Contrast-induced Nephropathy in Kidney Transplant Recipients: A Single-center Experience.

INTRODUCTION: Data regarding contrast-induced nephropathy (CIN) in kidney transplant (KT) recipients are scarce despite the distinct risk factors such as the use of immunosuppressive agents, sympathetic denervation, glomerular hyperfiltration, and high prevalence of the cardiovascular disease. This study aimed to determine the prevalence of CIN in KT recipients who received low-osmolality iodine-based contrast material (CM) for radiological assessment. METHODS: Between 2010 and 2020, 79 of the 3180 KT recipients followed at Hamed Al-Essa organ transplant center received low-osmolality iodine-based contrast for radiological assessment for various indications. Preventive measures including holding metformin, intravenous hydration, sodium bicarbonate and N-acetylcysteine were given before contrast administration. CIN was defined as an increase in serum creatinine of 25% from the baseline within 72 hours. RESULTS: The enrolled patients were divided into two groups: those who developed CIN (n = 7) and those with no increase in serum creatinine level (n = 72). The mean age of the patients was 52.1 ± 12.3 years; 44 of them were males, and the cause of end-stage kidney disease was mostly diabetic nephropathy. The pre-transplant demographics were comparable between the two groups. Fortyseven cases received contrast for coronary angiography, and 32 received it for a CT scan. The graft function deteriorated in group 1, but no significant difference was found between the two groups at the end of the study. CONCLUSION: CIN is not uncommon in KT recipients receiving CM, especially with ischemic heart disease. Risk stratification, optimizing hemodynamics, and avoiding potential nephrotoxins are essential before performing CM-enhanced studies in KT recipients.  DOI: 10.52547/ijkd.7165.

Triplet Pregnancy in a Diabetic Mother With Kidney Transplant: Case Report and Review of the Literature.

Triplet and higher-order multiple pregnancies can carry increased fetal and maternal complications. Reports of triplet pregnancies after kidney transplant are scarce and have been associated with perinatal complications. Presence of diabetes in such cases worsens both fetal and maternal outcomes. Here, we present a triplet pregnancy in a kidney transplant recipient with diabetes. We also reviewed the literature for causes, prevalence, and outcomes in association with chronic kidney disease, kidney transplant, and diabetes mellitus. The patient, a 31-year-female who received a living-donor kidney transplant, had a first-time pregnancy 6 years after transplant. Pregnancy was complicated by gestational diabetes, preeclampsia, and miscarriage. She continued to have postpartum-impaired glucose tolerance. She became pregnant again after 6 months but required insulin therapy during her third trimester. Pregnancy was terminated by cesarean section for a viable small boy. Two years later, she had triplet pregnancy after ovulation induction with clomiphene. Glycemic control was maintained using intensive insulin therapy guided by frequent home blood glucose monitoring (HbA1c was 5.8% at 22 wk). Both gynecologic care and nephrologic care were carried out through outpatient follow-up. Pregnancy was complicated by hypertension and mild renal dysfunction without proteinuria and ended in elective premature cesarean section at 32 weeks of gestation. She had 3 male babies with low birth weights (1320, 1380, 1275 g), with the largest baby developing sepsis and requiring an intensive care unit stay and then incubator for 49 days. The other 2 required incubators for 36 days. Their weights after 22 months were 9, 16, and 11 kg. The mother is now normotensive with normal renal function and impaired glucose tolerance. Care of diabetic kidney recipients with triplet pregnancy constitutes a special challenge requiring a multispecialty skilled team to ensure the best outcome.

Ultrasound-guided botulinum toxin A injection in the treatment of belly dancer's dyskinesia.

BACKGROUND: Belly dancer's dyskinesia is an extremely rare condition. It manifests as semicontinuous, slow, writhing, sinuous abdominal wall movements that are bothersome to the patient. Management of this condition is extremely difficult and challenging. METHODS: We describe four patients with belly dancer's dyskinesia who were treated with Botulinum Toxin A (BTX) injections under ultrasound guidance. RESULTS: All patients underwent the same BTX injection procedure using an aseptic technique under ultrasound guidance. The patients responded well to the BTX injections after an unsatisfactory course of medical treatment. The patients reported complete abolishment of abnormal abdominal movements with no side effects. CONCLUSIONS: We report a cohort of patients with belly dancer dyskinesia treated successfully with BTX injections. Ultrasound guidance for injections increases the accuracy and reduces the risk of the complications. BTX injection under ultrasound guidance is a safe and effective treatment modality that should be employed as a first-line in the management of patients with belly dancer's dyskinesia.

Bilateral chylothorax in a renal transplant recipient: case report and literature review.

Chylothorax is the accumulation of chyle in the pleural cavity as a result of damage to the lymphatic ducts. We treated a young man who was a kidney transplant recipient who had a prior internal jugular vein permanent catheter for hemodialysis, who developed dyspnea and hypoxemia. Chest radiography showed bilateral pleural effusion. Analysis of the white, milky, cloudy, odorless effusion fluid showed cell count > 500/µL; lymphocytes, 60%; total protein, 3.6 mg/dL; urea nitrogen, 45 mg/dL; creatinine, 90 µmol/L; triglycerides, above 2.2 mmol/L (repeatedly high); lactate dehydrogenase, 450 U/L (normal); and cultures, no growth. Magnetic resonance imaging showed thrombosis of the major neck veins, superior vena cava, and azygos vein. Treatment included pleural drains, gut rest, and dietary modification, octreotide, and warfarin. The chylothorax resolved with no relapse. In summary, chylothorax may occur in patients associated with thrombosis of major veins associated with a permanent dialysis catheter.

Outcome evaluation of a zero-profile implant for anterior cervical diskectomy with fusion.

AIM: Supplementing anterior cervical diskectomy and fusion (ACDF) with plates enhances stabilization, increases fusion and reduces failure rates. Zero-P implant for stand-alone anterior interbody fusion procedures of the cervical spine was recently developed to avoid complications associated with anterior cervical plates. We evaluate the outcome of its use in our patients undergoing ACDF. MATERIAL AND METHODS: 84 patients were selected to undergo ACDF with Zero-P implant of whom 75 (52 male and 23 female) were followed up for 12 to 16 months (mean 14.2 months) with a total of 94 operated levels (54 single, 21 double level). Patients underwent pre- and postoperative clinical evaluation with full neurological examination, visual analogue scale (VAS), Neck Pain and Disability Scale (NPAD) and Bazaz-Yoo dysphagia index for postoperative dysphagia. Postoperative plain X-ray evaluation of fusion and implant-associated complications was done. REAULTS: All patients had significant reduction in arm and neck pain and NPAD maintained over 12 months, no implant-associated complications during follow-up, and radiological fusion by 3 months. None had dysphagia after 3 months postoperatively. CONCLUSION: The Zero-P implant is a valid alternative to anterior cervical plating after ACDF with a very low incidence of postoperative dysphagia and no implant-related complications.

Computed tomographic evaluation of the distance between the medial border of longus colli muscle and foramen transversarium in ventral approaches to the subaxial cervical spine.

AIM: Iatrogenic vertebral artery (VA) injury during ventral approaches to the subaxial cervical spine ranges from 0.22% to 2.77%. Evaluation of the extent of safe lateral working distance before the V2 segment of the VA is reached can be helpful to avoid this complication. MATERIAL AND METHODS: In 100 patients (48 males and 52 females) axial computed tomographic scanning was used to measure the distance from the medial border of longus colli muscle (LCM) to the medial border of the foramen transversarium along the anterior border of the vertebral body at each level from C3-4 down to C6-7. The arithmetic mean of the 2 measurements at the upper and lower end-plates of the corresponding level was considered representative of the safe lateral working distance at this level. Statistical significance was set as P value < 0.001. RESULTS: No statistically significant difference was found between the measurements in the whole study population at various levels or between subgroups. A gradual increase in the distances was noticed from C3-4 down to C6-7 level in all subgroups except for spondylotic males. CONCLUSION: This study offers useful morphometric data that can help the surgeon avoid VA injury during anterior procedures to the subaxial cervical spine.

In vitro antimicrobial efficacy of riboflavin and ultraviolet light on Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa.

PURPOSE: Ultraviolet (UV) light and riboflavin has been developed as a collagen cross-linking treatment for corneal ectasia. This treatment has also been used to treat infectious corneal ulcers with apparent favorable results. In this experiment, the antibacterial action of riboflavin alone, UV light alone, and the combination of riboflavin and UV light was tested on Staphylococcus aureus, methicillin-resistant S aureus (MRSA), and Pseudomonas aeruginosa. METHODS: Thirty agar plates with S aureus overlays were used. Ten plates were exposed to riboflavin (0.1% solution in dextran) alone, 10 plates were exposed to UV light (365 nm) alone, and 10 plates were exposed to a combination of riboflavin and UV light. Fifteen agar plates with MRSA and 15 plates with P aeruginosa were tested. Five plates of each group were exposed to riboflavin, 5 plates of each group were exposed to UV light alone, and 5 plates of each group were exposed to a combination of riboflavin and UV light. All plates were incubated for 24 hours and then analyzed. RESULTS: All plates exposed to riboflavin alone showed no bacterial death. All S aureus and MRSA plates exposed to UV light alone showed no bacterial growth. Three of five P aeruginosa plates exposed to UV light alone showed no bacterial death; two of five P aeruginosa plates exposed to UV light alone showed minimal inhibition. All plates exposed to the combination of riboflavin and UV light showed bacterial death. CONCLUSIONS: Riboflavin in combination with UV light is an effective modality to eradicate the bacteria S aureus, MRSA, and P aeruginosa.