Effect of intravenous alfacalcidol on lymphocyte phenotyping in hemodialysis patients.

Chronic renal failure is associated with decreased production of active vitamin D and also results in altered lymphocyte population. We studied the effect of alfacalcidol on lymphocyte phenotype. There were 15 patients (10 males, 5 females) with a mean age of 54.3+/-14.4 years who had been on chronic maintenance haemodialysis for a mean period of 3.2+/-1.5 years. Intravenous alfacalcidol was given three times weekly during dialysis for a duration of 6 months. Our results show a significant increase in NK cells from 0.20+/-0.12 to 0.27+/-0.28 (P=0.001), without a significant change in CD2, CD19, CD4, CD8 population, and CD4/CD8 ratio.

Pseudotumor cerebri in renal transplant recipients: a diagnostic challenge.

We describe two patients with renal transplants who developed pseudotumor cerebri (PTC) in the course of their follow-up. They illustrate the diagnostic challenge in such situations. Patients with renal transplants usually have many other associated conditions which may lead to headache, visual disturbances or papilledema. A high index of suspicion is necessary for prompt diagnosis and management of this rare and serious but treatable combination.

An unusual cause of recurrent bacteriuria in a kidney transplant recipient.

A 17-year old Saudi male presented to the transplant clinic of the King Fahad National Guard Hospital, Riyadh two weeks after undergoing a living unrelated kidney transplant in India. Graft function was normal and routine urine culture grew Pseudomonas aeruginosa for which he was treated; a follow-up urine culture was negative. Five months later, routine urine culture again documented the presence of Pseudomonas while the patient continued to be asymptomatic with normal graft function. Abdominal ultrasound showed shrunken native kidneys and a normal graft. A slightly echogenic mass was detected in the bladder. Cystocopy showed a retained non-absorbable suture at the area of the uretero-vesical anastomosis. Cystoscopic removal of the suture was carried out following which urine cultures have remained persistently negative.

Rifampicin-induced acute renal failure: a case report.

Acute oliguric renal failure (ARF) developed in a patient two weeks after he was started on intermittent anti-tuberculous therapy including rifampicin. The clinical picture was compatible with acute allergic interstitial nephritis. Renal histology revealed mainly acute tubular necrosis with mild tubulo-interstitial mononuclear cellular infiltrate. Intermittent therapy, as in our patient, has been the major factor in the development of rifampicin induced ARF in cases reviewed in the literature.

Comparative effects of enalapril and nifedipine on renal hemodynamics in hypertensive renal allograft recipients.

The comparative effects of enalapril (E) and nifedipine (N) on renal hemodynamics were assessed in twenty-two moderately hypertensive, cadaveric renal transplant patients who were maintaining stable renal function. Fourteen patients were on cyclosporin (CSA) and eight were receiving azathioprine with prednisolone (AZA). In each patient effective renal plasma flow (ERPF) was determined four times, first baseline, second with E, third as another baseline after a washout period, and fourth with N; and renal vascular resistance (RVR) was derived in each. ERPF and RVR were significantly compromised in the CSA group (202 +/- 55 ml/min and 65 +/- 18 mmHg/ml/min) compared to the AZA group (302 +/- 99 and 43 +/- 15 respectively). During E therapy, RVR further increased in the CSA group to 82 +/- 37 while it decreased in the AZA group to 31 +/- 7 (both changes were significant when compared to their respective baseline values). N, on the other hand, only significantly lowered RVR in the AZA group. Furthermore, two patients, one from each group, developed acute reversible renal failure shortly after E therapy. However, both agents were effective in lowering blood pressure to a comparable degree in both groups. In conclusion, our data showed a somewhat less favourable renal hemodynamic response to short-term enalapril therapy in hypertensive renal transplant patients maintained on CSA. However, the significance of such hemodynamic changes for long-term renal function remains uncertain.

Acyclovir-induced acute tubulo-interstitial nephritis.

Two patients with presumed herpes simplex encephalitis developed severe non-oliguric acute renal failure shortly after acyclovir infusions. Renal function returned to normal in less than 3 weeks after discontinuation of acyclovir. Renal biopsies done during the acute phase demonstrated interstitial oedema, eosinophils and cellular aggregates in both and granulomata in the second case suggesting acyclovir-induced hypersensitivity interstitial nephritis.

Renal diseases in Kuwait. Experience with 244 renal biopsies.

The biopsy slides and clinical data on 244 patients who underwent percutaneous renal biopsies in the last 4 years in Kuwait were retrospectively reviewed. The data were analysed to show a correlation between clinical presentation and histological findings. We noted a high incidence of membranoproliferative glomerulonephritis (MPGN) presenting as nephrotic syndrome in association with schistosomal infection, an endemic disease in many of the neighbouring countries. Lupus nephritis was also observed at a relatively increased incidence compared with the West. On the other hand, amyloidosis and IgA nephropathy were less common, 5% for each.

Short-term effect of angiotensin-converting enzyme inhibitor enalapril in incipient diabetic nephropathy.

The short-term effect (2 weeks) of angiotensin-converting enzyme inhibitor (enalapril) on renal hemodynamics and urinary albumin excretion was investigated in eleven normotensive patients with incipient diabetic nephropathy (IDN). Six patients had had elevated baseline glomerular filtration rate (GFR) and each responded to enalapril with a decline in the GFR, from a mean of 160.7 to 134 ml/min/1.73 m2, (p less than 0.05). Their respective filtration fraction values also decreased from a mean of 27.8 to 23.8% (p less than 0.01). Such renal hemodynamic change was accompanied by a decrease in urinary albumin excretion (33 to 19 micrograms/min, p less than 0.05). The remaining 5 patients had displayed normal baseline GFR (mean, 109.6 ml/min/1.73 m2), responded to enalapril with minimal change in the GFR (115.2 ml/min/1.73 m2) and showed no significant improvement in their microalbuminuria. It is concluded that enalapril is effective in lowering glomerular filtration pressure and ameliorating microalbuminuria in the normotensive patient with IDN only when the baseline GFR is elevated.

Incidence of peritonitis, distribution of causative bacteria and outcome in continuous ambulatory peritoneal dialysis (CAPD) in Kuwait.

In 28 CAPD patients in Kuwait, 69 peritonitis episodes occurred in an observation period of 311 patient treatment months (1 episode per 4.5 PTM). Microorganisms were isolated 53 times (gram-positive 34, gram-negative 17, fungi 2). Peritonitis was the principal cause for stopping CAPD, i.e. on 9 occasions. Gram-negative and fungal peritonitis had particularly high failure rates.