Saudi Journal of Kidney Diseases and Transplantation最新文献

This study investigated the relationship between renalase and diurnal blood pressure (BP) rhythm, left ventricular mass index (LVMI) and carotid intima-media thickness (IMT) in autosomal dominant polycstic kidney disease (ADPKD) patients. The study included 59 ADPKD patients and 36 healthy volunteers. Renalase, noradrenalin, adrenaline, creatinine (Cr) and spot urine microalbumin-Cr ratio were studied; 24-h ambulatory BP and carotid IMT were measured, and LVMI was calculated. The ADPKD group comprised 21 hypertensive and 38 normotensive patients, and the control group comprised 36 healthy participants. Renalase levels were significantly higher in hypertensive and normotensive ADPKD patients than in the control group (69.7 ± 90.02 ng/mL and 91.93 ± 106.55 ng/mL vs. 16.9 ± 51.4 ng/mL; P = 0.042 and P = 0.001, respectively). The renalase levels were higher in the hypertensive ADPKD group than in the normotensive ADPKD group but they were not statistically significant (91.93 ± 106.55 ng/mL vs. 69.7 ± 90.02 ng/mL; P = 0.486). LVMI was significantly higher in the hypertensive ADPKD group compared with the normotensive ADPKD and control groups (92.2 ± 20.9 vs. 76.2 ± 16.89 and 68.6 ± 12.75; P = 0.02 and P = 0.001, respectively). There was no statistically significant difference in carotid IMT between the groups (0.59 ± 0.16, 0.65 ± 0.17 and 0.58±0.1; P = 0.442, respectively). Renalase levels were significantly higher in the normotensive ADPKD and hypertensive ADPKD groups compared with the control group, but its relationship with circadian BP rhythm, LVMI and carotid IMT was not demonstrated.

Renal size is an important parameter used for the clinical evaluation of renal growth and renal diseases in children. Renal length is the most useful parameter for measuring renal size. Therefore, establishing the normal value of renal length in children is valuable, as it can serve as a baseline for the diagnosis of renal diseases and possible interventions. The objective of our study was to assess renal length in Bangladeshi children by ultrasonography. This cross-sectional study was carried out in the Department of Pediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from January 2019 to June 2020. In total, 369 apparently healthy children aged 1 month to 18 years were included in this study. Renal length was measured by ultrasonography by same experienced radiologist. The mean renal length ± standard deviation was calculated for each age group. The correlation of renal length with age and anthropometric parameters was tested using Pearson's correlation test. No statistical difference was found in renal length between the two sexes. The left kidney was significantly longer than the right kidney (P <0.001). There were strong positive correlations of renal length with age and anthropometric parameters. The best positive correlation was found between renal length and height (r = 0.95 and 0.94 for the right and left kidneys, respectively). Linear regression equations were obtained to predict the renal length from age and anthropometric parameters. Renal length has a strong positive correlation with body length/height.

Peritoneal dialysis (PD) has been reported as a long-term maintenance treatment of refractory congestive heart failure (RCHF). In this study, we aimed to evaluate the outcome of 24 PD patients with RCHF and Stage IV chronic kidney disease. The continuous ambulatory PD program consisted of two or three exchanges daily and one exchange nightly. In the follow-up period, clinical and echocardiographic biochemical findings and the need for hospitalization were recorded. Fifteen patients (66.7%) were male, and the mean age was 62.75 years. Under the PD treatment, the average daily urine volume and ultrafiltration of the patients were 800-1000 mL and 1000-15,000 mL, respectively. Ten patients were followed for 24 months and eight patients were followed for 12 months. During the follow-up period, there was a regression in the New York Heart Association heart failure class (from Class IV to Class II in 18 patients), and a decrease in body weights and an increase in serum sodium levels in all patients. Only two patients were hospitalized for cardiovascular disease over 2 years. During the follow-up period, one patient was transferred to hemodialysis because of peritonitis. In conclusion, in patients with RCHF and chronic renal failure without dialysis, PD in addition to standard treatment may be a safe treatment choice.

Granulomatous interstitial nephritis (GIN) is rare in childhood and is associated with poor outcomes. We report a 6-year-old girl who developed nephrotic-range proteinuria following chronic non-steroidal anti-inflammatory drug (NSAID) use for juvenile idiopathic arthritis (JIA). Other possible etiologies were ruled out, and the diagnosis of GIN was confirmed by renal biopsy. NSAIDs were henceforth withheld and prednisolone was started, which resulted in amelioration of proteinuria. Strong suspicion, quick diagnosis and early initiation of therapy improve the outcome in GIN and prevents or delays kidney failure.

Minimal change disease is a significant cause of primary nephrotic syndrome in adults of all ages, accounting for approximately 10-15% of cases. Prednisolone is commonly taken for a minimum of 4 weeks and a maximum of 16 weeks in adult patients with minimal change disease at a dose of 1.0 mg/kg/day (with a maximum of 80 mg/day). Long-term use of high-dose steroids increases the chance of developing a variety of steroid-related toxicities, the most common of which are diabetes mellitus, gastrointestinal problems, infections, osteoporosis and steroid-induced psychiatric syndrome, all of which can impair quality of life. Here, we report a case of spinal epidural lipomatosis, which is an uncommon side effect of steroid medications encountered by us in an adult patient who presented with nephrotic syndrome and had a kidney biopsy that revealed minimal change disease and was treated with steroids.

Hearing loss in end-stage chronic renal failure is more common than in the general population. The etiopathogenetic mechanisms reported included the use of ototoxic drugs, hypertension, fluid and electrolyte disorders associated with kidney failure, and factors related to hemodialysis itself, such as acute hypotension, reduced blood osmotic pressure, acute urea clearance, and the immunological reaction caused by dialyzer membranes. The aim of our study was to evaluate auditory function in patients with end-stage chronic renal failure, to study the prevalence of hearing loss and the factors that may influence its occurrence in these patients, and to evaluate the effects of a single session of hemodialysis on the parameters of hearing. A descriptive and analytical cross-sectional study was conducted in hemodialysis patients attending the hemodialysis center of the university hospital Ibn Rochd of Casablanca. The inclusion criteria were age less than 65 years, patient consent, the absence of otologic pathology, and the absence of a documented history of drug ototoxicity. We collected demographic, clinical and laboratory data. All patients underwent a complete otologic examination. Tone audiometry was performed in all patients one hour before the hemodialysis session; a subgroup of patients received a second audiogram after the dialysis session. Thirty patients were enrolled. The average age was 47.37 ± 10.17 years; the sex ratio was 1, and 13.3% had hearing loss at all tested frequencies. Severe hearing loss was only found at the high frequencies (4000 and 8000 Hz); it was around 10%. Low frequencies (125 and 200 Hz) were affected in 61.67% of cases. Higher frequencies (4000 and 8000 Hz) were affected in 63.33% of cases. The prevalence of hearing loss in speech frequencies (500, 1000, 2000 and 4000 Hz) was about 33.3% (10 patients). It was mild in 20% of cases and moderate in 13.33% of cases. Sensorineural hearing loss was found in 16.6% of cases, conductive hearing loss in 10% and mixed hearing loss in 6.67%. No statistically significant correlation was found between hearing impairment in these patients and their age, gender, duration of hemodialysis, body mass index, history of ototoxic drugs, hypertension, hypotension during dialysis and biochemical parameters. There was a statistically significant correlation between hearing loss and the presence of peridialytic cramps. The comparison of hearing thresholds before and after hemodialysis did not find any statistically significant difference. The prevalence of hearing impairment in patients undergoing hemodialysis remains high. We have not been able to demonstrate the effect of hemodialysis on hearing. Hearing loss can negatively affect patients' quality of life. A hearing evaluation of patients treated for chronic renal failure may be necessary to enable appropriate and early care for possible impairment and thus avoid the social impact of deafness.

Immunoglobulin M IgM nephropathy (IgMN) is a controversial entity first described in 1970. Since its inception, the disease remains underdiagnosed because of its diverse clinical as well as morphological presentations and its lack of recognition as a separate distinct entity. We undertook this study, which includes a large number of cases, to better characterize and understand the natural history of this disease. The objective of the study was to determine the clinico-pathological features of patients diagnosed with IgMN. This cross-sectional study was conducted from 1 January 2013 to 28 February 2020 at the Department of Histopathology, Shifa International Hospital, Islamabad. All renal biopsies diagnosed as IgMN were included in the study. A comparative analysis was performed to see the associations of the clinicopathological features with the histological patterns. Univariate analysis was conducted to determine predictors of end-stage renal disease (ESRD). During the study period, 175 (2.80%) cases were diagnosed as having IgMN. The male to female ratio was 1.65:1. The mean age was 28.68 ± 16.19 years. Minimal change disease was the most common histological pattern, seen in 44% (n = 77) of the cases. Of our cases, 89% presented with nephrotic syndrome (NS) and 37.5% of the patients developed ESRD. Mean blood pressure, serum creatinine, treatment type, and response were found to be significantly associated with ESRD. IgMN in our population was frequently seen to present with NS, with variable morphological patterns. It has a poor prognosis with increased resistance to steroids and the frequent development of ESRD.

Lupus nephritis occurs in 10-40% of patients with systemic lupus erythematosus. Although crescents involving >50% of the glomeruli portend a poor prognosis, little is known about outcomes with fewer crescents. We compared the clinicopathological profiles of different percentages of crescents, treatment outcomes, the type of immunosuppression used, the characteristics of anti-neutrophil cytoplasmic antibody-positive cases, and predictors of poor outcomes in cases of lupus nephritis with crescents. This was a 14-year retrospective single-center cohort study of patients with lupus nephritis who had cellular and/or fibrocellular crescents. In total, 8515 native biopsies were evaluated. Lupus nephritis was observed in 457 patients, and crescents were found in 110 patients. The patients were predominantly young females with nephritic syndrome. The remission rate was higher in those with ≤25% of crescentic glomeruli (Cr1) [complete remission (CR): 33.3%, partial remission (PR):17.6%] and those with 25-50% (Cr2) (CR: 24.1%, PR: 10.3%) than in those with >50% (Cr3) (CR: 13.0% PR: 3.3%). Chronic kidney disease (CKD) and end-stage renal disease (ESRD) rates were higher in Cr3 (CKD: 43.3%; ESRD: 10.0%) than in Cr1 (CKD: 21.5%; ESRD: 6.8%) and Cr2 (CKD: 34.4%; ESRD: 13.8%). Serum creatinine at biopsy, estimated glomerular filtration rate at the time of biopsy, rapidly progressive glomerulonephritis clinical presentation, the percentage of global glomerulosclerosis, the percentage of tubular atrophy, and >50% crescents predicted poor outcomes. Lupus nephritis with a higher proportion of crescents has an aggressive clinical presentation, the progression of the disease is rapid, and it has a poor response to treatment, warranting intensive immunosuppression.