Zinc alpha 2 glycoprotein as an early biomarker of diabetic nephropathy in patients with type 2 diabetes mellitus / Zinco-alfa2-glicoproteina (ZAG) como biomarcador precoce de nefropatia diabética em pacientes com diabetes mellitus tipo 2

Abstract Introduction: Although microalbuminuria remains the gold standard for early detection of diabetic nephropathy (DN), it is not a sufficiently accurate predictor of DN risk. Thus, new biomarkers that would help to predict DN risk earlier and possibly prevent the occurrence of end-stage kidney disease are being investigated. Objective: To investigate the role of zinc-alpha-2-glycoprotein (ZAG) as an early marker of DN in type 2 diabetic (T2DM) patients. Methods: 88 persons were included and classified into 4 groups: Control group (group I), composed of normal healthy volunteers, and three patient groups with type 2 diabetes mellitus divided into: normo-albuminuria group (group II), subdivided into normal eGFR subgroup and increased eGFR subgroup > 120 mL/min/1.73m2), microalbuminuria group (group III), and macroalbuminuria group (group IV). All subjects were submitted to urine analysis, blood glucose levels, HbA1c, liver function tests, serum creatinine, uric acid, lipid profile and calculation of eGFR, urinary albumin creatinine ratio (UACR), and measurement of urinary and serum ZAG. Results: The levels of serum and urine ZAG were higher in patients with T2DM compared to control subjects and a statistically significant difference among studied groups regarding serum and urinary ZAG was found. Urine ZAG levels were positively correlated with UACR. Both ZAG levels were negatively correlated with eGFR. Urine ZAG levels in the eGFR ˃ 120 mL/min/1.73m2 subgroup were higher than that in the normal eGFR subgroup. Conclusion: These findings suggest that urine and serum ZAG might be useful as early biomarkers for detection of DN in T2DM patients, detectable earlier than microalbuminuria.

Resumo Introdução: Embora a microalbuminúria continue sendo o padrão ouro para a detecção precoce da nefropatia diabética (ND), ela não é um preditor suficientemente preciso do risco de ND. Assim, novos biomarcadores para prever mais precocemente o risco de ND e possivelmente evitar a ocorrência de doença renal terminal estão sendo investigados. Objetivo: Investigar a zinco-alfa2-glicoproteína (ZAG) como marcador precoce de ND em pacientes com debates mellitus tipo 2 (DM2). Métodos: Os 88 indivíduos incluídos foram divididos em quatro grupos: grupo controle (Grupo I), composto por voluntários saudáveis normais; e três grupos de pacientes com DM2 assim divididos: grupo normoalbuminúria (Grupo II), subdivididos em TFG normal e TFG > 120 mL/min/1,73 m2), grupo microalbuminúria (Grupo III) e grupo macroalbuminúria (Grupo IV). Todos foram submetidos a urinálise e exames para determinar glicemia, HbA1c, função hepática, creatinina sérica, ácido úrico, perfil lipídico, cálculo da TFG, relação albumina/creatinina (RAC) e dosagem urinária e sérica de ZAG. Resultados: Os níveis séricos e urinários de ZAG foram mais elevados nos pacientes com DM2 em comparação aos controles. Foi identificada diferença estatisticamente significativa entre os grupos estudados em relação aos níveis séricos e urinários de ZAG. Os níveis urinários de ZAG foram positivamente correlacionados com a RAC. Ambos os níveis de ZAG foram negativamente correlacionados com TFG. Os níveis urinários de ZAG no subgrupo com TFG ˃ 120 mL/min/1,73m2 foram maiores do que no subgrupo com TFG normal. Conclusão: Constatamos que a ZAG sérica e urinária pode ser um útil biomarcador precoce para detecção de ND em pacientes com DM2, sendo detectável mais precocemente que microalbuminúria.

Clinical trial for the control of water intake of patients undergoing hemodialysis treatment / Ensaio clínico para o controle da ingestão hídrica de pacientes em tratamento hemodialítico * / Ensayo clínico para el control de la ingestión hídrica de pacientes en tratamiento hemodialítico

ABSTRACT Objective: to analyze the impact of an educational and motivational intervention for patients with a chronic kidney disease, undergoing hemodialysis treatment, on the control of fluid intake during interdialytic periods. Method: a quasi-experimental, non-randomized clinical trial with patients from a Nephrological Unit of the State of São Paulo. Participants were included in two groups: Control Group with 106 patients and Intervention Group with 86 patients, totaling 192 participants. The used intervention was an educational and motivational video to control liquid intake, based on the Bandura's Theory. The measure of control of water intake was the percentage of lost weight, also considered the variable outcome of the research. For the data analysis, descriptive analyses and regression analysis of the Inflated Beta Model were used. Results: patients who participated in the intervention had a decrease in the pattern of weight gain in interdialytic periods, with a 3.54 times more chance of reaching the goal of 100% of weight loss when compared to participants from the control group. Conclusion: the educational and motivational intervention was effective in reducing the percentage of weight loss in patients undergoing hemodialysis. Brazilian Clinical Trials Registry (ReBEC) under the opinion RBR-4XYTP6.

RESUMO Objetivo: analisar o impacto de uma intervenção educativa e motivacional para pacientes com doença renal crônica em tratamento hemodialítico, no controle do consumo de líquidos, nos períodos interdialíticos. Método: estudo quase experimental do tipo ensaio clínico não randomizado, com pacientes de uma Unidade Nefrológica no interior do Estado de São Paulo. Os participantes foram inseridos em dois grupos: Grupo Controle com 106 pacientes e Grupo Intervenção com 86 pacientes, totalizando 192 participantes do estudo. A intervenção utilizada tratou-se de um vídeo educativo e motivacional para controle do consumo de líquidos, baseado na Teoria de Bandura. A medida de controle da ingestão hídrica foi o percentual de peso perdido, também considerado a variável desfecho da pesquisa. Para a análise dos dados foram utilizadas análises descritivas e análise de regressão do Modelo Beta Inflacionado. Resultados: os pacientes que participaram da intervenção apresentaram diminuição no padrão de ganho de peso nos períodos interdialíticos, com 3,54 vezes mais chance de atingir a meta de 100% de perda de peso, comparados aos participantes do grupo controle. Conclusão: a intervenção educativa e motivacional mostrou-se efetiva na diminuição do porcentual de perda de peso dos pacientes em hemodiálise. Registro Brasileiro de Ensaios Clínicos (ReBEC), sob o parecer RBR-4XYTP6.

RESUMEN Objetivo: analizar el impacto de una intervención educativa y motivacional para pacientes con enfermedad renal crónica en tratamiento hemodialítico, en el control del consumo de líquidos, en los periodos interdialíticos. Método: estudio casi experimental del tipo ensayo clínico no aleatorio, con pacientes de una Unidad Nefrológica en el interior del Estado de São Paulo. Los participantes fueron inseridos en dos grupos: Grupo Control con 106 pacientes y Grupo Intervención con 86 pacientes, totalizando 192 participantes del estudio. La intervención utilizada se trató de un video educativo y motivacional para el control del consumo de líquidos, basado en la Teoría de Bandura. La medida de control de la ingestión hídrica fue el porcentaje de peso perdido, también considerado la variable de resultado de la investigación. Para el análisis de los datos fueron utilizados análisis descriptivos y análisis de regresión del Modelo Beta aumentado. Resultados: los pacientes que participaron de la intervención presentaron disminución en el patrón de ganancia de peso en los periodos interdialíticos, con 3,54 veces más chances de alcanzar la meta de 100% de pérdida de peso, comparados a los participantes del grupo de control. Conclusión: la intervención educativa y motivacional se mostró efectiva en la disminución del porcentaje de pérdida de peso de los pacientes en hemodiálisis. Registro Brasileño de Ensayos Clínicos (ReBEC), bajo el dictamen RBR-4XYTP6.

[Herbs from Iranian traditional medicine for reinforcement of kidney and prevention of renal atrophy]

Background: Renal disorders including renal failure are common complications which affect the whole body system. The treatment methods in modern medicine seem to be inadequate in a large number of cases. Regarding the increasing interest of the community towards traditional and complementary medicine, the potential of Persian medicine [PM] in management of renal diseases, could be put to test in research programs in order to find possible effective treatment. Objective: The aim of this study is to introduce materia medica which are commonly used in PM for the purpose of protection and functional empowerment of the kidneys against destructive factors

Methods: This research is a literature-based study on effective material medica used in the treatment of two significant renal disorders; renal weakness and renal atrophy [Hozal]. Six pharmaceutical references of Persian medicine from different historical periods were searched by certain keywords related to renal weakness and renal atrophy

Results: Fourteen materia medica related to the prevention or treatment of renal weakness and fifteen for renal atrophy were found. Poppy [Papaver somniferum]. Amber and shellac are the most repeated medicines in the treatment of renal weakness; whereas fig [ficus carica], banana [musa sapientum] and hazelnut [corynus avelana] are mostly_repeated for either prevention or treatment of renal atrophy

Conclusion: Medicinal plants represented by Persian medicine references could be a basis for experimental and clinical researches for drug development in the field of prevention or even treatment of acute or chronic renal failure

Um caso de recuperação da função renal na síndrome hemolítico-urêmica tratada com eculizumab / A case of renal recovery in atypical hemolytic uremic syndrome treated with eculizumab

Resumo A síndrome hemolítico-urêmica atípica (SHUa) é uma doença grave, pouco prevalente, com acometimento em qualquer idade e apresentação esporádica ou familiar. A SHUa é causada por uma ativação descontrolada do sistema complemento. A plasmaférese foi o tratamento padronizado por anos, com resultados desfavoráveis, levando à doença renal crônica terminal ou morte em aproximadamente 40% dos pacientes durante as primeiras manifestações clínicas. O Eculizumab é um anticorpo monoclonal humanizado contra o componente C5 do complemento e nos últimos anos vem sendo utilizado como novo arsenal terapêutico com resultados promissores. O presente caso descreve uma paciente adulta tratada com eculizumab em que se obteve resultados satisfatórios evitando-se potenciais riscos e aumento da morbidade com o procedimento de plasmaférese.

ABSTRACT Atypical Hemolytic Uremic Syndrome (aHUS) is a rare, life-threatening disease that can occur at any age and be sporadic or familial. aHUS is caused by an uncontrolled activation of the complement system. Plasma Exchange (PE) has been the standard treatment for years with poor results, leading approximately 40% of patients to end-stage renal disease (ESRD) or death during the first clinical manifestation. Eculizumab, an humanized monoclonal antibody directed against complement component C5, has emerged in the last few years as a new therapheutic aproach with promising results. Our goal is to present a case of an adult patient where eculizumab was sucessfully used as upfront therapy avoiding the potential significant morbidity of PE.

Síndrome nefrótico idiopático: recomendaciones de la Rama de Nefrología de la Sociedad Chilena de Pediatría. Parte 2 / Idiopathic Nephrotic Syndrome: recommendations of the Nephrology Branch of the Chilean Society of Pediatrics. Part two

El síndrome nefrótico idiopático es la glomerulopatía más frecuente en la infancia, afecta a 1-3/100 mil niños menores de 16 años y se presenta con más frecuencia entre los 2 y 10 años. Su causa es desconocida, y la mayoría de las veces responde a corticoides, con buen pronóstico a largo plazo. El síndrome nefrótico corticorresistente representa un 10-20% de los síndromes nefróticos idiopáticos en pediatría. Tiene mal pronóstico, y su manejo constituye un desafío terapéutico significativo. La mitad de los pacientes evoluciona a insuficiencia renal crónica terminal en un plazo de 5 años, estando expuestos además a las complicaciones secundarias a un síndrome nefrótico persistente y a efectos adversos de la terapia inmunosupresora. El objetivo fundamental del tratamiento es conseguir una remisión completa, pero una remisión parcial se asocia a una mejor sobrevida renal que la falta de respuesta. Este documento surgió de un esfuerzo colaborativo de la Rama de Nefrología de la Sociedad Chilena de Pediatría con el objetivo de ayudar a los pediatras y nefrólogos infantiles en el tratamiento del síndrome nefrótico idiopático en pediatría. En esta segunda parte, se discute el manejo del síndrome nefrótico corticorresistente, así como de las terapias no específicas.

Idiopathic nephrotic syndrome is the most common glomerular disease in childhood, affecting 1 to 3 per 100,000 children under the age of 16. It most commonly occurs in ages between 2 and 10. Its cause is unknown, and its histology corresponds to minimal change disease in 90% of cases, or focal segmental glomerulosclerosis. Steroid-resistant nephrotic syndrome represents 10-20% of idiopathic nephrotic syndrome in pediatrics. It has a poor prognosis, and its management is a significant therapeutic challenge. Half of patients evolve to end-stage renal disease within 5 years, and are additionally exposed to complications secondary to persistent NS and to the adverse effects of immunosuppressive therapy. The primary goal of treatment is to achieve complete remission, but even a partial remission is associated with a better renal survival than the lack of response. This paper is the result of the collaborative effort of the Nephrology Branch of the Chilean Society of Pediatrics with aims at helping pediatricians and pediatric nephrologists to treat pediatric idiopathic nephrotic syndrome. In this second part, handling of steroid-resistant nephrotic syndrome as well as nonspecific therapies are discussed.

Características clínicas de los pacientes diabéticos que acuden por primera vez a una consulta nefrológica en hospitales públicos de Lima / Clinical characteristics of diabetic patients attending for the first time a nephrologic consultation in Lima public hospitals

Introducción: La diabetes mellitus es la principal causa de enfermedad renal crónica y se recomienda una referencia temprana al nefrólogo, ya que se ha reportado peores resultados en pacientes con referencia tardía. Objetivos: Determinar las características de los pacientes diabéticos en su primera consulta nefrológica. Diseño: Estudio multicéntrico, observacional y analítico. Lugar: Hospital Nacional 2 de Mayo, Hospital Nacional Arzobispo Loayza, Hospital Daniel Alcides Carrión y Hospital María Auxiliadora. Participantes: Pacientes diabéticos. Intervenciones: Se estudió a los pacientes en su primera consulta nefrológica entre septiembre 2011 y febrero 2012. Para la descripción se utilizó porcentajes, frecuencias y desviaciones estándar. Principales medidas de resultados: Características clínicas de los pacientes diabéticos. Resultados: Se estudió 200 pacientes diabéticos, con tiempo de diagnóstico promedio de 12,9 años. El 73 por ciento recibió educación para autocuidados. El 40 por ciento refería que no tomaba sus medicamentos y 57 por ciento no seguía su dieta regularmente. El 70 por ciento era hipertenso con tiempo de diagnóstico promedio de 4,2 años; 36,5 por ciento era obeso, 52,8 por ciento sufría de dislipidemia, 10,5 por ciento tenía antecedente de enfermedad cardiovascular. El 81,5 por ciento refería no haber tenido una evaluación previa de la función renal. El 39,5 por ciento tenía hemoglobina glicosilada (HbA1c) >7 por ciento, 48,5 por ciento colesterol >200 mg/dL, 54,5 por ciento cLDL>100 mg/dL y 46,5 por ciento triglicéridos >150 mg/dL; 57 por ciento un tiempo de filtración glomerular<60 mL/min y 37 por ciento presentó albuminuria de 300 mg/d o más. Conclusiones: Casi la mitad de los pacientes no seguía las recomendaciones de autocuidados. Debido a los factores de riesgo cardiovascular involucrados en este grupo, se debería reforzar su educación.

Introduction: Diabetes mellitus is the leading cause of chronic renal disease; early referral to the nephrologist is recommended as the outcome is worse in patients with late referral. Objectives: To determine clinical characteristics of diabetic patients upon their first nephrologic consultation. Design: Multicenter, observational and analytical study. Setting: Hospital Nacional 2 de Mayo, Hospital Nacional Arzobispo Loayza, Hospital Daniel Alcides Carrion and Hospital Maria Auxiliadora. Participants: Diabetic patients. Interventions: Diabetic patients were studied between September 2011 and February 2012. Percentages were used to describe frequencies and standard deviations. Main outcome measures: Clinical characteristics of diabetes patients. Results: From 200 diabetic patients with 12.9 years mean time to diagnosis 73 per cent had received education for self-care, 40 per cent reported not taking their medications and 57 per cent did not follow a regular diet; 70 per cent were hypertensive with 4.2 years average from time of diagnosis, 36.5 per cent were obese, 52.8 per cent had dyslipidemia; 10.5 per cent had a history of cardiovascular disease, and 81.5 per cent reported no prior assessment of renal function; 39.5 per cent had glycated hemoglobin (HbA1c) >7 per cent, 48.5 per cent cholesterol >200 mg/dL, 54.5 per cent LDLc >100 mg/dL, and 46.5 per cent triglycerides >150 mg/dL. Fifty seven per cent had a glomerular filtration rate <60 mL/min, and 37 per cent albuminuria 300 mg/d or more. Conclusions: Almost half of all patients did not follow self-care recommendations. Due to substantial cardiovascular risk factors involved, education of this group should be strengthened.

Detección de factores de riesgo e indicadores tempranos de enfermedad renal crónica en población adulta en una campaña de salud renal / Detection of risk factors and early indicators of chronic kidney disease in an adult population during a kidney health campaign

Introducción: La Enfermedad Renal Crónica (ERC) en el adulto es una afección frecuente y constituye un importante problema de Salud Pública a nivel mundial. Se la ha relacionado con un riesgo elevado de insuficiencia renal crónica terminal, enfermedad cardiovascular y muerte. Dada la creciente incidencia de ERC y la disponibilidad de medidas terapéuticas efectivas, es de vital importancia realizar la detección precoz de factores de riesgo (FR), con el fin de retrasar o prevenir su progresión. Con el objetivo de detectar precozmente indicadores de ERC y FR asociados, realizamos una campaña de salud renal en una población adulta. Metodos: Participaron 608 personas >18 años, evaluándose PA, IMC, glucemia, creatinina y en orina matinal se calculó el cociente albuminuria/creatininuria. La ERC se estadificó según albuminuria y/o filtrado glomerular estimado (IFG) por MDRD4, CKD-EPI y C.G. Resultados: La media de edad,fue 54.8±15.4 años, con predominio de mujeres (72%). El 61.5% presentaban uno o más FR: edad >55 años 52.8 %, HTA 39.3%, obesidad 36.8%, alteraciones del metabolismo hidrocarbonado (AMHC) 21.2%, diabetes: 14.1% (DBT), tabaquismo 12.3% y albuminuria 11%. Detectamos ERC en el 14%, 40% varones, con albuminuria 78.8% e IFG<60 ml/m 37.6%. El 95.2% asociaba FR. Las siguientes variables estuvieron asociadas a ERC (p<0.05): sexo masculino, edad > 55, HTA, DBT, obesidad, tabaquismo y nivel de educación. En el análisis multivariado mantuvieron significación: edad >55, obesidad, HTA, DBT y nivel de educación. El 21.8% de los hipertensos, el 37.3% con AMHC y el 100% con albuminuria lo desconocían. Conclusión: En esta población ser varón, tener >55 años, HTA, obesidad y/o DBT incrementa el riesgo de desarrollar ERC. Identificamos un alto porcentaje (61.5%) de individuos con FR y ERC. La detección precoz de FR y su tratamiento reducirían significativamente la incidencia y progresión de la ERC. Encontramos una frecuencia de ERC y albuminuria similar a otros reportes, lo cual contribuye al conocimiento de esta enfermedad y su prevalencia en Argentina

Introduction: Chronic kidney disease (CKD) in adults is a common condition and a major public health issue worldwide. There has been related to a high risk of End Stage Renal Disease (ESRD), cardiovascular disease and death. Given the increasing incidence of CKD and the availability of effective therapeutic measures, is of vital importance perform early detection of risk factors (RF), in order to delay or prevent progression to ESRD. The optimal cost-effective strategy seems to be an investigation aimed at patients with one or more risk factors for CKD. In order to detect early indicators of CKD and associated risk factors, we conducted a study in an adult population. Methods: In a cross-sectional study was evaluated BP, BMI, blood glucose, serum creatinine and albumin/creatinine ratio in urine sample in 608 people> 18 years. Participants were classified for stages of CKD according to the presence of albuminuria and / or estimated glomerular filtration rate (MDRD4, CKD-EPI and CG). For statistical analysis (Stata 11.0) we used Fisher’s exact test, Ttest and Cox regression to explore the association between variables. Effect measure RR and 95% CI, was considered significant when P <0.05. Results: Mean age 54.8 ± 15.4 years, 72% were females. 61.5% had one or more CKD RF.Presence of CKD RF : age> 55 years 52.8%, hypertension 39.3% obesity 36.8%, carbohydrate metabolism disorders (CHMD)21.2%, diabetes: 14.1% (DBT), smoking 12.31%, albuminuria 11%. CKD was found in 14% of participants, 40% were male, albuminuria in 78.8% and GFR <60 ml/m in 37.6%. The 95.2% of participants with CKD had RF. The following variables were associated with ERC (p <0.05): male gender, age> 55, hypertension, diabetes, obesity, smoking and educational level. In multivariate analysis remained significant: age> 55, obesity, hypertension, diabetes and educational level. The 21.8% of hypertensive patients, 37.3% of those with CHMD and 100% with albuminuria did not know that condition. Conclusion: In this population to be a male, to have> 55 years, hypertension, obesity and diabetes it increases the risk of developing CKD. We identified a high percentage (61.5%) of individuals with RF and ERC. The implementation of campaigns for early detection of RF and treatment would reduce the incidence and progression of CKD. We found a frequency of CKD and albuminuria similar to others international reports contributing to the understanding of this disease and its prevalence in Argentina.

Enfermedad renal en la diabetes: a propósito del día mundial del riñón: [editorial] / Diabetic renal disease: the World Kidney Day in Chile: [editorial]

The third version of the World Kidney Day will be held on May 13, 2010 in Chile and will be focused in diabetic renal damage, the main cause of chronic kidney disease (CKD). Currently, we are living a pandemia of CKD, a progressive and irreversible condition with high social and economic impact. In Chile, we have 857 patients per million inhabitants in hemodialysis and 35 percent are secondary to diabetes. Our general prevalence of diabetes is 4.2 percent, rising to 15 percent in people aged more than 64 years. With a 34 percent prevalence of hypertension, an aging population, high prevalence of obesity, and a sedentary lifestyle, there is an estimation of a rise in 85 percent of the prevalence of diabetes in South-America, for the next decades. The steps to be taken are clear: campaigns should be aimed at (1) prevention of type 2 diabetes; (2) screening for early diabetic kidney disease; (3) increasing patient awareness of kidney disease; (4) using medications of proven strategy and fnally (5) research on new therapies. These concepts must be included in community and professional education to reduce the effects of this pandemia.

Síndrome nefrótico familiar: presentación de 12 casos y revisión de la literatura / Familial nephrotic syndrome: case reports and literature review

Estudio descriptivo de una serie de casos de 12 pacientes no consanguíneos: 6 pares de hermanos de entre 2 y 16 años. Cinco de estos pares de hermanos carecían de antecedentes familiares de nefropatías; y un par presentaba antecedente materno de insuficiencia renal crónica terminal secundaria a síndrome nefrótico corticorresistente.

Cálculo del impacto económico para Chile del uso de losartán en diabéticos tipo 2 con nefropatía diabética, basado en resultados del estudio RENAAL / Economic impact of Losartan use in type 2 diabetic patients with nephropathy

Background: The study RENAAL (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan) demonstrated that Losartan was more effective lo reduce the progression of kidney disease in diabetic patients with proteinuria and a reduction in glomerular filtration rate. Aim: To perform a cost benefit analysis of Losartan use from provider and payer points of view. Material and methods: Published data of the RENAAL study was analyzed. The costs of the use or not use of Losartan in patients with diabetic nephropathy were compared in terms of total costs of the disease including medications, hospital admissions for myocardial infarction, cerebrovascular accidents and congestive cardiac failure and the costs of chronic hemodialysis. Results: The reduction in antihypertensive medication use, hospital admissions, and the delay in dialysis requirement from a mean of 65 to 79 months induced by Losartan use, results in net savings of $7,576,135 per patient, at 3.5 years of intervention. The figure does not change using different sensitivity scenarios. Conclusions: The eventual use of Losartan in type 2 diabetic patients results in important savings.

Changing epidemiology of end-stage renal disease in last 10 years in Iran

The rapid increase in the prevalence of end-stage renal disease [ESRD] necessitates putting into practice some strategies to prevent its development and progression, especially in the developing world. Detailed chronological changes in the incidence of ESRD may sharpen the focus on its prevention. We, therefore, determined the detailed epidemiological features of ESRD in Iran. Data of the national registry of Iran's ESRD provided by the Ministry of Health were used to retrieve the ESRD figures between 1997 and 2006. A total of 35 859 patients who initiated renal replacement therapy [20 633 men and 15 226 women] were registered during the study period from 1997 to 2006. The annual number of patients with ESRD beginning maintenance treatment in Iran increased 130% between 2000 and 2006. During 1997 to 2006, the proportion of new cases of ESRD attributed to diabetes mellitus increased 2-fold from 16% in 1997 to 31% in 2006. The mean age of newly registered men and women increased from 47.0 years and 49.0 years to 52.5 years and 53.0 years, respectively. As for all and major causes of ESRD, age-adjusted incidence rates for men generally were higher than those for women. Male-female ratio was 1.3:1, with no significant changes during this period. We strongly recommend considering chronic kidney disease prevention with initial focusing on strategies and treatment modalities that slow ESRD progression in order to postpone the need for renal replacement therapy

Reduction of kidney damage by supplementation of vitamins C and E in rats with deoxycorticosterone-salt-induced hypertension

We assessed whether cosupplementation of vitamins C and E has additive beneficial effects on reducing the kidney damage and attenuation of the arterial pressure elevation compared to administration of either vitamin C or vitamin E alone in deoxycorticosterone acetate-salt-induced hypertension. Forty rats were divided into 4 study groups and 1 sham-operated group. Unilateral nephrectomy was carried out in the study groups and hypertension was induced by deoxycorticosterone injection and 1% sodium chloride and 0.2% potassium chloride added to the drinking water. Vitamins C and E [200 mg/kg/day] or combination of them were administered with DOCA-salt for 4 weeks in 3 study groups. The effects of DOCA and salt and treatment with vitamins were compared in terms of blood pressure, urinary protein excretion, antioxidant activity of the kidneys, and renal histological changes. Four weeks of supplementations of vitamins C, vitamin E, and both in the DOCA-salt-treated rats had comparable significant effects in decreasing systolic blood pressure. Urinary protein excretion and histological damage did not significantly change with the combination therapy of vitamins C and E compared to the vitamin C or E alone. The renal levels of glutathione and ferric reducing/antioxidant power in combination therapy group were similar to the two other treatment groups and were significantly higher than non-treated group. Co-administration of vitamin C and E does not have an additive beneficial effect on reducing the kidney damage and hypertension compared to either vitamin C or E alone in DOCA-salt-induced hypertension

Frequency of microalbuminuria in type 1 diabetic children

Diabetic nephropathy is a serious complication of type 1 diabetes which involves one third of the patients. The aim of this study was to estimate the frequency of microalbuminuria in type 1 diabetic patients visited in Pediatric Endocrine Clinic in Hamedan, west province of Iran, in 2007. Diabetic patients visited in Pediatric Diabetes Clinic were enrolled in the study. Variable data such as age, sex, duration of the disease, stage of puberty, dose of insulin/kg/day, and blood pressure of the patients were obtained according to history and physical examination. 24h urine samples were collected for protein, creatinine, and microalbumin. Data analysis was assessed using independent t-test and chi-square test. One-hundred five patients [56 females and 49 males] with a mean age of 13.3 +/- 5.5 years, were evaluated. Fifteen [14.3%] cases had microalbuminuria. Mean age in microalbuminuric group was 16.2 +/- 2.8, in non-microalbuminuric group 12.7 +/- 5.6 years [P=0.024]. Mean duration of diabetes was 9.1 +/- 3.2 yr in microalbuminuric and 4.5 +/- 3.9 in non-microalbuminuric group. There was a significant correlation between duration of diabetes and microalbuminuria [P<0.001]. Blood pressure was normal in 95.5% of the patients while in patients with microalbuminuria 73.3% had hypertension [P<0.001]. Frequency of microalbuminuria was higher in patients taking lower doses of insulin corrected to their body weight [P=0.008]. Frequency of microalbuminuria was significant, so regular screening is highly recommended for early detection and timely treatment of diabetic nephropathy in order to prevent progression to end stage renal disease