Pub Date : 2021-10-01DOI: 10.4103/jesnt.jesnt_16_21
T. Azeez, O. Efuntoye, B. Abiola, Segun M. Adeyemo, B. Adewale
Background Diabetic kidney disease (DKD) is a microvascular complication of diabetes mellitus. Considering that the burden of diabetes mellitus is rising in Nigeria, there is a need to ascertain the burden of one of its most common complications. The objective of the meta-analysis was to determine the pooled prevalence of DKD in Nigeria and identify its risk factors. Patients and methods The study is a meta-analysis and it followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Google scholar, PubMed, AJOL, SCOPUS, medRxiv, and the gray literature were systematically searched using appropriate key terms. Statistical analysis was done with MetaXL. The inverse-variance heterogeneity model was used for the meta-analysis and heterogeneity was determined using the I2 statistic and the Cochran’s Q test. Publication bias was checked with the Doi plot and LFK index. Results Nineteen studies met the eligibility criteria. The total sample size was 56 571. The pooled prevalence of DKD in Nigeria was 28% (95% confidence interval 3–58). The Cochran’s Q was 747 (P<0.001), while the I2 statistic was 97.6%. The Doi plot was drawn and the LFK index was 6.22. The most common risk factors for DKD were suboptimal glycemic control, hypertension, obesity, duration of diabetes, male sex, and advancing age. Conclusion The prevalence of DKD in Nigeria is high and greater attention should be focused on managing the risk factors so as to alleviate the burden of the disease.
{"title":"The burden of diabetic kidney disease in Nigeria − systematic review and meta-analysis","authors":"T. Azeez, O. Efuntoye, B. Abiola, Segun M. Adeyemo, B. Adewale","doi":"10.4103/jesnt.jesnt_16_21","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_16_21","url":null,"abstract":"Background Diabetic kidney disease (DKD) is a microvascular complication of diabetes mellitus. Considering that the burden of diabetes mellitus is rising in Nigeria, there is a need to ascertain the burden of one of its most common complications. The objective of the meta-analysis was to determine the pooled prevalence of DKD in Nigeria and identify its risk factors. Patients and methods The study is a meta-analysis and it followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Google scholar, PubMed, AJOL, SCOPUS, medRxiv, and the gray literature were systematically searched using appropriate key terms. Statistical analysis was done with MetaXL. The inverse-variance heterogeneity model was used for the meta-analysis and heterogeneity was determined using the I2 statistic and the Cochran’s Q test. Publication bias was checked with the Doi plot and LFK index. Results Nineteen studies met the eligibility criteria. The total sample size was 56 571. The pooled prevalence of DKD in Nigeria was 28% (95% confidence interval 3–58). The Cochran’s Q was 747 (P<0.001), while the I2 statistic was 97.6%. The Doi plot was drawn and the LFK index was 6.22. The most common risk factors for DKD were suboptimal glycemic control, hypertension, obesity, duration of diabetes, male sex, and advancing age. Conclusion The prevalence of DKD in Nigeria is high and greater attention should be focused on managing the risk factors so as to alleviate the burden of the disease.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"153 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134263573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.4103/jesnt.jesnt_17_21
S. Khamis, Y. Yassin, A. Tawfeek, H. Kasem, S. Ibrahim, Elsayed Ghonamy
Background Diabetic kidney disease (DKD) represents the major cause of chronic kidney disease. New biomarkers for early diagnosis of DKD are of interest. Our objective is to elucidate the significance of microRNA-192 (miRNA-192) and neutrophil gelatinase-associated lipocalin (NGAL) as early predictors of diabetic nephropathy in comparison with albuminuria in type-2 diabetic patients. Patients and methods A number of 45 persons in three groups, group 1: 15 healthy persons with no diabetes mellitus (DM). Group 2: 15 patients diagnosed with type-2 diabetes mellitus (T2DM) without albuminuria. Group 3: 15 patients diagnosed with T2DM with albuminuria. Estimation of serum miRNA, NGAL, urine albumin/creatinine ratio, serum creatinine, urea, fasting blood glucose, 2-h postprandial blood glucose, and glycated hemoglobin. Results The study showed that the serum miRNA-192 and NGAL levels were significantly higher in patients diagnosed with T2DM with albuminuria in comparison with patients diagnosed with T2DM without albuminuria. There was a significant positive correlation between miRNA-192 and NGAL and urine albumin/creatinine ratio. Conclusion Serum NGAL and miRNA-192 may serve as tools to follow up the development and progression of DKD.
{"title":"Role of microRNA as a marker in detection of diabetic nephropathy in type-2 diabetic Egyptian patients","authors":"S. Khamis, Y. Yassin, A. Tawfeek, H. Kasem, S. Ibrahim, Elsayed Ghonamy","doi":"10.4103/jesnt.jesnt_17_21","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_17_21","url":null,"abstract":"Background Diabetic kidney disease (DKD) represents the major cause of chronic kidney disease. New biomarkers for early diagnosis of DKD are of interest. Our objective is to elucidate the significance of microRNA-192 (miRNA-192) and neutrophil gelatinase-associated lipocalin (NGAL) as early predictors of diabetic nephropathy in comparison with albuminuria in type-2 diabetic patients. Patients and methods A number of 45 persons in three groups, group 1: 15 healthy persons with no diabetes mellitus (DM). Group 2: 15 patients diagnosed with type-2 diabetes mellitus (T2DM) without albuminuria. Group 3: 15 patients diagnosed with T2DM with albuminuria. Estimation of serum miRNA, NGAL, urine albumin/creatinine ratio, serum creatinine, urea, fasting blood glucose, 2-h postprandial blood glucose, and glycated hemoglobin. Results The study showed that the serum miRNA-192 and NGAL levels were significantly higher in patients diagnosed with T2DM with albuminuria in comparison with patients diagnosed with T2DM without albuminuria. There was a significant positive correlation between miRNA-192 and NGAL and urine albumin/creatinine ratio. Conclusion Serum NGAL and miRNA-192 may serve as tools to follow up the development and progression of DKD.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134424664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/jesnt.jesnt_8_21
R. Hagag, Shimaa El-attar, Waleed A Elrefaey, Amin E Nawar, Nashwa El gharbawy
Background Chronic kidney disease (CKD) is an irreversible condition that leads to progression to end-stage renal disease that requires hemodialysis or kidney transplantation for patient survival and these patients are at risk of developing many complications. In the present study, the retinal findings in CKD patients on hemodialysis are evaluated. Patients and methods This is a cross-sectional noninterventional study that was carried out on CKD patients on hemodialysis for at least 3 months in the Nephrology Unit, Tanta University, Egypt; 160 eyes of 80 patients were included over 6 months. A complete ophthalmic evaluation was performed. Color fundus and spectral domain optical coherence tomography were performed at presentation. Results The visual acuity ranged from 6/6 to 6/18 in 80 eyes, which represents 50%, from 6/24 to 6/60 in 62 eyes, which represents 38.75%, and from less than 6/60 to perception of light in 18 eyes, which represents 11.25%. Fundus examination revealed that eight eyes were normal (5%). Hypertensive retinal changes occurred in 82 eyes with variable degrees of retinopathy. Diabetic retinopathy was found in 30 (18.75%) eyes and macular degeneration was detected in 20 (12.5%) eyes. Retinal vasculitis occurred in two (1.25%) eyes, branch retinal vein occlusion was detected in six (3.75%) eyes, glaucomatous optic neuropathy was found in eight (5%) eyes and central retinal artery occlusion occurred in four (2.5%) eyes. Conclusion The most common visual problems in hemodialysis patients that lead to visual loss are hypertensive and diabetic retinopathy. Hence, it is mandatory to screen fundus changes in CKD to prevent loss of vision.
{"title":"Retinal findings in chronic kidney disease patients on hemodialysis","authors":"R. Hagag, Shimaa El-attar, Waleed A Elrefaey, Amin E Nawar, Nashwa El gharbawy","doi":"10.4103/jesnt.jesnt_8_21","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_8_21","url":null,"abstract":"Background Chronic kidney disease (CKD) is an irreversible condition that leads to progression to end-stage renal disease that requires hemodialysis or kidney transplantation for patient survival and these patients are at risk of developing many complications. In the present study, the retinal findings in CKD patients on hemodialysis are evaluated. Patients and methods This is a cross-sectional noninterventional study that was carried out on CKD patients on hemodialysis for at least 3 months in the Nephrology Unit, Tanta University, Egypt; 160 eyes of 80 patients were included over 6 months. A complete ophthalmic evaluation was performed. Color fundus and spectral domain optical coherence tomography were performed at presentation. Results The visual acuity ranged from 6/6 to 6/18 in 80 eyes, which represents 50%, from 6/24 to 6/60 in 62 eyes, which represents 38.75%, and from less than 6/60 to perception of light in 18 eyes, which represents 11.25%. Fundus examination revealed that eight eyes were normal (5%). Hypertensive retinal changes occurred in 82 eyes with variable degrees of retinopathy. Diabetic retinopathy was found in 30 (18.75%) eyes and macular degeneration was detected in 20 (12.5%) eyes. Retinal vasculitis occurred in two (1.25%) eyes, branch retinal vein occlusion was detected in six (3.75%) eyes, glaucomatous optic neuropathy was found in eight (5%) eyes and central retinal artery occlusion occurred in four (2.5%) eyes. Conclusion The most common visual problems in hemodialysis patients that lead to visual loss are hypertensive and diabetic retinopathy. Hence, it is mandatory to screen fundus changes in CKD to prevent loss of vision.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122960529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/jesnt.jesnt_12_21
Swaraj Sathyan, Ajay K. Sharma, A. Halawa
Induction agents are widely used at the time of kidney transplantation to decrease the risk of rejection. While there is a strong immunological rationale supporting the use of induction immunosuppression, the clinical evidence demonstrating benefit in low-immunological-risk recipients in addition to current effective maintenance immunosuppression is less robust, especially in terms of improvement in long-term graft survival. This review aims to shed light on the immunological basis of use of induction immunosuppression, available options of induction agents and the current evidence and recommendation for their use in low-immunological-risk kidney transplant recipients.
{"title":"Induction agents and their role in low-immunological-risk kidney transplant recipients: A Review","authors":"Swaraj Sathyan, Ajay K. Sharma, A. Halawa","doi":"10.4103/jesnt.jesnt_12_21","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_12_21","url":null,"abstract":"Induction agents are widely used at the time of kidney transplantation to decrease the risk of rejection. While there is a strong immunological rationale supporting the use of induction immunosuppression, the clinical evidence demonstrating benefit in low-immunological-risk recipients in addition to current effective maintenance immunosuppression is less robust, especially in terms of improvement in long-term graft survival. This review aims to shed light on the immunological basis of use of induction immunosuppression, available options of induction agents and the current evidence and recommendation for their use in low-immunological-risk kidney transplant recipients.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129412646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/jesnt.jesnt_4_21
Osama Ashry Ahmed Gheith, A. Nagib, M. Halim, S. Rida, T. Mahmoud, P. Nair, T. Alotaibi
Background It has been reported that the long-term survival of second transplants may be similar to that of primary transplants. Reports of retransplantation outcomes are scarce, especially in the middle east region. We aimed to present our experience with second renal transplant in Kuwait and compare the donor source among our retransplant recipients. Patients and methods Data of kidney retransplants, under follow-up at the Hamed Al-essa Organ Transplant Center of Kuwait, between 1980 and 2019 were retrospectively analyzed. Out of 3038 kidney transplants, 198 (6.51%) were kidney retransplants. The number of kidney transplants from living donors was 150; from deceased donors, 48 and third transplants represented 15 cases. We compared living donor group 1 with deceased donor group 2 in terms of demographics, posttransplant complications and outcome. Results We observed that episodes of acute antibody-mediated rejection (nine cases, 18.7%, in group 1 vs. eight cases, 16.6%, in group 2, respectively) and T-cell-mediated rejection (14 cases, 9.33%, in group 1 vs.15 cases, 10%, in group 2, respectively) were more frequent among patients in group 2, but this did not reach statistical significance. In terms of the second graft outcome, we observed that the percentage of patients with failed grafts was higher among group 2 patients, but this did not reach statistical significance during their last follow-up, while the two groups were comparable in terms of patient outcome. Conclusion Both living donor and cadaveric renal allotransplants carry the same risk for graft rejection, either AMR or ACR. Meanwhile retransplants who received their kidneys from either living or deceased donors had experienced similar graft and patients’ outcomes. Therefore, retransplant either from living or deceased donor is considered a good option after first renal allograft loss.
{"title":"Long-term outcome of kidney retransplants with different donor sources","authors":"Osama Ashry Ahmed Gheith, A. Nagib, M. Halim, S. Rida, T. Mahmoud, P. Nair, T. Alotaibi","doi":"10.4103/jesnt.jesnt_4_21","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_4_21","url":null,"abstract":"Background It has been reported that the long-term survival of second transplants may be similar to that of primary transplants. Reports of retransplantation outcomes are scarce, especially in the middle east region. We aimed to present our experience with second renal transplant in Kuwait and compare the donor source among our retransplant recipients. Patients and methods Data of kidney retransplants, under follow-up at the Hamed Al-essa Organ Transplant Center of Kuwait, between 1980 and 2019 were retrospectively analyzed. Out of 3038 kidney transplants, 198 (6.51%) were kidney retransplants. The number of kidney transplants from living donors was 150; from deceased donors, 48 and third transplants represented 15 cases. We compared living donor group 1 with deceased donor group 2 in terms of demographics, posttransplant complications and outcome. Results We observed that episodes of acute antibody-mediated rejection (nine cases, 18.7%, in group 1 vs. eight cases, 16.6%, in group 2, respectively) and T-cell-mediated rejection (14 cases, 9.33%, in group 1 vs.15 cases, 10%, in group 2, respectively) were more frequent among patients in group 2, but this did not reach statistical significance. In terms of the second graft outcome, we observed that the percentage of patients with failed grafts was higher among group 2 patients, but this did not reach statistical significance during their last follow-up, while the two groups were comparable in terms of patient outcome. Conclusion Both living donor and cadaveric renal allotransplants carry the same risk for graft rejection, either AMR or ACR. Meanwhile retransplants who received their kidneys from either living or deceased donors had experienced similar graft and patients’ outcomes. Therefore, retransplant either from living or deceased donor is considered a good option after first renal allograft loss.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"502 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123396380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/jesnt.jesnt_1_21
A. Shaltout, S. Samir, F. Lashin, M. Sherif, M. Aboelnasr
Background Patients with end-stage kidney disease (ESKD) on hemodialysis (HD) have a high prevalence of left ventricular hypertrophy (LVH), which is associated with increased cardiovascular risk. Hyperparathyroidism in these patients plays a key role in the development of LVH. The aim of this study was to evaluate the correlation of parathyroid hormone (PTH) level with left ventricular mass in patients with ESKD on HD. Other factors that contribute to the development of LVH were also included. Patients and methods This study included 40 patients with ESKD at our dialysis unit. Patients were classified into two groups: group I included 20 patients with LVH and group II included 20 patients without LVH. Patients were defined as having LVH if they had left ventricular mass index more than 95 g/m2 in women and more than 115 g/m2 in men. Results There was a statistically significant increase in PTH in patients in group I than group II (P=0.009). Hemoglobin % was significantly lower in patients in group I than group II (P=0.042). Left ventricular mass index showed a significant positive correlation with PTH and a significant negative correlation with hemoglobin %. Conclusion Hyperparathyroidism and anemia are the two major contributors to the development of LVH in patients with ESKD on HD.
{"title":"Correlation of parathyroid hormone level with left ventricular mass in patients with end-stage kidney disease on hemodialysis","authors":"A. Shaltout, S. Samir, F. Lashin, M. Sherif, M. Aboelnasr","doi":"10.4103/jesnt.jesnt_1_21","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_1_21","url":null,"abstract":"Background Patients with end-stage kidney disease (ESKD) on hemodialysis (HD) have a high prevalence of left ventricular hypertrophy (LVH), which is associated with increased cardiovascular risk. Hyperparathyroidism in these patients plays a key role in the development of LVH. The aim of this study was to evaluate the correlation of parathyroid hormone (PTH) level with left ventricular mass in patients with ESKD on HD. Other factors that contribute to the development of LVH were also included. Patients and methods This study included 40 patients with ESKD at our dialysis unit. Patients were classified into two groups: group I included 20 patients with LVH and group II included 20 patients without LVH. Patients were defined as having LVH if they had left ventricular mass index more than 95 g/m2 in women and more than 115 g/m2 in men. Results There was a statistically significant increase in PTH in patients in group I than group II (P=0.009). Hemoglobin % was significantly lower in patients in group I than group II (P=0.042). Left ventricular mass index showed a significant positive correlation with PTH and a significant negative correlation with hemoglobin %. Conclusion Hyperparathyroidism and anemia are the two major contributors to the development of LVH in patients with ESKD on HD.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"117 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133753021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/jesnt.jesnt_5_21
M. Emam, Mohamed Moneem, O. Gheith, T. Mahmoud, A. Nagib, Khalid Abdultawab, Z. Elsayed, P. Nair, T. Al-Otaibi
Thalassemia minor has a good prognosis, whereas thalassemia major (TM) is a severe disease, and the long-term prognosis depends on the treatment adherence to transfusion and iron chelation therapies. To our knowledge, there are no reported thalassemia cases that underwent kidney transplant. We aimed to highlight a successful kidney transplant in a patient with TM with stable graft function after 16 months of follow-up. In our case, repeated blood transfusions were inevitably associated with iron overload despite iron chelating agents. Moreover, she developed anti-HLA antibodies, but fortunately, there were no donor-specific antibodies, which facilitated the procedure of renal transplant that was performed on 17/3/2019. After 6 weeks of transplant, she started follow-up in the clinic and resumed iron chelation using deferasirox along with much less frequent blood transfusion. After more than 20 months of follow-up, she is enjoying stable graft function, hemoglobin around 9.2 g/dl, and with occasional trace proteinuria. This is a case report showing a β-TM case can undergo renal transplant with no contraindications under special circumstances, and it is the first case in the literature.
{"title":"Successful kidney transplantation of a patient with thalassemia major: case report and review of literature","authors":"M. Emam, Mohamed Moneem, O. Gheith, T. Mahmoud, A. Nagib, Khalid Abdultawab, Z. Elsayed, P. Nair, T. Al-Otaibi","doi":"10.4103/jesnt.jesnt_5_21","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_5_21","url":null,"abstract":"Thalassemia minor has a good prognosis, whereas thalassemia major (TM) is a severe disease, and the long-term prognosis depends on the treatment adherence to transfusion and iron chelation therapies. To our knowledge, there are no reported thalassemia cases that underwent kidney transplant. We aimed to highlight a successful kidney transplant in a patient with TM with stable graft function after 16 months of follow-up. In our case, repeated blood transfusions were inevitably associated with iron overload despite iron chelating agents. Moreover, she developed anti-HLA antibodies, but fortunately, there were no donor-specific antibodies, which facilitated the procedure of renal transplant that was performed on 17/3/2019. After 6 weeks of transplant, she started follow-up in the clinic and resumed iron chelation using deferasirox along with much less frequent blood transfusion. After more than 20 months of follow-up, she is enjoying stable graft function, hemoglobin around 9.2 g/dl, and with occasional trace proteinuria. This is a case report showing a β-TM case can undergo renal transplant with no contraindications under special circumstances, and it is the first case in the literature.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"3681 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127525081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.4103/jesnt.jesnt_41_20
A. Abdel-Rahman, M. Ibrahim, A. Elmowafy, Tamer M. Gouda, M. Zahran, A. El-okely, Essam M Elsawy, H. Saleh, E. Wafa
Background Variable prophylaxis regimens have been adapted to guard against cytomegalovirus (CMV) after renal transplantation. High-dose valganciclovir (VGCV) is the gold standard, but it is of very high cost. Herein, we compared another low-cost regimen [low-dose valacyclovir (VCV)] with low-dose VGCV to assess the efficacy and safety of VCV. Patients and methods This is a single-center randomized controlled trial that was held in Urology and Nephrology Center, Mansoura University, Egypt. The patients were divided into two groups according to CMV prophylaxis regimen used. Group I included 40 kidney transplant recipients who received low-dose VCV (2 g b.i.d.), and group II included 40 kidney transplant recipients who received low-dose VGCV (450 q.d.). Results Our patients’ age ranged from 18 to 58 years, and the majority were males. The median years of transplantation were 1.9 years. Efficacy of both regimens was similar. Interruption of VCV was more frequent, with significant difference, and it was associated with increased incidence of CMV infection but without any statistical significance. The cost of low-dose VGCV was very high in comparison with low-dose VCV. Conclusion Low-dose VCV showed the same efficacy and safety of low-dose VGCV as CMV prophylaxis protocol after kidney transplantation.
{"title":"Evaluation of cytomegalovirus prophylaxis regimens in renal transplant recipients as an economy-saving strategy: a randomized comparative study","authors":"A. Abdel-Rahman, M. Ibrahim, A. Elmowafy, Tamer M. Gouda, M. Zahran, A. El-okely, Essam M Elsawy, H. Saleh, E. Wafa","doi":"10.4103/jesnt.jesnt_41_20","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_41_20","url":null,"abstract":"Background Variable prophylaxis regimens have been adapted to guard against cytomegalovirus (CMV) after renal transplantation. High-dose valganciclovir (VGCV) is the gold standard, but it is of very high cost. Herein, we compared another low-cost regimen [low-dose valacyclovir (VCV)] with low-dose VGCV to assess the efficacy and safety of VCV. Patients and methods This is a single-center randomized controlled trial that was held in Urology and Nephrology Center, Mansoura University, Egypt. The patients were divided into two groups according to CMV prophylaxis regimen used. Group I included 40 kidney transplant recipients who received low-dose VCV (2 g b.i.d.), and group II included 40 kidney transplant recipients who received low-dose VGCV (450 q.d.). Results Our patients’ age ranged from 18 to 58 years, and the majority were males. The median years of transplantation were 1.9 years. Efficacy of both regimens was similar. Interruption of VCV was more frequent, with significant difference, and it was associated with increased incidence of CMV infection but without any statistical significance. The cost of low-dose VGCV was very high in comparison with low-dose VCV. Conclusion Low-dose VCV showed the same efficacy and safety of low-dose VGCV as CMV prophylaxis protocol after kidney transplantation.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129124159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.4103/jesnt.jesnt_4_20
Elshahat A. Yousef, Sherif M. H. El-kannishy, Lamia Arfa, R. Mahmoud
Background Critically ill patients are at risk of developing critical illness-related corticosteroid insufficiency (CIRCI). This may present as hypotension, unresponsiveness to catecholamine infusions, and/or ventilator dependence. Acute kidney injury (AKI) usually complicates critically ill patients and is associated with hemodynamic instability. There is usually failure to predict the severity and to assess the response to therapy in AKI. The aim of this study was to assess the plasma cortisol level and its relation to hospital mortality in AKI patients. Patients and methods This is a prospective, observational study that included 66 patients with AKI admitted to the Dialysis and Nephrology Unit, Mansoura University Hospital, who were assessed clinically, followed by cortisol level assay done at the day of admission. Patients were followed clinically and biochemically till discharge. Patients were classified according to random plasma cortisol level into two groups: group 1 included 14 patients with random plasma cortisol of less than 10 μg/dl (CIRCI group) and group 2 included 52 patients with random plasma cortisol of greater than or equal to 10 μg/dl. Results There was a significant increase in platelet count in group 1 compared with group 2, while there was a significant decrease in serum potassium level in group 1 compared with group 2. Moreover, there was a significant decrease in urine output volume in group 1 compared with group 2 (P=0.03). Finally the hospital mortality rate was significantly higher in group 1 (CIRCI group) compared with group 2 (P=0.004). Conclusion AKI patients with low cortisol level at admission have higher mortality rate during the hospitalization period.
{"title":"Plasma cortisol level and its relation to in-hospital mortality in acute kidney injury patients","authors":"Elshahat A. Yousef, Sherif M. H. El-kannishy, Lamia Arfa, R. Mahmoud","doi":"10.4103/jesnt.jesnt_4_20","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_4_20","url":null,"abstract":"Background Critically ill patients are at risk of developing critical illness-related corticosteroid insufficiency (CIRCI). This may present as hypotension, unresponsiveness to catecholamine infusions, and/or ventilator dependence. Acute kidney injury (AKI) usually complicates critically ill patients and is associated with hemodynamic instability. There is usually failure to predict the severity and to assess the response to therapy in AKI. The aim of this study was to assess the plasma cortisol level and its relation to hospital mortality in AKI patients. Patients and methods This is a prospective, observational study that included 66 patients with AKI admitted to the Dialysis and Nephrology Unit, Mansoura University Hospital, who were assessed clinically, followed by cortisol level assay done at the day of admission. Patients were followed clinically and biochemically till discharge. Patients were classified according to random plasma cortisol level into two groups: group 1 included 14 patients with random plasma cortisol of less than 10 μg/dl (CIRCI group) and group 2 included 52 patients with random plasma cortisol of greater than or equal to 10 μg/dl. Results There was a significant increase in platelet count in group 1 compared with group 2, while there was a significant decrease in serum potassium level in group 1 compared with group 2. Moreover, there was a significant decrease in urine output volume in group 1 compared with group 2 (P=0.03). Finally the hospital mortality rate was significantly higher in group 1 (CIRCI group) compared with group 2 (P=0.004). Conclusion AKI patients with low cortisol level at admission have higher mortality rate during the hospitalization period.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128329433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.4103/jesnt.jesnt_1_20
A. Mahmoud, S. Afifi, S. Shalaby, Said M. Al-Barshomy
Background Malnutrition, an important problem in geriatric medicine, is becoming more recognized in hemodialysis patients, as a factor that can even worsen the prognosis and the quality of life of these patients. It is imperative for the nephrology community to recognize this syndrome of malnutrition and work to manage it. Malnutrition can be detected commonly in all age groups of dialysis patients, and it represents a sensitive marker for morbidity and mortality better than chronological age. It could also act as a major cofactor for depression and cognitive impairment development in dialysis patients. We aimed to assess the nutritive status of the elderly patients with end-stage renal disease (ESRD) undergoing hemodialysis using modified subjective global assessment score (M-SGAS) and to correlate between it and different biochemical parameters. Patients and methods A total of 100 ESRD elderly patients on regular hemodialysis were included. All patients were subjected to the following: history taking, including weight change, dietary intake, gastrointestinal symptoms, and functional capacity (nutritionally related functional impairments, comorbidity); physical examination, including decreased fat stores or loss of subcutaneous fat (eyes, triceps, biceps, and chest), signs of muscle wasting (temple, clavicle, ribs, knee, interosseous, quadriceps, and scapula), mid-upper arm and calf circumference, and BMI; malnutrition score (sum of all number) using SGAS; and laboratory investigations, including complete blood count, serum creatinine, blood urea, C-reactive protein, serum albumin, parathyroid hormone, serum calcium, serum phosphorus. urea reduction ratio, and KT/V. Results There was a decrease in anthropometric measures in both males and females, indicating that both sexes are prone to malnutrition to the same degree. On comparing between male and female patients with respect to total M-SGAS, they lie in the moderate degree of total M-SGAS, with no significant difference between males and females. There was a statistically significant negative correlation between M-SGAS and triceps skin fold, mid-arm muscle circumference, and mid-arm circumference, and also there was a statistically significant negative correlation between duration of dialysis and mid-arm circumference. Conclusion The M-SGAS can be used as reliable, rapid, and precise method for nutritional assessment in elderly patients with ESRD on regular hemodialysis. There is a high prevalence of malnutrition among all age groups, even those younger than 40 years old. Malnutrition is associated with female sex, hypoalbuminemia, increased inflammatory markers such as elevated C-reactive protein and elevated total leukocytic count, and in those with low hemoglobin level. Malnutrition also is more detected in patients with hyperparathyroidism.
{"title":"Evaluation of nutritional status of regular hemodialysis elderly patients using modified subjective global assessment score","authors":"A. Mahmoud, S. Afifi, S. Shalaby, Said M. Al-Barshomy","doi":"10.4103/jesnt.jesnt_1_20","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_1_20","url":null,"abstract":"Background Malnutrition, an important problem in geriatric medicine, is becoming more recognized in hemodialysis patients, as a factor that can even worsen the prognosis and the quality of life of these patients. It is imperative for the nephrology community to recognize this syndrome of malnutrition and work to manage it. Malnutrition can be detected commonly in all age groups of dialysis patients, and it represents a sensitive marker for morbidity and mortality better than chronological age. It could also act as a major cofactor for depression and cognitive impairment development in dialysis patients. We aimed to assess the nutritive status of the elderly patients with end-stage renal disease (ESRD) undergoing hemodialysis using modified subjective global assessment score (M-SGAS) and to correlate between it and different biochemical parameters. Patients and methods A total of 100 ESRD elderly patients on regular hemodialysis were included. All patients were subjected to the following: history taking, including weight change, dietary intake, gastrointestinal symptoms, and functional capacity (nutritionally related functional impairments, comorbidity); physical examination, including decreased fat stores or loss of subcutaneous fat (eyes, triceps, biceps, and chest), signs of muscle wasting (temple, clavicle, ribs, knee, interosseous, quadriceps, and scapula), mid-upper arm and calf circumference, and BMI; malnutrition score (sum of all number) using SGAS; and laboratory investigations, including complete blood count, serum creatinine, blood urea, C-reactive protein, serum albumin, parathyroid hormone, serum calcium, serum phosphorus. urea reduction ratio, and KT/V. Results There was a decrease in anthropometric measures in both males and females, indicating that both sexes are prone to malnutrition to the same degree. On comparing between male and female patients with respect to total M-SGAS, they lie in the moderate degree of total M-SGAS, with no significant difference between males and females. There was a statistically significant negative correlation between M-SGAS and triceps skin fold, mid-arm muscle circumference, and mid-arm circumference, and also there was a statistically significant negative correlation between duration of dialysis and mid-arm circumference. Conclusion The M-SGAS can be used as reliable, rapid, and precise method for nutritional assessment in elderly patients with ESRD on regular hemodialysis. There is a high prevalence of malnutrition among all age groups, even those younger than 40 years old. Malnutrition is associated with female sex, hypoalbuminemia, increased inflammatory markers such as elevated C-reactive protein and elevated total leukocytic count, and in those with low hemoglobin level. Malnutrition also is more detected in patients with hyperparathyroidism.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128480003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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