Clinical and histopathological spectrum of IgA nephropathy in Kuwait

Little is known about the nature and the course of IgA nephropathy [IgAN] in Arab countries. The aim of this work was to study the spectrum of clinical presentation and histopathological findings at our institution. Retrospective review, all renal biopsies at the Mubarak Al Kabeer Hospital between January 2000 and December 2004. Cases of IgA nephropathy were selected, and their medical records and biopsy findings were reviewed. Eighty patients [9.2% of all native kidney biopsies] were diagnosed to have IgAN nephropathy. Sixty-nine biopsies were included in the study; 11 were excluded. Forty-three [62.3%] patients were male and 26 [37.7] patients were female. Fifty [72.5%] patients were below the age of 40 years. Mean [SD] duration of follow-up was 3.6 [1.3] years. The first presentation included nephritic-range proteinuria [49.3%] and renal impairment [50.7%]. During the follow-up period, 56 [81.2%] patients were stable or improved. Hass classification of biopsies showed 36.2% had class I, 27.5% had class II, 13.0% had class III, 5.8% had class IV, and 17.4% had class V IgAN. Females had milder forms of the disease than males. Macroscopic hematuria and renal impairment at presentation were seen more in patients with class IV and V IgAN. The presenting serum creatinine and uric acid values were higher in those with Hass classes III to V. Deterioration of renal function during the follow-up period was more significant in the presence of hypertension, renal impairment, or macroscopic hematuria at the time of biopsy. The prevalence of IgAN in Kuwait is about 9.2%. Renal impairment or macroscopic hematuria at presentation was seen in patients with more aggressive renal lesions and contributed to poor outcome

Renal biopsy in patients with type 2 diabetes mellitus: Indications and nature of the lesions

The prevalence of non diabetic renal disease [NDRD] among patients with type 2 diabetes mellitus varies widely depending on the selection criteria and the populations being studied. The aim of this study was to evaluate the renal biopsies performed on type 2 diabetic patients for suspicion of NDRD and to correlate the pathological with the clinical and laboratory findings. We selected and reviewed biopsies performed on type 2 diabetics for clinically suspected NDRD from January 2006 to December 2008 at a single hospital. Clinical and laboratory data were analyzed in relation to the histopathology findings. Patients were grouped into either group I with isolated DGS or group II with NDRD on top of DGS. Thirty-one biopsies were performed on type 2 diabetic patients; Seventeen patients [54.8%] were males. Mean age was 50.68 [11.29] years. The mean duration of diabetes was 9.33 [3.6] years. Renal biopsy showed that among the studied group 14 patients [45.2%] showed NDRD on top of DGS. Crescentic glomerulonephritis was the commonest finding seen in 3 cases [21.4% of group II cases] followed by acute tubulointerstitial nephritis and hypertensive changes each was seen in 2 cases [14.4%]. Other findings included IgA nephropathy, primary focal segmental glomerulosclerosis, rhabdomyolysis, membranoproliferative glomerulonephritis each of them was seen in one case [7.1%]. Group I had a significantly higher level of proteinuria 4.97 [2.08] gm/24 hrs urine than group II 2.72 [1.09] gm/24 hrs urine [P=.003]. There was no significant difference between the two groups in age, duration of diabetes, gender, presence of hypertension, hematuria, serum creatinine or glomerular filtration rate. The present study showed that crescentic glomerulonephritis is the commonest NDRD among diabetic patients. A higher level of proteinuria was reported among those with NDRD superimposed on DGS. So, Renal biopsy should be performed in diabetics when the clinical scenario is atypical

Bacterial spectrum of perm-cath related infection among hemodialysis patients

Dual-lumen cuffed central venous catheter [perm-cath] is an alternative vascular access in maintenance hemodialysis Infection however is a major problem associated with long-term central venous catheters. This study assesses the spectrum of catheter related bacterial infectkin among hemodialysis patients. Charts of 174 patients were reviewed during The period between January 2005 and December 2006. Quantitative blood culture was obtained simultaneously from the catheter and from a peripheral vein when catheter related infection is suspected. Episodes of catheter related infection were registered including the causative bacteria. 76perm-cath double-lumen catheters rooted in 76 [43.7%] hemodialysis patients. Seventy nine episodes of catheter related bacteria in 45 [59%] patients were analyzed Six [13.33%] patients had more than one episode of catheter related infection. The rate of infection is equal to 3.3 per hundred patient-month treatment The causative bacteria included Gram-positive organisms in 51 [64.6%]. Staphylococcus aureus in 33 [41.8%] episodes. Methicillin resistant staphylococcus aureus [MRSA] was detected in 25 [31.6%] episodes. Coagulase negative staphylococcus species in 9[11.4%] episodes, and enterococci in 6[7.5%] episodes. Gram-negative bacteria were the cause of infection in 28 [35.4%] episodes. Pseudomonas was isolated in 6[7.5%] episodes, acinetobacter in 5[6.3%] episodes, and E-coli in 5[6.3%] episodes. Other bacteria were the cause of infection in 15[18.9%] episodes. Bacteremia was reported in 47[59.5%] episodes. Isolated exit site infection was reported in 26[32.9%] episodes. Concomitant exit site infection and septicemia was reported in 6 [7.5%] episodes. Seventy five [95%] episodes were cured with proper antibiotics without catheter removal and 4 episodes [5%] required catheter removal. This study dearly demonstrated that MRSA is most common cause of perm-cath infection in hemodialysis patient. Early treatment and or catheter removal reduces patients' morbidity. Exit site infection should be treated punctually

Impact of hemodialysis on QT interval and QT interval dispersion in end stage renal disease patients

Cardiac arrhythmia is considered as one of the major causes of cardiac death in end-stage renal disease patients [ESRD]. Increased QT interval and QT dispersion [QTD] measurements on a surface electrocardiogram [ECG] have shown to be a useful and reliable method for predicting life-threatening ventricular arrhythmia. QT interval reflects the total ventricular recovery time, and QTD is a direct measure of regional heterogeneity of myocardial repolarization. These two electrical markers are flound to be independent predictors of cardiovascular mortality among uremic patients. The aim of this work was to assess the effect of hemodialysis on QT interval, corrected QT interval, as well as QT interval dispersion in Kuwaiti patients with ESRD [without any significant history of cardiovascular disease]

Methods: Forty ESRD patients on regular hemodialysis in Kuwait ministry of health hospitals were enrolled in the study. The causes of renal failure were: chronic glomerulonephritis, chronic tubulointerstitial disease, systemic vasculitis, adult polycystic kidney disease, and hypertensive glomerulosclerosis. Patients with diabetes mellitus, overt ischemic heart disease, cardiac arrhythmias, or pacemaker implantation were excluded from the study. 12-lead electrocardiography [ECG] was taken ten minutes before and ten minutes after hemodialysis session. The QT interval was measured in each case and the corrected QT and QTD dispersion was calculated. Serum electrolytes [potassium-calcium-magnesium-phosphorus, as well as serum creatinine] were measured at the same time as ECG done

Results: Our study demonstrated a significant prolongation of the QT interval in ESRD patients after hemodialysis from 381.10 +/- 32ms to 415.00 +/- 31 ms [p= < .001]. A Significant prolongation of the corrected QT interval from 414.00 +/- 22.20 ms pre dialysis to 453.60 +/- 22.20 ms post dialysis was also demonstrated [p< 0.001]. In addition a significant prolongation of QT dispersion from 57.80 +/- 13.40 ms before hemodialysis to 77.80 +/- 2.60 ms after hemodialysis was found [p< 0.001]. There was no correlation between the changes in ECG intervals and the changes in serum electrolytes after hemodialysis. The changes in ECG intervals were independent on patients' gender, age, the presence of hypertension or hyperparathyroidism

Conclusion: Measuring QT interval, corrected QT interval and QT dispersion are considered 35 a good now invasive measurement of susceptibility to ventricular arrhythmias in ESRD patients on regular hemodialysis