فهرست مطالب

Iranian Journal of Kidney Diseases
Volume:13 Issue: 4, Jul 2019

  • تاریخ انتشار: 1398/07/28
  • تعداد عناوین: 12
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  • Reza F Saidi_Reza Moghadasali_Soroosh Shekarchian Pages 213-224

    There has been ample of preclinical and animal studies whichshowed efficacy and safety of using mesenchymal stem cells (MSCs)after transplantation for tissue repair, immunosuppression ortolerance induction. However, there has been a significant progressrecently using MSCs in small clinical trials after transplantation. Recent results using MSCs after transplantation seem to befeasible and safe. However, there are some limitations to show theeffectiveness of these cells including source, dose, timing and routeof infusions. Currently, live donor kidney transplantation has beenespecially considered and development of recent regimes includingimmunosuppression drugs and MSCs administration to kidney andother organs and deceased donor transplantation would be crucial.Therefore, in this review we focused on immunomodulatory effectsof MSCs that have been extensively studied to suppress variousinflammatory responses in kidney transplantation.

    Keywords: organtransplantation, stem cells, clinical trials, preclinical studies, mesenchymal stromal stem cell
  • Fatemeh Musavi Mehdiabadi, Farrokhlagha Ahmadi, Mahboob Lesan, Effat Razeghi Pages 225-231

    Introduction. Kidney transplant recipients are at risk of opportunisticinfections; previous studies demonstrated the association betweenlow level of vitamin D and the risk of viral infections. This studywas designed to evaluate the relationship between serum 25-hydroxyvitamin D level and active Cytomegalovirus infection / disease inkidney transplant recipients.Methods. A total number of 83 kidney transplant recipients enrolledin this case-control study from June 2013 to January 2014. 38patients had active CMV infection / disease and 45 patients hadno evidence of active CMV infection. Serum level of 25-hydroxyvitamin D was measured in these two groups and classified asdifferent levels of sufficient (more than 30ng/mL), insufficient (15-30ng/mL), and deficient (less than 15 ng/mL). Data were analyzedin SPSS 21 statistical software by using statistical tests of Pearsoncorrelation coefficient, chi-square and t-test.Results. Mean serum 25-hydroxy vitamin D level was 14.42 ng/mL in case group and 17.52 ng/mL in control group. There wasno significant difference between the groups in terms of patients'characteristics (P > .05). No significant statistical difference wasfound between mean 25-hydroxy vitamin D level in case and controlgroups (P > .05) but Vitamin D deficiency (serum 25-hydroxy vitaminD less than 15 ng/mL) was noticed in 63.1% of CMV infected groupversus 42.2% of control group. Thus vitamin D deficiency was seenmore prevalent in the CMV infected group (P > .05).Conclusion. Although we did not find a statistically significantrelationship between vitamin D levels and the CMV infection, CMVinfected patients had lower vitamin D level compared with noninfectedrecipients, hence vitamin D deficiency can be consideredas a risk factor for CMV reactivation after renal transplantation.

    Keywords: vitamin D, cytomegalovirus, kidneytransplantation
  • Simin Sadeghi, Fariba Falsafinejad, Hiva Danesh, Fatemeh Bizhani, Gholamreza Bahari, Mohammad Hashemi Pages 232-236

    Introduction. Nephrotic syndrome (NS), a common chronic pediatrickidney disease, is associated with immune system dysfunction.The exact role of MIF -137 G>C gene polymorphism on risk of NSis not clear. The current study aimed to evaluate the relationshipbetween MIF -173 G>C (rs755622) variant and susceptibility to NS.Methods. This case-control study conducted on 134 children withNS and 141 healthy children. Extraction of genomic DNA fromwhole blood was done using salting out method. Genotyping ofthe MIF -173 G>C polymorphism was performed using polymerasechain reaction restriction fragment length polymorphism (PCRRFLP)method.Results. The findings showed that MIF -173 G>C variant significantlyincreases the risk of NS in codominant (OR = 1.82, 95%CI = 1.08-3.08, P = 0.026, GC vs GG), dominant (OR = 1.90, 95%CI = 1.14-3.16,P = 0.015, GC+CC vs GG), overdominant (OR = 1.75, 95%CI = 1.04-2.94, P = 0.037, GC vs GG+CC) and allele (OR = 1.76, 95%CI = 1.13-2.74, P = 0.014, C vs G) inheritance models. Stratified analysisperformed by sex and response to treatment. The findings revealedthat this variant was associated with increased risk of NS in male.No correlation between the variant and response to treatment wasfound.Conclusion. In summary, the results indicated that MIF -137 G>Cis significantly associated with increased risk of NS. More studieswith larger sample size among different ethnicities are needed toverify our findings.

    Keywords: nephroticsyndrome, MIF, genepolymorphism
  • Amal Elbendary, Mohamed Abdel Azez Pages 237-243

    Introduction. Systemic lupus erythematous (SLE) as an autoimmunedisease caused by self immunoglobulin. It was proposed thatthe chromatin including nucleosomes is the main antigen inthe pathogenesis of SLE, and that antinuclear immunoglobulinG are associated with disease activity. Aim of the study was tostudy the diagnostic and prognostic value of serum levels ofantinuclear immunoglobulin G as the most famous anti-chromatinimmunoglobulin as a diagnostic tool and a disease activity markerin juvenile systemic lupus erythematous.Methods. The work was conducted on 90 pediatric Lupuspatients who attended to the Pediatric Nephrology Unit ofPediatric Department of Tanta University Hospital. Also on thirtyapparently healthy children with matched age and sex served asa control group. All subjects were subjected to history in details,clinical examination, SLEDAI score, anti-dsDNA and antinuclearimmunoglobulin G assay .Results. The mean serum level of antinuclear immunoglobulinG was statistically significantly higher in patients than controls(P < .001). But there was no statistically significant differencebetween patients' subgroups. There was a weak positive correlationbetween serum antinuclear immunoglobulin G and SLEDAI score(r = 0.213) but strong correlation between anti-dsDNA antibody andSLEDAI score (r = 0.711). Antinuclear immunoglobulin G showedhigher sensitivity but equal specificity to anti-dsDNA antibody forthe diagnosis of pediatric lupus patients.Conclusion. Antinuclear immunoglobulin G are more accurate thananti-dsDNA antibodies in the diagnosis of pediatric lupus patientsin anti-dsDNA negative children as antinuclear immunoglobulin Ghave higher sensitivity but as regard to disease activity antidsDNAantibody is more accurate.

    Keywords: pediatric, SLE, antinuclear immunoglobulin Gassay, disease activity
  • Javad Ghaffari, Hamid Mohammadjafari, Gholam Hossein Mohammadi, Mohammad Reza Mahdavi Pages 244-250

    Introduction. One of the most serious complications of acute febrilepyelonephritis in children is the development of renal scar. Thisstudy aimed to investigate the effect of dexamethasone on urinarycytokine levels and renal scar in children with acute pyelonephritis.Methods. In a double-blind randomized clinical trial, 60 childrenaged 3 months to 12 years with acute febrile pyelonephritis enrolled.The experimental group was treated with a combination of antibioticand dexamethasone, and the control group underwent treatmentwith antibiotic and placebo. The urinary levels of interleukin -6(UIL-6) and -8 (UIL-8) were measured before treatment as baselineand were repeated four days later.Results. 52 cases (23 patients with mean age of 34.19 ± 30.82 monthsin the dexamethasone group, and 29 patients with mean age of50.55 ± 44.41 months in the control group) completed the study. Inthe control group, the UIL-6 and UIL-8 level became significantlylower after four days treatment (P < .05). In the dexamethasonegroup, there was a statistically significant difference between bothUIL-6 and UIL-8 levels before and after treatment (P < .05). Inpatients who had scar on DMSA scan, the mean UIL-8 and UIL-6levels were significantly high before and after treatment.Conclusion. Results of this study showed that dexamethasone plusantibiotic have no clear superiority to antibiotic therapy alone indecreasing inflammatory cytokines and scar formation. We foundout that patients with scar had sustained high levels of biomarkersbefore and after treatment.

    Keywords: retroperitonealfibrosis, ureteral stents, nephrostomy, prednisolone
  • Firas Ahmed Al Hammouri, Firas Azar Khori, Adnan Abedalqader Abu Qamar, Abedelhakim Nimate, Awad Bakheet Kaabneh, Ashraf Almajali, Ali Zraigat, Abdullah Alomari Pages 251-256

    Introduction. to study the presentation, clinical course, laboratoryresults, imaging findings, medical and urological treatments ofidiopathic retroperitoneal fibrosis at our institution.Methods. Between January 2006 and December 2017, medical recordsand operatives' notes of 116 patients with idiopathic retroperitonealfibrosis (IPRF) were reviewed retrospectively. Diagnosis was doneby clinical and radiological imaging that fulfilled a strict criterion.All patients were initiated on Prednisolone 60 mg for two months,and reduced until reaching 10 mg daily, with a total duration of24 months in the responding patients. Renal drainage was done incases of obstructed kidneys. To assess response, both laboratoryresults and imaging studies at initiation and after 4 months werereviewed and compared.Results. Of 116 patients diagnosed with IRPF, eighty five (73.3%)were male and thirty one (26.7%) female, with mean ± SD age atpresentation was (50.5 ± 10.6) years. 79% of the patients complaintof abdominal and low back pain, 27% uremic symptoms, 10.3% hada new onset of hypertension, 3.4% presented with anejaculation,and 13.8% were totally asymptomatic. Uretric obstruction hadbeen resolved in 132 ureters after a mean of 152 days of treatment.Almost 30 % reduction in the fibrotic mass size was achieved in82 % of patients.Conclusion. Glucocorticoids is the the mainstay of treatment. Therenal function tests, of the vast majority of patients, normalizedwith treatment. Relapse may occur, so a follow-up over a longperiod of time is required. A high index of suspicion is neededfor diagnosis in asymptomatic patients.

    Keywords: retroperitonealfibrosis, ureteral stents, nephrostomy, prednisolone
  • Yalda Ravanshad, Anoush Azarfar, Mohammad Esmaeeli, Zahra Mostafavian, Elham Zahabi, Sahar Ravanshad Pages 257-261

    Introduction. Nocturnal enuresis is a condition, which can affectthe quality of life in children. The present study was designed toinvestigate the efficacy of low-dose imipramine combined withdesmopressin on treatment of patients with primary nocturnalenuresis who were defined as desmopressin non-responders.Methods. A randomized clinical trial was carried out on patientswith primary nocturnal enuresis. Forty children with enuresisranging from 5 to 12 years old were randomly divided into theintervention (n = 20) and control groups (n = 20). The subjects inthe intervention group were treated with desmopressin combinedwith 5 mg imipramine at bedtime, and those in the control groupwere given desmopressin alone. The patients were followed upweekly for one month. The number of wet nights was recorded.Results. Two individuals in the intervention and three individualsin the control group were excluded from the study. Our findingsindicated that the age and gender showed no significant difference.Furthermore, a significant better recovery in the enuresis wasobserved in 18 of 20 patients who were treated with combinationtherapy after 1 month (P < .05). In addition, the frequency ofrecovery was significantly higher (83.3%) in the intervention group,compared with the control group (29.4%).Conclusion. The analysis showed that low-dose imipramine is welltolerated in clinical practice and may represent a good short-termtreatment option in combination therapy where desmopressinalone is not efficient enough.

    Keywords: primary nocturnal enuresis, imipramine, desmopressin, combination therapy
  • Elham Ramezanzade, Farzanehsadat Minoo, Mohammad Kazem Lebadi, Alieh Jedinia, Yalda Haghdar Saheli, Pegah Aghajanzadeh, Ali Monfared, Masoud Khosravi Pages 262-268

    Introduction. The aim of current study is investigation of theimpact of serum FGF23 levels on blood pressure of patients withend-stage renal disease (ESRD) undergoing hemodialysis.Methods. Based on registry, 68 patients who underwent hemodialysis(HD) in the dialysis center of Shahid Beheshti hospital, Anzali,north of Iran, from April 2016 to May 2017 were enrolled. Enzyme-Linked ImmunoSorbent Assay (ELISA) was used to determineserum FGF23 levels. 24 hours blood pressure monitoring method,AMBB, was used to monitor the mean arterial pressure of patients.Spearman related analysis method was used to statistically analyzethe correlation of serum FGF23 level with mean arterial pressure,age, HD duration, kt/v, URR weight gaining, cause of ESRD, andthe mentioned laboratory parameters.Results. Serum FGF23 levels of ESRD patients were not significantlyrelated to age, time of HD and gaining weight. Furthermore,these parameters were not related to blood pressure. However,FGF23 expression levels in serum were positively correlated withphosphorous and calcium- phosphorous. The mentioned laboratoryparameters had no significant correlation with 24 hours bloodpressure changes. Meanwhile, the minimum diastolic pressureand intact parathyroid hormone (iPTH) level showed a significantdirect linear correlation.Conclusion. We suggest that understanding relationship betweenphosphate, FGF23 and cardiovascular disease can be applied intargeted phosphate-based treatment. Kidney failure and the nondippercondition may be highly related to one another and leadto ESRD. Therefore, a special investment in controlling bloodpressure and examining it with a tool such as ABPM can greatlyhelp patients to progress effectively.

    Keywords: chronic kidneydisease, FGF23, glomerularfiltration rate
  • Atefeh As'habi, Iraj Najafi, Hadi Tabibi, Mehdi Hedayati Pages 269-276

    Introduction. Poor nutritional status is prevalent in peritonealdialysis (PD) patients and is related to morbidity and mortality.Therefore, the aim of the present study was to assess the dietaryintake and its related factors in PD patients in Tehran, Iran.Methods. All eligible PD patients in Tehran peritoneal dialysiscenters were included in this cross-sectional study. Dietary intakeof PD patients was determined using a 3-day dietary recall. Also,a 4 mL blood sample was obtained from each patient to measureserum biochemical parameters.Results. Intake of energy, protein, and fiber were lower thanrecommended values in 81%, 92%, and 100% of PD patients;respectively. The prevalence of inadequate energy intake in PDpatients with dialysis vintage ≤ 5 years was significantly higheras compared to those with dialysis vintage > 5 years (P < .05). Asignificant association was observed between inadequate energyintake and inadequate vitamin B3 intake (P < .05). There was amarginally (not) significant association between inadequate energyintake and inadequate vitamin B1 intake (P = 0.06). Intake of thevitamins B1, B2, B3, B6, folic acid, B12, E, C, and of the minerals,calcium, and zinc from both the diet and supplements were lowerthan recommended values in 15%, 38%, 23%, 39%, 52%, 32%, 47%,29%, 54%, and 50.5% of PD patients, respectively.Conclusion. Insufficient intake of energy and various nutrients arecommon in PD patients in Tehran, Iran; which may contribute tomorbidity and mortality in these patients.

    Keywords: peritoneal dialysis, dietary intakes, nutritionalstatus, Iran
  • Farzin Khorvash, Firouzeh Moeinzadeh, Ali Saffaei, Atousa Hakamifard Pages 277-280

    Trimethoprim-sulfamethoxazole (TMP/SMX) is a bactericidalantibiotic. The most common adverse effect of TMP/SMX is skinrashes and gastrointestinal symptoms. Although hyperkalemia canoccur with TMP/SMX component but hyponatremia is uncommon. A55- year old woman, known case of rheumatoid arthritis, presentedwith fever and mild dyspnea. According to diagnostic work upthe infection with pneumocystis jirovecii was confirmed. TMP/SMX was started but after 10 days the patient acutely representedwith nausea and became lethargic. The laboratory studies showedmoderate hyperkalemia and severe hyponatremia. TMP/SMX wasstopped and alternative treatment started. Upon discontinuation ofthe drug, serum sodium and potassium levels were both changed tonormal. Hyponatremia as a life threatening adverse effect appearsto be rare with TMP-SMX therapy, but clinicians should be awareof electrolyte disturbances developed with this drug and electrolytemonitoring should always be considered.

  • Alireza Heidary * Page 281
  • Ali Tayebi, Behzad Einollahi, abolfaz Rahimi, Masoud Sirati nir Pages 347-361

    Non-adherence with treatment is a common problem among hemodialysis patients and was considered as a reliable factor in patients deteriorating, increasing admission chance and inappropriate responding to hemodialysis treatment. According to multiple factors related to Non-adherence to hemodialysis treatment and its importance in patients' quality of life, this study aimed at a systematic reviewing of adherence with treatment in dialysis patients in Iran. Treatment with adherence status is one of the problems that patient has on dialysis. This study aims at detecting the most important causes of Non-adherence in patients on dialysis according to previous studies. First, all of the studies related to our title were searched using some keywords (dialysis, hemodialysis, adherence, and non-adherence) for English and Persian databases; Iranmedex, Magiran, SID, Iran doc, Google, Google scholar, PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic that covering the period from 2010 to 2018 was reviewing following a predefined inclusion and exclusion criteria. Inclusion and exclusion criteria were: papers related to adherence or Non-adherence, papers were in English and Persian, the papers were original and all papers were free full text. As a result, 15 papers related to inclusion and exclusion criteria were identified and analyzed. Data were collected according to study features, measures of Non-adherence, prevalence rates and factors related to Non-adherence. The PRISMA guidelines were followed to conduct this systematic review. The most important reasons for Non-adherence with treatment included: psychological reasons, the lack of awareness and attitude of dialysis patients and lack of social support. Treatment for adherence is so important and can play a very significant role to improve the health in patients on dialysis. Therefore, it is needed to pay more attention to causes of Non-adherence to treatment in hemodialysis patients.

    Keywords: Non-adherence, dialysis, patient, compliance