Prevalence of secondary hyperparathyroidism among hemodialysis patients in three royal medical services centers

Objective: To determine the prevalence of secondary hyperparathyroidism among hemodialysis patients treated in three different centers

Methods: This is a descriptive study conducted by reviewing patient's medical records, Patients receiving hemodialysis therapy in three different centers: King Hussein Medical Center in Amman, Prince Hashem Hospital in Zarka, and Prince Ali Hospital in Karak, representing various governorate of Jordan. Patients included in the study were treated by hemodialysis for more than 6 months and have not had parathyroidectomy. We screened our patients for the purpose of the study during January 2014. Their laboratory values including serum creatinine, BUN, calcium, phosphorous, alkaline phosphatase and intact parathyroid hormone were recorded. Depending on the iPTH level, patients were divivded into three groups, adynamic bone disease group with iPTH levels less than 130pg/ml, euparathyroid group with iPTH within the target range for hemodialysis patients [130-210pg/ml], and secondary hyperparathyroidism group with iPTH more than 210pg/ml

Results: A total of 276 patients were included in this study. Males were 56.5% and females 43.5%, their age ranged from 23 to 87 years with duration of hemodialysis ranged from 6 to 300 months. Majority of patients [77.5%] found to have secondary hyperparathyroidism with an average intact parathyroid hormone level of 887.1pg/ml. The remaining patients showed either acceptable average intact parathyroid hormone level for the hemodialysis patients 127.7pg/ml [13.4%] or showed low average intact parathyroid level of 32.9pg/ml indicating the presence of the more serious adynamic bone disease [9.1%]

Conclusion: Despite advancing hemodialysis treatment facilities and the use of calcium containing phosphorous binders and vitamin D analogue the incidence of secondary hyperparathyroidism remains high. This may represent late referral to nephrology care or may indicate poor patient compliance to the prescribed medications. Additional efforts should be implemented to enhance early referral of patients with chronic kidney disease to nephrology care

Spectrum of glomerular diseases at King Hussein medical center

To determine the histopathological patterns of glomerulonephritis according to the clinical presentation. This is a retrospective analysis of light microscopy results of native kidney biopsies done during the period of January 1[st], 2005 until December 31[st], 2008. There were 273 native kidney biopsies performed during this period. Data were collected from the computer data base of Princess Iman Research and Laboratory Center, King Hussein Medical Center, Amman, Jordan. All biopsies were examined by our renal histopathologist. The most common indication was nephrotic syndrome and the most common cause of nephrotic syndrome in our patients was membranous glomerulonephritis. The main cause of subnephrotic proteinuria was minimal change disease and focal and segmental glomerulosclerosis. Membranoproliferative glomerulonephritis was the most frequent finding in patients presenting with microscopic hematuria. In acute nephritis the most common lesions were crescentic, diffuse proliferative and necrotizing glomerulonephritis. Acute tubular necrosis was the most common cause of acute kidney injury. Changes of end stage kidney disease were the most frequent findings in patient with chronic kidney disease. In patients with systemic lupus erythematosus with renal involvement, the most common lesion was class IV lupus nephritis. Kidney biopsy is an extremely helpful investigation and it should be performed once indicated. There is a need for a national registry of kidney biopsies. The histopathological findings are similar to other studies done in Jordan and in the neighboring countries

Urinary tract infections in renal transplant recipients: a single center study

To determine the types and frequency of urinary tract infections among renal transplant recipients. A total of 83 renal transplant recipients who attended the Nephrology out patient clinic at King Hussein Medical Center, during the two months of study period [September-November, 2005] were included in the study. Routine urine analysis and urine culture were performed in all patients. The study group had normal kidney function and minimum period of four weeks post renal transplant. Fifty-six [67%] were males and 27 [33%] were females, their ages ranged between [16-60] years with a mean of 35.9 years. The mean duration of transplantation was 26.4 months, and the mean serum creatinine was 1.14mg/dl. The source of their grafts were living related donors in 71 recipients [85.5%] and living unrelated donors in 12 recipients [14.5%] and none were from deceased donors. Seven recipients [8.4%] were on double immunosuppression therapy [calcineurin inhibitor and steroid] while 76 [91.6%] were on triple immunosuppression therapy. The frequency of urinary tract infections was 28.9%. Asymptomatic urinary tract infections occurred in 9.6%, however, symptomatic urinary tract infections occurred in 19.2%. Females constituted 75% of the asymptomatic group, while males among the symptomatic group were 87.5%. About two-thirds of isolated microorganisms were E.Coli [62.5%]. Males with renal transplants had higher frequency of symptomatic urinary tract infections, particularly if the graft was from living unrelated donor. All patients with pre transplant vesicoureteric reflux had symptomatic post transplant urinary tract infections, despite pretransplant unilateral or bilateral nephro-ureterectomy for patients with grade IV vesicoureteric reflux. Almost one-third of renal transplant recipients will develop urinary tract infections. Vesicoureteric reflux should be treated before renal transplant. Patients should be evaluated for urinary tract infections during routine out patient follow-up, particularly those with post transplant diabetes mellitus