Saudi Journal of Kidney Diseases and Transplantation最新文献

This study was conducted to determine the safety and efficacy of acute central venous catheters (CVC) using a sodium bicarbonate catheter locking solution (SBCLS) versus an antibiotic catheter locking solution (ACLS). Our study included patients aged >18 years on hemodialysis initiated through an internal jugular non-tunneled CVC. Safety was assessed by comparing catheter loss resulting from catheter dysfunction (CD) and catheter-related blood stream infections (CRBSI) in two study groups: the SBCLS group (using 7.5% sodium bicarbonate) and the ACLS group (using antibiotic + heparin). Efficacy was assessed by the adequacy of blood flow (>300 mL/min). In total, 160 patients were included: 80 with the SBCLS and 80 with the ACLS. There were no statistically significant differences in clinical demographics between the groups. The average duration of the catheters was 23 days in the ACLS group and 22 days in the SBCLS group. In the ACLS group, four lost catheters to CD, two lost them to CRBSI, and five lost them to other malfunctions. Adequate blood flow was achieved in 71 patients. In the SBCLS group, three lost catheters to CD, three lost them to CRBSI, and four lost them to other malfunctions. Adequate blood flow was achieved in 73 patients. No significant differences between the groups were observed for catheter loss to CRBSI (P = 0.648), CD (P = 0.699), malfunction (P = 0.731), and blood flow (P = 0.598). The safety and efficacy of non-tunneled CVC with sodium bicarbonate as the catheter locking solution were similar to those of the ACLS.

Patients with end-stage renal disease (ESRD) are at an increased risk of hepatitis C virus (HCV) infection. This study evaluated the prevalence of HCV infection in patients with ESRD on maintenance hemodialysis (MHD) and studied the effectiveness of sofosbuvir-velpatasvir and sofosbuvir-daclatasvir regimens in these patients. This study included patients with ESRD on MHD between January 2019 and December 2021 who were screened for HCV serology status. HCV-positive patients received sofosbuvir-velpatasvir or sofosbuvir-daclatasvir. Efficacy was assessed by the sustained virological response (SVR), and safety assessments included monitoring adverse events and laboratory parameters. Out of 1330 patients, 188 patients (14.1%) were positive for anti-HCV, with Genotype 1 being the most common genotype. Of these, 106 patients were included. The majority were males (61.3%), and the mean age was 48.4 years. Hypertension (45.3%) was the most common cause of renal failure, followed by diabetes (31.1%). Most patients (63.2%) were positive for HCV in the first 2 years of their dialysis treatment. Out of 106 patients, only 54 had received blood transfusions. Ninety-four (88.7%) patients received sofosbuvir-velpatasvir, whereas 12 (11.3%) received sofosbuvir-daclatasvir. SVR at 12 and 24 weeks after stopping treatment was seen in all (100%) patients. Asthenia and fatigue were the most common adverse events (11.2%). No patients reported on-treatment virologic failure or discontinuation of treatment because of adverse events. The prevalence of HCV infection in this population was 14.1%, and treatment of HCV infection using sofosbuvir-velpatasvir or sofosbuvir-daclatasvir regimens was well tolerated and effective.

We aimed to determine the knowledge of potassium and phosphorus in patients undergoing hemodialysis (HD) and to associate it with serum levels and other clinical variables. This cross-sectional study included 73 patients of both sexes, who were over 18 years old and had undergone HD for at least 3 months at Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil, between January and April 2019. Knowledge of phosphorus and potassium was measured by a questionnaire composed of 16 multiple choice questions (two general, seven about phosphorus, and seven about potassium) applied by the interviewer. For each mineral, a maximum of nine points could be scored. The mean ± standard deviation of correct answers was 9.78 ± 2.99 points for all questions, being higher for potassium (6.75 ± 1.65 points) than phosphorus (4.64 ± 2.10 points; P <0.001). A positive correlation was found between specific knowledge of phosphorus and its serum levels (r = 0.305; P = 0.009), but not for potassium (r = 0.101; P = 0.395). The number of correct answers positively correlated with the level of education (r = 0.390; P = 0.001) and negatively with age (r = -0.372; P = 0.001). The HD patients had intermediate levels of knowledge of phosphorus and potassium, with greater knowledge of potassium. Patients with higher serum phosphorus levels demonstrated greater knowledge about it, whereas this pattern was not observed for potassium levels. Knowledge of phosphorus and potassium was associated with younger patients and a higher level of education.

In Islamic countries, many religious scholars have allowed organ transplantation. However, ethical judgments on organ transplantation are disputable and unpredictable. Therefore, opinions about organ transplantation depend on personal beliefs, as well as religious faith, cultural convictions, and sociocultural factors, which deserve discussion and study. The objective of this study was to assess the knowledge of and attitudes toward organ donation in a multicultural society such as Dubai. A questionnaire was designed by a multidisciplinary team through a review of the literature. Participants were approached from October 2018 until September 2019. Our study showed a poor general knowledge of organ donation overall (447, 66%) and low awareness of the organ donation laws and regulations in the United Arab Emirates (UAE) (376, 55%). Most respondents mentioned that they were not willing to register to be an organ donor (393, 58%); nevertheless, they would accept an organ donation (347, 51%), even from a recently deceased person if required (376, 55%). The UAE faces scarcity among plenty as far as organ donation is concerned. Our study identified several consistent themes regarding barriers to organ donation among people in the UAE. The ever-increasing demand for organs can only be met by a multidisciplinary approach to educate the public and health-care providers further.

In 1952, X-linked agammaglobulinemia (XLA) was discovered as a rare inherited disorder. It markedly compromises the ability of the body to combat infectious microorganisms. Membranoproliferative glomerulonephritis (MPGN) Type I is characterized by subendothelial immune complex deposits. Patients with XLA can rarely develop immune-complex-induced diseases. Here, we report a case of MPGN Type I in a 12-year-old male patient with a past and family history of XLA. The patient presented with fever, productive cough, vomiting, and lower limb edema. Clinical and radiological examinations established a diagnosis of bronchopneumonia. The laboratory findings revealed proteinuria and hematuria, and a renal biopsy was performed. The histological examination of this biopsy revealed mesangial hypercellularity and thickened basement membranes. Immunofluorescence studies showed mesangiocapillary staining for Complement 3 and Immunoglobulin (Ig) G and, to a lesser extent, for IgA, IgM, and Complement 1q. Ultrastructural studies revealed partly thick, double-contoured glomerular basement membranes, glomerular endothelial cells with swollen cell bodies, and podocytes with effaced foot processes. Small subendothelial and mesangial eosinophilic deposits were identified. The diagnosis of MPGN type I was established. The patient was started on prednisolone. To the best of our knowledge, this is a rare case of MPGN Type I in a patient with XLA. The pathogenetic mechanisms underlying the development of MPGN Type I were not apparent in our patient. However, residual humoral immunity may play a role in the development of MPGN.

Hemodialysis (HD) and peritoneal dialysis (PD) treatments impact the economic burden and psychological distress faced by end-stage kidney disease (ESKD) patients and their caregivers. This review aimed to discuss the concept of an economic burden and the economic burden of different treatment options, and to highlight research gaps regarding the scarcity of previous studies relating economic burden to psychological well-being. We searched five electronic databases for papers published in 2010-2020. Papers focusing on measures of the economic burden from the government's perspective and diseases other than ESKD were excluded. Out of the 6635 publications identified, 10 publications were included. Three categories of economic burden were identified, namely, direct medical costs, direct non-medical costs, and indirect costs. Direct medical costs required the highest expenditure, whereas the lowest economic burden was for indirect costs. HD patients incurred a higher economic burden than PD patients. Most of the studies were carried out in Asia. The results of the research suggest that the economic burden may affect patients and caregivers, but it is unclear whether the economic burden affects the psychological well-being of the patients and caregivers. Very few studies have assessed the relationship between economic burden and psychological well-being, and further research is needed to gain further insight into the relationship between these two variables.

Circular RNAs (circRNAs) and long noncoding RNAs (lncRNAs) have a role in monitoring the appearance and progression of a great many diseases. They are useful markers for the prognosis and diagnosis of some diseases. In previous studies, the expression patterns of mRNAs, circRNAs, and lncRNAs related to immunoglobulin A (IgA) nephropathy have not been sufficiently discussed. Active prevention methods and treatment for IgA nephropathy (IgAN) are still not used. Integrated analyses and identification of the circRNAs and lncRNAs in IgAN have not been executed. We carried out a deep RNA sequencing analysis between controls and subjects with IgAN. In total, 125 antisense lncRNAs were identified to be greatly differentially expressed between the control and experimental groups. In addition, 606 mRNAs and 1275 circRNAs with differential expression levels were found between the groups. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathways were used as bioinformatic methods in this study. Our study showed the expression patterns of mRNAs, circRNAs, and lncRNAs in IgAN. We revealed the key roles of circRNAs and lncRNAs in the molecular mechanism of IgAN.

Rapidly progressive renal failure (RPRF) is not typical of diabetic nephropathy and suggests non-diabetic kidney disease (NDKD). We conducted an analysis of the data of RPRF patients (28 diabetic and 88 non-diabetic patients) with doubled creatinine over 2 weeks to 3 months and/or presented with >4 mg serum creatinine without prior renal disease to ascertain the types of lesions and compare the patients' histopathology. The primary outcome was dependence on dialysis at 1 year. Anti-neutrophilic cytoplasmic antibody-associated pauci-immune glomerulonephritis was the most common cause of RPRF in both groups. No particular lesion was more frequent in either group. Dependence on dialysis at 1 year was similar in both groups and was associated with dependence on dialysis at presentation but not diabetes. Crescentic glomerulonephritis was the most common in non-diabetic patients (57.9 vs. 25%, P = 0.002), and acute tubular necrosis (ATN) was seen in diabetic patients (21.4 vs. 11.4%, P = 0.179). Both factors were associated with adverse renal outcomes. Diffuse global glomerulosclerosis at presentation suggested a poor outcome in both groups. Diabetic nephropathy was seen in 14.29%, and its presence did not affect the outcome. The etiology of RPRF in diabetic patients has changed and is similar to that in non-diabetic patients, with no specific lesions predominating. Diabetic nephropathy does not alter the outcome for those with RPRF. Diffuse global glomerulosclerosis, being on dialysis at presentation, and ATN in a diabetic patient indicate a poor outcome and need close follow-up. Diabetic retinopathy should not prevent us from investigating for NDKD.

Diabetic renal injury is a microvascular complication associated with inflammation and oxidative stress, culminating in renal dysfunction. Conventionally, it is treated with hypoglycemic agents to address metabolic perturbations. However, the way to mitigate immunological, inflammation, and oxidative stress have seldom been studied. Hence, in the present study, the nephroprotective role of immunosuppressive and anti-inflammatory drugs, mycophenolate mofetil (MMF) in combination with the oral hypoglycemic agent glibenclamide, on streptozotocin (STZ)- induced diabetic renal damage was studied. Bodyweight, fasting blood glucose, and glycosylated hemoglobin levels were altered in the diabetic rats. Furthermore, renal injury was indicated by abnormal levels of urinary protein and creatinine and serum markers of renal function in diabetic rats. Hyperglycemia-induced oxidative stress and inflammation were also observed in the diabetic rats. The combination of MMF and glibenclamide treatment significantly attenuated the abnormal effects of hyperglycemia, oxidative stress, and inflammation-induced renal injury in diabetic rats. Histopathological studies confirmed the nephroprotective role of MMF and glibenclamide by reversing renal injury in diabetic rats. The present study suggests that MMF and glibenclamide have a protective role in STZ-induced diabetic renal damage.

Medicopsis romeroi is a dematiaceous fungus that rarely causes subcutaneous phaeohyphomycosis. Here, we report a subcutaneous phaeohyphomycosis caused by a rare dematiaceous fungus, M. romeroi, in a 56-year-old male renal transplant patient. The patient was admitted for graft dysfunction and was found to have painless swelling over the anterior aspect of the right knee, which was aspirated twice within 40 days. Broad septate hyphae (determined by microscopy) and growth of phaeoid in a culture were observed in both the specimens. No sporulation was observed in the slide culture. Swelling recurred even after treatment with voriconazole, so the lesion was surgically excised. Genotypically, the isolate was identified as M. romeroi in both specimens. He was discharged on voriconazole. During a 6-month follow-up, no relapse was noticed. Phaeohyphomycosis caused by M. romeroi is rare, with only a few cases reported in India. Laboratory diagnosis of Medicopsis by conventional methods is challenging. Medicopsis species should be considered one of the etiological agents for subcutaneous phaeohyphomycosis. Molecular methods should be used for the identification of unusual pathogens.