فهرست مطالب

Kidney Diseases - Volume:10 Issue: 2, Mar 2016

Iranian Journal of Kidney Diseases
Volume:10 Issue: 2, Mar 2016

  • تاریخ انتشار: 1394/12/20
  • تعداد عناوین: 9
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  • Sudabeh Alatab, Gholamreza Pourmand, Mohammed El Fatih El Howairis, Noor Buchholz, Iraj Najafi, Mohammad Reza Pourmand, Rahil Mashhadi, Naghmeh Pourmand Pages 51-61
    Introduction
    The incidence of urolithiasis has increased in both the developed and the developing countries during the past decades. Economically, the increase of urolithiasis contributes to the rise of the healthcare burden everywhere. Moreover, this increase has been associated with a change in the epidemiology of urolithiasis in terms of age and sex distribution, and also the location and type of calculi.
    Materials And Methods
    We searched the MEDLINE for relevant literature dating back to 1980. This review compared the trends in epidemiological factors affecting urolithiasis in the developed and the developing countries during the past decades.
    Results
    People in the developing countries are more likely to contract kidney calculi at a younger age than in the developed countries. Although calculus disease is still more prevalent in men than in women, the latter are increasingly affected in both worlds. Uric acid calculi are more prevalent in the developing than in industrialized countries. There is a progressive increase in the frequency of calcium oxalate and calcium phosphate calculi in the developing countries where these used to be less frequent.
    Conclusions
    The incidence and prevalence of urinary calculi is increasing globally. Many factors including aging of the population, changes in diet, global warming, and employment of more accurate diagnostic tools seem to be involved in this increase. An increasing affluence and adaptation of Western diet habits in many developing countries seem likely to contribute to the changes.
    Keywords: epidemiology, urolithiasis, age, sex, calculus composition
  • Saeed Mardani, Maryam Heidari, Hamid Nasri Pages 62-67
    Introduction
    Plasma adiponectin level is markedly in­creased among patients on hemodialysis. This investigation aimed to evaluate the relationship between renin-angiotensin system blockade and serum adiponectin concentration in nondiabetic patients on hemodialysis.
    Materials And Methods
    This randomized double-blind controlled trial was conducted on a group of nondiabetic patients on regular hemodialysis. The first group received losartan, 12.5 mg twice per day for the 1st week, 25 mg twice per day during the 2nd week, and 75 mg/d from the 3rd week to the end of the 16th week. Patients of the control group received placebo. Blood samples from all of the patients were collected at the beginning and at the end of the study to measure serum adiponectin.
    Results
    Seventy-three hemodialysis patients were divided randomly into the losartan group (40 patients) and the control group (33 patients). The mean adiponectin level in all of the patients was 10.6 ± 3.9 µg/mL. A significant decrease of serum adiponectin level was observed after 4 months of treatment with losartan (8.86 ± 3.43 µg/mL for losartan group versus 10.71 ± 3.94 µg/mL for the control group; P = .04). None of the patients had a serum potassium value greater than 5 mg/dL or hypotension during the intervention. There was no significant difference in serum potassium levels between the two groups.
    Conclusions
    The decrease in serum adiponectin level in nondiabetic patients on regular hemodialysis by losartan might offer a potential protective approach in these patients. Mechanisms responsible for this reduction remain to be investigated.
    Keywords: adiponectin, angiotensin receptor blocker, end, stage renal disease, losartan
  • Ramin Tolouian, Zuber D. Mulla, Jesus Diaz, Jorge Aguila, Luis Ramos, Duran Pages 68-74
    Introduction
    Magnetic resonance imaging (MRI) sequence acquisition techniques for iron assessment have revolutionized the study of iron overload in different organs. We hypothesized that MRI can accurately and reliably assess possible iron deposition in the myocardium and liver by measurement of T2* value.
    Materials And Methods
    Seventeen patients with end-stage renal disease on hemodialysis were enrolled. An electrocardiography-gated single breath hold fast multiecho T2* sequence was acquired in the short axis at basal and mid-ventricular levels. The same technique was utilized to estimate liver parenchyma iron content.
    Results
    Iron deposition in the liver was present in 50% of the hemodialysis patients. No iron deposition was found in the myocardium. A strong univariable inverse linear association was detected between serum albumin and T2* in the liver (r = -0.84, P
    Conclusions
    Even though using intravenous iron infusion is a common practice in chronic dialysis patients, it seems the myocardium as opposed to the liver is resistant to or protected against iron deposition. There were no meaningful differences in the relationship between iron overload in the liver and the dialysis time vintage. A more aggressive trend of iron therapy and different formulations of iron infusion could be an explanation of iron deposition in the liver.
    Keywords: Ramadan fasting, hemodialysis, end, stage kidney disease, electrolyte imbalance, blood pressure
  • Salman Imtiaz, Beena Salman, Murtaza Fakhruddin Dhrolia, Kiran Nasir, Hasan Nasir Abbas, Aasim Ahmad Pages 75-78
    Introduction
    Month of Ramadan bring many changes in life style, especially the diet of Muslims all over the world among both fasting and nonfasting individuals. Hemodialysis patients are kept on restricted diet because of fluid and electrolytes imbalance. The aim of this study was to compare changes in the clinical and biochemical parameters in fasting and nonfasting hemodialysis patients during the Ramadan.
    Materials And Methods
    In a longitudinal study, we recruited 282 patients who were on maintenance dialysis for more than 3 months. Measurements included body weight, blood pressure, serum potassium, serum albumin, and serum phosphorus at the beginning and during the last week of Ramadan.
    Results
    There were 252 patients who were not fasted while 34 patients were those who fasted during the Ramadan. In the nonfasting hemodialysis patients, serum albumin significantly increased at the end of Ramadan (P
    Conclusions
    Changes in dietary pattern and content during the Ramadan is safe in terms of electrolyte balance and blood pressure changes for patients on hemodialysis. It is also safe for those patients who want to fast during this month.
    Keywords: Ramadan fasting, hemodialysis, end, stage kidney disease, electrolyte imbalance, blood pressure
  • Bizhan Shabankhani, Anoushirvan Kazemnejad, Farid Zaeri, Fatemeh Espahbodi, Mahmoud Haji Ahmadi, Roksana Mirkazemi Pages 79-84
    Introduction
    Survival analysis for patients with end-stage renal disease and factors influencing their survival is crucial due to the increase in the number of these patients along with their high mortality rate. This study aimed to analyse the survival rate of patients in north of Iran undergoing hemodialysis and to assess factors influencing their survival.
    Materials And Methods
    A historical cohort study was conducted on 500 patients on maintenance hemodialysis in 3 hospitals of 2 cities (Sari and Babol) in Mazandaran province during a 6-year period from 2007 to 2013. The Cox regression analysis was used to assess the impact of sex, age, education, smoking habit, primary cause of kidney failure, living with family, cardiovascular diseases, weight, age at diagnosis, and age at initiating hemodialysis on survival of the patients.
    Results
    The median survival time for the 500 hemodialysis patients was 108 months. Death occurred in 174 patients (34.8%). History of smoking, age, being unemployed, being illiterate, and renal cyst, congenital diseases, and unspecified diseases as the cause of kidney failure were the associated factors with survival of the patients. The 1-, 2-, 3-, 5-, 10-, and 12-year survival for these patients was estimated to be 84%, 77%, 71%, 58%, 43%, and 33%, respectively.
    Conclusions
    This study showed a high level of mortality and poor survival prognosis for patient undergoing maintenance hemodialysis. History of smoking, age, being unemployed, being illiterate, and renal cyst, congenital diseases, and unspecified conditions as the cause of kidney failure were the associated factors with survival of these patients.
    Keywords: hemodialysis, indoleamine 2, 3, dioxygenase, monocytes, immune response
  • Ali Taghizadeh Afshari, Mohammad Reza Mohammadi Fallah, Mansour Alizadeh, Khadijeh Makhdoomi, Ezatollah Rahimi, Sara Vossoghian Pages 85-90
    Introduction
    Receiving a kidney transplant from donors with multiple renal arteries (MRAs) is suggested to be associated with higher risk of vascular and urologic complications and poor allograft outcomes compared to the donors with single renal artery (SRA). We evaluated survival rates in the recipients from donors with MRAs compared to those from donors with SRA.
    Materials And Methods
    In a retrospective study on 115 kidney allograft recipients, demographic characteristics and the outcomes of kidney transplantation were compared between the recipients from donors with MRAs compared to those from donors with SRA. These included acute tubular necrosis, acute allograft rejection, hypertension, vascular complications, urologic complications, kidney function indicators, and allograft survival at 1 year.
    Results
    There was no significant difference in the recipient's age, sex distribution, and weight, donor's age, donor-recipient familial relation, urologic complications, and duration of hospitalization between the two groups. However, MRA was significantly associated with a higher likelihood of right-side kidney donation, longer warm and cold ischemia times, and lower glomerular filtration rate and higher serum creatinine concentrations at discharge and 12 months after transplantation, as compared to SRA transplants. No significant difference was seen in late complications including hypertension and renal artery stenosis. One-year graft survival was slightly poorer in the MRA group than the SRA group.
    Conclusions
    Our results demonstrate that kidney allografts with MRAs are associated with risks but have acceptable outcomes during the 1st year after transplantation, as compared to SRA kidney allografts.
    Keywords: hemodialysis, indoleamine 2, 3, dioxygenase, monocytes, immune response
  • Theodoros Eleftheriadis, Georgios Pissas, Georgia Antoniadi, Konstantina Tsogka, Panagiota Makri, Vassilios Liakopoulos, Ioannis Stefanidis Pages 91-93
    Hemodialysis patients suffer from susceptibility to infections. Inflammation upregulates indoleamine 2,3-dioxygenase (IDO) in the antigen-presenting cells, which suppresses T-cell function. Plasma IDO activity or protein expression is increased in hemodialysis patients and is associated with immune disturbances. This observation, however, does not consider many factors, importantly the source of IDO, which has to be the antigen-presenting cells in order IDO to exert its immunosuppressive effect in the microenvironment of the immune response. In this study, monocytes were isolated from 30 hemodialysis patients and 20 healthy volunteers and IDO was assessed by Western blotting. The IDO level in the monocytes of hemodialysis patients was significantly, almost 3-fold, higher than in the monocytes of healthy volunteers. This localization enables IDO to exert its immunosuppressive effect and supports conclusions of previous studies that used more indirect methods for assessing the role of this enzyme in the context of the immune response in hemodialysis patients.
    Keywords: hemodialysis, indoleamine 2, 3, dioxygenase, monocytes, immune response
  • Morteza Sanei Taheri, Rozita Abolghasemi, Hamid Reza Haghighatkhah, Omolbanin Taziki, Mehran Arab Ahmadi, Behdad Behnam, Mohsen Zakavati Avval Pages 94-96
    Amyloidosis is an extracellular deposition of abnormal serum proteins. Systemic amyloidosis could involve different organs such as the spleen, liver, and kidneys. Renal artery microaneurysm is very rare in renal amyloidosis. We report a 44-year-old woman who was referred to our general hospital for evaluation of rising serum creatinine level, anemia, and pathological fracture. Two hours following renal biopsy, she developed severe pain in the left flank during voiding and ultrasonography revealed a large perinephric hematoma. She underwent angiography that incidentally showed pseudoaneurysm with diffused renal artery microaneurysm. The feeding artery to the pseudoaneurysm was completely ligated by an interventional radiologist. The subsequent histopathological report of the kidney revealed amyloidosis.
    Keywords: amyloidosis, microaneurysm, renal artery, multiple Myeloma, hematoma
  • Ezgi Coskun Yenigun, Nergiz Bayrakci, Simal Koksal Cevher, Nihal Ozkayar, Fatih Dede Pages 97-99
    Erythropoiesis-stimulating agents (ESAs) play an important role in the management of anemia in patients with chronic kidney disease, but the goals cannot be reached in 5% to 10% of the patients despite high-dose ESA treatment. In case of ESA resistance, all causes of anemia encountered in the general population should be carefully reviewed. We present a patient examined for ESA resistance that was diagnosed with systemic lupus erythematosus and subsequently showed improvement of anemia with systemic corticosteroids.
    Keywords: end, stage renal disease, erythropoietin, resistant anemia, systemic lupus erythematosus