فهرست مطالب

Iranian Journal of Kidney Diseases
Volume:12 Issue: 5, Sep 2018

  • تاریخ انتشار: 1397/07/02
  • تعداد عناوین: 11
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  • Dorna Davani, Davari, Iman Karimzadeh, Shahrokh Ezzatzadegan, Jahromi, Mohammad Mahdi Sagheb Pages 253-260

    Introduction Nowadays, creatine is one of the most common oral supplements used by professional athletes for boosting their strength and muscle mass. In this review, we collect available experimental and clinical data about renal safety of both short-term and long-term use of creatine. Materials and Methods. Scientific literature was critically searched by keywords "creatine," "renal insufficiency," and "renal dysfunction" and their synonyms in medical databases (Scopus, MEDLINE, EMBase, and ISI Web of Knowledge). Overall, 19 relevant clinical and experimental articles were selected for this review. Results. Short- and long-term creatine supplementations (range, 5 days to 5 years) with different doses (range, 5 g/d to 30 g/d) had no known significant effects on different studied indexes of kidney function such as glomerular filtration rate at least in healthy athletes and bodybuilders with no underlying kidney diseases. In addition, although short-term (range, 5 days to 2 weeks) high-dose oral creatine supplementation (range, 20 g/d to 0.3 g/kg/d) stimulated the production of methylamine and formaldehyde (as potential cytotoxic metabolites of creatine) in the urine of healthy humans, there was currently no definite clinical evidence about their adverse effects on the kidney function. Conclusions . Although creatine supplementation appears to have no detrimental effects on kidney function of individuals without underlying kidney diseases, it seems more advisable to suggest that creatine supplementation not to be used by sportsmen or women with pre-existing kidney disease or those with a potential risk for kidney dysfunction
    Keywords: athletes, creatine supplement, kidney, safety
  • Nooshin Dalili, Kianoush Kashani Pages 261-267
    Acute kidney injury is a very common complication of acute illnesses with dire consequences. There are significant differences in incidence, etiology, severity, and clinical impact of acute kidney injury between resource-sufficient and resource-limited regions. Awareness of such differences would potentially allow clinicians and policymakers to devise and provide region-specific interventions to decrease the incidence of acute kidney injury and mitigate its complications. In this review article, we describe the similarities and differences of acute kidney injury risk factors and risk stratifications based on the level of resource availability in different regions. We also outline differences between community- and hospital-acquired acute kidney injury in different countries. In the end, we outline the potential steps need to be taken to mitigate incidence and clinical impacts of acute kidney injury in both resource-sufficient and resource-limited regions.
    Keywords: acute kidney injury, prediction model, risk factor, resource availability
  • Halle Marie Patrice, Oumarou Moussa, Kaze Francois, Mapoure Yacouba, Mbatchou Hugo, Luma Henry Pages 268-274
    Introduction. Chronic kidney disease (CKD) is frequent amongst human immunodeficiency virus (HIV)-positive patients, and screening is not routinely performed in Sub-Saharan Africa due to resource constraints. We aimed to determine the prevalence of CKD and associated factors in HIV-infected patients in Cameroon. Materials and Methods. A cross-sectional study in Northern Cameroon included HIV-positive patients who attended the HIV clinic. Patients with an estimated glomerular filtration rate less than 60 mL/min/1.73 m² or urinary abnormalities underwent a second measurement 3 months later. Glomerular filtration rate was estimated using the 4-variable Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Logistic regression was used to identify factors associated with CKD. Results. We included 709 participants. The median CD4 count was 219 cells/mL. Proteinuria accounted for 34.4%; leukocyturia, 6.9%; and hematuria, 6.1%. Prevalence of CKD was 44.4% (CKD-EPI) and 47.2% (MDRD). Stages 3 to 5 of CKD were documented in 11.6% using the CKD-EPI and 7.5% using the MDRD. Factors associated with CKD were an age greater than 35 years (odds ratio [OR], 104; 95% confidence interval [CI], 1.02 to 1.06), longer duration of HIV (OR, 2.60; 95% CI, 1.53 to 3.95), history of hepatitis B (OR, 3.04; 95% CI, 1.08 to 8.54), and CD4 cells less than 200 cells/mL (OR, 3.64; 95% CI, 2.55 to 5.21).
    Conclusions. The prevalence of CKD is high among HIV patients in Cameroon. There is a need of implementing measures to encourage early detection of kidney disease in these patients.
    Keywords: chronic kidney disease, human immunodeficiency virus, risk factors, Cameroon
  • Seçil Conkar, Sevgi Mir, Eser Dogan, Zulal Ulger Tutar Pages 275-280
    Introduction. It is known that in children with chronic kidney disease (CKD), cardiovascular damage starts in the form of arterial stiffness. There are risk factors other than the traditional ones such as arterial stiffness hypertension, obesity, hypercholesterolemia, and insulin resistance. Vitamin D deficiency is rather common in CKD, and it was introduced as a risk factor for atherosclerosis; however, its relationship with arterial stiffness is not known completely. The purpose of this study was to research the relationship between 25-hydroxyvitamin D levels and arterial stiffness. Materials and Methods. Arterial stiffness was evaluated by measuring augmentation index (AI) and pulse wave velocity (PWV) from the radial and carotid arteries with a Vicorder. The 25-hydroxyvitamin D levels were measured by an immunoassay method. Results. In the 81 CKD patients (mean age, 13.21 ± 6.02 years; mean body mass index, 19.42 ± 5.12 kg/m2; and 56.8% male), the mean vitamin D level was 60.71 ± 39.52 ng/mL, the mean AI was 7.93 ± 7.77%, and the mean PWV was 9.79 ± 4.36 m/s. Serum levels of 25-hydroxyvitamin D was correlated with AI (r = -0.482, P = 0.001) and PWV (r = -0.57, P = .001). Conclusions. In this study, it was proven that vitamin D deficiency in children was related to nondiabetic and nondialysis CKD.
    Keywords: pulse wave velocity, arterial stiffness, child, chronic kidney disease, vitamin D
  • Zahra Golmohamadi, Hassan Argani, Amir Ghorbanihaghjo, Nadereh Rashtchizadeh, Nasrin Bargahi, Mehran Mesgari, Davoud Sanajou Pages 281-287
    Introduction. Nontraditional risk factors for cardiovascular disease (CVD), including mineral disorder, high fibroblast growth factor 23 (FGF23), low klotho, and low soluble TWEAK could predict the incipient risk of CVD in chronic kidney disease (CKD). The present study evaluates the effect of sevelamer on soluble tumor necrosis factor-like weak inducer of apoptosis (TWEAK), and klotho levels in adenine-induced CKD rats. Methods and Materials. Normal control rats without sevelamer were compared with 3 groups of adenine-induced CKD rats, including CKD rats without sevelamer, CKD rats treated with 3% sevelamer, and rats receiving adenine and 3% sevelamer concurrently. After 4 weeks of sevelamer treatment, serum levels of klotho and soluble TWEAK were measured, along with biochemical parameters related to kidney function. Results . Sevelamer significantly reduced serum levels of phosphate and increased serum levels of klotho and soluble TWEAK. Decreased levels of phosphate were negatively correlated with elevated levels of klotho and soluble TWEAK (r = -0.70, P = .003; r = -0.58, P = .02; respectively) in serum.
    Conclusions. Sevelamer successfully reduced serum levels of phosphate, and meanwhile, it led to an elevation in serum levels of klotho and soluble TWEAK in rat models of CKD.
    Keywords: chronic kidney disease, soluble tumor necrosis factor-like weak inducer of apoptosis, Klotho, sevelamer
  • Leyla Gadakchi, Mehrzad Hajialilo, Mohammad, Reza Nakhjavani, Sima Abedi Azar, Sousan Kolahi, Morteza Gojazadeh, Ali, asghar Ebrahimi, Aida Malek Mahdavi, Hamid Noshad, Alireza Khabbazi Pages 288-292
    Introduction . Lupus nephritis is a common and severe manifestation of systemic lupus erythematosus that can lead to end-stage renal disease and death. The aim of this study was to compare the efficacy and safety of mycophenolate mofetil (MMF) and cyclophosphamide as induction therapy and subsequently as maintenance therapy for lupus nephritis. Materials and Methods . In this retrospective case-control study, 67 patients with proliferative lupus nephritis who were treated with MMF (n = 45) and pulse of intravenous cyclophosphamide (n = 22) were included. Remission of the kidney disease, mortality, and adverse events were evaluated and compared between the two groups. Results. The 45 patients treated with MMF had a mean age of 33.8 ± 10.6 years and 17.1% of them were males. The 22 patients treated with pulse of intravenous cyclophosphamide had a mean age of 38.1 ± 11.1 years and 18.2% of them were males. Complete and partial kidney remission occurred in 40% and 42.2% of the patients treated with MMF and in 31.8% and 59.1% of the patients treated with cyclophosphamide, respectively. No significant differences were observed in complete and partial remission between the two groups. No mortality was reported in the studied patients. There were no significant differences in the frequency of adverse events between the two groups. Conclusions. The efficacy of MMF in long-term treatment of lupus nephritis was comparable to that of cyclophosphamide, and there is no significant differences in the rate of side effects between the two regimens
    Keywords: lupus nephritis, mycophenolate mofetil, cyclophosphamide
  • Mohamed N El_Gamasy_Walid Ahmed El_Shehaby Pages 293-298
    Introduction . Acute nephritic syndrome (ANS) is the most common cause of hypertensive heart failure in pediatric population. There are few publications on myocardial evaluation using electrocardiographic and echocardiographic data in pediatric patients with ANS. This study aimed to evaluate myocardial function by electrocardiography and 2-dimensional echocardiography in Egyptian pediatric patients with ANS. Materials and Methods . Sixty children with ANS were included and subjected to clinical, laboratory, electrocardiography for corrected QT interval, and 2-dimensional echocardiographic study on admission, and repeated at 6 and 12 weeks to measure left ventricular ejection fraction, left atrium-aorta ratio, and the ratio of peak early filling (E wave) to late diastolic filling (A wave) velocities (E/A ratio). Results. Prolonged corrected QT interval was reported in 22 patients (36.7%), of whom 18 had hypertension. Fourteen patients (23.3%) had left ventricular ejection fraction below 60%. The same children also had left atrium-aorta ratios more than 2 and E/A ratios more than 2. Left ventricular ejection fraction became within normal values by 6 weeks in 12 patients, and 2 become normal by 3 months of follow-up. 4 of 14 children with low left ventricular ejection fraction (28.6%) had normal arterial blood pressure. All of the 14 children completely recovered within 3 months. Conclusions. Myocardial dysfunction in the acute phase of ANS was alleviated in almost all children within 12 weeks. Although elevated blood pressure was the commonest etiology of congestive heart failure in children with ANS, the impact of primary myocardial functional disturbance could also be put into consideration
    Keywords: electrocardiography, echocardiography, myocardial dysfunction, child, acute nephritic syndrome
  • Gokhan Cakirca, Faruk Hilmi Turgut Pages 299-304
    Introduction This study was aimed to investigate the efficacy of matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), and the neutrophil gelatinase-associated lipocalin (NGAL)-bound form of MMP-9 (MMP-9/NGAL complex) markers in the determination of early nephropathy in patients with type 2 diabetes mellitus. Materials and Methods Twenty-five type 2 diabetic patients with normoalbuminuria, 27 type 2 diabetic patients with microalbuminuria, and 23 healthy controls were recruited. Serum levels of MMP-9, TIMP-1, and MMP9/NGAL complex were measured in all participants. Results. The MMP-9 level and MMP-9/TIMP-1 ratio were higher in patients with microalbuminuria when compared to the controls, while TIMP-1 level was lower (P = .005, P = .006, and P = .02, respectively). The MMP-9 level and MMP-9/TIMP-1 ratio were significantly higher in the patients with normoalbuminuria when compared to the controls (P = .005 and P = .02, respectively). In the normoalbuminuric patients, MMP-9 levels were negatively correlated with estimated GFR (r = -0.553, P = .008) and positively correlated with glucose (r = 0.449, P = .04), creatinine (r = 0.454, P = .03), and MMP9/NGAL complex (r = 0.575, P = .005). In the microalbuminuric patients, MMP-9 levels were positively correlated with total cholesterol (r = 0.430, P = .03), and MMP9/NGAL complex (r = 0.650, P = .001). Conclusions. The levels of MMP-9, TIMP-1, and MMP9/NGAL complex were similar in microalbuminuric and normoalbuminuric patients with type 2 diabetes mellitus. However, there was a significant MMP-9/TIMP-1 imbalance in both groups which may reflect impaired extracellular matrix homeostasis
    Keywords: diabetic nephropathy, matrix metalloproteinase-9, tissue inhibitor-1, MMP-9, NGAL complex, extracellular matrix
  • Zubair Khuja, Manzoor Parry, Roohi Rasool, Abdul Rashid Reshi Pages 305-311
    Introduction . The forkhead box P3 (FOXP3) gene is important for regulation and development of T cells, which are mediators of kidney allograft rejection. The FOXP3 gene polymorphism may be associated with the rejection of kidney transplants. This study was designed to determine the association of FOXP3 polymorphism with kidney transplant rejection. Materials and Methods . A total of 118 kidney transplant patients were included in this study and were grouped into rejection (n = 31) and nonrejection (n = 87) groups. The FOXP3 rs3761548 gene was genotyped by polymerase chain reaction-restriction fragment length polymorphism using the taqman probe technique. Gene polymorphism at rs3761548 of the FOXP3 gene was analyzed for association with rejection episodes and graft outcome of kidney transplants. Results. The CC genotype of rs3761548 was not present neither of the study nor the control group. The AA genotype was association with a higher risk of rejection compared to the C/A genotype (odds ratio, 2.329; 95% confidence interval, 1.041 to 5.210). The C/A genotype was also associated with a better response to treatment for rejection (odds ratio, 6.667; 95% confidence interval, 1.319 to 33.707) and better posttransplant graft function (odd ratio, 5.833; 95% confidence interval, 1.727 to 19.704). Conclusions. Our findings suggested an association between rejection episodes, posttransplant graft function, and the FOXP3 rs 3761648 polymorphism. Determination of FOXP3 rs 3761648 C/A genotype might be helpful for the identification of recipients with a lower risk of rejection and better graft survival.
    Keywords: kidney transplant_allograft rejection_FOXP3 gene_regulatory T cells
  • Sara Abolghasemi, Fatemeh Abbasi, Shabnam Tehrani, Mohsen Nafar, Mohammad Javad Nasiri Pages 312-314
    Mycobacterium haemophilum is a fastidious nontuberculosis Mycobacterium that must be considered in the differential diagnosis of infections in immunocompromised patients. Mycobacterium haemophilum typically is a pathogen of the cutaneous or subcutaneous tissue and also presents as septic arthritis, osteomyelitis, pulmonary disease, and lymphadenitis. We report a 32-year-old man with past medical history of kidney transplantation, endocarditis, gastrointestinal bleeding, and hypertension, complaining of multiple painful nodular lesions since 3 months earlier. A tissue biopsy and polymerase chain reaction detected Mycobacterium haemophilum. Atypical mycobacterial species like Mycobacterium haemophilum should be assessed in immunocompromised patients positive for acid fast staining and negative for Mycobacterium tuberculosis.
    Keywords: kidney transplantation, Mycobacterium haemophilum, immunocompromised status
  • Hatice Sahin, Ebru Gok Oguz, Hadim Akoglu, Gokhan Atilgan, Gulay Ulusal Okyay, Guner Karaveli Gursoy, Tugba Kip Teymur, Dilek Ertoy, Basol Canbakan, Mehmet Deniz Ayli Pages 315-318
    Two-thirds of complement C3 glomerulopathy (C3G) recur after transplantation and commonly cause graft loss. There is not a standard treatment protocol for these cases. We present a kidney transplant patient with recurrent C3G who was successfully treated with eculizumab. Nephrotic proteinuria and hematuria occurred and creatinine levels increased after transplantation. A graft biopsy revealed recurrent C3G. The patient was administered 250 mg pulse methylprednisolone for 3 days and had 9 sessions of plasmapheresis. Since elevated creatinine levels and proteinuria persisted, eculizumab was instituted. A complete remission was observed after 9-month maintenance eculizumab treatment. Eculizumab may be a potentially effective option in kidney transplant patients with recurrent C3G unresponsive to other treatment modalities.
    Keywords: eculizumab, complement C3 glomerulopathy, kidney transplantation