July-September 1994
Volume 5 | Issue 3
Online since Wednesday, June 11, 2008
Renal transplantation in children p. 333
MB Abdurrahman
Pediatric renal transplantation: A review of data from north American pediatric renal transplant cooperative study (NAPRTCS) p. 336
Paul T McEnery
Impact of donor source on short-term outcome of renal transplantation in children p. 347
Ahmed Bayoomi Shehab, Abdullah Fallatah, Iftikhar Ahmed Sheikh, Mohsen Mohammed Hussein Al-Koussi, Mohamed Salah Gabal, Faissal A.M Shaheen
Renal transplantation is the ideal renal replacement therapy for children with endstage renal disease (ESRD). Follow-up of pediatric transplant recipients is tedious because of special problems like non-compliance to treatment and a very active immunological status. Twenty-five pediatric patients with ESRD who received kidney transplants in four different centers were followed up at the Jeddah Kidney Center, Saudi Arabia for a mean period of 22 months. The donor source for transplantation was as follows: living related (LR) in seven, cadaveric (CAD) and living unrelated (LUR) in nine patients each. The overall graft survival was 88% and patient survival 100% at the end of the follow-up period. Living related kidney recipients exhibited 100% graft survival at 22 months and also had the best kidney function. All the graft losses were due to irreversible rejection episodes. Medical complications were common and comprised of hypertension (82%), infection (52%) and rejection (44%). Recipients of LR donor kidneys had the lowest incidence of these complications. Surgical problems encountered were few and minor and needed only conservative management. In our experience, children having renal transplantation have an excellent outcome at short-term particularly with LR donors.
Ten years follow-up of idiopathic focal and segmental glomerulosclerosis p. 354
RG Singh, DK Agarwal, Usha , KV Johny, Jaiprakash
Sixty-four biopsy proven cases of idiopathic focal and segmental glomerulosclerosis (FSGS) were studied retrospectively for 10 years. The mean age of the study patients was 29.5 years and 81.2% of the patients were males. Edema, hematuria, hypertension and azotemia were the main presenting features. All cases were initially treated with steroids alone. Nineteen cases (29.7%) had complete and 14 patients (21.9%) had partial remission while 31 cases (48.4%) had no response. Twenty non-responsive cases were given cyclophosphamide in addition to steroids and seven (35%) patients had complete remission and a similar number had partial remission. Patients who had azotemia, hypertension, nephrotic range proteinuria and diffuse mesangial hypercellularity in addition to segmental sclerosis on renal histology at presentation were classified as malignant FSGS. There were eight such cases of which two showed partial response to steroids. One patient went into complete remission with steroids and cyclophosphamide while two others showed partial remission. Mean duration before the occurrence of renal death in benign FSGS patients was six years while all malignant FSGS cases had renal death within two years. Differentiating benign and malignant FSGS will help in prognostication of patients with this pathology.
The impact of non-HLA factors on renal graft survival p. 359
Ahmed Adel Hassan, Essam Mahmoiid Amin, Ahmed Ibrahim Amer, Essam Lotfy Omar, Mohamed Hassan Aly
Several non-HLA factors such as, age, sex, blood group, and cytomegalovirus (CMV) carrier state of both the donor and the recipient are known to influence renal allograft survival. In a retrospective study on 150 living related donor renal transplant patients, we evaluated the effect of the above mentioned factors on graft survival. Patients were divided into two groups, according to immunosuppression protocols. Group 1 (n=120) patients were on triple therapy with cyclosporin-A, azathioprine and prednisolone whereas those in Group 2 (n=30) were on conventional therapy with azathioprine and prednisolone. In Group 1, the patients aged < 45 years had graft survival rates 100%, 94% and 83% at 1,2 and 3 years, whereas the rates were 87%, 87%, 68% respectively in those aged > 45 years (P < 0.06). Sex of neither the donors nor the recipients affected graft survival. Patients with blood group B had poor graft survival among Group 2 patients (P < 0.05). However, the patients with blood group B in Group 1 had significantly superior graft survival rates than the patients with the same blood group in Group 2 (P < 0.01). No significant difference in the graft survival rates was found between the two groups in relation to other blood groups. Also, there was no significant difference in the graft survival of the CMV negative and the CMV positive (IgG) recipients in both the study groups.
Etiopathogenesis of acute poststreptococcal glomerulonephritis p. 365
Maha A Azzam, Tej K Mattoo
The relationship between nephritogenic strains of group A beta-hemolytic streptococci (GABS) and acute poststreptococcal glomerulonephritis (APSGN) is well established. Recent studies have cast some doubts on the importance of the M-antigen which is widely used in classifying the nephritogenic strains of GABS. The renal injury occurs as a result of an immune-mediated process which involves the complement system. This leads to deposition of circulating immune complexes and/or their in-situ formation in the kidney resulting in renal damage. Newer antigenic fractions have been identified in GABS, which include; endostreptocin (ESS), nephritis strain associated protein (NSAP), and pre-absorbing antigen (Pa-Ag). These developments have allowed a better insight into the pathogenesis of APSGN.
Is erythropoietin safe in haemodialysis patients with multiple myeloma ? p. 371
Magdi Hussein, Jacob Mooij, Haysam Roujouleh
The use of recombinant human erythropoietin (rHuEpo) for the treatment of anemia of end-stage renal disease (ESRD) is now well established. There have also been reports about its use in treating the anemia of other diseases including multiple myeloma (MM). Some concern about the usage of rHuEpo in patients with MM has been raised by studies reporting worsening of myeloma activity after starting this drug. However, other studies have reported its safety in patients with MM. We report here a patient on maintenance haemodialysis, not known to have MM who developed symptoms related to this disease four months after starting rHuEpo. Although we might speculate that the onset of symptoms was coincidental and not causally related to rHuEpo, we recommend close monitoring of the disease activity in patients with MM receiving rHuEpo.
Natural progression of calciphylaxis in a patient on haemodialysis p. 374
Abraham George, T Timothy Paul, Chandrahasan Kedharnath, Magdy Diwan, Mohammad Ashraf Want, Hla Mon
A 40 year old patient with end-stage renal disease developed features of calciphylaxis and tumoral calcification after four and half years on regular haemodialysis. The patient had hyperphosphatemia, with high calcium-phosphate index and radiological evidence of hyperparathyroidism before the onset of symptoms. Conservative management was without success and the patient developed florid symptoms. Parathyroidectomy was delayed due to unavoidable circumstances. When it was eventually performed there was a prompt regression of the calcific masses, but not of the vascular calcifications. The natural progression of the disease and its regression by parathyroidectomy provides an interesting insight into this phenomenon, the full blown picture of which is rarely seen these days.
PRACTICAL PROCEDURE
Continuous arteriovenous and continuous venovenous haemodialysis p. 379
Faissal A.M Shaheen, Iftikhar Ahmed Sheikh, Mohammad Ziad Souqiyyeh
Treatment of end-stage renal failure in Abu Dhabi, United Arab Emirates p. 384
Yassin I El Shahat, Shakuntala Varma, M Zahir Bari, Shah Nawaz, Inderjit Dhawan, Marwan Masry, Kyran Hayes, Avinash Pingle