome characterized by long-term essential hypertension, hypertensive retinopathy, left ventricular hypertrophy, minimal proteinuria, and progressive renal insufficiency. In the absence of renal biopsy, the diagnosis of hypertensive nephrosclerosis is one of exclusion.

Methods: We retrospectively studied 735 patients who had renal biopsies at Ain Shams University Hospitals between January 2008 and Dec 2010. The prevalence of vascular hypertensive changes was studied in relation to clinical presentation and the glomerular pathology pattern.

Results: Male to female ratio was 1:1 and the mean age was 27±17 years. No vascular hypertensive changes were found in 44.5% of biopsies while mild, moderate and severe changes were found in 28%, 22% and 4.2% respectively. Malignant hypertensive changes were seen in 1.2% of biopsies. Lupus nephritis was the most common etiology representing 18.9% of all cases, followed by focal segmental glomerulosclerosis (FSGS) (13.5%), membranoproliferative glomerulonephritis (13.3%) and membranous glomerulonephritis (8.2%). Moderate to severe vascular hypertensive changes were more common in biopsies with FSGS compared to other glomerulopathies. Hypertensive nephrosclerosis as the sole cause of renal failure represented only 1.6% of cases. Significant associations were found between the degree of vascular hypertensive changes and the grade of hypertension. Patients with severe vascular hypertensive changes were significantly older and had significantly higher serum creatinine levels compared to other groups.

Conclusion: History and grade of hypertension significantly influence the degree of vascular hypertensive changes in renal biopsy. Moderate to severe vascular hypertensive changes were more common in biopsies with FSGS compared to other pathologies.

Keywords: Hypertension; Nephroangiosclerosis; Renal Biopsies.

Introduction: Childhood renal diseases are increasing in Nigeria. It is necessary to monitor the nature of these diseases in each locality for effective health care planning. Our aim was to document the nature of renal diseases in the Niger Delta Region of Nigeria and compare it with other regions in the country.

Methods: We reviewed the documents of all children presenting with renal diseases between January 2010 and December 2012 to the Delta State University Teaching Hospital in Oghara and GN Children's Clinic in Warri, the two major pediatric nephrology service providers in the Niger Delta region of Nigeria.

Results: A total of 110 patients were studied, comprising 73 males and 37 females. About half the patients were aged 5-10 years. Renal diseases accounted for 1.6% of all admissions during the same period. The commonest presentations were nephrotic syndrome (30%), acute glomerulonephritis (18.2%), urinary tract infection (16.3%), acute kidney injury (10.9%), chronic kidney diseases (7.3%) and obstructive uropathy (7.3%). Regarding the outcome of renal diseases, 80% of the patients achieved full recovery, 14.6% died and 5.4% were discharged against medical advice or lost to follow up. The highest mortality rate was among patients with chronic kidney disease (75%), followed by acute kidney injury (41.7%).

Conclusion: A renal registry based on unified definitions of renal diseases is required for the proper planning of health care strategies. Mortality rate of chronic kidney disease was high in this study mostly due to late presentation.

Introduction: Congenital abnormalities of the kidney and urinary tract (CAKUT) are significant causes of end stage renal disease (ESRD) in children. Some of these abnormalities, when identified early, are amenable to treatment. In developing countries, very few published reports exist concerning the pattern and scope of CAKUT in childhood.

Methods: This is a retrospective review of all patients with confirmed Pelvi-Ureteric Junction (PUJ) obstruction who were diagnosed antenatally with hydronephrosis between Jan 2002 and Dec 2007 at the Red Cross Children's Hospital, Cape Town. The clinical course of every patient was reviewed for a twelve-month period after confirmation of the diagnosis.

Results: One hundred patients, 80 males and 20 females, were included in the analysis. Thirty-two children (32%) had bilateral PUJ obstruction while the rest had unilateral involvement of the left (40%) or right (28%) kidney; overall, 132 kidneys were affected. mild, moderate and severe pelvic dilatation was present in 44.7%, 36.4% and 18.9% of affected kidneys respectively. One child required nephrostomy during the first day of life while eighteen children were treated by pyeloplasty. Urinary tract infection was confirmed in eleven children. At 12 months of follow-up, 83 affected kidneys (62.9%) demonstrated spontaneous resolution of PUJ obstruction while 14 (18.5%) kidneys improved after surgical intervention. Spontaneous resolution occurred more often in kidneys with mild to moderate pelvic dilatation.

Conclusion: Spontaneous resolution of the PUJ obstruction occurred in a substantial proportion of children by twelve months of follow-up and complete resolution is more likely in mild to moderate dilatation.