Iranian Journal of Kidney Diseases
Volume:10 Issue: 6, Nov 2016

Diabetic nephropathy (DN) is a serious complication of diabetes mellitus, and its prevalence has been increasing in developed countries. Diabetic nephropathy has become the most common single cause of end-stage renal disease (ESRD) worldwide. Oxidative stress and inflammation factors are hypothesized to play a role in the development of late diabetes complications. Chronic hyperglycemia increases oxidative stress, significantly modifies the structure and function of proteins and lipids, and induces glycoxidation and peroxidation. Therefore, hyperglycemia causes auto-oxidation of glucose, glycation of proteins, and activation of polyol mechanism. Overproduction of intracellular reactive oxygen species contributes to several microvascular and macrovascular complications of DN. On the other hand, reactive oxygen species modulates signaling cascade of immune factors. An increase in reactive oxygen species can increase the production of inflammatory cytokines, and likewise, an increase in inflammatory cytokines can stimulate the production of free radicals. Some studies have shown that kidney inflammation is serious in promoting the development and progression of DN. Inflammatory factors which are activated by the metabolic, biochemical, and hemodynamic derangements are known to exist in the diabetic kidney. This review discusses facts for oxidative stress and inflammatory factors in DN and encompasses the role of immune and inflammatory cells, inflammatory cytokines, and stress oxidative factors.

The information on burden of alcohol abuse in Iran is scarce. However, the available data show that mortality rates and frequency of its use have increased in the Iranian community. In particular, Iran occupies the 1st rank in the number of outbreak incidents and victims of toxic alcohols such as methanol in the Middle East. Mortality and morbidity of toxic alcohols are high if prompt diagnosis and treatment are not initiated rapidly. On-time diagnosis, proper case finding, and standard treatment have an essential role to reduce mortality and morbidity of toxic alcohols particularly blindness and other physical and psychological disabilities. This review focuses on intoxication with methanol, ethylene glycol, and isopropanol, and their treatment.

Introduction. Chronic kidney disease (CKD) is a progressive and irreversible impairment of kidney function; if it progresses to the end-stage of CKD, dialysis or kidney transplant is needed. In general, there are no definitive treatment to slow the progression of CKD. This study aimed to determine the effect of synbiotic supplementations on azotemia in patients with CKD.
Materials and Methods. A randomized controlled trial was conducted on 66 patients with CKD (stages 3 and 4). The participants were randomly divided into 2 groups to receive synbiotic supplement, 1000 mg/d, and placebo (2 capsules a day) for 6 weeks. At the beginning and end of the study, blood parameters and kidney function were evaluated.
Results. Of the 66 patients studied, 16 patients (24.2%) were women and 50 (75.8%) were men. The mean age and body mass index of the participants were 61 ± 7.65 years and 28.52 ± 4.06 kg/m2, respectively. The level of blood urea nitrogen showed a significant reduction following the intake of synbiotic supplement (from 40.80 ± 22.11 mg/dL to 36.14 ± 20.52 mg/dL, P = .01). Serum creatinine, uric acid, and other indicators of kidney function showed no significant change.
Conclusions. The intake of synbiotic supplement could reduce blood urea nitrogen in patients with CKD in stages 3 and 4; however, it had no effect on the other markers of kidney function.

Introduction. Calcineurin inhibitor nephrotoxicity is major problem after organ transplantation. It is multifactorial, but oxidative stress may have an important role in this process. It has been shown that angiotensin II receptor blockers have renoprotective effects but their molecular mechanism is largely unknown. Antioxidative effect is an important role of the recently known anti-aging protein, klotho. This study aimed to evaluate effect of valsartan in alleviation of cyclosporine A nephrotoxicity via a probable increase in serum klotho levels or decreasing oxidative stress.
Materials and Methods. Thirty-two Sprague-Dawley rats were divided into 4 groups to receive 1 mL/kg/d of olive oil as control; 30 mg/kg/d of cyclosporine; 30 mg/kg/d of cyclosporine and 50 mg/kg/d of valsartan; and 50 mg/kg/d of valsartan. After the 6 weeks of administration period, serum levels of klotho and 8-hydroxydeoxyguanosine were measured using an enzyme-linked immunosorbent assay. Serum malondialdehyde level was measured spectrophotometrically.
Results. The mean serum level of klotho was significantly lower in the cyclosporine group compared with control and valsartan groups. Klotho level in the valsartan group was significantly higher than those in the other groups. The cyclosporine group was detected to have significantly higher serum 8-hydroxydeoxyguanosine and malondialdehyde levels compared with the other study groups. The levels of klotho were negatively correlated with 8-hydroxydeoxyguanosine and malondialdehyde levels.
Conclusions. Administration of valsartan may lead to attenuation of the nephrotoxic side effect of cyclosporine via enhancing klotho and decreasing oxidative stress levels.

Introduction. Hypertension is a worldwide health concern. Complications of hypertension not only affect adult patients, but also involve children. Given the importance of assessing children with hypertension in order to decrease adulthood complications, we aimed to assess the prevalence of hypertension in urban schoolaged children in Rasht, Iran.
Materials and Methods. This cross-sectional study was conducted on 2072 school-aged children in Rasht, Iran, from January 2013 to December 2015. Inclusion criteria were age between 7 and 17 years and residence and attending school in the urban area of Rasht.
Results. Overall, 205 (9.9%) and 144 (6.9%) of the participants were hypertensive and prehypertensive, respectively. The mean systolic blood pressure was 124.54 ± 11.86 mm Hg in the children. The prevalence of obesity in the children was 3.5%. Comparing the normal, prehypertensive, and hypertensive groups, there was a significantly increasing trend regarding age, height, weight, and body mass index associated with higher blood pressure categories.
Conclusions. This study showed a high rate of hypertension among school-aged children in Rasht. Hypertensive children tended to be have a higher body mass index than the prehypertensive and normal-weight participants. Case identification and early assessment of these children is recommended.

Introduction. This study aimed to evaluate the outcome and predictors of survival in hemodialysis patients of Hasheminejad Kidney Center where a comprehensive dialysis care program has been placed since 2004.
Materials and Methods. Data of 560 hemodialysis patients were used to evaluate 9-year survival rates and predictors of mortality. Cox regression models included comorbidities as well as averaged and 6-month-averaged time-dependent values of laboratory findings as independent factors.
Results. Survival rates were 91.9%, 66.0%, 46.3%, and 28.5%, at 1, 3, 5, and 9 years, respectively, in all patients and 90.8%, 61.6%, 42.1%, and 28.0% in 395 incident patients starting hemodialysis after 2004. Adjusted survival models demonstrated age, male sex, diabetes mellitus, cardiovascular disease, and high-risk vascular access as baseline predictors of mortality, as well as averaged low hemoglobin level (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.36 to 2.90) and a single-pool KT/V Conclusions. Our patients have relatively comparable survival rates with high-profile dialysis centers. Aiming to better achieve the recommended targets, especially hemoglobin and nutritional and bone metabolism factors, should be considered for optimal dialysis outcomes.

Introduction. Patients on long-term hemodialysis are at a higher risk of cardiovascular disease and premature mortality. It is generally believed that omega-3 supplementation can prevent cardiovascular events due to its anti-inflammatory and anti-atherosclerotic effects.
Materials and Methods. Fifty-two hemodialysis patients were divided into 2 groups to receive omega-3 and placebo for 6 six months. Serum biomarkers and inflammatory agents were measured in both groups before and after the intervention. Quality of life was also assessed before and after the trial using the Kidney Disease Quality of Life-Short Form questionnaire.
Results. Patients who received omega-3 showed an increase in serum calcium level (P = .005), a decrease in vascular cell adhesion molecule (P = .04), and an increase in the high-density lipoprotein cholesterol level (P Conclusions. Our data showed beneficial effects of omega-3 supplementation during chronic hemodialysis on inflammatory processes and also quality of life. We suggest administration of omega-3 in the hemodialysis community in a preventive manner for improvement of cardiovascular events and quality of life.

Introduction. Patients on dialysis have a high rate of death, mainly of cardiovascular cause. Nephrologists are actively looking for ways to improve patients’ outcomes, and alternative dialysis strategies, such as long conventional hemodialysis and hemodiafiltration, are currently being investigated. The aim of this study was to compare anemia, nutrition, inflammation, mineral metabolism, and 3-year survival rates between patients treated with hemodiafiltration and prolonged high-flux hemodialysis (HFH).
Materials and Methods. A total of 58 dialysis patients were divided into 2 groups to undergo hemodiafiltration 3 times weekly, 12 hours in total per week, or prolonged duration of HFH (≥ 15 h/w). One-year biochemical parameters were collected retrospectively, together with 36 months patients’ survival (prospectively).
Results. Patients in the HFH group had longer dialysis vintage; significantly higher levels of hemoglobin (despite less frequent use of erythropoietin-stimulating agents), serum albumin, serum calcium, and serum bicarbonate; and a lower intact parathyroid hormone level. Survival rates were comparable between the two groups. The Cox proportional hazard model showed that patients treated with longer HFH had a 32% relative risk reduction of mortality compared to patients treated with hemodiafiltration, but without statistical significance (hazard ratio, 0.68; 95% confidence interval, 0.21 to 2.20; adjusted for diabetes mellitus).
Conclusions. Longer duration of hemodialysis with high-flux membranes had beneficial effects on anemia indexes, mineral metabolism, nutrition parameters, and acidosis in comparison with hemodiafiltration. However, hemodiafiltration did not offer a 36-months survival benefit over prolonged HFH.

Introduction. Burnout, a syndrome with 3 dimensions of emotional exhaustion, depersonalization, and reduction of personal accomplishment, is very common among hemodialysis nurses, while data are scarce regarding the prevalence of burnout syndrome (BS) among peritoneal dialysis (PD) nurses. This study aimed to assess and compare demographic and professional characteristics and burnout levels in hemodialysis and PD nurses, and to investigate factors that increase the level of burnout in dialysis nurses.
Materials and Methods. A total of 171 nurses from 44 dialysis centers in Turkey were included in a cross-sectional survey study. Data were collected using a questionnaire defining the social and demographic characteristics and working conditions of the nurses as well as the Maslach Burnout Inventory for assessment of burnout level.
Results. There was no significant difference in the level of burnout between the hemodialysis and PD nurses groups. Emotional exhaustion and depersonalization scores were higher among the shift workers, nurses who had problems in interactions with the other team members, and those who wanted to leave the unit, as well as the nurses who would not attend training programs. In addition, male sex, younger age, limited working experience, more than 50 hours of working per week, and working in dialysis not by choice were associated with higher depersonalization scores. Personal accomplishment score was lower among the younger nurses who had problems in their interactions with the doctors, who would not regularly attend training programs, and who felt being medically inadequate.
Conclusions. Improving working conditions and relations among colleagues, and also providing further dialysis education are necessary for minimizing burnout syndrome. Burnout reduction programs should mainly focus on younger professionals.

Introduction. One of the major risk factors for cardiovascular disease is lipid abnormalities among hemodialysis patients. The present study was designed to investigate the effects of flaxseed oil consumption on serum lipids and lipoproteins in hemodialysis patients.
Materials and Methods. In a randomized double-blinded controlled trial, 34 hemodialysis patients were assigned to either the flaxseed oil or the control group. The patients in the flaxseed oil group received 6 g/d of flaxseed oil for 8 weeks, whereas the control group received 6 g/d of medium chain triglycerides oil. At baseline and the end of week 8, blood samples were obtained after a 12- to 14-hour fast and serum concentrations of triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and lipoprotein(a) were measured.
Results. Serum triglyceride concentration decreased significantly up to 23% in the flaxseed oil group at the end of week 8 compared to baseline, and the reduction was significant in comparison with the medium chain triglycerides oil group (P Conclusions. This study indicates that daily consumption of 6 g of flaxseed oil reduces serum triglyceride concentration, which is a risk factor for cardiovascular disease in hemodialysis patients, whereas it has no effects on other lipid parameters, especially lipoprotein(a).

Reninoma is a tumor that secretes excessive renin and is a rare cause of secondary hypertension. We report a case of reninoma with delayed diagnosis in a 33-year-old woman taking an angiotensin receptor blocker. During angiotensin receptor blocker medication, she had exhibited no electrolyte abnormality. The angiotensin receptor blocker was stopped for pregnancy planning purposes, and subsequent hypokalemia was observed. Abdominal computed tomography showed an enhanced round mass in the right kidney. Right partial nephrectomy was performed and the renal mass was removed. Histologic findings confirmed a diagnosis of reninoma. The patient’s blood pressure and serum potassium remained normal after surgery. Diagnosis of reninoma might be delayed in patients taking angiotensin receptor blockers because they can mask hypokalemia due to reninoma.

Dyskeratosis congenita (DC) is a very rare inherited disorder. It is caused by dysfunction of telomere maintenance. It involves RNA telomerase components relevant to various mutations leading to a classic triad of physical findings consisting of nail dystrophy of the hands and feet, mucosal leukoplakia, and reticular pigmentation of the skin, most commonly on the head, neck, and trunk. Bone marrow failure along with pulmonary complications and malignancies are all common causes of premature death in patients with DC as well as other abnormalities. We report a new case of DC with impure nephrotic syndrome relevant to histopathologic signs of a diffuse mesangial sclerosis, leading to an early end-stage renal disease. Challenges remain to understand the diverse spectrum of DC especially in children. To the best of our knowledge this is the first case of DC associated to diffuse mesangial sclerosis.