Iranian Journal of Kidney Diseases
Volume:2 Issue: 1, 2008 Jan

Hypertension (HTN) is a major cause of stroke, left ventricular hypertrophy, congestive heart failure, arteriosclerosis, end-stage renal disease, and peripheral vascular disease. Oxidative stress and its constant companion, inflammation, play a critical part in the pathogenesis of many acute and chronic illnesses including HTN and its long-term complications. There is compelling evidence that oxidative stress, inflammation, and HTN are involved in a self-perpetuating vicious cycle which, if not interrupted, culminates in progressive target organ injury and dysfunction. This article is intended to review the available evidence for the role of oxidative stress and inflammation in the pathogenesis of HTN. In addition, evidence will be presented to demonstrate the role of HTN in the pathogenesis of oxidative stress and inflammation. Finally, evidence for participation of tissue angiotensin system in the vicious cycle of oxidative stress, inflammation, and HTN will be presented, and the approach to treatment of HTN-associated oxidative stress will be discussed.

Introduction. Our aim was to determine the frequency of peptic ulcer and Helicobacter pylori infection by gastrointestinal evaluations in pretransplantation phase in children with end-stage renal disease (ESRD). Materials and Methods. Twenty-four children with ESRD (13 girls and 11 boys) with a mean age of 14.7 ± 3.4 years on maintenance hemodialysis were included in this study. Upper gastrointestinal endoscopies were performed and 4 gastric, antral, and duodenal biopsy specimens were obtained for urease test and histological study. Serum gastrin levels were measured in all patients, too. A control group was chosen to compare the rate of H pylori infection between children with ESRD and healthy children. Results. Gastrointestinal symptoms were present in 16 (66.7%) of 24 patients. Seventeen (70.8%) patients had abnormal upper gastrointestinal endoscopic findings. Infection with Helicobacter pylori was detected in 16 patients and 5 healthy children (66.7% versus 20.0%, P <. 001). The frequency of dyspeptic symptoms was not different significantly between uremic patients with and without H pylori infection (P =. 67). The same results were found regarding the upper gastrointestinal abnormalities found by endoscopy (P =. 65). Oral alkalizing supplement was received by 63% of symptomatic and 80% of asymptomatic patients. Serum gastrin levels were significantly higher in infected patients than in noninfected patients with H pylori (P <. 001). Conclusions. We found a significant number of patients with peptic ulcer diseases, H pylori infection, and secondary hypergastrinemia. This study showed that clinical symptoms are not a reliable predictor of gastrointestinal problems and this is more confusing in patients who received alkalizing solutions.

Introduction. Our aim was to evaluate the frequency and risk factors of posttransplant diabetes mellitus (PTDM) at our kidney transplant center, and to compare graft and patient outcomes between the kidney recipients with and without PTDM. Materials and Methods. We studied 203 kidney transplant recipients with a negative history of diabetes mellitus before transplantation. We examined them for PTDM and made diagnosis on the basis of the American Diabetes Association criteria. Measurements of plasma glucose were carried out from 3 months to 24 months after transplantation. All data including recipient and donor demographics, cause of end-stage renal disease, cytomegalovirus and hepatitis C virus antibody tests, and patient and graft outcomes were assessed in relation to PTDM. Results. High fasting plasma glucose was seen in 24 (11.8%), 19 (9.4%), 16 (7.9%), and 13 (6.4%) patients at 3, 6, 12, and 24 posttransplant months, respectively. Moreover, impaired glucose tolerance was seen in 17 (8.4%), 16 (7.9%), 17 (8.4%), and 19 (9.4%) patients at the corresponding times, respectively. Accordingly, 39 patients (19.2%) were diagnosed to have PTDM. The mean age of the kidney recipients with PTDM was 46.5 ± 12.3 years as compared to 38.6 ± 13.4 years in nondiabetic kidney recipients (P =. 02). The 5-year patient and graft survival rates were not significantly different between the kidney recipients with and without PTDM. Conclusions. This study showed that PTDM is a common metabolic disorder in our kidney transplant patients. We recommend a less diabetogenic immunosuppressive protocol, especially for our older recipients.

We report a case of acute renal failure related to rhabdomyolysis in a patient with Sheehan syndrome, while other diseases that could cause rhabdomyolysis were excluded. The patient’s kidney function completely recovered with 3 sessions of intermittent hemodialysis. After thyroxine replacement therapy, musculoskeletal symptoms disappeared and creatine kinase concentrations decreased. Steroid replacement therapy was also administered. The present case suggests that rhabdomyolysis could occur in a patient with Sheehan syndrome without other precipitating factors

Introduction. We evaluated relations between interleukins (IL) IL-6 and IL-10 and euthyroid sick syndrome (ESS) in patients with nonthyroidal illness (NTI). Materials and Methods. Sixty patients and 20 healthy volunteers were recruited. The patients had either chronic kidney disease (CKD), congestive heart failure (CHF), or acute myocardial infarction (MI), distributed equally in 3 subgroups. Serum levels of IL-6 and IL-10, thyroid stimulating hormone (TSH), total T4, and T3 were determined. Results. In the 60 patients with NTI, we detected a significantly lower T3 and T4 levels compared to controls, while TSH level was within the reference range. Also, IL-6 level was substantially higher than that in controls (P <. 001) and correlated with T3 (r = -0.620, P <. 001) and T4 (r = -0.267, P <. 001). Similarly was IL-10 level (P <. 001) that correlated with T3 (r = -0.512, P <. 001), but not with T4. The ILs correlated positively with each other (r = 0.770, P <. 001). Only IL-6 was a predictor of low T3 (P =. 001). The proportion of patients with subnormal T3, T4, and TSH levels was highest in those with MI along with greatest IL-6 and IL-10 levels compared to patients with CHF and CKD. Patients with CKD showed the least disturbance in IL-6 and IL-10 despite the lower levels of T3, T4, and TSH in a higher proportion of them compared to patients with CHF. Conclusions. The high frequency of ESS in patients with NTI may be linked to IL-6 and IL-10 alterations. Perturbation of IL-6, and not IL-10, might be involved in the pathogenesis of ESS along with other key players as suggested by our findings in CKD.

Introduction. Prompt diagnosis and localization of pyelonephritis are of great importance in children. The urinary excretion of enzymes, and in particular N-acetyl-beta-D-glucosaminidase (NAG), is considered a simple noninvasive marker for detection of renal tubular dysfunction due to pyelonephritis. This study was performed to determine the diagnostic value of urinary NAG in acute pyelonephritis. Materials and Methods. In a quasi-experimental study conducted on 72 children with confirmed pyelonephritis, we measured urinary NAG, creatinine, and NAG-creatinine ratio before and after the treatment. Diagnostic values of these parameters were evaluated by considering the patients before and after the treatment as disease-positive and disease-negative groups, respectively. Results. The patients were 18 boys (25.0%) and 54 girls (75.0%) with a mean age of 43.0 ± 39.0 months. The mean levels of urinary NAG were 12.20 ± 6.14 U/L and 5.46 ± 7.98 U/L before and after the treatment, respectively (P <. 001). The sensitivity and specificity of urinary NAG-creatinine ratio for diagnosis of pyelonephritis were 73.6% and 77.3%, respectively, with a cutoff point of 10.16 U/g (area under the curve = 0.76, 95% confidence interval, 0.67 to 0.76). Significantly higher levels of urinary NAG were found in those who had a negative urine culture at diagnosis (8.8 ± 10.4 U/L) compared to those with a positive urine culture (4.5 ± 8.7 U/L). Conclusions. We concluded that urinary NAG is elevated in children with pyelonephritis and it can be considered as a further criterion in the diagnosis of upper urinary tract infection.

Introduction. The aim of this study was to evaluate the frequency of unexplained pulmonary hypertension (PHT) among patients on hemodialysis at 2 centers and to evaluate possible predisposing factors. Materials and Methods. In this cross-sectional study, PHT was screened by Doppler echocardiography on the day after dialysis in 62 patients with end-stage renal disease receiving maintenance hemodialysis via arteriovenous access. Pulmonary hypertension was defined as a systolic pulmonary arterial pressure (PAP) higher than 35 mm Hg, and the systolic PAP was calculated using the modified Bernoulli equation. Clinical variables were compared between patients with and without PHT. Results. A PAP higher than 35 mm Hg was found in 32 patients (49.3%) receiving hemodialysis, with a mean systolic PAP of 39.58 ± 13.27 mm Hg. Blood hemoglobin level was significantly lower in the patients with PHT than those without PHT (9.8 ± 1.97 g/dL versus 11.07 ± 1.86 g/dL; P =. 01). In addition, serum levels of albumin was lower in these patients (3.38 ± 0.32 g/dL versus 3.75 ± 0.44 g/dL; P =. 02). Conclusions. This study demonstrates a surprisingly high prevalence of PHT among patients with end-stage renal disease receiving hemodialysis. We concluded that the best approach to this unrecognized complication that is associated with reduced survival is keeping it in mind and looking for it in the management of patients on dialysis.

Introduction. Achievements in short-term graft survival since the introduction of cyclosporine has not been matched by improvement in long-term graft function, and chronic allograft nephropathy remains the second commonest cause of graft attrition over time. We aimed to evaluate the long-term results of conventional immunosuppression by steroid and azathioprine in comparison with cyclosporine-based triple therapy in living donor kidney transplants.Materials and Methods. We evaluated the long-term follow-up data of 369 living related kidney transplant recipients that were on prednisolone-azathioprine immunosuppressive therapy (group 1) or triple therapy by prednisolone, cyclosporine, and azathioprine (group 2). All recipients were followed-up for more than 10 years (mean, 240 ± 12 months). Comparative analyses included patient and graft survival rates, condition at last follow-up, graft rejection, and graft function.Results. There were 130 patients in group 1 and 239 in group 2. The overall frequency of acute rejection episodes was not significantly different between the two groups. However, the proportion of patients with chronic allograft nephropathy was significantly higher in group 2 (21% versus 35%, P =. 001). Graft survival rates were 85.3% versus 92.4% at 1 year, 69.9% versus 71.9% at 5 years, and 52.5% versus 50.8% at 10 years in groups 1 and 2, respectively (P =. 03). The two groups were comparable regarding posttransplant malignancies, diabetes mellitus, serious bacterial infections, and hepatic diseases. However, hypertensive patients were significantly more frequent in group 2.Conclusions. Chronic allograft nephropathy was significantly higher in patients receiving cyclosporine, possibly due to the risk of drug-induced nephrotoxicity, glomerular disease recurrence, and hypertension. Nowadays, it is possible to achieve excellent calcineurin inhibitors-free regimen using newer maintenance immunosuppressive agents.