فهرست مطالب

Iranian Journal of Kidney Diseases
Volume:8 Issue: 6, Nov 2014

  • تاریخ انتشار: 1393/08/21
  • تعداد عناوین: 15
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  • Mohammadreza Ardalan, Sadegh Chinikar, Mohammadali Mohajel Shoja Pages 438-442
    Hemorrhagic fever with renal syndrome (HFRS) is a serious human disease of zoonotic viral origin. A group of different viruses that belong to the family of hemorrhagic fever could represent with HFRS. The basic pathophysiologic feature is virus-induced leaky microcirculation. There is no effective antiviral treatment against them. Because of rapid environmental changes, global warming, and increased global traveling, different hemorrhagic fever syndromes could be found anywhere in the world and beyond their old endemic borders. This review is a brief overview of HFRS in Iran during the early and mid-twentieth century.
  • Abdulmecit Yildiz, Cuma Gul, Alparslan Ersoy, Burak Asiltas, Selime Ermurat, Selda Dogan, Kemal Karaagac, Saim Sag, Aysegul Oruc, Nimet Aktas, Gokhan Ocakoglu, Ibrahim Dogan, Sumeyye Gullulu, Mustafa Gullulu Pages 443-449
    Introduction
    Recent studies report reduced vascular compliance and elevated levels of fibroblast growth factor 23 (FGF23) in patients with autosomal dominant polycystic kidney disease (ADPKD) and preserved kidney function. In the present study, we investigated the relationship between vascular compliance and FGF23 in patients in early phases of ADPKD.
    Materials And Methods
    We studied 54 ADPKD patients with preserved kidney function and 24 healthy individuals. All participants underwent noninvasive pulse wave analysis in order to determine large arterial elasticity index (LAEI) and small arterial elasticity index (SAEI) using a modi?ed Windkessel model. Levels of FGF23 in addition to several cardiovascular risk factors were evaluated. Linear regression analyses were performed to determine independent correlates of LAEI, SAEI, and FGF23.
    Results
    In the ADPKD group, 33 patients were hypertensive and the remaining patients were normotensive. Serum FGF23 levels of both ADPKD groups were significantly higher than that in the controls. Both hypertensive and normotensive ADPKD patients had lower LAEI and SAEI levels compared to the controls. There was no significant correlation between vascular compliance parameters and FGF23 levels. Having ADPKD was independently associated with increased FGF23 levels and decreased SAEI.
    Conclusions
    Fibroblast growth factor 23 was found substantially elevated and arterial compliance was found significantly decreased in early ADPKD patients regardless of hypertension. However, there was no significant correlation between FGF23 levels and arterial function parameters. Additional studies are required to determine possible mechanisms of these disturbances and cardiovascular effects of FGF23 in ADPKD patients.
  • Hamid Barahimi, Mohammad Aghighi, Katayon Aghayani, Abbas Rahimi Foroushani Pages 450-456
    Introduction
    Chronic kidney disease (CKD) is a public health problem that needs an integrated program to be detected, monitored, and controlled. This study reports the results of a CKD program designed and implemented in Shahreza, Iran.
    Materials And Methods
    After initial evaluation of CKD in Shahreza, a CKD management program was developed in the Ministry of Health and the pilot project was started in February 2011 in Shahreza rural areas. The patients at risk, including those with diabetes mellitus and hypertension, were tested with serum creatinine and urine albumin-creatinine ratio. The CKD management program included training, screening, monitoring, and controlling of weight, hypertension, diabetes mellitus, lipids, and vitamin D.
    Results
    This pilot program was organized in the rural population aged over 30 years who were suffering from hypertension, diabetes mellitus, or both, and resulted in the discovery of cases in various stages of CKD. The prevalence of CKD in this high-risk group was 21.5%. Persistent albuminuria and a glomerular filtration rate less than 60 mL/min/1.73 m2 were 13% and 11%, respectively. The rate of CKD stages 1, 2, 3a, 3b, 4, and 5 were 2.75%, 6.82%, 10.08%, 0.92%, 0.31%, and 0.17% respectively. After 1 year of the program implemented, incidence rate of CKD was 24% and improvement rate was 21%. In diabetic patients, the mean of hemoglobin A1c decreased from 8.5 ± 1.9% to 7.5% ± 1.8%.
    Conclusions
    Integration of CKD programs in primary health care is possible and results in improvement in management of CKD patients.
  • Shokoufeh Savaj, Javad Savoj, Ismail Jebraili, Seyed Hashem Sezavar Pages 457-460
    Introduction
    There are some clinical trials showing that short-term ischemia in one organ can protect different organs against higher intensity and longer ischemic insult. We designed a study to assess whether remote ischemic preconditioning (RIPC) on one organ can decrease the rate of contrast-induced acute kidney injury (AKI) in diabetic patients who undergo coronary artery angiography (CAA).
    Materials And Methods
    This randomized control trial included 96 diabetic patients who were candidates for CAA. Exclusion criteria were congestive heart failure and complications during CAA. All of the patients received 1000 mL of normal saline before CAA. The RIPC group underwent 3 cycles of 5-minute ischemia in their right arm. Serum creatinine was measured before and 24 hours after CAA.
    Results
    Contrast-induced AKI was reported in 5 cases in the control group and 1 case in the RIPC group (P =. 13, odds ratio, 5.4). The differences in serum creatinine level before and after the procedure was significantly lower in RIPC group than that in the control group (P =. 04, odds ratio, 0.08). Serum creatinine rise significantly correlated with contrast dose (P =. 02) and a history of hypertension (P =. 02) in both groups.
    Conclusions
    Ischemic preconditioning had a protective effect on contrast-induced AKI in our study. Since this method is harmless and cost effective, further studies on patients with chronic kidney disease is required to evaluate addition of ischemic preconditioning to our clinical practice for prevention of contrast-induced AKI.
  • Farshid Haghverdi, Sepideh Mortaji, Parvin Soltani, Naser Saidi, Tahmineh Farbodara Pages 461-466
    Introduction
    This study was aimed to investigate the effects of raloxifene on intact parathyroid hormone (PTH) level and bone mineral density (BMD) for 8 months in women on hemodialysis and women with chronic kidney disease stage 5 not dependent on dialysis to determine its effect on secondary hyperparathyroidism and osteoporosis.
    Materials And Methods
    Fifty-one women on hemodialysis and 9 with chronic kidney disease stage 5 were randomly assigned to receive oral raloxifene, 60 mg/d, or placebo for 8 months. Baseline blood determinations and BMD were done and repeated after 8 months. Serum levels of total calcium, phosphorus, alkaline phosphatase, and intact PTH were measured.
    Results
    Serum levels of intact PTH significantly decreased in both groups, and there was no difference between the two groups after 8 months (P =. 37). Serum phosphorus levels also decreased by 1.8% in the two groups. After 8 months of treatment, the BMD of the lumbar spine and femural neck decreased by 1.9% in the control group, while an increase in BMD was observed in the raloxifene group,with an average increase in both BMDs of the lumbar spine and the femural neck by 2% (significant in the lumbar spine; P =. 01).
    Conclusions
    Raloxifene has proven to be an effective medication in terms of improving BMD, with no adverse effects. However, it had no effect on controlling hyperparathyroidism in our patients. Long-term studies should be done to investigate the effects of raloxifene in chronic kidney disease and dialysis patients.
  • Shahrzad Ossareh, Shiva Tabrizian, Marjan Zebarjadi, Rashin S. Joodat Pages 467-474
    Introduction
    This study was designed to evaluate the adherence of maintenance hemodialysis patients to medications and its correlation with quality of life and depressive symptoms.
    Materials And Methods
    A total of 150 maintenance hemodialysis patients with a mean age of 56.4 ± 16.4 years (52.7% women) were included. Medication adherence was evaluated via the Simplified Medication Adherence Questionnaire, based on which nonadherent patients were identified. Specifically, the Drug-Intake Percentage Questionnaire was used for evaluation of adherence to phosphate binders, quality of life was assessed with short Form-36 and depression by the Beck Depression Inventory (BDI).
    Results
    A BDI score of 15 and greater was documented in 40.7%, and nonadherence in 24.7% of the patients. Adherent patients were significantly older than nonadherent ones, had a lower mean parathyroid hormone level, and had lower BDI scores. The quality of life scores were not significantly different between adherent and nonadherent patients. Multivariable analysis demonstrated that BDI score was a significant predictor of nonadherence (odds ratio for each unit increase, 1.11; 95% confidence interval, 1.04 to 1.18; P =. 001). Overall, 55.5% of patients were taking more than 66% of their prescribed dose of calcium carbonate, while 10.3% and 53.8% of patients were taking more than 66% of their prescribed dose of aluminum hydroxide and sevelamer, respectively.
    Conclusions
    Adherence to medication was mainly associated with hemodialysis patients'' depressive symptom scores. Control of depression may significantly improve adherence to medications and patient management.
  • Shahrokh Ezzatzadegan Jahromi, Mohammad Saleh Mahmoodi, Fatemeh Behroozi, Jamshid Roozbeh, Fatemeh Emamghoreishi Pages 475-480
    Introduction
    Unfractionated (UF) heparin is the most common anticoagulant used during hemodialysis. Failure of the kidneys to excrete potassium as well as heparin-induced reduction of aldosterone synthesis put hemodialysis patients at risk of hyperkalemia. It has not yet been clearly known whether hyperkalemia is also induced by low-molecular-weight (LMW) heparins. This study aimed to evaluate the effect of switching UF heparin to LMW heparin enoxaparin, as an anticoagulant during hemodialysis, on serum potassium level in patients on hemodialysis.
    Material And Methods
    In two hemodialysis units, 58 patients were randomly assigned into two groups, to receive two different anticoagulation protocols for 3 weeks; one group continued to receive their routine dose of UF heparin, 5000 units, and the other received enoxaparin, 0.5 mg/kg, at the beginning of each hemodialysis session.
    Results
    While there was no significant difference between baseline blood measurements of the two groups in terms of kidney function tests and electrolytes, following 3 weeks of the study, the mean serum potassium level decreased from 4.9 ± 0.8 mEq/L to 4.5 ± 0.5 mEq/L in the LMW heparin group (P =. 001); however, there was no change in the mean serum potassium level in those who continued to receive their usual dose of UF heparin. In a subgroup analysis, diabetic patients in the enoxaparin group did not experience significant reduction in serum potassium levels.
    Conclusions
    Our study revealed the role of LMW heparins as a potential alternative to UF heparins in the hemodialysis patients with hyperkalemia.
  • Abass Abdelfatah Morad, Hafez Mahmoud Bazaraa, Rasha Essam Eldin Abdel Aziz, Dalia Adel Abdel Halim, Mohamed Gamal Shoman, Mervat Esmail Saleh Pages 481-485
    Introduction
    Patients with end-stage renal disease are known to suffer from chronic inflammation as the result of an ongoing subacute cytokine induction, which may contribute considerably to dialysis-related long-term morbidity and mortality. In order to assess the inflammatory risk associated with online hemodiafiltration compared to conventional hemodialysis, we compared the cytokine induction profile of pediatric patients during treatment with each these modalities of dialysis.
    Materials And Methods
    Thirty pediatric patients on regular hemodialysis for at least 6 months were shifted to online hemodiafiltration. We collected serum samples before and 6 months after initiation of online hemodiafilration. The target pro-inflammatory cytokines selected were interleukin-6, tumor necrosis factor-α, and high-sensitivity C-reactive protein.
    Results
    High-sensitivity C-reactive protein decreased significantly on hemodiafiltration. The mean C-reactive protein level after 6 months was 3.41 μg/mL in the online hemodiafilration as compared to 7.98 μg/mL in the hemodialysis group (P =. 01). Plasma interleukin-6 and tumor necrosis factor-α and tumor necrosis factor-α also decreased significantly on hemodiafiltration and the values were 100.44 pg/mL versus 168.40 pg/mL (P =. 002) and 11.45 pg/mL versus 15.70 pg/mL (P =. 008), respectively, for the hemodiafilration and hemodialysis groups.
    Conclusions
    Online hemodiafiltration is associated with dampened pro-inflammatory cytokine profile compared to conventional hemodialysis in children with end-stage renal disease.
  • Mohammadreza Ardalan, Hamid Nasri Pages 486-488
    Familial Mediterranean fever (FMF) is an inherited auto-inflammatory disorder. Secondary AA amyloidosis is the most devastating complication of FMF. Nonamyloid renal involvements have also been reported in association with FMF, including vasculitis, focal and diffuse glomerulonephritis, and IgA nephropathy. We describe a patient with FMF and E148Q mutation who presented with massive proteinuria, elevated serum creatinine level, and acute glomerulonephritis picture. Disease remission was achieved after treatment with corticosteroids and colchicine.
  • Nader Nouri-Majelan, Sarasadat Moghaddasi, Mohammad Davud Qane, Farzane Shefaie, Roghayyeh Masoumi Dehshiri, Mohammad Kassem Amirbaigy, Mahmoud Baghbanian Pages 489-491
    Candida infection in the small intestine is uncommon. We report an unusual case of duodenal candidiasis that presented as chronic diarrhea in a patient who had previously undergone kidney transplantation. A 60-year-old man presented with profuse watery diarrhea that had lasted 6 months 13 years after kidney transplantation. Upper gastrointestinal endoscopy results indicated candidiasis within the esophagus and duodenum. Biopsy results revealed active duodenitis with hyphal and yeast forms of Candida overlying the duodenal epithelium in periodic acid Schiff staining. The patient was successfully treated with fluconazole. After 6 months of follow-up, the patient had no complaint of diarrhea. Duodenal candidiasis may be the result of chronic diarrhea in patients with a history of kidney transplantation.
  • Pages 495-498
  • Pages 499-506