Anti-glomerular Basement Membrane Antibody Disease Presenting as Acute Renal Failure During Pregnancy.

A 30-year-old seventh gravida presented with acute renal failure at 28 weeks of gestation. All her previous pregnancies were normal. With a differentional diagnosis of acute pyelonephritis, acute interstitial nephritis (cefuroxime induced) or rapidly progressive glomerulonephritis, treatment with antibiotics, intensive hemodialysis (HD) and pulse methylprednisolone followed by oral prednisolone was initiated. She was maintained on HD 5-6 times per week aiming at serum urea level of less than 15 mmol/L. After six weeks on HD, she underwent a cesarean section at 34 weeks of gestation with delivery of a baby weighing 1.6 kg. Percutaneous left renal biopsy performed one week post-delivery showed anti-glomerular basement membrane (GBM) antibody-mediated crescentic glomerulonephritis. The anti-GBM antibody, which was negative during pregnancy, was found to be positive at this juncture and remained so until ten months post-delivery while on HD. The patient continues to be on regular maintenance HD.

Chronic peritoneal dialysis a single-center experience.

OBJECTIVE: In Saudi Arabia, experience with continuous ambulatory peritoneal dialysis (CAPD) as a renal replacement therapy is limited, and publications are scanty. The present study was undertaken to evaluate CAPD in the Saudi population. PATIENTS AND METHODS: All patients managed by CAPD from May 1993 to September 2002 were included in the study. Tenckhoff indwelling silicone-rubber double-cuff catheters were surgically implanted. Peritoneal dialysis (PD) was started 2 weeks after catheter insertion. Generally, 2-L exchanges 4 times daily were used. Our total of 91 PD patients included 50 men in the age range 13 - 80 years (mean: 48 +/- 18 years), and 41 women in the age range 16 - 76 years (mean: 52 +/- 18 years). Forty-nine patients performed dialysis by themselves; 42 patients needed a helper. RESULTS: Between April 2001 and September 2002, we noted, on average, 1 episode of peritonitis per 21 patient-months and 1 episode of exit-site infection per 24 patient-months. The most common causative organisms for peritonitis were Pseudomonas (16%), Staphylococcus epidermidis (16%), and Staphylococcus aureus (7%). No organisms were grown in 13% of peritonitis episodes. The organisms most commonly responsible for exit-site infection were Pseudomonas aeruginosa (50%) and Staphylococcus (31%). We removed catheters from 32 patients, 12 of those for mechanical reasons. Of the 20 patients whose catheter was removed for infection, P. aeruginosa was cultured in 11 cases. Nine of 23 patients switched to hemodialysis were switched for refractory peritonitis. By the end of the study, 38 patients were still on CAPD, 23 had been switched to hemodialysis, 10 had undergone renal transplantation, and 20 had died. The major causes of death were peritonitis with sepsis (n = 6), cardiovascular causes (n = 5), and sudden death at home or in other hospitals (n = 5). CONCLUSION: Continuous ambulatory peritoneal dialysis is a viable option of renal replacement therapy in Saudi Arabia. The main problem encountered was peritonitis.