BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifyi...BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifying the prevalence of these abnormalities and understanding their predictors is vital for optimizing pretransplant risk stratification and improving post-transplant outcomes.AIM To determine the prevalence of left ventricular hypertrophy(LVH),left ventricular systolic dysfunction(LVSD),diastolic dysfunction(DD),pulmonary hypertension(PH),and their predictors,and to assess their impact on graft function in pre-transplant candidates.METHODS The study included all successful transplant candidates older than 14 who had a baseline echocardiogram.Binary logistic regression models were constructed to identify factors associated with LVH,LVSD,DD,and PH.RESULTS Out of 259 patients,LVH was present in 64%(166),12%(31)had LVSD,27.5%(71)had DD,and 66(25.5%)had PH.Independent predictors of LVH included male gender[odds ratio(OR):2.51;95%CI:1.17-5.41 P=0.02],PH(OR=2.07;95%CI:1.11-3.86;P=0.02),DD(OR:2.47;95%CI:1.29-4.73;P=0.006),and dyslipidemia(OR=1.94;95%CI:1.07-3.53;P=0.03).Predictors for LVSD included patients with DD(OR=3.3,95%CI:1.41-7.81;P=0.006)and a family history of coronary artery disease(OR=4.50,95%CI:1.33-15.20;P=0.015).Peritoneal dialysis was an independent predictor for DD(OR=10.03;95%CI:1.71-58.94,P=0.011).The presence of LVH(OR=3.32,95%CI:1.05-10.55,P=0.04)and mild to moderate or moderate to severe mitral regurgitation(OR=4.63,95%CI:1.45-14.78,P=0.01)were significant factors associated with PH.These abnormalities had no significant impact on estimated glomerular filtration at discharge,6 months,1 year,or 2 years post-transplant.CONCLUSION Significant echocardiographic abnormalities persist in a potential transplant candidate despite cardiac clearance,although they don’t affect future graft function.Understanding the risk factors associated with these abnormalities may help clinicians address these factors pre-and post-transplant to achieve better outcomes.展开更多
Health literacy (HL) is essential to access, comprehend, assess and use health data allowing patients to make better health and quality of life decisions. To assess the health literacy level of hemodialysis Egyptian p...Health literacy (HL) is essential to access, comprehend, assess and use health data allowing patients to make better health and quality of life decisions. To assess the health literacy level of hemodialysis Egyptian patients, a cross-sectional study from March to September 2020 was conducted at 4 hemodialysis (HD) units on 439 patients. A translated questionnaire including demographic characteristics and health literacy components was conducted. This study adapted Nutbeam’s model incorporating critical health literacy, interactive health literacy, and functional health literacy. Health literacy of hemodialysis patients was satisfactory among 35.5% of the studied patients. The average total score of health literacy questionnaire was (15.53 ± 4.32) distributed as (2.90 ± 1.26) for functional literacy, (3.10 ± 1.26) for basic health knowledge, (1.65 ± 1.21) for communicative literacy, (2.53 ± 0.70) for interactive literacy, (1.75 ± 1.30) for advanced health knowledge, (1.74 ± 0.48) for critical literacy, and (1.83 ± 0.93) for patient safety. It was found that poor health literacy was associated with low income (OR = 2.54, CI 95%: 1.66_3.89, <i>p</i> < 0.001), of increasing age (OR = 0.12 CI 95%: 0.07_0.19, <i>p</i> < 0.001), low education (OR = 1.08, CI 95%: 1.04_1.11, <i>p</i> < 0.001) and the patient did not undergo kidney transplant (OR = 4.19 CI 95%: 1.12_15.62, <i>p</i> = 0.033). There was a prevalent low health literacy among the studied regular hemodialysis patients which was affected by education, age and income and in turn it affected the adherence to treatment. Understanding the linkage between HL and self-care attitudes should enhance efforts to improve hemodialysis outcomes.展开更多
HLA-C,HLA-DP and HLA-DQ are thought to be benign due to low expression and few initial negative studies.Historically,most allocation programs used HLA-A,HLA-B and HLA-DR antigens for matching.With the advent and use o...HLA-C,HLA-DP and HLA-DQ are thought to be benign due to low expression and few initial negative studies.Historically,most allocation programs used HLA-A,HLA-B and HLA-DR antigens for matching.With the advent and use of single-bead antigen assays,more was learned about donor-specific antibodies(DSAs)against these antigens.Interest in these antigens and antibodies grew when cases of acute antibody-mediated rejection(AMR),mixed rejections,chronic AMR,and reduced graft survival were reported with DSAs against these antigens.Although the deleterious effects of these DSAs are more pronounced in retransplants,harmful effects have also been observed in first-time recipients.DSAs against each of these antigens can trigger rejection alone.Their combination with DSAs against HLA-A,HLA-B and HLA-DR can cause more damage.It has been shown that strategies that reduce mismatches for these antigen lead to fewer rejections and better graft survival.There is a need for greater consensus on the universal typing of these antigens prior to transplantation for better patient and graft outcomes.This review focuses on the interaction of these antigens with lymphocytes and killer immunoglobulin receptors,arguments for not typing them,detailed analyses of the literature about their harmful effects,potential strategies moving forward,and recommendations for the future.展开更多
BACKGROUND Diabetic patients with atypical presentation are often challenging in terms of diagnosis and management.Kidney biopsy is not routinely done in diabetics,and clinicians are always in a dilemma in such a scen...BACKGROUND Diabetic patients with atypical presentation are often challenging in terms of diagnosis and management.Kidney biopsy is not routinely done in diabetics,and clinicians are always in a dilemma in such a scenario to decide whether to do a biopsy or not.Since non-diabetic kidney diseases(NDKD)are common,and some patients may have NDKD superimposed on diabetic kidney diseases(DKD),therefore,kidney biopsy may be warranted to rule out NDKD.AIM To determine the prevalence of NDKD,DKD,or mixed lesions,identify predictors of NDKD,and investigate renal and patient survival,as well as factors associated with these outcomes.METHODS This retrospective observational study was conducted on patients with biopsyproven NDKD,DKD,and mixed lesions(having both NDKD and DKD).Binary logistic regression models were constructed to identify predictors of NDKD.Kaplan-Meier survival analysis was performed to compare time to kidney failure and patient survival across the three histological groups.Multivariable Cox proportional hazards regression was used to identify clinical and pathological factors associated with kidney failure and all-cause mortality.RESULTS A total of 103 biopsies were analyzed.Sixty-four(62.1%)had NDKD alone or mixed lesions.The most common NDKD pathologies were interstitial nephritis in 12(29.2%),focal segmental glomerulosclerosis in 10(24.4%),and immune complex–mediated glomerulonephritis in five(12.2%)patients.Compared to DKD,NDKD was associated with significantly lower odds of proteinuria>3.5 g/day[odds ratio(OR),0.02;P=0.0015],retinopathy(OR=0.04;P=0.0067),and diabetes duration≥10 years(OR=0.01;P=0.0002).However,NDKD had higher odds of anemia(Hemoglobin<12 g/dL;OR=9.56;P=0.0107)and creatinine levels>180μmol/L(OR=18.68;P=0.0063).Kaplan-Meier analysis showed significant differences in renal survival(log-rank P=0.0033).Patients with NDKD have the best outcomes,while those with DKD have the worst.In a multivariable Cox regression analysis,increasing age,creatinine,arteriosclerosis,and severe interstitial fibrosis and tubular atrophy were independently associated with kidney failure.At the same time,the use of renin angiotensin system blockers was protective(hazard ratio=0.43,P=0.02).Kaplan-Meier curves for patient survival also differed significantly(log-rank P=0.018);patients in the mixed group showed the highest mortality,while those with NDKD showed the lowest.Mortality was independently associated with older age,hypoalbuminemia,diabetic retinopathy,arteriosclerosis,and higher creatinine.CONCLUSION NDKD and mixed lesions are frequent in diabetic patients.These histological lesions carry distinct prognostic implications.Clinical features such as a shorter diabetes duration,absence of retinopathy,anemia,and elevated creatinine levels suggest NDKD and warrant biopsy.NDKD had better renal and patient survival rates,while mixed lesions had the worst outcomes.Older age,hypoalbuminemia,retinopathy,arteriosclerosis,and elevated creatinine were key predictors of mortality.展开更多
BACKGROUND Brugada syndrome(BS)is a rare disorder affecting approximately 5 in every 10000 people.Reports of kidney donation in individuals with BS are exceptionally uncommon.CASE SUMMARY The decision to permit live k...BACKGROUND Brugada syndrome(BS)is a rare disorder affecting approximately 5 in every 10000 people.Reports of kidney donation in individuals with BS are exceptionally uncommon.CASE SUMMARY The decision to permit live kidney donation places significant responsibility on clinicians.Donors must adapt to life with a single kidney.While the risk of developing chronic kidney disease post-donation is minimal,it remains higher than in matched healthy individuals.Additionally,the theoretical risk of electrolyte imbalances in kidney donors with BS may have important clinical implications.We present a case of successful kidney donation by a donor with an incidental diagnosis of a sporadic case of BS type 1.An extensive electrophysiological evaluation was conducted to assess the risk of arrhythmia to approval for donation.Anesthetic management was meticulously planned,and the donor was monitored postoperatively in a coronary care unit for 48 hours.This case underscores the ethical considerations and the multidisciplinary approach necessary to ensure donor safety.CONCLUSION Kidney donation in individuals with BS requires careful evaluation to mitigate the risk of fatal arrhythmias during surgical and anesthetic stress.With comprehensive preoperative assessment and vigilant perioperative management,kidney donation can be performed safely.展开更多
Renal allograft rejection and its detection are challenging problems for transplant clinicians.Transplant physicians rely on serum creatinine,estimated glomerular filtration rate,proteinuria,donor-specific antibodies,...Renal allograft rejection and its detection are challenging problems for transplant clinicians.Transplant physicians rely on serum creatinine,estimated glomerular filtration rate,proteinuria,donor-specific antibodies,and graft biopsy to detect rejection.The sensitivity and specificity in these blood and urine tests are low,and the invasiveness of graft biopsy has led transplant clinicians to seek alternative diagnostic tools.Cell-free DNA(cfDNA)is a fragment of DNA released from cell death due to necrosis and apoptosis.Donor-derived cfDNA(dd-cfDNA)has been proposed as a potential non-invasive biomarker for detecting rejection.However,one must interpret it cautiously in conditions such as ischemia-reperfusion injury,delayed graft function,BK virus nephropathy,post-kidney biopsy,and dual kidney transplantation,which may cause dd-cfDNA elevation.There is a lack of standardized cutoff values for diagnosing various types of rejections.Low specificity,higher cost,and lack of universal availability are the multiple obstacles to using this tool.There is a need to establish clinical guidelines for its future utility in early rejection detection,graft surveillance,and tailoring of immunosuppression.展开更多
There is shortage of organs,including kidneys,worldwide.Along with deceased kidney transplantation,there is a significant rise in live kidney donation.The prevalence of prediabetes(PD),including impaired fasting gluco...There is shortage of organs,including kidneys,worldwide.Along with deceased kidney transplantation,there is a significant rise in live kidney donation.The prevalence of prediabetes(PD),including impaired fasting glucose and impaired glucose tolerance,is on the rise across the globe.Transplant teams frequently come across prediabetic kidney donors for evaluation.Prediabetics are at risk of diabetes,chronic kidney disease,cardiovascular events,stroke,neuropathy,retinopathy,dementia,depression and nonalcoholic liver disease along with increased risk of all-cause mortality.Unfortunately,most of the studies done in prediabetic kidney donors are retrospective in nature and have a short follow up period.There is lack of prospective long-term studies to know about the real risk of complications after donation.Furthermore,there are variations in recommendations from various guidelines across the globe for donations in prediabetics,leading to more confusion among clinicians.This increases the responsibility of transplant teams to take appropriate decisions in the best interest of both donors and recipients.This review focuses on pathophysiological changes of PD in kidneys,potential complications of PD,other risk factors for development of type 2 diabetes,a review of guidelines for kidney donation,the potential role of diabetes risk score and calculator in kidney donors and the way forward for the evaluation and selection of prediabetic kidney donors.展开更多
AIM： To determine epidemiology of Bruneian paediatric chronic kidney disease （CKD） patients and factors that affect growth and progression of disease.METHODS： A cross-sectional study conducted on all children belo...AIM： To determine epidemiology of Bruneian paediatric chronic kidney disease （CKD） patients and factors that affect growth and progression of disease.METHODS： A cross-sectional study conducted on all children below 18 years old who were diagnosed with CKD over a ten year period （2004 to 2013）. The reference population was all children （〈 18 years old） suffering from CKD and attending the tertiary paediatric nephrology clinic in Brunei Darussalam. Demographic （current age, age of diagnosis, gender, ethnicity）, anthropometric （weight and height）, diagnosis, laboratory data （serum creatinine and haemoglobin, urinalysis） and blood pressure were extracted from the patients’ clinical case notes and recorded using a data collection form.RESULTS： The study revealed a high national prevalence [736 per million child population （pmcp）] and incidence （91 pcmp） of CKD. If CKD was defned at Stage 1, 2, 3, 4 or 5, the associated prevalence fgures were 736, 132, 83, 50 and 33 pmcp. Glomerulonephritis accounted for 69% of all prevalent cases, followed by congenital abnormalities of kidney and urinary tract （20%） and tubulointerstitial diseases （8%）. Minimal change disease being the most common histological diagnosis. The median age of diagnosis was 4.5 years, with congenital disease patients experiencing an earlier onset of diagnosis. A large proportion of patients were below the 5% percentile for height and weight. Non-glomerular diseases, adolescent and female patients were significantly associated with poor growth, but not glomerular filtration rate, age of diagnosis or steroid usage. CONCLUSION： Brunei has a high prevalence of chronic kidney disease in the paediatric population with glome-rulonephritis being the most common disease.展开更多
文摘BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifying the prevalence of these abnormalities and understanding their predictors is vital for optimizing pretransplant risk stratification and improving post-transplant outcomes.AIM To determine the prevalence of left ventricular hypertrophy(LVH),left ventricular systolic dysfunction(LVSD),diastolic dysfunction(DD),pulmonary hypertension(PH),and their predictors,and to assess their impact on graft function in pre-transplant candidates.METHODS The study included all successful transplant candidates older than 14 who had a baseline echocardiogram.Binary logistic regression models were constructed to identify factors associated with LVH,LVSD,DD,and PH.RESULTS Out of 259 patients,LVH was present in 64%(166),12%(31)had LVSD,27.5%(71)had DD,and 66(25.5%)had PH.Independent predictors of LVH included male gender[odds ratio(OR):2.51;95%CI:1.17-5.41 P=0.02],PH(OR=2.07;95%CI:1.11-3.86;P=0.02),DD(OR:2.47;95%CI:1.29-4.73;P=0.006),and dyslipidemia(OR=1.94;95%CI:1.07-3.53;P=0.03).Predictors for LVSD included patients with DD(OR=3.3,95%CI:1.41-7.81;P=0.006)and a family history of coronary artery disease(OR=4.50,95%CI:1.33-15.20;P=0.015).Peritoneal dialysis was an independent predictor for DD(OR=10.03;95%CI:1.71-58.94,P=0.011).The presence of LVH(OR=3.32,95%CI:1.05-10.55,P=0.04)and mild to moderate or moderate to severe mitral regurgitation(OR=4.63,95%CI:1.45-14.78,P=0.01)were significant factors associated with PH.These abnormalities had no significant impact on estimated glomerular filtration at discharge,6 months,1 year,or 2 years post-transplant.CONCLUSION Significant echocardiographic abnormalities persist in a potential transplant candidate despite cardiac clearance,although they don’t affect future graft function.Understanding the risk factors associated with these abnormalities may help clinicians address these factors pre-and post-transplant to achieve better outcomes.
文摘Health literacy (HL) is essential to access, comprehend, assess and use health data allowing patients to make better health and quality of life decisions. To assess the health literacy level of hemodialysis Egyptian patients, a cross-sectional study from March to September 2020 was conducted at 4 hemodialysis (HD) units on 439 patients. A translated questionnaire including demographic characteristics and health literacy components was conducted. This study adapted Nutbeam’s model incorporating critical health literacy, interactive health literacy, and functional health literacy. Health literacy of hemodialysis patients was satisfactory among 35.5% of the studied patients. The average total score of health literacy questionnaire was (15.53 ± 4.32) distributed as (2.90 ± 1.26) for functional literacy, (3.10 ± 1.26) for basic health knowledge, (1.65 ± 1.21) for communicative literacy, (2.53 ± 0.70) for interactive literacy, (1.75 ± 1.30) for advanced health knowledge, (1.74 ± 0.48) for critical literacy, and (1.83 ± 0.93) for patient safety. It was found that poor health literacy was associated with low income (OR = 2.54, CI 95%: 1.66_3.89, <i>p</i> < 0.001), of increasing age (OR = 0.12 CI 95%: 0.07_0.19, <i>p</i> < 0.001), low education (OR = 1.08, CI 95%: 1.04_1.11, <i>p</i> < 0.001) and the patient did not undergo kidney transplant (OR = 4.19 CI 95%: 1.12_15.62, <i>p</i> = 0.033). There was a prevalent low health literacy among the studied regular hemodialysis patients which was affected by education, age and income and in turn it affected the adherence to treatment. Understanding the linkage between HL and self-care attitudes should enhance efforts to improve hemodialysis outcomes.
文摘HLA-C,HLA-DP and HLA-DQ are thought to be benign due to low expression and few initial negative studies.Historically,most allocation programs used HLA-A,HLA-B and HLA-DR antigens for matching.With the advent and use of single-bead antigen assays,more was learned about donor-specific antibodies(DSAs)against these antigens.Interest in these antigens and antibodies grew when cases of acute antibody-mediated rejection(AMR),mixed rejections,chronic AMR,and reduced graft survival were reported with DSAs against these antigens.Although the deleterious effects of these DSAs are more pronounced in retransplants,harmful effects have also been observed in first-time recipients.DSAs against each of these antigens can trigger rejection alone.Their combination with DSAs against HLA-A,HLA-B and HLA-DR can cause more damage.It has been shown that strategies that reduce mismatches for these antigen lead to fewer rejections and better graft survival.There is a need for greater consensus on the universal typing of these antigens prior to transplantation for better patient and graft outcomes.This review focuses on the interaction of these antigens with lymphocytes and killer immunoglobulin receptors,arguments for not typing them,detailed analyses of the literature about their harmful effects,potential strategies moving forward,and recommendations for the future.
文摘BACKGROUND Diabetic patients with atypical presentation are often challenging in terms of diagnosis and management.Kidney biopsy is not routinely done in diabetics,and clinicians are always in a dilemma in such a scenario to decide whether to do a biopsy or not.Since non-diabetic kidney diseases(NDKD)are common,and some patients may have NDKD superimposed on diabetic kidney diseases(DKD),therefore,kidney biopsy may be warranted to rule out NDKD.AIM To determine the prevalence of NDKD,DKD,or mixed lesions,identify predictors of NDKD,and investigate renal and patient survival,as well as factors associated with these outcomes.METHODS This retrospective observational study was conducted on patients with biopsyproven NDKD,DKD,and mixed lesions(having both NDKD and DKD).Binary logistic regression models were constructed to identify predictors of NDKD.Kaplan-Meier survival analysis was performed to compare time to kidney failure and patient survival across the three histological groups.Multivariable Cox proportional hazards regression was used to identify clinical and pathological factors associated with kidney failure and all-cause mortality.RESULTS A total of 103 biopsies were analyzed.Sixty-four(62.1%)had NDKD alone or mixed lesions.The most common NDKD pathologies were interstitial nephritis in 12(29.2%),focal segmental glomerulosclerosis in 10(24.4%),and immune complex–mediated glomerulonephritis in five(12.2%)patients.Compared to DKD,NDKD was associated with significantly lower odds of proteinuria>3.5 g/day[odds ratio(OR),0.02;P=0.0015],retinopathy(OR=0.04;P=0.0067),and diabetes duration≥10 years(OR=0.01;P=0.0002).However,NDKD had higher odds of anemia(Hemoglobin<12 g/dL;OR=9.56;P=0.0107)and creatinine levels>180μmol/L(OR=18.68;P=0.0063).Kaplan-Meier analysis showed significant differences in renal survival(log-rank P=0.0033).Patients with NDKD have the best outcomes,while those with DKD have the worst.In a multivariable Cox regression analysis,increasing age,creatinine,arteriosclerosis,and severe interstitial fibrosis and tubular atrophy were independently associated with kidney failure.At the same time,the use of renin angiotensin system blockers was protective(hazard ratio=0.43,P=0.02).Kaplan-Meier curves for patient survival also differed significantly(log-rank P=0.018);patients in the mixed group showed the highest mortality,while those with NDKD showed the lowest.Mortality was independently associated with older age,hypoalbuminemia,diabetic retinopathy,arteriosclerosis,and higher creatinine.CONCLUSION NDKD and mixed lesions are frequent in diabetic patients.These histological lesions carry distinct prognostic implications.Clinical features such as a shorter diabetes duration,absence of retinopathy,anemia,and elevated creatinine levels suggest NDKD and warrant biopsy.NDKD had better renal and patient survival rates,while mixed lesions had the worst outcomes.Older age,hypoalbuminemia,retinopathy,arteriosclerosis,and elevated creatinine were key predictors of mortality.
文摘BACKGROUND Brugada syndrome(BS)is a rare disorder affecting approximately 5 in every 10000 people.Reports of kidney donation in individuals with BS are exceptionally uncommon.CASE SUMMARY The decision to permit live kidney donation places significant responsibility on clinicians.Donors must adapt to life with a single kidney.While the risk of developing chronic kidney disease post-donation is minimal,it remains higher than in matched healthy individuals.Additionally,the theoretical risk of electrolyte imbalances in kidney donors with BS may have important clinical implications.We present a case of successful kidney donation by a donor with an incidental diagnosis of a sporadic case of BS type 1.An extensive electrophysiological evaluation was conducted to assess the risk of arrhythmia to approval for donation.Anesthetic management was meticulously planned,and the donor was monitored postoperatively in a coronary care unit for 48 hours.This case underscores the ethical considerations and the multidisciplinary approach necessary to ensure donor safety.CONCLUSION Kidney donation in individuals with BS requires careful evaluation to mitigate the risk of fatal arrhythmias during surgical and anesthetic stress.With comprehensive preoperative assessment and vigilant perioperative management,kidney donation can be performed safely.
文摘Renal allograft rejection and its detection are challenging problems for transplant clinicians.Transplant physicians rely on serum creatinine,estimated glomerular filtration rate,proteinuria,donor-specific antibodies,and graft biopsy to detect rejection.The sensitivity and specificity in these blood and urine tests are low,and the invasiveness of graft biopsy has led transplant clinicians to seek alternative diagnostic tools.Cell-free DNA(cfDNA)is a fragment of DNA released from cell death due to necrosis and apoptosis.Donor-derived cfDNA(dd-cfDNA)has been proposed as a potential non-invasive biomarker for detecting rejection.However,one must interpret it cautiously in conditions such as ischemia-reperfusion injury,delayed graft function,BK virus nephropathy,post-kidney biopsy,and dual kidney transplantation,which may cause dd-cfDNA elevation.There is a lack of standardized cutoff values for diagnosing various types of rejections.Low specificity,higher cost,and lack of universal availability are the multiple obstacles to using this tool.There is a need to establish clinical guidelines for its future utility in early rejection detection,graft surveillance,and tailoring of immunosuppression.
文摘There is shortage of organs,including kidneys,worldwide.Along with deceased kidney transplantation,there is a significant rise in live kidney donation.The prevalence of prediabetes(PD),including impaired fasting glucose and impaired glucose tolerance,is on the rise across the globe.Transplant teams frequently come across prediabetic kidney donors for evaluation.Prediabetics are at risk of diabetes,chronic kidney disease,cardiovascular events,stroke,neuropathy,retinopathy,dementia,depression and nonalcoholic liver disease along with increased risk of all-cause mortality.Unfortunately,most of the studies done in prediabetic kidney donors are retrospective in nature and have a short follow up period.There is lack of prospective long-term studies to know about the real risk of complications after donation.Furthermore,there are variations in recommendations from various guidelines across the globe for donations in prediabetics,leading to more confusion among clinicians.This increases the responsibility of transplant teams to take appropriate decisions in the best interest of both donors and recipients.This review focuses on pathophysiological changes of PD in kidneys,potential complications of PD,other risk factors for development of type 2 diabetes,a review of guidelines for kidney donation,the potential role of diabetes risk score and calculator in kidney donors and the way forward for the evaluation and selection of prediabetic kidney donors.
文摘AIM： To determine epidemiology of Bruneian paediatric chronic kidney disease （CKD） patients and factors that affect growth and progression of disease.METHODS： A cross-sectional study conducted on all children below 18 years old who were diagnosed with CKD over a ten year period （2004 to 2013）. The reference population was all children （〈 18 years old） suffering from CKD and attending the tertiary paediatric nephrology clinic in Brunei Darussalam. Demographic （current age, age of diagnosis, gender, ethnicity）, anthropometric （weight and height）, diagnosis, laboratory data （serum creatinine and haemoglobin, urinalysis） and blood pressure were extracted from the patients’ clinical case notes and recorded using a data collection form.RESULTS： The study revealed a high national prevalence [736 per million child population （pmcp）] and incidence （91 pcmp） of CKD. If CKD was defned at Stage 1, 2, 3, 4 or 5, the associated prevalence fgures were 736, 132, 83, 50 and 33 pmcp. Glomerulonephritis accounted for 69% of all prevalent cases, followed by congenital abnormalities of kidney and urinary tract （20%） and tubulointerstitial diseases （8%）. Minimal change disease being the most common histological diagnosis. The median age of diagnosis was 4.5 years, with congenital disease patients experiencing an earlier onset of diagnosis. A large proportion of patients were below the 5% percentile for height and weight. Non-glomerular diseases, adolescent and female patients were significantly associated with poor growth, but not glomerular filtration rate, age of diagnosis or steroid usage. CONCLUSION： Brunei has a high prevalence of chronic kidney disease in the paediatric population with glome-rulonephritis being the most common disease.
