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   2018| January-March  | Volume 18 | Issue 1  
    Online since May 2, 2018

 
 
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REVIEW ARTICLES
Effect of Ramadan fasting on patients with different kidney diseases: An updated review
Yasser ELSayed Matter, Hussein A Sheashaa, Ayman F Refaie
January-March 2018, 18(1):1-5
DOI:10.4103/jesnt.jesnt_13_17  
Ramadan fasting is one of the five pillars of Islam and is compulsory for all adult Muslims who have no medical or religious excuses. Ramadan fasting is defined as a complete abstinence from food, drink, medications, sexual activity, and smoking from dawn to dusk. Regarding the kind Islamic religion, patients have permission not to fast according to the medical advice. However, most Muslim patients express their desire to fast during Ramadan month and they are very broken when their physicians inform them not to fast. There are a lot of controversies regarding Ramadan fasting for chronic kidney diseases (CKD) and hemodialysis patients with absence of strict guidelines that help nephrologists in this issue. Renal transplant recipients who have stable kidney function for at least 1 year post-transplantation can fast with cautious follow-up. Risk of dehydration due to fasting for long periods especially in the summer season is the main concern for patients with kidney stone diseases. There is still no strong evidence if that Ramadan fasting can induce renal stone formation in susceptible patients or not. However, most studies have shown that fasting for this kind of patients with good hydration after breaking the fast may be allowed without significant risk of renal colic incidence. According to the last published guidelines by the International Diabetes Federation and Diabetes and Ramadan International Alliance, Chronic dialysis or CKD stages 4 and 5 and CKD stage 3 patients are considered to be at very high risk and high risk categories, respectively, and are exempted from fasting.
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LETTER TO THE EDITOR
Fluorescein angiography and the kidney, friend or foe?
Mohamed E El-Rggal
January-March 2018, 18(1):24-25
DOI:10.4103/jesnt.jesnt_26_17  
  4,733 294 -
REVIEW ARTICLES
Kidney paired donation program, a national solution against commercial transplantation?
Mohamed E Elrggal, Mona Tawfik, Mohammed A Gawad, Hussein A Sheasha
January-March 2018, 18(1):6-10
DOI:10.4103/jesnt.jesnt_1_18  
End-stage renal disease is a growing health problem worldwide. Renal transplantation provides a better patient survival and quality of life compared with other means of renal replacement therapy. There is a serious shortage of transplantable kidneys, especially in countries where deceased donation is not allowed. Kidney paired donation (KPD) is a novel program applied to expand the donor pool, increase kidney transplantation rates, and allow a better donor recipient matching specially for sensitized patient. It permits living kidney transplantation in a short waiting time with better graft survival compared with those with deceased kidney transplantation. This review article aims to highlight the importance of KPD program as a promising solution for organ shortage and commercial transplantation. It also discusses the idea of implementing such programs in Egypt and offers future suggestions that may help its establishment.
  2,905 307 -
ORIGINAL ARTICLES
Procalcitonin as an inflammatory marker in comparison between high-flux and low-flux hemodialysis in patients with end-stage renal disease
Hesham M El Sayed, Hussein S Hussein, Sabah A Hammad
January-March 2018, 18(1):11-16
DOI:10.4103/jesnt.jesnt_25_17  
Background Although procalcitonin (PCT) has been described as a new marker of infection and inflammation, it has not been extensively studied in hemodialysis (HD) patients. Patients and methods We measured PCT serum levels and high-sensitivity C-reactive protein (hs-CRP) before and immediately after HD in 50 adult HD patients (25 treated with high-flux membranes and 25 with low-flux membranes), without history of concurrent infections. Results The baseline PCT levels before HD were higher than healthy individuals. There was a highly significant decrease in PCT serum levels after HD session in patients undergoing HD by high-flux membranes but not by low-flux membranes (high flux 0.54 ng/ml pre-HD vs. 0.26 ng/ml post-HD, P=0.001, whereas in low flux 0.50 ng/ml vs. 0.53 ng/ml, P=0.066). Hs-CRP levels were unchanged in both groups. There was no correlation between PCT and CRP. Conclusion Although PCT is considered a sensitive and specific diagnostic and prognostic marker of systemic bacterial infection, we suggest that specific reference ranges might be developed in patients with impaired renal function; moreover, its clinical usefulness might be limited in patients undergoing HD with high-flux membranes.
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Fibroblast growth factor-23 and vascular calcification in chronic kidney disease and hemodialysis patients
Sherif A Zaki, Iman E El Gohary, Eman M Elsharkawy, Doaa I Hashad, Doaa M Emara, Marwa R.A El Hameed
January-March 2018, 18(1):17-23
DOI:10.4103/jesnt.jesnt_28_17  
Context Fibroblast growth factor-23 (FGF-23) is secreted by osteoblasts and regulates phosphate and vitamin D homeostasis. As a potential explanatory mechanism of FGF-23-associated mortality, multiple studies have consistently demonstrated that higher FGF-23 levels are independently associated with greater risk of prevalent and incident left ventricular hypertrophy (LVH). In contrast, observational studies reported conflicting results on the association of FGF-23 with arterial calcification, which is another prominent pattern of cardiovascular injury in chronic kidney disease (CKD). Aims The aim was to correlate between serum FGF-23 and vascular calcification (VC) in CKD and hemodialysis (HD) patients. Settings and design A single-center cross-sectional study was conducted on 60 patients who were divided into two groups. Group I included thirty patients with CKD stages 4 and 5, and group II included thirty patients on maintenance HD. Group III included 30 age-matched and sex-matched healthy volunteers. Materials and methods Estimation of serum calcium, phosphorus, bone-specific alkaline phosphatase, intact parathyroid hormone, and serum FGF-23 level was carried out. Assessment of LVH by echocardiography and VC by multidetector computed tomography was done. Results There was a statistically significant negative correlation between FGF-23 and serum calcium level in group I and of no statistical significant correlation in group II and III, whereas there were a statistically significant positive correlations between FGF-23 with serum phosphorus, bone-specific alkaline phosphatase and intact parathyroid hormone in groups I and II and of no statistical significant correlations in group III. There were statistically significant positive correlations between FGF-23 and both left ventricular mass index and VC in groups I and II (P<0.001) and of no statistical significant correlation in group III. Conclusion FGF-23 correlates with LVH and VC in CKD and HD patients.
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