Hypertension among patients with end stage renal disease on regular haemodialysis at Gezira hospital for renal diseases and surgery

The prevalence of hypertension in patients with chronic kidney disease, ftom ail causes, increases iiueavly as veuai fuuctiou deteriorates, reaching approximately 95% as patients approach end-stage renal disease. To determine the incidence of hypertension in patients on haemodialysis and to evaluate the control of blood pressure among patients with end stage renal disease. This was a prospective cross sectional study, conducted at Gezira Hospital for Renal Diseases and Surgery, Wad Medani, in January 2010. 133 patients with end stage renal disease were enrolled in this study ,blood pressure was measured pre, intra and post dialysis sessions. Drug therapy and the complications of hypertension were recorded. 89% of all patients were hypertensive, 94.07% out of them were on antihypertensive. Blood pressure was not adequately controlled in 62.16% of the patients. Paradoxical hypertension was found in 12.78%. 14.41% of the hypertensive group admit to have poor compliance for their antihypertensive medications. Calcium channel blockers were used in 42.94%, angiotensin converting enzyme inhibitors 36.72%, beta-blockers 15.26%, angiotensin II receptor in 2.26%, Alpha blocker in 2.26% and diuretics in 0.07% of the cases. 35.58% of the patients were suffering congestive heart failure and 2.26% suffered from cerebrovascular accident. The prevalence of hypertension in patients on regular haemodialysis mounting to 90%

Renal transplantation Gezira hospital for renal disease and surgery [GHRDS]

Recent years have witnessed an explosive growth in the number of patients experiencing end stage renal disease [ESRD], as well as number of centers providing therapeutic modalities such as hemodialysis, peritoneal dialysis and renal transplantation. Algorithm: 1. To audit the practice of renal transplantation in Gezira hospital for renal disease and surgery [GHRDS]. 2. To recommend and contribute in some aspects that may reduce surgical complications and transplant-related deaths, and improve the outcome. 3. To assess the impact of preoperative co-morbid medical conditions of the recipient on the frequency of surgical complications of renal transplantation in GHRDS Patients and Methods: This is non-interventional descriptive retrospective review was made of all patients transplanted in the period June 2001-June 2008 in GHRDS. A total of 82 renal transplants were performed at GHRDS in our study period, all were adults and they are representing our study population group. Data was analyzed by computer program the SPSS. To determine the statistical significance of differences, the Pearson test was used and probability test [P. value] with p < 0.05 considered as significant. The incidence of surgical complications was correlated with several pretransplant, technical and post-transplant risk factors. Among the 82 patients underwent living donor renal transplantation in the GHRDS in the period 2001-2008 some surgical complications were occurred. These complications included hemorrhage in 9 patients, hematoma necessitating surgical exploration in 5 patients, urinary leakage in 7 patients, ureteric obstruction with clots in 3 patients, significant hematuria in 5 patients, wound dehiscence in 4 patients. The incidence of urological complications [ureteric obstruction and urinary leakage] was 8.1% and vascular complications 4.9%. There were 3 gastrointestinal complications [3.4%]. We lost 10 grafts [12.2%] and 9 recipients [10.9%]. The practice of renal transplant in GHRDS was found to be sound and comparable to the learning curve of the literature. The numbers of patients transplanted not yet paralleling the increasing numbers of patients with ESRD

Hemodialysis, plea of availability versus adequecy Gezira experience

This is a prospective cross sectional study carried out in Gezira Hospital for Renal Diseases and Surgery [Sudan] to assess the adequacy of hemodialysis in 206 patients with end stage kidney disease on regular hemodialysis twice per week using. Pre and post hemodialysis blood sample were obtained from the study group, spKt/V and urea reduction ratio were calculated. Mean Kt/v was found to be 1.19 and urea reduction ratio was 59.55%. None of the patients in this study group achieved the National Kidney Foundation Dialysis Outcomes Quality Initiative [K/DOQI] recommendations for adequate hemodialyis, since it requires three hemodialyis sessions per week and our patients are receiving two sessions per week. In order to improve the situation herewith we recommended increased number of sessions from two to three times per week and /or increase the duration of hemodialysis session, increase blood flow rate and dialysate flow rate. Moreover, decrease the number of patients on regular hemodialysis by encouraging the patients to take the other renal replacement therapy [peritoneal dialysis and renal transplantations]

anti-inflammatory properties of interleukin 18 binding protein in rheumatoid arthritis

Interleukin-18 binding protein [IL-18BP] is functioning as a natural anti-inflammatory and immunosuppressive molecule by neutralizing the effects of IL-18 during inflammation. This study aimed to identify the role of IL-18BPa in the regulation of immune responses associated with the pathogenesis of RA. 65 RA patients, 22 OA patients, and 40 sex and age matched healthy donors were enrolled in this study. Synovial specimens were obtained through synovectomy or arthroscopic procedures. SFMC and PBMC were prepared by using Ficoll-Hypaque separation procedure. Superarray analysis was used to measure the expression profile of immune-related genes in normal PBMC treated with recombinant human IL-18BPa. The mRNA levels of Th1 and Th2 cytokines were measured by Real-time PCR, and the protein levels of IFN-gamma, IL-4 were detected by ELISA. SuperArray analysis of immune related gene expression profile in normal PBMC treated with IL-18BPa indicated decreases in the gene expression of IFN- gamma and its regulatory molecules STAT-1 and STAT-2. This study pointed out that IL-18BPa has additional anti-inflammatory property through downregulating the expression of IFN- gamma and IL-12, at the same time, upregulating the expression of IL-4 and IL-10. Both IFN- gamma and IL-12 could upregulate the mRNA and protein levels of IL-18BPa in both the normal and RA subjects. Our results demonstrated the importance of IL-18BPa as an immune regulatory molecule and as a promising therapy for treating RA

[Penile fracture epigrams from our experience in 15 Sudanese patients]

To review clinical pattern and outcome of fracture penis retrospectively from January 2000 to January 2008 in Gezira hospital for renal diseases and surgery, Sudan. Total number of patients were 75 and the range of age was 15-45 years with a mean age of 25 years. Diagnosis was established mainly through clinical work up. Most patients were subjected to a surgical intervention. The defects in the tunica was approximated by the used 2-0 proleine with inverted knot and/or delayed absorbable sutures and Foley catheter was routinely fixed after insurance of the integrity of the urethra. Most of cases presented with penile pain [13 patients, 87%], swelling due to extension of a haematoma [9 patients, 60%], bruises and detumescence [10 patients, 67%], curvature and fracture of erection were the presenting claim for the delayed patients [3 patients, 20%]. Most of them developed complications [8 patients, 53%], this included [4 patients, 27%] developed erectile, dysfunction, [2 patients, 13%] developed curvature and one patients [6%] developed calcification urethral stricture. We concluded that early surgical intervention, antibiotics administration and early seeking of medical advice are recommended in order to preserve penile function in cases of fracture penis. Investigations got minor role in the diagnosis of fracture penis

Changes in serum calcium, phosphate, albumin and parathyroid hormone before and after hemodialysis in Sudanese patients with end-stage renal failure

To determine the concentrations of serum parathyroid hormone [PTH] and bone minerals and their association before and after hemodialysis. A cross sectional study was done on patients with end-stage renal disease [ESRD] on treatment with maintenance hemodialysis [HD]. Levels of serum calcium, phosphate, urea, creatinine, albumin, and intact parathormone [iPTH] were measured. The total number of patients studied was 50 [40 males; 10 females], the mean age was 40.3 +/- 26.5 years, and the average duration on hemodialysis [HD] was 53 months. Serum PTH level was significantly lower after hemodialysis treatment; it was 945.8 +/- 995.9pg/ml and 781.7 +/- 928.1 pg/ml before and after HD respectively, but still over the normal range. Serum phosphate concentration was remarkably differ before and after HD [5.59 +/- 1.8 mg/ml vs 4.38 +/- 1.2 mg/ml respectively]. In contrast, the mean value of serum calcium concentration was changed significantly after HD [6.7 +/- 1.5 mg/dl] compared with the level before HD [5.6 +/- 6.7 mg/dl]. PTH correlated positively with phosphate [r=0.30, p=0.03], and negatively with calcium [r=-0.299, p=0.04] levels. A significant decrease in serum urea and creatinine levels was reported after HD. Serum albumin showed no significant difference before and after HD. PTH was remarkably decreased post dialysis in our patients with definite increased serum Ca[+]. There is no significant difference between PTH and patient's age, sex and duration in HD Sudanese patients