Iranian Journal of Kidney Diseases
Volume:11 Issue: 5, Sep 2017

Introduction. Modifying cardiovascular risk factors is very important for the patients after kidney transplantation. Statins are a potentially beneficial intervention for kidney transplant patients, and the effect of statins on cardiovascular outcomes in patients with chronic kidney disease varies according to the stages. This systematic review summarizes the potential beneficial effects of statins on kidney allograft outcome.
Materials and Methods. A systematic review and meta-analysis was conducted by literature search using the PubMed, Science Direct, Scopus, ISI Web of Knowledge, and Google Scholar. Articles published after 2000 reporting hazard ratios (HRs) for the effect of statins on patient and graft survival of kidney transplant patients were included.
Results. Seven articles were included in the systematic review, involving 1870 kidney transplant patients that received statins and 3339 kidney transplant patients as the control group. Statins has no protective effect on transplant rejection, graft survival or patient survival after kidney transplantation. The effect of statins on graft survival, however, was significant when adjusted for factors such as age, sex, and serum creatinine level (HR, 0.80; 95% CI, 0.69 to 0.92; P = .003). Similarly, patient survival was significantly better with statin use (adjusted HR, 0.75; 95% CI, 0.63 to 0.88; P = .003).
Conclusions. The present study may provide valuable information on the potential beneficial effects of statins in kidney allograft recipients. Meta-analysis showed that the use of statins correlated independently with improved patient and graft survival after kidney transplantation.

Aspartame is one of the most popular artificial sweeteners over the world. Although its consumption is considered to be safe in acceptable daily intake ranges which were set by the United States Food and Drugs Administration and other regulatory agencies, there are lots of controversies regarding its safety nowadays. Some of the recent experimental and epidemiological studies showed that consumption of aspartame may causes some adverse health effects including obesity, metabolic syndrome, and alteration in gut microbiota. Moreover, studies on the nephrotoxic effect of aspartame have increased. A search of several literature databases for publications on adverse effects of aspartame on the kidney function from 1980 to 2016 showed that long-term consumption of aspartame led to a dose-dependent increased production of free radicals in renal tissues as well as kidney injury, based on several studies on animals However, given the lack of clinical data in this area, it is difficult to make a definitive conclusion regarding nephrotoxic effect of aspartame. Overall, consumers should be aware of the potential side effects of aspartame and other artificial sweeteners. At present it may be recommended that only a minimal amount of them would be consumed.

Introduction. This study aimed to assess the association of glomerular filtration rate (GFR) with cardiometabolic risk factors in Iranian adolescents.
Materials and Methods. Data of the 3rd round of a school-based surveillance system entitled "Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable Disease (CASPIAN III)" study was used for this study. A sample of 367 adolescents aged between 10 and 18 years was randomly selected. Glomerular filtration rate was estimated using the original and the updated Schwartz equations. The association of GFR with anthropometric data, blood pressure, lipid profile, and blood glucose was assessed in boys and girls by age group.
Results. Of the participants, 50.4% were boys and 26.2% were from rural regions. In the age group of 14 to 18 years, the ratio of low- to high-density lipoprotein cholesterol was significantly lower in the girls than the boys (P Conclusions. The above findings showed that obese and overweight Iranian adolescents were more likely to have lower kidney function. Strategies to decline impaired kidney function may include prevention of obesity and central obesity in this population.

Introduction. There is inconsistent evidence regarding the potential role of L-arginine intake on kidney function. This study investigated the association of dietary L-arginine intake and the risk of chronic kidney disease (CKD) in adults.
Materials and Methods. We evaluated 1780 men and women participated in the Tehran Lipid and Glucose Study, followed for a median of 6.3 years. Dietary intakes of total L-arginine as well as animal- and plant-derived L-arginine were assessed using the validated semi-quantitative food frequency questionnaire, at baseline. Demographics, anthropometrics, and biochemical variables were evaluated at baseline and again after a 3-year and a 6-year follow-up. The incidence of CKD was assessed across tertiles of L-arginine and its categories using multivariable logistic regression models.
Results. The mean dietary intakes of total, plant-derived, and animal-derived L-arginine were 4.1 ± 1.5 g/d, 1.8 ± 0.9 g/d, and 2.1 ± 0.8 g/d, respectively. In the fully-adjusted logistic regression model, the highest compared to the lowest intakes of animal-derived L-arginine (2.57 g/d versus 1.05 g/d) increased the risk of CKD (relative risk, 1.54; 95% confidence interval, 1.06 to 2.14, P = .02 for trend). Animal-derived L-arginine was negatively associated with changes of estimated glomerular filtration rate and creatinine clearance rate during the follow-up. There was no significant association between total or plant-derived L-arginine intakes and the risk of CKD after 6.3 years of follow-up.
Conclusions. Our findings suggested an adverse effect of higher intakes of L-arginine from animal sources that could be a dietary risk factor for development of kidney disease.

Introduction. Embryogenesis of the kidney glomeruli, especially its vascular component, has not been well documented. Glomeruli capillary tuft is surrounded and enveloped by visceral epithelial cells, which is a unique portal system that connects afferent with efferent arteriole without interaction with venular circulation. We hypothesized that the portal system embryologically has developed by extension of the intima of afferent arteriole into the stroma of glomerulus. We also hypothesized that juxtaglomeruli apparatus was developed from remnants of smooth muscle cells of the media of afferent arteriole at the anastomosing site with the Bowman capsule entrance.
Materials and Methods. We studied 5 human fetal kidneys by hematoxylin-eosin, periodic acid-Schiff, and immunoperoxidase staining techniques.
Results. Hematoxylin-eosin staining of fetal kidney showed presence of erythrocytes in early vesicle form of glomeruli that was confirmed by immunohistochemical staining with CD31, smooth muscle actin, and CD34 markers. These stains showed extension of extraglomerular arterioles to the glomeruli. Periodic acid-Schiff staining showed also the continuity of the basement membrane in extraglomeruli and internal glomerular vascular tufts.
Conclusions. This study shows that there is a relationship between the metanephric blast cells and major vessel critical for angiogenesis. When afferent arteriole come in contact with the immature glomeruli, its intima migrates into the glomerular tuft to form intraglomerular capillary system, while its smooth muscle remains at the entrance orifice and develops juxtaglomerular apparatus cells.

Introduction. Therapeutic drug monitoring of vancomycin is an important issue in clinical decision-making and dosage modifying, particularly among patients in critical conditions and decreased kidney function. Urine is typically readily available in hospitalized patients and therapeutic drug monitoring in urine may be a reliable and noninvasive procedure compared to frequent blood sampling. We aimed to determine and validate the diagnostic yield of vancomycin trough level in urine.
Materials and Methods. In a prospective study, 95 patients who were treated with vancomycin for any clinical condition were enrolled in this study. Patients were divided into 2 groups according to their glomerular filtration rate (greater than 80 mL/min/1.73 m2 versus 15 mL/min/1.73 m2 to 80 mL/min/1.73 m2). Vancomycin serum trough levels and simultaneous urine trough levels were detected by high-pressure liquid chromatography.
Results. The mean serum and urine trough levels of vancomycin were 13.13 ± 1.34 mg/L and 7.79 ± 1.23 mg/L, respectively. The serum and urine trough levels had a positive linear correlation (r = 0.38, P Conclusions. Urine levels of vancomycin correlate with simultaneous serum levels and may consistently predict serum levels in patients with normal kidney function. Therefore, urine vancomycin monitoring might be used as a noninvasive alternative to blood sampling, particularly in patients with normal kidney function.

Introduction. This study was aimed to evaluate the correlation of body mass index (BMI), waist circumference (WC), and waist-stature ratio (WSR) with urinary composition in urolithiasis patients.
Materials and Methods. Medical reports of 1410 urolithiasis patients referred to a tertiary in Tehran, from 2010 to 2015, were reviewed. Collected data included WC, BMI, and WSR, 24-hour urine composition, and the first-morning urine pH. Urinary relative supersaturation of calcium oxalate, calcium phosphate, and uric acid were calculated. Linear correlation and logistic regression models were used for study analyses.
Results. A total of 511 records were reviewed. In the women, supersaturation of calcium oxalate significantly correlated with BMI, WC, and WSR. Supersaturation of uric acid significantly correlated with WC. Using regression analyses, BMI and WSR were associated with greater supersaturation of calcium oxalate abnormality, which persisted after adjustment for confounding factors (odds ratio, 1.080; 95% confidence interval, 1.001 to 1.166 for BMI; odds ratio, 1.053; 95% confidence interval, 1.001 to 1.108 for WSR). Larger WC accompanied abnormal values for supersaturation of calcium oxalate; however, the model was marginally significant (odds ratio, 1.032; 95% confidence interval, 1.000 to 1.065; P = .05) in multivariable analysis. In the men on the other hand, none of the obesity indexes were associated with the supersaturation measures.
Conclusions. Although both obesity and abdominal obesity correlated with supersaturation of calcium oxalate, mostly by changes in urine volume and pH in women, none of those indexes showed significant correlation with urine composition in the men population of our study.

Introduction. Data on risk factors associated with low bone mineral density are limited in patients with end-stage renal disease. This study evaluated the factors deemed associated with lumbar and femoral Z and T scores.
Materials and Methods. Clinical and demographic data of 98 patients waiting for kidney transplantation were collected, as well as lumbar and femoral bone densitometries, before transplantation. Osteoporosis and osteopenia and factors associated with bone mineral density were assessed.
Results. According to the femoral T score, 38.8% (95% confidence interval [CI], 29.1% to 48.4%), 44.9% (95% CI, 35.1% to 54.7%), and 16.3% (95% CI, 9.0% to 23.6%) of the patients had normal bone density, osteopenia, and osteoporosis, respectively. According to the lumbar T score, 54.1% (95% CI, 44.2% to 63.9%), 33.7% (95% CI, 24.3% to 44.0%), and 12.2% (95% CI, 5.8% to 18.7%) of the patients had normal density, osteopenia, and osteoporosis, respectively. Age, serum levels of creatinine and parathyroid hormone, and use of calcitriol and calcium carbonate were associated with femoral densitometry scores. Serum total protein level, Rh-negative status, and B blood type were associated with the lumbar scores.
Conclusions. Parathyroid hormone contributed to bone loss in our kidney transplant candidates, and B and Rh-negative blood types were associated with a higher risk of lumbar osteoporosis while total protein was negatively associated with the risk of bone loss. Calcitriol might improve femoral mineral density, but calcium carbonate was negatively associated with femoral bone density. Age and higher creatinine levels were associated with higher femoral bone densities.

Acute interstitial nephritis (AIN) is known as a common cause of acute kidney injury, found in 15% to 27% of kidney biopsies. Drug-induced AIN is currently the most common cause of AIN. The most common medications causing AIN are antibiotics and nonsteroidal anti-inflammatory drugs. We describe a case of Citrullus colocynthis (herbal remedy for diabetes mellitus and weight reduction) that induced AIN. A 31-year-old woman with major thalassemia, diabetes mellitus, and hepatitis C infection was admitted because of flank pain and unexpected increase in serum creatinine level. She had been using Citrullus colocynthis for 3 months. Kidney biopsy results suggested AIN. She did not respond to steroid therapy and underwent hemodialysis. We suggest the use of Citrullus colocynthis as a herbal medicine with extreme caution.

Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent episodes of painful inflammation in the abdomen, chest, or joints. The coexistence of multiple myeloma (MM) and FMF is an extremely rare event. Here, we report a case of FMF with concurrent MM. A 63-year-old woman was diagnosed with FMF since 15 years earlier. She was admitted with a complaint of low back pain. Regarding the presence of back pain, anemia, hypercalcemia, and kidney failure, a diagnosis of MM was suspected. A skeletal survey showed punched-out lesions in the skull. Serum protein electrophoresis demonstrated an immunoglobulin G kappa monoclonal gammopathy, and bone marrow aspiration revealed 30% involvement by abnormally appearing plasma cells, suggestive of MM. Although the association between FMF and MM may be a mere coincidence, further studies are necessary to understand their concurrent development.