Should post kidney transplantation hyperlipidemia considered a risk factor for graft function?

Hyperlipidemia is a common problem after kidney transplantation.To uncover the real impact of post kidney transplantation hyperlipidemia on graft function and survival, and to determine whether it is just a biochemical phenomenon after using immunosuppressant or a part of disease pathology. 330 kidney transplants were managed in Sina Hospital Kidney Transplantation Unit affiliated to Tehran University of Medical Sciences, Tehran, Iran from September 1994 till February 2010. The demographic characteristics of the patients, causes of chronic kidney diseases, history of pretransplantation dialysis, pretransplantation comorbidities [e.g., hypertension, diabetes mellitus [DM], hyperlipidemia and coronary artery disease], rejection episodes, status of infection with cytomegalous virus [CMV], post-transplantation DM, hyperlipidemia, ischemic heart disease [IHD], and graft and patient survival were recorded. A serum creatinine level >2 mg/dL was considered as "graft deterioration," and return to dialysis as "graft loss." According to the presence or absence of post kidney transplantation hypercholesterolemia [>200 mg/dL] or hypertriglyceridemia [>200 mg/dL], the patients were classified into "hyperlipidemic" or "non-hyperlipidemic." The presence of clinical or paraclinical coronary artery disease was also determined in both groups.The incidence of hyperlipidemia elevated from 8% to 50% before and after transplantation. 2.7% developed clinical IHD. 13% of hyperlipidemics and 22% of non-hyperlipidemics developed graft deterioration. Among hyperlipidemics with deteriorated grafts 40% had premorbid diseases, 68% had CMV infection and 82% had hypertension. Only 22% had previous acute rejection and 27% received deceased kidney transplant.Post-kidney transplantation hyperlipidemia is just an associated phenomenon secondary to the use of immunosuppressant medications, which have no obvious impact on renal graft function and can be easily controlled by instituting dietary modifications and use of modern antilipid medications. Post kidney transplantation CMV infection and hypertension are considered as the main threatening risk for renal graft-even more dangerous than acute or chronic rejections

[Evaluation of variability of acute phase proteins in hemodialysis patients]

The prognosis of chronic dialysis patients is poor, in part due to the high incidence of cardiovascular disease and malnutrition. It has been recognized that 30-50% of hemodialysis patients have serological evidence of an activated inflammatory response. Chronic inflammation may cause malnutrition and progressive atherosclerotic cardiovascular disease. It would be obvious interest to study prevalence of inflammatory factors particularly CRP as prominent components of inflammatory syndrome in dialysis patients. We studied 125 dialysis patients in a cross sectional study during summer of 2001 in two university hospitals. Serum CRP [agglutination method], albumin [bromocresol green method] and ferritin [ELISA] were measured in all patients. One hundred and twenty five patients including 53 [44.1%] men and 72 [55.9%] women were enrolled in this study. Fourteen patients [11.2%] had hypoalbuminemia, 81 [64.8%] had high serum ferritin, and 57 subjects [45.6%] were CRP positive. According to high prevalence of inflammatory factors especially C-reactive protein in dialysis patients, CRP and other inflammatory factors should be screened in this group of patients routinely because of their prognostic importance

[Importance of high C-reactive protein in patients with chronic renal disease]

An elevated serum C reactive protein [CRP] has been shown to be strongly predictive of morbidity and mortality in dialysis patients. However, little information is available regarding CRP levels in predialysis renal failure. The aim of our study was, determine the significance of high CRP levels in pre dialysis patients. In a cross- sectional study 100 pre dialysis patients were studied. The CRP levels, nutritional data [body mass index [BMI], serum albumin, cholestrol, triglycerides], hematocrit [HCT], hemoglobin [Hb], serum creatinine, creatinine clearance, urinary protein levels and blood pressure were measured and compared between patients with high [>6mg/l] or low [<6mg/l] CRP levels. In 100 chronic pre dialysis patients mean age was 48/8 +/- 12/8 years. CRP was greater than 6mg/l in 35%. We found some satistical relationship between high serum CRP levels and BMI, creatinine clearance, serum Albumin, serum cholestrol and high blood pressure. The prevalence of inflammation is high in predialysis patients. As occurs in dialysis patients, predialysis inflammation predicts morbidity in pre dialysis stage but further investigation should be done in this regard

[Diagnostic accuracy of the visualization of acanthocyturia by phase contrast microscope in differentiating the glomerular and nonglomerular origin of hematuria]

Introduction: Hematuria is one the most common complaints of patients with renal disease. One of the first evaluations of hematuria is to determine its origin. Phase contrast microscope is applied to assess the morphology of erythrocytes in the urine. We conducted this survey to determine the diagnostic accuracy of the visualization of acanthocyturia by phase contrast microscope in differentiationg the glomerular and nonglomerular origin of hematuria at Imam Khomeini Hospital, Tehran University of Medical Sciences

Methods and Materials: In a cross-sectional study, we studied 67 patients with hematuria who came to the nephrology clinic of Imam Khomeini Hospital from September 1997 till December 1998. Samples of morning urine [8-10 ml] were taken and studied with x40 lens of phase contrast microscope. Two samples were at least taken from each patient in a 15-30 days interval. The data regarding personal information, chief complaint, physical examination and paraclinical surveys were recorded in a specific form

Results: Of all 67 studied patients, 42 [62.6%] had dysmorphic RBCs. Of these, 32 [54%] had acanthocyturia, among whom seven patients [16.6%] had acanthocyturia less than 5%. Sensitivity and specificity of acanthocyturia, acanthocyturia more than 5% and acanthocyturia with proteinuria in differentiating glomerular from non-glomerular origin of hematuria were 73.3%, 76.1%, 53.3%, 95.2%, 100% and 95%, respectively

Conclusion: According to our study which was done with small number of cases, the phase contrast microscope has high sensitivity and specificity for diagnose the origin of hematuria