Mohamed Ashraf Fouda

Kimura disease: a case report and review of the literature with a new management protocol.

Kimura disease (KD) is a chronic inflammatory disorder with angiolymphatic proliferation, usually affecting young men of Asian race but is rare in other races. The etiology of KD is still unknown. It is often accompanied by nephrotic syndrome. Herein, we present an atypical manifestation of Kimura disease occurring in a Caucasian man with steroid-responsive early membranous glomerulonephritis. Kimura disease can present atypically in a middle-aged Caucasian man with secondary steroid-responsive nephrotic syndrome. Steroid, endoxan, and MMF can be used safely and successfully in such situation. The diagnosis of KD can be difficult and misleading, and patients with this disease are often evaluated using avoidable procedures by just not being aware of KD.

Prospective Randomized Study of Azathioprine versus Cyclosporin in Live-Donor Kidney Transplantation

A total of 112 recipients of haploidentical live-related donor kidney transplants were assigned randomly prior to transplantation to two groups of immunosuppressive treatment. The first group (54 patients) received the conventional immunotherapy of azathioprine (AZA) and prednisolone (P; AZA-P group). In the second group, 58 patients were given cyclosporin (Cs) and P (Cs-P group). All patients had previous third-party blood transfusions. The follow-up period ranged from 3 to 6 years (mean 50 +/- 8 months) during which 13 patients (24%) in the AZA-P group and 6 (10%) in the Cs-P group were switched to the alternate immunotherapy (p > 0.05). Analysis of patient and graft survival along the follow-up period did not disclose significant differences between patients of the two groups. While the overall frequency of acute rejection episodes was not significantly different between the two treatment groups, the number of patients who had 2 or more rejection episodes was higher in the AZA-P group (p < 0.04). The mean serum creatinine levels were significantly higher in the Cs-P group than corresponding levels in the AZA-P group at 1, 12 and 24 months after transplantation. We have concluded that at least 75% of the haploidentical human lymphocyte antigen mismatched live-related donor renal transplants can be maintained on AZA-P immunotherapy with a comparable degree of success to those treated with Cs-P. However, in at least 15% of patients with conventional immunotherapy, Cs could reverse ongoing rejections, and therefore, it can be considered as a rescue treatment in AZA-treated patients with steroid-resistant or ongoing rejections.

Prospective randomized study of azathioprine vs cyclosporine based therapy in primary haplo-identical living-donor kidney transplantation: 20-year experience.

BackgroundThe achievements in short-term graft survival since the introduction of cyclosporine (CsA) have not been matched by improvements in long-term graft function. Chronic allograft nephropathy (CAN) remains the second most common cause of graft attrition over time, after patient mortality. We aimed to evaluate the long-term results of azathioprine vs CsA in live-donor kidney transplantation in a prospective randomized study.MethodsWe studied 475 renal transplant recipients who had had transplantations performed at the Urology and Nephrology Center, Mansoura University, before 1988 and who had received a primary immunosuppressive protocol consisting of either steroid and azathioprine (steroid/Aza; group 1, 300 patients) or steroid and CsA (steroid/CsA; group 2, 175 patients). Only adult primary renal transplant recipients aged between 18 and 60 years and with one haplotype HLA mismatch were included. All patients received kidneys from living-related donors, with previous donor nonspecific blood transfusions. The study was based on the long-term follow-up data of these renal transplant recipients. Comparative analyses included patient and graft survival rates, condition at last follow up, rejection (acute and chronic), and graft function (serum creatinine and creatinine clearance).ResultsThe overall frequency of acute rejection episodes was not significantly different between the two groups. Graft survival rates were: group 1 vs group 2, 69% vs 58% at 5 years, and 52% vs 36% at 10 years, but at 20 years, graft survival rates had declined to 26% and 24%. No significant differences were encountered between the two groups regarding post-transplant malignancies, diabetes mellitus, hepatic impairment, or serious bacterial infections.ConclusionsFrom this study we can conclude that the long-term result of historical conventional therapy (steroid/Aza) without induction therapy is effective for living-donor kidney transplants. In spite of the comparable graft function for the two groups, the steroid/CsA group experienced more hypertension, as well as many adverse reactions to CsA. Nowadays, since the introduction of induction therapy and the utilization of newer maintenance immunosuppressive agents – such as mycophenolate mofetil (MMF) and rapamycin – it is possible to achieve an excellent calcineurin inhibitors (CNI)-free regimen.

New Onset Diabetes Mellitus after Living Donor Renal Transplantation: A Unique Pattern in the Egyptian Population

Objectives: Our aim was to identify the diabetic risk profile of new onset diabetes after live donor renal transplantation (NODAT) and its impact on patient and graft survival in Egyptian population. Patient and methods: A retrospective review of 2019 renal allograft recipients has been performed. Risk factors, medical complications, patient and graft survival were analyzed. Results: After a mean follow up period of 8.8 ± 5.8 years, 450 (22.2%) recipients developed NODAT. A 455 post transplantation time matched control recipients without DM was selected. Time table revealed that 50% of NODAT cases discovered during the first 6 months post transplantation. The NODAT recipients were significantly older and obese with higher body mass index. Family history of DM was significantly positive among the NODAT group. Cox’s multivariate regression analysis revealed that the older age, positive family history of DM, high BMI, HCV infection and hypercholesterolemia were of significant risk factor. Medical complications were significant in the NODAT group. Patient survival was significantly lower in the NODAT group on the other hand the graft survival was comparable. Conclusion: NODAT does not statistically affect the graft survival. But, NODAT is a major problem endangers the patient life and must be minded to consider such patient as especially at higher risk for diabetic complications.

Impact of clinical and histopathological factors on outcome of Egyptian patients with crescentic glomerulonephritis

This study included 128 patients withcrescentic glomerulonephritis (CGN) havingsufficient clinical and histopathological dataand were followed up in our institute for amean period of 34 ± 28 months. There were 49males and 79 females with mean age 22.7 ± 14years. We studied the effect of clinical,laboratory and histopathological parameters onkidney function and patient survival at the endpoint of the study. The multivariate analysisrevealed that serum creatinine at presentation,nephrotic range proteinuria during the followup period, percentage of glomeruli affected bycrescents, percentage of fibrous crescents andabsence of cellular infiltration weresignificant risk factors affecting the kidneyfunction at termination of the study. The onlyrisk factor which correlated significantly withthe patient mortality was the serum creatinineat last follows up.

Effect of donor and recipient variables on the long-term live-donor renal allograft survival in children

Abstract Objective: We aimed to analyse donor and recipient predictors of graft survival in children who received live-donor renal grafts. Patients and methods: The study comprised 273 children who received live-donor renal transplants at our center between March 1976 and October 2010. The follow-up ranged from 6 months to 25 years. Donor variables included donor age, gender, donor/recipient body weight ratio (DR BWR), ABO blood groups, human leukocyte antigen, and DR mismatching. Donor-specific problems, e.g., ischemia time during surgery and number of renal arteries, were included. Recipient variables included recipient age, sex, original kidney disease, ischemia time, acute tubular necrosis (ATN) after transplantation, immunosuppression, number of acute rejection episodes, re-transplantation, and development of hypertension. Results: Independent variables with a sustained effect on the 5- and 10-year graft survival on multivariate analysis were: ATN after transplant, number of acute rejections, hypertension, and DR BWR. At the last follow-up, 185 patients (67.8%) had a functioning graft, while 82 (30.0%) had graft failure. Only six patients (0.02%) were lost to follow-up. Conclusion: Donor and recipient variables that affect short- and long-term graft survival in children with a live-donor renal allograft are DR BWR, number of acute rejections, ATN and hypertension after transplant. Considering these variables provides a better outcome.

Acute vascular rejection after kidney transplantation outcome and effect of different therapeutic modalities

Steroid resistant acute vascular rejection (A VR) is great obstacle in successful renal transplantation (KTx). The aim of this work was to evaluate the outcome of histologically confirmed acute vascular rejection-which of occurred in severe aggressive form in 39 patients following kidney transplantation as well as to study the outcome of therapy. These cases were chosen from Inoo renal allograft recipients who underwent kidney transplantation in the period between March, 1976 and April 1997 in Urology-Nephrology Center, Mansoura, Egypt.