فهرست مطالب

Kidney Diseases - Volume:10 Issue: 3, May 2016

Iranian Journal of Kidney Diseases
Volume:10 Issue: 3, May 2016

  • تاریخ انتشار: 1395/03/09
  • تعداد عناوین: 10
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  • Saeed Safari, Mahmoud Yousefifard, Behrooz Hashemi, Alireza Baratloo, Mohammad Mehdi Forouzanfar, Farhad Rahmati, Maryam Motamedi, Iraj Najafi Pages 101-106
    Introduction. During the past decade, using serum biomarkers and clinical decision rules for early prediction of rhabdomyolysis-induced acute kidney injury (AKI) has received much attention from researchers. This study aimed to broadly review the value of scoring systems and urine dipstick in prediction of rhabdomyolysis-induced AKI.
    Materials and Methods. The study was designed based on the guidelines of the Meta-analysis of Observational Studies in Epidemiology statement. Search was done in electronic databases of MEDLINE, EMBASE, Cochrane Library, Scopus, and Google Scholar by 2 independent reviewers. Studies evaluating AKI risk factors in rhabdomyolysis patients with the aim of developing a scoring model as well as those assessing the role of urine dipstick in these patients were included.
    Results. Of the 5997 articles found, 143 were potentially relevant studies. After studying their full texts, 6 articles were entered into the systematic review. Two studies had developed or validated scoring systems of the "rule of thumb," and the AKI index, and the Mangled Extremity Severity Score. Four studies were on the predictive value of urine dipstick in risk prediction of rhabdomyolysis-induced AKI, with favorable results.
    Conclusions. The findings of this systematic review showed that based on the available resources, using the prediction rules and urine dipstick could be considered as valuable screening tools for detection of patients at risk for AKI following rhabdomyolysis. Yet, the external validity of the mentioned tools should be assessed before their general application in routine practice.
    Keywords: rhabdomyolysis, acute kidney injury, prognosis, decision support techniques
  • Ayse Feyda Nursal, Akin Tekcan, Suheyla Uzun Kaya, Ercan Turkmen, Serbulent Yigit Pages 107-112
    Introduction. Familial Mediterranean fever (FMF) is a recessively inherited disease which is characterized by recurrent episodic fever, abdominal pain, and polyserositis. It is caused by mutations in the MEFV gene, encoding the pyrin protein. The most important complication of FMF is secondary (AA) amyloidosis that leads to kidney failure. This study aimed to identify the frequency and distribution of MEFV mutations in Turkish patients with FMF-associated AA amyloidosis.
    Materials and Methods. A total of 57 patients with FMF-associated AA amyloidosis and 60 healthy controls were included in this study. We analyzed the MEFV gene for E148Q, M694V, M680I, and V726A mutations and R202Q variant by polymerase chain reaction and restriction fragment length polymorphism methods.
    Results. The male-female ratio was 0.72. The mean age of the patients was 29.8 ± 12.8 years. Among the patients, the rate of the MEFV mutations was found to be 77.2%. The most frequently observed genotype was homozygous M694V mutation, which was present in 17 patients (29.8%, P Conclusions. In this study, mutation analysis of MEFV gene confirmed that the most frequent mutation was homozygous M694V genotype. R202Q may be important in patients with FMF-associated AA amyloidosis. Thus, it is suggested that investigation of R202Q should be considered as a genetic test for Turkish FMF patients.
    Keywords: familial Mediterranean fever, AA Amyloidosis, gene mutation
  • Maryam Rastin, Samaneh Soltani, Fatemeh Nazemian, Maryam Sahebari, Seiede Zahra Mirfeizi, Nafise Tabasi, Mahmoud Mahmoudi Pages 113-118
    Introduction. Lupus nephritis is a serious organ involvement with unknown etiology, and glomerulonephritis class IV is one of the most severe forms of the disease which correlates with poor prognosis and death. Immunological abnormalities are implicated in the expression of lupus nephritis. In this study, we examined some T helper 17 and regulatory T-related cytokines and molecules in systemic lupus erythematosus patients with glomerulonephritis class IV.
    Materials and Methods. The study group comprised of 20 glomerulonephritis class IV SLE patients and 20 sex- and age-matched SLE patients without kidney involvement as control group. Blood samples was collected from each participant, lymphocytes were isolated, and RNA was extracted from lymphocytes. Then cDNA was synthesized using reverse transcription enzyme‚ and finally using specific primers and probes, the expression levels of forkhead box P3 (Foxp3), transforming growth factor (TGF)-β, interferon (IFN)-γ‚ interleukin (IL)-6, and IL-17 genes were analyzed by real-time polymerase chain reaction based on the TaqMan method.
    Results. The expression levels of IL-6‚ IL-17, IFN-γ, and Foxp3 genes were significantly higher in SLE patients with glomerulonephritis class IV than those with non-nephritis SLE. However, the expression of TGF-β was not significantly different between the SLE patients with and without glomerulonephritis class IV involvement.
    Conclusions. According to our results, it seems that in class IV glomerulonephritis patients, increased Foxp3-producing regulatory T cells has an imperfect capacity to control the pathogenic IL-17- and IFN-g-producing cells.
    Keywords: systemic lupus erythematous_T helper 17 lymphocyte_regulatory T lymphocyte_diffuse proliferative glomerulonephritis
  • Parvin Mirmiran, Emad Yuzbashian, Zahra Bahadoran, Golaleh Asghari, Fereidoun Azizi Pages 119-125
    Introduction. The objective was to examine whether dietary acid load was associated with chronic kidney disease (CKD) in adults.
    Materials and Methods. The cross-sectional analyses included 4564 participants, aged 20 years and older, who participated in the 4th phase of the Tehran Lipid and Glucose Study and had complete dietary and serum creatinine data. Dietary data were obtained from using a 147-item food-frequency questionnaire. Dietary acid load was calculated as the potential renal acid load (PRAL). Anthropometrics, blood pressure, and fasting plasma glucose, and lipids were measured. Chronic kidney disease was defined as an estimated glomerular filtration rate (GFR) less than 60 mL/min/1.73 m2 calculated using the Modification of Diet in Renal Disease equation. Risk of CKD was obtained in quartiles of PRAL with logistic recreation.
    Results. The mean dietary PRAL of the participants was -22.0 mEq/d. After adjustment for age, sex, and body mass index, the odds ratio for CKD in the highest compared to the lowest quartile of PRAL was 1.38 (95% confidence interval [CI], 1.02 to 1.83). After additional adjustment for energy intake and smoking, the odds ratio for CKD in the 4th quartile of PRAL compared to the 1st was 1.42 (95% CI, 1.06 to 1.91). In the final model, after additional adjustment for dietary intake of total fat, carbohydrate, dietary fiber, fructose, sodium, diabetes mellitus, and hypertension, the risk of CKD in the highest dietary PRAL category, compared to the lowest, increased by 42%.
    Conclusions. After adjusting for possible confounding factors, we found that higher PRAL (more acidic diet) was associated with higher prevalent CKD in Iranian adults.
    Keywords: diet, acid, base load, chronic kidney disease
  • Saeid Safiri, Mostafa Qorbani, Ramin Heshmat, Ramin Tajbakhsh, Amir Eslami Shahr Babaki, Shirin Djalalinia, Mohammad Esmaeil Motlagh, Mohammad Hasan Tajadini, Hamid Asayesh, Omid Safari, Roya Kelishadi Pages 126-134
    Introduction. There is controversial evidence on association of serum acid uric (SUA) with cardiometabolic risk factors and metabolic syndrome in adults. This study aimed to investigate the associations of SUA levels, components of metabolic syndrome, and other cardiometabolic risk factors, in a nationally representative sample of Iranian adolescents.
    Materials and Methods. This study included 132 participants who met the criteria of metabolic syndrome and 235 participants without metabolic syndrome. The participants were grouped according to the tertiles of SUA. Metabolic syndrome was defined according to the Adult Treatment Panel III criteria modified for children and adolescents. The relationship between SUA and cardiometabolic risk factors and metabolic syndrome was assessed by multivariable logistic regression analysis.
    Results. The mean age of the participants was 15.21 ± 2.35 years, with no significant difference between the boys and the girls. The participants whose SUA was categorized in the 2nd tertile and those falling into the 3rd tertile had significantly higher systolic blood pressure (P Conclusions. Our study showed that those adolescents with metabolic syndrome had higher SUA levels. Its association with some components of metabolic syndrome supports that SUA might be an additional component of metabolic syndrome even during adolescence.
    Keywords: serum uric acid, metabolic syndrome, adolescents, Iran
  • Turhan Caskurlu, Mehmet Kanter, Mustafa Erboga, Zeynep Fidanol Erboga, Mustafa Ozgul, Gokhan Atis Pages 135-143
    Introduction. This study was designed to investigate the effect of Nigella sativa (NS), in reperfusion-induced renal injury in rats.
    Materials and Methods. A total of 24 male Sprague-Dawley rats were divided into 3 groups of controls and rats that underwent ischemia-reperfusion with and without pretreatment with NS. A rat model of renal reperfusion injury was induced by 45-minute occlusion of the bilateral renal pedicles and 24-hour reperfusion. In the NS group, a single dose NS (400 mg/kg orally) was administered by gastric gavage.
    Results. Renal reperfusion caused severe histopathological injury such as tubular damage, atrophy dilatation, loss of brush border, and hydropic epithelial cell degenerations. Treatment with NS significantly attenuated the severity of reperfusion injury and significantly lowered tubulointerstitial damage score as compared with the reperfusion group. When kidney sections were stained with anti-proliferating-cell nuclear antigen antibody, nuclear factor kappaB p65 antibody, and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling, there was a clear increase in the number of positive cells in the reperfusion group in the renal cortical tissues. However, there was a significant reduction in the number of stain-positive cells in kidney tissue from the NS group. Treatment of renal reperfusion injury with NS decreased the elevated tissue malondialdehyde levels and increased the reduced activities of the enzymatic antioxidants glutathione peroxidase and catalase.
    Conclusions. Pretreatment with NS has a protective effect against renal damage induced by renal reperfusion. This protective effect is possibly due to its ability to inhibit reperfusion-induced renal damage, apoptosis, and cell proliferation.
    Keywords: reperfusion injury, kidney injury, proliferation, apoptosis, Nigella sativa, rat
  • Sedigheh Ahmadi, Shima Dehghan Banadaki, Hassan Mozaffari, Khosravi Pages 144-150
    Introduction. Carnitine supplementation may improve the general health and quality of life of hemodialysis patients by improving adipokines levels. The aim of the study was to investigate the effects of L-carnitine supplementation on leptin levels, adiponectin levels, and body weight of hemodialysis patients.
    Materials and Methods. Fifty hemodialysis patients were randomly divided into the carnitine group, who received oral L-carnitine, 1 g/L for 3 months, and the control group. Anthropometric measurements and serum levels of adipokines were measured at baseline and at the end of the intervention.
    Results. Forty-two participants completed the study. Serum leptin concentrations decreased after 12 weeks of the intervention in both groups, but these changes were not significant. The mean change of leptin concentration were, -1.7 ± 19.0 μg/mL and -7.1 ± 20.0 μg/mL in the carnitine group and the control group, respectively (P = .39). The mean adiponectin levels at baseline and after the intervention were 8.6 ± 11.19 μg/mL and 9.8 ± 4.1 μg/mL in the carnitine group (P = .67) and 5.0 ± 2.5 μg/mL and 11.2 ± 5.4 μg/mL in the control group, respectively (P Conclusions. This study showed that a daily supplementation of 1000 mg oral syrup of L-carnitine for 12 weeks did not affect leptin and adiponectin levels or the body weight or body mass index of hemodialysis patients.
    Keywords: L, carnitine, supplement, leptin, adiponectin, hemodialysis
  • Ebru Gok Oguz, Gulay Ulusal Okyay, Hadim Akoglu, Ozgur Merhametsiz, Tolga Yildirim, Basol Canbakan, Mehmet Deniz Ayli Pages 151-155
    Introduction. Antibody-mediated rejections (AMRs) are critical clinical issues encountered in short- and long-term follow-up of kidney transplant patients. Whereas plasmapheresis is a mainstay treatment option in acute AMR cases, there is a paucity of data regarding its efficacy in management of chronic AMR. This report describes our experience addressing this issue.
    Materials And Methods. We retrospectively investigated the data of 7 kidney transplant patients diagnosed with chronic AMR who were on 5 sessions of plasmapheresis (1 to 2 volume exchanges with fresh frozen plasma) on alternate days and 200 mg/kg of intravenous immunoglobulin after each session of plasmapheresis.
    Results. At 6 months after the initiation of treatment, 6 patients experienced partially improved kidney function. One patient had no response and her kidney function progressively deteriorated.
    Conclusions. Our preliminary results are encouraging for the combination of plasmapheresis and intravenous immunoglobulin as an adjunctive therapy for kidney transplant patients suffering from chronic AMR.
    Keywords: chronic antibody, mediated rejection, immunoglobulin, kidney transplantation, plasmapheresis
  • Al, Motassem Yousef, Hisham Qosa, Nailya Bulatova, Ali Abuhaliema, Hussein Almadhoun, Ghada Khayyat, Muhammad Olemat Pages 156-163
    Introduction. This study aimed to evaluate the effects of single nucleotide polymorphisms CYP3A4*1B and CYP3A5*3 on tacrolimus dose requirement among kidney transplant recipients.
    Materials and Methods. Blood levels of tacrolimus were measured using microparticle enzyme immunoassay. Genotyping analysis utilized specific polymerase chain reaction-restriction fragment length polymorphism methods for 137 kidney transplant recipients.
    Results. The median tacrolimus dose was significantly lower in the CYP3A4*1/*1 carriers (0.06 mg/kg/d; range, 0.007 mg/kg/d to 0.17 mg/kg/d) as compared to the CYP3A4*1B/*1B carriers (0.1 mg/kg/d; range, 0.03 mg/kg/d to 0.22 mg/kg/d; P = .001). Patients with at least 1 CYP3A5*1 wild-type allele required higher median doses of tacrolimus (median, 0.08 mg/kg/d; range, 0.03 mg/kg/d to 0.22 mg/kg/d) as compared to the CYP3A5*3 carriers (median, 0.05 mg/kg/d; range, 0.007 mg/kg/d to 0.17 mg/kg/d; P = .002).
    Conclusions. This study showed that tacrolimus dose requirement is lower in Jordanian kidney transplant recipients compared to other populations. Moreover, we found a correlation between genetic variations in CYP3A4 and CYP3A5 enzymes and tacrolimus blood levels among our kidney transplant recipients.
    Keywords: CYP3A, tacrolimus, polymorphism, kidney transplantation
  • Aleksandra Wieczorek, Lukasz Matusiak, Jacek C. Szepietowski Pages 164-167
    Acquired perforating dermatosis (APD) is an uncommon skin disorder seen in majority among patients with chronic kidney disease and also in those with diabetes mellitus. We present the clinicopathological features of APD in a 65-year-old patient with diabetes mellitus and end-stage kidney disease on hemodialysis and review the recent advances in the management of APD, as well as the mechanisms of transepidermal elimination of perforating dermatoses.
    Keywords: acquired perforating dermatosis, hemodialysis, Kyrle disease, treatment, etiology