Renal biopsy in glomerulonephritis

Glomerulonephritis [GN] is responsible for 25-30% of end-stage renal disease [ESRD] among all causes. Renal biopsy is important to determine the GN treatment method and its prognosis. In some cases, renal biopsy is required for definitive diagnosis. Biopsies were used as a diagnostic method in different disease from 1930. They were performed blindly and at bedside. Complication rate varies from 2 to 20% in different reports. Percutaneous renal biopsy is a routine diagnostic procedure in nephrology nowadays, and it should be individualized for each patient depending on their age, BMI, coagulation status and the availability of skilled radiologist. In this paper, we review image-guided renal biopsy in glomerulonephritis

[Prevalence of low mineral bone density in renal transplant recipients one year or more after transplantation]

Reduction in mineral bone density is a common complication following kidney transplantation and its adverse outcome could be minimized with well recognition and treatment. In this study we evaluated the prevalence of mineral bone density decrease in kidney recipients at least one year after the transplantation. Kidney recipients from whom transplant surgery at least a year had assed and had a good kidney function were selected. Mineral bone densitometry using X- ray energy absorptiometry was performed. The serum levels of Ca, P, Alkaline Phosphatase and Paratormone were measured and the collected data were statistically analyzed. Overall 182 patients were studied. The total rate of mineral bone density decrease was 87.4%. Osteopenia in the femoral bone was 73.6% and osteoporosis was 13.8%. In the lumbar vertebrae an osteopenia of 66.5% and an osteoporosis of 20.9% were noticed. Variance of analysis showed that there were no statistically significant differences between duration of dialysis before kidney transplantation [P=0.777, P=0.420], duration of kidney transplantation [P=0.927, 0.271], the mean of serum PTH [P=0.908, P=0.146] and calcium [P=0.348, P=0.265] in respect to densitometry of femoral bone and lumbar vertebrae. The frequency of mineral bone density reduction one year after kidney transplant in patients with a good transplanted kidney function was high

Serum triiodothyronine level as an indicator of inflammation in patients undergoing dialysis

It has been shown that inflammation affects thyroid function. In patients with end-stage renal disease, low plasma triiodothyronine [T3] may be an unsuspected expression of the inflammatory state of these patients. This study evaluated the correlation between T3 and high-sensitivity C-reactive protein [HSCRP] levels in patients on peritoneal dialysis [PD] and hemodialysis. This is a cross-sectional study aiming at the correlation between T3 and HSCRP levels among 30 patients on PD, 30 patients on hemodialysis, and 20 healthy individuals. Serum levels of HSCRP, T3, thyroxine [T4], thyroid stimulating hormone, T3 resin uptake, and free T3 index [FT3I] and free T4 index [FT4I] were compared between the three groups. There were no significant differences between hemodialysis and PD patients in respect to T3, T4, FT3I, and FT4I. In PD and hemodialysis patients, T3 and FT3I were lower than in controls [P < .001], but there was no significant difference between PD and hemodialysis patients. T3 resin uptake and thyroid stimulating hormone differed significantly between PD and hemodialysis patients. There was a significant inverse correlation between HSCRP and T3 and FT3I among hemodialysis patients [P = .04]; however, there was no such correlations in PD patients. The relationship between T3 and HSCRP suggests that inflammation might be involved in the low T3 syndrome in hemodialysis patients, but we did not find a significant correlation between T3 and HSCRP levels in patients on peritoneal dialysis

[Changes in body fluid composition before and early after renal transplantation and comparing it with normal persons]

In this study we evaluated the body composition before and two weeks after kidney transplantation and compared it with the healthy people by BIA. A total of 23 progressive renal failure patients who attended the transplantation were recruited for this study. The control group included 27 graft donors .Patients were checked one day before hemodialysis and a day before transplantation, by BIA. After transplantation, body composition was assessed between days 1-7 and on the 14[th] day of post transplantation. The control group included 27 graft donors. The comparison of body composition between two groups [donors and recipients] showed significant changes before hemodialysis and after transplantation, and TBW% decreased from the 7[th] day post transplantation. The Main cause of low level of TBW% was the decrease in ECW% and ECW/ICW from the beginning of 2[nd] week after transplantation. Just TBW% in normal males was different from that it normal females but in recipients there was no difference between males and females. The body composition takes a long time to reach to the normal level and two weeks after transplantation some agents are probably responsible for intense changes of body composition including drugs and mild prerenal azotemia specially on the 2[nd] week after transplantation

Assessment of bone density in patients before and after kidney transplantation

Accentuation of bone loss is one of the most important skeletal complications after transplantation. Early diagnosis and treatment of osteopenia and osteoporosis reduce risk of fractures and prevent the aggravation of it by using corticosteroid after kidney transplantation. A total of 50 patients that received graft during the research time, 31 of them completed it. They were screened for decreased bone mineral density at baseline, 6 and 12 months after transplantation with dual-energy x-ray absorptiometry [DEX A] of lumbar spine and hip. A total of 31 patients [17 [55.8%] female and 14 [45.2%] male] with end stage renal disease entered the study. The mean age of patients in both genders were 39.67 +/- 14.5 years [range: 20-67years]. Replacement therapy in 24 patients [77.4%] was hemodialysis and in 7 patients [22.6%] was peritoneal dialysis. Before transplantation, the mean of T-score in femoral neck and lumbar vertebra were -0.88 +/- 1.19 and-0.37 +/- 1.12 respectively, osteopenia was found in 41.9% and 29% of each region. On 6 months after transplantation, the mean of T-score in femoral neck and lumbar vertebra -1.42 +/- 0.95 and -1.41 +/- 1.36 respectively. Incidence of osteopenia in each region was 83.9% and 64.5% in turn. We tried to examine them in the first year after transplantation, the mean of T-score in femoral neck was-1.13 +/- 1.11 and in lumbar vertebra was -1.29 +/- 1.33. After 6 months, bone mass reduction was significant [p<0.05], but there was not any significant difference between 6 and 12 months following transplantation [p>0.05]. Bone loss was highest in the first 6 months after transplantation. Then, treatment was necessary during this period of time

Cyclosporine trough levels and its side effects in kidney transplant recipients

Cyclosporine is the backbone of immunosuppression in kidney transplantation. However, it is associated with side effects, some of which are dose-dependent. We evaluated association between cyclosporine trough level and its side effects. In 50 kidney transplant recipients, serum cyclosporine level, fasting blood glucose, and serum creatinine were measured 7 times during first 6 months after transplantation. The participants were also assessed for blood pressure, hand tremor, and headache at each visit. The relationship between cyclosporine trough level and hypertension, hyperglycemia, hand tremor, and headache were evaluated. There were no significant relationship between cyclosporine levels and allograft function. Except at the second week and sixth month, there were no significant differences between drug doses in various serum cyclosporine trough level groups. At the second week, the mean drug dose in patients with cyclosporine trough levels less than the target therapeutic level was 279.16 +/- 56.23 mg/d, while in the patients with cyclosporine levels higher than the therapeutic level, its dose was 302.08 +/- 66.61 mg/d [P < .05]. At the sixth month, the mean drug dose was 137.50 +/- 17.67 mg/d in the patients with lower than target cyclosporine levels, and it was 242.18 +/- 58.25 mg/d in those with cyclosporine levels higher than the therapeutic level [P < .05]. There was no significant relationship between serum cyclosporine level and its side effects. We demonstrated cyclosporine trough level had no direct relation with drug side effects and it is not a suitable measure for assessment of drug side effects