New protocols for treatment of class IV lupus nephritis with emphasis on rituximab as the sole maintenance therapy

Objective: A safe and effective treatment for lupus nephritis [LN]

Design: An 8-year prospective study

Setting: Hospital-based

Subjects: Three groups of patients with class IV LN; comparison of 2 new treatment-protocols for class IV LN with a retrospective group of patients who had received the standard treatment for LN

Intervention: The 2 treatment groups had received an induction phase of monthly intravenous Cyclophosphamide, Mycophenolate [MP] and Prednisone [P]. The maintenance phase in the first group was only MP and P, while patients in the second group had received only yearly Rituximab infusions

Main outcome measures: Morbidity and mortality

Results: Patients in the first group did not have significant relapses, yet had 10 episodes of infections during the maintenance phase. In the second group, there were five treatment failures, yet none had renal deterioration, infections or death. In the third group, seven relapses occurred during the induction period and three in the maintenance one. Moreover, complications included 1 death of disseminated sepsis, 12 cases of chronic renal failure, three kidney losses, 16 episodes of major infections, two cases of aseptic necrosis, two cases of gonadal failure, two cases of hemorrhagic cystitis and 2 cases of retinal deposits

Conclusions: Rituximab infusions, used once yearly, are effective and a safe maintenance therapy for most patients with LN after a short course of three anti-proliferative agents. In those who failed to respond, MP and P are more effective and safer than the standard protocol

Sonographic assessment of renal size in healthy adults

To assess the normal sonographic values of renal length and cortical thickness in healthy adults and establish reference ranges in our population for comparison when examining renal disease. Sonographic assessment of renal length and cortical thickness were performed from January 2006 to December 2011 in 252 healthy individuals who were self-referred to the El-Reshaid Renal Clinic in Kuwait. They were screened for the absence of renal abnormalities. Weight and height were measured, and body mass index [BMI] and body surface area calculated. Patients were divided into 5 age groups: 18-30, 31-40, 41-50, 51-60 and 61 -80 years, in order to generate reference graphs for renal length and cortical thickness. The mean renal lengths for the right and left kidney were 10.68 +/- 1.4 and 10.71 +/- 1.0 cm, respectively [p = 0.56] without a significant change with age. The minimum cortical thickness was 0.6 cm. The renal length correlated with the weight of the patients [p < 0.01] and their BMI [p < 0.01] but not with their height. There was no difference in renal size or cortical thickness in patients older than 60 years despite an age-related decline in the glomerular filtration rate [p < 0.001]. Renal length and cortical thickness did not vary significantly with age. Renal length correlated well with weight and BMI but not with height. Hence, establishing normal ranges of renal parameters is essential for comparison in situations where possible renal disease is being investigated

Postmortem biopsies: the experience in Kuwait

To report our 4-year experience in postmortem needle biopsy of liver, heart, kidney and lung tissues when formal autopsy could not be performed. Subjects and In the period from January 2000 to December 2003, postmortem biopsies were done at Al-Amiri Hospital, Kuwait, in 19 cases where the original diagnosis or cause of death was not clear. The procedure was performed by a dedicated trained medical team using a biopsy needle or limited incisions guided by the knowledge of the clinical presentation and results of laboratory and radiological investigations. The actual diagnosis was established in 8 cases by postmortem histological findings and corrected in another 9 cases. In the remaining 2 cases with systemic sepsis, autopsy only confirmed the antemortem clinical diagnosis. Our study shows that needle biopsy is an adequate technique for postmortem examination and should be considered as the minimum alternative to conventional autopsy