Comparison of high and low dose of cyclophosphamide in lupus nephritis patients: a long-term randomized controlled trial.

To evaluate the outcome of low doses of cyclophosphamide (Cyclo) therapy in lupus nephritis (LN) patients, we studied 117 biopsy-proven, de novo LN WHO class IV patients double-blinded and randomized in December 1997 to receive Cyclo in different doses; Group I (n=73) received Cyclo 10 mg/kg monthly for six months then every two months for 12 months. Group II (n=44) received Cyclo 5 mg/kg monthly for six months then every two months for 36 months. The patients were followed-up till January 2007. Six months post-induction values for creatinine clearance were significantly higher in Group I (67.7 ± 28.6 mL/min) compared with Group II (55.1 ± 30.1 mL/min), P = 0.026. Serum C4 and ANA were not significantly different between the groups (P > 0.05). At the mean follow-up of 6.77 ± 3.3 years, the mean creatinine clearance was 44.74 ± 31.7 mL/min in Group I vs. 49.3 ± 38.8 in Group II. Urinary protein was 1.65 ± 1.8 g/dL in Group I vs. 1.02 ± 1.01 in Group II (P = 0.03). The survival curve showed that kidney survival overtime was comparable in both groups (P = 0.2). Complete remission was observed in 25 (34.2%) patients in Group I vs. 11 (25%) in Group II (P = 0.288), while partial remission was similar in both groups; 43 (58.9%) patients in Group I vs. 26 (59%) patients in Group II. End-stage renal disease was observed in 10 (13.7%) patients in Group I vs. 9 (20.4%) patients in Group II (P = 0.359). Side-effects were more frequent in Group I patients than in Group II patients; gonadal toxicity and malignancy were lower in Group II patients (P = 0.0000). Moreover, different infections occurred in 23 (31.3%) patients vs. six (13.6%), digital infarcts occurred in 1.35% vs. 0%, diabetes in 4.1% vs. 2.27%, and vasculitis in 4.1% vs. 2.27% in Group I vs. Group II, respectively. Sustained amenorrhea without pregnancy was observed in both groups; however, significantly more in Group I patients, P ≤ 0.05. We conclude that low-dose Cyclo therapy is sufficiently effective for WHO class IV LN patients with lower side-effects compared with standard dose.

A validation study comparing the sensitivity and specificity of the new Dr. KSU H1N1 RT-PCR kit with real-time RT-PCR for diagnosing influenza A (H1N1).

BACKGROUND AND OBJECTIVES: A new test (Dr. KSU H1N1 RT-PCR kit) was recently developed to provide a less expensive alternative to real-time reverse transcriptase-polymerase chain reaction (RT-PCR). We report the findings of a validation study designed to assess the diagnostic accuracy, including sensitivity and specificity, of the new kit, as compared to real-time RT-PCR. DESIGN AND SETTING: Cross-sectional validation study conducted from 18-22 November 2009 at a primary care clinic for H1N1 at a tertiary care teaching hospital in Riyadh. PATIENTS AND METHODS: Nasopharyngeal swab samples and data on socio-demographic characteristics and symptoms were collected from 186 patients. Swab samples were sent to the laboratory for testing with both real-time RT-PCR and the new Dr. KSU H1N1 RT-PCR kit. We measured the sensitivity and specificity of the new test across the entire sample size and investigated how these values were affected by patient socio-demographic characteristics and symptoms. RESULTS: The outcomes of the two tests were highly correlated (kappa=0.85; P<.0001). The sensitivity and specificity of the new test were 99.11% and 83.78%, respectively. The sensitivity of the new test was affected only minimally (96%-100%) by patient characteristics and number of symptoms. On the other hand, the specificity of the new test varied depending on how soon patients were tested after onset of symptoms (100% specificity when swabs were taken on the first day of the symptoms, decreasing to 75% when swabs were taken on or after the third day). The specificity of the new test also increased with increasing body temperature. CONCLUSION: The new test seems to provide a cost-effective alternative to real-time RT-PCR for diagnosing H1N1 influenza. However, further testing may be needed to verify the efficacy of the test in different settings and communities.

Dyslipidemia in dialysis patients.

In order to evaluate the lipid profiles of dialysis patients, we retrospectively reviewed all the chronic kidney disease (CKD) patients on chronic hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD), followed up between June 2004 and May 2005, in two tertiary hospitals in Riyadh, Saudi Arabia. There were 380 patients including 206 (54.2%) females and the mean age of the patients was 45.9 ± 15.8 years. The mean dialysis duration was 65.0 ± 58.3 months. Diabetes was present in 97 (25.5%) of the patients and hypertension in 84 (22.1%). Younger patients had more disturbed lipid profile than elderly patients, and females had higher lipid values than males. The CAPD patients had worse lipid profile than those on HD, irrespective of age, sex and duration of dialysis. The presence of diabetes, hypertension, smoking and cardiovascular disease (CVD) all contributed to the worsening of lipid profiles of our patients. Dialysis patients showed improvement in lipid profile initially followed by gradual deterioration. We conclude that dyslipidemia, which increases the risk of CVD by increasing atherogenesis, progresses over time in dialysis patients and becomes worse in CAPD patients.

How do medical students in their clinical years perceive basic sciences courses at King Saud University?

BACKGROUND AND OBJECTIVES: The inclusion of detailed basic science courses in medical school curricula has been a concern of students. The main objective of this study was to explore the attitudes of medical students towards basic sciences courses taught to them in the preclinical years and the applicability of these courses to current clinical practice. DESIGN AND SETTING: A cross-sectional survey was conducted during 2008-2009 among medical students in their clinical years at King Saud University, Riyadh, Saudi Arabia. METHODS: Thirty percent of all students (n=314) were randomly selected to receive a questionnaire designed to evaluate their opinions about course load, ability to recall information, value of practical sessions, availability of references and course guidelines, and the applicability of individual courses to clinical practice. RESULTS: Students identified anatomy and pathology as the courses most overloaded with content (76% and 70%, respectively). Half of the students felt they retained the most knowledge of physiology (50%), while less than a quarter of students (19%) felt they retained the most information from biochemistry coursework. The role of practical sessions in facilitating theoretical understanding was more evident in anatomy (69%). Physiology was perceived as the subject with the highest applicability to clinical practice (66%), while pathology (29%) was identified as the subject with the least practical application. Students became increasingly negative in their opinions about basic science courses as they progressed through their medical education. CONCLUSION: Current attitudes of medical students towards their basic science courses indicate a need to reform the curricula so as to maximize the benefit of these courses.

Concomitant macro and microvascular complications in diabetic nephropathy.

To determine the prevalence of concomitant microvascular and macrovascular complications of diabetic nephropathy we retrospectively reviewed the medical records of all 1,952 type 2 diabetic patients followed-up at Security Forces Hospital, Riyadh, Saudi Arabia from January 1989 to December 2004. There were 626 (32.1%) patients (294 (47%) were males) who developed diabetic nephropathy. Their mean age was 66.9 +/- 11.4 years, mean duration of diabetes was 15.4 +/- 7.5 years, mean age at the onset of nephropathy was 61.5 +/- 12.4 years, and mean duration of nephropathy was 3.9 +/- 3.8 years. Concomitant diabetic complications included cataract (38.2%), acute coronary syndrome (36.1%), peripheral neuropathy (24.9%), myocardial infarction (24.1%), background retinopathy (22.4%), stroke (17.6%), proliferative retinopathy (11.7%), foot infection (7.3%), limb amputation (3.7%) and blindness (3%). Hypertension was documented in 577 (92.2%) patients, dyslipidemia in 266 (42.5%) and mortality from all causes in 86 (13.7%). There were 148 (23.6%) patients with one complication, 81 (12.9%) with two, 83 (13.3%) with three, and 61 (9.7%) with four or more. Deterioration of glomerular filtration rate was observed in 464 (74%) patients and doubling of serum creatinine in 250 (39.9%), while 95 (15.2%) developed end-stage renal disease (ESRD) at the end of study and 79 (12.6%) required dialysis. Complications were significantly more prevalent among males with greater number reaching ESRD level than females (P< 0.05). Relative risks of developing complications were significant after the onset of nephropathy; ACS (1.41), MI (1.49), stroke (1.48), diabetic foot (1.6), amputation (1.58) and death (1.93). We conclude that complications of diabetes are aggressive and progressive including high prevalence of diabetic nephropathy. Careful monitoring and proper institution of management protocols should be implemented to identify diabetic patients at high risk for complications and mitigate progression into ESRD.

Obesity among female school children in North West Riyadh in relation to affluent lifestyle.

OBJECTIVE: To estimate the prevalence of obesity among elementary school female students and to identify some obesity-associated risk factors. METHODS: This cross-sectional study surveyed healthy female school students (grades 4-6) during 2006-2007. Four private schools in North West Riyadh, Kingdom of Saudi Arabia were selected where the majority of high income families enrolled their daughters. One thousand and two hundred students were included. A pre-designed validated questionnaire was used for data collection. Weights and heights were measured, and the body mass index (BMI) was calculated. Students were categorized into obese and non-obese according to BMI by age scale. RESULTS: A total of 1072 students participated in the study with a response rate of 89.3%. Obesity was prevalent among 14.9% of students. We observed that the proportion of obese students inversely increased by age and schooling grade (p<0.001). Ninety-five percent of the students living in villas or big houses were obese. Approximately 89.2% admitted that they are performing some exercises; however, 13.8% of them were obese. Consuming fast food and soft drinks were common practiced among obese students. Watching television on daily basis was prevalent among 97.5% of obese students. CONCLUSION: The existence of obesity promoting factors, calls for integrating interventions at family and school level to match changes in social and cultural context. Awareness is needed to enhance healthy lifestyle.

Diabetes complications in 1952 type 2 diabetes mellitus patients managed in a single institution in Saudi Arabia.

BACKGROUND AND OBJECTIVES: Because there is no recent update on the state of diabetes and its concomitant complications in Saudi Arabia, we undertook a study of the prevalence of health complications in patients with type 2 diabetes mellitus admitted to our institution. METHODS: We conducted a retrospective review of medical records of adult Saudi patients with type 2 diabetes who were seen in clinics or admitted to the Security Forces Hospital, Riyadh, Saudi Arabia, between January 1989 and January 2004. RESULTS: Of 1952 patients, 943 (48.3%) were males. For the whole study population the mean age at enrollment was 58.4+/-14.2 years, the mean age at onset of diabetes was 48.1+/-12.8 years, the mean duration of diabetes was 10.4+/-7.5 years, and the mean duration of follow-up was 7.9+/-4.6 years. Nephropathy was the most prevalent complication, occurring in 626 patients (32.1%). Acute coronary syndrome occurred in 451 (23.1%), cataracts in 447 (22.9%), retinopathy in 326 (16.7%), and myocardial infarction in 279 (14.3%), Doubling of serum creatinine was seen in 250 (12.8%) and 79 (4.0%) went into dialysis. Hypertension was present in 1524 (78.1%) and dyslipidemia in 764 (39.1%). Overall mortality was 8.2%. Multiple complications were frequent. Males had higher prevalence of complications than females (P<.05). Mortality was significantly higher in males 92 (9.8%) than females 69 (6.8%) (P=.024). The prevalence of complications significantly increased with duration of diabetes and age (P<.05). CONCLUSION: Among Saudis, the prevalence of concomitant diabetic complications is high, with cardiovascular and renal complications the most frequent. Many patients had multiple complications. Early and frequent screenings in the patients with type 2 diabetes are desirable to identify patients at high risk for concomitant complications and to prevent disabilities.

Public opinion on organ donation in Saudi Arabia.

To evaluate factors affecting the knowledge and/or attitudes of the Saudi Arabian public with respect to organ donation and transplantation, a cross sectional study was conducted on a random sample of 948 Saudi citizens between 20-60 years of age during 2005. The collected data included: knowledge about organ donation campaigns, knowledge of the Saudi Center for Organ Transplantation (SCOT), religious knowledge towards related issues, attitudes toward organ donation and self or close-relative experience of organ transplantation. The study revealed that 58.5% of participants heard about the existence of SCOT, 91.1% knew the need for organ donation, and 92.7 knew that organ donation could save lives. The organ donation campaign was known to 62.3% of the participants. Of these participants, 57.9% were made aware of organ donation campaigns through TV ads, 52.8% from magazines and newspapers and 11.7% from scientific sources. While 23.7% of the participants were unaware of any issued Islamic fatwa regarding organ donation, another 36.1% did not respond to this question revealing a lack of knowledge. Forty-two percent of the respondents agreed to donate their organs after death. Among the various reasons against organ donation, 27.5% feared that the act of organ donation contradicted their religious beliefs, while 3.5% believed that there was no benefit to organ donation. It is concluded that a need for proper information dissemination exists. A multidisciplinary approach is suggested including government support backed by strong recommendations from knowledgeable religious sources.

Knowledge of breast cancer and its risk and protective factors among women in Riyadh.

BACKGROUND: We conducted this study to assess knowledge of breast cancer and sources of information about breast cancer among women in Riyadh. We also analyzed whether associations existed between demographic variables, knowledge of breast cancer, and the practice of breast self-examination and use of mammography screening. METHODS: Women interested in participating in this community-based descriptive study provided data by completing a pre-tested structured RESULTS: Of 864 participating women, 84% were Saudi, 45% were married and 67.8% had a university level education. Eighty percent were between the ages of 20 to 50 years. Knowledge of breast self examination (BSE) was high; 82% (95% confidence intervals [CI], 79.2%-84.4%) knew about BSE, while 61% (95% CI: 57.9%-64.5%) knew about mammography, but only 41.2% (95% CI, 37.9%-44.5%) had performed BSE and 18.2% (95%CI, 15.5%-20.8%) had had mammography screening. Knowledge of breast cancer, risk factors and protective factors for breast cancer was moderate. There was a statistically significant association between the demographic characteristics (marital status, educational status and family history of breast cancer) and knowledge and practice of BSE and CONCLUSION: Though it has limitations, this study revealed an imbalance between the knowledge and practice of BSE among women. It also showed that there is only moderate knowledge of risk and protective factors for breast cancer and that knowledge and practice of BSE and mammograms vary according to marital and educational status. Hence, frequent community-based awareness programs are needed so that all women can know and practice BSE, which in turn helps to prevent breast cancer.

Effect of chronic viral hepatitis on graft survival in Saudi renal transplant patients.

BACKGROUND: In Saudi Arabia the prevalence of hepatitis C among hemodialysis patients is very high ranging from 60 to 80%. A large number of these dialysis patients go for renal transplant, resulting into a higher prevalence of hepatitis C virus (HCV) infection in renal transplant patients. Yet no current systematic report is available on the influence of hepatitis C status on patient and graft survival. The present study was therefore undertaken to address this objective. METHODS: Retrospective analysis of data of 448 renal transplantation subjects was undertaken. The mean follow-up period was 5.85 +/- 2.7 (median 5.3) years. The factors associated with renal graft survival were reviewed and these include: age, sex, and type of donor, immunosuppressive medication, episodes of infection, blood pressure, serum creatinine, and status of hepatitis. The primary end-points were renal graft function and patient survival. Logistic regression, COX regression analysis, and Kaplan-Meier survival estimates were used to evaluate the influence of hepatitis C on the above parameters. RESULTS: Among 448 recipients of first kidney transplant patients, 286 (63.8%) were positive for HCV infection. In the HCV-positive group, 204 (71.32%) were males. Kaplan-Meier survival analysis showed a significantly better graft survival for HCV-negative patients than HCV-positive patients (p < 0.001; log-rank test). Logistic regression analysis and COX regression analysis have shown different grades of graft dysfunction were present in HCV-positive patients after adjustment for covariates: age, sex, blood pressure, type of donor, and immunosuppressive medication; the presence of HCV was a major predictor of bad outcome and significantly influenced graft survival (odds ratio = 4.37; 95% Cl = 1.81-4.77). Significant deterioration of liver function was noted in HCV-positive patients at the last follow-up, taking ALT as a marker (ALT level 80.6 +/- 5.8 U/l at the last follow-up versus 49.5 +/- 32 U/l at baseline p < or = 0.0001). Sixteen patients had a chronic active course and 1 patient developed biopsy-proven liver cirrhosis and portal hypertension. A serious and significantly greater incidence of fatal chest infections was seen in HCV-positive patients. Although mortality was greater in HCV-positive versus HCV-negative patients (20 vs. 7), the difference did not attain statistical significance (p = 0.23) and none of the patients died as a result of hepatic failure. CONCLUSION: The presence of HCV infection greatly influenced graft survival in renal transplant patients and a higher proportion of infected patients had renal and hepatic dysfunction. A significant increase in fatal chest infections was noted in HCV-positive patients. Overall mortality was higher in HCV-positive patients, but it was not statistically significant. All measures should be taken to prevent HCV transmission in the dialysis population. Renal transplant recipients with HCV infection need close monitoring for both graft and liver function.

Perception of female students of king saud university towards premarital screening.

OBJECTIVES: The aim of this study was to investigate the perception of King Saud University female students towards the implementation of premarital screening (PMS) in the Kingdom of Saudi Arabia (KSA). METHODS: Two consecutive surveys on knowledge, attitudes and practice (KAP) were conducted two and nine months after the compulsory implementation of PMS in KSA in 1/1/1425H. The female students of King Saud University were given health education lectures before the survey. The first survey was done with a designed close-ended questionnaire distributed at pre and post stages of the health education lecture. However, the second one explored the participants' perception of the same items in open-ended questions summarized as a "consensus statement". In fulfillment of their demands, the signed statement was mailed to the legislative authorities. RESULTS AND DISCUSSION: A total of 140 university female students attended the first lecture. The response rate for both pre and post lecture surveys were 132 (94.3%) and 128 (91.4%) respectively. A total of 112 out of 132 (84.8%) students in the pre test and 111 out of 128 (86.7%) in the post-test were single. Of the married students 7/20 (35.0%) and 7/17 (41.2%) in pre and post tests had previously had PMS screening. The attitude of the students towards PMS was generally positive. One hundred and eight (81.8%) in the pre test and 110 (85.9%) in the post test saw the importance of PMS in controlling the commonest hereditary diseases. However, a smaller percentage of students (69.7% and 75.0%) in pre and post lecture respectively were in favor of the compulsory application of PMS in KSA. In spite of the positive attitude of all the students in the pre and post tests, fears were expressed towards the confidentiality of PMS test results and it was felt that social and psychological problems would ensue from abnormal results. This, however, does not represent the feeling of the entire population in KSA since the participants of the study formed a select group. The second awareness lecture was attended by 319 students from the College of Education. They were subsequently requested to state their perceptions of PMS application with regard to its content, nature and method of application in KSA in their own words. The collected forms were summarized into a "consensus statement" and signed by all 319 students. They felt that the scope of PMS should be extended to investigate and screen for other diseases especially sexually transmitted diseases that would adversely affect the health of members of the family and the community as a whole. Their worry about the lack of screening for other diseases may be because a majority of the study group were single and would, therefore, refuse to get married on account of the risks to their future offspring. In addition, it may reflect their knowledge of the effects of globalization on the transmission of diseases. CONCLUSIONS: Health education is an important means of improving the public's perception of newly-introduced health interventions. University students have a good perception of the compulsory implementation of PMS in KSA. Pre-marital screening could be extended to include a broader spectrum of health/genetic disorders and will be useful for early identification and possible intervention as well as the prevention of complications.

L-carnitine supplementation in hemodialysis patients.

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.

Complications of CAPD: A Single Center Experience.

To evaluate the complications of CAPD and their contributing factors in order to improve the patients' survival and reduce morbidity and mortality, we studied records of 65 CAPD patients treated at our hospital from October 1996 to January 2002. There were 32 (49%) males and the mean age of the patients was 48 +/- 16 years. All the patients were on the twin bag CAPD system. The mean duration of follow-up on CAPD was 29 +/- 20 months. There were 75 episodes of complications occurring in the patients with a rate of 0.41 episodes/patient years. Peritonitis was the most frequent and serious complication accounting for 55 episodes with a rate of 0.35 episodes/patient years. Only 51% of the episodes showed positive culture; the organisms included Staphylococcus epidermidis (18.2%), Staphylococcus aureus (3.6%), Pseudomonas (16.4%), E. coli (1.8%), Azadobacter (5.45%) and Serratia (3.6%). All the episodes of infection, except one, responded to treatment but 10 patients had recurrent infection; one patient was cured only after removal of the catheter. There were 12 exit site infection episodes and five catheters were removed due to mechanical and infectious reasons. Three patients were switched to hemodialysis (HD), nine patients were transplanted and 11 patients expired; none died due to peritonitis. We conclude that the mortality rate of the complications on CAPD has declined in the present study compared to our previous report early in the 1990s due mostly to the adoption of the twin bag CAPD system.

Plasma fibrinogen and its correlates in adult Saudi population.

OBJECTIVE: To determine plasma fibrinogen and its correlates in the adult Saudi population and to investigate hyperfibrinogenemia as a possible risk factor for cardiovascular diseases (CVD). METHODS: A cross-sectional survey was designed and carried out through multi-stage stratified cluster random sampling of every third house in 6 heterogeneously populated districts of Riyadh, Kingdom of Saudi Arabia, during the period 1999 to 2002. Demographic and clinical data of 2263 adult Saudi subjects, consisting of 1934 (85.5%) men and 329 (14.5%) women, was collected through a standard questionnaire. Body mass index (BMI), blood pressure (BP) and history of smoking were recorded. Plasma fibrinogen, total serum cholesterol, triglycerides, high density lipoproteins (HDL) and blood sugar were determined in fasting blood samples. RESULTS: The majority (84.6%) of the subjects were between 20-50 years of age. The mean plasma fibrinogen was 336 +/- 115 mg/dl, and was increasing with age both in men and women. The mean +/- SD fibrinogen in women (357 +/- 118 mg/dl) was significantly higher (p value of 0.03) than men (332 +/- 114 mg/dl). Hyperfibrinogenemia (>400 mg/dl) was indicated in 554 (24.6%) of the total subjects. Among hyperfibrinogenemic Saudi adults, the prevalence of hypercholesterolemia was 14.3%, hypertriglyceridemia 24%, obesity 26.3%, systolic/diastolic hypertension 11.5% and 11% and hyperglycemia 26% (in women only). A reciprocal relation was observed between HDL and plasm fibrinogen. Significant positive correlation was seen between fibrinogen and BMI, systolic and diastolic BP and total cholesterol. There was no significant difference in the distribution of plasma fibrinogen between smokers and non-smokers (p value of 0.864). The difference in the magnitude of metabolic as well as modifiable CVD risk factors between smokers and non-smokers was not significant, except serum triglyceride which was significantly higher in smokers than non-smokers (p value of 0.020). CONCLUSION: A significant positive correlation was observed between hyperfibrinogenemia and obesity, systolic/diastolic hypertension and hypercholesterolemia. Our results thus support the earlier reports that hyperfibrinogenemia is a potential CVD risk factor. Unlike other reports, we could not find any correlation between smoking and plasma fibrinogen in our studied subjects. The value of hyperfibrinogenemia as a definite risk factor for CVD has to be quantified in future case-control studies comparing its significance between CVD subjects and normal controls.

Spectrum and outcome of primary glomerulonephritis.

Glomerulonephritis (GN) is a major cause of chronic renal failure (CRF). To evaluate the trends and outcome with modern improved treatment strategies, we retrospectively reviewed the clinical records of 120 patients with biopsy proven primary GN at our center from January 1990 to June 2001. All the biopsy specimens were subjected to light, electron and immunofluorescent microscopy. The recorded clinical parameters included the presenting symptoms, blood pressure readings, complete blood count, urinalysis, 24-hr urinary protein excretion, creatinine clearance besides rendered therapy and the outcome. Focal segmental glomerulosclerosis was the most common GN and accounted for 56 (47.6%) cases. The frequency of other GN cases in our study included IgA GN in 21 (17.5%) patients, membranous GN in 20 (16.7%), minimal change disease (MCD) in 13 (10.8%), membranoproliferative GN in 4 (3.3%), post infection in 4 (3.3%) and rapidly progressive glomerulonephritis (RPGN) in 2 (1.7%). The type of nephropathy had great influence on outcome and response to therapy. The deterioration of patients with FSGS was the fastest of the glomerulopathies, and nine (16.1%) patients developed end-stage renal failure (ESRD). MCD and post infection GN had the best outcome. Corticosteroids alone along with supportive medication conferred good results in MCD, while combined therapies of mycophenolate mofetil (MMF) and/or cyclophosphamide with corticosteroids provided better outcomes in the rest of the GN. RPGN responded well to the cyclophosphamide and the patients did not develop ESRD. Hyperuricemia, high serum creatinine and hypertension predicted worse outcomes. The control of blood pressure and glucose, and treatment of hyperuricemia and hypoalbuminemia had salutary effect on the outcome. We conclude that due to the better delivered care the outcome of primary GN has improved over the years. However, FSGS is still the most frequently encountered primary GN and has the worst outcome. In the present study, combined therapies with corticosteroids and cytotoxic drugs and supportive therapy were associated with better outcome.