Journal of The Egyptian Society of Nephrology and Transplantation最新文献

{"title":"Pattern of vascular access-related infection in hemodialysis patients","authors":"M. Zeid, A. Mahmoud, M. Khalil, Noha Elkohly","doi":"10.4103/jesnt.jesnt_26_21","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_26_21","url":null,"abstract":"Background Vascular access-related infections (VARI) represent a substantial burden for patients undergoing hemodialysis (HD) that is unfortunately inevitable. The spectrum of causative organisms varies between different regions and centers, so it is necessary for each dialysis unit to have its database. This prospective descriptive multicenter study was conducted over a 6-month duration to delineate the pattern of VARI among patients undergoing HD units of Alexandria University Hospitals, and to determine the possible relationship between VARI, type of vascular access, pattern of causative organisms, and various risk factors. Materials and methods The study enrolled all patients with documented clinical and bacteriological evidence of VARI. Infection incidence-rate event/1000 dialysis session (ds) was calculated. Results During the study period, 877 HD patients were approached. A total of 66 VARI episodes were identified in 62 patients, with 58 bloodstream infection (BSI) episodes and 8 local-access infections, with an overall incidence rate of 4.64/1000 ds. About 64% of isolated organisms were Gram-negative bacilli, 33.3% Gram-positive cocci, and 2.8% fungi. The most frequent isolated pathogens were Klebsiella pneumonia, Escherichia coli, and methicillin-resistant Staphylococcus aureus (MRSA). Conclusion VARI rate was higher in HD patients with temporary central venous catheter compared with permanent tunneled catheters. Gram-negative microorganisms and MRSA were the most frequent identified organisms. Creation of arteriovenous fistula should not be delayed to avoid the use of temporary catheters, which carry high risk of VARI.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131435748","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}

{"title":"Role of oral lactoferrin as a source of iron supplementation in correction of anemia in pediatric patients with chronic kidney disease stages 2–4","authors":"M. El-Farsy, I. El-Hakim, R. Al-Arian","doi":"10.4103/jesnt.jesnt_22_21","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_22_21","url":null,"abstract":"Background Children with chronic kidney disease (CKD) have multiple risk factors for anemia such as primary erythropoietin deficiency, blood loss, decreased red blood cell (RBC) survival, bone marrow suppression, iron deficiency, inflammation and infection, malnutrition, hyperparathyroidism, vitamin B12 and folate deficiency, aluminum toxicity, and carnitine deficiency. This study was performed to evaluate the effect of oral bovine lactoferrin on patients with iron deficiency with CKD stages 2–4. Patients and methods This follow-up cohort clinical study was conducted on children with CKD in the conservative clinic, Pediatric Nephrology Unit, Children’s Hospital, Ain Shams University. It included 45 pediatric patients with CKD stages from 2 to 4 for 6 months without a control group. This is a follow-up case study in which all the included patients were on erythropoietin therapy ranging from 150 to 300 IU/kg once per week. The patients were subjected to history and laboratory evaluation, including hemoglobin (Hb), serum iron, serum ferritin, and total iron-binding capacity (TIBC), which were done for the patients at baseline and 6 months after treatment with bovine lactoferrin for 6 months. Results Blood Hb and RBC volume were significantly increased beginning from first month after oral lactoferrin therapy, serum iron and serum ferritin were significantly increased 6 months after intervention, and serum TIBC was significantly decreased after intervention. The current study had shown no significant difference between males and females regarding laboratory changes 6 months after intervention. Laboratory improvements were significantly lowest among cases with stage 4, followed by stage 3, and the highest among cases with stage 2. There was a decrease in all anemia clinical manifestations after 6 months of lactoferrin administration; the differences were significant only in easy fatigability, constipation, and gastrointestinal upset, which were the most frequent adverse effects. Conclusion Oral lactoferrin was found to be effective in treating iron-deficiency anemia regarding blood Hb, blood RBCs, serum iron, serum ferritin, and TIBC in association with erythropoietin therapy. The effect declines with the progression of CKD.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131725508","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}

{"title":"Short-term biochemical and anthropometric effects of nutritional education for serum phosphorus control in hemodialysis patients","authors":"K. Salem, Hussein Sheashaa, Doaa El-Sabakhawy, M. Amin, N. Sayed-ahmed, M. Nassar","doi":"10.4103/jesnt.jesnt_45_20","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_45_20","url":null,"abstract":"Background Hyperphosphatemia is a frequently encountered and difficult-to-manage problem in hemodialysis (HD) patients and is an important risk factor for cardiovascular diseases. This study was carried out to explore the effect of nutritional education on the serum phosphorus level in HD patients. Patients and methods This open-label, single-center randomized controlled trial involved 100 HD patients. Patients were randomly assigned to one of two groups: the education group underwent a 12-week nutritional education program, whereas the control group received standard treatment. Nutritional education was provided by a trained renal dietitian in the form of educational sessions, brochures, audiovisual teaching aids, and patient-tailored dietary recommendations. Detailed nutritional and laboratory tests were done before randomization and 3 weeks after the end of the study. Results Serum phosphorus level and calcium–phosphorus product were significantly lower among the education group (P=0.02 and 0.04, respectively) with a percent reduction of serum phosphorus of -13.8 ± 21.41 after nutritional education. Nutritional education (B: -0.57, 95% confidence interval: -1.13 to -0.01, P=0.04) and the dietary protein intake (B: -0.47, 95% confidence interval: -0.94 to -0.003, P=0.04) were the predictors of serum phosphorus level at the end of the study. Three weeks after termination, BMI, waist circumference, and malnutrition inflammation score were lower (P=0.04, 0.04 and 0.02, respectively), whereas midarm muscle circumference was higher (P=0.004) among the education group. Conclusion Nutritional education can help in controlling the serum phosphorus level in HD patients without causing derangements in the nutritional status and should be provided in each HD unit.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115494188","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}

{"title":"An epiphanic case of X-linked Alport syndrome caused by a hitherto unreported COL4A5 gene mutation","authors":"Avinash Ullur, P. Subramanian, R. Santanaraman, D. Rangarajan, D. Gunasekaran, Sudha Rao","doi":"10.4103/jesnt.jesnt_42_21","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_42_21","url":null,"abstract":"Alport Syndrome (AS) is an inherited glomerular disease, which invariably progresses to End Stage Kidney Disease (ESRD). It can be associated with hearing impairment and ocular defects. The disease can be X-linked caused by mutations in the Type 4 Collagen alpha 5 chain (COL4A5), Autosomal Recessive (ARAS) or Autosomal Dominant (ADAS) caused by mutations in the Type 4 Collagen alpha 3 chain (COL4A3) or alpha 4 chain (COL4A4). We report a novel mutation in COL4A5 Gene causing XLAS resulting in Chronic Kidney Disease in a 34-year-old male. Whole genome sequencing of the patient, showed hemizygous variant (c.1690G>C, p. Gly564Arg) in the COL4A5 gene. The same variant was detected in his mother and his only daughter establishing that the mutation is pathogenic.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125761445","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}

{"title":"Evaluation and risk factors of microalbuminuria in children with type 1 diabetes in Aswan University Hospital: a hospital-based study","authors":"M. Gabri, Ashraf Meabed, Treza Abdelshahid, H. Ali, Eslam M. Fathy, E. Zaki","doi":"10.4103/jesnt.jesnt_8_22","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_8_22","url":null,"abstract":"Background Diabetic nephropathy is the major complication of diabetes and is one of the leading causes of end-stage renal disease. Early identification of nephropathy is crucial to slow down this process. Assessment of albuminuria is used as an early clinical marker for impaired kidney function. The aim of this study is to evaluate the magnitude of microalbuminuria (MA) in children with type 1 diabetes and determine the factors correlated to it. Patients and methods A cohort study that was carried out on diabetic children attained the endocrinology clinic in our hospital from August 2019 to October 2020. Children aged 6–18 years old with a history of 2 years of diabetes were subjected to history, examination, and investigation, including urea, creatinine, lipid profile, hemoglobin A1c, and 24-h urinary albumin were done twice. Statistical analysis used χ2, Fisher exact, and independent Wilcoxon t test for comparison between groups. Spearman and Pearson’s for correlations. Results The median (interquartile range) of MA in the first visit was 10 mg/24 h (6.15–20 mg/24 h) in the first visit versus 9.5 mg/24 h (4.9–23.55 mg/24 h) in the second visit, with an insignificant P value. The abnormal numbers of hemoglobin A1c in the first visit were 85.7 and 79.3% in the second visit; P value is 0.350. Children with abnormal MA were 13.2% in the first visit versus 20% in the second visit with only four patients having persistent MA. MA was positively correlated to the Tanner stage in the first visit to blood pressure, serum triglyceride, and Tanner stage in the second visit, and negatively correlated to high-density lipoprotein. Conclusion Most of our patients had uncontrolled diabetes with an increasing prevalence of MA over time.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115028559","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}

{"title":"Serum hepcidin levels and cardiovascular outcomes in patients on maintenance hemodialysis: a study from South India","authors":"Kankokaran Anupama, Manjusha Yadla","doi":"10.4103/jesnt.jesnt_20_21","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_20_21","url":null,"abstract":"Background Cardiovascular mortality is high in patients on maintenance hemodialysis. Different factors and plausible mechanisms have been explained for the increased risk. A recent concept of iron dysregulation and the related biomarker serum hepcidin was thought to be one of the novel markers of cardiovascular disease. We undertook this study to study the fatal and nonfatal cardiovascular events in dialysis population. Patients and methods All the patients who satisfied inclusion criteria were included in the study. All the patients have been on either twice-/thrice-weekly dialysis with polysulfone membrane of 1.3-m2 surface area. Serum hepcidin levels were estimated in blood samples using the appropriate techniques. All the patients were followed up for 18 months to assess the fatal and nonfatal cardiovascular outcomes. Results A total of 80 patients satisfied the criteria and were followed up. Mean serum hepcidin levels were 116.3 ± 32 ng/ml. On univariate analysis of factors influencing mortality, age, sex, and presence of comorbidities did not show significant association, but the levels of serum bicarbonate, albumin, creatinine, cholesterol, triglycerides, and the high-sensitivity C-reactive protein, hepcidin, showed a significant association with mortality. Serum hepcidin level of 120 ng/ml predicted mortality with a sensitivity of 100% and specificity of 85%. Conclusions Serum hepcidin is associated with all-cause mortality and cardiovascular mortality in patients on hemodialysis. Hepcidin levels may serve a good predictor of cardiovascular outcomes in patients on hemodialysis.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"118 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134347128","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}

{"title":"Study of left ventricle hypertrophy, dilatation, and ejection fraction changes before and after kidney transplantation","authors":"Noha Elkohly, Mohamed Abdelfadeel, Eman Elsharqawy, M. Zeid","doi":"10.4103/jesnt.jesnt_30_21","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_30_21","url":null,"abstract":"Background People with end-stage renal disease (ESRD) are at risk of developing serious cardiovascular complications. Left ventricular hypertrophy is the most prevalent cardiac finding observed. Renal transplantation is the best renal replacement modality offered to these patients with an expected improvement in cardiovascular complications. The aim of this work the present study aims to compare changes in left ventricle hypertrophy, dilatation, and ejection fraction before and after kidney transplantation. Patients and methods This cross-sectional study included 30 renal transplant recipients. Echocardiography was performed for all patients before transplantation and 6–12 months after transplantation. Patients with a reported history of posttransplant rejection or heart failure were excluded from the study. All patients were on hemodialysis before transplantation, and the mean postrenal transplant duration was 10.33 ± 1.95 months. All patients received the same posttransplant immunosuppressive regimen. Results The mean left ventricular ejection fraction before and after renal transplantation was 59.70 ± 7.86 and 68.82 ± 7.93, respectively (P<0.001). The mean left ventricular mass index showed a significant improvement from 144.1 ± 44.15 before transplant to 115.1 ± 38.79 after transplant, with a P value of 0.002. Conclusion According to the results of this study, renal transplantation can improve left ventricle parameters in patients with ESRD.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124207282","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}

{"title":"Seeking action for diabetic nephropathy patient care","authors":"M. Nataraj","doi":"10.4103/jesnt.jesnt_10_22","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_10_22","url":null,"abstract":"","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129609709","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}

{"title":"Safety and efficacy of low-dose glucocorticoid regimen in the induction phase treatment of class 4, 5 lupus nephritis: a retrospective study","authors":"G. Vakrani, Nambakam Tanuja, Sania Saba","doi":"10.4103/jesnt.jesnt_3_22","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_3_22","url":null,"abstract":"Background Renal involvement in systemic lupus erythematosus is known as lupus nephritis (LN). LN presents with varied renal features. Class 4 and 5 LN are traditionally treated with prolonged standard high doses of prednisolone with various immunosuppressants such as cyclophosphamide and mycophenolate. These high doses of prednisolone are associated with numerous side effects. There is deficient data on the dose, duration of glucocorticoid therapy, and also paucity of data on comparison between the standard dose versus low-dose glucocorticoid therapy. Hence, this study can help in evaluating the use of low-dose glucocorticoids, its impact on renal outcome, and looking at side effects. Materials and methods It was a retrospective observational study conducted to look at the safety and efficacy of low-dose glucocorticoid regimen in induction phase treatment of class 4, 5 LN. Results On treatment, it was found that the resolution of microscopic hematuria, and improvement of low C4, and hypoalbuminemia were statistically significant in the low-dose steroid group. The resolution of proteinuria was seen in both groups and the resolution of renal failure was noted in both groups but was statistically significant in the standard dose group. Increased incidence of steroid-related complications was seen in the standard dose steroid group. Conclusions These findings possibly indicate that low-dose steroid therapy is good enough to treat LN with proteinuria, but a standard dose steroid is required in the presence of renal failure in LN, though increased incidence of steroid-related complications was seen in the standard dose steroid group.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114884961","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}

{"title":"Management of postkidney transplant anemia – is it feasible to maintain patient and allograft survival?","authors":"A. Halawa, Fedaey Abbas, M. E. El Kossi, I. Shaheen, Ajay Sharma","doi":"10.4103/jesnt.jesnt_5_22","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_5_22","url":null,"abstract":"Background Kidney transplantation has been established as the best therapy for end-stage renal disease. After transplantation and to provide a prolonged and safe patient and allograft survival, early and prompt diagnosis of posttransplant sequelae, for example, posttransplant anemia (PTA) in particular, is currently crucial. Timing of presentation of this disease has its effect on PTA development. The ‘early’ presented PTA (before 6 months) may differ clinically from the ‘late’ one (after 6 months) with respect to the underlying background. Although early PTA is multifactorial, allograft dysfunction is usually the underlying mechanism in the ‘late’ one. Furthermore, PTA is currently considered as an independent risk factor for the evolution of cardiovascular system events; the latter has been proved to be the first leading cause of death in this cohort of patients. The aims and objectives of this review is to evaluate critically the risk factors responsible for PTA development, its epidemiology, diagnostic criteria, etiology for both ‘early’ and ‘late’ PTA, the available therapeutic approaches for PTA, as well as the effect of PTA in allograft and patient survival. Methods Current available literature and analysis of various trials concerned with PTA. Results The impact of anemia on patients as well as allograft outcomes cannot be simply overlooked. Management of the early as well as late PTA is crucial. However, a variety of hazards of its therapeutic options should be thoroughly considered. Conclusions A lowered threshold of post-transplant anemia (PTA) awareness and its early management has its crucial impact on allograft as well as patient survival. Benefits of PTA correction is not only reflected on patients’ and allograft longevity but also on upgrading KTRs’ quality of life.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124113696","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}