Saudi Journal of Kidney Diseases and Transplantation最新文献

This practice guideline was developed by the chronic kidney disease (CKD) Task Force, which was composed of clinical and methodological experts. The Saudi Arabian Ministry of Health and its health holding company commissioned this guideline project to support the realization of Vision 2030's health-care transformation pillar. The synthesis of these guidelines was guided by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)- ADOLOPMENT methodology. The final guidelines addressed 12 clinical questions on the management of blood pressure in patients with CKD through a set of recommen-dations and performance measures. The recom-mendations included antihypertensive agents in children; renin- angiotensin system inhibition (RASi) versus non-RASi in adults; intensive versus standard blood pressure targets; early versus late assessment for kidney replacement therapy (KRT); late versus early preparation strategies for KRT; CKD symptoms during assessment for KRT or conservative manage-ment; initiation of KRT in patients with deteriorating CKD; choice of KRT modality or conservative management in certain CKD patient groups; changing or discontinuing KRT modalities; the frequency of reviews for KRT or conservative management; and information, education, and support. These conditional recommendations were based on a low to very low certainty of evidence, which highlights the need for high-quality randomized trials com-paring different antihypertensive agents in patients with CKD.

Ambulatory blood pressure monitoring (ABPM) is a reliable modality and is preferred over office blood pressure monitoring (OBPM) for detecting hypertension. However, despite its advantages, the utilization of 24-h ABPM in evaluating living kidney donors has not been universally adopted by transplant centers, partly because of the lack of data about the utility of ABPM. This study aimed to identify patients with masked and white-coat hypertension, thereby ensuring appropriate identification of their true hypertension status and assessments of the risk to donors. This study included 73 potential living kidney donors. BP was measured in the office using a standardized protocol as well as by ABPM. Detailed clinical and biochemical parameters were assessed. Target organ damage was assessed in all the donors by assessing proteinuria, hypertensive retinopathy, and echocardiography. Out of the 73 donors, 64.4% were females and 35.6% were males. The average age of individuals in our donor population was 42.0 ± 11.28 years. In total, 31.5% were detected to be hypertensive by OBPM. With ABPM, only 21.9% of donors were hypertensive. The overall prevalence of white-coat hypertension was 30.4%; that of masked hypertension was 6.0%. In donors diagnosed as hypertensive by OBPM, three individuals were identified as having target organ damage. However, two additional donors who were initially missed as hypertensive using OBPM had target organ damage. OBPM overestimated the prevalence of hypertension compared with ABPM. ABPM is the better modality in terms of diagnosing white coats and masked hypertension. ABPM also more reliably correlates with target organ damage than OBPM.

Microalbuminuria is a well-established, strong, and independent risk factor of cardiovascular disease. Patients with microalbuminuria are also said to have a higher atherosclerotic load in the form of multivessel coronary artery disease (CAD) than those who do not. In this study, we tried to correlate microalbuminuria with the severity of CAD. In this cross-sectional study, 100 patients with CAD diagnosed on the basis of coronary angiography were enrolled from August 2019 to August 2021. Triple-vessel CAD was observed in 79.4% of cases with the presence of microalbuminuria compared with 3% of cases without microalbuminuria. The association of microalbuminuria with the severity of disease was statistically significant (P <0.01). A significant correlation was observed between microalbuminuria and the Framingham risk score in cases of CAD (P <0.01), which was a measure of the 10-year risk of cardiovascular disease.

Patients with hematological malignancies (HMs) are at high risk of infections and comorbidities that substantially increase the occurrence of renal failure. Thus, the management of renal dysfunction in patients with HMs is crucial. The current study aimed to determine the incidence of renal involvement in patients with HMs and analyze their clinical profile in the context of renal disorders. A prospective observational study was conducted on 200 patients suffering from various HMs. Renal involvement was determined through blood and urine analyses. The mean age of the patients was 51.84 ± 17.47 years, with the male-to-female ratio being 1.5:1. Multiple myeloma (MM) (30.5%) and non-Hodgkin's lymphoma (NHL) (30.5%) were the most commonly observed types of HM, whereas plasmacytoma (1%) was the least observed. Moreover, 39.5% and 16.5% of patients were diagnosed with moderate and severe anemia, respectively. Mean calcium, creatinine, and blood urea nitrogen levels were 8.97 ± 1.19 mg/dL, 1.41 ± 1.37 mg/dL, and 16.83 ± 14.50 mg/dL, respectively. Mean sodium, potassium, and uric acid levels were 135.49 ± 6.79 mEq/L, 4.157 ± 0.65 mEq/L, and 5.81 ± 2.82 mg/dL, respectively. Twelve percent of the patients (24 out of 200) presented with renal insufficiency and nephrotic syndrome. Ten patients were diagnosed with NHL, 10 patients with MM, two with chronic myeloid leukemia, and two with acute myeloid leukemia. The causes of renal impairment in most cases were patchy interstitial lymphoid infiltrates, cast nephropathy, acute tubular necrosis, and minimal change disease.

Diabetic nephropathy (DN) is a major complication of diabetes mellitus (DM), leading to end-stage renal disease. A wide spectrum of nondiabetic renal diseases (NDRDs) is reported in type 2 DM. We retrospectively reviewed the medical records of patients with type 2 DM who underwent a kidney biopsy from September 2019 to November 2021 at our center. Patients were grouped as having isolated DN, isolated NDRD, or mixed NDRD with underlying DN. According to the 379 renal biopsies performed during the study period, 57 patients had DM. The prevalence of DN, isolated NDRD, and combined pathologies was 36.8%, 35.1%, and 28.1%, respectively. The most common NDRD was infection-related glomerulonephritis (IRGN) (50.0%), followed by membranous nephropathy (3.0%), focal segmental glomerulosclerosis (10%), pyelonephritis (10%), minimal change disease (1.8%), fibrillary glomerulonephritis (1.8%), and ANCA-associated vasculitis (1.8%). The most common pathological finding of NDRD in the mixed group was IRGN (56.3%), followed by acute tubular injury (31.3%). The duration of DM was significantly shorter (4.8 ± 2.3 years vs. 9.7 ± 3.3 years, P = 0.035) in NDRD patients compared with patients with DN. NDRD was observed in 15% and mixed lesions in 25% of patients, with concomitant diabetic retinopathy (P = 0.029). We conclude that with increasing evidence of NDRD even in patients with DN, careful application of renal biopsies in diabetic patients would assist in the early diagnosis and institution of specific therapy for NDRD to ensure better patient and renal survival.

Boswellia serrata has been used in traditional medicine to treat various inflammatory diseases. Acetyl-11-keto-β-boswellic acid (AKBA) and incensole acetate (IA) are two active ingredients of B. serrata that possess anti-inflammatory and antioxidant activities. The present study aimed to investigate the protective effects of AKBA and IA against lipopolysaccharide (LPS)- induced acute kidney injury (AKI) in rats. Wistar rats were intraperitoneally pretreated with AKBA or IA for 2 weeks. After 30 min, an LPS injection was applied to induce AKI. Blood samples and kidney tissues were collected and used for biochemical assays. AKBA and IA not only significantly decreased interleukin-6 as a marker of renal inflammation but also attenuated the oxidative stress markers in kidney tissues. AKBA and IA also remarkably decreased serum creatinine and blood urea nitrogen. These results suggest that AKBA and IA have protective effects against AKI in rats through regulating inflammation and oxidative stress.

Pulmonary mucormycosis is rare in kidney transplant recipients and has a high mortality rate. We report a case of pulmonary mucormycosis presenting as round pneumonia 1 year and 1 month after the transplant. The diagnosis was confirmed by a percutaneous lung biopsy. A complete resection of the lung mass, followed by intravenous liposomal amphotericin B therapy, saved the life of the patient. In conclusion, early and prompt diagnosis followed by complete resection of the lesion in pulmonary mucormycosis is lifesaving.

Recently, the effect of an aqueous extract of asafetida on acute angiotensin II hypertensive rats was evaluated. The present study evaluated the antihypertensive and antioxidant effects of asafetida on a rat model of renovascular hypertension (RVH) using four groups. RVH was induced by clipping the renal artery; the sham group underwent surgery but without clipping. The RVH rats received losartan (Los, an AT1 receptor antagonist) or asafetida by gavage for 4 weeks. On the 28th day, the femoral artery was cannulated, and the systolic blood pressure (SBP), mean arterial pressure (MAP), and heart rate (HR) were recorded. Finally, the levels of superoxide dismutase (SOD) activity, malondialdehyde (MDA), and total thiol content in the kidney and heart tissues were measured. In RVH rats, SBP and MAP significantly increased compared with the control. Los and the extract significantly reduced the changes in SBP, MAP, and HR that were induced in the RVH rats (P <0.05-0.001). In RVH rats, levels of MDA significantly increased and the content of total thiol and SOD decreased in both the heart and kidney tissues. Los plus the extract significantly decreased MDA and increased total thiol and SOD in the heart and kidney tissues. We concluded that an aqueous extract of asafetida gum has antihypertensive and antioxidant effects in the RVH rat model. The effect of the extract is similar to that of Los, which suggests that this effect of asafetida is mediated via an effect on the angiotensin Type I receptor.

Renal failure is a common feature of multiple myeloma (MM) that occurs in 20%-40% of newly diagnosed patients with MM and is the result of monoclonal immunoglobulin light chains. Many studies have examined the effect of autologous stem cell transplantation (ASCT) in MM patients with renal impairment and the safety of performing the transplantation in patients with renal failure. This study aimed to compare renal function before and after ASCT in Egyptian MM patients with renal insufficiency to evaluate the effect of ASCT on renal recovery. Our study included 31 MM patients with renal impairment out of 400 patients who met the criteria of the International Myeloma Working Group for symptomatic MM. The estimated glomerular filtration rate (eGFR) calculated by the Modification of Diet in Renal Disease formula was compared before and after the transplant. Only four patients (12.9%) were dependent on dialysis. Six of those with a history of hemodialysis (HD) who were either dependent on dialysis or dialyzed according to need achieved independence from HD. There was no significant correlation between the degree of renal impairment and the disease's status at the time of transplantation (P = 0.86). The study showed significant improvements in serum creatinine levels compared with its value before the transplant (P = 0.016) and in eGFR (P = 0.004). In total, 45% of patients achieved renal improvement, shown by a 25% increase in GFR above the baseline. There was a significant improvement of renal function after ASCT in MM patients with renal impairment.