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

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

[Comparison of quality of life between hemodialysis and peritoneal dialysis patients in Imam Reza and Ghaem hospital dialysis centers in Mashhad]

Relative differences in QOL between hemodialysis [HD] and peritoneal dialysis [PD] are not clearly known. The objective of this study was to compare QOL between HD and PD patients in Emam Reza and Ghaem hospital dialysis centers. We compared 40 patients [17male and23 female] on PD with 40 matched patients [20 male and 20 female] on HD. Health related 36 item short form questionnaire [SF-36] were used to assess the quality of life. For the SF-36, eight domain scores [physical functioning [PF], role limitations as a result of physical problems [RP], body pain [BP], general health perceptions [GH], social functioning [SF], role limitations as a result of emotional problems [RE], vitality [VT], mental health [MH]] were calculated. We also calculated summary Physical Component [PCS], Mental Component [MCS] and total scores of QOL. This study included 80 patients treated with HD and PD. The worst score was for RP dimension in both groups, and the best score was for RE in PD patients and BP in HD patients. SF-36 domains of GH, RP, VT and PCS were all significantly higher in the PD patients as compared to the HD patients. The only domain for which significant differences favoured HD patients was BP. [P < 0.05]. This study provided evidence that patients in PD treatment modality were experiencing better quality of life in SF-36 domains of GH, RP, VT, PCS in comparison to HD patients

Elevated serum C-reactive protein level and microalbuminuria in patients with type 2 diabetes mellitus

Microalbuminuria is a marker of vascular endothelial damage. In addition, it is reported that high serum levels of C-reactive protein [CRP] is a novel cardiovascular risk factor that impairs endothelial function. The aim of this study was to evaluate the relationship between microalbuminuria and elevated serum level of high-sensitivity CRP [HS-CRP] in type 2 diabetic patients. We measured serum levels of HS-CRP in 87 patients with type 2 diabetes mellitus. They were divided into a microalbuminuric group [n = 45] and those with a 24-hour urine albumin less than 30 mg/d [n = 42]. The relationship of serum HS-CRP level with albuminuria and other characteristics of the patients was assessed. Patients with microalbuminuria were significantly older and affected by diabetes mellitus longer than those without microalbuminuria. Also, their mean HS-CRP was significantly higher [4.98 +/- 1.45 mg/L versus 2.82 +/- 2.10 mg/L; P < .001]. The Pearson correlation test showed a significant correlation between HS-CRP level and urine albumin level [r = 0.43; P < .001]. The specificity and sensitivity of HS-CRP for detection of microalbuminuria in were 78.5% and 68.8%, respectively, and the positive and negative predictive values were 77.5% and 70.2%, respectively. In type 2 diabetic patients, microalbuminuria is accompanied by elevated HS-CRP, suggesting activation of inflammatory pathways in progression of renal and cardiovascular atherosclerotic disease. As an easier and cheaper test for assessment of diabetic nephropathy, we recommend further studies on HS-CRP in diabetic patients

Influence of dialysis duration, peritoneal transport parameters, and gender on effluent CA 125 concentration in patients on peritoneal dialysis

Peritoneal effluent cancer antigen 125 [CA125] concentration is a marker of mesothelial cell mass in patients on continuous ambulatory peritoneal dialysis [CAPD]. Accordingly, we aimed to observe the effects of CAPD duration, sex, and peritoneal membrane efficacy on CA125 levels in peritoneal effluent. In 30 patients who were on CAPD for 6 months, concentrations of CA125 were determined in the 4-hour effluent peritoneal dialysate at the 6th and 12th month of CAPD initiation. The laboratory results were assessed in relation to the patients' sex and peritoneal membrane efficacy which was measured by the peritoneal equilibration test, weekly creatinine clearance, and the Kt/V. The patients were 16 men and 14 women with a mean age of 34.3 years [range, 17 to 56 years]. With increasing the duration of CAPD, dialysate CA125 levels decreased significantly [P < .001]. Whereas, there were no significant changes in Kt/V and creatinine clearance at 12 months. In the men, the CA125 levels were significantly lower 6 months after the start of CAPD compared to the women [P = .047]. I n low transporter and low average transporter patients, peritoneal effluent had slightly higher levels of CA125 in comparison with those in high transporter and high average transporter patients [P = .08]. We found that peritoneal effluent CA125 level decreases in both men and women with increasing of CAPD duration, without any association with peritoneal transport parameters. Of interest, there was a gender difference in the CA125 levels in our series

Survery of cutaneous complications after renal transplantation in Emam Reza [PH] and Qaem Hospitals, Mashhad

Renal transplantation is an appropriate treatment for end stage renal disease and helps prolongation of patients survival with better quality, but immunosuppressive drugs that are used for inhibition of rejection after transplantation may cause some adverse effects in other organs such as the skin. Apparently, early recognition of those side effects and their appropriate management can reduce morbidity and mortality. This study was designed to study cutaneous complications in renal transplantation recipients. In this descriptive study cutaneous side effects in one hundred kidney transplant patients who were admitted to transplantation clinics of Qaem and Emam Reza hospital of Mashhad during a six-month period [April to September 2003] were studied. Sixty-five patients were males and 35 cases were females. The mean age was 36 years [SD=14]. Totally, cutaneous manifestations were observed in 88% of patients. In a descending order they included hypertrichosis, cushinoid appearance, gingival hyperplasia, steroid acne, common warts, herpes simplex infection, superficial fungal infection, candidiasis, actinic keratosis, porokeratosis, lymphoma, stria, telangiectasia and sebaceous hyperplasia. Early recognition of these complications and appropriate treatment of them can reduce probable mortality and morbidity