Saudi Journal of Kidney Diseases and Transplantation最新文献

Identifying potential cases of brain death is the first step of the organ donation process. The present study aimed to determine the effect of empowerment based on the Iranian OPUs supporting system (IROSS)on the knowledge, attitudes, and practices of intensive care nurses in identifying potential organ donors. In a quasi-experimental study, 80 nurses from the intensive care unit and emergency department of two hospitals affiliated with Shahrekord University of Medical Sciences were selected by convenience sampling and then randomly distributed into two groups, namely the intervention and control groups. The intervention group received IrOSS-based empowerment through workshops, lectures, role-playing, observation, and presence at the patients' bedside, and then, they were followed up for 2 months. Before and immediately after the intervention, as well as 2 months later, the knowledge and attitudes questionnaires and the practice checklist were completed by the two groups. Before the intervention, the mean score of knowledge, attitudes, and practices of the intervention group was not significantly different from that of the control group (P >0.05). However, immediately after the intervention and 2 months afterward, the statistical difference was positive (P <0.01), as the repeated measures analysis of variance showed an increasing trend in the mean score of knowledge, attitudes, and practices in three different situations in the intervention group (P <0.05). The empowerment of nurses using the IrOSS were effective in identifying potential organ donors.

Environmental factors play a substantial role in causing chronic kidney disease, but only traditional risk factors such as hypertension, diabetes mellitus, and glomerulonephritis have received widespread attention. This study examined the role of environmental lead exposure in causing kidney disease among artisans in auto mechanic workshops in Nigeria. This was a crosssectional study involving auto mechanics in selected workshops in Ibadan. Sociodemographic details were obtained. Other details obtained included the period of exposure to lead or lead materials and occupational history. Serum lead levels, urinalysis, kidney function, and blood glucose were tested. Four hundred and twelve participants, mostly males (99%) participated. The mean and standard deviation serum lead level was 15.4 ± 7.8 μg/dL. The mean and standard deviation estimated glomerular filtration rate for all participants was 72.9 ± 36.7 mL/min. Serum lead levels correlated with eGFR (r = 0.396, P = 0.044) and microalbuminuria (r = 0.413, P = 0.042). The number of years working in painting correlated with microalbuminuria (r = 0.801, P = 0.0190). Most artisans working in auto mechanic shops in our study had serum lead levels of ≤25 μg/dL, and there was an association between working with iron and lead-containing metals and kidney disease, and serum lead levels were a risk for kidney damage.

Acute interstitial nephritis (AIN) is an immune-mediated kidney injury. We studied its clinicopathological features, the role of corticosteroids, the outcomes, and the predictors of poor outcomes in biopsy-proven AIN. This was a 5-year retrospective, single-center observational cohort study of patients with biopsy-proven AIN. Of 2890 native renal biopsies, 61 (2.1%) had the features of AIN. The most common etiology was drug intake (27 patients), followed by infection-related AIN (14 patients), autoimmune conditions (six patients), malignancy (four patients), others (five patients), and unknown causes (four patients). Patients with autoimmune diseases were younger (P = 0.02), had a higher frequency of anemia (P = 0.004), and features of chronicity (P = 0.006). Hematuria (P = 0.004) and eosinophils (P = 0.05), and crystals in the tubules were mostly seen in drug-induced AIN. There was a significant difference in the recovery of patients receiving steroids within 1 week and 1 week after presentation. The predictors of poor outcomes were serum creatinine [hazard ratio (HR) = 1.4, P = 0.04)], an autoimmune etiology (HR = 3.2, P = 0.05), interstitial fibrosis or tubular atrophy (HR = 1.4, P = 0.04), and delayed treatment with corticosteroids (HR = 0.01, P = 0.04). Infections and ayurvedic medicines are important causes of AIN in India. The triad of eosinophils in the interstitium, oxalate crystals in the tubular epithelium, and red blood cells in the tubular lumen suggest drug-induced AIN. The initial time period is crucial, and we advocate using corticosteroids even before biopsy reports are available.

The stria vascularis, which is located in the cochlea of the inner ear, and the renal tubules contain similar anatomical, physiological, immunological, and pathological properties. Therefore, nephrotoxic drugs; electrolyte imbalances; and biochemical, immunological, osmotic, and vascular differences may affect the middle and inner ear and the central pathways. We evaluated the middle ear mechanisms, inner ear functions, and hearing thresholds of 30 renal transplant (RT) recipients (60 ears); 30 healthy volunteers (60 ears) served as the control group. All patients underwent an audiological assessment by means of pure-tone audiometry, otoacoustic emission (OAE), and contralateral suppression of transient-evoked OAE measurements. The mean follow-up after transplant was 6.8 ± 6.1 years (range: 1-20 years). Hearing for the four frequency averages between the two groups was significantly different (P = 0.002). When the cochlea's outer hair cells were evaluated, the signal-to-noise ratio was significantly lower at frequencies of 1000 and 1400 Hz in the RT group versus the control group (P <0.001 and P = 0.008, respectively). When frequency-specific suppressions were assessed, there was no significant suppression at any frequencies in the RT group, but significantly lower suppression was found at all frequencies in the control group (P <0.001 for all frequencies). These results support the presence of auditory dysfunction in RT recipients. Low levels of OAE support our conclusion that RT recipients are prone to cochlear dysfunction. Therefore, audiometric evaluations should be conducted before and after RT, and the recipients should be informed about possible otological involvement.

Obstructive uropathy accounts for about 5%-10% of all cases of acute kidney injury. Unlike the pediatric population, in which congenital anomalies of the urinary tract account for the majority of cases of urinary tract obstruction (UTO), malignancies account for the majority of upper UTO in adults. We report three rare cases of obstructive acute kidney injury. One case was secondary to an inflammatory abdominal aortic aneurysm (IAAA), and two cases were secondary to retroperitoneal fibrosis (RPF). The reason for presenting this case series is the fact that but IAAA and RPF are rare and, because of the rarity of the disease, there are no specific guidelines regarding its evaluation and optimal management. This addition to the literature in the form of case reports and a case series might help us to better understand the disease and help in formulating standard management protocols.

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.