The Association of M235T Genetic Polymorphism in Angiotensinogen Gene and Other Non-Genetic Factors with Essential Hypertension among Jordanian Patients.

BACKGROUND: Hypertension, characterized by elevated pressure, poses a significant health risk. Recent studies in Jordan highlight high hypertension rates, emphasizing the need for genetic investigations to comprehend essential hypertension determinants. The AGT gene, part of the Renin Angiotensin System, is linked to blood pressure regulation. Limited information exists on the frequency of this polymorphism among Jordanian hypertensive patients. AIMS: This study explores the association between the AGT M235T polymorphism and essential hypertension in Jordan. METHODS: A cross-sectional study with 435 participants (199 hypertensive, 236 non-hypertensive) was conducted at the University of Jordan Hospital. Blood pressure was measured, and genetic analysis of the AGT M235T polymorphism was completed using the PCR-RFLP technique. Chi-square and t-tests were used for comparisons using SPSS software. RESULTS: Hypertensive patients exhibited significantly higher weight, BMI, and blood pressure. Genotyping results showed no significant difference (p > 0.05, Chi-square) in AGT M235T polymorphism distribution between control and patient groups. In addition, allele frequencies showed comparable patterns (p > 0.05, Chi-square). All genotype frequencies showed no deviation from the Hardy-Weinberg equation (p > 0.05, Chi-square). CONCLUSIONS: The AGT M235T genetic polymorphism is not more prevalent among hypertensive patients in Jordan, although the average weight and BMI among hypertensive patients is higher than the non-hypertensive participants. Obesity can be addressed as a potential risk factor for essential hypertension in Jordan. In addition, it is recommended to find out the influence of the AGT M235T genetic polymorphism on the response of antihypertensive drugs among hypertensive patients in Jordan.

Accuracy and feasibility of portable blood pressure monitoring in the detection of atrial fibrillation in hemodialysis patients.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in clinical practice and is a common comorbidity in hemodialysis patients. AF contributes to cardiovascular complications; therefore, it is recommended to screen for AF in high-risk patients to prevent serious complications. As we currently lack a handy AF screening tool, the aim of this study was to assess the accuracy of a modified BP monitor (Omron M6), in detecting AF in hemodialysis patients. In a cross-sectional analysis conducted from October 2018 to February 2019, we enrolled all the hemodialysis patients, older than 18 years and maintained on hemodialysis for at least 3 months in four hemodialysis centers in Jordan. Logistic regression was used to predict the accuracy, while the R package (epiR) was used to determine the sensitivity and specificity of the Omron M6 in screening AF. A total of 227 patients participated in the study, with a median age of 57 years (42.8-67.3); among these, 44.5% were female. Of all the participants, 18 were detected with AF, which was confirmed by a 12-lead ECG. The prevalence of AF in our study was 7.9%, while the sensitivity, specificity and accuracy of the Omron M6 in detecting AF were calculated as 83.0% (95% CI, 59.0-96.0), 94.0% (95% CI, 90.0-97.0) and 93.4% (95% CI, 88.0-95.0) respectively. We concluded that Omron M6 has high sensitivity, specificity, and accuracy in screening AF among hemodialysis patients. However, further studies are required to ascertain and firmly establish this preliminary finding.

Congenital insensitivity to pain and anhydrosis due to a rare mutation and that is complicated by inflammatory bowel disease and amyloidosis: a case report.

Patients with congenital insensitivity to pain and anhydrosis syndrome are at risk for renal amyloidosis and inflammatory bowel disease. Physicians caring for such patients should be aware of these complications.

Spot urine protein-to-creatinine ratio compared with 24-hour urinary protein in patients with kidney transplant.

OBJECTIVES: This study sought to determine the correlation between protein-to-creatinine ratio and 24-hour urinary protein excretion, to examine agreement between the 2 methods, and to determine the discriminant value for protein-to-creatinine ratio that reliably determines significant threshold levels of proteinuria. MATERIALS AND METHODS: Proteinuria was assessed by 24-hour urine protein excretion and protein-to-creatinine ratio. Correlation and limits of agreement between the 2 methods were evaluated. The discriminant cutoff values for spot urine protein-to-creatinine ratio in predicting 24-hour urine protein excretion were determined using receiver operating characteristic curves. RESULTS: A positive correlation (r=0.7459, P < .0001) was found between spot urine protein-to-creatinine ratio and 24-hour urine protein excretion. A Bland-Altman plot shows that the 2 tests have reasonable limits of agreement at a low level of protein excretion, but the limits become wider as protein excretion increases. The area under the receiver operating characteristic curve for urine protein-to-creatinine ratio at various cutoffs was 0.967 (95% confidence interval: 0.880-0.996; P < .0001). The cutoff level of 0.433 had a sensitivity and specificity of 100% and 90%. CONCLUSIONS: We conclude that the protein-to-creatinine ratio in spot urine specimens in patients undergoing a kidney transplant is a convenient and reliable method of estimating protein excretion in urine.

A family with five siblings affected with nephronophthisis.

Nephronophthisis is an autosomal recessive disease that leads to end-stage renal disease. These days, molecular genetic analysis is used pre-emptively for making a definitive diagnosis in patients who have clinical and radiological data suggestive of the disease. Herein, we are reporting a 12-year-old girl who was genetically diagnosed to have juvenile nephronophthisis, which explained the mystery of the chronic kidney disease in her four affected siblings.

Comparison of creatinine clearance estimates with routine measured clearance in adult Jordanians with a kidney transplant.

OBJECTIVES: There are conflicting data on using the Cockroft-Gault formula and the Modification of Diet in Renal Disease formula to assess graft function in kidney transplants. This study uses a cohort of Jordanian kidney transplant patients to assess performance of the Cockroft-Gault formula and the Modification of Diet in Renal Disease equations by using the criterion standard of measured creatinine clearance. MATERIALS AND METHODS: Creatinine clearance measured by 24-hour urine creatinine in patients with a kidney transplant was compared with the estimated clearance using the Cockroft-Gault formula and the Modification of Diet in Renal Disease equations. Correlation, limits of agreement, and concordance analyses were used. RESULTS: There was a positive correlation between both the Cockcroft-Gault (r=0.878; P < .001) and the Modification of Diet in Renal Disease (r=0.732; P < .001) equations with creatinine clearance. The former was statistically superior (P = .0416). Using Bland-Altman plots, the limits of agreement were wide for both methods. After log transformation, the limits of agreement were -0.06 to +0.27 for the Cockcroft-Gault formula, and -0.21 to + 0.26 for the Modification of Diet in Renal Disease. Concordance analyses showed a correlation coefficient of 0.7384 (95% CI: 0.6134 to 0.8273) when the Cockcroft-Gault formula was used, and 0.7257 (95% CI: 0.5622 to 0.8345) for the Modification of Diet in Renal Disease. Pearson P coefficient (precision) and bias correction factor Cb (accuracy) for the Cockcroft-Gault formula and for the Modification of Diet in Renal Disease were 0.8762, 0.8427, 0.7324, and 0.9908. CONCLUSIONS: In Jordanian patients with a renal transplant, although the Cockcroft-Gault formula performed slightly better than the Modification of Diet in Renal Disease equation in estimating creatinine clearance, neither of these equations can accurately predict renal graft function.

Benign pheochromocytoma presented 6 years after kidney transplantation.

Hypertension is very common in kidney transplant patients; however, severe and resistant cases should raise suspicion of secondary causes. Pheochromocytomas are rare but serious tumors because of their lethal hypertensive and possible malignant nature. The diagnosis is occasionally elusive, but prompt diagnosis and localization is essential for definitive surgical management. We report a case of a patient with benign pheochromocytoma presenting largely asymptomatically, but with severe resistant hypertension, 6 years after kidney transplantation. To the best of our knowledge, this is the first case report of this type of tumor after kidney transplantation.

Management of hypertension and factors affecting its control in Jordanian renal transplant recipients.

BACKGROUND: Hypertension affects 70-90 % of all kidney transplant recipients. It is associated with poor graft survival and is a contributing factor to the increased cardiovascular mortality. The reasons for the insufficient blood pressure control in transplanted patients have not been thoroughly investigated. OBJECTIVE: To evaluate the extent of blood pressure control in Jordanian hypertensive renal transplant recipients and to assess factors associated with such control. SETTING: Three outpatient renal transplant clinics in Amman. METHOD: A cross-sectional observational study including 181 patients. We have considered blood pressure <130/80 mm Hg as controlled hypertension. Bivariate and multivariate logistic regression analyses were used to determine clinical factors associated with achievement of blood pressure control. MAIN OUTCOME MEASURES: Proportion of patients who achieved hypertension control and clinical factors associated with good blood pressure control. RESULTS: Mean systolic blood pressure was 128.6 ± 16.3 mm Hg and mean diastolic blood pressure was 82.8 ± 11.5 mm Hg. Blood pressure control was achieved only in 58 % of patients. The most commonly prescribed antihypertensives were calcium channel blockers (58 %) followed by beta-blockers (44 %). In bivariate analysis, female gender (p = 0.017) and creatinine clearance (p = 0.002) were positively associated, while number of antihypertensive medications was inversely associated (p = 0.04) with achievement of blood pressure control. After including these factors in multivariate logistic regression analysis, only creatinine clearance remained independently associated with hypertension control (odds ratio, OR 1.04; 95 % confidence interval [CI] 1.01-1.06; p = 0.003). CONCLUSION: Blood pressure control among renal transplant recipients in Jordan was found to be inadequate. The only factor found to be independently associated with adequate blood pressure control was creatinine clearance.

Achievements of kidney disease outcomes quality initiative goals in hemodialysis patients at Jordan University Hospital.

This study was conducted to assess the current practice patterns of care for hemodialysis (HD) patients at the Jordan University Hospital Dialysis Center using Dialysis Outcomes Quality Initiative Guidelines as the reference. In a cross-sectional study, we assessed 61 patients on HD. The Kt/V was calculated, and data on serum levels of hemoglobin, iron, ferritin, transferrin saturation, calcium, phosphate, and intact parathormone (PTH) were collected. The values were compared with the dialysis outcomes quality initiative (K/DOQI) recommended target values. Forty-one patients (67.2%) had an arteriovenous fistula as the primary access. The mean hemoglobin level was 10.8 ± 1.4 g/dL, 9.8% of patients had mean serum ferritin < 100 ng/dL and 14.7% had transferrin saturation < 20%. The mean serum calcium level was 9.1 ± 0.9 mg/dL and serum calcium level between 8.5 and 10.5 mg/dL was found in 82% of HD patients. The mean serum phosphorus was 3.9 ± 1.1 mg/dL and 59% of patients had serum phosphorus between 3.5 and 5.5 mg/dL. The mean serum PTH was 364 ± 315 and 14 patients (23%) had serum PTH between 150 and 300 pg/mL. The achieved standard of HD among our study patients was acceptable and, in many aspects, comparable with the NKF-KDOQI guidelines. However, there is still need to improve the management of anemia and control of hyperparathyroidism.

Comparison of 24-hour urinary protein and protein-to-creatinine ratio in the assessment of proteinuria.

To determine the correlation between protein-to-creatinine ratio (PCR) and 24-hour urinary protein (UP), we measured proteinuria in 68 patients attending the nephrology clinic at Jordan University Hospital by 24-hour urine protein excretion and protein-to-creatinine ratio. The cutoff values for spot urine protein-to-creatinine ratio in predicting 24-hour protein "threshold" excretion of 0.5, 1.0 and 3.5 g/day were determined using receiver operating characteristic curves. A very good correlation (r= 0.832, P< 0.0001) was found between spot urine protein-to-creatinine ratio and 24-hour urine protein excretion. Bland-Altman plot showed the two tests had reasonable limits of agreement at low level of protein excretion but the limits became wider as the protein excretion increased. For protein excretion < 2.0 g/day, the limits of agreement of spot urine (PCR) and (UP) were +1.48 and -1.2 g/day. The spot urine protein-to-creatinine ratios of 0.72 (sensitivity 0.97; specificity 1.0), 1.2 (0.97; 0.89) and 3.23 (1.0; 0.86) mg/mg reliably predicted 24-hour urine total protein equivalent "thresholds" of 0.5, 1.0 and 3.5 g/day, respectively. We conclude that the protein-to-creatinine ratio in spot urine specimens is an accurate, convenient, and reliable method to estimate the protein excretion in urine. However, the protein-to-creatinine ratio will likely be within clinically acceptable limits only when proteinuria is at reasonably low levels.

Mini mental status examination (MMSE) in stable chronic renal failure patients on hemodialysis: The effects of hemodialysis on the MMSE score. A prospective study.

Cognitive impairment is common in hemodialysis (HD) patients. The mini mental status examination is a simple screening test for dementia. The objectives of this study were to (1) study and compare the predialysis and postdialysis mini mental status examination score and 2 subscores and compare them with those of a control group and (2) determine the factors affecting these scores. This was a prospective study of 54 HD patients, which involved calculation of their predialysis (PrHDSc) and (2-4 weeks later) postdialysis (PoHDSc) scores and comparison of these with the control scores (CoSc). The mean scores for PreHDSc and PoHDSc were 26.5+/-2.7 and 26.4+/-3.3, respectively. Both were significantly lower than CoSc, 28.4+/-1.6 (95% CI for score difference 0.99-2.97, P<0.001). The subscores for orientation, registration, and recall (ORR) and attention (ATT) before and after HD were 14.2+/-1.3, 14.3+/-1.8, and 3.5+/-1.7, 3.2+/-1.8, respectively. Both were significantly lower than the CoSc, 15.2+/-1.2 and 4.2+/-1.1 (P=0.001 and 0.004, respectively). There were no significant differences between the PrHDSc and PoHDSc (P values of 0.87, 0.63, and 0.45, respectively). Patients' PrHDSc correlated positively with PoHDSc and dialysis efficiency measured by the urea reduction ratio and Kt/V (r=0.58, 0.4, and 0.34, respectively). Education level correlated positively with PrHDSc r=0.41 but not PoHDSc. Hemodialysis duration correlated negatively with PrHDSc r=-0.3. There was no correlation among age, chronic renal failure duration, HD frequency, weight loss, systolic or diastolic blood pressure drop, and PrHDSc or PoHDSc. Hemodialysis patients scored significantly less than the control patients. Their score was not affected by HD. This may reflect the stable cognitive function/dysfunction or the mild sensitivity of the test.

Spectrum of glomerulonephritis in adult Jordanians at Jordan university hospital.

We retrospectively reviewed the records and histopathological findings of 64 adequate native kidney biopsies performed at the Jordan University Hospital from January 2002 through December 2006. The nephrotic syndrome (NS) was the main reason for biopsy in 51.6% of the cases and deterioration of kidney function in 31%. Primary glomerulonephritis (GN) was diagnosed in 59.4% of the biopsies, and focal segmental glomerulosclerosis (FSGS) was the most common pathology detected (17.2%). Systemic lupus erythematosis was found in 17 patients (26.6%), and it was the commonest secondary GN pathology.

Brucella glomerulonephritis resulting in end-stage renal disease: a case report and a brief review of the literature.

Brucella glomerulonephritis is a rare condition with only a few reported cases. We review the literature, and describe a 24-year-old female who presented with edema and proteinuria. Blood grew Brucella melitensis. Renal biopsy showed diffuse proliferative glomerulonephritis. The patient progressed to end-stage renal disease despite antibiotic and steroid therapy.

The spectrum of bone disease in Jordanian hemodialysis patients.

OBJECTIVE: To evaluate the spectrum of mineral abnormalities and bone disease (BD) in hemodialysis patients at Jordan University Hospital (JUH), Amman, Jordan. METHODS: A cross-sectional study was conducted among 63 patients (38 males and 25 females), mean age 44.19 years (range 17-76 years), with chronic kidney disease (CKD) on regular hemodialysis at JUH between November 2004 and April 2005. All patients have undergone complete blood count, chemistry profile, alkaline phosphatase, serum albumin, intact parathyroid hormone (iPTH) and plain x-rays. RESULTS: Bone disorders were identified in 45 patients on x-rays (70%). Osteopenia was found in 43 patients (68.3%), subperiosteal resorption in 24 patients (38.3%) and metastatic calcification in 22 patients (35%). Hypocalcemia was found in 28.6% and hypercalcemia in 7.9%. All patients were taking calcium carbonate, and 55.5% of patients were on vitamin D supplements. The calcium levels in 63.5% and the phosphorus levels in 50.8% of patients were within the recommended guidelines of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI). Serum i-PTH level was above 300 pg/ml high turnover bone disease in 24.6% of patients, 21.3% had iPTH of 150-300 pg/ml target, and 44.3% had i-PTH levels below 100 pg/mL suggesting a dynamic bone disease. Patients with severe bone disease had a statistically significant higher iPTH levels (p<0.005). CONCLUSION: Bone disease and mineral abnormalities are common in hemodialysis patients at JUH. Earlier detection of bone disease and better overall management strategy may reduce the frequency and severity of bone disease in CKD patients in Jordan.