Iranian Journal of Kidney Diseases
Volume:6 Issue: 4, jul 2012

Hepatitis C virus (HCV) infection and diabetes mellitus are frequent problems worldwide that induce high health and financial burden in different societies، both of which are also highly prevalent in patients with chronic kidney disease. Diabetes mellitus is a known underlying cause of end-stage renal disease، and on the other hand، HCV is responsible for a wide variety of renal manifestations، such as membranous nephropathy، cryoglobulinemia، and membranoproliferative glomerulonephritis. Moreover، along with its direct impact on kidney damage، HCV is also known to play a role in progression of other causes of kidney diseases. It is known that HCV infection is highly prevalent among patients with diabetic nephropathy. This article reviews the existing literature on the relationship between HCV infection and diabetes mellitus in patients with chronic kidney disease، and also overviews the interplay of these two factors in the transplantation era.

Introduction. There are scarce data on estimating the time of completing kidney maturation in very-low-birth-weight (VLBW) infants. The aim of this study was to determine whether different aspects of kidney function differ between VLBW infants and normal babies at 18 to 30 months postconceptional age.Materials and Methods. This study was carried on 23 VLBW infants and 21 normal-birth-weight infants at 18 to 30 months corrected postconceptional age, who were born between June 2007 and June 2008 at Alzahra Hospital and Shahid Beheshti Hospital, in Isfahan, Iran. Very low birth weight was defined as a birth weight between 1000 g and 1500 g, while gestational age is less than 32 weeks. In both groups, children with a history of sepsis, asphyxia, intubation, hypoxic ischemic encephalopathy, and pyelonephritis were excluded.Results. The mean of systolic, diastolic, and mean arterial blood pressure were not significantly different between the two groups. Urine calcium-creatinine ratio, fraction excretion of magnesium, and renal threshold for phosphate were significantly higher in the VLBW children compared with the control group. Glomerular filtration rate was higher in the control group than in the VLBW group.Conclusions. Our results demonstrated that in VLBW children at the corrected age of 24 ± 6 months, some aspects of tubular and glomerular functions are still impaired. Longer longitudinal cohort studies on VLBW are required to determine the time of completing kidney function maturation in these children.

Assessment of glomerular filtration rate (GFR) is the best index of kidney functions. We aimed to determine the accuracy of El-Minia equation for estimation of GFR in different stages of chronic kidney disease (CKD) in the El-Minia population of CKD patients، in comparison to other proposed equations. The study included 320 isotopic GFR measurements by 99m-Tc technetium diethylene triamine pentaacetic acid. Patients were categorized into the five CKD stages based on this measurement، and estimated GFRs based on the El-Minia، Cockroft-Gault، Chronic Kidney Disease Epidemiology Collaboration، Modification of Diet in Renal Disease (MDRD)، abbreviated MDRD، Walser، Nankivell، Cockcroft-Gault، and Mayo Clinic equations were validated using the National Kidney Foundation guidelines. The El-Minia Equation showed the best performance in all 5 stages of CKD، except for stage 1، in which the Cockroft-Gault equation showed the best performance (44% within ± 10% error). In addition، the El-Minia equation provided the best accuracy to classify CKD stages، except for stage 4، in which the MDRD gave the best accuracy (82%). Worsening of the accuracy was documented in all the eight equations with more severe stages of kidney disease. These results were not significantly changed when the analyses were restricted to diabetic patients. The El-Minia equation represents a better estimation of GFR in all stages of CKD than other published equations for CKD patients in El-Minia، Egypt. This equation was the best one for classification of CKD in these patients.

This study aimed to evaluate renal involvement and factors affecting the prognosis in patients with Henoch-Schonlein purpura (HSP). The outcomes of 107 children diagnosed with HSP who had been followed up for at least 6 months were reviewed. Renal involvement was observed in 26. 1% of the patients. The mean age of the patients with renal involvement was 8. 8 ± 4. 0 years as compared to 7. 1 ± 2. 9 years in the patients without renal involvement (P =. 02). The risk of renal involvement was found to be significantly higher in the patients who were 10 years old and over (P <. 001). In the group with renal involvement، the frequency of scrotal involvement was significantly higher than that of the group without renal involvement (P =. 02). The mean serum immunoglobulin A level of the patients with renal involvements was significantly higher (P =. 04) and the mean serum complement C3 levels was significantly lower (P =. 04) than those of the patients without renal involvement. None of the patients with renal involvement reached end-stage kidney failure. No significant relationship was observed between the development of renal involvement and early steroid treatment. This study proposes that in old children with HSP، elevated serum immunoglobulin A levels، decreased serum complement C3 levels، and scrotal involvement are associated with renal involvement. We failed to find any effect of steroid treatment on development of renal involvement.

The aim of this study was to examine the effects of oral administration of omega-3 fatty acid on kidney functional disturbances، histological damages، and oxidative stress due to reperfusion injury. Male Sprague Dawley rats received a standard diet for 2 weeks. Through gavage، the rats in acute kidney failure and omega-3 groups received 4 mL normal saline or omega-3 fatty acid (0. 4 g/kg) daily. After 2 weeks، the rats underwent surgery and renal ischemia on both sides. During the last 6 hours، the rats were transferred to the metabolic cage for urine sampling. At the end of the period، blood samples were obtained from the aorta and the kidneys were removed for hematoxylin-eosin staining، histological analysis، and oxidative stress measurement. The sham group also received normal saline، but the operation was done without renal ischemia، whereas the control group did not received any substances or operation. The decrease in glomerular filtration rate induced by reperfusion was relatively improved by omega-3 administration، which resulted in the decrease in plasma urea and creatinine concentrations. In addition، the relative excretion of sodium and potassium، and urine flow rate decreased in the omega-3 group as compared with the acute kidney failure group. The degrees of histologic damages and oxidative stress that had increased following reperfusion injury were also significantly lowered by omega-3 administration. Preventive oral administration of omega-3 supplement may decrease histological damages، oxidative stress، and kidney dysfunction following reperfusion injury.

The management of neonates with congenital hydronephrosis (CHN) diagnosed antenatally is still controversial. A prospective study was performed in all newborn infants with CHN born over a 2-year period in order to identify which neonates require a full radiologic investigation including investigation with invasive tests such as voiding cystoureterography (VCUG) and diuretic-enhanced renography. Data on kidney ultrasonography، VCUG، and diuretic renography were collected. The ultrasound grading of hydronephrosis was determined according to Society of Fetal Urology criteria. Sixty-one neonates (47 boys and 14 girls) with CHN were enrolled. All underwent kidney ultrasonography within 72 to 96 hours after birth. Four (7%) had no residual CHN، 34 (56%) had and 23 (38%) unilateral CHN. Of the 41 newborns exposed to diuretic renography، 18 (44%) had ureteropelvic junction obstruction (UPJO). Of the 34 infants that underwent VCUG، 8 (24%) had vesicoureteral reflux (7 bilateral grade 2 or higher، 1 unilateral grade 1 CHN SFU classification). None of the unilateral grade 1 or 2 CHN due to UPJO had vesicoureteral reflux and none with vesicoureteral reflux had UPJO. Twelve patients required surgery (7 had UPJO and 3 high-grade vesicoureteral reflux). These data suggest that mild to moderate unilateral or bilateral CHN rarely coexists with severe obstruction or vesicoureteral reflux. Therefore، systemic VCUG and renography in such patients do not seem justified. Postnatal ultrasonography in combination with renography and VCUG is warranted in the routine examination of neonates presenting with severe unilateral or bilateral CHN.

Kidney transplantation from deceased donor has progressively increased in Iran; however، there are limited published data on its outcome. We evaluated the short-term outcome of kidney transplants using deceased donors in Iran. A total of 121 adult patients who received a kidney allograft from a deceased donor in Baqiyatallah Transplant Center were enrolled. The following data were collected: age، gender، body mass index، cold and warm ischemia times، history of dialysis and blood transfusion، blood pressure، panel reactive antibodies، episodes of acute rejection، acute tubular necrosis، serum creatinine concentration، and surgical complications. The median age of the kidney allograft recipients was 48 years (range، 16 to 71 years). Male gender was predominant (n = 82) with slightly better patient and graft survivals without significant differences. The mean cold ischemic time was 190 ± 50 minutes (range، 1. 5 to 4. 7 hours). One- and 2-year graft survival rates were 94. 0% and 86. 8%، respectively. One- and 2-year patient survival rates were 97. 4% and 91. 9%، respectively. Acute tubular necrosis was the only risk factor for worsening of the graft survival (68. 2% versus 85. 7% for 2-year survival، P =. 001) and the patient survival (81. 5% versus 94. 4% for 2-year survival، P =. 06). No significant correlation was seen between patient survival and other variables. The results of the present study indicate a favorable outcome in short-term period for deceased-donor kidney transplantation in our center.

Bone disease and bone fractures are common among kidney transplant recipients. The aim of this study was to investigate the prevalence of vitamin D deficiency، hyperparathyroidism، and osteoporosis kidney transplant patients. A total of 113 kidney transplant recipients (58 women and 55 men) were selected consecutively from the transplant clinic between January and April 2010. A serum sample from each patient was analyzed for creatinine، calcium، phosphorus، 25-hydroxyvitamin D، and intact parathyroid hormone levels. Bone mineral density was measured by the dual energy x-ray absorptiometry method and classified according to the classification of the World Health Organization. Risk factors of bone mineral density outcomes were evaluated in univariable and multivariable analyses. Forty-five percent of the patients had vitamin D deficiency and 76. 2% had hyperparathyroidism. There was a significant correlation between vitamin D deficiency and high serum parathyroid hormone (P =. 04) and serum creatinine levels (P =. 001). However، there were no significant associations of serum calcium and phosphorus with vitamin D or parathyroid hormone levels. The osteoporosis and osteopenia were reported in 12. 4% and 52. 2% of the recipients in the lumbar spine and 45. 1% and 36. 3% of the patients in the femoral neck، respectively. Multivariable analyses showed that there were significant correlations between patients'' age and body mass index and femoral neck osteoporosis. Risk factors for lumbar spine osteoporosis were end-stage renal disease duration، serum calcium، and body mass index. Vitamin D deficiency، hyperparathyroidism، and osteoporosis are very common in our kidney transplant recipients. Early diagnosis and treatment of these abnormalities should be included in the posttransplant follow-up of patients in order to prevent severe bone diseases and bone fractures.

Sirolimus is the one of new immunosuppressants that may be a substitute to traditional drugs such as cyclosporine. We present our investigation on sirolimus-based immunosuppression in kidney transplant recipients as compared with cyclosporine-based immunosuppression. We enrolled 100 patients in an open-labeled randomized clinical trial at Shahid Labbafinejad Medical Center. The patients were assigned to one of the immunosuppressive groups to receive either sirolimus or cyclosporine in combination with mycophenolate mofetil and steroids. All kidney transplant recipients were followed up by for serum creatinine and glomerular filtration rate for 4 years. There was no significant differences between the two groups regarding serum creatinine level and GFR until for years posttransplant; however، serum creatinine levels were significantly lower and the GFRs were higher in the sirolimus group after 3 and 4 years. The mean serum creatinine was 1. 24 ± 0. 28 mg/dL in the sirolimus group and 1. 57 ± 0. 33 mg/dL in the cyclosporine group at 4 years posttransplant (P =. 02). Also، GFR was 79. 8 ± 22. 3 mL/min/1. 73 m2 in the sirolimus group and 70. 3 ± 23. 6 mL/min/1. 73 m2 in the cyclosporine group B (P =. 04). Acute rejection was 1. 7-fold higher in the cyclosporine group than in the sirolimus group. Our study demonstrated that sirolimus in the immunosuppressive regimen of kidney transplant recipients had better outcomes regarding graft and patient survival. The effectiveness of sirolimus for kidney allograft recipients should be further assessed to be implemented from the first day after transplantation.

Primary Ewing sarcoma of the kidney is a very rare neoplasm that generally occurs in young adults. We report a 69-year-old woman with a history of breast cancer who on a routine annual bone scan was found to have a suspicious area over the right kidney. Computed tomography revealed a 16 by 15-cm mass that was removed by a radical nephrectomy. Pathologic examination confirmed the diagnosis of Ewing sarcoma. Three months later، the patient developed recurrence of the tumor at the nephrectomy site that significantly regressed after chemotherapy

Kidney transplantation has been established as the treatment of end-stage renal disease. Despite great improvement in transplant science، complications are still frequently seen after kidney transplantation. We describe the first case of isolated angiomyolipoma in the kidney allograft developed 3 years after transplantation and treated with partial nephrectomy of the allograft.