Publications

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2017
Barsoum, R., and M. El-Khatib, "Uric acid and life on earth.", Journal of advanced research, vol. 8, issue 5, pp. 471-474, 2017 Sep. uric_acid_and_life_on_earth.pdf
Barsoum, R. S., "End Stage Renal Disease (ESKD) in Egypt and North Africa ", Chronic Kidney Disease in Disadvantaged Populations, London, San Diego, Cambridge, Oxford, Elsevier, 2017.
Barsoum, R., E. William, and S. Khalil, "Hepatitis-c and kidney disease", Journal of Advanced Research, vol. 8, issue 2, pp. 113–130, 2017. hepatitis_c_and_kidney_disease__a_narrative_review.pdf
Barsoum, R. S., "History of Nephrology and Kidney Transplantation in Egypt", HISTORY OF NEPHROLOGY AND KIDNEY TRANSPLANTATION IN ARAB WORLD, Mansoura, Mansoura University Press, 2017.
Barsoum, R. S., "Schistosomiasis and Glomerular Disease", UpToDate, Alphen aan den Rijn, The Netherlands, Volters Kluwer, 2017. schistosomiasis_and_glomerular_disease_-_uptodate.pdf
Barsoum, R., "The story of the African Association of Nephrology (AFRAN)", African Journal of Nephrology, vol. 20, issue 1, pp. 2-10, 2017. the_story_of_afran.pdf
2016
El-Fishawy, H., G. Saadi, M. Hassaballa, M. G. Hussein, W. Doss, G. Ragab, and R. Barsoum, "Antiviral treatment prioritization in HCV-infected patients with extrahepatic manifestations – An Egyptian perspective.", Journal of Advanced Research, vol. 7, pp. 391-402, 2016.
Barsoum, R., "Burden of end-stage kidney disease: North Africa", Clinical nephrology 86 (13), 14, vol. 86, issue 13, pp. 14-18, 2016.
Sharaf El Din, U. A. A., M. Mansour, E. M. El Hamamsy, O. Henawy, M. El Khodary, S. Abdelghany, and B. R, "Liprotein (a) in transplant recipients: a case controlled prospective clinical study", African Journal of Nephrology, vol. 3, issue 2, pp. 95-102, 2016.
2015
Barsoum, R. S., S. S. Khalil, and F. A. Arogundade, "Fifty years of dialysis in Africa: challenges and progress.", American journal of kidney diseases : the official journal of the National Kidney Foundation, vol. 65, issue 3, pp. 502-12, 2015 Mar. Abstract

This review addresses the development of dialysis services in Africa in the face of past and contemporary challenges. Maintenance dialysis treatment programs developed in 29 countries over the past 50 years, usually many years after their independence and the end of subsequent territorial and civil wars. Eight countries had the resources to launch national dialysis programs, conventionally defined as those accommodating at least 100 patients per million population. Additionally, based on information obtained from international and local publications, conference proceedings, and personal communications, it appears that limited short-term dialysis therapy currently is available in most African countries. Currently, the prevalence of and outcomes associated with dialysis in Africa are influenced significantly by the following: (1) local health indexes, including the prevalence of undernutrition and chronic infections; (2) per capita gross domestic product; (3) national expenditures on health and growth of these expenditures with incremental demand; (4) availability and adequate training of health care providers; and (5) literacy. In an attempt to reduce the socioeconomic burden of maintenance dialysis treatment, 12 countries have adopted active transplantation programs and 5 are striving to develop screening and prevention programs. Our recommendations based on these observations include optimizing dialysis treatment initiatives and integrating them with other health strategies, as well as training and motivating local health care providers. These steps should be taken in collaboration with regulatory authorities and the public.

Barsoum, R., "Kidney in Schistoeomiasis", Comprehensive Clinical Nephrology, Philadelphia, Elsevier, 2015.
Barsoum, R., "Schistosomiasis", Oxford Textbook of Clinical Nephrology, London, Oxford University Press, 2015.
2014
Knoll, G. A., M. B. Kokolo, R. Mallick, A. Beck, C. D. Buenaventura, R. Ducharme, R. Barsoum, C. Bernasconi, T. D. Blydt-Hansen, H. Ekberg, et al., "Effect of sirolimus on malignancy and survival after kidney transplantation: systematic review and meta-analysis of individual patient data.", BMJ (Clinical research ed.), vol. 349, pp. g6679, 2014. Abstract

OBJECTIVE: To examine risk of malignancy and death in patients with kidney transplant who receive the immunosuppressive drug sirolimus.

DESIGN: Systematic review and meta-analysis of individual patient data.

DATA SOURCES: Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to March 2013.

ELIGIBILITY: Randomized controlled trials comparing immunosuppressive regimens with and without sirolimus in recipients of kidney or combined pancreatic and renal transplant for which the author was willing to provide individual patient level data. Two reviewers independently screened titles/abstracts and full text reports of potentially eligible trials to identify studies for inclusion. All eligible trials reported data on malignancy or survival.

RESULTS: The search yielded 2365 unique citations. Patient level data were available from 5876 patients from 21 randomized trials. Sirolimus was associated with a 40% reduction in the risk of malignancy (adjusted hazard ratio 0.60, 95% confidence interval 0.39 to 0.93) and a 56% reduction in the risk of non-melanoma skin cancer (0.44, 0.30 to 0.63) compared with controls. The most pronounced effect was seen in patients who converted to sirolimus from an established immunosuppressive regimen, resulting in a reduction in risk of malignancy (0.34, 0.28 to 0.41), non-melanoma skin cancer (0.32, 0.24 to 0.42), and other cancers (0.52, 0.38 to 0.69). Sirolimus was associated with an increased risk of death (1.43, 1.21 to 1.71) compared with controls.

CONCLUSIONS: Sirolimus was associated with a reduction in the risk of malignancy and non-melanoma skin cancer in transplant recipients. The benefit was most pronounced in patients who converted from an established immunosuppressive regimen to sirolimus. Given the risk of mortality, however, the use of this drug does not seem warranted for most patients with kidney transplant. Further research is needed to determine if different populations, such as those at high risk of cancer, might benefit from sirolimus.

2013
Barsoum, R. S., G. Esmat, and T. El-Baz, "Human schistosomiasis: clinical perspective: review.", Journal of advanced research, vol. 4, issue 5, pp. 433-44, 2013 Sep. Abstract

The clinical manifestations of schistosomiasis pass by acute, sub acute and chronic stages that mirror the immune response to infection. The later includes in succession innate, TH1 and TH2 adaptive stages, with an ultimate establishment of concomitant immunity. Some patients may also develop late complications, or suffer the sequelae of co-infection with other parasites, bacteria or viruses. Acute manifestations are species-independent; occur during the early stages of invasion and migration, where infection-naivety and the host's racial and genetic setting play a major role. Sub acute manifestations occur after maturity of the parasite and settlement in target organs. They are related to the formation of granulomata around eggs or dead worms, primarily in the lower urinary tract with Schistosoma haematobium, and the colon and rectum with Schistosoma mansoni, Schistosoma japonicum, Schistosoma intercalatum and Schistosoma mekongi infection. Secondary manifestations during this stage may occur in the kidneys, liver, lungs or other ectopic sites. Chronic morbidity is attributed to the healing of granulomata by fibrosis and calcification at the sites of oval entrapment, deposition of schistosomal antigen-antibody complexes in the renal glomeruli or the development of secondary amyloidosis. Malignancy may complicate the chronic lesions in the urinary bladder or colon. Co-infection with salmonella or hepatitis viruses B or C may confound the clinical picture of schistosomiasis, while the latter may have a negative impact on the course of other co-infections as malaria, leishmaniasis and HIV. Prevention of schistosomiasis is basically geared around education and periodic mass treatment, an effective vaccine being still experimental. Praziquantel is the drug of choice in the treatment of active infection by any species, with a cure rate of 80%. Other antischistosomal drugs include metrifonate for S. haematobium, oxamniquine for S. mansoni and Artemether and, possibly, Mirazid for both. Surgical treatment may be needed for fibrotic lesions.

Barsoum, R. S., "Urinary schistosomiasis: review.", Journal of advanced research, vol. 4, issue 5, pp. 453-9, 2013 Sep. Abstract

UNLABELLED: In this review, the clinical manifestations of urinary schistosomiasis are displayed from a pathogenetic perspective. According to the prevailing host's immune response profile, urinary schistosomiasis may be broadly categorized into cell-mediated and immune-complex-mediated disorders. The former, usually due to Schistosoma haematobium infection, are attributed to the formation of granulomata along the entire urinary tract. As they heal with excessive fibrosis, they may lead to strictures, calcifications and urodynamic abnormalities. The main impact is lower urinary, the site of heaviest ovi-position. Secondary bacterial or viral infection is common, any may be incriminated in secondary stone formation of the development of bladder malignancy. Immune-complex mediated lesions are usually associated with hepatosplenic schistosomiasis due to Schistosoma mansoni infection. Circulating complexes composed of schistosomal gut antigens and different classes of immunoglobulins deposit in the kidneys leading to several patterns of glomerular pathology. The latter have been categorized under six classes based on the histological and immunofluorescence profile. These classes have been linked to respective clinical manifestations and depend on the stage of evolution of the host's immune response, extent of associated hepatic fibrosis and co-infection with salmonella or hepatitis C. Secondary amyloidosis develops in 15% of such patients, representing a critical impairment of macrophage function.

CONCLUSION: The wide clinicopathological spectrum of urinary schistosomiasis mirrors the evolution of the host's immune response according to chronicity of infection, bacterial or viral co-infection and, in the case of glomerulonephritis, to the extent of hepatic co-morbidity.

Barsoum, R. S., "Burden of chronic kidney disease: North Africa.", Kidney international supplements, vol. 3, issue 2, pp. 164-166, 2013 May. Abstract

North Africa (NAF) is composed of six countries located in the African Sahara, namely the Western Sahara, Morocco, Algeria, Tunisia, Libya, and Egypt. Common features between these countries include similar climate, ecology, population genetics, and the socioeconomic environment. This commonality reflects on the chronic kidney disease (CKD) profile in these countries. While there are some estimates on the epidemiology of end-stage kidney disease, that of earlier stages is unknown. Several national screening programs are currently addressing this issue, such as the EGIPT-CKD project in Egypt and the MAREMAR study in Morocco. Preliminary results from the former suggest a prevalence of proteinuria in 10.6% of the relatives of patients on regular dialysis treatment. Despite the lack of reliable registries, it was possible to gather information on the etiology of CKD by direct contact with leading nephrologists in those countries. It turns out that glomerulonephritis (GN) accounts for 9-20%, diabetes 11-18%, hypertensive nephrosclerosis 10-35%, chronic interstitial nephritis 7-17%, and polycystic disease 2-3%. Compared to two decades earlier, diabetes has become more common at the expense of GN, proliferative GN, and amyloidosis regressed in favor of IgA and membranous nephropathies in Tunisian adults. Conventional schistosomal nephropathies are regressing in favor of hepatitis C viral (HCV) nephropathy in Egyptians. Focal segmental glomerulosclerosis is increasing at the expense of proliferative GNs in the region at large. Access to regular dialysis has been optimized during the past decade, with favorable outcomes despite the high incidence of HCV infection, tuberculosis, and protein-calorie malnutrition. Kidney transplantation is available in all NAF countries except the Western Sahara. About 650 transplants are performed annually from live donors, the majority in Egypt, where data from the largest center in Mansoura display a 10-year graft survival of 62%. Many transplants are performed from living unrelated donors, particularly in Egypt, which creates an ethical debate. Legislation for deceased-donor transplantation has been passed successively over the past two decades in Tunisia, Morocco, Algeria, and Egypt, which is expected to reflect quantitatively and qualitatively on the transplantation activity in the near future.

Barsoum, R. S., "Parasitic kidney disease: milestones in the evolution of our knowledge.", American journal of kidney diseases : the official journal of the National Kidney Foundation, vol. 61, issue 3, pp. 501-13, 2013 Mar. Abstract

Of the 342 parasites that infect humans, 20 are associated with kidney disease, yet of these, only schistosomes, plasmodia, filariae, and leishmanias are held responsible for significant clinical or epidemiologic impact. Reviewing the evolution of human knowledge for these parasites discloses a lot of similarities regarding their discovery, patterns of kidney injury, and pathogenic mechanisms. From a historical perspective, our relevant information may be classified into 4 phases: (1) disease documentation in ancient and medieval scripts as far back as 2000-3000 bce; (2) discovery of the parasites, their life cycles, and clinical correlates by European clinicians working in African and Asian colonies during the second half of the 19th century; (3) discovery and characterization of the renal manifestations of monoparasitic infections during the second half of the 20th century; and (4) recognition of the confounding effects of coinfection with bacteria, viruses, or other parasites. The spectrum of respective kidney diseases extends all the way from acute kidney injury to glomerulonephritis, amyloidosis, urologic disorders, and malignancy. Discovery of the common immunopathogenetic host response to parasitic infections has provided a knowledge core that explains the similarities, diversities, and interactions with regard to kidney injury.

2012
Barsoum, R. S., "A decade after the KDOQI CKD guidelines: a perspective from Egypt.", American journal of kidney diseases : the official journal of the National Kidney Foundation, vol. 60, issue 5, pp. 745-6, 2012 Nov. Abstract
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2011
Barsoum, R. S., "A mission in evolution: the International Society of Nephrology in the past 10 years--2001-2010.", Kidney international, vol. 79, issue 9, pp. 935-43, 2011 May. Abstract

The International Society of Nephrology is now 50 years old! It has dedicated the year 2010 to celebrate its Gold Anniversary in many ways, including documentation of its progress during the past decade, following an earlier article addressing the period 1960-2000. The present article describes the changing mission of the Society in the direction of achieving its ultimate vision of "global elimination of kidney disease." While maintaining its leadership in the promotion of science, it became the prime driving force in capacity building for the diagnosis, prevention and management of kidney disease in the developing world. The society has recently modified its directive from addressing only the physicians providing renal care to supporting other health care providers, and sharing in community education on how to avoid kidney disease. This required the acquisition of new skills in publishing, marketing, politics and fund-raising, which could only be handled by professional management, which the Society has utilized since 2003. It also necessitated enlargement of the leadership circle to include members from all over the world, for which reason the constitution had to be amended twice during the past decade, and the bylaws re-written in 2007. The pride that International Society of Nephrology takes from its scientific and outreach achievements is the fuel that drives its machinery to endless horizons in the humanitarian arena.

Barsoum, R., "Schistosomiasis", Oxford Desk Reference Nephrology, London, Oxford University Press, 2011.
2008
Barsoum, R. S., "Trends in unrelated-donor kidney transplantation in the developing world.", Pediatric nephrology (Berlin, Germany), vol. 23, issue 11, pp. 1925-9, 2008 Nov. Abstract

Living unrelated donors (LUDs) constitute an incremental source of kidneys for transplantation at a global level. Excellent outcomes are reported, superior to those of deceased-donor transplantation and comparable to related donor transplantation. LUD include six categories: spouses, distant relatives, paired-exchange, living-deceased exchange, and non-directed and directed donors. Although a financial reward may be involved in any of these categories, it is in the declared selling of organs that ethical concerns have intensified. There are three patterns of paid LUDs in the developing world: organized, erratic and commercial. The only model of organized LUDs is in Iran, where a central agency assigns and compensates the donors. Erratic LUD transplantation has been experienced, and subsequently banned, in the development of transplant programmes in most developing countries. However, the tightness and enforcement of the official ban are geographically different, providing variable room for uncontrolled trafficking. Commercial transplantation has, thus, become phenomenal in a few countries, gradually evolving into an organized business that follows market dynamics, including advertisement, brokerage, commissions, auctions and tourism. While most international organizations and activist groups condemn commercial transplantation, it is often perceived, in certain cultures and under particular socioeconomic standards, as a human right that meets the demands of all stakeholders, and should be organized rather than declined just for the purpose of meeting the values of a third party.

Arogundade, F. A., and R. S. Barsoum, "CKD prevention in Sub-Saharan Africa: a call for governmental, nongovernmental, and community support.", American journal of kidney diseases : the official journal of the National Kidney Foundation, vol. 51, issue 3, pp. 515-23, 2008 Mar. Abstract

The upsurge in incidence and prevalence of chronic kidney disease (CKD) in both developed and developing nations has necessitated a renewed interest in global CKD prevention because it is now regarded as a public health threat. Although CKD management is consuming a huge proportion of health care finances in developed countries, it is contributing significantly to morbidity, mortality, and decreased life expectancy in developing ones. CKD epidemiological characteristics in Sub-Saharan Africa (SSA) are strikingly different from those observed in other regions. Although middle-aged and elderly populations are predominantly affected in developed countries, in SSA, CKD mainly affects young adults in their economically productive years, with hypertension and infection-related chronic glomerulonephritis as the major causes. Morbidity and mortality are high because most affected individuals cannot access renal replacement therapy. Other contributory factors for this dismal picture include late presentation, limited renal replacement therapy and its unaffordability, absence of kidney disease prevention programs, and the poor literacy level. This gloomy outlook of CKD in the subregion makes prevention the only viable option in the long term while struggling to improve access to renal replacement therapy in the short term. Unfortunately, most countries in SSA have no prevention programs, and where available, they are either institutions or individual based with very little or no governmental support. This review focuses on the burden of CKD in SSA and reviews the available prevention programs with a view to stimulating governments, communities, and organizations to establishing an inexpensive and affordable program in the entire subregion.

2007
Barsoum, R. S., "Hepatitis C virus: from entry to renal injury--facts and potentials.", Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, vol. 22, issue 7, pp. 1840-8, 2007 Jul. Abstract
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Abboud, O., R. Barsoum, F. Berthoux, M. Field, R. Johnson, S. Lin, and P. Massari, "European Best Practice Guidelines for Peritoneal Dialysis acknowledged by ISN.", Nature clinical practice. Nephrology, vol. 3, issue 1, pp. 6-7, 2007 Jan. Abstract
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Barsoum, R., "The ISN's Sister Renal Center program.", Nature clinical practice. Nephrology, vol. 3, issue 1, pp. 1, 2007 Jan. Abstract
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