Ahmed Hassan Mitwalli *, Jamal S. Al-Wakeel *, Awatif Alam **, Nauman Tarif *, Hassan Abu-Aisha *, Mohamed Rashed ***, Nora Al Nahed **

*Department of Medicine, Division of Nephrology, and ** Department of Family and Community Medicine, King Khalid University Hospital, ***Genetic and Metabolic Laboratory, King Faissal Specialist Hospital and Research Center, KSA


ABSTRACT.L-Carnitine supplementation has shown beneficial effects in patients on hemodialysis. We studied 36 ESRD adult patients with a mean age of 47.5  15 years to evaluate the effect of L-Carnitine supplementation on hemoglobin, lipid levels and physical performance in patients on hemodialysis. The study group consisted of 18 randomly selected patients who received L-Carnitine 15 mg/kg and the control group consisted of 18 randomly selected patients who received equal volume of normal saline as a placebo three times a week for six months. Laboratory tests were performed at baseline, then monthly until the end of the study. A significant increase in the hemoglobin (Hb) and hematocrit (HCT) in the presence of unchanged doses of erythropoietin hormonal supplementation was observed (pre 79  7.5 gm/l, post 103  10.6 gm/l) P<0.001 (pre 24 2 %, post 33  4%) P<0.001 respectively) in the L-Carnitine treated group. Similarly total serum cholesterol (TCL) and serum triglyceride (TG) levels showed a statistically significant decrease in the study group, TCL (pre 4.6  1.2, post 3.7  1.1 mmol/L), P <0.03 and TG (pre 3.1  1.7, post 1.8  0.6 mmol/L) P < 0.004. The physical performance as assessed by mild and moderate exercise showed a trend towards improvement. There was a significant increase in free carnitine and total carnitine levels in the L-Carnitine treated group. In conclusion, these results demostrate positive effect of L-Carnitine supplementation in the hemodialysis patients marked by an increase in Hb, HCT, a decrease in TCL and TG and improved physical performance in comparison to the control group.

Key Words: ESRD, Dialysis, Anemia, L-Carnitine.

Mycophenolate Mofetil (MMF) Efficacy in Glomerulonephritis (GN),a Retrospective Analysis

Sameer O. Huraib, Junaid I. Qureshi, Khaja H.M. Quadri, Ahmed Al Flaiw, Ghormullah Al Ghamdi, Abdulqadir Jumani, Fayez Al Hejaili, Hammad Raza, Abdulaziz Al Johani,
Abdulmalik Al-Katheri, Abdullah A. Al-Khader

King Fahad National Guard Hospital, Riyadh, Saudi Arabia

ABSTRACT. Mycophenolate Mofetil MMF has been widely used in post-transplant immunosuppression. Its role is emerging in GN. MMF demonstrated promising results compared with cyclosphosphamide in stage IV lupus nephritis, in a recently published trial. It has been found to have a wide safety profile, with mostly gastroinetestinal side effects, which can be avoided through titration. Its action is through inhibition of the enzyme IMDPH (ionosine monophosphate dehydrogenase), leading to purine antagonism and inhibition of lymphocytes. We were aiming to demonstrate the efficacy of MMF in our GN population. In this study, we reviewed 17 patients who received MMF (dose – 1 gm po bid) for the past year. They were only included if it was given for the management of resistant primary glomerulonephritis. Complete remission has been defined as proteinuria of less than 0.5 g/day and partial remission as a reduction of proteinuria < 50% of starting MMF therapy; all 17 MMF therapy patients uniformly achieved good BP (< 140/80) control. MMF was used for a minimum of 1 year and a maximum of 2 years. The results indicate that 7 patients (41%) had a partial remission to MMF. This group was composed of 2 membranous GN, 2 lupus GN (stage IV and stage V) and two with FSGS (1 with single kidney not biopsied) and one with MPGN. Five of 17 (29%) achieved complete remission and this group consisted of 1 membranous GN, 2 lupus GN (type IV and membranous), one FSGS and one with MPGN. Four of 17 (23%) were non-responders to therapy. This group consisted of 1 IgA and 3 FSGS patients. In 1 patient, the full dose of MMF could not be used secondary to side effects. We conclude that the MMF appears to be an effective alternate treatment modality in resistant membranous GN, lupus nephritis (type IV and V) and possibly MPGN, and to a lesser extent in resistant FSGS. Further prospective data may demonstrate the efficacy of MMF in GN.

Key Words: Resistant glomerulonephritis, Mycophenolate mofetil.