Hassan Abu-Aisha

Pattern of glomerular disease in Saudi Arabia

Clinical data and renal biopsy study of 186 adult patients found to have nephropathy and seen at the Security Forces Hospital, Riyadh, over a 5-year period (1989 to 1994) were reviewed. Primary glomerular disease accounted for more than three fourths of all patients (79%), and the most common histological lesion was focal segmental glomerulosclerosis (40.8%) associated with a high incidence of hypertension (86.7%), nephrotic syndrome (61.7%), hematuria (48.8%), and renal impairment (33.3%). Mesangioproliferative glomerulonephritis was the second most common lesion (21.1%), followed by membreous glomerulonephritis (13.6%), immunoglobulin A nephropathy (IgAN) (13.6%), membranoproliferative glomerulonephritis (9.5%), and minimal change disease (1.4%). Although not as common as in most other developed countries, IgAN is being increasingly recognized in Saudis. Lupus nephritis remained the commonest cause of secondary glomerulonephritis (48.5%), whereas amyloidosis was conspicuously absent. There is no evidence, at least in this series, that chronic infection such as hepatitis B virus infection has a major role in the development of glomerulonephritis.

Effect of recombinant human erythropoietin on lymphocyte phenotyping and phagocyte activity in hemodialysis patients

The effect of recombinant human erythropoietin (rHmEPO) on lymphocytic phenotyping as well as on the phagocyte activity of polymorphonuclear cells and monocytes was evaluated in 16 patients on maintenance hemodialysis. The mean age of the patients was 38.2 +/- 16.2 years. There were seven men and nine women. All patients were started on 50 U/kg of rHmEPO intravenously three times per week, and the dosage was increased gradually to achieve target haemoglobin of 12 g/dL. Predialysis blood samples were taken monthly for 3 months, and phagocyte respiratory burst as well as lymphocyte subsets were studied. Healthy blood donors were taken as controls. By 3 months of rHmEPO treatment, there was no significant increase in total T and B cells, but there was a significant increase in both CD4 (P < 0.001) and CD8 (P < 0.005): however, there was no significant change in the CD4/CD8 ratio. There was significant reduction in the natural killer cells (P < 0.005). The phagocyte activity studies showed a significant increase in the respiratory burst in whole blood (P < 0.001) and opsonized zymosan (P < 0.001) as well as improvement in the suppressed polymorphonuclear cell and monocyte activity by uremia. Phagocytosis studied by yeast uptake showed significant improvement from the pretreatment suppressed phagocytes to normal activity posttreatment. In conclusion, treatment with rHmEPO increases CD4 and CD8 cell counts without affecting the CD4/CD8 ratio, decreases the natural killer cells, and improves the impaired phagocyte activity in hemodialysis patients.

Dual-lumen femoral vein catheterization as vascular access for hemodialysis : A prospective study

Prospectively from January 1991 to January 1993, the efficacy and complications of 104 polyurethane, double-lumen femoral vein catheterizations (FVC) in 96 renal failure patients were studied. Ambulation was allowed in the hospital as well as at home while the catheter was in. There were 53 males and 43 females, with ages ranging from 13 to 87 (mean, 48.3 ±19.7) years. Forty-eight patients had chronic renal failure and 48 had acute renal failure. The catheters were used for 1 to 26 days (mean, 8 ±5 days). Fifty-two (50%) of the FVC were used for 2 weeks and 14 (13.5%) for 3 weeks or longer. The various complications encountered were infection (n=31), poor blood flow (n=8), displaced catheter (n=6), thrombosis of the catheter (n=4), hematoma (n=4), bleeding (n=3), exit site infection (n=3), ileofemoral vein thrombosis (n=2), and tear in the catheter wall (n=2). On removal, bacterial colonization was present in 34 out of 93 catheter tips (36.5%); Staphylococcus epidermidis (n=12) was the commonest organism grown. There was no significant difference of infection between diabetic and nondia betic chronic renal failure patients. The duration of catheterization was found to have no relation with either thrombosis or infection. Femoral vein catheters can be used for hemodialysis for 2 to 3 weeks and ambulation during cannulation may be allowed.

The pattern of diabetic nephropathy among Saudi patients with noninsulin-dependent diabetes mellitus.

There were no studies on the different stages of diabetic nephropathy in Saudi Arabia, particularly the earliest stages. We have therefore investigated the frequency of occurrence of varying degrees of proteinuria including microalbuminuria in noninsulin-dependent diabetes mellitus (NIDDM) Saudi patients as well as the correlation of varying degrees of proteinuria with other diabetic complications and risk factors. One hundred and twenty-five NIDDM patients were studied. Fifty-seven were males and 68 were females. Their mean age was 49.8 +/- 10 years with a mean duration of diabetes of 9.48 +/- 6 years. The mean of HbA1c was 10.3 +/- 2.6%, serum creatinine was 76.7 +/- 23 mmol/L, creatinine clearance 94.3 mL/min, glomerular filtration rate 129.7 +/- 44 and effective renal plasma flow was 496.5 +/- 153. The pattern of proteinuria group was as follows: nephrotic range proteinuria 5.6%, clinical proteinuria 30.4%, microalbuminuria 16.8%. Hypertension and retinopathy were present in 36.8% and 37% of the patients respectively. A significant correlation was found between the presence of hypertension, duration of diabetes and development of diabetic nephropathy. Similarly, a significant correlation was found between retinopathy and the degree of proteinuria. In conclusion, the pattern of diabetic nephropathy in the Saudi NIDDM patients is similar to that in the Western world. Hypertension and duration of diabetes mellitus are important risk factors in the development of diabetic nephropathy. There is a good correlation between retinopathy and the degree of proteinuria.

Hemodialysis Vascular Access and Complications

From January, 1985, to July, 1991, 105 uremic patients had 148 vascular accesses for chronic hemodialysis. Thirty-three (31.4%) patients received more than one access. Of 148 accesses, 131 (88.5%) were arteriovenous (AV) fistulae and 17 (11.5%) were AV grafts. The mean hospital stay for patients with AV fistula was twenty-four days and for those with polytetraflouroethylene (PTFE) graft was thirty-five days. The maturation period for fistulae and grafts was six to eighty-one days and two to forty-five days respectively Early postoperative complications included death in 1 patient, major bleeding in 6 (4.6%) fistulae and primary failure in 28 (21.4%) fistulae and 2 (11.8%) grafts. Deep vein thrombosis occurred in the upper limb of 1 patient with AV graft, and ischemic manomelic neuropathy developed in 1 patient with AV graft. Late complications included bleeding in 6 (4.6%) fistulae and 4 (23.5%) grafts, ischemia in 2 (0.15%) fistulae and late failure due to thrombosis in 19 (14.5%) fistulae and 7 (41.2%) grafts. Infection of the access occurred in 18 (13.7%) fistulae and 14 (82.3%) grafts and led to death in 1 patient. AV fistulae patency rate was 80% after one year and 67% after five years. The patency rate for AV grafts was 67% after one year and 48% after five years.

Peritonitis in Chronic Peritoneal Dialysis: Analysis of a 4-Year Experience at King Khalid University Hospital

Our experiences with peritonitis over a 4-year period in a continuous ambulatory peritoneal dialysis program at a teaching hospital were reviewed. The incidence, etiology, sensitivity pattern of in...

Continuous Ambulatory Peritoneal Dialysis in Children in Saudi Arabia

Over a period of 5 years, 26 children with end-stage renal disease were started on maintenance continuous ambulatory peritoneal dialysis (CAPD) program in King Khalid University Hospital, Riyadh. A...

Comparison between Continuous Ambulatory Peritoneal Dialysis and in Center Hemodialysis

The data on 39 patients on hemodialysis and 19 on continuous ambulatory peritoneal dialysis (CAPD) were compared in terms of correction of metabolic abnormalities, types of complications necessitat...

Intermittent peritoneal dialysis (IPD) in the elderly

Twenty-one elderly patients with end-stage renal disease (ESRD) secondary to various etiologies received IPD at our unit. It was done manually by trained staff nurses. Each patient received 20-24 one hour exchanges of 2 liters PD solution twice a week through a permanent Tenckhoff catheter. Mean age of patients was 63 years (range 60–96),12 were male and 9 female. Mean duration of stay on IPD was 23 months (range 18–41). The etiologies of ESRD were: diabetes mellitus (9 patients), unknown etiology (7), hypertension (3), glomerulonephritis and liver cirrhosis (hepatitis C) (2). The peritonitis rate was one episode per 16.3 patient/month. The causative organisms were staphylococcus, coliforms, acinobacter and pseudomonas. Six patients died due to each of the following: 2 septicemia not related to PD; 2 hepatic failure; 2 massive myocardial infarction. Two patients were changed to hemodialysis due to recurrent peritonitis. We observed 7 episodes of catheter exit-site infection; causative organisms were staphylococcus (4), and pseudomonas (3). Staphylococcus cases of exit-site infection responded to local fucidin ointment and oral antibiotic, while in the pseudomonas cases the catheter had to be removed. All patients received erythropoietin and have maintained good hemoglobin levels (10.1 ± 1.2 gm%). They also had adequate control of their serum creatinine and urea level. As the patients improved, they became less dependent on their relatives.

Non-peritonitis complications of continuous ambulatory peritoneal dialysis in Saudi Arabia.

Although peritonitis is the major complication and leading cause of morbidity in patients undergoing continuous ambulatory peritoneal dialysis (CAPD), there are other complications of this long-term renal replacement therapy (RRT) modality. In order to evaluate the non-peritonitis complications, we retrospectively studied 60 new patients who were accepted in our CAPD program over a period of eight years from 1984 to 1993. Out of the 60 patients, 31 were females and 29 were males, with a mean age of 37.0 +/- 18 years. Tenckhoffs catheter was implanted by surgeons under direct vision in the operating theater through a midline incision. Nine of our patients had previous abdominal surgery and 11 females had pregnancies before CAPD, ranging from one to 10 with a mean of four. A total of 49 episodes of complications were observed, 32 early and 17 late. Early complications were defined if they occurred within three months from starting the procedure and late complications were defined as occurring after this period. There were 15 catheter blocks (25%), nine dialysate leaks (15%) and five hemoperitoneums (8.3%). Two serious and unusual complications were observed. In one of our patients, a mesenteric blood vessel injury occurred during catheter insertion, which necessitated massive blood transfusions and laparotomy. The other patient developed intestinal obstruction due to obstruction of intestinal loops around the catheter; this was corrected by removal of the catheter without the need for laparotomy. The late complications included six hernias, three hydroceles, three exit site infections, three tunnel infections and one case of loss of ultrafiltration.