Riyad Said

Hepatitis C associated glomerulonephritis.

To determine the prevalence and type of glomerulonephritis (GN) associated with hepatitis C virus (HCV) cirrhosis, we prospectively evaluated 28 consecutive Saudi patients with HCV cirrhosis for liver transplantation. Six patients (21%) underwent kidney biopsies for proteinuria, unexplained elevated serum creatinine or both. All 6 had GN, 4 had membranoproliferative, one focal segmental and one membranous GN. Immunologic and electron microscopic studies demonstrated immune complex deposition in the glomeruli. Two patients with significant proteinuria were treated with interferon alpha for 3 months with improvement in kidney and liver function. To our knowledge, this is the first report of focal segmental GN associated with HCV. This high prevalence of HCV associated GN is alarming and warrants further studies in cirrhotic and noncirrhotic patients, particularly as an indication for therapeutic intervention.

Interferon-alpha facilitates renal transplantation in hemodialysis patients with chronic viral hepatitis

Interferon-alpha has not been used previously in hemodialysis patients with chronic hepatitis B and C. This uncontrolled report evaluates the biochemical and/or histologic profile resulting from the administration of interferon-alpha in seven hemodialysis patients, two with chronic hepatitis B and five with hepatitis C. Biochemical improvement was noted in all patients. Histologic progression did not occur in the two cases in which such assessment was made, and five of them were subsequently transplanted without recurrence of disease.

Membranoproliferative glomerulonephritis associated with multicentric angiofollicular lymph node hyperplasia

A 14-year-old boy presented with fever, anemia, hepatosplenomegaly, generalized lymphadenopathy and nephrotic syndrome. Lymph node biopsy showed angiofollicular lymph node hyperplasia (generalized Castlemans disease) of the plasma cell type. Kidney biopsy showed membranoproliferative glomerulonephritis type 1. Complete remission was achieved with corticosteroid treatment and repeat kidney biopsy 22 months later showed complete resolution of the renal pathology. The association between membranoproliferative glomerulonephritis and multicentric angiofollicular lymph node hyperplasia, plasma cell type, has not previously been reported.

Rapid Progressive Glomerulonephritis in Patients With Familial Mediterranean Fever

Two patients with a long-standing history of familial Mediterranean fever (FMF) presented with gross hematuria, oliguria, and acute renal failure; both required dialysis support. Kidney biopsies from both patients revealed crescentic rapid progressive glomerulonephritis (RPGN) without amyloidosis. One patient recovered renal function with methylprednisolone pulse therapy and cyclophosamide. The second patient did not improve and required regular hemodialysis. He is asymptomatic on colchicine therapy. To our knowledge, these are the first cases documenting the presence of RPGN in patients with FMF.

IgA Nephropathy in Patients with Familial Mediterranean Fever

Two patients with a long-standing history of familial Mediterranean fever were found to have both microscopic hematuria and proteinuria during the acute attacks. Kidney biopsies from both patients revealed diffuse mesangial proliferative glomerulonephritis with intense mesangial IgA and C3 deposits and no evidence of amyloidosis. To our knowledge these are the first 2 cases documenting the presence of mesangial IgA nephropathy in patients with familial Mediterranean fever.

Simultaneous occurrence of acute poststreptococcal glomerulonephritis and acute rheumatic fever.

The simultaneous occurrence of acute poststreptococcal glomerulonephritis and acute rheumatic fever is a rarity. We report here such an occurrence in a 9-year-old Saudi boy whose kidney biopsy showed diffuse exudative glomerulonephritis with subepithelial humps on electron microscopy in the presence of active rheumatic carditis.

Renal Failure in a Living-Related Kidney Donor: Case Report and Review of the Literature

End-stage renal disease developed in a 37-year-old Saudi patient who donated a kidney to his brother 11 years previously. Biopsy of the remaining kidney showed focal-segmental glomerulosclerosis. Dialysis support was needed, and finally the patient received a living-nonrelated kidney transplant. The allograft function in the recipient brother remains very good 11 years after transplantation.

Digital Subtraction Venography in the Diagnosis of Renal Vein Thrombosis

Fifteen cases of renal vein thrombosis were seen in patients with nephrotic syndrome, both adult and pediatric, and all had kidney biopsies. Six patients were found to have membranoproliferative glomerulonephritis, 3 membranous nephropathy, 2 focal segmental glomerulosclerosis, 2 renal amyloidosis and one each minimal change disease and diffuse mesangial proliferative glomerulonephritis. The diagnosis of renal vein thrombosis was made in all patients by utilizing digital subtraction venography. This method is simple, safe, noninvasive and quite efficient.

Hypertension in Jordanian children: a retrospective analysis of 70 cases

Seventy patients, aged 1–20 years, were seen at Jordan University Hospital with high blood pressure (BP) over a 3-year period. BP values ranged from 140 to 230 mmHg for systolic pressure and from 90 to 130 mmHg for diastolic pressure. Essential hypertension was seen in only 6 patients (8.6%); secondary hypertension (n=64 or 91.4%) was due to renal parenchymal diseases (RPD) in 46 patients (65.7%), reno-vascular lesions in 8 (11.4%), renal transplantation in 5 (7.2%), teenage pregnancy in 4 (5.7%), and phaeochromocytoma in 1 patient (1.4%). The aetiologies of RPD were as follows: end-stage renal disease requiring dialysis in 14 patients, acute glomerulonephritis in 14, idiopathic nephrotic syndrome in 10, chronic renal insufficiency in 5, and polycystic kidney in 3 patients. Surgical cure of hypertension was achieved in 5 of the children with reno-vascular lesions and in the patient with phaeochromocytoma.