Comparisons between different blood pressure measurement techniques in patients with chronic kidney disease

BACKGROUND: Automated office blood pressure (AOBP) machines measure blood pressure (BP) multiple times over a brief period. We aimed to compare the results of manual office blood pressure (MOBP) and AOBP methods with ambulatory BP monitoring (ABPM) in patients with chronic kidney disease (CKD). METHODS: This study was performed on 64 patients with CKD (stages 3–4). A nurse manually measured the BP on both arms using a mercury sphygmomanometer, followed by AOBP of the arm with the higher BP and then ABPM. Mean BP readings were compared by paired t test and Bland–Altman graphs. RESULTS: The mean ± standard deviation (SD) age of participants was 59.3 ± 13.6. The mean ± SD awake systolic BP obtained by ABPM was 140.2 ± 19.0 mmHg, which was lower than the MOBP and AOBP methods (156.6 ± 17.8 and 148.8 ± 18.6 mmHg, respectively; P < 0.001). The mean ± SD awake diastolic BP was 78.6 ± 13.2 mmHg by ABPM which was lower than the MOBP and AOBP methods (88.9 ± 13.2 and 84.1 ± 14.0 mmHg, respectively; P < 0.001). Using Bland–Altman graphs, MOBP systolic BP readings showed a bias of 16.4 mmHg, while AOBP measurements indicated a bias of 8.6 mmHg compared with ABPM. CONCLUSION: AOBP methods may be more reliable than MOBP methods for determining BP in patients with CKD. However, the significantly higher mean BPs recorded by AOBP method suggested that AOBPs may not be as accurate as ABPM in patients with CKD.

PKD2 mutation in an Iranian autosomal dominant polycystic kidney disease family with misleading linkage analysis data

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic renal disorder caused by mutation in 2 genes PKD1 and PKD2. Thus far, no mutation is identified in approximately 10% of ADPKD families, which can suggest further locus heterogeneity. Owing to the complexity of direct mutation detection, linkage analysis can initially identify the responsible gene in appropriate affected families. Here, we evaluated an Iranian ADPKD family apparently unlinked to both PKD1 and PKD2 genes. This is one of the pioneer studies in genetic analysis of ADPKD in Iranian population. METHODS: Linkage reanalysis was performed by regenotyping of flanking microsatellite markers in 8 individuals of the ADPKD family. Direct mutation analysis was performed by Sanger sequencing. RESULTS: Mutation analysis revealed a pathogenic mutation (c.1094+1G>A) in the PKD2 gene in the proband. Analyzing 2 healthy and 4 clinically affected members confirmed the correct segregation of the mutation within the family and also ruled out the disease in 1 suspected individual. Misinterpretation of the linkage data was due to the occurrence of 1 crossing over between the PKD2 intragenic and the nearest downstream marker (D4S2929). Homozygosity of upstream markers caused the recombination indistinguishable. CONCLUSION: Although analysis of additive informative polymorphic markers can overcome the misleading haplotype data, it is limited because of the lack of other highly polymorphic microsatellite markers closer to the gene. Direct mutation screening can identify the causative mutation in the apparently unlinked pedigree; moreover, it is the only approach to achieve the confirmed diagnosis in individuals with equivocal imaging results.

Association between angiotensinogen M235T polymorphism and preeclampsia in Iranian pregnant women

To determine the possible association between the M235T variant of angiotensinogen gene and preeclampsia in Iranian preeclamtic women with hypertension during pregnancy. During a case control study, we used polymerase chain reaction-based restriction fragment length polymorphism [PCR-RFLP] analysis to investigate the association between M235T polymorphism in preeclamtic women compared to normotensive controls. The M235T polymorphism was significantly associated with increased preeclampsia risk in the studied population as supported by a p value of 0.017 and chi-square value of 8.12. The frequency of mutated allele and genotype distribution showed a significant difference between preeclamtic women and control groups. The result indicates that the AGT M235T polymorphism plays a significant role in preeclampsia observed in selected Iranian preeclamtic women, and it can be considered as a major risk factor for preeclampsia

Effects of intravenous fluid therapy on clinical and biochemical parameters of trauma patients

The administration of crystalloid fluids is considered as the first line treatment in management of trauma patients. Infusion of intravenous fluids leads to various changes in hemodynamic, metabolic and coagulation profiles of these patients. The present study attempted to survey some of these changes in patients with mild severity trauma following normal saline infusion. This study comprised 84 trauma patients with injury of mild severity in Shahid Rajaei Hospital, Shiraz, Iran, during 2010-2011. The coagulation and metabolic values of each patient were measured before and one and six hours after infusion of one liter normal saline. Then, the values of mentioned parameters on one and six hours after infusion were compared with baseline measures using repeated measures analysis of variance. Eighty four patients included in the present study [76% male]. Hemoglobin [Hb] [df: 2; F=32.7; p<0.001], hematocrit [Hct] [df: 2; F=30.7; p<0.001], white blood cells [WBC] [df: 2; F=10.6; p<0.001], and platelet count [df: 2; F=4.5; p=0.01] showed the decreasing pattern following infusion of one liter of normal saline. Coagulation markers were not affected during the time of study [p>0.05]. The values of blood urea nitrogen [BUN] showed statistically significant decreasing pattern [df: 2; F=5.6; p=0.007]. Pressure of carbon dioxide [PCO2] [df: 2; F=6.4; p=0.002], bicarbonate [HCO3] [df: 2; F=7.0; p=0.001], and base excess [BE] [df: 2; F=3.3; p=0.04] values showed a significant deteriorating changes following hydration therapy. It seems that, the infusion of one liter normal saline during one hour will cause a statistically significant decrease in Hb, Hct, WBC, platelet, BUN, BE, HCO3, and PCO2 in trauma patients with mild severity of injury and stable condition. The changes in, coagulation profiles, pH, PvO2, and electrolytes were not statistically remarkable

Effectiveness of topical curcumin for treatment of mastitis in breastfeeding women: a randomised, double-blind, placebo-controlled clinical trial

To determine the efficacy of topical curcumin in reducing breast inflammation in women suffering from lactational mastitis. A randomized double-blind, placebo-controlled study including 63 breastfeeding women with lactational mastitis were randomly assigned to receive curcumin topical cream, one pump every 8 hours for 3 days [n=32] or topical moisturizer as placebo [n=31]. Using an index for severity of breast inflammation, all of the patients had moderate breast inflammation before entering the study The outcome of treatment was evaluated using the same index at 24,48 and 72 hours of starting the treatment. There was no significant difference between two study groups regarding the baseline characteristics such as age [p=0.361] and duration of lactation [p=0<551]. After 72-hour of therapy, patients in curcumin groups had significantly lower rate of moderate [p=0.019] and mild [p=0.002] mastitis. Patients in curcumin group had significantly lower scores for tension [p<0.001], erythema [p<0.001] and pain [p<0.001] after 72-hour of treatment. The results of the current study indicate that topical preparation of curcumin successfully decrease the markers of lactational mastitis such as pain, breast tension and erythema within 72 hours of administration without side effects. Thus, topical preparation of curcumin could be safely administered for those suffering from lactational mastitis after excluding infectious etiologies

Outcomes of kidney transplantation in patients with systemic lupus erythematosus: a single-center study

This study aimed to compare outcomes of kidney transplantation in patients with systemic lupus erythematosus [SLE] and a matched control group of non-SLE kidney recipients. In a case-control study, 33 patients with kidney transplantation due to end-stage renal disease caused by SLE were matched to a control group consisted of 33 non-SLE patients who had been transplanted during the same period of time in our center. The clinical characteristics, complications, and patient and graft survival were compared between the two groups. In each group, 12 patients [36.4%] received a kidney from a deceased donor, 15 [45.4%] from a living unrelated donor, and 6 [18.2%] from a living related donor. There was no significant difference between the outcome in SLE patients and duration of dialysis before transplantation. The mean duration of hospital stay was 23.4 +/- 18.1 days in the SLE group, while it was 13.0 +/- 7.3 days in the controls [P = .006]. One-year graft survival was 79.0% in patients with SLE and 90.9% in non-SLE patients [P = .17]. One-year patient survival was 93.9% in patients with SLE versus 81.8% in the controls [P = .26]. Nine patients in the SLE group versus 11 patients in the control group developed posttransplant complications [P = .59]. Although hospital stay after transplantation was longer in the SLE kidney recipients than controls, safety of kidney transplantation was comparable. Graft failure in the SLE patients was not significantly different between patients with different sources of kidneys

Risk factors for contrast-related acute kidney injury according to risk, injury, failure, loss, and end-stage criteria in patients with coronary interventions

Although a series of risk factors for contrast-induced nephropathy are known, data on significance of some of the risk factors such as age, sex, hypercholesterolemia, hyperuricemia, and dose of contrast medium are inconsistent. Our aim was to identify risk factors for contrast-related acute kidney injury [AKI]. In this prospective study, 290 consecutive patients with a serum creatinine level lower than 3 mg/dL undergoing percutaneous angiography were analyzed. Contrast-related AKI was evaluated using the risk, injury, failure, loss, and end-stage [RIFLE] criteria, and its correlation with clinical and laboratory data of the patients was analyzed. Contrast-related AKI was found in 15.5% of the patients, with a maximum RIFLE category [risk in 13.8%, injury in 1.4%, and failure in 0.3%]. Serum creatinine level, contrast volume, safe contrast volume factor, diabetes mellitus, and dehydration were significantly associated with contrast-related AKI. Age, sex, and serum uric acid level did not differ significantly between those with and without contrast-related AKI. Multiple logistic regression analysis disclosed diabetes mellitus to be the strongest predictor for being at risk of contrast-related AKI [odds ratio, 5.1; 95% confidence interval, 1.9 to 11.0; P=.001], followed by hypercholesterolemia [odds ratio, 4.6; 95% confidence interval, 1.1 to 8.3; P=.03], and an estimated glomerular filtration rate lower than 90 mL/min/1.73 m[2] [odds ratio, 3.0; 95% confidence interval, 1.8 to 5.7; P=.003]. Our results indicate that diabetes mellitus, hypercholesterolemia, and underlying chronic kidney disease are the major factors of contrast-related AKI

booster phenomenon of tuberculin skin testing in patients receiving hemodialysis

The risk of developing tuberculosis is high among chronic hemodialysis patients. The tuberculin skin test [TST] has been in use for diagnosing latent TB, but few data are available on TST in hemodialysis patients. This study was done to identify the TST reactivity and frequency of booster effect in serial TST among hemodialysis patients. A total of 100 patients in three hemodialysis centers were prospectively tested. Patients with less than 10mm indurations were given additional TST one and four weeks later to determine the frequency of booster effect. The cumulative prevalence of a positive TST was 7% for the first test and 16% for the third test. There was a weak, but significant correlation between TST positivity, serum albumin level, urea reduction ratio and KT/V [p<0.05]. There was no influence of age, gender, hemodialysis duration and primary renal disease. This study showed that the TST reactivity and booster effect among our hemodialysis patients in Iran are lower than in other societies. Inadequate hemodialysis and poor nutrition may contribute to the lower tuberculin skin test reactivity in our hemodialysis patients

Arteriovenous fistula thrombosis in patients on regular hemodialysis: a report of 171 patients

Fistula thrombosis in patients on maintenance hemodialysis is an important morbidity factor. Arterial or venous thrombotic events have been described as complications in patients on regular hemodialysis. This study was designed to evaluate the risk factors for arteriovenous fistula thrombosis. One hundred and seventy-one patients with arteriovenous fistula on maintenance hemodialysis were studied prospectively during a period of 14 months for any episode of arteriovenous fistula thrombosis, after anticardiolipin antibodies were assayed by ELISA. Other risk factors for thrombosis such as the presence of diabetes or hypertension, the use of erythropoietin [rhEPO], fistula site, gender, age, ultrafiltration, hypotension during dialysis, and the number of dialysis visits in a week were assessed. Fifty-six percent of patients had IgG-anticardiolipin antibodies =/> 10GPL, which was significantly correlated with dialysis duration [23.18 +/- 24.56 months in patients with anticardiolipin antibodies

Predictive factors for persistent hyperparathyroidism after kidney transplantation

A successful kidney transplantation [KT] corrects the main metabolic abnormalities responsible for secondary hyperparathyroidism [HPT]. Nonetheless, after several months, many patients keep abnormally high parathyroid hormone [PTH] levels and/or become hypercalcemic with persistent HPT. In the present survey, the frequency of high PTH levels and the influence of certain important factors on its evolution among patients with successful KT were investigated within three months posttransplantation. A total of 126 patients, who had successful KT, entered the study between 2000 and 2002. On the day of operation and three months later, demographic data and serum calcium, phosphorus, albumin, creatinine, and immunoreactive PTH [iPTH] [by IRMA] were checked. Hypercalcemic patients, at third month, were followed up for one year after transplantation. With respect to the post-KT iPTH level, patients were divided into two groups; those with iPTH above and below 60 pg/mL. The importance of several factors on the evolution of hyperparathyroidism was determined. Sequential changes in serum calcium were also assessed in hypercalcemic patients up to one year after transplantation. Twenty-one [16.6%] out of 126 patients had a post-KT serum calcium of >10.8 mg/mL. Post-KT iPTH value of > 60 pg/mL was found in 9 [7.1%] out of the 126 cases. There was a statistically significant relationship between the age of patients and duration of dialysis and a post- KT high PTH level [P < 0.001]. Other risk factors did not seem to have a significant correlation with the post-KT high PTH level. In all hypercalcemic patients, PTH levels normalized but hypercalcemia persisted in 14 [88%] out of 16 patients up to 1 year after transplantation. Increased age of the patient as well as the duration of dialysis had significant influences on development of persistent HPT, three months posttransplantation. We believe that it is better to transplant the patients as soon as possible, in order to prevent the devastating complication of persistent HPT and hypercalcemia