Monkeypox in a Kidney Transplant Recipient: Case Report and Literature Review.

Monkeypox (mpox) infection is usually a self-limiting disease; however, kidney transplant recipients may be at a higher risk of serious complications, due to their immunosuppressed status. Nevertheless, the reported mpox cases in transplant recipients are very few, thus data on the clinical course and prognosis details of mpox in transplant recipients are scarce. Indeed, only 2 cases of mpox in kidney transplant recipients have been reported: one patient achieved good clinical recovery, and the other patient experienced a disseminated form of the disease with urinary and gastrointestinal complications. Yet, both patients recovered fully with no allograft involvement. Here, we report a case and images of a 46-year-old male patient, with a history of posttraumatic splenectomy in 1999 and a living related kidney transplant in 2010, who presented to us with fever, sore throat, and skin rash. After thorough examination, a throat swab sent for mpox DNA polymerase chain reaction was positive; similarly, a cutaneous swab taken from a skin lesion was positive for mpox by DNA polymerase chain reaction, although he had no history of recent travel or contact with mpox cases. Our patient received supportive care and made a good clinical recovery with no disease sequelae. In this report, we describe the patient's clinical course and outcome, as well as photographic illustrations of skin lesion progression. With the present outbreak of mpox cases, clinicians should consider mpox in differential diagnoses of skin rash in immunosuppressed patients. Early identification of the infection, through viral detection by DNA polymerase chain reaction from samples taken from the skin rash, is necessary to facilitate a prompt diagnosis.

Topical Henna Application Causing Acute Kidney Injury and Acute Hemolytic Anemia.

Body art by henna staining is a practice that is widely prevalent in the Middle East and Africa, and has been known to be in vogue for hundreds of years. The practice is also significant as a ceremonial custom for weddings and social gatherings. However, due to its natural components (Lawsone) and additives, including para-phenylene-diamine (PPD), henna has also been associated with a number of health hazards, including acute hemolysis and acute kidney injury (AKI). We report in this case, a female patient who presented with AKI and acute hemolytic anemia following excessive pre-wedding henna staining of her arms and legs.

Inflammatory Bowel Diseases and Kidney Transplantation: A Narrative Review of Clinical Management Approaches.

Inflammatory bowel disease is not uncommon among kidney transplant recipients. In transplant patients with chronic diarrhea and abdominal pain, de novo inflammatory bowel disease can be considered among differential diagnoses, after exclusion of infectious causes and drug-induced diarrhea. Inflammatory bowel disease, in the cnnnontext of organ transplant, is associated with a higherrisk of morbidity, increased rate of hospitalization, and higher mortality.Therefore, a multidisciplinary approach, before and after transplant, among a gastroenterologist specialized in inflammatory bowel disease, a gastrointestinal surgeon, and a transplant clinician is essential, given the higher clinical complexity for this subgroup of patients. Limited data are available on management of inflammatory bowel disease in kidney transplant recipients, although the concurrent use of immunosuppressive therapy can mitigate flare-ups but with increased infection risks. Colorectal cancer can be a serious complication of inflammatory bowel disease; hence, patient compliance with regular colonoscopy surveillance programs is crucial. Patients with inflammatory bowel disease who are undergoing kidney transplant have a shorter overall survival rate compared with matched control groups. However, inferences based on studies involving inflammatory bowel disease in kidney transplant recipients are blighted by small sample sizes,thus making it difficult to draw accurate conclusions. Our review was undertaken to comprehensively report the clinical approaches to kidney transplant recipients with inflammatory bowel disease, describing their clinical course, outcomes, and management plan.

An Interesting Case of Hypothyroidism Associated Acute Kidney Injury.

Muscle involvement is common in hypothyroidism. However, hypothyroidism as a causal factor for severe rhabdomyolysis and acute kidney injury (AKI) is rarely reported. We report a case of a 56-year-old Arab male who presented with unexplained acute worsening of chronic kidney disease. The patient was detected to have hypothyroidism and rhabdomyolysis on laboratory investigations. However, thyroxine replacement led to partial recovery of renal function. CPK also improved with vigorous hydration and thyroxine replacement. Although this is a rare association, in the absence of other causes of rhabdomyolysis, hypothyroidism should be suspected in patients presenting with AKI and high creatinine phospho-kinase.

Global Practices and Policies of Organ Transplantation and Organ Trafficking.

OBJECTIVES: Organ trafficking has emerged worldwide as an important medical and ethical concern. In this study, we reviewed the literature presented on this matter to evaluate the global practices, ethical standards, and legal aspects of organ transplantation. MATERIALS AND METHODS: We adopted a qualitative study design to perform this study, which included conduct of a literature review. The main focus was organ transplantation. RESULTS: Our review suggested a dire need to adopt ethical principles and implement equitable distribution of organs around the globe as per the respective need. CONCLUSIONS: Further studies are needed to evaluate the role and status of organ recipients to create a much more organized environment for safe and effective implantation of evidence-based principles of clinical transplantation globally.

Management of diabetes mellitus in dialysis patients: Obstacles and challenges.

BACKGROUND AND AIMS: Diabetic kidney disease (DKD) is a major health issue that is associated with an increased risk of morbidity and mortality. The treatment of DKD is challenging given changes in blood glucose homeostasis, unclear accuracy of glucose metrics, and altered kinetics of the blood glucose-lowering medications. There is uncertainty surrounding the optimal glycemic target in this population although recent epidemiologic data suggest that HbA1c ranges of 6-8%, as well as 7-9%, are associated with increased survival rates among diabetic dialysis patients. Furthermore, the treatment of diabetes in patients maintained on dialysis is challenging, and many blood glucose-lowering medications are renally metabolized and excreted hence requiring dose adjustment or avoidance in dialysis patients. METHOD: ology: PubMed, Google Scholar, and Medline were searched for all literature discussing the management of diabetes in dialysis patients. RESULTS: The literature was discussed under many subheadings providing the latest evidence in the treatment of diabetes in dialysis patients. CONCLUSION: The management of diabetes in dialysis is very complex requiring a multi-disciplinary team involving endocrinologists and nephrologists to achieve targets and reduce morbidity and mortality.

Five-Year Mortality Analysis in Hemodialysis Patients in a Single-Center in Dubai.

The purpose of this study is to determine the mortality among patients on hemodialysis (HD). This observational cohort study was conducted at Dubai Hospital during the period between January 2012 and December 2016. All adults' patients with end-stage renal disease (ESRD) on HD irrespective of their age, gender, and duration of dialysis were enrolled. Mortality among these patients along with certain information like age at the time of death, gender, cause of ESRD, comorbidities, and serology report, were collected. Out of a total of 411 patients, 112 (27.3%) patients died during the study period, 56% were male and their median age at the time of initiation of dialysis and at the time of death was 59.38 ± 13.5 and 63.8 ± 13.6, respectively. Thirteen patients suffered early mortality; i.e., died within 365 days of initiation of dialysis. Diabetes mellitus (DM) was the most common cause of ESRD (73%) among the deceased populations, whereas hypertension was the most prevalent comorbidity in our study group. Anemia (46%), hypoalbuminemia (54%), and hypoparathyroidism (72%), whereas high ferritin (63%) and abnormal phosphorus (61.6%) were predominant biochemical parameters in the deceased patients. The leading cause of death was cardiovascular in 48 patients (42.85%) followed by infection/sepsis (21 patients, 18.75%), unknown causes/sudden death (including sudden death at home) in 18 patients (16.07%) and cerebrovascular events in seven patients (6.2%). Other causes include gastrointestinal hemorrhage, liver disease, and pulmonary embolism. In general, older age group, DM, prolonged duration on dialysis and cardiac diseases were the common causes of mortality in our study population. We found that the conventional risk factors such as old age, diabetes, cardiovascular disease, duration on dialysis, dialysis adequacy, low hemoglobin and low albumin, abnormal phosphorus, and high ferritin are comparatively prevalent in our study patients. Monitoring and timely intervention of these risk factors can help in reducing mortality in future.

Epidemiology of end-stage renal disease in Dubai: Single-center data.

Hemodialysis (HD) was first established in Dubai in the year 1980 and was in its full capacity by the year 1983. Since then, the HD population has been growing rapidly. This report represents the demographic data and clinical characteristics of our HD patients during the period between January 2012 and October 2016. Diabetic nephropathy (57%) and hypertension (12.4%) are emerging as the most common causes of end-stage renal disease (ESRD) in our data, followed by undetermined causes in those who presented as ESRD (10.9%), and then by rejected transplant in 4.6%. Obstructive uropathy in our data was 4.37% among all causes. The causes were primary glomerulonephritis (only proven cases in kidney biopsy were counted) in 3.6%, adult polycystic kidney disease in 2.43%, and lupus nephritis in 1.45% of cases. The prevalence of ESRD in the current study was 152 patients per million population per year.

Pattern of acute glomerulonephritis in adult population in Dubai: A single-center experience.

Epidemiological data of renal diseases have great geographic variability throughout the world. Due to the lack of a national renal data registry system, there is no information on the prevalence rate, clinical and pathological features of various glomerulonephritis (GN) in the United Arab Emirates (UAE). In a retrospective cross-sectional study, we analyzed 158 renal biopsies done in Dubai Hospital, UAE, between the years of 2005 and September 2014, with an aim to determine the prevalence rate and frequency of different pathological patterns of GN in adult patients who presented with proteinuria ± hematuria. In our study, primary GN still remains more common than secondary GN (66.4% vs. 33.5%). Among the primary GN in our analysis, minimal change disease was the most common primary GN affecting 20% of the study population (13.2% of the total GN causes) followed with membranous GN (18.2%), then membrano- proliferative GN (15.3%) and focal segmental glomerulosclerosis (13.46%), while among the secondary causes lupus nephritis (LN) is the most prevalent GN in UAE, predominantly in the Emirati national population whom constituted 48% of total biopsies. Indeed, LN had the highest incidence among all types of GN even the primary ones, constituting 23.4% of total GN in Dubai (74% of the total secondary causes). Furthermore, systemic lupus erythematosus was the most common GN in women while the minimal change was widely affecting male patients. Among elderly, the most common pathology was diabetic glomerulosclerosis followed by amyloidosis.

Tuberculosis of the arterio-venous graft in a renal transplant recipient.

A 44-year-old Pakistani lady with end-stage renal disease secondary to rapidly proliferative glomerulonephritis underwent successful renal transplantation. Three years later, she was referred to the surgeon with an abscess in the axillary region at the site of a previous arterio-venous (AV) graft. She underwent repeated incision and drainage of the abscess, which was constantly recurring. Nine months later, she presented with a tender swelling at the site of the AV graft with purulent discharge. The graft was removed; culture and histology confirmed the presence of tuberculosis (TB). This patient presents a rare case of TB infection in the AV graft.