impact of hepatitis b infection on outcome of kidney transplantation: a long-term study

With the success of kidney transplantation, liver disease has emerged as an important cause of morbidity and mortality in kidney recipients. To determine the impact of hepatitis B virus [HBV] infection on patients and graft survival in both short- and long-terms. 99 renal transplant patients infected with HBV on follow-up in two major transplant centers were included in a retrospective study. These patients were grafted between 1986 and 2005 and divided into two groups: [1] those only positive for hepatitis B surface antigen [HBsAg] and [2] those who were also positive for hepatitis C virus antibodies [HCV Ab]. There were 88 patients with HBsAg[+] and 11 with both HBsAg[+] and HCV Ab[+]. The mean +/- SD age of patients was 38.8 +/- 13.2 years, and the median follow-up after transplantation was 19 months. Although not significant, the allograft survival rate in the first group [HBV[+] was better compared to that in the second group [HBV[+] and HCV[+]; 1, 5 and 10 years graft survival rates were 91, 77 and 62 in the first group and 70, 56 and 28 in the second group, respectively [P=0.07]. The overall mortality was 5% [4 of 88] in the first and 27% [3 of 11] in the second group [P=0.02]. Renal allograft recipients with HBV and HCV infections has a poor survival rate compared to pa- tients with only HBV infection. However, there is no significant difference in terms of renal graft survival between the two groups

[Effects of combined administration of lipoic acid and pyridoxine on serum systemic and vascular inflammatory factors in patients with diabetic nephropathy]

Systemic and vascular inflammation are two risk factors for the development of diabetic nephropathy. In diabetic patients, serum systemic and vascular inflammatory factors have positive correlations with albuminuria. The present study was designed to investigate the effects of combined administration of lipoic acid and pyridoxine on the serum concentrations of these factors in patients with diabetic nephropathy. The study was a double-blind randomized clinical trial in which 38 patients with diabetic nephropathy [23 females and 15 males] were randomly assigned to either the supplement-taking or the placebo group. The patients in the supplement group received 800 mg lipoic acid and 80 mg pyridoxine daily for 12 weeks, while the placebo group received corresponding placebos. At baseline and the end of week 12, a urine sample and 10 ml blood was collected from each patient after a 12 to 14-hour fast and serum high sensitive C-reactive protein [hs-CRP], soluble intercellular adhesion molecule type 1 [sICAM-1], soluble vascular cell adhesion molecule type 1 [sVCAM-1], sE-selectin, Interleukine-6 [IL-6], glucose, percent of blood hemoglobin A1c and urinary albumin were measured. In the present study, no significant differences were observed between the two groups in mean changes of hs-CRP, IL-6, sICAM-1, sVCAM-1, sE-selectin, glucose, percent of blood hemoglobin A1c. Mean urinary albumin concentration decreased significantly in the supplement-taking group at the end of week 12, compared to the baseline [P<0.05] and the reduction was significant in comparison with the placebo group [P<0.05]. The results of the present study indicate that combined administration of lipoic acid and pyridoxine has no effect on serum systemic and vascular inflammatory factors, but it reduces urinary albumin concentration significantly. Therefore, combined administration of lipoic acid and pyridoxine may have an effective role in retarding the progression of diabetic nephropathy with a mechanism different from the effects of these supplements on inflammation

Effects of combined administration of lipoic acid and pyridoxine on albuminuria, oxidative stress, blood pressure, serum advanced glycated end products, nitric oxide and endothelin-1 in patients with diabetic nephropathy

Diabetic nephropathy is the most common cause of kidney failure. High serum concentrations of advanced glycated end products, oxidative stress, and hypertension are three important risk factors for diabetic nephropathy. As individual administration of lipoic acid or pyridoxine is not effective in improving diabetic nephropathy, the present study was designed to investigate the effects of combined administration of lipoic acid and pyridoxine on albuminuria, oxidative stress, blood pressure, serum advanced glycated end products, nitric oxide and endothelin-1 in patients with diabetic nephropathy. The study was a double-blind randomized clinical trial, in which 38 patients with diabetic nephropathy [23 females and 15 males] were randomly assigned to either a supplement-taking group or a placebo group. The patients in the supplement group received 800 mg lipoic acid and 80 mg pyridoxine daily for 12 weeks, while the placebo group received placebos. At baseline and at the end of week 12, a urine sample and 8 ml blood were collected from each patient after a 12- to 14-hour fast and serum pentosidine, carboxymethyl lysine, malondialdehyde, endothelin-1, nitric oxide, glucose, urinary albumin, systolic and diastolic blood pressures were measured. The serum concentrations of pentosidine and carboxymethyl lysine decreased significantly in the supplement-taking group at the end of week 12 as compared to the baseline values [P<0.05] The combined supplement also brought about significant reductions in the serum malondialdehyde [25%], systolic blood pressure [2 mmHg] and urinary albumin concentration [74 mg/g creatinine]; the reductions were significantly different from the placebo group values [P<0.05]. On the other hand, the serum nitric oxide concentration increased significantly in the supplement-taking group as compared to the placebo group [P<0.05]. No significant differences were observed between the two groups in the mean changes of serum endothelin-1, glucose or diastolic blood pressure. The results indicate that combined administration of lipoic acid and pyridoxine reduces significantly serum pentosidine, carboxymethyl lysine, malondialdehyde, systolic blood pressure and urinary albumin concentration, and increases serum nitric oxide. This treatment may, thus, have an effective role in retarding the progression of diabetic nephropathy

Comparision between effects of bicarbonate and acetate dialysates on spirometry parameters in patients with chronic renal failure undergoing hemodialysis

Chronic renal failure causes impairment of all body organs including heart and lungs. Main problem in these patients are pulmonary edema due to increased permeability of capillaries, intravascular and interstitial volume overload, hypertension and heart failure. These changes cause altered physiologic and mechanical function of lungs. The objective of this study is evaluating the effect of dialysates and other intervening factors on spirometry parameters. This cross-sectional study was performed on 41 patients with chronic renal failure in September and October 2006 in Labbafi Nejad Hospital, Tehran. Patients were randomly divided to bicarbonate and acetate groups. Prior to and after hemodialysis, patients were meticulously weighed and spirometry parameters [FVC, FEV1, FEV1/FVC%. FEF 25-27] were measured. Biochemical indices were checked. Spirometry parameters were analyzed using t-test, and p-value less than 0.05 was considered statistically significant. We compared 29 patients undergoing dialysis with bicarbonate and 21 patients on dialysis with acetate. Respiratory function improvement in spirometry parameters was only significant in patients undergoing dialysis with bicarbonate dialysate, and when results were compared according to gender, they were statistically significant only in men. This improvement was meaningful in FEF [25-27%], FEV1, FVC. Post dialysis weight loss and serum chemistry had no significant correlation with improvement of spirometry parameters. Dialysis with bicarbonate dialysate causes significant improvement in spirometry parameters and respiratory function in men

[Renal transplantation in children with cystinosis]

Cystinosis is an inherited metabolic disease in which transfer of cystine out of lysosome is impaired. This phenomenon leads to accumulation of cystine in different organs and causes organ dysfunction. Growth retardation is seen in these patients and later they go on to develop renal failure needing dialysis or renal transplantation. The aim of this study was to evaluate the outcome and complications of renal transplantation in patients with cystinosis. In this case series study in years 1996-2006 all patients with renal failure due to cystinosis who received renal transplantation, were followed for 43 +/- 1/1 months, Before operation, all patients were examined to determine if they are appropriate candidate for renal transplantation and after operation DPTA scan was performed to evaluate graft function and in later follow up necessary lab tests were done. All patients received triple immunosuppressive therapy including cyclosporine, prednisolone and Mycophenolate Mofetil. In the presence of rejection symptoms such as fever and a rise in creatinine, graft rejection was confirmed by DPTA scan and sonography of transplanted kidney. Patient survival was 100% and 4 years graft survival was 86.7%. Mean creatinine level before operation was 5.44 +/- 2.58 and post operation was 0.86 +/- 1.03 and at the last follow-up was 1.51 +/- 1.45 mg/dl, mean GFR at the last follow-up was 54.1 +/- 31.2 ml/min/1.73m2. Six [40%] patients were on dialysis before operation, 5 [33%] had acute rejection and 5 [33%] suffered from UTI after the operation. Growth retardation was seen in all of patients. Thirteen patients [86%] were affected by CMV infection and 6 [40%] by CMV disease; that were treated successfully by Ganciclovir for 2 weeks. One patient was affected by vessel thrombosis in post operation period and one patient had graft loss due to kink of vessel after operation. Renal transplantation in patients with cystinosis has favorable outcome. It is the treatment of choice for patients with cystinosis and End Stage Renal Failure [ESRF]

Risk factors and laboratory diagnostics for post renal transplant tuberculosis: a case-controlled, country-wide study on definitive cases

Tuberculosis [TB] is a common cause of morbidity and mortality in renal transplant recipients. It is usually misdiagnosed because of lack of medical awareness and its infrequency in renal transplant recipients. 44 cases [0.3%] with post-transplant TB out of 12820 patients who had renal transplants performed between 1984 to 2003 were found from the hospital records of 12 major kidney transplantation centers in Iran. These cases were compared with 184 healthy transplant subjects whose transplants were performed by the same surgical team as the controls. The mean age of cases and controls was 37.7 [13-63] and 35.6 [8-67] years [p=0.3], respectively. The mean duration of pre-transplantation hemodialysis was 30.3 [3-168] months in cases and 18.2[1-180] months in controls [p=0.03]. A past history of tuberculosis was detected in 2 cases and 1 control [p=0.3]. The mean doses of initial and maintenance immunosuppressive drugs in cases and controls were not significantly different. A total of 25 cases [56.8%] and 60[32.6%] controls had rejection prior to diagnosis of TB [p=0.004; OR=2.7, CI95%: 1. 3-5.6]. To our knowledge, this is the first study that demonstrated increasing risk of post-transplant TB by extending the duration of pre-transplant hemodialysis and the number of post-transplant rejection episodes. Further study is needed to clarify our new findings specifically in respect of different immunosuppressive regimens