complications and increases the likelihood of patients being discharged on the day of their operation.Our experience with embedded catheters is encouraging and matches other reports. The Finnish experience with embedded catheters (5) showed a high rate of subcutaneous leaks after externalization; however, they used single-cuffed catheters and we did not experience any such complications, except for the case when an iatrogenic hole was created at the time of externalization. There were also initial concerns that embedded catheters may suffer drainage problems, but this was not demonstrated in our study: only 1 in 19 catheters suffered initial drainage problems that necessitated replacement, a rate that compares well with complications of PD catheters inserted by other methods of insertion (6). Other reports from Europe (5,7,8) also reported no concerns of primary patency.Initially, Dasgupta and Moncrief postulated that embedded catheters would reduce bacterial colonization, leading to a reduced incidence of peritonitis (2,9); however, this particular benefit was not shown in a subsequent study (10). Perhaps this is the reason why embedding catheters has not been widely adopted in the UK and Europe. Nevertheless, should we reevaluate the potential advantages of this technique? The rate of day case insertion of PD catheters in the UK appears to be lower than that in North American units (personal communications). Even UK units with access to day surgical units generally admit patients postoperatively. Embedding catheters may have certain organizational and clinical advantages (11) that might increase the day case rate for units currently admitting patients overnight.
BACKGROUND:Little is known about the nature and the course of IgA nephropathy (IgAN) in Arab countries. The aim of this work was to study the spectrum of clinical presentation and histopathological findings at our institution.DESIGN AND SETTING:Retrospective review, all renal biopsies at the Mubarak Al Kabeer Hospital between January 2000 and December 2004.METHODS:Cases of IgA nephropathy were selected, and their medical records and biopsy findings were reviewed.RESULTS:Eighty patients (9.2% of all native kidney biopsies) were diagnosed to have IgAN nephropathy. Sixty-nine biopsies were included in the study;11 were excluded. Forty-three (62.3%) patients were male and 26 (37.7) patients were female. Fifty (72.5%) patients were below the age of 40 years. Mean (SD) duration of follow-up was 3.6 (1.3) years. The first presentation included nephritic-range proteinuria (49.3%) and renal impairment (50.7%). During the follow-up period, 56 (81.2%) patients were stable or improved. Hass classification of biopsies showed 36.2% had class I, 27.5% had class II, 13.0% had class III, 5.8% had class IV, and 17.4% had class V IgAN. Females had milder forms of the disease than males. Macroscopic hematuria and renal impairment at presentation were seen more in patients with class IV and V IgAN. The presenting serum creatinine and uric acid values were higher in those with Hass classes III to V. Deterioration of renal function during the follow-up period was more significant in the presence of hypertension, renal impairment, or macroscopic hematuria at the time of biopsy .CONCLUSION:The prevalence of IgAN in Kuwait is about 9.2%. Renal impairment or macroscopic hematuria at presentation was seen in patients with more aggressive renal lesions and contributed to poor outcome.
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