Saudi Journal of Kidney Diseases and Transplantation最新文献

Many patients with advanced chronic kidney disease (CKD) managed in a specialized multidisciplinary clinic start dialysis urgently during hospitalization rather than electively as outpatients. This study aimed to identify risk factors for starting unplanned dialysis among patients with advanced CKD who attended multidisciplinary low-clearance clinics between January 1, 2020, and December 31, 2021. Of these, 175 patients started dialysis: 101 (26.7%) started it urgently, whereas 74 (19.5%) started it electively. Patients with urgent initiation of dialysis received less education, had fewer clinic visits and follow-up and were seen less often in the vascular clinic. In the univariate regression analysis, congestive heart failure significantly increased the risk of acute dialysis. Moreover, the risk increased in patients who did not receive dialysis education. The risk increased in patients who were not seen in a vascular clinic and did not have a vascular access plan. Moreover, high albumin levels at initial presentation to the clinic had a lower risk for elective initiation of dialysis. In the multivariate regression analysis, use of renin-angiotensin-aldosterone system inhibitors and attending a vascular clinic reduced the risk of unplanned dialysis by 73% and 96%, respectively. Acute unplanned initiation of dialysis is common even in CKD patients followed in low-clearance clinics. Early referral to multidisciplinary low clearance clinics, timely education, compliance with timely follow-up periods, and creation of access in patients at risk may reduce hospital admissions, hospital stays, admission to intensive care units, costs, and morbidity in these patients.

Acute kidney injury (AKI) is common in premature newborns and is associated with high mortality. It is unclear which risk factors lead to AKI in these neonates. We aimed to determine the incidence, risk factors, and outcomes of AKI in preterm neonates in the neonatal intensive care unit (NICU). They were screened and staged for AKI as per the amended neonatal criteria of Kidney Disease Improving Global Outcomes and followed up until discharge or death. Serum creatinine levels and urine output were measured. The incidence of AKI was 18.5% (37/200 neonates). The majority developed non-oliguric AKI. The risk factors significantly associated with AKI in neonates were the presence of sepsis, birth asphyxia, shock, respiratory distress syndrome, and hypothermia. The majority of neonates with AKI had a birthweight <1500 g and a gestational age of <32 weeks and had a higher risk of mortality, in contrast to than those without AKI. Mortality and NICU stay were significantly higher among those with Stage 3 AKI compared with Stage 2 and Stage 1 AKI. To prevent AKI and reduce the burden of high mortality in premature neonates, it is essential to prevent sepsis, birth asphyxia, and respiratory distress syndrome, as well as to detect shock and patent ductus arteriosus as early as possible. There is a need for good antenatal care to reduce the burden of prematurity.

Renal involvement of systemic lupus erythematosus needs aggressive treatment. Despite the development of multiple international guidelines, differences in practices exist. This study aimed to explore the current practices of pediatric rheumatologists and nephrologists for the diagnosis, management, and monitoring of lupus nephritis (LN) in Saudi Arabia through a survey. Among the 61 respondents, 54.1% were pediatric nephrologists and 49.9% were pediatric rheumatologists. Predominantly, the participating physicians received training either nationally (57%) or in North America (45%). Most of the respondents (77%) did not have a combined rheumatology-nephrology clinic, primarily because of space or time limitations (75%), or a lack of the other specialty (13%). In terms of the decision to request a renal biopsy, the most common factors were nephrotic-range proteinuria (85%) and a lower level of proteinuria associated with hypocomplementemia or elevated anti-double-stranded (ds) DNA (73%). There was marginal agreement over monitoring the disease's activity and treatment response; Complements 3 and 4, anti-dsDNA, protein-creatinine ratio, and estimated glomerular filtration rate were the most popular parameters. The main reason for repeating a renal biopsy was a new renal manifestation that was inconsistent with the previous biopsy. There was considerable variability in the induction therapies used to initiate and taper corticosteroids and conventional immunosuppressive drugs. Most respondents (91%) used angiotensin-converting enzyme agents to control proteinuria. Considerable agreement exists among Saudi physicians managing children with LN but significant variations exist regarding the therapeutic strategies. Additional endeavors are needed to establish a unified national clinical approach for managing LN in children.

Quantifying the amount of proteinuria is mandatory in various disease conditions. The aim of this study was to study whether the spot urine protein-creatinine ratio (P-CR) correlates well with 24-h urinary total protein (UTP). The research hypothesis was that spot urine P-CR would correlate well with 24-h UTP. This was a cross-sectional, single-center study conducted in a tertiary care hospital. The spot urinary P-CR and 24-h urinary protein were determined from 70 patients with persistent glomerular proteinuria. This study included Nepalese patients aged 2-83 years, with a mean age of 36.56 years (standard deviation: 20.78). The number of males was slightly higher than females, and the male-female ratio was 1.26:1. Hypertension was present in 44.3% of patients, diabetes was present in 20% of patients, 74.3% of patients were suffering from acute glomerulonephritis with various causes, and 12.9% of patients had chronic kidney disease. A linear relationship existed between the spot urine P-CR and the 24-h UTP, with a correlation coefficient of 0.877 (P <0.01). The correlation was suboptimal at higher levels of protein excretion (>3.5 g/day). Random spot urine P-CR correlated well with the 24-h UTP, particularly at lower levels of protein excretion.

Tumor-induced osteomalacia (TIO) is a disorder in which the clinical signs and symptoms of osteomalacia and the biochemical abnormalities of hypophosphatemia, phosphaturia, and low serum levels of 1,25(OH)2 Vitamin D3 are secondary to a neoplasm. A 33-year-old woman presented with musculoskeletal pain and proximal myopathy with a duration of 2.5 years which was treated with Vitamin D supplements. On the basis of the biochemical tests and histopathology, she was reevaluated and found to have TIO secondary to a phosphaturic mesenchymal tumor. The tumor was resected (limb salvage with endoprosthesis), and she had no pain or weakness at followup. The case reminds the readers to consider the possibility of TIO when evaluating patients with isolated hypophosphatemia, which may lead to long-term disability and prolonged morbidity if untreated. Early recognition and diagnosis of TIO is crucial since resection of the tumor usually reverses its manifestations.

Renal angiomyolipomas (AMLs) and pulmonary lymphangioleiomyomatosis (LAM) are two major presentations of tuberous sclerosis (TS), an autosomal dominant multisystem disorder. Renal AMLs can lead to life-threatening complications like hemorrhage and cause progressive renal failure requiring dialysis and kidney transplant. mTOR inhibitors showed promising results in TS patients with renal AMLs, LAM, and subependymal giant cell astrocytomas. This case report is a follow-up of a patient we reported in 2010 with giant AMLs and LAM who required an emergency nephrectomy for massive hemorrhage from giant left-sided AMLs.

The objective of this study was to understand the utilization pattern of erythropoietin in end-stage renal disease patients, along with the effect of body weight and sex on the patients' responses. In this retrospective single-center study, 120 patients were included who were on a once weekly (n = 79), twice weekly (n = 37), or thrice weekly (n = 4) regimen. The doses of erythropoiesis-stimulating agents (ESA) were collected, and the erythropoietin resistance index (ERI) was determined. The Kruskal-Wallis test was used to evaluate the dose schedules, and the once-weekly regimen produced a greater response (P = 0.001). The asymptotic significance of Pearson's Chi-square-test equating the mean ERI and body mass index (BMI) was 0.034. No statistically significant correlation was estimated between sex and mean ERI (P = 0.201). Our study demonstrated that the once-weekly regimen dominated over the others in terms of efficacy, and individuals with a higher BMI were found to respond better to the ESA therapy.

Fabry disease (FD) is associated with inflammation, proteinuria, and chronic kidney disease. Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) plays an important role in inflammation in diabetic nephropathy and lupus nephritis. Since there is a close relationship linking serum TWEAK (sTWEAK), inflammation, and carotid intima-media thickness (CIMT) in various kidney diseases, we aimed to determine the relationship between sTWEAK levels and CIMT in subjects with and without proteinuria in a cross-sectional study involving 15 FD patients (seven females, eight males) and seven healthy controls (four females, three males). There were no differences in age, sex, estimated glomerular filtration rate, and biochemical parameters (serum glucose, albumin, creatinine, uric acid, C-reactive protein (CRP), low-density lipoprotein, and high-density lipoprotein) between FD patients and healthy controls. The spot urine protein-creatinine ratios of healthy controls and FD patients were 90 mg/g and 185 mg/g, respectively (P = 0.022). STWEAK levels were higher in FD patients than in healthy controls (P = 0.007). The CIMT of FD patients and healthy controls was 0.55 ± 0.14 mm and 0.42 ± 0.04 mm, respectively (P = 0.007). STWEAK was positively correlated with CRP and CIMT, and negatively with proteinuria (P = 0.005, P = 0.013, and P = 0.018, respectively). In the multivariate analysis, only sTWEAK was an independent variable of increased CIMT. We demonstrated that sTWEAK and CIMT were increased in FD patients. STWEAK might have a role in the pathogenesis of subclinical atherosclerosis in FD.

This study aimed to evaluate the level of anxiety and its risk factors among patients undergoing hemodialysis in the Ténès area, Chlef Province, Algeria. The survey was conducted on 45 hemodialyzed patients at the public hospital of Ténès (Ahmed Bourass). Sociodemographic data were collected using a questionnaire, and anxiety was diagnosed by the hospital anxiety and depression scale. Among 45 patients, 44.44% were anxious. Anxiety was significantly associated with profession and antidepressant treatment (P <0.05). The other factors were insignificantly related to anxiety, such as age, sex, education level, and comorbidities. Anxiety is prevalent among end-stage renal disease patients. Unemployment and medications were identified as the main risk factors. Multidisciplinary strategies need to be established to prevent the occurrence of anxiety and improve patients' quality of life.

Congenital nephrotic syndrome (NS) is characterized by early-onset heavy proteinuria. Most cases of congenital NS are associated with genetic mutations in the podocyte proteins. The causal relationship of perinatal infections with congenital NS has not yet been proven. Inadequate response to the treatment of such infections should prompt us to conduct genetic testing for congenital NS. The heavy proteinuria associated with congenital NS is usually difficult to control with conventional treatment. It often results in progressive kidney disease with a high risk of mortality in early life. Here, we describe an infant who developed congenital NS and was found to have a coexisting Cytomegalovirus infection and an underlying NPSH1 mutation. Proteinuria did not respond to a standard dose of enalapril. A supramaximal dose of enalapril was tried and was effective and safe in controlling the proteinuria. It was associated with improved growth, complete resolution of edema, normal serum albumin, and normal renal function beyond 2 years of age.