Iranian Journal of Kidney Diseases
Volume:8 Issue: 2, Mar 2014

Chronic antibody-mediated rejection among kidney transplant recipients is a major unresolved problem which is covered in this review article which included different lines of its management.

Procalcitonin is a reliable and specific marker of bacterial infections such as urinary tract infection. Some authors suggest measurement of serum procalcitonin as a predictor of vesicoureteral reflux (VUR). We investigated this association in children admitted because of acute pyelonephritis. Forty-eight children with the first febrile urinary tract infection were included. Twelve patients had low-grade VUR, 9 patients had high-grade VUR, and 27 patients did not have any VUR in their imaging assessment. There was a significant association between high-grade VUR and higher levels of procalcitonin (P =. 04). The sensitivity of a procalcitonin level of 0.31 ng/mL or greater was 90% and the specificity was 32% for diagnosis of high-grade VUR. We concluded that serum procalcitonin concentration is a sensitive and promising predictor of high-grade VUR.

The global prevalence of chronic kidney disease (CKD) is increasing consistently. Progression of CKD to end-stage renal disease could be slowed down by early detection and treatment, yet CKD and its risk factors have been poorly studied in many countries. This study investigated the CKD prevalence and its contributing risk factors in adult population of Southern Iran. In this cross-sectional study on randomly recruited participants from adult population, we investigated the CKD prevalence (stages 3 to 5) and its risk factors in Southern Iran. After calculation of sample size (10 385 cases), data was collected in a total of 10 397 individuals. Medical and demographic data was obtained, as well as measurement of height, body weight, blood pressure, and blood urea nitrogen, and serum creatinine. A fresh spot urinalysis was also performed. The overall prevalence of CKD stages 3 to 5 was 11.6%. Stages 1, 2, 3, 4, and 5 of CKD were found in 8.5%, 66.1%, 11.4%, 0.1%, and 0.1% of the participants, respectively. The prevalence of CKD (stages 3 to 5) was significantly higher compared to those with the non-CKD group, in the older than younger participants, and in the women as compared to the men. There was a strong positive correlation between age, female sex, hypertension, and high body mass index with different stages of CKD. The prevalence of CKD is high in Southern Iran and its contributing risk factors are older age, female sex, hypertension, and high body mass index.

It has been demonstrated that kidney length is associated with office blood pressure (BP) measurements. Several studies support that ambulatory BP measurements in comparison to conventional BP better correlate with hypertensive target organ damage, and that the lack of nocturnal dip in BP (nondipping) is related to an increase in the incidence of cardiovascular event in essential hypertensive patients. This study evaluated the specific relationship between kidney length, renal cortical thickness (RCT), and circadian BP in hypertensive patients. In a cross-sectional study, 144 patients with newly diagnosed essential hypertension underwent physical examination, office BP measurements, laboratory analysis, ambulatory BP monitoring, renal ultrasonography, and spot and 24-hour urine collection. There were 103 dipper (71.5%) and 41(28.5%) nondipper patients. Among the dippers, 13 were extreme dippers and among nondippers 11 were reverse dippers. Most of the ambulatory BP measurements were not associated with kidney length or RCT. Kidney length and RCT were not different among dippers, extreme dippers, nondippers, and reverse dippers. The kidney length and RCT were not different between patients with white coat hypertension and sustained hypertension, either. Logistic regression analysis did not show any independent association between kidney length, RCT, and nondipping status. Kidney length and RCT may not be associated with circadian BP monitoring.

This study was conducted to compare catheter function, dialysis adequacy, and dialysis-related complications among patients receiving long-term dialysis via Palindrome catheter, Permcath catheter, and arteriovenous fistula (AVF) as vascular access. Forty-three patients undergoing dialysis with Permcath catheter, 49 with Palindrome catheter, and 56 with AVF were recruited. Urea clearance (KT/V), urea reduction rate, and the highest blood flow at the arteriovenous junction during dialysis were determined during the dialysis sessions. Catheter-related infection, catheter-associated thrombosis, and annual patency rate were also evaluated. In patients using Permcath catheter for dialysis, the incidence of secondary renal injury (metabolic diseases, hypertension, and ischemic kidney diseases) was 73.1%, which was significantly higher than that in patients with AVF (51.5%; P <. 001). In the Palindrome group, maximum blood flow, KT/V, urea reduction rate, and annual patency rate were significantly higher than those in the Permcath group, and the incidence of access-related infection was significantly higher than that in the AVF group. In the Palindrome group, the prevalence of thromboembolism was 30.6%, which was significantly lower than that in the Permcath group (46.5%), but higher than that in the AVF group (5.4%). For dialysis patients, Palindrome catheter was superior to Permcath catheter and comparable with the AVF in terms of the maximum blood flow, dialysis adequacy, and annual patency rate. Dialysis with Palindrome catheter has a high infection rate and a high incidence of thromboembolism as in the dialysis with Permcath catheter.

We aimed to identify immune status of the stable kidney allografts from the point of some cellular changes that may occur after transplantation. This study considered 57 patients with no rejection during the 6 months after transplantation. Flow cytometric frequencies of circulatory CD4+CD25+FoxP3+ and CD8+CD28- regulatory T cells (Treg) as well as myeloid dendritic cells type 1 (MDC1) and type 2 (MDC2) and plasmacytoid dendritic cells (PDC) were measured before transplantation and 2 weeks and 1, 3, and 6 months after transplantation. Using adjusted model of repeated measure analysis, we assessed the influence of different parameters on different cell subsets. The mean number of Tregs and PDCs decreased 2 weeks after transplantation and then increased as they reached their values before transplantation within a few months after transplantation. The mean MDC1s increased during 2 weeks and then decreased to its before-transplantation values within 6 months. The frequency of Tregs (r = 0.90) and MDC1s (r = 0.75) at month 3 could strongly predict their frequencies at month 6. Different variables including family relationship between donor and recipient, glomerular filtration rate, and human leukocyte antigen antibody mismatch did not change the frequency of different cell subsets during the time. The dynamism and circulatory changes in the frequency of Tregs and PDCs are opposite to MDCs after kidney transplantation. We describe these changes in a group of patients with stable graft; however, our study does not render any idea in patients with unstable or rejecting grafts.

The aim of this study was to compare the effect of continuous care model with routine care on the quality of life among patients who receive a kidney transplant. In a randomized clinical trial, 90 kidney transplant patients were selected from 4 hospitals in Tehran, Iran, and were randomly assigned to 2 group. In the experimental group, continuous care model was applied for 3 months and the control group received routine care. The scale scores of the Kidney Transplant Questionnaire concerning quality of life were monthly compared between the two groups. Of 90 patients, 4 in the experimental and 8 in the control group were excluded from the study. Final analysis was performed on 41 in the experimental and 37 in the control groups. No significant difference was found between the two groups in terms of demographic variables. Although the quality of life scores increased in both groups, the mean scores of the experimental group were significantly higher than those in the control group at 1, 2, and 3 months. Continuous care model may improve the kidney transplant patients'' quality of life.

The aim of this study was to assess the prevalence and severity of BK virus infection, BK virus nephritis, and related risk factors among kidney transplant recipients. BK viremia during the first year of kidney transplantation was assessed prospectively in 32 successive recipients. BK virus DNA was extracted and determined in all samples by real-time polymerase reaction assay for 1 year after kidney transplantation. The mean age of the patients was 33.3 ± 15.3 years. Sixteen patients (50%) received antithymocyte globulin for induction therapy. Living donor transplant consisted of 75% of the kidney donations. Maintenance immunosuppressive therapy included cyclosporine A in 27 patients (84.4%), plus tapering prednisolone and mycophenolate mofetil. BK viremia was detected in 8 patients (25%). The highest detected plasma viral load was less than 4000 copies per milliliter. BK virus was respectively positive in 5 (62.5%), 2 (25%), and 1 (12.5%) patients during the first 4, 8, and 12 months after transplantation. Biopsy-proven rejection and antirejection therapy by methylprednisolone pulses were 5 and 2.3 times more common in patients with BK virus infection (P =. 01 and P =. 01), respectively. Despite occurrence of BK virus infection in 25% of our patients, BK nephropathy did not develop in any of them. Routine screening of BK virus infection, particularly in centers with low prevalence of BK virus nephritis, may not be cost effective for predicting this disease.

This study was conducted to investigate the association between serum uric acid level and blood pressure in type 2 diabetes mellitus. Sixty patients with type 2 diabetes mellitus were enrolled to the study. None of the patients had a history of gout, were treated with allopurinol, or were treated with antihypertensive drugs previously. The mean duration of DM was 9.2 ± 4.9 years. The mean serum creatinine level was 0.98 ± 0.22 mg/dL, and the mean serum UA level was 4.4 ± 1.2 mg/dL. The mean protein level in 24-hour urine sample was 388 ± 22 mg/d. The mean systolic and diastolic blood pressure values were 133.0 ± 13.0 mm Hg and 84.0 ± 7.4 mm Hg, respectively. There was no significant difference in levels of serum uric acid, hemoglobin A1c, serum creatinine, proteinuria, or systolic and diastolic pressure between the men and the women. A significant positive correlation was seen between serum UA and systolic (r = 0.312, P =. 02) and diastolic blood pressure (r = 0.297, P =. 03). Results of this study suggest that serum uric acid had a strong association with levels of systolic and diastolic blood pressure in type 2 diabetic patients. More attention to the serum uric acid level and treatment of hyperuricemia could halt the progress of diabetic nephropathy.

Salmonella species are a rare cause of urinary tract infection in children. They are associated with a high incidence of structural abnormalities or immunosuppressive status. We report the case of a healthy 7-year-old boy with pyelonephritis due to Salmonella group. He did not have a history of recent gastroenteritis.