Iranian Journal of Kidney Diseases
Volume:5 Issue: 3, May 2011

Introduction. Cigarette smoking has adverse effects on kidney transplant recipients, causing cardiovascular disease, kidney function impairment, and cancer. However, there are surprisingly few studies on the impact of cigarette smoking among kidney transplant recipients and its consequences after transplantation. We performed a systematic review of the literature to identify the effects of cigarette smoking on patient and graft survival rates among kidney transplant recipients.Materials and Methods. We searched the PubMed from 1968 to 2009 to identify studies on the effect of cigarette smoking on kidney transplant recipients, using the following keywords: kidney transplantation, cigarette, smoking, tobacco, and nicotine. The electronic and manual searches yielded 357 articles, of which 39 were considered potentially relevant by titles and abstracts and were selected for full text review. Twenty-seven irrelevant reports were excluded.Results. A total of 12 papers were selected for review, comprising of 1801 kidney transplant recipients with a history of smoking. The impact of cigarette smoking on kidney recipient survival was only evaluated by 6 studies and the relative risk of smoking for death was available in 3 reports, varying between 0.8 and 2.2. Cigarette smoking was an independent risk factor for patient death. In addition, on univariable and multivariable analyses, graft survival correlated with a history of cigarette smoking and the relative risk for graft failure ranged from 1.06 to 2.3.Conclusions. Cigarette smoking was associated with an increased risk of death and graft loss. Therefore, every attempt should be made to encourage kidney transplant candidates to stop smoking.

Introduction. Histological typing, especially the evidence of anaplasia and stage of the tumor are two major prognostic indicators in Wilms tumor, but some genetic factors have recently been noted. Mutations in TP53, which is a tumor suppressor gene, have been demonstrated to be associated with poor prognosis in some malignancies. There are also few studies which have confirmed the correlation between p53 protein overexpression and advanced course in Wilms tumor. This study was conducted to determine the correlation p53 immunoexpression and prognosis and outcome of Wilms tumor.Materials and Methods. The overexpression of p53 in 44 specimens of children (26 boys and 18 girls) with Wilms tumor (median age, 36 months; range, 4 to 96 months) was assessed in Mofid Children's Hospital, Tehran, Iran. The overexpression of p53 was determined by immunohistochemistry with antihuman p53 antibody.Results. A positive immunostaining for p53 was detected in 24 of the 44 cases (54.7%). The grade of the tumor and anaplasia were associated with p53 positivity, but there was no association of p53 with the tumor stage. In comparison to p53 negatives, week-moderate and high p53-expressing tumors had significantly decreased the overall survival (hazard ratio, 3.75 and 8.61; P =. 05 and P =. 01, respectively).Conclusions. Overexpression of p53 protein in Wilms tumor is an indicator of poor pro gnosis, because it is correlated with unfavorable histology tumors and a shorter survival period.

Introduction. Upregulation of interleukin-2 may be involved, not only in the pathophysiology of nephrotic syndrome, but also in steroid resistance treatment, by increasing expression of multidrug resistant gene-1 (MDR1) gene on lymphocytes and its product P-glycoprotein effluxing corticosteroid. Our aim was to assess the relation of serum soluble interleukin-2 receptor (sIL2R) levels and MDR1 gene expression on lymphocytes with nephrotic syndrome and its corticosteroids therapy.Materials and Methods. We examined 40 children with nephrotic syndrome (15 cases of recent onset and 25 known cases with relapse) and 20 healthy children as a control group. We examined every patient twice at the time of disease activity and within 1 week of remission.Results. A significant increase was found in sIL2R level and MDR1 gene in the patients in comparison with the control group whether in activity or remission, and they were significantly higher in activity than in remission. Levels of sIL2R and MDR1 gene expression in different subgroups were higher in known cases with relapse than in new onsets, both in activity and remission, and relatively higher in steroid-resistant than in steroid-sensitive ones.Conclusions. We propose sIL2R and MDR1gene expression levels as early predictors of steroid resistance in nephrotic syndrome for early control of disease by immediate introduction of cytotoxic drugs. This is the first report providing new insight into the use of sIL2R as a predictor of steroid resistance. Thus, wide-scale studies are needed to determine a cutoff level of sIL2R above which cytotoxic drugs are introduced.

Introduction. The aim of this study was to evaluate the role of hydrochlorothiazide in pediatric calculus formers with hypercalciuria and define possible factors affecting response to treatment.Materials and Methods. Nineteen pediatric calculus formers, 12 girls and 7 boys, aged 15 days to 60 months, with idiopathic hypercalciuria received high-dose hydrochlorothiazide (1 mg/kg/d to 2 mg/kg/d) and citric acid-potassium citrate (1 mEq/kg/d) and were evaluated in a 2-year period. Avoiding high-salt diets was recommended throughout the study and increasing fluid intake was encouraged.Results. The patients received hydrochlorothiazide for 2.5 to 15 months (mean, 6 ± 3 months), and 10 of them (52.6%) reached normacalciuria. Resolution of hypercalciuria was associated with decreased calculi sizes in 1 (5.3%) and stone-free condition in 4 (21.1%). No significant differences were found between responders and nonresponders with regard to age at presentation, gender, family history of calculus, and size and number of calculi.Conclusions. Our study showed that a combination of diet modification and hydrochlorothiazide has reasonable hypocalciuric effects; however, it is not very efficient in stopping calculus formation process. In addition, clinical and radiological data were not helpful to predict patients with better response to treatment.

Introduction. Carotid intima-media thickness (CIMT) has been introduced as a cardiovascular disease predictor which may increase in hamodialysis patients. As there are many risk factors in the uremic state that theoretically lead to increase in CIMT, this study was aimed to determine risk factors of CIMT increase in a group of hemodialysis patients.Materials and Methods. Seventy-two hemodialysis patients with a mean age of 61.3 ± 15.0 years and 49 individuals with no history of chronic disease (control group) underwent ultrasonography for measurement of CIMT. Correlation of demographic, clinical, and laboratory factors with CIMT was studied. Carotid intima-media thickness was measured by one radiologist in the bilateral common carotid artery, and the mean value of the two sides was reported.Results. The mean duration on dialysis was 82.4 ± 78.0 months. The mean CIMT was 0.96 ± 0.25 mm (range, 0.4 to 1.7 mm) in hemodialysis patients and 0.76 ± 0.06 mm (range, 0.58 to 0.91 mm) in the control group (P <. 001). The mean CIMT was significantly higher in men compared to women on dialysis and in diabetic compared to nondiabetics patients. There was a positive correlation between CIMT and age (r = 0.266, P =. 02) and serum cholesterol (r = 0.375, P =. 002). No correlation was found between CIMT and other studied variables.Conclusions. Carotid intima-media thickness was greater in hemodialysis patients compared to the control group. It was mainly affected by traditional cardiovascular risk factors and uremic risk factors did not specifically affect CIMT.

Introduction. The aim of the study was to assess the validity and reliability of the SF-12 questionnaire in a sample of Iranian patients undergoing hemodialysis.Materials and Methods. One hundred and forty-four hemodialysis patients were included from dialysis centers in Zanjan, Iran, and were asked to complete the SF-12 and SF-36 questionnaires. An initial test-retest reliability evaluation was performed on a sample of 70 patients from the total group, with a retest interval of 14 days. Reliability was estimated by internal consistency and validity was assessed using known-group comparisons and construct validity on the patient group as a whole. A linear regression analysis was used to assess any variation in the physical component summary and mental component summary scores of the SF-36 with the respective component summary scores of the SF-12. In addition, the factor structure of the questionnaire was extracted by performing a confirmatory factor analysis.Results. Cronbach alpha for physical and mental component summaries were 0.89 and 0.90, respectively. The SF-12 showed a good discriminatory ability between subgroups of patients based on demographic and clinical variables. The confirmatory factor analysis for the original two-factor structure showed a good fit index (chi2 = 23.30, degrees of freedom = 13), goodness-of-fit index = 0.96, and root mean squared error of approximation = 0.079).Conclusions. In general, the SF-12 has good psychometric properties and can be used as a shorter version of the SF-36 questionnaire in future studies involving Iranian patients undergoing hemodialysis.

Introduction. Patients with end-stage renal disease are at a high risk of hepatitis C virus (HCV) infections. These patients are on maintenance hemodialysis where they are exposed to dialysis fluid and dialysis membrane that generate an acute-phase response, which leads to inflammation, reflected in increased inflammatory markers like C-reactive protein (CRP) and interleukin-6 (IL-6). The aim of this study was to investigate levels of IL-6 and CRP in patients on hemodialysis and to determine effects of HCV on these markers.Materials and Methods. A total of 43 patients (39.5% men and 60.5% women; age range, 21 to 65 years) on maintenance hemodialysis for a period of at least 3 months were included. Twenty-four of them were HCV positive. Serum IL-6 and CRP were assessed in all patients.Results. Of HCV-positive patients, 11 (45.8%) had high levels of CRP, while 13 (54.2%) had low levels and increased levels of IL-6 (1064 ± 544.2 pg/mL, P =. 19). Of 19 HCV-negative patients, 13 (68.4%) had high levels of CRP, while 6 (31.6%) had low levels, and all these patients had low levels of IL-6, as compared to HCV-positive patients. No significant correlation was observed between the levels of CRP or IL-6 and the duration of dialysis.Conclusions. In our study, we found high serum IL-6 and CRP levels in HCV-positive hemodialysis patients, compared with HCV-negative ones. However, we failed to show the significance of these differences. More studies with large sample sizes and evaluation of the other inflammatory markers are warranted.

Introduction. CD86 is a costimulatory molecule that participates in the regulation of T-cell lymphocytes activation. Thus, we examined a genetic marker on the CD86 gene in kidney transplant outcome.Materials and Methods. In our retrospective study, 168 kidney allograft recipients were genotyped by direct sequencing. Patients were classified into 2 groups of 29 human leukocyte antigen (HLA)-identical haplotype allograft recipients and 139 recipients showing one or more mismatches in the HLA haplotype. Forty-five patients (26.8%) developed at least 1 acute rejection (AR) episode, 7 in the first and 38 in the second group.Results. Acute rejection was associated with the presence anti-HLA antibodies before transplantation (P =. 03). The AA genotype and A allele at position +1057 in the CD86 gene were more frequent in patients without AR (9.75% and 28.5%, respectively) compared with those showing an AR (2.22% and 23.3%, respectively). This difference was statistically significant in the anti-HLA-positive recipients, as AA frequency was 31.3% in non-AR patients and zero in AR ones (P =. 04) and A allele frequency was 46.9% and 20.8%, respectively (P =. 04). Patients bearing AA genotype reached a higher graft survival time (9.84 years) than those carrying GA (8.21 years, P =. 32) or GG (7.61 years, P =. 72) genotypes.Conclusions. These results suggest that AA genotype and A allele of CD86 +1057G>A polymorphism may confer a protection against acute kidney allograft rejection in Tunisian patients.

Introduction. Renal reperfusion injury is associated with increased mortality and morbidity due to acute kidney failure. Oxidative stress induced with renal reperfusion affects glomeruli and tubular epithelium through reactive oxygen species; therefore, the use of medicinal plants appears rational for improvement of reperfusion effects. The aim of present study was to examine the preventive effect of garlic juice (Allium sativum) on renal reperfusion injury in rats.Materials and Methods. A total of 30 male Wistar rats were divided into 5 groups: control, garlic, sham (right nephrectomy), reperfusion, and reperfusion + garlic groups. After right nephrectomy, renal ischemia and reperfusion were induced. At the end of the experiment, all rats were killed and kidney function tests and histopathological examination were performed.Results. Reperfusion increased serum urea and fractional excretion of sodium levels, while it decreased urine potassium levels and creatinine clearance. However, garlic juice significantly decreased serum urea levels in the reperfusion + garlic group compared with the reperfusion group (P <. 001). Preteatment with garlic juice also resulted in significant increase in urine potassium (P =. 03) compared to reperfusion. Fractional excretion of sodium and creatinine clearance were also improved. On histological examination, rats pretreated with garlic juice had nearly normal morphology.Conclusions. The results of this study showed that garlic juice significantly prevented renal reperfusion-induced functional and histological injuries.

There is little information regarding kidney function in patients with beta-thalassemia minor. In this study we investigated kidney function tests in 50 children with beta-thalassemia minor (22 boys and 28 girls). Twenty-four-hour urine samples were collected and analyzed for sodium, potassium, calcium, magnesium, creatinine, phosphate, uric acid, protein, and beta2-microglobulin. Blood samples were obtained for hematologic and biochemical analyses including complete blood count, serum ferritin, sodium, potassium, calcium, phosphate, magnesium, creatinine, and uric acid. This group of children with beta-thalassemia showed some evidence of tubulopathy such as proteinuria (32%), beta2-microglobulin excretion (36%), calciuria (4%), phosphaturia (4%), and uricosuria (20%). Our findings support the existence of renal tubular dysfunction in beta-thalassemia minor. However, further studies in large series are needed to shed light on the possible relation of these two distinct diseases.

Emphysematous pyelonephritis is an acute necrotizing infection of the renal parenchyma, resulting in presence of gas within either in the collecting system or perinephric space. We herein report our experience with 5 cases of emphysematous pyelonephritis in 2 men and 3 women managed by broad spectrum antibiotics, supportive measures including hemodialysis (2 patients), ureteral stenting (2 patients), surgical drainage of perinephric collection (1 patient), and control of diabetes mellitus (4 patients). Four patients were discharged after a mean hospital stay of 18 days. A nondiabetic male patient with a nonobstructed kidney died on the second postoperative day due to persistent septicemia despite nephrectomy. Emphysematous pyelonephritis is a potentially fatal disease requiring careful and prompt diagnosis and individualized rational therapy. Ureteropelvic stenting should be used for drainage of pent-up collections as a lifesaving measure through relieving the obstruction. Perinephric fluid collection should be drained either percutaneously or surgically.

Urogenital tuberculosis (TB) is a common late manifestation of an earlier symptomatic or asymptomatic pulmonary TB infection. A latency period ranging from 5 to 40 years between the time of the initial infection and the expression of urogenital TB frequently occurs. As one of the most common sites of involvement of extrapulmonary TB, urogenital TB accounts for 15% to 20% of the infections. We present a patient who had culture-negative active tubercular kidney disease due to silent tuberculous infection. Our case demonstrates the limitations of noninvasive testing in establishing the diagnosis of renal tuberculosis.