Khawar Abbas

Predictors of Outcome in Malarial Renal Failure

We studied 38 patients with acute renal failure (ARF) due to malaria over a 5-year period between 1990 and 1994 at the Institute of Urology and Transplantation. There were 30 males and 8 females who ranged in age from 13 to 75 years. Most were critically ill on presentation with blood urea levels between 116 and 587 mg% and serum creatinine concentrations between 3 and 30 mg%. Anemia accompanied by hyperbilirubinemia was a result of severe hemolysis. Antimalarial therapy consisted of quinine sulfate, chloroquine, or both. Of the 38 patients, 32 required hemodialysis and eventually recovered normal (n = 29) or near normal (n = 3) function. Six patients died.

Plasma cell‐rich acute rejections in living‐related kidney transplantation: a clinicopathological study of 50 cases

Acute rejections (ARs) with plasma cell‐rich infiltrates (PCARs) are associated with poor outcomes.

Vasculitis with renal involvement in essential mixed cryoglobulinemia: Case report and mini-review

The discovery of a strong association between hepatitis C virus (HCV) infection and mixed cryoglobulinemia (MC) has led to an increasingly rare diagnosis of idiopathic essential MC (EMC). The incidence of EMC is high in regions where there is a comparatively low HCV infection burden and low in areas of high infection prevalence, including HCV. The diagnosis of EMC requires an extensive laboratory investigation to exclude all possible causes of cryoglobulin formation. In addition, although cryoglobulin testing is simple, improper testing conditions will result in false negative results. Here, we present a 46-year-old female patient with a case of EMC with dermatological and renal manifestations, highlighting the importance of extensive investigation to reach a proper diagnosis. We review the need for appropriate laboratory testing, which is often neglected in clinical practice and which can result in false negative results. This review also emphasizes the significance of an extended testing repertoire necessary for better patient management. Despite a strong association of MC with HCV infection and other causes that lead to cryoglobulin formation, EMC remains a separate entity. Correct diagnosis requires proper temperature regulation during sample handling, as well as characterization and quantification of the cryoprecipitate. Inclusion of rheumatoid factor activity and complement levels in the cryoglobulin test-panel promotes better patient management and monitoring. Consensus guidelines should be developed and implemented for cryoglobulin detection and the diagnosis of cryoglobulinemic syndrome, which will reduce variability in inter-laboratory reporting.

Renal Allograft Biopsy Findings in HLA Identical Renal Transplant Recipients

Objectives HLA identical transplants are immunologically privileged and have the best graft survival in both deceased and living donor settings, yet the grafts do fail. This study describes the causes of graft failure in HLA identical transplants as detected on renal allograft biopsies. Patient and Methods: Between 1992 and 2012, 3749 live-related transplants were performed at our center. Of these, 756 (20%) were HLA identical. Immunosuppression comprised of triple drug regimen: CyA/AZA or Tacrolimus/MMF with steroids. Graft dysfunction episodes were confirmed by biopsy, when indicated. Graft biopsies were reported according to Banff classification. All recipients were followed-up lifelong, where all treatment is provided free including immunosuppression drugs. Results In the follow-up period of 4 to 20 years, 160/756 (21%) of the identical grafts were lost with 5, 10, 15 years survival rates of 85%, 68% and 60% respectively. A comparison of those who lost grafts (Group A, n=160) vs. those who maintained function (Group B, n=596) showed that in Group A, donors were older (35±9 vs. 32±9, p=0.001), GFR was lower (97±24 vs. 110±23 ml/min, p=0.001) and there were more females (46% vs. 33%, p=0.031). Among recipients in group A, there were more females (25% vs. 18%, p=0.03) and hypertensives (60% vs. 49%, p=0.04). Acute rejection rates in group A were higher (13% vs. 4.8% p=0.001), as was cyclosporine toxicity on biopsy (14% vs. 11%, p=0.20) and recurrence of original disease (9% vs. 4%, p=0.03) as compared to Group B. Of the 160 grafts lost, 24% were functioning but lost due to death of recipients, 7% were lost due to recurrence, 7% to infection in the graft, 6% to acute rejection and 50% to interstitial fibrosis/tubular atrophy (IFTA). Conclusion HLA identical grafts have superior survival due to immunological privilege, but are susceptible to non-immunological injury, including CyA toxicity.

A living donor risk model for predicting kidney allograft and patient survival in an emerging economy.

Living donor kidney is the main source of donor organs in low to middle income countries. We aimed to develop a living donor risk model that predicts graft and patient survival in an emerging economy.