فهرست مطالب

nephropathology - Volume:6 Issue:4, 2017
  • Volume:6 Issue:4, 2017
  • تاریخ انتشار: 1396/09/18
  • تعداد عناوین: 22
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  • Azar Nickavar*, Baranak Safaeian Pages 270-271
  • Smita Divyaveer*, Vaibhav Tiwari, Malagouda Patil, Chetan Mahajan, Tanima Das Bhattacharya, Avinandan Banerjee, Koushik Bhattacherjee, Arpita Raychaudhury, Rajendra Pandey Pages 272-274
    Background
    Renal failure in pregnancy is usually due to acute kidney injury and very uncommonly due to rapidly progressing glomerulonephritis (RPGN). We describe here a case of RPGN in the first trimester of pregnancy.
    Case Presentation
    A 26 years old female patient in first trimester of pregnancy presented with RPGN. Investigations revealed dual serological positivity of anti-neutrophil cytoplasmic antibody (ANCA) and anti-glomerular basement membrane antibody (anti-GBM). The biopsy showed crescentic glomerulonephritis with linear with IgG deposition on GBM as well as mesangial IgA deposition. Despite aggressive therapy with cyclophosphamide and plasma exchange she continued to be dialysis dependent and developed end-stage renal disease.
    Conclusions
    RPGN is an uncommon cause of renal failure in pregnancy. While the dual ANCA and anti-GBM are common in RPGN and this concurrent occurrence is wellknown, however, the association of ANCA and IgA nephropathy has been described rather uncommonly. This rare case has positivity of all three in pregnancy.
    Keywords: Rapidly progressing glomerulonephritis, Pregnancy, ANCA associated vasculitis, Anti-GBM disease, IgA nephropathy
  • Bita Geramizadeh*, Abdolaziz Khezri, Rahil Giti Pages 275-277
    Background
    Mucinous adenocarcinoma of the renal pelvis is a very uncommon tumor, most often secondary to chronic infection and long standing irritation due to conditions such as urolithiasis.
    Case Presentation
    Herein we report our experience with an old age male that presented with flank pain. Mucinous adenocarcinoma in situ has been discovered incidentally in his nephrectomy specimen.
    Conclusions
    Mucinous adenocarcinoma in situ, is extremely rare and to the best of our knowledge only two cases have been reported in the English literature so far.
    Keywords: Mucinous adenocarcinoma, Renla pelvis, Incidental
  • Mehri Mollaee, Tibor FÜlop, Sohil Abdul Salim, Mehrdad Hamrahian* Pages 278-281
    Background
    Nodular glomerulosclerosis is a characteristic histological finding of diabetic nephropathy (DN) with thickened glomerular basement membrane (GBM) and hyalinized arterioles. Idiopathic nodular glomerulosclerosis (ING), a rare distinct clinicopathologic entity, is the term used to denote classic DN confirmed by light microscopy, immunofluorescence, and electron microscopy in the absence of diabetes mellitus (DM). ING has been linked to heavy tobacco smoking, chronic hypertension, obesity and insulin resistance. Its association with marijuana use is unknown.
    Case Presentation
    We report a case of biopsy-proved ING in the absence of pre-existing history of DM and heavy smoking. This report addresses the possible accentuation of tobacco use risk by marijuana.
    Conclusions
    This report addresses the possible accentuation of tobacco use risk by marijuana.
    Keywords: Idiopathic nodular glomerulosclerosis, Marijuana, Proteinuria, Smoking
  • Mitra Naseri* Pages 282-289
    Background
    Abnormalities in calcium, phosphorous and parathyroid hormone (PTH) metabolisms are common in dialysis patients. Reaching target levels for these serologic factors and calcium × phosphorous products is recommended to minimize cardiovascular events.
    Objectives
    The aim of this study was to examine calcium, phosphorous and intact PTH (iPTH) abnormalities in a group of dialysis patients.
    Patients and
    Methods
    Bone minerals status and iPTH levels were assessed in 46 dialysis patients aged 19-300 (165.2 ± 75.73) months. Low and high Ca dialysate solutions routinely were used for hemodialysis (63%) and peritoneal dialysis (30.4%) patients respectively. Comparisons between groups were performed with considering age (≤5, 6-10, and > 10 years), gender and modality of dialysis.
    Results
    Serum calcium and corrected calcium levels were significantly higher in peritoneal dialysis (PD) patients. Hypoparathyroidism was the most frequent iPTH abnormality (58.7%). It was more prevalent in males. Hyperparathyroidism was more frequent in females.
    Conclusions
    We found that hypoparathyroidism is the most prevalent PTH abnormality. We also noted that patients on peritoneal dialysis are more prone to develop this form of PTH abnormality. We found that phosphate control is better in peritoneal dialysis vs. hemodialysis cases.
    Keywords: CKD, Hemodialysis, Peritoneal dialysis, PTH, Parathormone
  • Zhiyar Abdulrahman, Hamza Bennani Naciri, Asma Allal, Federico Sallusto, BÉnÉdicte Debiol, Laure Esposito, CÉline Guilbeau-Frugier, Nassim Kamar, Lionel Rostaing* Pages 290-303
    Background
    ABO-incompatible (ABOi) is as efficient as ABO-compatible (ABOc)kidneytransplantation in the setting of live-donation.
    Objectives
    To evaluate the long-term outcomes (i.e. >6 months) of 44 consecutive ABOi living-donor kidney-transplants (KTx). The results were compared to those from 44 ABOc KTx that were matched with ABOi-patients on age, gender, and date of transplantation.
    Patients and
    Methods
    With regards to immunosuppression (IS) only ABOi-patients received pre-transplant IS, that included rituximab. Induction therapy relied significantly more frequently on basiliximab in ABOc- than in ABOi-patients 77.2% vs. 38.6% (P = 0.0002). Post-transplant IS relied only on tacrolimus/mycophenolic acid and steroids in ABOipatients, whereas some ABOc-patients were alternatively on cyclosporine (13.6%)/everolimus (11.3%) and no steroids (7%), respectively (P = 0.05).
    Results
    In ABOi-patients there was no isoagglutinin titer rebound posttransplant. At last follow-up patient and graft survival was similar in the two groups, as well as kidneyallograft function. Acute rejection rates (cellular, humoral, or mixed) were similar across both groups (ABOi: 22.7%; ABOc: 20.4%). With regards to bacterial and viral infections the only significant difference between the two groups was that at month three there were significantly more BKV viruria in ABOi (25%) vs. 6.8% in ABOc (P = 0.03). De novo donor-specific alloantibody were detected in 13.6% ABOi and 4.5% ABOc patients (ns). Readmission rates in our department for less than two days were more frequent for ABOi conversely readmission rates for more than two days was similar across the groups.
    Conclusions
    ABOi-kidney transplantation after desensitization provides in the long-term same results as those observed in live-donor ABOc-kidney transplantation.
    Keywords: ABO-incompatible, ABO-compatible, Living-kidney transplantation, Outcomes
  • Gurudev Konana, Vijay Varma*, Mahesh Eswarappa, Sonika Puri, Gireesh Mathihally, Rakesh Madhyastha, Sujeeth Reddy, Vijaya Mysorekar, Clement Wilfred Pages 304-308
    Background
    The histologic pattern causing nephrotic syndrome (NS) and their clinical outcome varies depending on age, sex, race, socioeconomic status and geographic location. There has been a changing trend in the histologic spectrum of NS in the last few decades, in India as well as worldwide.
    Objectives
    The objective of the present study was to see the histologic spectrum of adult NS in our institution and to compare it with data from other centers.
    Patients and
    Methods
    All adults (≥ 18 years) with nephrotic range proteinuria who underwent renal biopsy from August 2012 to February 2015, were consecutively included in this prospective study. NS caused by diabetes and other secondary glomerular diseases were excluded.
    Results
    Eighty (65.4%) patients were males and 42 (34.4%) were females. The median age at the time of biopsy was 36 years (interquartile range [IQR]: 24.8–45). The most common lesions were minimal change disease (MCD) in 40.2%, membranous nephropathy (MN) in 24.6% and focal segmental glomerulosclerosis (FSGS) in 16.4% of the patients. MCD was observed mostly commonly in the age group 18-35 years and MN was seen mostly commonly in age group 36-55 years.
    Conclusions
    MCD still continues to be leading cause of NS in south Indian adults as evidenced from previous studies from this region. Other common causes include MN and FSGS. The incidence of MPGN is on the decline.
    Keywords: Nephrotic syndrome, Renal, Biopsy, Minimal change disease, Focal segmental glomerulosclerosis, Glomerulonephritis???
  • Kouame Hubert Yao*, Moctar TourÉ, Noel Coulibaly, Sery Patrick Diopoh, Serge Didier Konan, Yvon Kouassi, Innocent Adoubi Pages 309-316
    Background
    Renal failure (RF) is a risk factor for morbidity and mortality in cancer patients.
    Objectives
    To describe the profile of cancer patients with RF.
    Patients and
    Methods
    This is a retrospective descriptive study of RF in patients enrolled in the national cancer registry of Abidjan, during the period from January 2012 to December 2015. The diagnosis of RF was confirmed based on a measured glomerular filtration rate (GFR)
    Results
    The mean age was 54 ± 13.9 years in the group with RF versus 49 ± 14.8 years in the group without RF (P = 0.003). The etiologies of RF were urinary tract obstruction (41.2%), administration of platinum salts (19.8%) and water losses (12.2%). In multivariate analysis, age (P = 0.009), presence of hypertension (P = 0.02), uterine cancer (P = 0.0001) and prostate cancer (P = 0.014) were associated with the risk of RF in cancer patients. Factors such as male gender (P = 0.007), HIV infection (P = 0.021), GFR
    Conclusions
    Late diagnosis leads to renal complications with an increased risk of mortality.
    Keywords: Renal failure, Glomerular filtration rate, Cancer, Obstructive nephropathy, Anemia
  • Jannan Ghapanchi, Abdul Aziz Haghnegahdar*, Maryam Faghih, Fahimeh Rezazadeh, Reza Derafshi, Mitra Farzin, Mohammad Hassan Kalantari Pages 317-323
    Background
    The number of patients with chronic liver failure (CLF) or chronic kidney disease (CKD) referred to dental clinics are increasing. However, there are few studies about the effect of these diseases on jaw bones.
    Objectives
    The aim of this study was to evaluate the inferior mandibular cortex changes of the patients with CLF and CKD that are candidate for liver and kidney transplantation, in panoramic views.
    Patients and
    Methods
    Panoramic radiographs were obtained from 83 patients with a history of CLF and 43 patients with CKD who were undergoing the assessment for transplantation and also 126 control cases. The mean was calculated for the width of inferior mandibular cortex. The relationship between the thicknesses of the inferior mandibular cortex with the duration of disease was determined using Pearson’s correlation coefficient test. T and chisquare tests were used for evaluating the inferior cortex of the mandible according to age and sex, respectively.
    Results
    Compared with the control group, the means of the cortical thickness in CLF and CRF patients were significantly different (P
    Conclusion
    Compared with normal population, a decrease in the thickness of inferior mandibular cortex is observed in CKD and CLF patients. This decrease is not affected by age and duration of the disease but is meaningfully related to sex, especially females.
    Keywords: Chronic kidney disease, Chronic liver disease, Inferior mandibular cortex, Panoramic radiography, Transplant, Bone density
  • Ali Sadeghi, Mojtaba Kalantar, Shahrzad Molavinia, Gholamreza Houshmand, Mohammad Bahadoram, Mahdi Esmaeilizadeh, Mehdi Goudarzi* Pages 324-332
    Background
    Cyclophosphamide (CP) is amongst the most effective alkylating anticancer drugs which regardless of its harmful side effects including nephrotoxicity, hematotoxicity, mutagenicity and also immunotoxicity, commonly raised for the treatment of a number of cancers and autoimmune ailments.
    Objectives
    This study was undertaken to investigate the ameliorative effect of Lavandula officinalis L extract (LOE) in nephrotoxicity induced by CP in mice.
    Materials And Methods
    In this experimental study, 35 male Swiss albino mice (20–25 g) were randomly divided into 5 groups, each group consist of 7 mice. Mice were pretreated with LOE orally in doses of 100, 200 and 400 mg/kg for 5 consecutive days and CP (200 mg/kg, ip) was administrated on the fifth day 1 hour after the last dose of extract. Then on the sixth day, animals were sacrificed. Blood samples were collected to determine serum creatinine (Cr) and blood urea nitrogen (BUN) levels. Malondialdehyde (MDA), glutathione (GSH) levels and catalase (CAT) and superoxide dismutase (SOD) activity were assayed in kidney tissue. The kidney was maintained in formalin for histological examination.
    Results
    Results showed a significant increase in the levels of MDA, Cr and BUN, and decrease of GSH, CAT and SOD by CP administration. Pre-treatment with LOE showed reduction in the levels of MDA, Cr and BUN and increase of GSH, CAT and SOD in all doses but the most significant alteration was observed at doses of 200 and 400 mg/ kg (P
    Conclusions
    Our results indicated that LOE has produced amelioration in biochemical indices and oxidative stress parameters against CP-induced nephrotoxicity.
    Keywords: Nephrotoxicity, Cyclophosphamide, Lavandula officinalis L., Mice
  • Tahereh Malakoutian, Sepideh Hajian*, Ahmad Ebrahimi, Koosha Kamali Pages 333-337
    Background
    The changes in some epigenetic elements such as microRNAs result in aberrant immune responses leading to production and secretion of nephritogenic autoantibodies as the main fundament of lupus nephritis (LN).
    Objectives
    The present study aimed to assess the miRNA profile of kidney biopsies in patients with LN with the purpose of describing the critical role of these elements in LN creation.
    Patients and
    Methods
    In this case-control single center study 11 patients who suffered LN (as the case group) and 11 patients with normal kidney function who were candidate for nephrectomy due to cancer or cyst (as the control group) were included. Kidney biopsies were taken from all LN and control subjects. RNA was extracted and converted to cDNA, then the cDNA was evaluated using NANODROP and then intra-renal expression of candidate miRNAs were quantified in the two groups. In the present study, four topranked miRNAs, miR-638, miR-146a, miR-198, and miR-731 were selected for qRT-PCR.
    Results
    Consistent with the microarray data, we found no significant difference in the expression of all miRNAs between LN and control groups. Using REST 2009 software, we did not also reveal any difference in expression of four miRNAs studied between the patients with LN and those without LN in both parametric and nonparametric patterns.
    Conclusions
    The expression of miR-638, miR-146a, miR-198, and miR-731 may not be related to occurrence of LN in Iranian population.
    Keywords: SLE, Kidney, Biopsy, microRNA, Lupus nephritis
  • Tahereh Safari*, Mehdi Nematbakhsh, Saideh Miri, Omid Ghofran, Fatemeh Fereidooni, Abbass Ali Niazi, Hossein Bagheri Pages 338-345
    Background
    Nephrotoxicity is the most recognized side effect of gentamicin. Vitamin E and vitamin C demonstrate their effective role in the prevention of nephrotoxicity. Likewise, previous studies have suggested that women have low risk of end-stage renal disease at premenopausal period.
    Objectives
    This study aims to investigate the possibility of any gender difference in response to antioxidant effects vitamins E and C in gentamicin-induced nephrotoxicity.
    Materials And Methods
    Wistar rats were randomly assigned to 6 groups each including both male and female rats. The first and second groups received saline (control group) and almond oil, the third group received gentamicin. The fourth group received a regular dose of gentamicin vitamin E. Similarly, the fifth group received a regular dose of gentamicin vitamin C. The sixth group received a dose of gentamicin vitamin C and E simultaneously constantly. This protocol continued for 9 days.
    Results
    Gentamicin increased significantly urea, creatinine (Cr) and malondialdehyde (MDA), but it decreased superoxidase dismutase (SOD) level (P
    Conclusions
    Antioxidant vitamins modified gentamicin-induced nephrotoxicity in both genders, with some difference in response to vitamins E and C between the genders, that was higher in female rats.
    Keywords: Gentamicin, Nephrotoxicity, Vitamin E Vitamin C, Gender difference
  • Rubina Naqvi*, Muhammed Mubarak Pages 346-348
  • Smiley Annie George*, Issam Francis Pages 349-351
    Background
    Kayexalate and sevelamer are resin medications commonly used in the setting of chronic renal failure for the treatment of hyperkalemia and hyperphosphatemia respectively, are known to cause bowel ischemia, ulcerations, necrosis, pseudotumors and perforations and the incidence is higher after post-transplant. Herein we report its presence on the surface of a graft nephrectomy following a masked intestinal perforation.
    Case Presentation
    A 30-year-old male, a renal transplant recipient for dysplastic kidney underwent graft nephrectomy due to wound infection, peri-graft collection and risk of hemorrhage from the vascular anastomotic site. Histological evaluation showed extensive acute tubular necrosis and peri-renal abscess with vegetable matter and numerous colored crystals morphologically consistent with kayexalate and sevelamer. The possibility of an underlying resin induced intestinal perforation was rendered.
    Conclusions
    Kayexalate or sevelamer induced mucosal injury in the gastrointestinal tract could be a clinical emergency and a high index of suspicion particularly in a post transplant setting may allow prompt recognition and surgical cure. From the pathologists’ view familiarity with the morphological appearances of these non-systemic resin medications and its histologic mimics enables accurate diagnosis and timely clinical intervention.
    Keywords: Graft nephrectomy, Kayexalate, Sevelamer, Fish-scales
  • Niloufar Alimohammadi, Parisa Javadian*, Afsaneh Malekpour, Shahram Tahmasebian Pages 352-355
    Background
    The association between the function of fibroblast growth factor 23 (FG 23) and different components of calcium metabolism has remained unclear in patients with renal dysfunction undergoing hemodialysis.
    Objectives
    The present study aimed to assess the association of the level of FGF23 and calcium metabolism status in hemodialysis patients.
    Patients and
    Methods
    This cross sectional study conducted on 90 consecutive patients suffering end-stage renal disease (ESRD) who underwent hemodialysis. The serum levels of FGF23 and intact parathyroid hormone (iPTH) levels were measured using the ELISA technique.
    Results
    The serum levels of FGF23 were directly associated with iPTH level (r = 0.251, P = 0.020) and slightly with the duration of dialysis (r = 0.203, P = 0.063). However serum FGF23 was not significantly related to other indices including levels of calcium, phosphorus, magnesium, vitamin D, albumin, and even body mass index (BMI). No difference was found in the level of FGF23 between men and women with ESRD under hemodialysis.
    Conclusions
    In ESRD patients undergoing hemodialysis, the association of FGF23 with iPTH was detected, while there was not any relationship of FGF23 with other indices including calcium, phosphorus, and vitamin D.
    Keywords: Fibroblast growth factor 23, End-stage renal disease, Hemodialysis, Parathyroid hormone, Parathormone
  • Anoush Azarfar, Mohammad Esmaeeli, Mitra Naseri, Shapour Badiee Aval, Fatemeh Ghanee Sharbaf, Sahar Ravanshad, Yalda Ravanshad*, Hassan Mehrad-Majd, Sara Molkara Pages 356-358
    Background
    In different tissues, the endothelin is produced by vascular endothelium. They are potent vasoconstrictor peptides. There is a little information about the role of endothelin in reflux nephropathy.
    Objectives
    The aim of this study is to evaluate urinary levels of endothelin in patients with vesicoureteral reflux (VUR).
    Patients and
    Methods
    It was a cross-sectional study that conducted on 81 children who received voiding cystourethrogram (VCUG). Based on VCUG reports, patients were divided into two groups; with reflux (40 persons) and without reflux (41 persons). We got a urine sample from patients with mid-stream or urine bag method. The endothelin level was assessed with ELISA immunoassay. Data was analyzed using SPSS 16.
    Results
    Based on VCUG reports, 40 patients (49.4%) had urinary reflux, of them 20 cases suffered from unilateral urinary reflux and others from bilateral. Of 40 patients with reflux, 23 cases (57.5% of reflux group) had kidney scar and seven individuals (17.5%) had abnormal kidney sonography. Of patients with urinary reflux, 13 cases (32.5%) had grad 1 urinary reflux, 8 cases (20%) grade 2, and 5 cases (12.5%) grade 3 and finally 14 cases (35%) grade 4. The UET-1 levels were significantly higher in VUR patients compared to the control group (P
    Conclusions
    Urine endothelin-1 level can be considered as an alternative to VCUG for screening vesicourethral reflux.
    Keywords: Reflux, Endothelin, Voiding cystourethrography, Chronic renal failure, Vesicoureteral reflux
  • Rupesh Raina*, Tushar Chaturvedi, Shyam Polaconda, Amrita Siri Mukunda, Sidharth Kumar Sethi, Vinod Krishnappa Pages 359-362
    Background
    Bartter’s syndrome is a rare autosomal recessive renal tubular disorder characterized by hypokalemia, hypochloremia, metabolic alkalosis, hyperreninemia and hyperaldosteronemia with normotension. Bartter syndrome has five types; type 1 (mutation in sodium/potassium chloride transporter), type 2 (mutation in voltage gated potassium channel), type 3 (mutation on chromosome 1 that encodes Barttin and makes only kidney-specific chloride channel B non-functional), type 4 ( mutation in BSND gene encoding Barttin and makes both kidney-specific chloride channels A & B non-functional) and type 5 (L125P gain in function mutation in calcium-sensing receptor).
    Case Presentation
    A 28-year-old male was hospitalized for evaluation of nausea, vomiting, generalized weakness and persistent chronic hypokalemia. Bartter’s syndrome was suspected based on clinical and laboratory evidence, however serum aldosterone level was normal. Further genetic testing confirmed the diagnosis of Bartter’s syndrome type 3.
    Conclusions
    We report a case of Bartter’s syndrome type 3 with a unique finding of normal aldosterone level.
    Keywords: Bartter's syndrome, Hypokalemia, Renal tubular acidosis, Hypermagnesuria, Normal aldosterone levels
  • Mitra Naseri*, Nona Zabolinejad, Syed Ali Alamdaran, Reza Shojaeian Pages 363-367
    Background
    Autosomal recessive polycystic kidney disease (ARPKD) associates with significant renal and liver-related morbidity and mortality in children. Rarely severe enlargement of kidneys necessitates nephrectomy and initiating dialysis.
    Case Presentation
    A 5-day-old newborn boy with prenatal ultrasonography suggestive of ARPKD admitted in the hospital due to anuria from first day of life. One week after admission, left nephrectomy was conducted because of severe enlargement of kidneys accompanied by respiratory distress and repeated vomiting. Patient was placed on peritoneal dialysis. Pathology of kidney revealed cystic lesions consisted of dilated collecting duct, with lack of involvement of glomeruli and other parts of the nephrons. Patient died at age 17 days with respiratory hemorrhage.
    Conclusions
    Our case is interesting because of progressive increase in kidney sizes requiring nephrectomy. Such huge nephromegaly in ARPKD has not been reported yet.
    Keywords: ADPKD, ARPKD, Childhood, Nephromegaly
  • Shankar Prasad Nagaraju*, Sindhura Lakshmi Koulmane Laxminarayana, Aswani Srinivas Mareddy, Srikanth Prasad, Sindhu Kaza, Srinivas Shenoy, Karan Saraf, Dharshan Rangaswamy, Ravindra Prabhu Attur, Rajeevalochana Parthasarathy, Uday Venkat Mateti, Vasudeva Guddattu, Mahesha Vankalakunti Pages 368-373
    Background
    Current KDIGO guidelines suggest corticosteroids (CS) administration in IgA nephropathy (IgAN) with persistent proteinuria >1 g/d despite 3-6 months of supportive care and estimated glomerular filtration rate (eGFR) >50 mL/min/1.73 m2 . The benefits of CS in patients with eGFR
    Objectives
    To assess the effect of steroids on disease progression and proteinuria in IgAN patients with eGFR 50 mL/min/1.73 m2 .
    Patients and
    Methods
    A cohort of biopsy proven primary IgAN diagnosed between March 2010 - February 2015 who received oral CS with minimum follow-up of 6 months were included. They were categorized into two groups according to their eGFR (group - eGFR 50 mL/min/1.73 m2 ). The eGFR and urine protein creatinine ratio (UPCR) were followed up at entry, 6 months, 12 months and at the end of follow-up. Outcomes studied were change in eGFR, proteinuria and progression to end-stage renal disease (ESRD).
    Results
    Out of 44 patients, 23 were in group1 and 21 patients in group 2. At the end of follow-up, similar reduction of proteinuria (UPCR) was observed in both groups (P=0.62). However, group 1 had a significant fall in eGFR compared to improvement in group 2 (P 0.004). One in each group has reached CKD stage 5 (P=0.73).
    Conclusions
    Addition of CS to conservative treatment in IgAN patients with initial eGFR 50 ml/min/1.73 m2 seems to reduce proteinuria but not beneficial in preventing progression of disease as compared to patients with higher eGFR (>50 mL/min/1.73 m ).
    Keywords: IgA Nephropathy, eGFR, Corticosteroids, Immunosuppression, Proteinuria
  • Fariba Mohebichamkhorami, Shirin Farivar, Mahmoud Rafieian Kopaei* Pages 374-379
    Background
    Systemic lupus erythematosus (SLE) is characterized by multisystem organ involvement. Enhanced neutrophil extracellular traps (NETs) formation and release as well as impaired clearance of NETs have been reported in SLE patients. Renal involvement is common in SLE which might be through deposition of immune complexes within the kidneys. M694V mutation is one of the hot spots of Mediterranean fever gene (MEFV). MEFV mutations have been previously reported in a number of auto-inflammatory and autoimmune diseases in Iranian patients.
    Objectives
    This case-control study was aimed to evaluate the potential influences of M694V gene mutation in SLE disease and in development of renal involvement.
    Patients and
    Methods
    Genotyping of 130 patients and 116 healthy controls was done for M694V mutation (rs61752717, c.2080A>G) using amplification refractory mutation system- polymerase chain reaction (ARMS-PCR) method.
    Results
    Significant differences in the alleles and genotypes frequencies of M694V mutation between SLE patients and ethnically matched healthy controls were detected in this study (9.9% versus 2.4% P=0.000, OR [odds ratio]= 4.277, CI= 2.213-8.265). Furthermore a significant difference of renal involvement between M694V mutation carriers versus noncarriers (8.5% versus 10.4%, P=0.017, OR= 2.149, CI= 1.135- 4.072).
    Conclusions
    The association between M694V mutation and SLE susceptibility was observed. Additionally, renal involvement was significant in SLE patients compared to controls. This finding probably is developed through NET-associated Dnase1 inhibition and maybe amyloidosis. This study may help to explain the nature of the inflammatory state in mutation carriers and assist to an accurate understanding of how it influences SLE pathogenesis.
    Keywords: Renal involvement, M694V, Neutrophil extracellular traps, Systemic lupus erythematosus, Amyloidosis
  • Kevin Manuel*, Marie Moses Ambroise, Renu Gboy Varghese, Ilangovan Veerapan, Georgi Abraham Pages 380-388
    Background
    Viral infections are a significant cause of graft loss and dysfunction in kidney transplant recipients. Cytomegalovirus and BK polyomavirus have often been explained as the most common viral etiological agents.
    Objectives
    The current study was undertaken to assess the prevalence of cytomegalovirus and BK polyomavirus infection in post-renal transplant individuals in a tertiary care centre in South India and also to study the histopathological changes of such infections in the kidney allograft biopsies.
    Patients and
    Methods
    We conducted a retrospective investigation of 100 cases using archival renal biopsy specimens which were subjected to immunohistochemical stains to detect cytomegalovirus and BK polyoma virus. These findings were then correlated with the histopathological alterations detected in H&E sections.
    Results
    We detected the prevalence of cytomegalovirus in 7% and BK polyoma virus in 3%. Cytomegalovirus was statistically associated with pre- and post-transplant infections along with diabetic status. We noted that, out of the seven patients who were immunohistochemically cytomegalovirus positive, only five had positive cytomegalovirus IgM status. With BK polyoma virus, we noted a statistical significance with pre- and posttransplant infections. However, we did not find evidence of cytomegalovirus and BK polyoma virus co-infection in any of the renal allograft biopsies.
    Conclusions
    Routine immunohistochemical evaluation of cytomegalovirus and BK polyoma viral infections in kidney allograft recipients must be done, especially in those with preand post-transplant infections and diabetes.
    Keywords: BK polyomavirus, Cytomegalovirus, Immunohistochemistry, Renal transplantation
  • Salman Khazaei, Mehdi Yaseri, Vida Sheikh, Mohammad Ali Mansournia* Pages 389-394
    Background
    Hemodialysis (HD) represents the main way of renal replacement therapy (RRT) for end-stage renal disease (ESRD) patients in Iran. Few studies have investigated the survival of HD patients in Iran.
    Objectives
    This study conducted to reach better understanding predictors of survival for HD patients. Patients and
    Methods
    This is a retrospective cohort study conducted in 1142 HD patients in Hamadan province during 11 years from 2007 to 2017. The checklist used to gather information was comprised of patient’s demographic and clinical information. The analysis was carried out using Laplace regression and Cox regression model.
    Results
    The most prevalent causes of ESRD were reported to be high blood pressure (BP) (28.9%) and diabetes (24.34%). The probability of survival at the end of 1st, 5th, and 10th year was 0.81, 0.4 and 0.13, respectively. Results of multivariate Cox regression showed that being rural dweller, low albumin, ferritin and hemoglobin level and having positive CRP at diagnosis have a negative significant impact on survival of HD patients (P
    Conclusions
    Being rural dweller, low albumin and hemoglobin level and having positive CRP at diagnosis amongst other factors were possible factors affecting the survival of HD patients in this study. Considering the low survival probability of these patients, efforts should be made to real-time diagnosis of the cause of renal diseases.
    Keywords: Kidney failure, Hemodialysis, Survival, Cox regression models, Laplace regression