فهرست مطالب

Kidney Diseases - Volume:5 Issue: 4, Jul 2011

Iranian Journal of Kidney Diseases
Volume:5 Issue: 4, Jul 2011

  • تاریخ انتشار: 1390/04/04
  • تعداد عناوین: 15
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  • Eduardo Pimenta Page 215
    Resistant hypertension is an increasingly common medical problem, and patients with this condition are at a high risk of cardiovascular events. The prevalence of resistant hypertension is unknown, but data from clinical trials suggest that 20% to 30% of hypertensive individuals may be resistant to antihypertensive treatment. The evaluation of these patients is focused on identifying true resistant hypertension and contributing and secondary causes of hypertension, including hyperaldosteronism, obstructive sleep apnea, chronic kidney disease, renal artery stenosis, and pheochromocytoma. Treatment includes removal of contributing factors, appropriate management of secondary causes, and use of effective multidrug regimens. More established approaches, such as low dietary salt and mineralocorticoid receptor blockers, and new technologies, such as carotid stimulation and renal denervation, have been used in the management of patients with resistant hypertension
  • Vishal Sharma, Vivek Kumar, Alka Sharma Page 228
  • Masoumeh Mohkam, Abdollah Karimi, Narges Eslami, Alireza Khatami, Fatemeh Fallah, Saiid Maham, Farzaneh Jadali, Fatemeh Abdollah Gorji Page 229
    Introduction. Hypertension is one of the most common diseases in the world and a major risk factor for cardiovascular, renal, and neurologic diseases. It seems that hypertension and overweight in children are a growing epidemic. The aim of this study was to investigate the prevalence of hypertension in school-aged children in Tehran.Materials and Methods. In a cross-sectional study, blood pressure and anthropometric measurements were performed on school-aged children in Tehran from 2008 to 2009. Children aged 7 to 11 years from 5 public schools in Tehran were included. Blood pressure, weight, and height measurement were performed at the school. At each screening, 3 seated blood pressure, weight, and height measurements were made and at least after 3 minutes of rest and choosing proper cuff, blood pressure was measured by a pediatric nephrologist and a pediatric assistant.Results. A total of 425 school-aged children were included. Twenty-four percent of the primary school children had hypertension and 12% were shown to be overweight. Hypertension was more common in students of the north of Tehran in comparison to other geographic parts of Tehran. There was a significant difference in the prevalence of hypertension between girl students of north of Tehran and girls of the other parts of Tehran.Conclusions. We concluded that hypertension is a common problem in school-aged children. Our study re-emphasized the need for prevention and control of high blood pressure in children to manage the global diseases burden due to hypertension.
  • Fatemeh Emamghoraishi, Shohreh Farshad, Mehdi Kalani Page 234
    Introduction. Escherichia coli are the most frequent pathogens in acute urinary infections. They are classified based on various types of O antigen. Escherichia coli strains that cause urinary tract infections possess several genes encoding urovirulent factors. To assay the relation of virulent factors of E coli in acute urinary infections, the serotypes and virulence factor genotypes were determined.Materials and Methods. We studied 96 E coli isolates from children with acute urinary infections. Four urovirulence determinants were analyzed by DNA colony hybridization, including the genes for type 1 fimbriae (pil), P fimbriae (pap), S fimbriae (sfa), hemolysin (hly), and cytotoxic necrotizing factor 1 (cnf1). O serotypes were also determined.Results. The most frequently found virulence factor-encoding gene in the E coli strains studied was the gene for type 1 fimbriae (27.4%). The prevalence of pap, sfa, hly, and cnf1 were higher in serotypes causing pyelonephritis than cystitis. The most common type of O antigen was O1 (12.2%). There was a significant correlation between serotype and genotype in uropathogenic E coli.Conclusions. The high prevalence of O6 serotypes in children urinary tract infections and the high percentage of virulent genes in serotype O6 suggested a close relation between serotype and genotypes of uropathogen E coli.
  • Mohammad Ali Mashhadi, Houshang Sanadgol, Mahmoudali Keikhaei Page 238
    Introduction. Ifosfamide is an alkylating agent, frequently used in the treatment of sarcoma. Major side effects of ifosfamide are classified as nephropathy, neuropathy, and hematologic complications. The aim of present study was to determine the frequency and severity of ifosfamide nephropathy in patients with various types of sarcoma.Materials and Methods. Ninety patients (52 males and 38 females) who had received ifosfamide chemotherapy for sarcoma were included in this study. Data on physical examination, laboratory studies, and estimation of glomerular filtration rate were collected. The median duration of follow-up was 6 to 12 months. Records of documented nephropathy were identified in these patients.Results. The age range of patients on ifosfamide was 5 to 59 years. Thirty-four of the patients were children and 56 were adults. The most common renal side effects were proteinuria (15.5%), glycosuria (7.8%), elevation of serum creatinine (2.2%), hematuria (14.4%), and combination of proteinuria and glycosuria (5.5%). None of the patients had gross hematuria, but microscopic hematuria was present in 14.4%.Conclusions. Ifosfamide nephropathy was seen with different degrees of severity in patients with sarcoma. Monitoring of the side effects of ifosfamide should be revised in different populations.
  • Alireza Soleimani, Omid Nasiri, Hassan Nikoueinejad, Mojtaba Yousefzade, Fatemeh Foroozanfard, Mashaallah Tabatabaizadeh, Seyyed Alireza Moraveji, Mohsen Rajali Page 242
    Introduction. Since the level of B-type natriuretic peptide (BNP) increases in heart failure, elevated plasma BNP concentration is used as a predictor in the diagnosis and management of heart failure. Due to the diminished renal clearance of BNP, its level is above normal in kidney failure. This study evaluated the BNP prognostic value for assessing ventricular function in patients with chronic kidney disease.Materials and Methods. All the participants were diagnosed with chronic kidney disease. Echocardiography was employed to assess ejection fraction. Body mass index, serum creatinine, and BNP were measured for all the patients. Prognostic value of BNP was assessed for ventricular function measured by ejection fraction.Results. Forty-four patients, including 34 men and 10 women, participated in the study. Level of BNP had a significant correlation with body mass index, ejection fraction, age, and gender. The sensitivity and specificity of BNP levels of 150 pg/mL and 705 pg/mL were 93.3% and 28.6% and 50.0% and 85.7%, respectively, for the diagnosis of ventricular dysfunction in the patients with chronic kidney disease.Conclusions. These findings suggest that a level of BNP of 705 pg/mL is a rather acceptable predictive factor for heart failure in patients with chronic kidney disease. The participants’ height and weight, which were associated with BNP as body mass index, contributed to this level.
  • Mojgan Jalalzadeh, Ramin Mohammadi, Fatemeh Mirzamohammadi, Mohammad Hassan Ghadiani Page 248
    Introduction. The role of metabolic syndrome (MS) in hemodialysis population has not been thoroughly studied. This study aimed to determine the prevalence of MS and to identify its correlates among hemodialysis patients.Materials and Methods. This cross-sectional study was conducted on patients in a hemodialysis center. The MS was defined according the Adult Treatment Panel III criteria. Clinical data of the patients were collected and blood samples were studied to measure fasting blood glucose and lipid profile.Results. Eighty hemodialysis patients, including 47 men (58.8%) and 33 women (41.2%) with a mean age of 55.6 ± 15.6 years, were enrolled in this study. Metabolic syndrome was diagnosed in 23 patients (28.7%). Hypertension was present in 55 patients (68.8%). Fifteen patients (18.8%) were diabetic, 24 (30.0%) had a high serum triglyceride, 22 (27.5%) had a low high-density lipoprotein cholesterol, and 20 (25.0%) had evidence of abdominal obesity. Patients with MS had significantly higher body mass indexes (P <. 001), fasting blood glucose levels (P <. 001), and triglyceride levels (P =. 004). Metabolic syndrome was not associated with gender, age, and duration of hemodialysis. Men showed significant abnormality in glucose metabolism (P =. 008). Prevalence of low high-density lipoprotein cholesterol was significantly higher in the women than in the men (P =. 02).Conclusions. The prevalence of MS in our hemodialysis patients was relatively high, with the most common element being hypertension. We suggest that there needs to be a new set of criteria defined for MS in hemodialysis patients.
  • Roghayeh Akbari, Masoud Mireskandari, Reza Alizadeh-Navaei, Ahad Ghods Page 255
    Introduction. Mannose-binding lectin (MBL) is a part of the innate immune system. Many studies showed an association of low serum MBL levels with decreased host defense against various infectious agents. Considering paradoxical reports about the serum level of MBL in hemodialysis patients, this study aimed to measure and compare serum MBL levels in hemodialysis patients and healthy individuals.Materials and Methods. In a cross-sectional study, 70 hemodialysis patients and 70 volunteers with normal routine laboratory tests and physical examination were assessed for serum MBL level (measured by an enzyme-linked immunosorbent assay). In addition, serum C-reactive protein levels in hemodialysis patients were measured to rule out correlation of increased serum MBL level with inflammation.Results. In hemodialysis patients, 32 (45.7%) were men and 38 (54.3%) were women. In the control group, 34 (48.6%) were men and 36 (51.4%) were women (P =. 87). The mean age showed no significant difference in hemodialysis (44.5 ± 13.5 year) and control (46.4 ± 12.4 years) groups. Serum level of MBL was significantly higher in hemodialysis patients (2.12 ± 1.49? g/mL) than that in the controls (1.49 ± 2.12? g/mL; P <. 001). No significant correlation was found between serum MBL and C-reactive protein levels (r = 0.002, P =. 98) among the hemodialysis patients.Conclusions. Serum MBL level in hemodialysis patients was significantly higher than that in the control group of healthy individuals. This may have some implications in management of patients and prediction of kidney allograft survival.
  • Amir Hooshang Mohammadpour, Fatemeh Nazemian, Seyed Adel Moallem, Seyed Ali Alamdaran, Elham Asad-Abadi, Jamal Shamsara Page 260
    Introduction. Cardiovascular disease is a major factor in the deterioration of the health and the death of hemodialysis patients. Previous studies have mainly shown a decreased level of heat shock protein 27 (HSP27) in patients with cardiovascular disease. We conducted this study to investigate whether HSP27 correlates with common carotid intima-media thickness (CCIMT) and if it has a potential to be a biomarker for cardiovascular disease.Materials and Methods. In this cross-sectional study, the correlation between HSP27 serum concentration and CCIMT was investigated in 42 hemodialysis patients. An enzyme-linked immunosorbent assay method was used to measure HSP27 level in the plasma of the patients, and a high-resolution B-mode ultrasonography was applied to measure CCIMT.Results. There was an inverse significant correlation between serum concentration of HSP27 and CCIMT only in patients that had hypertension as their only cardiovascular risk factor (r = - 0.61, P =. 02).Conclusions. According to our results and the fact that HSP27 has been shown to be expressed in atherosclerotic plaques of both experimental animals and humans, we suggest that circulatory HSP27 concentration has a potential of being used as a marker for cardiovascular events.
  • Omid Sedighi, Atieh Makhlough, Zahra Kashi, Maryam Zahedi Page 267
    Introduction. Prevalence of hypertension is high in hemodialysis patients. Increase of intracellular calcium due to hyperparathyroidism is one of probable factors for hypertension in hemodialysis patients. In this study, the relationship between serum parathyroid hormone (PTH) level and severity of hypertension in hemodialysis patients was investigated.Materials and Methods. In a case-control study, 50 hemodialysis patients with hypertension were compared with 50 hemodialysis patients without hypertension. The two groups were comparable in age, sex, body mass index, hemodialysis duration, KT/V, serum calcium, hemoglobin, and erythropoietin dose. Serum PTH level was measured in the two groups.Results. The mean age was 57.0 ± 7.7 years in the hypertensive group and 56.4 ± 6.0 years in the control group (P =. 61). The mean hemodialysis duration was 15.28 ± 5.74 months in the hypertensive group and 14.98 ± 6.35 months in the control group. The mean serum PTH was 487.18 ± 408.85 pg/mL in hypertensives (445.12 ± 447.92 pg/mL in stage 1 of hypertension and 561.94 ± 326.67 pg/mL in stage 2 of hypertension, P =. 003) and 170.64 ± 122.09 pg/mL in the case group (P =. 001).Conclusions. According to this study, there is a positive relationship between serum PTH and severity of hypertension in hemodialysis patients. We conclude that control of secondary hyperparathyroidism might be helpful in controlling hypertension in hemodialysis patients.
  • Pornpimol Rianthavorn Page 271
    It is crucial that nephrologists correctly identify acute focal bacterial nephritis, as timely and adequate treatment with appropriate antibiotics can prevent unnecessary investigations, invasive surgical procedures, and renal complications such as renal abscess or renal scar. An urgent kidney ultrasonography should be performed if there is a delayed response to appropriate antibiotic treatment in patients with urinary tract infection. Serial kidney ultrasonography plays a significant role in confirming the diagnosis and monitoring the progression of acute focal bacterial nephritis. We presented a patient with acute focal bacterial nephritis and showed that a serial kidney ultrasonography could prevent the use of invasive investigations and inappropriate surgical procedures.
  • Farheen Badar, Shah Farhan Azfar, Shagufta Wahab, Mohammad Khalid Page 275
    Renal replacement lipomatosis of the kidney is a rare entity characterized by renal sinus and perirenal fat proliferation often caused by renal calculi. Most of the renal parenchyma is replaced by fat and the kidney is usually small, atrophic and nonfunctioning. We report magnetic resonance imaging and ultrasonography findings of a pregnant woman with xanthogranulomatous pyelonephritis and renal replacement lipomatosis coexisting in the same kidney.
  • Pedram Ahmadpoor, Fatemeh Pour-Reza-Gholi, Mohsen Nafar, Mahmoud Parvin, Fariba Samadian, Shiva Samavat, Saeed Amirkhanloo Page 278
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