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  Access statistics : Table of Contents
   2022| July-September  | Volume 22 | Issue 3  
    Online since July 22, 2022

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Management of postkidney transplant anemia – is it feasible to maintain patient and allograft survival?
Fedaey Abbas, Mohsen El Kossi, Ihab S Shaheen, Ajay Sharma, Ahmed Halawa
July-September 2022, 22(3):129-147
Background Kidney transplantation has been established as the best therapy for end-stage renal disease. After transplantation and to provide a prolonged and safe patient and allograft survival, early and prompt diagnosis of posttransplant sequelae, for example, posttransplant anemia (PTA) in particular, is currently crucial. Timing of presentation of this disease has its effect on PTA development. The ‘early’ presented PTA (before 6 months) may differ clinically from the ‘late’ one (after 6 months) with respect to the underlying background. Although early PTA is multifactorial, allograft dysfunction is usually the underlying mechanism in the ‘late’ one. Furthermore, PTA is currently considered as an independent risk factor for the evolution of cardiovascular system events; the latter has been proved to be the first leading cause of death in this cohort of patients. The aims and objectives of this review is to evaluate critically the risk factors responsible for PTA development, its epidemiology, diagnostic criteria, etiology for both ‘early’ and ‘late’ PTA, the available therapeutic approaches for PTA, as well as the effect of PTA in allograft and patient survival. Methods Current available literature and analysis of various trials concerned with PTA. Results The impact of anemia on patients as well as allograft outcomes cannot be simply overlooked. Management of the early as well as late PTA is crucial. However, a variety of hazards of its therapeutic options should be thoroughly considered. Conclusions A lowered threshold of post-transplant anemia (PTA) awareness and its early management has its crucial impact on allograft as well as patient survival. Benefits of PTA correction is not only reflected on patients’ and allograft longevity but also on upgrading KTRs’ quality of life.
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Vascular access thrombosis among end-stage renal disease patients with acute COVID19 infection (a retrospective cohort study)
Ahmed M Elmahdi, Rasha I Gawish, Wael E Shalaan, Marwa Gamal Eldin, Nahla A Gamal, Moustafa H Mabrouk
July-September 2022, 22(3):168-178
Background According to studies, coronavirus disease 2019 (COVID19) infection is linked to an elevated risk of venous thromboembolism (TE). The frequencies of overall COVID19 thrombotic events and the influence of TE on COVID19 mortality, however, are unknown. Although respiratory symptoms are the most common symptom of the disease, evidence is growing suggesting that it is linked to coagulation system malfunction, which puts patients at risk for venous and arterial TE and higher mortality as well. Materials and methods A retrospective cohort study was conducted on 50 end-stage renal disease patients on maintenance hemodialysis (25 patients with confirmed COVID19 infection and 25 patients without COVID19 infection) to determine the incidence of vascular access thrombosis among patients with COVID19 during a 3-month period. Risk factors for mortality and severity were considered as secondary outcomes. Patients with previous history of vascular access dysfunction were excluded from the study. Results In all, 24% of COVID19-positive patients (n=6) developed vascular access thrombosis during 3 months of follow-up while no one of the COVID19-negative patient developed access thrombosis. The incidence of vascular access thrombosis was statistically higher in the COVID19 positive group (p value < 0.022). The incidence of vascular access thrombosis was significantly can u please add this part : increased in patients who had lymphopenia, elevated LDH, also it was more common in patients who needed mechanical ventilation and who had severe diseaseConclusion The incidence of vascular access thrombosis was statistically higher in the COVID19 positive group (p value < 0.022). The incidence of vascular access thrombosis was significantly can u please add this part: increased in patients who had lymphopenia, elevated LDH, also it was more common in patients who needed mechanical ventilation and who had severe disease.
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Study of vitamin D3 level in Egyptian hemodialysis patients and the effect of replacement therapy
Alaa A. A. Sabry, Mohamed Elazazy, Ahmed Abd El Wahab
July-September 2022, 22(3):163-167
Background The ability of extrarenal tissues to convert 25-hydroxyvitamin D into 1,25-hydroxyvitamin D and its dependence on substrate levels provide the rationale for supplementing vitamin D in dialysis patients who usually have severe depletion of both calcitriol and vitamin D. The primary aim of the study was to detect serum vitamin D3 levels in a cohort of Egyptian hemodialysis patients and to check the effect of 12-week therapy of cholecalciferol on serum calcium, phosphate, and parathyroid hormone (PTH) in vitamin D-naïve hemodialysis patients with vitamin D deficiency. Patients and methods A total of 40 patients (25 males and 15 females) with chronic kidney disease on regular hemodialysis, attending the Nephrology Unit of internal Medicine Department, Mansoura University Hospital, during the period from January to June 2017, were included. According to laboratory investigations and clinical examination, deficient patients were treated with Devarol-S (cholecalciferol) for 3 months and then revaluated. Deficient patients received intramuscular injection of 50 000 IU monthly for 3 consecutive months. Results The patient group included 40 persons, comprising 27 (73%) male patients and 13 (27%) female patients. Their mean age was 47.16 ± 14.92 years. The mean dialysis duration was 4.68 ± 2.42 years. At 3 months after vitamin D replacement, significant increase in serum calcium (8.33–8.89 mg/dl), phosphorous (4.99–5.85 mg/dl), and vitamin D3 (4.01–28.43 ng/ml) levels were observed compared with pretreatment levels. There was also significant decrease in PTH level (419.30–377.20 pg/ml). After 3 months of follow-up, there were no significant changes in the levels of hemoglobin, Kt/v, albumin, and alkaline phosphatase in the study group. Conclusions In most patients, treatment with cholecalciferol in a 50 000 IU/month dose permits safe correction of vitamin D deficiency and control of PTH level, yet serum phosphorus should be monitored.
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Safety and efficacy of low-dose glucocorticoid regimen in the induction phase treatment of class 4, 5 lupus nephritis: a retrospective study
Girish P Vakrani, Nambakam Tanuja, Sania Saba
July-September 2022, 22(3):148-153
Background Renal involvement in systemic lupus erythematosus is known as lupus nephritis (LN). LN presents with varied renal features. Class 4 and 5 LN are traditionally treated with prolonged standard high doses of prednisolone with various immunosuppressants such as cyclophosphamide and mycophenolate. These high doses of prednisolone are associated with numerous side effects. There is deficient data on the dose, duration of glucocorticoid therapy, and also paucity of data on comparison between the standard dose versus low-dose glucocorticoid therapy. Hence, this study can help in evaluating the use of low-dose glucocorticoids, its impact on renal outcome, and looking at side effects. Materials and methods It was a retrospective observational study conducted to look at the safety and efficacy of low-dose glucocorticoid regimen in induction phase treatment of class 4, 5 LN. Results On treatment, it was found that the resolution of microscopic hematuria, and improvement of low C4, and hypoalbuminemia were statistically significant in the low-dose steroid group. The resolution of proteinuria was seen in both groups and the resolution of renal failure was noted in both groups but was statistically significant in the standard dose group. Increased incidence of steroid-related complications was seen in the standard dose steroid group. Conclusions These findings possibly indicate that low-dose steroid therapy is good enough to treat LN with proteinuria, but a standard dose steroid is required in the presence of renal failure in LN, though increased incidence of steroid-related complications was seen in the standard dose steroid group.
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Study of left ventricle hypertrophy, dilatation, and ejection fraction changes before and after kidney transplantation
Noha Mohamed Elkohly, Mohamed Abdelnasr Abdelkareem Abdelfadeel, Eman Mohamed Elsharqawy, Montasser Mohamed Zeid
July-September 2022, 22(3):154-162
Background People with end-stage renal disease (ESRD) are at risk of developing serious cardiovascular complications. Left ventricular hypertrophy is the most prevalent cardiac finding observed. Renal transplantation is the best renal replacement modality offered to these patients with an expected improvement in cardiovascular complications. The aim of this work the present study aims to compare changes in left ventricle hypertrophy, dilatation, and ejection fraction before and after kidney transplantation. Patients and methods This cross-sectional study included 30 renal transplant recipients. Echocardiography was performed for all patients before transplantation and 6–12 months after transplantation. Patients with a reported history of posttransplant rejection or heart failure were excluded from the study. All patients were on hemodialysis before transplantation, and the mean postrenal transplant duration was 10.33 ± 1.95 months. All patients received the same posttransplant immunosuppressive regimen. Results The mean left ventricular ejection fraction before and after renal transplantation was 59.70 ± 7.86 and 68.82 ± 7.93, respectively (P<0.001). The mean left ventricular mass index showed a significant improvement from 144.1 ± 44.15 before transplant to 115.1 ± 38.79 after transplant, with a P value of 0.002. Conclusion According to the results of this study, renal transplantation can improve left ventricle parameters in patients with ESRD.
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Seeking action for diabetic nephropathy patient care
Megha Nataraj
July-September 2022, 22(3):181-182
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Takayasu arteritis presenting as renal infarction
Mansoor C Abdulla, Rinoy R Anand
July-September 2022, 22(3):179-180
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