Background: Hemodialysis patients are at higher risk of contracting infections particularly methicillin-resistant Staphylococcus aureus (MRSA). MRSA is a serious infection and could be fatal within hours to days if undiagnosed. Dialysis catheter commonly known as permacath is a tunnel catheter used for maintenance hemodialysis which is associated with serious complications, especially infections and thrombosis. Different methodologies were designed and tested to determine the relation of infection with permcath. The use of a cuff was thought to prevent catheter related infections but none proved beneficial.1 This finding was supported further in a systematic review conducted in 2009.2 Usage of permacath is on the rise despite awareness of its higher risk of morbidities and mortalities which is contrary to the slogan of Fistula First Initiative.3 We aimed to evaluate the prevalence of MRSA infections in hemodialysis patients with tunneled hemodialysis catheters. Methods: This is a retrospective, qualitative cross-sectional and non-experimental single center study conducted at Sultan Qaboos University Hospital (SQUH) Hemodialysis Unit over eight years. Inclusion criteria include: Adult patients >18 years of age with diagnosis of end stage renal disease requiring hemodialysis. Exclusion criteria included age < 18 years old and patients on peritoneal dialysis. Records of hemodialysis patients from 1st January 2010 through 6th May 2018 were retrieved through TrackCare (electronic medical records). The patients were divided into two groups. Positive MRSA infection (defined as a positive Gram stain with cocci in clusters and which was further confirmed by positive DNA polymerase chain reaction (PCR) for MRSA) either from the periphery or central line or pus swab from the catheter tunnel site at the time of admission or during hospitalization.4 The remaining screened patients were classified as negative MRSA. Informed consent was waived as it is a retrospective study and our work was based on collecting information from TrackCare. All patients’ data were de-identified prior to analysis. Results: From 2010 to 2018, 1356 hemodialysis patients were identified within the hospital information system (HIS). Based on our inclusion criteria, a total of 1064 screened patients were included in our study. Those remaining who were not screened were been excluded. Fifteen patients were detected positive with MRSA infection (Figure 1), 12 patients had permacath and three had arteriovenous fistula (AVF). Overall, the prevalence of MRSA infection was 1.1% (12/1064) in hemodialysis patients with tunneled catheters. Conclusions: In our study, the MRSA prevalence rate was lower than the international reported statistics (4.2–6.5 per 100 patients).5 This supports the use of adequate infection control policies and practices adopted in the unit. We propose that fistula should be the preferred access option for the maintenance hemodialysis. However, in cases where catheter is the only option, due to whatever reason, then using chlorhexidine im...
Introduction. The presentation of a renal mass presumes a malignancy unless proven otherwise by histologic evaluation. Presentation of the case. We present a case of a 40-yearold man with advance uremia necessitating renal replacement. Results. Radiologic images showed a right renal mass and the patient underwent a nephrectomy. The pathologic diagnosis was a benign renal neoplasm, oncocytoma. This neoplasm is not a cause of renal failure but may be associated with other malignant lesions. Focal segmental glomerulosclerosis was the reason for renal failure. The lesion was discovered incidentally during the workup of chronic kidney disease. Discussion. Histopathology delineated two separate pathologies designing the management plan. Conclusions. After a few months of haemodialysis, the patient was able to receive a renal transplant-a therapy of choice as oncocytoma is a benign condition which doesn't preclude transplantation.
Background: The most common immunosuppressant, Anti-thymocyte Globulin (ATGs) has been widely used by clinicians for the treatment and prevention of rejection at the time of organ transplant. Transplantation is the best option for the people with renal failure at end stage, requiring replacement of renal therapy. This is a promising treatment option with significant benefits in terms of mortality and morbidity. ATG prevents organ rejection by inhibition of activated T-cells and other immune and nonimmune cells. The aim of the study was to compare different induction regimens with ATG for the survival of smooth kidney transplantation. Methodology: Studies of the last 20 years, focusing on kidney transplantation and the efficacy of antithymocyte use for kidney transplantation were reviewed for the study literature. The keywords used were Kidney Transplantation, Induction agents, ATG, Allograft, Immunosuppressant Agents. Results: Literature suggested that the most important problem with transplantation is the protection of the allograft from activated immunological forces, which begin to react early in the period after transplantation and cause significant damage with serious short-term and long-term consequences. This process is called rejection, which is usually classified as cell-mediated and antibody-mediated rejection. The phenomenon mediated by cells causes concern, as it is the cause of future failures and damage to the allograft. To combat these phenomena with different results, various strategies were adopted. Among these therapies, ATG has recognized the exceptional importance of preventing cellular mediated rejection, allowing allotransplants to function smoothly with the greatest possible long-term benefits. Conclusion: It can be concluded on the basis of previous studies that ATG as an induction agent, is more efficient in reducing the rejection rate in the renal transplantation as compared with other agents.
Surgical treatments for Insulin Dependent Diabetes Mellitus (IDDM) complicated with Advanced Chronic Kidney Disease (CKD) have emerged with the hope of providing a better sustainable quality of life. This article aims to highlight the utility of kidney and pancreas transplant in the management of IDDM with renal failure. There are different surgical methodologies, of which Simultaneous Pancreas And Kidney Transplantation (SPK) has been the most promising; in terms of graft survival and decreasing the need for a second surgical intervention in terms of kidney transplant. However, long waiting lists to find matching donors and post-operative complications are the most challenging obstacles. All recipients shall be screened for anti-HLA antibodies, non-HLA antibodies and Coronary Heart Disease (CHD). The presence of CHD poses a mortality risk post-surgery. Recipient selection requires a meticulous insight based on the insulin requirements, with the fact that not all will achieve insulin independence. A donor’s risk factors must be estimated by the Pancreas Donor Risk Index (PDRI), the higher the score lower the chances of graft survival. Pancreatic graft failure has no unanimously agreed definition of rejection and is dependent on a variety of donor and recipient factors. Close follow up and a high index of suspicion for any unexplained signs or symptoms is required to detect early allograft rejection, and the consideration of other surgical and medical etiologies is also required. This mini review will discuss various options for the management of insulin dependent diabetics whose diabetes remain uncontrolled with maximal efforts and have developed advanced chronic kidney disease pending renal replacement.
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