Journal of Nephrology & Therapeutics

End Stage Renal Disease (ESRD) is an important cause of morbidity and mortality globally. Understanding the risk factors of ESRD can help identify preventive strategies. This study aimed to determine the risk factors of ESRD among patients undergoing hemodialysis in the governmental hospitals in Gaza Strip. Retrospective-hospital basedcase control study was conducted on patients with ESRD, at Ministry of Health Hospitals at the time of study in 2014 (N=264), proportional stratified random sample used for sample selection (n=132) cases matched with sex, age, and locality to 132 control were chosen. Data was collected using a questionnaire including socio-demographic, medical history, and life style and additional data were obtained from medical record. The results showed that the most common risk factors associated with ESRD were hypertension (42.4% versus 20.5%) and diabetes mellitus (28% versus 16.7%). Kidney stone (21.2% versus 4.5%), urinary tract infection (65.9% versus 27.3%) and glomerulonephritis (19.7% versus 6.1%) follow it. For medications analgesic drug formed among cases and controls (22% versus 9.1%). For smoking it was (47.7% versus 23.5%), obesity (41.7% versus 34.1%), anxiety (17.4% versus 6.1%). For low activity (48.5% versus 28%), primary educational level (95.1% versus 39.4%), low household income (76.5% versus 59.1%), family history (70.5% versus 47.7%). A multiple logistic regression controlling for age, gender, and location showed that significant predictors of ESRD were hypertension, glomerulonephritis, and obesity. In conclusion, the study suggests that most of the identified risk factors are preventable by easy ways as screening of highly risk people and encourage health life style.

Introduction: Treatment of Multiple Myeloma with high cut off filters was started in 2007. Working hypothesis: The High Cut Off hemodialysis is a cost-efficient treatment. Objective: To demonstrate that a combination treatment of chemotherapy and High cut off dialysis improves patient survival and quality of life, while saving costs by chronic dialysis. Methodology: Up to 13 treatments with HCO filters have been applied in the University Hospital Lozano Blesa of Zaragoza to patients with acute renal failure (ARF) secondary to Multiple myeloma. Results: 13 treatments were performed on 12 patients with high cut off hemodialysis. Six patients were diagnosed with monoclonal gammopathy Kappa and 6 were diagnosed with monoclonal gammopathy Lambda, with high levels of light chains in serum over 500 mg/L (11,036 mg/L on average at the beginning). We have achieved an improvement of renal function and have allowed the patient to live without dialysis dependence in 77%. We demonstrated that the savings would be 11.782 Euros. Discussion: This paper focused on the idea that although the high cost of high cut off filters is an inconvenience, this should not impede their use because the technique has been proven more effective and cost efficient Conclusion: The treatment is cost-effective; cost savings can be estimated in more than 11,000 euros/patient.

Background: The etiologies and outcome of Acute Kidney injury (AKI) in resource-limited countries are largely related to poverty. Outcome is marred by limited access to renal replacement therapy. Recently, partial government funding for hemodialysis in Cameroon and the SYL program have increased access to RRT for AKI in Cameroon. Data on AKI is sparse in Cameroon. We sought to describe the epidemiology of diagnosed AKI amongst patients in a tertiary hospital. Method: We retrospectively reviewed records of patients seen by the nephrology department for AKI over a 13 months period in a tertiary Hospital in Cameroon. Diagnostic of AKI was done using usual criteria. We evaluated access to dialysis, renal recovery at hospital discharge and at 3 months and patient survival at hospital discharge. Results: A total of 108 (61 males, 12 children) patients with AKI were identified among 303 nephrology in-patient consults or admissions during the study period. The mean age was 45.65± 21.23 years. Community acquired AKI was most common (70.4%). Pre-renal, renal and obstructive causes accounted for 26.9%, 62% and 11.1% patients respectively. Infections (n=36, 33.34 %) and toxins (n=21, 19.4 %) were most frequent causes. AKI was pregnancy related in 12 (11%), and malaria-related in 10 (10 %) cases. AKI was multifactorial in 21.3% of patient. Dialysis was indicated in 55 (50.9%) patients but only 30 (27.8%) patients effectively underwent the therapy. Reasons for no access to dialysis were lack of appropriate material and lack of funds. At 3 months, 34 (31.5%) were known dead, 41 (38%) complete renal recovery, 25 (23%) partial recovery and 8 (7.5%) loss to follow-up. No patient was dialysisdependent. Conclusion: Infection and nephrotoxins are the main etiologic factor of AKI. Its prognostic is severe: half of patients need dialysis and third die.

mphocyte ratio (NLR) is novel prognostic marker in various inflammatory conditions. We performed a retrospective study investigating whether NLR has prognostic significance in patients suffered from AKI. Materias and Methods: Two hundred and ninety five AKI patients were evaluated retrospectively. Baseline values on admission, final values at discharge and after discharging during follow-up period in outpatient clinic until six months to one year were recorded. Results: It has been shown that, final NLR and timely changed NLR during hospital course are significant mortality predictors in AKI patients both in univariate and mutually adjusted multivariate logistic regression analysis. To predict mortality, we showed that, level of 9.90 point for final NLR has 73% sensitivity and 87% specifity as compared to value below in ROC analysis (HR: 7.31, CI 3.36-15.91; p < 0.001). Conclusion: NLR can be a novel screening tool for AKI patients during their hospital course

Case 1: A 25 year-old woman, presented with asthenia; weight loss; severe hypertension and acute unilateral anterior uveitis. She had also proteinuria; hematuria; aciduria; kidney failure and grade I hypertensive retinopathy. Kidney biopsy showed a non caseating granuloma in the interstitial tissue, and tubulointerstitial nephritis (TIN) with granulomatous lesions in the medullary parenchyma. All explorations were negative but QuantiFERON was 10 times normal without koch’s bacillus. No other sites of granulomas. The patient partially responded to corticoid treatment. She replased after untimely stopping corticosteroids. Corticosteroid-sparing was provided by mycophenolate mofetil. Case 2: A 46 year-old patient, with family history of mother who died of CKD, presented with recurrent anterior uveitis, kidney failure, proteinuria, and inflammatory syndrome, research of infectious agents or auto-immunity origin was negative. Renal biopsy showed TIN lesions in subacute stage; biopsy of the salivary glands showed stage III chronic lymphocytic sialadenitis without Sjogren syndrome or sarcoidosis. The patient received corticosteroid treatment. Discussion: The presence of TIN, recurrent anterior uveitis, no notion of drug intake, response to corticosteroids and exclusion of other diagnoses leads to TINU syndrome. Positivity of Quantiferon is explained by the fact that TINU syndrome is associated with high serological markers in the absence of their corresponding diseases, and presence of chronic lymphocytic sialadenitis explained by these immunological disorders without Sjogren syndrome, Both patients remained well without recurrence of uveitis 2 and 6 years later respectively. Conclusion: TINU syndrome is secondary to immunological disorders as evidenced interstitial infiltrate of the renal parenchyma, the inflammatory disease of the uvea and good response to corticosteroid therapy.

Aim: This study sought to explore factors affecting Iranian living related donors’ motivation for kidney donation. Background: Living related donor kidney transplant is an ideal treatment among other options for chronic renal failure due to the greater compatibility of donor and recipient’s human leukocyte antigen. Accordingly, identifying factors affecting living related donors’ motivation for kidney donation is essential for transplant teams, including nurses, and can help them adopt strategies for encouraging family members to donate.
Methods: This was a descriptive qualitative study to which fourteen family donors (six females and eight males) were recruited purposively from transplantation centers of all teaching hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran. The study data were collected through in-depth semi-structured interviews and were analyzed by using the conventional content analysis approach.
Findings: Factors affecting Iranian living related donors’ motivation for kidney donation fell into three main categories including feelings of love and responsibility, spiritual motives, and knowledge of greater success rate of living related donor transplant. The first category consisted of the two sub-categories of close and constant companionship and inability to tolerate recipient’s discomfort.
Conclusion: The findings of the present study indicate that both personal factors (such as feeling of responsibility and spiritual motives) and organizational factors (such as informing family members about the importance and the benefits of family donation) are among the main motives for kidney donation by living related donors. Employing strategies for promoting these factors could facilitate the process of kidney donation by living related donors.