case-control study on occult hepatitis b infection in chronic hemodialysis patients from south-west of Iran

Blood born viral infections such as hepatitis B virus [HBV] are major concerns in chronic hemodialysis [CHD] patients and hemodialysis units. Undetected HB[s] Ag in the presence of viral DNA, occult HBV infection [OBI], isa concern in the care of CHD patients and hemodialysis unit as a mode of transmission.In this case-control study we compare the frequency of OBI in the CHD patients with the normal population.82 consecutive CHD patients and 82 healthy individuals without any risk factors for HBV infection were enrolled in this study. A selection criterion was negative serum HB[s] Ag by ELISA method. Subsequently, the sera were tested for HBV DNA by nested PCR method.In the CHD group, 55 [67.1%] were male and 27 [32.9%] were female, with the overall mean age of 54.32 +/- 13.67 years old. The mean age of control group was 32.65 +/- 8.51 years old, with 26 [31.7%] male and 56 female [69.3%]. HBV DNA was present in 9 [11%] CHD patients, 4 [8%] of whom were seronegative for anti-HBc and anti-HB[s] antibodies. No HBV DNA was identified in the control group [p<0.0001]. History of blood transfusion was presentin all OBI CHD patients and 59 [80.9%] of non-OBI CHD patients. Duration of hemodialysis in OBI CHD and non-OBI CHD patients were 73.56 +/- 39.53 and 44.24 +/- 24.59 months, respectively [p =0.002]. The prevalence of occult HBV infection is relatively high in patients with chronic hemodialysis in our region. Duration of hemodialysis and history of blood transfusion are important risk factor for OBI infection. A more sensitive method, such as PCR, may need to be considered in this patient population

Oxford-MEST classification in IgA nephropathy patients: a report from Iran

There is a limited knowledge about the morphological features of IgA nephropathy [IgAN]in the middle east region. The objective of this study was to evaluate the spectrum of histopathological findings in IgAN patients at our laboratory. At this work, an observational study reported which was conducted on IgAN patients using the Oxford-MEST classification system. In this survey, of 102 patients 71.6% were male. The mean age of the patients was 37.7 +/- 13.6 years. Morphologic variables of MEST classification was as follows; M1: 90.2%, E: 32%, S: 67% also, T in grads I and II were in 30% and 19% respectively, while 51% were in grade zero. A significant difference was observed in segmental glomerulosclerosis [P=0.003] and interstitial fibrosis/tubular atrophy frequency distribution [P=0.045], between males and females. Furthermore, it was found that mesangial hypercellularity was more prevalent in yonger patients. Moreover, there was a significant correlation between serum creatinine and crescents [P<0.001]. There was also significant correlation of serum creatinine with segmental glomerulosclerosis [P<0.001]. Higher prevalence of segmental glomerulosclerosis and interstitial fibrosis/tubular atrophy, as the two of, four variables of Oxford-MEST classification of IgAN in male patients further attests that male gender is a risk factor in this disease. In this study the significant correlation between serum creatinine and crescent was in an agreement with previous studies and suggests for the probable accomodation of extracapillary proliferation as a new variable in MEST system

Survival at 1, 3, and 5 years in diabetic and nondiabetic patients on hemodialysis

We analyzed survival of 185 adult patients on maintenance hemodialysis [9 h/wk to 12 h/wk] at Emam Khomini Hospital in Ahvaz, Iran. Patient survival at 1, 3, and 5 years was 89.2%, 69.2%, and 46.8%, respectively. There was no significant difference between diabetic and nondiabetic patients in 1-year survival [87.1% versus 89.7%, P = .66]. But, 3- and 5-year survival rates of diabetic patients were significantly lower than those of nondiabetic patients [52.2% versus 73.8%, P = .04; zero versus 56.9%, P < .001; respectively]. Based on our findings, the survival of diabetic patients undergoing hemodialysis was much worse than survival of nondiabetic patients. Thus, prevention of diabetic nephropathy should be more emphasized; and if end-stage renal disease is present, other renal replacement therapies such as kidney transplantation must be considered as soon as possible

Changes in plasma concentrations of hypoxanthine and uric acid before and after hemodialysis

Purine metabolites constitute a major class of uremic toxins, and reliable characterization of which helps nephrologists to choose the most appropriate treatment for the patients individually. In the present study, we assessed plasma concentrations of hypoxanthine and uric acid as purine metabolites in patients on maintenance hemodialysis, before and after a dialysis session. A total of 20 patients on maintenance hemodialysis were enrolled in this study. All of the patients underwent a routine 4-hour dialysis, as scheduled 3 times per week. Polysulfone membranes and bicarbonate dialysis solution were used in all dialysis sessions. Blood specimens were taken from the arteriovenous fistula immediately before and after one hemodialysis session, in order to measure plasma concentrations of hypoxanthine and uric acid by high-performance liquid chromatography, and to compare the predialysis and postdialysis values. Before hemodialysis, the mean plasma hypoxanthine and uric acid concentrations were 18.93 +/- 8.28 micro mol/L and 44.16 +/- 22.88 micro mol/L, respectively. After hemodialysis, these concentrations reduced to 13.68 +/- 4.42 micro mol/L and 15.61 +/- 11.12 micro mol/L, respectively. Hypoxanthine concentration had a 27.7% decrease after hemodialysis [mean difference, 5.25 +/- 6.24 micro mol/L; 95% confidence interval, 2.32 to 8.10; P < .001]. Also, uric acid concentration decreased by 64.6% [mean difference, 28.55 +/- 14.39 micro mol/L; 95% confidence interval, 21.81 to 32.28; P < .001. Plasma concentrations of hypoxanthine and uric acid are higher than normal before hemodialysis, and they decrease significantly after hemodialysis; however, both of them may be still higher than normal values

Posttransplant lymphoproliferative disorders in kidney transplant recipients. An Iranian multicenter experience

Limited data with adequate sample size exist on the development of posttransplant lymphoproliferative disorder [PTLD] in living donor kidney recipients. We conducted a retrospective cohort study on the data of 10 transplant centers to identify the incidence of PTLD in Iran. Data of 9917 kidney transplant recipients who received their kidneys between 1984 and 2008 were reviewed. Fifty-one recipients [0.5%] who developed PTLD were evaluated with a median follow-up of 47.5 months [range, 1 to 211] months. Patients with PTLD represented 24% of all posttransplant malignancies [51 out of 211 cases]. There was no relationship between PTLD and sex [P = .20]. There were no statistically significance differences considering the age at transplantation between patients with and without PTLD. The late-onset PTLD [70.6%] occurred more frequently compared to the early form. There was no signification relationship between early-onset and late-onset groups in terms of clinical course and outcome. In patients who received azathioprine, PTLD was more frequent when compared to those who received mycophenolate mofetil [P < .001]. The lymph nodes were the predominantly involved site [35.3%], followed by the gastrointestinal tract, brain, kidney allograft, lung, ovary, vertebrae, and palatine. Age at diagnosis and the time from transplantation to diagnosis were comparable for various involvement sites of PTLDs. The overall mortality in this series of patients was 51.0%. Posttransplant lymphoproliferative disorder is a rare but devastating complication and long-term prognosis can be improved with early recognition and appropriate therapy

Changes in plamsa concentrations of hypoxanthine and xanthine in renal vein as an index of delayed kidney allograft function

The aim of this study was to evaluate the plasma levels of hypoxanthine [HX] and xanthine in the renal vein blood samples for prediction of delayed graft function [DGF]. Two blood samples were taken from 47 kidney recipients, intraoperatively. The first sample was obtained from a peripheral vein before vascular anastomosis and the second from the allograft renal vein, 15 minutes after the anastomosis. Purine metabolites including xanthine and HX were measured and their associations with operative time, anastomosis time, frequency of clamping, urine output, and DGF were evaluated. The mean levels of xanthine and HX were 0.12+/-0.10 mg/L and 0.37+/-0.17 mg/L in the first plasma samples, respectively. Thirty patients [63%] had no significant changes in neither of their purine metabolite levels and 17 [37%] had higher levels of HX, but not xanthine, in their second samples. Only anastomosis time had a significant relation with the level of the metabolites [P = .04]. Three patients [10%] with no changes in the metabolites and 5 [29.4%] with higher HX levels had DGF [P = .12]. The anastomosis time and frequency of vascular clamping were higher and the urine output after the anastomosis was lower in the patients with DGF. Cold ischemia in kidney transplantation causes a mild increase in the HX concentration indicative of short-term ischemia effects on the cell metabolism. But it cannot predict DGF. Anastomosis time, frequency of clamping, and urine output after the anastomosis are more sensitive indices

Public attitudes toward cadaveric organ donation a survey in Ahwaz

The aim of this study was to evaluate the attitudes of the residents of Ahwaz toward organ donation after brain death. A total of 1000 people between 15 and 70 years of age were selected by cluster sampling in Ahwaz, south-west of Iran. A questionnaire was designed about the attitudes of the interviewees toward organ donation after brain death by themselves and by their family members, demanding compensation for organ donation, and the need for consent or testimony. Of the participants, 75% were pro organ donation, while 22% were against it and the remaining 3% had no specific idea. Age, sex, and occupation did not influence the attitudes; however, the ethnicity, educational level, economic status, and having a loved one in need of organ transplantation significantly increased the willingness of these people for organ donation [P < .05]. Regarding the issue of demanding compensation for organ donation, 27% of the participants were in favor of the idea and 73% disagreed. A higher proportion of the participants with higher educational levels believed in organ donation without any consent or testimony [P = .02]. According to our study, many people are pro organ donation after death. It is necessary to have a regular program for these people to give them the opportunity to register and receive a donation card. For the people who do not have the tendency for the matter, we had better try to increase their knowledge by educational programs and provide sufficient information

role of pretransplant smoking on allograft survival in kidney recipients

Cigarette smoking contributes to a number of health-related problems, but its impact on allograft survival in kidney recipients is not clear. This study was performed to evaluate the relationship between smoking and graft survival. A total of 199 adult kidney recipients were enrolled in this study. All transplantations had been done in our center and all grafts had been taken from living donors. The patients were asked about their cigarette smoking behavior before transplantation and assessed for diabetes mellitus, hypertension, and hyperlipidemia, pre- and post-operatively. Of 199 recipients, 142 [71.4%] were male and 57 [28.6%] were female. They were 40.45 [range 18 to 65] years old. Forty-one recipients [20.6%] were smokers before kidney transplantation that 87.7% of them continued smoking after transplantation. Mean pack-year smoking was 13.2. Of the patients, 32.7% and 33.7% had hypertension, 19.3% and 23.1% had diabetes mellitus, and 46.2% and 42.2% had hyperlipidemia, before and after transplantation, respectively, showing no significant difference. Pretransplant smoking was significantly associated with reduced overall graft survival [P = 0.01], but no correlation between smoking cessation after transplantation with survival graft was found. Cigarette smoking before kidney transplantation contributes significantly to allograft loss. However, smoking is not associated with increase in rejection episodes. Although we could not prove it, smoking cessation after renal transplantation may have beneficial effects on graft survival. These effects should be emphasized for patients with end-stage renal disease who are candidates for kidney transplantation

Short-term and long-term outcomes of kidney transplantation in diabetic and nondiabetic patients

The purpose of this study was to compare the short-term and longterm kidney transplant outcomes in diabetic and nondiabetic patients. We studied all kidney recipients in Golestan hospital, Ahwaz, from 1995 to 2003. The patients were divided into two groups of diabetic and nondiabetic, and 1-year, 2-year, and 5-year survival rates of the patient and the kidney were evaluated. We also evaluated and compared the causes of death between these two groups. There were 50 diabetic patients with a mean age of 51 years, and 350 nondiabetic patients with the mean age of 29 years old [P = .03]. One-year, 2-year, and 5-year graft survival rates were 90% versus 91.5%, 86% versus 89%, and 76% versus 83% in diabetic and nondiabetic patients, respectively [P = .19]. The patient survival rates were 92% versus 93%, 88% versus 91%, and 76% versus 84% in diabetic and nondiabetic patients, respectively. The most common cause of death was myocardial infarction in diabetic patients [50%], and septicemia among the nondiabetic ones [50%]. The most common cause of kidney allograft loss was patient's death [75%] in diabetic patients and kidney rejection [40%] in nondiabetics. Long-term kidney transplantation results have been significantly improved comparing with other studies. Thus, kidney transplantation is recommended as the treatment of choice in diabetic patients with end-stage renal disease. However, a complete evaluation of cardiac problems for these patients is recommended before the surgery