Browsing by Author "Hejaili, Fayez"

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Causes of Acute Thrombotic Microangiopathy in Patients Receiving Kidney Transplantation
(Başkent Üniversitesi, 2004-12) Jumani, Abdul; Hala, Kfoury; Tahir, Saadi; Al-Ghamdi, Ghormullah; Al-Flaiw, Ahmed; Hejaili, Fayez; Qureshi, Junaid; Raza, Hammad; Ghalib, Muhammed; Al-Khader, Abdullah
Objectives: Thrombotic microangiopathy is a well-known problem in patients following renal transplantation. In postrenal transplantation, thrombotic microangiopathy is often a reflection of hemolytic uremic syndrome. We aimed to determine the causes of thrombotic microangiopathy in a population of renal transplantation recipients and discuss the literature. Materials and Methods: We investigated the causes of thrombotic microangiopathy during a 1year period, from June 2003 to June 2004, at the King Fahad National Guard Hospital in Riyadh, Saudi Arabia, by reviewing the slides of all transplant biopsies (n = 25) performed during this interval. Pre- and posttransplant crossmatching was done when possible. Results: Five cases of thrombotic microangiopathy were found. Three of these cases were from the 25 transplantations performed at King Fahad National Guard Hospital, while the other 2 transplantations had been performed abroad and were referred to us for follow-up. Three cases were related to cyclosporine, and 1 case was secondary to both cyclosporine and tacrolimus. The fifth case had features of thrombotic microangiopathy related to an antiphospholipid syndrome in a patient with systemic lupus erythematosus. Conclusions: In the literature, the most-frequent cause of hemolytic uremic syndrome in patients following renal transplantation is recurrence of the hemolytic uremic syndrome. Other causes include drug-related (cyclosporine, tacrolimus) toxicity, procoagulant status, and antibody-mediated rejection. We found that the most-frequent cause of thrombotic microangiopathy was drug related, secondary mainly to cyclosporine. In the current study, the frequency of thrombotic micro-angiopathy was similar to the percentage reported in the literature (20%).
Cystatin C-based Formula is Superior to MDRD, Cockcroft-Gault and Nankivell Formulae in Estimating the Glomerular Filtration Rate in Renal Allografts
(Başkent Üniversitesi, 2009-12) Hejaili, Fayez; Sayyari, Abdulla A. Al; Tamimi, Waleed; Qutb, Ammar; Syed, Ghulam; Tamim, Hani M.; Jondeby, Mohammad Al; Jaradat, Maha; Ghamdi, Ghormullah Al; Qurashi, Salem Al; Flaiw, Ahmed
Objectives: There are conflicting reports on the reliability of the various glomerular filtration rate formula in renal allografts, to assess the performance of various glomerular filtration rate formula in estimating renal function of renal allografts. Materials and Methods: Glomerular filtration rate was measured using an isotope Tc99m DTPA in 97 renal transplant patients and estimated using modification of diet in renal disease, Cockroft-Gault formula, Nankivell, and a cystatin C-based formula. The overall performance of these formula was evaluated by calculating bias, accuracy and precision. Results: Mean age was 39.8 years (± 12.7), body mass index was 26.9 (± 6.3) and serum creatinine was 114.5 µmol/L (± 39.3). The mean measured glomerular filtration rate was 58.1 mL/min (± 25.6). The bias with modification of diet in renal disease was 7.7 (P = .03), with Cockroft-Gault formula it was 3.2 (P = .3), with Nankivell it was 10.3 (P = .0002), and with cystatin C it was 0.31 (P = .9) The precisions (r) for modification of diet in renal disease, Cockroft-Gault formula, Nankivell, and cystatin C were 0.26 (P = .01), 0.26 (P = .01), 0.42 (P = .0001), and 0.60 (P < .0001), respectively. We also investigated the impact of sex, age, body mass index, and glomerular filtration rate on the performance of these 4 formula. Conclusion: The best correlation, highest precision, accuracy, and least bias were seen when using cystatin C. The largest bias was seen when using Nankivell and modification of diet in renal disease formula.