Hassa Al Zaabi , MD, MSc Nephrology Medicine , is a specialist nephrologist at Zayed Military Hospital, Abu Dhabi, UAE .Al Zaabi started her medical education in The Arabian Gulf University in the Kingdom of Bahrain. Following her undergraduate education , Al Zaabi continued her postgraduate training in nephrology at Zayed Military Hospital. During her postgraduate training , Alzaabi obtained a Masters degree in Nephrology Medicine from University of Sheffield after training for a year at Sheffield Kidney Institute in Sheffield , UK.
Al Zaabi also worked as a Deputy Medical Director at Zayed Military Hospital for over 3 years and Head of Nephrology for a year .
Currently, Al Zaabi is working at Zayed Military Hospital at the clinic and dialysis unit and also works at the Ministry of Defense as a Head of Delivery Management Section . Her interests are Chronic Kidney Disease and End Stage Renal Disease.
Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder characterized by the growth of numerous cysts in the kidneys. Symptoms vary in severity and age of onset, but usually develop between the ages of 30 and 40.
ADPKD is a progressive disease and symptoms tend to get worse over time. The most common symptoms are kidney cysts, pain in the back and the sides and headaches. Other symptoms include liver and pancreatic cysts, urinary tract infections, abnormal heart valves, high blood pressure, kidney stones, and brain aneurysms.
ADPKD is most often caused by changes in the PKD1 and PKD2 genes, and less often by changes in the GANAB and DNAJB11 genes.It is inherited in a dominant pattern.
The diagnosis of ADPKD should be suspected in patients with clinical features mentioned and in those with a family history of ADPKD.
Preferred method — Mayo classification system, which categorizes patients into five prognostic classes from the lowest to the highest risk for disease progression (classes 1A, 1B, 1C, 1D, and 1E).
The Mayo classification requires demographic data such as the patient's age, height, and TKV.
The TKV can be calculated using a TKV calculator available online using a single representative coronal image .
Treatment for ADPKD involves managing the symptoms and slowing disease progression. The most serious complication of ADPKD is kidney disease and kidney failure. ADPKD is the most common inherited disorder of the kidneys. Tolvaptan is a vasopressin V2-receptor (V2R) antagonist with proven beneficial results in ADPKD.
Dr.Mohamed Alsaid Abdellatif is a Senior Specialist of nephrology in the Ministry of Health situated in Damietta .
• 27 year-old female • Primi gravida. • Delivered by C.S-spinal anasethia> full term baby • 10 hours later, the patient returned to home, she complained from headache. • The obstetrician ordered to give fluids
Day 1 • Severe Headache, malaise, lethargy and dizziness. • The family called the physician . • No bleeding • Fluids, analgesics, assurance
Day 2 • The patient became dyspneic . • The obstetrician asked the family to consult chest physician. The chest physician ordered CBC which revealed leukocytosis and HB 9 g/dl. • Blood pressure : 100/70 mmHg ---- • He called the obstetrician and started broad spectrum antibiotic
Day 3 • The patient became feverish • The obstetrician accompanied the patient to the emergency hospital . • They spent 10 hours in the hospital . • CBC revealed leukocytosis.us revealed small collection 5*5 • The patient returned to her locality Diagnosis :infected collection Treatment: iv antibiotics
Day 4 Her level of consciousness is deteriorating. She was referred to ICU Oliguric …..90/60 mmhg Creatinine 5 mg/dl K 6.5 m.mol/l PH 7.1 HCO3 15…. Nephrology consultation.
Dr.Mohamed Abdelnasr Abdelkareem Abdelfadeel works at Internal Medicine and Cardiology departments as a Faculty of Medicine in the Alexandria University located in Alexandria, Egypt.
Background: Â End-stage renal disease (ESRD) population are at risk of serious complications with the cardiovascular one being the commonest. Left ventricular hypertrophy (LVH) is the most frequent cardiac finding observed in this group of patients. It is mainly attributed to chronic pressure and volume overload. Renal transplantation is the best renal replacement modality offered to these patients with an expected improvement in cardiovascular related complications.
Aim of the work: We aimed to study the changes in left ventricle hypertrophy, dilatation and ejection fraction before and after kidney transplantation
Methods: This cross-sectional study included 30 renal transplant recipients with a mean age of (34.13 Â± 11.80) years. Echocardiographic study was done to all patients before the transplant operation and 6-12 months after transplantation. In the studied sample, 80% of the patients were known to be hypertensive and 16.7% had diabetes mellitus. Patients with a reported history of post-transplant rejection episodes or heart failure were excluded from the study. All patients were on hemodialysis before transplantation and the mean pre-transplant dialysis duration was (15.83 Â± 13.23) months while the mean post renal transplant duration was (10.33 Â± 1.95) months. All patients received living kidney donation and were subjected to the same post-transplant immunosuppressive drug regimen.
Results: The mean left ventricle ejection fraction (EF) before and after renal transplantation was (59.70 Â± 7.86) and (68.82 Â± 7.93), respectively (P <0.001). The mean left ventricle end diastolic dimension (LVEDD) was (55.27 Â± 7.77) pre-transplant which was improved to (49.57 Â± 6.49) post-transplant with a P value (P <0.001), similarly the mean left ventricle end-systolic dimension (LVESD) was (37.11 Â± 7.40) pre-transplant which improved to (30.40 Â± 6.07) post-transplant with a P value (P <0.001)Â and the meanÂ left ventricular mass index (LVMI) showed a significant improvement fromÂ (144.1 Â± 44.15) pre-transplant into (115.1 Â± 38.79) post-transplant with a P value (P =0.002).
Conclusion: According to the results of this study the renal transplantation could improve left ventricle parameters in patients with end stage renal disease.
Dr.Faswal Pichan is a Clinical Dialysis Technologist. He purseued BBA in the MG university and DDT under DME. He also stuidied Bsc in Dialysis Technolagy at Singhania university.
A fourteen month old Labrador dog (BRUNO) was presented to the pet hospital with a recent history of viper envenomation. Dog was vocalising and restless. On the day of presentation, seem creation and blood nitrogen (BUN) values were 3.7mg/dL and 89.1 mg/dL respectively. The serurm creatinine and blood urea nitrogen values elevated within two days to 6.7mg/dL and 138.6mg/dL respectively. The doy become oliguria.The clinical signs and laboratory values were consistent with acute kidney injury. Intermittent haemodialysis (IHD) was carried out as dog was refractory to medical management. Post IHD creatinine and BUN values were 6.7 mg/dL and BUN Values 101 mg/dL, respectively. Serum creatinine and BUN value increased to 7 mg/dL and 130 mg/dL, the next day after IHD. Second session of IHDreduced serum creatinine and BUN values to 6 mg/dL and 97.8 mg/dL. Dog continued to be dull, anorexic with oliguria. Third session of IHD helped in reduction of serum creationine and Oliguria resolved. The dog resumed his appetite and was clinically stable. Dog was observed for next 24 hours and discharged. On review after three days, dog exhibited considerable improvement; creatinine and BUN value were 3.1 mg/dL and 54.4 mg/dL, respectively. Ten days later follow up revealed that creatinine and BUN value stabilised at 1 mg/dL and 24 mg/dL. Dog showed alow and steady recovery from acute kindney injury overa period of 20 days. BRUNO IN PET HOSPITIAL KOCHIN Viper envenomation induces kidney injury (Hrovat et at 2013) Intermittent haemodialysis is a renal replacement therapy which is used to alleviate lifethreatening azotaemia electrolyte and acid-base imbalances and control intravascular volume (Cowgill) and Elliott, 2000).
Dr.Marsida Duli is the Head of Nursery and Physiotherapy Department at European University of Tirana, Albania.
Chronic renal disease is a functional diagnosis defined as the irreversible, general, and progressive reduction of more than half of renal function, which is translated through the GFR value. In Chronic Renal Insufficiency, progressive loss of renal function is accompanied by a progressive reduction in kidney size over a period of several months or several years. IRK is a consequence of a large number of diseases such as glomerulonephritis, diabetes, hypertension, polycystic kidney disease, etc. In the initial stages of advanced chronic renal failure everything works normally, consequently patients seek medical attention only in cases where the disease progresses to the uremic stage. Normally adult patients become aware of renal failure when the GFR drops below 15 mL / min, known as the terminal stage of kidney disease. Ultrasound examination is able to identify Chronic Renal Insufficiency in the early stages, to identify different pathologies causing it, to differentiate between different types of histopathological lesions.
Purpose: The study aims to provide data on the change of morphological parameters of the kidney of a population with Chronic Renal Disease through ultrasound, as well as to identify valid correlations of impaired renal function.
Methodology: The study is retrospective, conducted at QSUT with the cards of patients hospitalized with Chronic Renal Disease during the years 2012-1015 at the Nephrology service. Data collection for 2184 cards was performed through an individual file for each card, with data on morphological changes in ultrasound, clinical and demographic.
Results: The average age of patients with SRK is 55.38 years, and mostly female. ICP represents the leading cause of SRKs with 39.2%, followed by Diabetic Nephropathy and GNK. There is a statistically significant relationship between kidney size and stages of Chronic Renal Disease, between the thickness of the renal parenchyma and the stage of the disease, Creatinemia and Azotemia levels. In renal polycystosis there is a positive relationship between the stage of SRK and the number of cysts; patient age and number of cysts.
Conclusions: Kidney size decreases with the progression of SRK stages, but are not indicative for assessing the type of underlying disease causing SRK. With increasing SRK stage, creatinine and azotem.
Prof. (Dr.) Rajesh Sherke is a Senior Consultant Nephrologist at Al Qassimi Hospital, Sharjah, United Arab Emirates. He has also worked as a consultant nephrologist in Ministry of Health and Prevention in UAE.
Hyperkalemia is a potentially serious medical condition in which elevated serum potassium levels can increase the risk of severe cardiac electrophysiology abnormalities (e.g., cardiac arrhythmias) and sudden death. Modulation of renin-angiotensin-aldosterone system (RAAS) in reducing disease progression and in improving the outcome in heart failure and chronic kidney disease is very well documented and is recommended in respective guidelines. Unfortunately, patients with heart failure and chronic kidney disease are at greater risk of hyperkalemia with RAAS inhibitors than those without these conditions. Prescribing of reninâ€“angiotensin inhibitors and mineralocorticoid antagonists is often limited by occurrence of hyperkalemia and further, underutilization of these potentially beneficial medications in consistent with established guidelines is common due to perceived risk of hyperkalemia. Although, there are effective management strategies in the treatment of acute hyperkalemia, the long-term management of hyperkalemia often requires withdrawing or reducing the doses of drugs proven to improve the outcome in heart failure and chronic kidney disease and/or implementing severe and sometimes intolerable dietary potassium restrictions. Withdrawal of RAAS inhibitors leads to increased morbidity and mortality consequent to rapid disease progression resulting in incremental healthcare cost. On the contrary, hyperkalemia itself is associated with significant adverse clinical outcome and incremental financial burden. The presence of hyperkalemia is a big risk factor for all-cause mortality regardless of the kidney function and results in increased emergency department visits and hospitalizations with economic consequences. There is unmet need of long-term treatment strategies of hyperkalemia. The new potassium binders (patiromer and zirconium cyclosilicate) have extended novel treatment options of chronic hyperkalemia allowing the use of RAAS inhibitors.