Hong Kong Journal of Nephrology

Nephrologist-led Team Approach in Advance Care Planning for ESRD Patients

Ka-Foon Chau — 2010-04-01

Diabetic Kidney Disease: Act Now or Pay Later

2010-04-01

Immunization in Renal Transplant Recipients: Where Do We Stand?

Ankur Gupta, Sanjay Kumar Agarwal — 2010-04-01

Infections are a major cause of morbidity and mortality in renal transplant recipients. Adequate vaccination strategies can prevent a majority of them. This review highlights the various vaccines, their dosing, schedule, efficacy and safety in renal transplant patients.

Outcomes of Renal Transplantation in Elderly Patients: Experience From Two Centers

2010-04-01

Background: Elderly patients are the fastest growing age group in end-stage renal failure. Data from overseas show that transplantation is a safe and reliable mode of treatment for this group of patients. However, local data about the outcome in these patients are lacking. The aim of this study was to determine and compare the outcomes of renal transplantation among elderly recipients and younger recipients. Methods: Using the Organ Registry and Transplant System in Kwong Wah Hospital and Princess Margaret Hospital, adult patients who had undergone renal transplantation and who had been followed-up by the two medical units were recruited. They were divided into the control group (age < 60) and the elderly group (age ≥ 60) according to age at transplantation. The following data were collected for cross-sectional analysis: comorbid illnesses, transplantation details, immunosuppressive therapy, incidence and severity of acute rejections, incidence of infection and malignancy, graft and patient survival, and causes of graft loss and death. Results: A total of 324 episodes of transplantation were recorded (266 controls and 58 elderly). The incidence of acute rejection was higher in the control group (18% vs. 8.6%, p = 0.08). There was a trend towards higher incidence of infection and malignancy in the elderly group, though the difference did not reach statistical significance. The graft survival rate was similar in the two groups, while the 5-year patient survival rate was worse in the elderly group (92.1% vs. 79.3%, p = 0.0058). Conclusion: The transplantation outcomes in elderly recipients are satisfactory, and age per se should not be considered a contraindication to transplantation.

A Clinicopathologic Study of Glomerular Disease: Experience of the King Fahd Hospital of the University, Eastern Province, Saudi Arabia

2010-04-01

Published studies from different centers in Saudi Arabia have reported contradicting results regarding glomerular lesions. In this retrospective study, we report our experience in King Fahd Hospital of the University at Al-Khobar in the Eastern province, including a description of the morphologic and clinical characteristics of primary and secondary glomerular disease. The study included 233 renal biopsies obtained from patients presenting with glomerular manifestations over a period of 23 years (1986–2008), investigated by light microscopy, immunofluorescence (149 cases) and electron microscopy (34 cases). One hundred and eighty-seven cases (80.3%) were primary glomerulonephritides. Minimal change glomerulopathy was the most common type of primary glomerulonephritis found (29.4% of primary glomerulonephritides), followed by mesangioproliferative glomerulonephritis (19.8%), and focal/segmental glomerulosclerosis (15.5%). Membranoproliferative glomerulonephritis was found in 9.6% of cases, membranous glomerulopathy in 8.6%, IgA nephropathy in 6.4%, end-stage glomerulopathy in 5.9%, crescentic glomerulonephritis in 3.2%, and IgM nephropathy in 1.6%. Of the secondary glomerulonephritides (46 cases constituting 19.7% of the biopsies), lupus nephritis was the most frequently diagnosed disease (71.7% of secondary glomerulonephritides). Diabetic glomerulosclerosis was found in 10.9% of cases, amyloidosis in 6.5%, and Alport syndrome in 4.3%. Wegener's granulomatosis, Henoch-Schönlein purpura nephritis and hypertensive nephrosclerosis each represented 2.2% of cases (one case each). Other than a significantly higher incidence of minimal change glomerulopathy and lupus nephritis (p < 0.001) and a significantly lower prevalence of membranoproliferative glomerulonephritis (p = 0.029), our results are generally comparable to those reported by the Saudi registry for glomerulopathy and in some neighboring countries. Ageand sex-adjusted analyses revealed that minimal change glomerulopathy and lupus nephritis were also the most prevalent primary and secondary glomerulopathies in the pediatric age group (below 15 years) as well as in adults, females and males.

Supportive Management in Patients With End-stage Renal Disease: Local Experience in Hong Kong

2010-04-01

We report a retrospective observational study on supportive care services in a local renal center. Seventy-four patients who had opted for supportive management after renal replacement therapy assessments in 2008 were included in the study. They were older with more comorbidities than those who had opted for dialysis. Their reported symptoms on subsequent visits were recorded. Patients and their families had a realistic acceptance of death, as reflected by the high preference for do-not-resuscitate orders on their final admission. This demonstrates the importance of structured multidisciplinary renal replacement therapy assessment with advanced care planning in the management of patients with end-stage renal disease.

Prolapsing Ureterocele Causing Bilateral Hydronephrosis and Hydroureters

Keith K. Lau, Luis H. Braga — 2010-04-01

SIADH After Influenza Vaccination

Sze Kit Yuen, Mo Lin Wong, Yiu Kay Chan, Chi Kai Chow, Man Wah Tse — 2010-04-01

Hemodialysis as Underlying Condition in Swine Flu Death Cases

Viroj Wiwanitkit — 2010-04-01