Vascular Access Related Infections in Hemodialysis Patients

Anil K. Saxena, B.R. Panhotra, Abdulrahman S. Al-Mulhim

Division of Nephrology, Postgraduate Department of Medicine,
King Fahd Hospital & Territory Care Center, Hofuf, Al-Hasa, Saudi Arabia

ABSTRACT:  Hemodialysis (HD) patients are at considerably high risk for vascular access-related blood stream infections (VRBSI) that result in serious complications. Such severe infections are a great deal more frequent with central venous catheters (CVCs) and polytetrafluoroethylene (PTFE) grafts than with arteriovenous fistula (AVF). Nonetheless, the CVCs, though having “undesirable” side effects, remain “unavoidable” for the patients requiring instant dialysis access, as a consequence of the unpredictable course of chronic renal disease. Although early antibiotic treatment should include the coverage for Staphylococcus aureus, the treatment of catheter-related blood stream infections (CRBSI) remains controversial. Antimicrobial- anticoagulant ‘locks’ have shown promising results in several recent randomized controlled trials in the treatment and prevention of CRBSI. Policy of increasing AVF prevalence beyond 50% is bound to have an enduring positive effect on HD outcomes. Standard infection control measures for hygiene and aseptic handling of CVCs cannot be overemphasized. The catheters with ‘bioactive’ surface with thrombo-resistant and infection-resistant properties will be available in the near future.

Key Words: Hemodialysis, Access, Infection, Management, Prevention, Strategies.
 

Renal Replacement Therapy in End-Stage Sickle Cell Nephropathy: Presentation of Two Cases and Literature Review

Samir H. Al-Mueilo

Assistant Professor and Consultant Nephrologist, Coordinator, Hemodialysis Unit, Department of Internal Medicine, King Fahd Hospital of the University, Alkhobar, Saudi Arabia

ABSTRACT. Chronic renal failure develops in 4-18% of patients with sickle cell anemia. Hemodialysis and kidney transplant are viable options in the management of end-stage renal disease in patients with sickle cell disease (SCD). Information on kidney disease among Saudi patients with SCD is non-existing. In this report, the clinical course of two adult males with end-stage sickle cell nephropathy from Eastern Saudi Arabia is described. Literature on renal replacement therapy in sickle cell anemia (SCA) is discussed.

Key Words: Sickle cell anemia, End-stage sickle cell nephropathy, Hemodialysis,
Kidney transplantation, Saudi Arabia.
 

Idiopathic Retroperitoneal Fibrosis Revealed by Renal Colic

Abdelouahab Bouhabel *, Feriel Takoucht *, Pascal Meier **

* Department of Nephrology, Constantine Military Hospital, Constantine – Algeria, ** Division of Nephrology, Department of Medicine, Vaudois University Hospital, Lausanne, Swaziland


ABSTRACT. Retroperitoneal fibrosis is an uncommon disease that can be defined as the presence of a fibrous mass, which surrounds vascular structures and ureters. The start of the disease is insidious but can be diagnosed by radiological means such as computerized tomography and magnetic resonance imaging. Steroids and immunosuppressive agents may prevent progression toward advanced renal failure. We report a case of 41-year-old man who presented with bilateral renal colic as the only clinical manifestation of this disease and its favorable response to treatment.

Key Words: Retroperitoneal fibrosis, Renal colic, Renal failure, Ureteral obstruction, Steroids.