Kidney biopsy in jordan: complications and histopathological findings.

In this retrospective study, we reviewed the medical records, and histopathology findings of 191 patients who underwent renal biopsies at King Hussein Medical Center (KHMC) during a four-year period (1993-97). All were performed using Tru-Cut needles under ultrasound guidance. There were 119 males (62.3%) and 72 females (37.7%); the mean age was 29.1 years (range 5-76 years). Side effects of the renal biopsies included pain at the site of he biopsy in 17 (8.9%), gross hematuria in six (3.1%) and hematuria requiring blood transfusion in one (0.5%) patient. Nephrotic syndrome was the most common indication for biopsy followed by acute renal failure of unknown etiology. Among the nephritic patients, minimal change disease and post-infectious glomerulonephritis (GN) were the commonest findings in children below the age of 15 years, membrano-proliferative GN ranked first in adults whole membranous GN and amyloidosis were more common in the elderly. WE conclude that renal biopsy was associated with a n acceptably low rate of complications in our practice, and that the patterns of renal histology vary slightly from those reported from other countries.

Functional status of patients on maintenance hemodialysis.

Factors associated with physical well being were examined in adults with end-stage renal disease (ESRD) in two large hemodialysis units of the Royal Medical Services in Jordan. Utilizing the Karnofski scale we measured the functional status of 200 Patients who had been on maintenance hemodialysis for at least 12 months. A Marnofski scale of less than 70 incidents frank disability (Inability to perform routine living activities without assistance), in addition current vocational status was assessed as well as any existing comorbid conditions. The mean age of the study group was 45.2 years (range 16 to 70) and included 108 (54%) males and 92 (46%) females, there were 39 (19.5%) diabetic patients and 27 (13.5%) patients were receiving erythropoietin (EPO). The mean hematocrit of the entire group was 27.8%. As measured by Karnofski scale, 64 (32%) of the patients were unable to perform routine living activity without assistance; dependence on wheelchair was reported by 9 (4.5%) patients. The mean comorbidity index of patients who scored less than 70 on the Karnofski scale was 1.5 compared to 0.7 for those who scored at least 70 on the same scale (p< 0.001). Analysis of factors showed that age and diabetes mellitus affected functional status. Of the laboratory variables measured, only serum albumin concentration correlated significant with Karnofski scale. Fourteen (21.8%) of the patients who scored below 70, had serum albumin concentration above 40g/L compared to 66 (48.5%) of the patients who scored at least 70 on the Karnofski scale (p< 0.001). We conclude that a significant proportion of patients on maintenance hemodialysis is functionally disabled. The elderly, diabetics, patients with high co-morbidity index and those with low serum albumin are most likely to have poor functional status.

Hypertension as a presentation of bilateral intrarenal arateriovenous malformation.

Congenital arteriovenous malformations are rare lesions of the kidneys. The first case of bilateral renal arteriovenous malformations was described in 1987. A case of extensive bilateral intrarenal arterivenous malformations presented to us as a case of hypertension. Renal angiography confirmed the diagnosis. Magnetic resonance angiography ruled out these malformations in cerebral circulation, and enhanced abdominal CT scan was normal. The blood pressure of the patient was controlled by medical therapy only.

Acquired cystic disease of kidney in chronic renal failure in jordan.

Acquired cystic disease of the Kidney (ACDK) is a well documented complication of end stage renal failure in patients managed conservatively or supported by dialysis. The aim of the present study is to highlight the scope of the problem among our patients, and to evaluate the clinical characteristics of the disease. A Total of 124 patients with chronic renal failure (106 on dialysis, 18 non-dialyzed) were studied with ultrasonography by the same radiologist. ACDK was defined as the presence of four or more cysts in each kidney. The cysts should have sharp smooth wall with acoustic enhancement. In non-dialyzed patients, 5.5% had ACDK, 33.5% had one to three cysts and 61% had no cysts. Among dialysis patients 42.5% had ACDK, 26% had one to three cysts and 31.1% had no cysts. During of dialysis therapy and age were greater in patients with ACDK (74 +/- 30 months. 58 +/- 3 years respectively) compared to those with no cysts (11 +/- 8 months. 26 +/- 4 years). The major clinical complications were intracystic hemorrhage in three cases and stones in seven cases. No correlation was noted between the presence of cysts and the original kidney disease, gender, hematocrit or adequacy of dialysis. We conclude that, ACDK occurs commonly in patients with chronic renal failure; however, patients are generally older and have been on dialysis longer than patients without cysts. Ultrasound, in the hands of an experienced radiologist, is a relatively adequate screening tool for ACDK and its complications.

Treatment of Post-transplant Erythrocytosis with Enalapril.

This prospective study was carried out to estimate the efficacy and safety of Enalapril therapy in post-transplant erythrocytosis. Thirteen long-term renal allograft recipients (11 males and two females) with increased hematocrit values (>51%) and elevated red cell mass were treated with Enalapril for 12 weeks; their age ranged from 18 to 54 years. At the end of the study period the mean hematocrit values decreased from 53.9% to 46.7%, red cell mass significantly decreased from 50.8 ml/kg to 40.5 ml/kg. During the following six months without Enalapril treatment, an increase in hematocrit was observed reaching a mean of 47.5%. In conclusion, enalapril can be safely and efficiently used to treat post-transplant erythrocytosis.

Hospital acquired acute renal failure.

This study was performed to evaluate hospital-acquired renal insufficiency with special reference to the causative factors, clinical course and patient management. A total of 100 patients who were admitted to medical and surgical wards at the King Hussein Medical Center, Amman, Jordan over a 15-month period and who developed renal failure during their hospital stay, were referred to, and seen at the nephrology department. The patients ages varied from 18 to 77 years; there were 59 males and 41 females. Reduced renal perfusion, major surgery and administration of nephrotoxic drugs accounted for the majority of episodes of renal failure (77%). In general, non-oliguric patients fared better, they required dialysis less frequently and had lower mortality compared to the oliguric patients. Severity of renal failure and multi-organ involvement adversely affected the prognosis. However, age of the patient had no influence on the outcome.

Tuberculosis in patients on maintenance hemodialysis: a single center experience.

This retrospective study was performed to review the prevalence, clinical presentation and outcome of tuberculosis (TB) in patients on maintenance hemodialysis (HD) as compared to that of the general population in Jordan. The records of 927 patients who were maintained on maintenance HD at King Hussein Medical Center between 1986 and 1993 were reviewed for the development of TB. There were 550 males and 377 females in the study group. Eleven of these patients (1.2%) were diagnosed to have TB during this period. This figure is higher than the prevalence rate of 0.015% reported among the general population in some regions of Jordan. Of the 11 patients with TB, there were four males and seven females. Their ages varied from 28 to 70 years and the duration on maintenance HD before the onset of TB ranged between 1 and 24 months. Extra-pulmonary manifestations predominated (81.8%) and TB lymphadenitis was the commonest lesion observed. Five patients died during the study period but none due to a direct consequence of TB or its treatment. We conclude that the prevalence of TB is high among patients on HD In Jordan when compared with the general population.

Malignancy in renal transplant recipients at king hussein medical center.

The files of 181 patients who underwent kidney transplantation at King Hussein Medical Center between 1983 and 1992 were reviewed to study the incidence and pattern of malignancy in them. Of them, 149 patients (82.3%) were recipients of live related donor allografts while 32 (17.7%) had received cadaveric allografts. Three patients (1.7%) developed malignancy giving an estimated annual incidence for post-transplant malignancy of 17/10,000 kidney transplanted patients. The first patient had squamous cell carcinoma of the nose, the second, Kaposi's sarcoma and the third, Non-Hodgkin's lymphoma involving the retroperitoneal lymph nodes. All these patients were on triple immunosuppressive drug protocol. The malignancies were diagnosed after a mean of 25.6 months following transplantation. The patient with squamous cell carcinoma responded to local excision of the tumor without altering the immunosuppressive therapy. The Kaposi's sarcoma regressed after discontinuation of cyclosporine without any adverse effects on the graft function while the patient with lymphoma died two months after the diagnosis was made. Our study shows that the incidence of malignancy after transplantation in Jordan is similar to what is reported in the literature.

Ureterolithiasis in a Renal Transplant Patient Secondary to Encrustation about a Suture Line.

A renal transplant recipient presented with abdominal pain and anuria secondary to multiple radio-opaque obstructing calculi. A ureteroscopy with ultrasonic disintegration was done, and the fragments were spontaneously passed later. The calculi had formed on a non-absorbable suture line. Although ureterolithiasis in the transplanted kidney is amongst the least common of the urological complications following renal transplantation, it is an important reversible cause of obstruction that should always be considered. Also, non-absorbable suture lines should not be used in the urinary tract because they may serve as a nidus for stone formation.