Amgad El-Agroudy | Arabian Gulf University (original) (raw)

Papers by Amgad El-Agroudy

Research paper thumbnail of Quality of Life in Kidney Donors: A Single-Center Experience

Background: Live kidney donation is used to treat end-stage renal disease, but it poses risks and... more Background: Live kidney donation is used to treat end-stage renal disease, but it poses risks and decisionmaking challenges for donors. This study examines kidney donors' long-term quality of life (QOL). Methods: We conducted a cross-sectional survey on kidney donors between 1982 and 2018. We used the Short Form-36 (SF-36) (Arabic version) to measure the donors' QOL. Out of 60 donors contacted, 44 agreed to participate and responded. Demographic information, donor-recipient relationships, and specific questions about the donation were collected and analyzed. Results: The mean age of the donors was 50.1 ± 11.7 years at follow-up, and 26 (59.1%) were males. Most donors were siblings and parents, accounting for 36.4% (n=16) each. The time since the donation was 111.5 ± 97.1 months. All donors decided voluntarily to donate and all of them would do it again if given a chance. However, one donor (2.3%) complained that the donation had caused problems in his marriage, while six donors (13.4%) experienced clinically relevant distress, and two donors (4.5%) experienced financial disadvantages. Donors had high QOL scores, with a mean score of 73.1 and 96.9 (on a scale of 1-100) for the eight subscales. The highest score was for role social functioning, while the lowest was for energy/fatigue. The mean scores for the four fatigue subscales were low, ranging from 61.8 to 86.8. The lowest score was for feeling calm and reassured, while the highest was for feeling frustrated. In social functioning, the highest score was for the effect of mental health on work performance (97.2). We analyzed various demographic factors and their correlation with QOL and found no significant correlation in most domains regarding sociodemographic characteristics. Conclusions: Our research indicates that most kidney donors have had a positive experience over the past four decades. Both male and female donors of all ages reported good long-term QOL, further enhanced by recognition and support from their families and friends. These findings provide further support for our current policy on organ donation.

Research paper thumbnail of Management of Idiopathic Nephrotic Syndrome: Co-Administration of Cyclosporine and Lyophilized Grapefruit Juice

Novel Techniques in Nutrition & Food Science, 2018

Research paper thumbnail of Association and prognostic impact of persistent left ventricular hypertrophy after live-donor kidney transplantation: a prospective study

Clinical and experimental nephrology, 2010

Persistent or de novo left ventricular hypertrophy (LVH) is a risk factor for cardiovascular dise... more Persistent or de novo left ventricular hypertrophy (LVH) is a risk factor for cardiovascular diseases and congestive heart failure following renal transplantation (RT). Our aim was to determine the associations and impact of persistent LVH on RT outcome. We included 72 live-donor renal allograft recipients with mean age of 28.5 years who had evidence of LVH at time of transplantation and had stable functioning grafts 1 year after transplantation. Cardiac status of all recipients was assessed before transplantation and at 1 year after transplantation by echocardiography. Recipients were subdivided into two groups according to persistence or regression of LVH 1 year after transplantation. The first group included 33 patients who had persistent LVH. The second group included 39 patients in whom LVH had regressed (control group). Both groups were closely followed for 10 years. Univariate analysis showed that persistent LVH 1 year after RT was significantly associated with high serum cre...

Research paper thumbnail of Long-term graft outcome in patients with chronic allograft nephropathy after immunosuppression modifications

Clinical and Experimental Nephrology, 2008

This retrospective study was conducted to assess the efficacy and safety of immunosuppression con... more This retrospective study was conducted to assess the efficacy and safety of immunosuppression conversion on progression of chronic allograft nephropathy (CAN). One hundred-seventy four cyclosporin (CsA)-treated renal transplant recipients were studied. Patients were included if they had a biopsy-proven CAN (mild to moderate) with serum creatinine < or =3.5 mg/dL. Patients were treated with either: (A) MMF/reduced dose CsA [MMF for azathioprine (Aza)] (n=132); (B) Aza/Tac for CsA (n=42). Patient records were checked for graft function and survival, co-morbidities after conversion. Mean follow-up before conversion was 52.2+/-31.1 and 47.9+/-27.4 month in-group A and B, respectively. There was a significant deterioration of graft function in-group B after 5-years (P<0.5). Ten-year actuarial graft survival was 38% in-group A and 19% in-group B (P=0.04). Nine patients started dialysis within 12 months. Tacrolimus-treated patients had a lower insignificant incidence of hyperlipidemia (P=0.05), but a significantly higher incidence of diabetes mellitus (P=0.04).There was no significant change or difference in blood pressure between groups. Our results suggest that in patients with CAN and deteriorating allograft function, CsA minimization and addition of MMF achieved favorable efficacies in retarding the decline of graft function. Further prospective studies with larger cohorts are needed for validation.

Research paper thumbnail of Study of malignancy among egyptian kidney transplant recipients

Transplantation Proceedings, 1997

Transplantation Proceedings, Volume 29, Issue 7, Pages 3067-3070, November 1997, Authors:MA Bakr;... more Transplantation Proceedings, Volume 29, Issue 7, Pages 3067-3070, November 1997, Authors:MA Bakr; M. Sobh; A. el-Agroudy; S. Sally; MA Fouda; M. el-Mekresh; F. Moustafa; M. el-Baz; E. Wafa; MA Ghoneim. Advertisement. ...

Research paper thumbnail of Effect of Intravenous Immunoglobulin and Simvastatin on Suppression of Hla Alloantibodies in Sensitized Transplant Candidates

Transplantation Journal, 2004

Research paper thumbnail of Parenteral Iron Therapy in Treatment of Anemia in End-Stage Renal Disease Patients: A Comparative Study between Iron Saccharate and Gluconate

Nephron Clinical Practice, 2005

Research paper thumbnail of Effect of High-Dose Intravenous Immunoglobulin on Amyotrophic Lateral Sclerosis and Multifocal Motor Neuropathy

Archives of Neurology, 1994

ABSTRACT To determine if high-dose intravenous immunoglobulin therapy is effective in improving m... more ABSTRACT To determine if high-dose intravenous immunoglobulin therapy is effective in improving muscle strength or in arresting the pace of disease progression in patients with rapidly progressive amyotrophic lateral sclerosis. An open-label pilot study of intravenous infusions of high-dose immunoglobulin administered once a month for 3 months in nine patients with classic amyotrophic lateral sclerosis. Selected patients had a rapidly progressive course with signs of worsening noticeably evident every 6 weeks prior to therapy. A patient with multifocal motor neuropathy with conduction block that presented as a lower motor neuron syndrome was concurrently treated to document the efficacy of the same preparation of immunoglobulin in a potentially treatable disease that simulates lower motor neuron syndrome. The efficacy of high-dose intravenous immunoglobulin infusions was assessed by objective measurement of maximum voluntary isometric contraction in all muscle groups of two limbs before and after therapy. The Clinical Center of the National Institutes of Health, Bethesda, Md. All patients with amyotrophic lateral sclerosis worsened during the study. By the end of the third month, their mean total muscle scores (megascores) had declined by 71.2 points, from a mean of 369.7 (range, 200 to 605) to 298.5 (range, 130 to 552) points. The pace of progression did not change during the 4-month observation period. In contrast, the patient with multifocal motor neuropathy responded to intravenous immunoglobulin therapy and increased his megascores by 146 points after 3 months. The GM1 antibody titers were normal in all the patients. High-dose intravenous immunoglobulin, a prohibitively expensive drug, has no apparent therapeutic role in improving the symptoms or arresting the pace of progression in patients with amyotrophic lateral sclerosis. In contrast, multifocal motor neuropathy is an immunopathologically different disease that responds to intravenous immunoglobulin therapy.

Research paper thumbnail of Steroid-avoidance immunosuppression regimen in live-donor renal allotransplant recipients: a prospective, randomized, controlled study

Experimental and Clinical Transplantation, 2007

Steroids have occupied a major role in renal transplantation for more than 4 decades. However, ch... more Steroids have occupied a major role in renal transplantation for more than 4 decades. However, chronic use of steroids is associated with numerous comorbidities. We sought to elucidate the safety and efficacy of a steroid-free immunosuppression regimen in live-donor renal transplant recipients. One hundred patients were randomized to receive tacrolimus, mycophenolate mofetil, basiliximab induction, and steroids only for 3 days (experimental group, n=50 patients) or tacrolimus, mycophenolate mofetil, basiliximab induction, and steroid maintenance (control group, n=50 patients,). The median follow-up was 12 months. Patient and graft survival rates were 100% in both groups. The rate of biopsy-proven acute rejection was 16% in both groups. For patients in the control group, the mean serum creatinine level was 111.22 micromol /L compared with 110.39 micromol/L in patients in the experimental group. Posttransplant hypertension was encountered in 4% of the patients in the experimental grou...

Research paper thumbnail of Can intravenous immunoglobulin and simvastatin solve the problem of sensitization in renal transplant candidates?

International Urology and Nephrology, 2007

The value of intravenous immunoglobulin (IVIG) and simvastatin as potential modalities for the tr... more The value of intravenous immunoglobulin (IVIG) and simvastatin as potential modalities for the treatment of sensitized patients was evaluated by testing the efficacy of these agents on a relatively large cohort of adult hemodialysis patients (11) who were waiting for renal allotransplantation at our center. The patients had persistently positive crossmatches with their living related donors and a panel reactive antibody titer of more than 20%. All patients received IVIG (500 mg/kg per day on alternate days for a total of six doses); panel reactive antibody (PRA) titer and crossmatch testing were carried out after each dose and before each subsequent one. Two months after the last dose, eight patients received simvastatin (20 mg/day) for a period of 2 months; PRA titer and crossmatch testing were carried out every two weeks. Only four patients showed an insignificant reduction of PRA activity (P = 0.36); no patient attained a negative crossmatch. Simvastatin

Research paper thumbnail of Management of sensitized patients awaiting renal transplantation: Does sequential therapy of intravenous immunoglobulin and simvastatin offer a solution?

European Journal of Pharmacology, 2007

Research paper thumbnail of Histologic and Clinical Findings in Living Donor Allografts with Long-Term Stable Function

American Journal of Nephrology, 2006

Protocol biopsy is an important strategy which assesses the histological changes that can occur i... more Protocol biopsy is an important strategy which assesses the histological changes that can occur in the renal allograft and adversely affect its outcome. We aimed to evaluate histological changes in long-term living donor transplants. Elective biopsies were done for 120 live donor renal transplant recipients with well-functioning grafts and no rejection history at least 1 year or more after transplant. All patients had serum creatinine levels <2 mg/dl. The histopathological findings using the chronic allograft damage index score were correlated with different clinical and immunological parameters. Chronic tubulointerstitial fibrosis was the most prevalent finding (85% of cases), mostly of mild degree. Normal biopsies were reported in only 7.5% of cases, whereas chronic cyclosporine nephrotoxicity was detected in 5.8% of biopsies. Posttransplant hypertension was significantly correlated with glomerulosclerosis, and posttransplant diabetes with glomerulosclerosis, mesangial matrix increase, tubular atrophy and interstitial fibrosis. The main risk factors associated with a high chronic allograft damage index score were DR mismatching, posttransplant diabetes and time of biopsy. All histopathological changes increased with advancing donor age and declining graft function. Elective biopsies showed that histopathological findings do exist even with stable renal function that may pave the way for predicting long-term graft outcome.

Research paper thumbnail of Histological Characterization of HCV-Associated Glomerulopathy in Egyptian Patients

International Urology and Nephrology, 2005

Research paper thumbnail of Renal Data from the Arab World

The purpose of this study was to investigate the relation between selected demographic and clinic... more The purpose of this study was to investigate the relation between selected demographic and clinical characteristics and quality of life (QOL) scores in patients with end-stage renal disease who receive dialysis. We conducted the study at one hemodialysis (HD) unit in Bahrain from May 2018 to July 2018. We used standard QOL Index (QOLI) score instrument in Arabic form. This study included 100 patients (66 men and 34 women), aged 22 to 80 years on treatment with maintenance HD for four to 190 months. Inclusion criteria were as follows: those aged >18 years with no severe morbidities or psychological diseases and were on dialysis for at least three months. The following QOL scores were recorded: the health and functioning domain (64.8 ± 15.3), the social and economic domain (65.6 ± 14.1), the psychological/spiritual domain (74.9 ± 14.3), and the family subscale domain (75.9 ± 14.5). Male patients had reduced QOL though not statistically significant and younger patients had better QOL scores. The QOL scores revealed a decreasing trend with decreasing level of education, and they were higher among those who were not working and stayed at home. In addition, the family subclass scores were significantly higher among the married patients. Correlations between the demographic characteristics and QOL scores showed that there was a significant negative correlation between family domain and educational level and marital status, while there was a significant positive correlation between residence and psychological domain.

Research paper thumbnail of Steroid-avoidance immunosuppression regimen in live-donor renal allotransplant recipients: a prospective, randomized, controlled study

Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2007

OBJECTIVES Steroids have occupied a major role in renal transplantation for more than 4 decades. ... more OBJECTIVES Steroids have occupied a major role in renal transplantation for more than 4 decades. However, chronic use of steroids is associated with numerous comorbidities. We sought to elucidate the safety and efficacy of a steroid-free immunosuppression regimen in live-donor renal transplant recipients. PATIENTS AND METHODS One hundred patients were randomized to receive tacrolimus, mycophenolate mofetil, basiliximab induction, and steroids only for 3 days (experimental group, n=50 patients) or tacrolimus, mycophenolate mofetil, basiliximab induction, and steroid maintenance (control group, n=50 patients,). The median follow-up was 12 months. RESULTS Patient and graft survival rates were 100% in both groups. The rate of biopsy-proven acute rejection was 16% in both groups. For patients in the control group, the mean serum creatinine level was 111.22 micromol /L compared with 110.39 micromol/L in patients in the experimental group. Posttransplant hypertension was encountered in 4% ...

Research paper thumbnail of Editorial Board/Masthead

Research paper thumbnail of Hepatic dysfunction in kidney transplant recipients: prevalence and impact on graft and patient survival

Clinical and experimental nephrology, 2007

Liver disease has emerged as an important cause of morbidity and mortality in renal transplant re... more Liver disease has emerged as an important cause of morbidity and mortality in renal transplant recipients. Liver insufficiency is the cause of death in up to 28% of long-term survivors after renal transplantation. The aim of this work was to evaluate the prevalence and causes of hepatic dysfunction in renal transplant recipients in Egypt, and its impact on both renal graft function and patient survival. This study comprised 447 kidney transplant recipients who received their grafts between January 1999 and December 2003 at Mansoura Urology and Nephrology Center. Among these recipients, 104 patients showed persistent hepatic dysfunction, while the remaining 343 had normal liver function or transient hepatic dysfunction of less than 6 months' duration. We found that the prevalence of persistent hepatic dysfunction in our recipients was 23.3%. Infections such as hepatitis C virus (HCV;, with longer dialysis duration and blood transfusion as risk factors), HBV, and cytomegalovirus (...

Research paper thumbnail of Treatment of osteopenia and osteoporosis in renal transplant children and adolescents

Pediatric Transplantation, 2004

Treatment of osteopenia and osteoporosis in renal transplant children and adolescents Kidney tran... more Treatment of osteopenia and osteoporosis in renal transplant children and adolescents Kidney transplantation corrects most of the metabolic abnormalities that cause renal osteodystrophy. However, many transplanted patients develop osteoporosis and other bone lesions that are related, at least in part, to their immunosuppressive regimen (1). Few studies were concerned with the value of preventive and therapeutic interventions for post-transplant bone disease; moreover, none of them were carried out for children. Most pharmacologic agents available for therapy of osteoporosis have not been subject to prospective controlled studies in organ transplant recipients. This prompted us to enroll our patients with post-transplant osteopenia or osteoporosis in a prospective randomized study to demonstrate the value of various pharmacologic agents on post-transplant bone disease. Cyclical therapy with clodronate or calcitonin appears to induce a gain in BMD at the lumbar spine in patients with low bone mass after kidney transplantation (2). Cruz et al. (3) found that renal transplant patients with osteoporosis and biochemical parameters of high bone turnover are at continued risk for bone loss and therapy El-Husseini AA, El-Agroudy AE, El-Sayed MF, Sobh MA, Ghoneim MA. Treatment of osteopenia and osteoporosis in renal transplant children and adolescents.

Research paper thumbnail of Impact of schistosomiasis on patient and graft outcome after renal transplantation: 10 years' follow-up

Nephrology Dialysis Transplantation, 2001

Background. Schistosomiasis is a major health problem in some areas of the world. Schistosomalspe... more Background. Schistosomiasis is a major health problem in some areas of the world. Schistosomalspecific nephropathy is a well-known occurrence and eventually leads to end-stage renal failure. Patients with schistosomal infection were considered to be suitable recipients for renal transplantation. However, the long-term impact of schistosomiasis on kidney transplantation is not yet been reported. Methods. The long-term impact of schistosomiasis on patient and graft outcomes was studied by comparing two groups of subjects from a total of 243 patients. Group I consisted of cases with schistosomal infections and group II consisted of schistosoma-free controls. Schistosomiasis was documented in group I by identifying schistosoma eggs in urine, stool or rectal mucosal biopsy. Also intra-operative biopsies from bladder mucosa of the graft recipients and from the lower end of the ureter of living donors were obtained to search for schistosoma eggs. Results. Sixty-three cases of schistosomiasis were diagnosed in both recipients and donors, 65 cases in recipients only, and eight cases in donors only. Infected recipients and donors with active lesions were treated at least 1 month before transplantation by combined antischistosomal drugs (praziquantel and oxamniquine). The 243 patients (136 schistosomainfected cases and 107 controls) were followed regularly for a period of 10 years after transplantation. We found that there was no significant difference in the incidence of acute and chronic rejection between the groups; however, higher cyclosporin doses were needed for the infected group with subsequent higher incidence of both acute and chronic cyclosporin nephrotoxicity. Moreover, the schistosomal group had a significantly higher incidence of urinary tract infection and urological complications with no evidence of schistosomal re-infection.

Research paper thumbnail of A Prospective Randomized Study for the Treatment of Bone Loss with Vitamin D During Kidney Transplantion in Children and Adolescents

American Journal of Transplantation, 2004

The effect of treatment with alfacalcidol on posttransplantation bone loss in children and adoles... more The effect of treatment with alfacalcidol on posttransplantation bone loss in children and adolescents was investigated. Of the 63 young patients who received renal transplant and were subjected to dual-energy x-ray absorptiometry (DEXA), 30 patients had low-bone mineral density (BMD) (z-score ≤ −1) and were enrolled into the study. Their mean age at the time of transplantation was 14.5 ± 4.0 years and the mean duration after transplantation was 48 ± 34 months. Patients with low BMD were randomized into two equal homogeneous groups: group 1 (control) received placebo and group 2 received daily alfacalcidol 0.25 lg by mouth. Parameters of bone metabolism (intact parathyroid hormone, serum osteocalcin and urinary deoxypyridinoline) and BMD were assessed before and after the study period. After 12 months of treatment BMD at the lumber spine decreased from −2.2 to −2.5 in group 1 while it increased from −2.1 to −0.6 in group 2 (p < 0.001). Serum intact parathyroid hormone level decreased significantly in group 2 (p = 0.042). Apart from transient hypercalcemia in 1 patient in group 2, no other significant adverse effects were noted. This study suggested the value of alfacalcidol in the treatment of bone loss in young renal transplant recipients.

Research paper thumbnail of Quality of Life in Kidney Donors: A Single-Center Experience

Background: Live kidney donation is used to treat end-stage renal disease, but it poses risks and... more Background: Live kidney donation is used to treat end-stage renal disease, but it poses risks and decisionmaking challenges for donors. This study examines kidney donors' long-term quality of life (QOL). Methods: We conducted a cross-sectional survey on kidney donors between 1982 and 2018. We used the Short Form-36 (SF-36) (Arabic version) to measure the donors' QOL. Out of 60 donors contacted, 44 agreed to participate and responded. Demographic information, donor-recipient relationships, and specific questions about the donation were collected and analyzed. Results: The mean age of the donors was 50.1 ± 11.7 years at follow-up, and 26 (59.1%) were males. Most donors were siblings and parents, accounting for 36.4% (n=16) each. The time since the donation was 111.5 ± 97.1 months. All donors decided voluntarily to donate and all of them would do it again if given a chance. However, one donor (2.3%) complained that the donation had caused problems in his marriage, while six donors (13.4%) experienced clinically relevant distress, and two donors (4.5%) experienced financial disadvantages. Donors had high QOL scores, with a mean score of 73.1 and 96.9 (on a scale of 1-100) for the eight subscales. The highest score was for role social functioning, while the lowest was for energy/fatigue. The mean scores for the four fatigue subscales were low, ranging from 61.8 to 86.8. The lowest score was for feeling calm and reassured, while the highest was for feeling frustrated. In social functioning, the highest score was for the effect of mental health on work performance (97.2). We analyzed various demographic factors and their correlation with QOL and found no significant correlation in most domains regarding sociodemographic characteristics. Conclusions: Our research indicates that most kidney donors have had a positive experience over the past four decades. Both male and female donors of all ages reported good long-term QOL, further enhanced by recognition and support from their families and friends. These findings provide further support for our current policy on organ donation.

Research paper thumbnail of Management of Idiopathic Nephrotic Syndrome: Co-Administration of Cyclosporine and Lyophilized Grapefruit Juice

Novel Techniques in Nutrition & Food Science, 2018

Research paper thumbnail of Association and prognostic impact of persistent left ventricular hypertrophy after live-donor kidney transplantation: a prospective study

Clinical and experimental nephrology, 2010

Persistent or de novo left ventricular hypertrophy (LVH) is a risk factor for cardiovascular dise... more Persistent or de novo left ventricular hypertrophy (LVH) is a risk factor for cardiovascular diseases and congestive heart failure following renal transplantation (RT). Our aim was to determine the associations and impact of persistent LVH on RT outcome. We included 72 live-donor renal allograft recipients with mean age of 28.5 years who had evidence of LVH at time of transplantation and had stable functioning grafts 1 year after transplantation. Cardiac status of all recipients was assessed before transplantation and at 1 year after transplantation by echocardiography. Recipients were subdivided into two groups according to persistence or regression of LVH 1 year after transplantation. The first group included 33 patients who had persistent LVH. The second group included 39 patients in whom LVH had regressed (control group). Both groups were closely followed for 10 years. Univariate analysis showed that persistent LVH 1 year after RT was significantly associated with high serum cre...

Research paper thumbnail of Long-term graft outcome in patients with chronic allograft nephropathy after immunosuppression modifications

Clinical and Experimental Nephrology, 2008

This retrospective study was conducted to assess the efficacy and safety of immunosuppression con... more This retrospective study was conducted to assess the efficacy and safety of immunosuppression conversion on progression of chronic allograft nephropathy (CAN). One hundred-seventy four cyclosporin (CsA)-treated renal transplant recipients were studied. Patients were included if they had a biopsy-proven CAN (mild to moderate) with serum creatinine &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =3.5 mg/dL. Patients were treated with either: (A) MMF/reduced dose CsA [MMF for azathioprine (Aza)] (n=132); (B) Aza/Tac for CsA (n=42). Patient records were checked for graft function and survival, co-morbidities after conversion. Mean follow-up before conversion was 52.2+/-31.1 and 47.9+/-27.4 month in-group A and B, respectively. There was a significant deterioration of graft function in-group B after 5-years (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.5). Ten-year actuarial graft survival was 38% in-group A and 19% in-group B (P=0.04). Nine patients started dialysis within 12 months. Tacrolimus-treated patients had a lower insignificant incidence of hyperlipidemia (P=0.05), but a significantly higher incidence of diabetes mellitus (P=0.04).There was no significant change or difference in blood pressure between groups. Our results suggest that in patients with CAN and deteriorating allograft function, CsA minimization and addition of MMF achieved favorable efficacies in retarding the decline of graft function. Further prospective studies with larger cohorts are needed for validation.

Research paper thumbnail of Study of malignancy among egyptian kidney transplant recipients

Transplantation Proceedings, 1997

Transplantation Proceedings, Volume 29, Issue 7, Pages 3067-3070, November 1997, Authors:MA Bakr;... more Transplantation Proceedings, Volume 29, Issue 7, Pages 3067-3070, November 1997, Authors:MA Bakr; M. Sobh; A. el-Agroudy; S. Sally; MA Fouda; M. el-Mekresh; F. Moustafa; M. el-Baz; E. Wafa; MA Ghoneim. Advertisement. ...

Research paper thumbnail of Effect of Intravenous Immunoglobulin and Simvastatin on Suppression of Hla Alloantibodies in Sensitized Transplant Candidates

Transplantation Journal, 2004

Research paper thumbnail of Parenteral Iron Therapy in Treatment of Anemia in End-Stage Renal Disease Patients: A Comparative Study between Iron Saccharate and Gluconate

Nephron Clinical Practice, 2005

Research paper thumbnail of Effect of High-Dose Intravenous Immunoglobulin on Amyotrophic Lateral Sclerosis and Multifocal Motor Neuropathy

Archives of Neurology, 1994

ABSTRACT To determine if high-dose intravenous immunoglobulin therapy is effective in improving m... more ABSTRACT To determine if high-dose intravenous immunoglobulin therapy is effective in improving muscle strength or in arresting the pace of disease progression in patients with rapidly progressive amyotrophic lateral sclerosis. An open-label pilot study of intravenous infusions of high-dose immunoglobulin administered once a month for 3 months in nine patients with classic amyotrophic lateral sclerosis. Selected patients had a rapidly progressive course with signs of worsening noticeably evident every 6 weeks prior to therapy. A patient with multifocal motor neuropathy with conduction block that presented as a lower motor neuron syndrome was concurrently treated to document the efficacy of the same preparation of immunoglobulin in a potentially treatable disease that simulates lower motor neuron syndrome. The efficacy of high-dose intravenous immunoglobulin infusions was assessed by objective measurement of maximum voluntary isometric contraction in all muscle groups of two limbs before and after therapy. The Clinical Center of the National Institutes of Health, Bethesda, Md. All patients with amyotrophic lateral sclerosis worsened during the study. By the end of the third month, their mean total muscle scores (megascores) had declined by 71.2 points, from a mean of 369.7 (range, 200 to 605) to 298.5 (range, 130 to 552) points. The pace of progression did not change during the 4-month observation period. In contrast, the patient with multifocal motor neuropathy responded to intravenous immunoglobulin therapy and increased his megascores by 146 points after 3 months. The GM1 antibody titers were normal in all the patients. High-dose intravenous immunoglobulin, a prohibitively expensive drug, has no apparent therapeutic role in improving the symptoms or arresting the pace of progression in patients with amyotrophic lateral sclerosis. In contrast, multifocal motor neuropathy is an immunopathologically different disease that responds to intravenous immunoglobulin therapy.

Research paper thumbnail of Steroid-avoidance immunosuppression regimen in live-donor renal allotransplant recipients: a prospective, randomized, controlled study

Experimental and Clinical Transplantation, 2007

Steroids have occupied a major role in renal transplantation for more than 4 decades. However, ch... more Steroids have occupied a major role in renal transplantation for more than 4 decades. However, chronic use of steroids is associated with numerous comorbidities. We sought to elucidate the safety and efficacy of a steroid-free immunosuppression regimen in live-donor renal transplant recipients. One hundred patients were randomized to receive tacrolimus, mycophenolate mofetil, basiliximab induction, and steroids only for 3 days (experimental group, n=50 patients) or tacrolimus, mycophenolate mofetil, basiliximab induction, and steroid maintenance (control group, n=50 patients,). The median follow-up was 12 months. Patient and graft survival rates were 100% in both groups. The rate of biopsy-proven acute rejection was 16% in both groups. For patients in the control group, the mean serum creatinine level was 111.22 micromol /L compared with 110.39 micromol/L in patients in the experimental group. Posttransplant hypertension was encountered in 4% of the patients in the experimental grou...

Research paper thumbnail of Can intravenous immunoglobulin and simvastatin solve the problem of sensitization in renal transplant candidates?

International Urology and Nephrology, 2007

The value of intravenous immunoglobulin (IVIG) and simvastatin as potential modalities for the tr... more The value of intravenous immunoglobulin (IVIG) and simvastatin as potential modalities for the treatment of sensitized patients was evaluated by testing the efficacy of these agents on a relatively large cohort of adult hemodialysis patients (11) who were waiting for renal allotransplantation at our center. The patients had persistently positive crossmatches with their living related donors and a panel reactive antibody titer of more than 20%. All patients received IVIG (500 mg/kg per day on alternate days for a total of six doses); panel reactive antibody (PRA) titer and crossmatch testing were carried out after each dose and before each subsequent one. Two months after the last dose, eight patients received simvastatin (20 mg/day) for a period of 2 months; PRA titer and crossmatch testing were carried out every two weeks. Only four patients showed an insignificant reduction of PRA activity (P = 0.36); no patient attained a negative crossmatch. Simvastatin

Research paper thumbnail of Management of sensitized patients awaiting renal transplantation: Does sequential therapy of intravenous immunoglobulin and simvastatin offer a solution?

European Journal of Pharmacology, 2007

Research paper thumbnail of Histologic and Clinical Findings in Living Donor Allografts with Long-Term Stable Function

American Journal of Nephrology, 2006

Protocol biopsy is an important strategy which assesses the histological changes that can occur i... more Protocol biopsy is an important strategy which assesses the histological changes that can occur in the renal allograft and adversely affect its outcome. We aimed to evaluate histological changes in long-term living donor transplants. Elective biopsies were done for 120 live donor renal transplant recipients with well-functioning grafts and no rejection history at least 1 year or more after transplant. All patients had serum creatinine levels &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;2 mg/dl. The histopathological findings using the chronic allograft damage index score were correlated with different clinical and immunological parameters. Chronic tubulointerstitial fibrosis was the most prevalent finding (85% of cases), mostly of mild degree. Normal biopsies were reported in only 7.5% of cases, whereas chronic cyclosporine nephrotoxicity was detected in 5.8% of biopsies. Posttransplant hypertension was significantly correlated with glomerulosclerosis, and posttransplant diabetes with glomerulosclerosis, mesangial matrix increase, tubular atrophy and interstitial fibrosis. The main risk factors associated with a high chronic allograft damage index score were DR mismatching, posttransplant diabetes and time of biopsy. All histopathological changes increased with advancing donor age and declining graft function. Elective biopsies showed that histopathological findings do exist even with stable renal function that may pave the way for predicting long-term graft outcome.

Research paper thumbnail of Histological Characterization of HCV-Associated Glomerulopathy in Egyptian Patients

International Urology and Nephrology, 2005

Research paper thumbnail of Renal Data from the Arab World

The purpose of this study was to investigate the relation between selected demographic and clinic... more The purpose of this study was to investigate the relation between selected demographic and clinical characteristics and quality of life (QOL) scores in patients with end-stage renal disease who receive dialysis. We conducted the study at one hemodialysis (HD) unit in Bahrain from May 2018 to July 2018. We used standard QOL Index (QOLI) score instrument in Arabic form. This study included 100 patients (66 men and 34 women), aged 22 to 80 years on treatment with maintenance HD for four to 190 months. Inclusion criteria were as follows: those aged >18 years with no severe morbidities or psychological diseases and were on dialysis for at least three months. The following QOL scores were recorded: the health and functioning domain (64.8 ± 15.3), the social and economic domain (65.6 ± 14.1), the psychological/spiritual domain (74.9 ± 14.3), and the family subscale domain (75.9 ± 14.5). Male patients had reduced QOL though not statistically significant and younger patients had better QOL scores. The QOL scores revealed a decreasing trend with decreasing level of education, and they were higher among those who were not working and stayed at home. In addition, the family subclass scores were significantly higher among the married patients. Correlations between the demographic characteristics and QOL scores showed that there was a significant negative correlation between family domain and educational level and marital status, while there was a significant positive correlation between residence and psychological domain.

Research paper thumbnail of Steroid-avoidance immunosuppression regimen in live-donor renal allotransplant recipients: a prospective, randomized, controlled study

Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2007

OBJECTIVES Steroids have occupied a major role in renal transplantation for more than 4 decades. ... more OBJECTIVES Steroids have occupied a major role in renal transplantation for more than 4 decades. However, chronic use of steroids is associated with numerous comorbidities. We sought to elucidate the safety and efficacy of a steroid-free immunosuppression regimen in live-donor renal transplant recipients. PATIENTS AND METHODS One hundred patients were randomized to receive tacrolimus, mycophenolate mofetil, basiliximab induction, and steroids only for 3 days (experimental group, n=50 patients) or tacrolimus, mycophenolate mofetil, basiliximab induction, and steroid maintenance (control group, n=50 patients,). The median follow-up was 12 months. RESULTS Patient and graft survival rates were 100% in both groups. The rate of biopsy-proven acute rejection was 16% in both groups. For patients in the control group, the mean serum creatinine level was 111.22 micromol /L compared with 110.39 micromol/L in patients in the experimental group. Posttransplant hypertension was encountered in 4% ...

Research paper thumbnail of Editorial Board/Masthead

Research paper thumbnail of Hepatic dysfunction in kidney transplant recipients: prevalence and impact on graft and patient survival

Clinical and experimental nephrology, 2007

Liver disease has emerged as an important cause of morbidity and mortality in renal transplant re... more Liver disease has emerged as an important cause of morbidity and mortality in renal transplant recipients. Liver insufficiency is the cause of death in up to 28% of long-term survivors after renal transplantation. The aim of this work was to evaluate the prevalence and causes of hepatic dysfunction in renal transplant recipients in Egypt, and its impact on both renal graft function and patient survival. This study comprised 447 kidney transplant recipients who received their grafts between January 1999 and December 2003 at Mansoura Urology and Nephrology Center. Among these recipients, 104 patients showed persistent hepatic dysfunction, while the remaining 343 had normal liver function or transient hepatic dysfunction of less than 6 months' duration. We found that the prevalence of persistent hepatic dysfunction in our recipients was 23.3%. Infections such as hepatitis C virus (HCV;, with longer dialysis duration and blood transfusion as risk factors), HBV, and cytomegalovirus (...

Research paper thumbnail of Treatment of osteopenia and osteoporosis in renal transplant children and adolescents

Pediatric Transplantation, 2004

Treatment of osteopenia and osteoporosis in renal transplant children and adolescents Kidney tran... more Treatment of osteopenia and osteoporosis in renal transplant children and adolescents Kidney transplantation corrects most of the metabolic abnormalities that cause renal osteodystrophy. However, many transplanted patients develop osteoporosis and other bone lesions that are related, at least in part, to their immunosuppressive regimen (1). Few studies were concerned with the value of preventive and therapeutic interventions for post-transplant bone disease; moreover, none of them were carried out for children. Most pharmacologic agents available for therapy of osteoporosis have not been subject to prospective controlled studies in organ transplant recipients. This prompted us to enroll our patients with post-transplant osteopenia or osteoporosis in a prospective randomized study to demonstrate the value of various pharmacologic agents on post-transplant bone disease. Cyclical therapy with clodronate or calcitonin appears to induce a gain in BMD at the lumbar spine in patients with low bone mass after kidney transplantation (2). Cruz et al. (3) found that renal transplant patients with osteoporosis and biochemical parameters of high bone turnover are at continued risk for bone loss and therapy El-Husseini AA, El-Agroudy AE, El-Sayed MF, Sobh MA, Ghoneim MA. Treatment of osteopenia and osteoporosis in renal transplant children and adolescents.

Research paper thumbnail of Impact of schistosomiasis on patient and graft outcome after renal transplantation: 10 years' follow-up

Nephrology Dialysis Transplantation, 2001

Background. Schistosomiasis is a major health problem in some areas of the world. Schistosomalspe... more Background. Schistosomiasis is a major health problem in some areas of the world. Schistosomalspecific nephropathy is a well-known occurrence and eventually leads to end-stage renal failure. Patients with schistosomal infection were considered to be suitable recipients for renal transplantation. However, the long-term impact of schistosomiasis on kidney transplantation is not yet been reported. Methods. The long-term impact of schistosomiasis on patient and graft outcomes was studied by comparing two groups of subjects from a total of 243 patients. Group I consisted of cases with schistosomal infections and group II consisted of schistosoma-free controls. Schistosomiasis was documented in group I by identifying schistosoma eggs in urine, stool or rectal mucosal biopsy. Also intra-operative biopsies from bladder mucosa of the graft recipients and from the lower end of the ureter of living donors were obtained to search for schistosoma eggs. Results. Sixty-three cases of schistosomiasis were diagnosed in both recipients and donors, 65 cases in recipients only, and eight cases in donors only. Infected recipients and donors with active lesions were treated at least 1 month before transplantation by combined antischistosomal drugs (praziquantel and oxamniquine). The 243 patients (136 schistosomainfected cases and 107 controls) were followed regularly for a period of 10 years after transplantation. We found that there was no significant difference in the incidence of acute and chronic rejection between the groups; however, higher cyclosporin doses were needed for the infected group with subsequent higher incidence of both acute and chronic cyclosporin nephrotoxicity. Moreover, the schistosomal group had a significantly higher incidence of urinary tract infection and urological complications with no evidence of schistosomal re-infection.

Research paper thumbnail of A Prospective Randomized Study for the Treatment of Bone Loss with Vitamin D During Kidney Transplantion in Children and Adolescents

American Journal of Transplantation, 2004

The effect of treatment with alfacalcidol on posttransplantation bone loss in children and adoles... more The effect of treatment with alfacalcidol on posttransplantation bone loss in children and adolescents was investigated. Of the 63 young patients who received renal transplant and were subjected to dual-energy x-ray absorptiometry (DEXA), 30 patients had low-bone mineral density (BMD) (z-score ≤ −1) and were enrolled into the study. Their mean age at the time of transplantation was 14.5 ± 4.0 years and the mean duration after transplantation was 48 ± 34 months. Patients with low BMD were randomized into two equal homogeneous groups: group 1 (control) received placebo and group 2 received daily alfacalcidol 0.25 lg by mouth. Parameters of bone metabolism (intact parathyroid hormone, serum osteocalcin and urinary deoxypyridinoline) and BMD were assessed before and after the study period. After 12 months of treatment BMD at the lumber spine decreased from −2.2 to −2.5 in group 1 while it increased from −2.1 to −0.6 in group 2 (p < 0.001). Serum intact parathyroid hormone level decreased significantly in group 2 (p = 0.042). Apart from transient hypercalcemia in 1 patient in group 2, no other significant adverse effects were noted. This study suggested the value of alfacalcidol in the treatment of bone loss in young renal transplant recipients.