Saudi Journal of Kidney Diseases and Transplantation
ISSN : 1319-2442
Published by: Medknow (10.4103)
Total articles ≅ 3,540
Latest articles in this journal
Saudi Journal of Kidney Diseases and Transplantation, Volume 32; https://doi.org/10.4103/1319-2442.352429
Coronavirus disease-2019 (COVID-19) has become a public health concern and global threat with high morbidity and mortality among kidney transplant recipients. However, risk factors and manifestations in this group of patients remain poorly understood. We aimed to study the clinical characteristics, laboratory parameters, and disease course of kidney transplant recipients with COVID-19 pneumonia. We enrolled 35 kidney transplant patients with COVID-19 pneumonia from March 2020 to November 2020 and studied their clinical records, laboratory results, radiological characteristics, and outcome. Their mean age was 44.82 ± 11.69 years (range: 17-65). The most common symptom was fever (94.28%) followed by cough (54.28%), fatigue (48.57%), shortness of breath (34.28%), and diarrhea/nausea/vomiting (22.85%). Leukopenia was seen in two patients (20.8%), and three patients had leukocytosis, while 75% of the patients had a white cell count in the normal range. Lymphopenia (<1100 per mm3) was seen in 23 patients (79%). All patients had elevated levels of C-reactive protein (CRP) with a range of 6-239.9 mg/L. An increase in serum creatinine from the baseline was seen in 25 patients (71.42%) with a mean of 2.62 mg/dL. Computerized tomography scan of the chest of 30 patients (85.71%) showed typical findings of multifocal ground glass shadows in both lung fields. Injection remdesivir was given in 28 patients (80%), and tocilizumab was given to three patients. Mortality was seen in six patients (17.14%), higher in those with O2 saturation <95% on admission (odds ratio: 6.29). Patients with kidney transplants display a high risk of mortality. The presence of multiple coexisting comorbidities, hypoxia at the time of admission, and high level of inflammatory markers (lactate dehydrogenase, CRP, D-dimer, and ferritin) is predictive of poorer outcomes.
Saudi Journal of Kidney Diseases and Transplantation, Volume 32; https://doi.org/10.4103/1319-2442.338282
Glomerulonephritis (GN) is rare kidney disease that often requires treatment with immunosuppressive drugs. The choice of therapy usually relies on international guidelines. There are no data so far regarding the treatment of glomerular diseases in the eastern Mediterranean region. This study aimed to describe the most frequently treated glomerular diseases among the Lebanese population. This is a retrospective study that reviewed all patients’ medication coverage claims, presented at the Lebanese Ministry of Public Health between 2014 and 2015. All patients that had kidney biopsies in their charts were included. A total of 144 patients were included: 35 children and 109 adults. Half of the children had minimal change disease treated with mycophenolate mofetil (MMF). In adults, 33% had lupus nephritis (LN) with a male to female ratio 12/24, 28.4% focal segmental glomerulosclerosis (FSGS), 14.6% membranous nephropathy (MN), and 24% other types. There was a significant difference in age among different GN (P = 0.01). MMF was the most commonly used drug in adults: 88.8% of LN cases, 51.6% in FSGS, 18.7% in MN, and 100% in immunoglobulin A nephropathy. This study showed that LN is the most frequently treated GN in Lebanon and was managed according to guidelines. MMF use was prevailing even in cases not suggested by the Kidney Disease Improving Global Outcomes. Further studies are needed to see whether these results apply to other countries.
Saudi Journal of Kidney Diseases and Transplantation, Volume 32; https://doi.org/10.4103/1319-2442.338303
Hypogonadism is common in patients with chronic kidney disease especially for end-stage renal disease (ESRD), which is referred to as uremic hypogonadism. Men with ESRD are prone to reproductive and sexual disorders such as sexual desire loss, abnormalities in orgasm, sexual dysfunction, and erectile dysfunction (ED). The mechanism of this complex disorder is not well known. Considering the above, we decided to study the effect of renal transplantation on hypogonadism and sexual activity in patients with ESRD. This study was performed on 45 patients with ESRD undergoing renal transplantation. Patients were included into two groups of live donor (24) and cadaveric (21), according to the type of kidney donors. The International Index of Erectile Function-5 (IIEF5) questionnaire was filled out for evaluation of erectile and sexual status. Laboratory parameters were assessed before the renal transplant in a single and valid laboratory including blood urea nitrogen, creatinine, thyroid function tests, luteinizing hormone, follicle-stimulating hormone, testosterone, and prolactin. We refilled the ED questionnaire and checked the laboratory tests again three and six months after transplantation. The mean age of the patients was 51.7 ± 8.0. The mean blood testosterone level in the live group was 347.1 ± 64.9 before transplantation, which reached 413.1 ± 25.9 in six months after transplantation. The same variable for the cadaveric group was 306 ± 56.2 and 355.3 ± 56.9, respectively. The IIEF5 scores before and six months after transplantation were 17.2 ± 4.5 and 24.6 ± 3.3 respectively for the live group and 10.8 ± 2.4 and 13.9% ± 4.1% for the cadaveric one, all of which were statistically significant. Renal transplantation significantly improves the condition of hypogonadism and ED in patients with ESRD. This improvement is not related to the type of donation.
Saudi Journal of Kidney Diseases and Transplantation, Volume 32; https://doi.org/10.4103/1319-2442.338294
Human brucellosis is a complex multisystem disease that can affect many organs. Renal involvement in human brucellosis is rarely found. Here, we present a case report of a patient who presented to us with acute kidney injury, complicating brucellosis. After thorough evaluation including kidney biopsy, the patient was found to have nephritic syndrome due to rapidly progressive glomerulonephritis. The patient reached a complete remission after completing a course of anti-brucellosis treatment.
Saudi Journal of Kidney Diseases and Transplantation, Volume 32; https://doi.org/10.4103/1319-2442.338301
The revolutionary innovations in biology and information technology influenced many medical and health disciplines. Although it is lagging behind others, renal medicine entered this chain of events. Nephrology and renal transplantation have many inherent challenges that needed to be addressed innovatively to receive these new frontiers in medicine. In a connected high biotech future, the applications of regenerative medicine, nanotechnology, genomics, artificial intelligence, 3D organ bioprinting, and smartphone applications will reshape the practice and research of renal medicine. Certainly, this will have a positive impact on patients’ outcomes and the health-care system. These changes are coming, but with new challenges such as excess costs, and many moral challenges. Providing precise equitable care with maintaining patient’s privacy and values will be difficult. In this review, we provide insights into future approaches to renal care.
Saudi Journal of Kidney Diseases and Transplantation, Volume 32; https://doi.org/10.4103/1319-2442.338293
About 3% of the population aged more than 50 years, is affected by monoclonal gammopathy of undetermined significance (MGUS), a premalignant condition that may progress to lymphoproliferative disorders. Since MGUS does not represent the diseases associated with end organ damage, a new term, monoclonal gammopathy of renal significance (MGRS) is coined for the monoclonal gammopathies that are associated with renal disorders. MGRS is classified into various types, including monoclonal immunoglobulin deposition disease (MIDD) and proliferative glomerulonephritis with monoclonal immunoglobulin deposition (PGNMID). PGNMID presents with membranoproliferative glomerulonephritis-type lesions associated with immunoglobulin deposition. This disease entity has a poor prognosis and its optimum treatment is yet to be established. We present the case of an elderly male, a known patient of light chain deposition disease, a form of MIDD, who initially lost to follow-up but later presented with PGNMID, wherein he was treated with steroid and cyclophosphamide, to which he responded.
Saudi Journal of Kidney Diseases and Transplantation, Volume 32; https://doi.org/10.4103/1319-2442.338284
Acute kidney injury (AKI) in postpartum is a rare, but deadly complication of pregnancy. It has great impact on maternal and fetal outcomes. The study aimed to study the incidence and etiological profile with outcomes of postpartum AKI patients and to see whether need for hemodialysis (HD) alters the outcome. This is a retrospective observation study done in a tertiary care center at the Department of Nephrology, Ramkrishnan Care Hospital, Raipur, Chhattisgarh, India. All postpartum women suffering from AKI between May 2011 and May 2017 were included in this study. Demographic, clinical, and laboratory data of the patients were included. Outcome variables including maternal and fetal mortality with renal outcome during discharge and follow-up for three months were noted. Patients were divided into two groups: Group 1 underwent HD and Group 2 was managed conservatively. Statistical analysis was done on the Statistical Package for the Social Sciences software version 17.0. Categorical data were expressed as ratio and proportions, while continuous data were expressed as mean plus standard deviation (SD). Quantitative data were analyzed by percentage, mean, SD, and t-test. Qualitative data were analyzed by Chi-square test. The incidence of postpartum AKI was 3.26% and the mean age of the study population was 27.3 ± 4.77 years. Multifactorial (53.27%) etiology was the most cause of postpartum AKI, and the second was puerperal sepsis (32.7%). Seventy-three (68.22%) patients had undergone HD. Four (4.47%) patients require lifelong HD. Renal biopsy was done in seven patients, three had cortical necrosis among fetal outcomes, total live births were 92 (85.98%), and 15 (14.01%) died in the neonatal period. There was no statistically significant difference between Group 1 and Group 2 in etiological profile (P >0.55), maternal mortality (P >0.66), and renal outcome (P >0.11). Postpartum AKI was associated with poor maternal outcome and renal recovery. Maternal mortality and renal recovery were not affected by need of dialysis in our patients. Proper antenatal care and peripartum monitoring with practicing aseptic precaution will definitely help in reduction of postpartum AKI and maternal mortality in our state.
Saudi Journal of Kidney Diseases and Transplantation, Volume 32; https://doi.org/10.4103/1319-2442.338278
Ischemic and reperfusion injury (IRI) occurs during organ transplantation. IRI during liver transplantation is well studied and established; results in coagulopathy due to release of heparin-like substances and platelet trapping. During renal transplantation, similar IRI phenomenon occurs, and thromboelastography (TEG) can be used to detect and manage coagulopathy. The preoperative, immediate postreperfusion, and postoperative day 1 TEG was done on 25 cases of live-related renal transplantation. Coagulopathy was defined by deranged and abnormal TEG variables values from baseline and supported by the clinical presence of nonsurgical oozing and bleeding in the surgical field. The postreperfusion TEG values showed coagulopathic changes. About 64% of patients had R-time (RT) more than 12 min, 64% of patients showed maximum amplitude (MA) <55 mm, and 76% of patients had alpha angle <55°. The presurgical TEG clotting index (CI) was +2.45 ± 1.25, postreperfusion CI was -1.96 ± 4.54, and postoperative CI was +4.02 ± 1.35. Univariate analysis revealed that antithymocyte globulin was a significant, but etiology was closure to a significant level as protecting factor, but in multivariate analysis, both variables showed protecting factor with insignificant results. There was a weak correlation between CI with serum creatinine at all time points suggested no linear relationship between serum creatinine and corresponding CI. Hence, the results of study proves that IRI during renal transplant is associated with transient self-limiting coagulopathy, that may be early detected by TEG. CI values in postoperative 24 h apart indicating a hyper-coagulable or prothrombotic state and post-reperfusion CI values show a trend toward hypocoagulable status. No significant effect of different immunosuppression on coagulation and week correlation was found of serum creatinine level (graft function) with CI, which conclude that changes in coagulation have not affected graft function.
Saudi Journal of Kidney Diseases and Transplantation, Volume 32; https://doi.org/10.4103/1319-2442.338297
Saudi Journal of Kidney Diseases and Transplantation, Volume 32; https://doi.org/10.4103/1319-2442.338311
Because of its high prevalence, hypertension (HTN) will continue to exert an increased financial burden on both the individual and the governmental health budgets unless we consider changing our efforts in managing HTN. Since the discovery of the first antihypertensive agent, during the 19th century, we had been focusing on blood pressure (BP) treatment by lowering the systolic and diastolic levels. Over decades, multiple drugs and combinations were introduced to lower the BP and reduce target organ damage, but they were unsuccessful in reducing the incidence or significantly limiting the prevalence. This study focuses on screening teenagers among middle and high schools. Looking for the prevalence and increasing awareness at the same time. It is about time to consider a different approach to stand against HTN. A world without HTN could be optimistic. However, looking into reducing the incidence and limiting the prevalence by early intervening and increasing awareness could be a reasonable first step in that direction. In this study, we screened 2747 students in 14 middle and high schools in Bahrain. The mean systolic BP was 114 mm Hg [standard deviation (SD): 13.9/standard error (SE): 0.27]. The mean diastolic BP was 67 mm Hg (SD 9.6/SE 0.18). Of the screened students, 38% had abnormal elevated BP. Among elevated BP, 68% had isolated systolic high pressure. Younger teenagers were having the higher BP. Age, gender, waist circumference, school, and nationality were among the independent variables associated with elevated BP. Body mass index was not related to elevated BP. Focusing more on prevention and early diagnosis could be a first step toward elimination of HTN, or at least reducing its prevalence.