Iranian Journal of Kidney Diseases
Volume:7 Issue: 1, Jan 2013

Iron deficiency is an important clinical concern in chronic kidney disease (CKD), giving rise to iron-deficiency anemia and impaired cellular function. Oral supplementation, in particular with ferrous salts, is associated with a high rate of gastrointestinal side effects and is poorly absorbed, a problem that is avoided with intravenous iron. The most stable intravenous iron complexes (eg, iron dextran, ferric carboxymaltose, ferumoxytol, and iron isomaltoside 1000) can be given in higher single doses and more rapidly than less stable preparations (eg, sodium ferric gluconate). Iron complexes that contain dextran or dextran-derived ligands can cause dextran-induced anaphylactic reactions, which cannot occur with dextran-free preparations such as ferric carboxymaltose and iron sucrose. Test doses are advisable for conventional dextran-containing compounds. Iron supplementation is recommended for all CKD patients with anemia who receive erythropoiesis-stimulating agents, whether or not they require dialysis. Intravenous iron is the preferred route of administration in hemodialysis patients, with randomized trials showing a significantly greater increase in hemoglobin levels for intravenous versus oral iron and a low rate of treatment-related adverse events. In the nondialysis CKD population, the erythropoietic response is also significantly higher using intravenous versus oral iron, and tolerability is at least as good. Moreover, in some nondialysis patients intravenous iron supplementation can avoid, or at least delay, the need for erythropoiesis-stimulating agents. In conclusion, we now have the ability to achieve iron replenishment rapidly and conveniently in dialysis-dependent and nondialysis-dependent CKD patients without compromising safet

Cisplatin still has a central role in cancer chemotherapy, but is associated with the risk of toxicities, the most common of which is nephrotoxicity. The aim of the present study is evaluation of cisplatin nephrotoxicity in Iranian population of cancer patients. All admitted patients to the oncology service who received cisplatin were included in a prospective study from 2004 to 2010. Clinical and laboratory data including kidney function tests were recorded at baseline and during follow-up visits. One hundred patients (56% men) were included. Their mean age was 44 years. Common adverse events were nausea (85%) and vomiting (78%), followed by anorexia and fatigue (20%), taste change (10%), hearing loss (8%), cramping abdominal pain (8%), and tinnitus (5%). The most important finding was normal kidney function, except for mild hypomagnesemia (grade 1 toxicity) in 18%, without any symptoms or other electrolyte abnormalities. None of the patients with hypomagnesemia had significant serum electrolyte imbalances, diarrhea, severe allergic reactions, difficulty in walking, or chest pain. Cisplatin has the potential to produce both mild and severe side effects. Although the neurologic and gastrointestinal toxicities were observed, renal toxicity (rising blood urea and creatinine or electrolyte abnormality) was not observed, and the only toxicity was grade 1 hypomagnesaemia.

Proanthocyanidines in grape seed extract (GSE) possess a wide array of pharmacological and biological actions, including anti-inflammatory, antioxidant, free radical scavenging, and vasodilatory properties as well as inhibition of phospholipase A2, cyclooxygenase, and lipooxygenase enzymes. The aim of this study was to examine the effects of the oral administration of GSE on renal disturbances due to reperfusion injury in rats. Thirty-two male Sprague-Dawley rats were divided into 4 groups. They received a standard diet for two weeks. During this period, one group also received normal saline and GSE (50 mg/kg) daily. At the beginning of day 14, the rats in 2 groups underwent surgery and bilateral renal ischemia, and one group had sham operation. Urine and blood samples were taken and the kidneys were removed for histologic and enzyme studies. The control group did not receive any solutions and did not have surgery. The increased amount of plasma creatinine concentration induced by reperfusion injury was improved by GSE administration. In addition, urine osmolality increased in the GSE group in comparison with the reperfusion injury only group. The degrees of histological damages and oxidative stress that had increased following reperfusion injury were also significantly lower with GSE administration.Oral supplementation of GSE for 2 weeks may decrease histologic damages and oxidative stress, and as a result, may reduce kidney function disturbances following reperfusion injury.

Serotonin receptors are present in osteoblasts and osteoclasts, and serotonin affects bone metabolism. The association of plasma serotonin with markers of bone formation and bone resorption in hemodialysis patients was evaluated. Twenty-four hemodialysis patients (11 diabetics) and 22 healthy volunteers were enrolled into the study. Serotonin was assessed in platelet-free plasma, whereas the markers of osteoblastic activity N-terminal midfragment osteocalcin and total procollagen type-1 aminoterminal propeptide as well as the marker of osteoclastic activity β-isomerized C-terminal cross-linked peptide of collagen type I were measured in serum. Serum intact parathyroid hormone was also assessed. Serotonin did not significantly differ between hemodialysis patients and healthy volunteers. All evaluated markers of bone metabolism and intact parathyroid hormone were much higher in hemodialysis patients. Serotonin was significantly correlated with all evaluated markers of bone metabolism in hemodialysis patients. Serotonin was reversely related to the patient's age. Serotonin, osteocalcin, procollagen type-1 aminoterminal propeptide, and β-isomerized C-terminal cross-linked peptide of collagen type I were much lower in diabetic hemodialysis patients. Serotonin may increase both bone formation and bone resorption in hemodialysis patients. The reverse relation of serotonin to patient's age as well as its lower levels in diabetic hemodialysis patients indicate that low plasma serotonin may contribute to the higher incidence of low-turnover bone disease that characterizes old and diabetic hemodialysis patients.

Pruritus is one of the most common cutaneous complications in hemodialysis patients. There is no consensus on etiologic and pathologic factors. This study is aimed to evaluate the correlation between serum intact parathyroid hormone (PTH) level and the severity of pruritus in hemodialysis patients. In a cross-sectional study, all of the patients referred to hemodialysis center of two hospitals in Sari, Iran, were primarily examined by a dermatologist and those who had no pathologic findings were included in the study. Serum levels of calcium, phosphorus, albumin, creatinine, and intact PTH were measured and evaluated against the pruritus scores. A total of 153 patients were studied of whom 52.3% (n = 80) were men. The prevalence of pruritus and hyperparathyroidism were 61.4% and 60.7%, respectively, and these were not significantly different between men and women. There was a significant difference in the mean itching score between the patents with and without hyperparathyroidism (5.71 ± 5.39 and 4.93 ± 2.93, respectively; P =. 005). Serum intact PTH level correlated with itching score in this population (r = 0.294, P <. 001), while no correlations were found between itching score and other laboratory parameters. Our study showed that intact PTH level is correlated to the severity of pruritus in hemodialysis patients. Therefore, control of hyperparathyroidism in hemodialysis patients is very important to overcome pruritus.

There are associations between serum magnesium level and some risk factors of cardiovascular disease and atherosclerosis, such as lipid profile, serum albumin, C-reactive protein, serum phosphorus, parathyroid hormone, and diabetes mellitus in hemodialysis patients. The aim of this study was to examine these associations. This study was conducted on 103 patients with end-stage renal disease on maintenance hemodialysis. Laboratory assessment was performed before hemodialysis session in a 12-hour fasting state. Patients were divided into two groups according to their serum magnesium concentration (< 2.6 mg/dL, n = 34 and ≥ 2.6 mg/dL, n = 69). The mean age of the patients was 57.4 ± 15.4 years. The mean serum magnesium was 2.80 ± 0.55 mg/dL (range, 1.7 mg/dL to 7 mg/dL). There were no significant differences in serum magnesium between patients with low and high values of high-density lipoprotein cholesterol, triglycerides, low-density lipoprotein cholesterol, and blood pressure. Of the 103 patients, 1 (1%) had hypomagnesemia, 41 (39.8%) had magnesium levels within normal range, and 61 (59.2%) had hypermagnesemia. Serum magnesium significantly correlated with plasma phosphorus level (r = 0.35, P <. 001) and albumin (r = 0.24, P =. 01). There were no correlations between serum magnesium level and age, body mass index, systolic blood pressure before dialysis, serum calcium, lipid profile, and apoprotein(a). In our cohort of hemodialysis patients, there were no correlations between serum magnesium levels and atherogenic lipids, serum calcium, or parathyroid hormone.

End-stage renal disease and hemodialysis affect intraocular pressure (IOP). This study aimed to evaluate the effects of a one session of hemodialysis on IOP. In this study, the IOP of 130 eyes of 65 hemodialysis patients (38 men and 27 women) was measured before and every 1 hour after the initiation of hemodialysis therapy. Patients with any glaucomatous conditions were excluded. Demographic information including age, gender, underling systemic or ocular diseases, hemodialysis duration and frequency, KT/V, and levels of blood pressure, body weight, blood urea, serum sodium, serum potassium, blood glucose before and after hemodialysis were recorded. The mean age of the patients was 60.3 ± 16.7 years. The mean predialysis and postdialysis IOPs were 13.50 ± 4.09 mm Hg and 12.73 ± 4.07 mm Hg, respectively (P =. 02). The mean IOP at the first and second hours (12.32 mm Hg and 11.83 mm Hg, respectively) of hemodialysis were significantly lower than the mean predialysis IOP (P <. 001 for each). In nondiabetics, the mean IOP significantly decreased after hemodialysis. The mean predialysis and postdialysis blood glucose levels were significantly different between diabetics and nondiabetics, but were not significant in each group of diabetics and nondiabetics. There was a significant inverse relationship between IOP and blood glucose changes after hemodialysis (r = -0.180, P =. 040). Increased blood glucose levels significantly decreases IOP in hemodialysis patients without glaucomatous features. Changes in other metabolic parameters do not affect IOP during hemodialysis.

Pulmonary hypertension (PH) is one of the most important accompanying comorbidities with hemodialysis in patients with end-stage renal disease. The prevalence of hemodialysis-induced PH is still a subject of debate. The goal of the present work was to determine the prevalence of PH in patients undergoing hemodialysis. This study was carried out on patients undergoing hemodialysis for at least 6 months. Pulmonary artery pressure (PAP) was measured by a cardiologist using echocardiography, and a value equal to or higher than 35 mm Hg was considered PH. The relationship of a high PAP with demographic and clinical characteristics of the patients was assessed.A total of 102 patients were included in the study. The mean of age was 59 ± 18 years. The most common cause of end-stage renal disease was diabetes mellitus (35%). The mean duration of hemodialysis was 24 ± 17 months. The mean ejection fraction and PAP were 57 ± 5% (range, 44% to 73%) and 39 ± 9 mm Hg (range, 25 mm Hg to 70 mm Hg), respectively. Overall, 66% of the patients had PH. These patients were more likely to be on dialysis for a longer duration and to have low ejection fractions. They were also older than other patients. Our findings show that PH is associated with duration of dialysis, age, and ejection fraction. Due to the high prevalence of PH among hemodialysis patients, it is necessary to screen this disorder and minimize its effects.

Paraquat is highly toxic to human and is widely used in agriculture as a contact herbicide. Paraquat poisoning is associated with high mortality varying from 35% to 50%. Six cases of paraquat poisoning were treated in our center. Acute kidney injury developed in all the cases and mortality was 66%. Respiratory and multiorgan failure are the main causes for mortality.

Primary sarcomas of kidney are rare tumors accounting for 1% to 3% of all primary renal malignancies. Among sarcomas fibrosarcoma is rare. Here we report a case of primary fibrosarcoma of the kidney in a 70-year-old man who presented with gradually increasing abdominal swelling and pain.

Hereditary periodic fever syndromes are a group of genetic diseases clinically characterized by recurrent febrile attacks. Patients are at variable risks for the development of systemic reactive (AA) amyloidosis, leading to the nephrotic syndrome and kidney failure. We present the first report of the occurrence of renal AA amyloidosis causing severe nephrotic syndrome in a Turkish child affected with hyperimmunoglobulinemia D syndrome.