Successful salvage treatment of resistant acute antibody-mediated kidney transplant rejection with eculizumab

Antibody-mediated rejection [ABMR] jeopardises short- and long-term transplant survival and remains a challenge in the field of organ transplantation. We report the first use of the anticomplement agent eculizumab in Oman in the treatment of a 61-year-old female patient with ABMR following a living unrelated kidney transplant. The patient was admitted to the Sultan Qaboos University Hospital in Muscat, Oman, in 2013 on the eighth day post-transplantation with serum creatinine [Cr] levels of 400 [micro]mol/L which continued to rise, necessitating haemodialysis. A biopsy indicated ABMR with acute cellular rejection. No improvement was observed following standard ABMR treatment and she continued to require dialysis. Five doses of eculizumab were administered over six weeks with a subsequent dramatic improvement in renal function. The patient became dialysis-free with serum Cr levels of 119 [micro]mol/L within four months. This case report indicates that eculizumab is a promising agent in the treatment of ABMR

spectrum of glomerular diseases on renal biopsy: data from a single tertiary center in Oman

To study the pattern of glomerular disease [GD] from the result of renal biopsies at our center. We conducted a retrospective review of 190 adult native renal biopsy reports from the pathology registry of renal biopsy performed at our hospital between 1992 and 2010. Lupus nephritis was the most common pathology 48/133 [36.1%] with a female preponderance. The most common primary glomerular disease was focal segmental glomerulosclerosis [FSGS] 26/133[19.5%], followed by membranous glomerulopathy [MGN] 13/133 [9.8%], and mesangial proliferative glomerulonephritis 6/133 [4.5%]. IgA nephropathy and acute proliferative glomerulonephritis each accounted for 4/133 [3.0%]. Membranoproliferative glomerulonephritis accounted for 3/133 [2.3%]. Focal proliferative and cresentic glomerulonephritis each accounted for 2/133 [1.5%]. Vasculitis was not common and there was no report of anti-GBM disease. Among the secondary glomerular diseases, lupus nephritis was the commonest condition with a female preponderance. Among the primary glomerular diseases, FSGS was the commonest. These results are consistent with global trend. IgA nephropathy is not common as the case in the Caucasian population. Vasculitis was not common and there was no report of anti-GBM disease

Estimated glomerular filtration rate [eGFR]: a serum creatinine-based test for the detection of chronic kidney disease and its impact on clinical practice

Chronic kidney disease [CKD] is an important epidemic and public health problem that is associated with a significant risk for vascular disease and early cardiovascular mortality as well as progression of kidney disease. Currently it is classified into five stages based on the glomerular filtration rate [GFR] as recommended by many professional guidelines. Radiolabelled methods for measuring GFR are accurate but not practical and can be used only on a very limited scale while the traditional methods require timed urine collection with its drawback of inaccuracy, cumbersomeness and inconvenience for the patients. However, the development of formula- based calculation of estimated GFR [eGFR] has offered a very practical and easy approach for converting serum creatinine value into GFR result taking into consideration patient's age, sex, ethnicity and weight [depending on equation type]. The commonly used equations include Cockraft and Gault [1976], Modification of Diet in Renal Disease [MDRD] [1999] and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] [2009]. It is the implementation of these equations particularly the MDRD that has raised the medical awareness in the diagnosis and management of CKD and its adoption by many guidelines in North America and Europe. The impact and pitfalls of each of these equations in the screening, diagnosis and management of patients with CKD are presented and discussed in this review

Infective endocarditis of the aortic valve caused by Pseudomonas aeruginosa and treated medically in a patient on haemodialysis

Infective endocarditis [IE] in patients on dialysis is a serious infection with a high mortality rate. It is usually caused by Gram positive bacteria with Gram negative organisms being relatively rare as a cause. Recommended treatment usually involves surgical valve replacement and the extended use of antibiotics. Successful treatment with antibiotics alone is rare. We report a case of IE caused by Pseudomonas aeruginosa in a patient on dialysis treated solely with antibiotics

Transplant renal artery false aneurysm: case report and literature review

This is a case report of a 59 years old male who had a commercial non-related living renal transplantation for his end stage renal insufficiency secondary to adult polycystic kidney disease. He suffered an immediate and early post-operative bleeding, which was managed conservatively. He was presented at Sultan Qaboos University Hospital four months after his transplant with abdominal pain, nausea, loss of appetite and a rise in serum creatinine levels. Ultrasonography and angiography have shown a 4 cm false aneurysm of the transplant renal artery at the anastomotic site with the external iliac artery. Surgical exploration with resection of the false aneurysm and reanastomosis of the donor renal artery to the external iliac artery was carried out successfully with preservation of the renal allograft. This is a rare case of an extra-renal false aneurysm at the anastomotic site of the transplant renal artery to the external iliac artery four months after renal allotransplantation. Literature review on the management and outcome of false aneurysms after renal transplant was carried out

Neurofibromatosis with bilateral renal artery stenosis and end stage renal disease: case report

Neurofibromatosis type 1 [NF-1] is an autosomal dominant, hereditary, neurocutaneous syndrome that may, primarily or secondarily, affect different organs or systems of the body including the cardiovascular system. The most common vascular abnormality in patients with NF-1 is renal artery stenosis. Here we report the case of a middle-aged gentleman who presented at Sultan Qaboos University Hospital, Oman, with end stage renal disease and severe hypertension and was diagnosed to have NF-1 with bilateral renal artery stenosis. He was started on renal replacement therapy