Non-specialist management of acute renal failure.

In a 12-month prospective study of the initial management of patients with acute renal failure (ARF) in East Kent (population 593 000), we evaluated the initial management of ARF and assessed what proportion of ARF may have been preventable. Patients were seen and assessed on a daily basis, and were followed until discharge from hospital or death; survivors were subsequently followed for 3 years. Overall, 288 patients developed ARF (486 per million population/year). Mean age at presentation was 73 years (range 14-96). Initial assessment was often suboptimal, and key features in investigation and initial management were often lacking. In 108 cases, ARF was iatrogenic and/or potentially preventable (53 preventable, 99 iatrogenic, 44 both). Overall survival was 56% at discharge from hospital, 35% at 1-year follow-up, 31% at 2 years, and 28% at 3 years. In discharged patients, recovery of function was complete in 69%. A significant proportion of ARF is preventable. Clear guidelines, easily accessible at the point of care, could aid the diagnostic evaluation of the patient with ARF and indicate where referral for a specialist opinion is appropriate.

Continuous ambulatory peritoneal dialysis. Experience in a single renal unit in the UK.

The outcome of 106 patients started on continuous ambulatory peritoneal dialysis (CAPD) in a single renal unit over a 3-year period was reviewed in order to compare our experience with that of other centres. The incidence of peritonitis was not different in diabetics compared with non-diabetics, in the elderly compared with younger patients, and in non-compliant compared with compliant patients. The patients' level of education had a significant effect on the number of days required to train for CAPD. Diabetics and non-compliant patients required more hospitalization. The need for community support increased the incidence of peritonitis.

Hepatitis B, delta and human immunodeficiency virus infections among Omani patients with renal diseases: A seroprevalence study.

The prevalence of hepatitis B virus (HBV), hepatitis delta virus (HDV), and human immunodeficiency virus (HIV) infections were determined in 102 patients on regular hemodialysis, 82 kidney recipients and 1030 nondialyzed, nontransplanted patients with various renal diseases. The prevalence rates of hepatitis B surface antigen (HBsAg) in dialysis and renal transplant patients (12.7% and 11.0% respectively) were significantly higher than the rate in a control group of patients who had never been dialyzed nor transplanted (2.9%, P<0.05). In patients who were HBsAg positive, evidence of HDV infection was found in one dialysis and two transplant patients only. HIV infection was confirmed in only two of 102 (2.0%) and three of 82 (3.7%) hemodialysis and kidney recipients respectively. These data indicate hepatitis B, delta and HIV infections are major health problems among hemodialysis and renal transplant patients in the Sultanate of Oman.

Prevalence of antibodies to hepatitis C virus among Omani patients with renal disease.

The prevalence of hepatitis C virus (HCV) infection in Omani patients with renal disease was determined using a second-generation enzyme immunoassay which detects antibodies to three HCV antigens. Based on the results of this assay, 27 of 102 (26.5%) sera from patients on haemodialysis, 11 of 82 (13.4%) sera from kidney transplant patients, and 1 of 103 (1%) sera from non-dialysed, non-transplanted patients with various renal diseases had antibodies to HCV. Among healthy subjects, none of 134 medical students and 5 of 564 (0.9%) blood donors were anti-HCV positive. Thus, the prevalence of HCV infection in dialysis and renal transplant patients was significantly higher than that found in patients with renal disease who had been neither dialysed nor transplanted (p < 0.05). In the latter group of patients, the frequency of anti-HCV was low, and comparable to that of healthy Omani subjects.

Prevalence of hepatitis B, hepatitis delta, and human immunodeficiency virus infections in Omani patients with renal diseases.

PIP: Patients treated at the Royal Hospital in Oman during January-June 1991 were divided in 3 groups. The 1st group included 103 patients (49 males, 54 females, with a mean of 39 years) who attended the Nephrology Clinic and none of whom were on dialysis. In the 2nd group there were 102 patients (46 males, 56 females, with a mean age of 42 years) on regular hemodialysis (with a mean duration of 35 months) because of end-stage renal failure. The 3rd group comprised 82 kidney transplant patients (44 males, 38 females, with a mean age of 33 years) with a mean duration of prior hemodialysis of 9 months in 80 patients. Blood serum samples from all patients as well as from 134 medical students and 564 blood donors were tested for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc) by enzyme-linked immunosorbent assay. HBsAg-positive samples were tested for antigen and antibody to hepatitis delta virus (HDV). The prevalence of HBsAg was significantly higher in hemodialysis and renal transplant patients than in nephrology clinic patients (P .05). Previous exposure to HBV was found in 48 of 103 (46.6%) nephrology clinic patients, in 53 of 102 (52%) hemodialysis patients, and in 43 of 82 (52.4%) renal transplant patients. Anti-HBc prevalence rates were significantly lower in medical students (23.1%) and blood donors (27%) than in the patient groups (P .001). In HBsAg-positive subjects HDV infection was found in 1 of 13 (7.7%) patients on dialysis and 2 of 9 (22.2%) kidney transplant recipients who had been transfused in the past. A double infection of HBV and HCV was found only in 4 hemodialysis and 2 transplant patients among 287 patients and 698 healthy subjects tested. Among 5 HIV-infected patients 3 transplant patients seroconverted between 3 and 7 months after kidney transplantation abroad; and 2 hemodialysis patients seroconverted after repeated dialysis and multiple blood transfusions used for kidney transplantation abroad.^ieng

Non-typhoid Salmonella in renal transplant recipients: a report of twenty cases and review of the literature.

We report 20 cases of non-typhoid Salmonella infection that occurred over a period of 10 years in 592 renal transplant recipients followed by our unit, and present a review of 58 previously reported cases. Analysis of these data suggests that infection occurs when immunosuppression is high (early in the post-transplant period, or after anti-rejection therapy). A significant number of patients have bacteraemia and widespread focal manifestations are common. Despite prolonged antibiotic therapy, relapses occur commonly causing significant morbidity, occasional graft loss and even death.

Pulmonary Kaposi's sarcoma in two recipients of renal transplants.

Among 350 recipients of renal transplants seen at the Riyadh Military Hospital, 12 developed Kaposi's sarcoma. Two of these sarcomas presented primarily as a problem of diffuse lung infiltrates in an immunocompromised host. In one the diagnosis was established by transbronchial lung biopsy. Withdrawal of immunosuppression led to satisfactory radiological resolution in both patients.