Coronary artery bypass surgery and acute kidney injury: impact of the off-pump technique

Acute kidney injury [AKI] is a common major complication after coronary artery bypass grafting [CABG] especially when the cardiopulmonary bypass is performed. This study was conducted to evaluate the impact of the off-pump technique on the incidence of AKI, also to determine the major risk factors for AKI. In this prospective cohort study, 535 consecutive adult patients who underwent CABG between January 2007 and May 2010 in a tertiary Hospital. Some 64 of 535 patients were operated through the off-pump coronary artery bypass [OPCAB] technique and another 471 patients by the on-pump coronary artery bypass graft [CABG] technique. Stratified sampling was used to assign patients to be operated either by the OPCAB or ONCAB technique. The AKI incidence and severity were compared between the two groups. In OPCAB group 9.4% [6 patients] and in ONCAB group 4.1% [19 patients] developed AKI with no significant difference. Furthermore, the AKI severity was alike in the two groups and 10.5% [2 patients] in ONCAB and 33.3% [2 patients] in OPCAB group had mild AKI, 78.9% [15 patients] in ONCAB and 50% [3 patients] in OPCAB group had moderate AKI, and 10.5% [2 patients] in ONCAB and 16.7% [1 patients] in OPCAB group had severe AKI. As the differences of incidence and severity of postoperative AKI between OPCAB and ONCAB groups were not significant, further studies to find other useful protective methods such as free-radical scavengers, anti-inflammatory agents, and other modalities are recommended to prevent AKI

[Evaluation short and long term graft and survival rates in kidney transplanted patients between 1995-2011]

Renal transplantation is a treatment of choice in most of the patients with end-stage of renal disease. Graft and patients survival rates are important issues for these patients and results are different in many centers throughout the world. Renal transplantation has been done in more than 25 centers till now in Iran. In this study, the short-term and the long-term graft survival rates of patients undergoing kidney transplants from living or deceased donor was evaluated in a cohort study and compared with other kidney transplants centers. In this cohort study, 353 consecutive patients [age from 11 to 65 years] with end stage renal disease [ESRD] between March 1995 and March 2011 attending to Shohada-Tajrish Hospital, Tehran, Iran, were recruited. SPSS software version 16 and Kaplan-Meier method were used to determine the survival rate. The one-month graft and patients survival rates were 93.2% and 99%, the one-year graft respectively. The patients survival rates were 89% and 97.4% and five-year graft and patients survival rates were 82.5 and 89.1% respectively. The serum creatinine level one month after transplantation [P=0.016], the age [P=0.12] and sex [P=0.012] of donor were showed to be the most important factors affecting the graft survival rate. Totally, according to the obtained results in this study, it could be conclude that the patients under evaluation in this study had a satisfactory short and long term graft survival rate compared with other large centers in the world. The most important factors for good graft survival were creatinine level at discharge, age and sex of donor

[Urinary tract infection prevalence among kidney transplant patients at Shohada Hospital: 11 Years Study]

Background: urinary tract infection [UTI] is the most common infectious complication following renal transplantation. The purposes of this study were to determine the causative agents of UTIs and the survival rate among renal transplant recipients

Material and method: we evaluated 214 recipients who underwent transplantation in terms of their urine culture at first month and kidney function at the first year after kidney transplantation during the period 1995 to 2005 at shohada hospital. All patients received prophylaxis with co-trimaxazole. Medical records of the patients were reviewed retrospectively

Result: from all patients' urine cultures, urinary tract infections were confirmed among 96[44.9%] of them. Bacterial infections were the most frequent etiologies: gram-negative bacilli in 67 [69.7%], gram-positive cocci in 23 [24%], and six fungal [6.3%] infections. In fact, the causative microorganisms were E.coli as the principal isolated agent in 42 cases [43.8%]. The survival rate of the graft at the end of the study period was 92.2%, and the survival rate of the transplant recipient's was94.8%

Conclusion: the incidence of UTI in transplant patients who received antibiotic prophylaxis was high. E.coli was the main agent isolated. UTI, the most frequent post transplantation infection, showed a good prognosis