Saudi Journal of Kidney Diseases and Transplantation最新文献

The nonadherence of hemodialysis (HD) patients correlates with morbidity and mortality. Despite severe consequences, noncompliance with their medical regimen is the norm for HD patients rather than the exception. Factors associated with nonadherence to dietary restrictions among HD patients have been explored in many studies; however, most were in Western countries and there is a remarkable paucity of studies in Saudi Arabia. HD patients have several features that put them at an increased risk of nonadherence to dietary restrictions, including prolonged, intensive treatment, and their medical regimens are easily determined with objective measures. This crosssectional study aimed to determine factors related to nonadherence to dietary restrictions among 361 HD patients randomly selected from HD centers in Makkah, Saudi Arabia. Individuals were assessed for adherence using the End-Stage Renal Disease - Adherence Questionnaire in addition to clinical examinations and laboratory investigations. Female patients were more likely to be nonadherent to dietary restrictions. Adherence to dietary restrictions was relatively higher among non-Saudi patients, older people, those who are married, those with university qualifications, those who are employed, and those with higher monthly incomes; nevertheless, these differences were not statistically significant. Despite the relatively higher frequency of adherence to dietary restrictions among patients with a duration of dialysis of <60 months, hypertensive patients, patients with a previous kidney transplant, and those with a previous history of psychiatric illnesses, these differences were not statistically significant. Patients with factors associated with nonadherence to dietary restrictions deserve special attention and support to improve their adherence.

Interleukin-18 (IL-18) is a pro-inflammatory cytokine that rises approximately 24-48 h before a diagnosis of acute kidney injury (AKI). Kidney injury molecule-1 (KIM-1) is one of the most promising early biomarkers. It participates in the process of both kidney injury and healing, although the precise mechanism of the restoration of tubular integrity after injury still remains unclear. The renal resistive index (RRI) is used for evaluating changes in intrarenal perfusion occurring in renal parenchyma diseases. The study included 80 critically ill patients with sepsis, divided into 40 patients who developed AKI and 40 patients without AKI. All patients were evaluated through their history, clinical examination, laboratory investigations of serum IL-18 and KIM-1, and the RRI. Serum IL 18, serum KIM-1, and the RRI were significantly higher in critically ill patients with sepsis and AKI. Receiver operating characteristic analysis for detecting AKI 1 day after admission showed that the area under the curve (AUC) for serum IL-18 was 86.1%, the AUC for serum KIM-1 was 86%, and the AUC for the RRI was 88%, demonstrating statistical significance for the diagnosis of AKI within the next 24 h. Serum IL-18, KIM-1, and the RRI represent early predictors of AKI in critically ill septic patients.

We report a case of a 69-year-old Caucasian male with a history of hypertension, Type 2 diabetes, and Stage IIIa chronic kidney disease (CKD), who presented to the emergency department with positional dizziness, generalized weakness, weight loss, and suppressed appetite. Two months earlier, the patient was diagnosed with coronavirus disease 2019 (COVID-19). The patient had non-oliguric acute kidney injury alongside preexisting CKD. The urinalysis showed hematuria and significant non-nephrotic proteinuria. His serological markers were positive for antineutrophil cytoplasmic antibodies with high titers. A kidney biopsy showed focal crescentic glomerulonephritis of the pauci-immune type. Initially, treatment with immunosuppressive medication was deferred because the biopsy findings suggested a poor renal outcome, as the cortical sample showed tubular atrophy and interstitial fibrosis of more than 50%. The patient was discharged but was later readmitted with worsening renal function, deep venous thrombosis in the lower extremities, and patchy lung consolidation suggesting possible pneumonia, which was ruled out. He required dialysis and brief empiric antibiotics for pneumonia, and anticoagulation for deep venous thrombosis, and was treated with intravenous (IV) pulsed steroids, followed by gradually tapering oral steroids and rituximab induction therapy. He continued dialysis three times a week. Three months after discharge, his renal function improved to near-baseline level, and he no longer required hemodialysis. He continues to be on maintenance IV rituximab therapy and low-dose oral steroids and is followed closely by a rheumatologist. Our case reflects the evolving state of understanding how COVID-19 impacts the immune system, its varying manifestations, and its management.

Immature granulocytes (IGs) are used as markers of infection and systemic inflammation. We aimed to investigate the diagnostic value of IGs in children with urinary tract infections (UTIs). Children with their first UTIs were included in this observational study. Blood samples were obtained before antibiotic therapy. The blood analysis was repeated 2 weeks after the treatment ended. In total, 194 children (95 with febrile UTI, 58 with cystitis, and 41 controls) were included. The percentage of IGs (IG%) and IG count (IGC) measured at the time of admission were higher in the patients with febrile UTI than in the patients with cystitis and the controls (P = 0.000). The IGC and IG% after treatment were higher in patients with renal scarring than in those without scarring (P = 0.012 and P = 0.021, respectively). Cox's regression analysis showed the significant associations of renal scarring with both IGC and IG% (hazard ratio: 8.181, P = 0.002; hazard ratio: 5.106, P = 0.033, respectively). Both IGC and IG% were positively associated with severe vesicoureteral reflux (VUR) [odds ratio (OR): 22.235, P = 0.025; OR: 15.597, P = 0.038, respectively]. In conclusion, the IG% and IGC, which can be easily measured in a routine complete blood count without the need for additional effort, could be used as biomarkers for predicting febrile UTI, renal scarring, and severe VUR in children.

Diabetic nephropathy (DN), a leading cause of chronic kidney disease, is known to develop in around 40% of patients with diabetes. NGAL, a biomarker expressed by the tubular epithelium, has been evaluated in both acute and chronic kidney injury. However, kidney damage revealed by the histology of renal tissue core biopsies has not been quantified by morphometry and its correlation with urinary NGAL (uNGAL) has not been studied. Our objective was to compare levels of uNGAL with the extent of kidney damage in the histopathological results of morphometry in patients with DN. This prospective analytical study was conducted in a tertiary hospital. Urine samples of 42 patients were collected and freeze-dried. uNGAL was estimated through a chemiluminescent microparticle immunoassay. Pearson's correlation coefficients between kidney damage quantified by morphometry and NGAL values were examined. The correlation of uNGAL with the percentage of acute tubular injury assessed by morphometry in the renal core was 7.35% (P = 0.64). uNGAL had the highest correlation with inflammation (r = 54.2%; P = 0.002). Another parameter with a significant correlation was glomerular sclerosis with r = 35.6% (95% confidence interval: 10%-60%) and an associated P = 0.02. UNGAL was strongly correlated with inflammatory kidney damage in patients with DN.

For several end-stage diseases, the only treatment option is organ transplantation, but the availability of organs is a challenge. More thorough knowledge and more positive attitudes toward organ donation among university students may encourage greater willingness to donate an organ. This study aimed to assess the knowledge, attitudes, and practices regarding organ donation among students of Jazan University, Saudi Arabia, via a 30-item questionnaire. Of the 558 respondents, 71.1% were males, 28.9% were females, and 92.1% were <25 years old. The participants were categorized as either in health-related colleges or other colleges. Differences in the level of knowledge were significant among age groups, with 19.5% of those aged 21-25 years having a high level compared with 2.3% of those aged 26+ years. Participants in health-related colleges had significantly higher levels of knowledge than those in other colleges. Differences between males and females were not significant. Regarding attitudes toward organ donation, some factors were significant (P ≤0.05). Positive attitudes were reported by 72% of males compared with 58% of females. Students in a health-related specialty and those in other specialties showed significant differences, but these were not found for educational level. In practice, 9.86% had an organ donation card; the only significant factors were age and specialty. Here, the participants' level of knowledge was low to medium, attitudes were negative, and most were not ready to donate organs. We recommend establishing educational campaigns on organ donation to increase knowledge, attitudes, and willingness to participate in this vital public service.

Globally, chronic kidney disease of unknown etiology (CKDu) has been recognized as an emerging cause contributing to the rise in chronic kidney disease (CKD). Nevertheless, in the Kingdom of Saudi Arabia, the epidemiology of CKDu remains understudied. The aim of this study was to assess the epidemiological, clinical, and laboratory characteristics of the CKDu population. From May 2021 to May 2022, a retrospective cross-sectional study was conducted on patients with Stage 4-5 CKD who presented to King Fahd Hospital in Jeddah. On the basis of the cause of CKD, patients were categorized into two groups: those with traditional risk factors for CKD (CKDt) and those without a recognizable cause of CKD (CKDu). Out of a total of 500 patients with Stage 4-5 CKD who were enrolled in the study, 100 patients were found to have CKDu. Compared with the 400 patients with CKDt, the patients in the CKDu group were younger (a mean age of 52.3 years vs. 66.1 years, P <0.001), with the majority in the middle age group of 40-65 years old (68% vs. 43%, P <0.001). They were predominantly males (72% vs. 56%, P = 0.003), with less hyperkalemia (4.29 vs. 5.13, P <0.043), and presented without a previous history of CKD (57% vs. 31%, P = 0.001). Among the 500 patients who were studied, 100 patients (20%) presented with CKDu who were predominantly younger males without a known history of CKD. Further studies on a nationwide scale are warranted.

Oxidative stress, imbalanced antioxidants, and dysregulated renal lipids are closely linked with diabetic nephropathy and eventual cause of end-stage renal failure. This study was performed to investigate the protective effect of bacoside-A on markers of lipid peroxidation, renal lipids, and markers of renal function in diabetic rats. Experimental diabetes was induced in Wistar rats by a single dose of streptozotocin [40 mg/kg body weight (BW)] via intraperitoneal injection. Oral administration of bacoside-A (10 mg/kg BW) and glibenclamide, a reference drug, continued for 45 days. Diabetic rats showed a significant increase in the levels of plasma glucose, renal lipids, markers of renal lipid peroxidation, and plasma biomarkers of renal function such as urea, uric acid, and creatinine. A significant decrease in the levels of plasma insulin, nonenzymatic antioxidants, and the activity of enzymatic antioxidants was seen compared with the normal controls. Bacoside-A (10 mg/kg BW) and glibenclamide (600 μg/kg BW) administered to diabetic rats resulted in a significant decrease in plasma glucose and renal lipids but a significant increase in the plasma insulin level. In addition, bacoside-A achieved a remarkable increase in the activity of enzymatic antioxidants and the levels of nonenzymatic antioxidants in the renal tissue of diabetic rats, along with significant decreases in the markers of lipid peroxidation and those of renal function, consequently substantiating the protecting effectiveness of bacoside-A in a diabetic state. These biochemical observations were supported by a histopathological study of the renal tissue. The present study suggested that bacoside-A, a triterpenoid, offers a higher renoprotective effect to counter abnormal parameters of renal function in diabetes-induced renal injury.

Proteinuria is a manifestation of sickle cell anemia (SCA)-related renal disease and is a risk factor of renal impairment. Angiotensin-converting enzyme (ACE) inhibitors have benefits, but their role in SCA remains undefined. This study aimed to assess the role of lisinopril, an ACE inhibitor, in reducing proteinuria in SCA patients. Thirty-five patients older than 15 years with known SCA (HbSS or HbS-β0) and a 24-h urinary protein level of 150 mg or more participated in this study. Urine was collected over 24 h to quantify proteinuria. The patients had a mean age of 28.5 ± 6.98 years. The median 24-h urinary protein before treatment was 0.3006 g and that after treatment was 0.150 g (P = 0.01). After a median follow-up of 38 months, 24-h urinary protein decreased in 27 (77%) patients and normalized in 18 (52%) patients. Urinary protein increased in 2 (6%) patients and remained stable (no change) in 6 (17%) patients. There was no significant difference in blood pressure (BP) before and after treatment. The average dose of lisinopril was 5 mg. Twenty patients were still on lisinopril at last follow-up. The reasons for stopping lisinopril included normalization of protein, noncompliance, adverse effects, and pregnancy. Lisinopril effectively reduced proteinuria in SCA patients, without significantly reducing BP. Only a few patients developed adverse effects, including coughing, dizziness, and diarrhea. It is unclear how long lisinopril should be continued and whether it can be stopped in patients with normalized urinary protein.

Organ donation is considered a life-saving treatment for end-stage organ failure worldwide. However, the severe organ shortage in Saudi Arabia creates a gap between patients in need of transplantation and the availability of organs. In Saudi Arabia, a limited number of studies have assessed knowledge and attitudes toward organ donation, especially in Jeddah City. Thus, this study aimed to assess the knowledge, attitudes, and barriers to organ donation and to determine the factors that may hinder or facilitate organ donation. Our findings indicated that almost half of the participants (49.2%) obtained their information from online resources. Fear of the unknown (31.2%) and a lack of knowledge (28.5%) were the main barriers to organ donation. A high percentage of the participants (73%) were unaware of any local or international legislation regarding organ donation. Half of the study participants were willing to donate their organs, with insignificant differences in age, gender, occupation, and education level. Only 5.4% of the respondents had an organ donor card. The study indicated that half of the participants were willing to donate organs, but they were unaware of local and international legislation. Therefore, an intensive education program and campaigns are recommended to increase public awareness about organ donation.