[Prevalence of low mineral bone density in renal transplant recipients one year or more after transplantation]

Reduction in mineral bone density is a common complication following kidney transplantation and its adverse outcome could be minimized with well recognition and treatment. In this study we evaluated the prevalence of mineral bone density decrease in kidney recipients at least one year after the transplantation. Kidney recipients from whom transplant surgery at least a year had assed and had a good kidney function were selected. Mineral bone densitometry using X- ray energy absorptiometry was performed. The serum levels of Ca, P, Alkaline Phosphatase and Paratormone were measured and the collected data were statistically analyzed. Overall 182 patients were studied. The total rate of mineral bone density decrease was 87.4%. Osteopenia in the femoral bone was 73.6% and osteoporosis was 13.8%. In the lumbar vertebrae an osteopenia of 66.5% and an osteoporosis of 20.9% were noticed. Variance of analysis showed that there were no statistically significant differences between duration of dialysis before kidney transplantation [P=0.777, P=0.420], duration of kidney transplantation [P=0.927, 0.271], the mean of serum PTH [P=0.908, P=0.146] and calcium [P=0.348, P=0.265] in respect to densitometry of femoral bone and lumbar vertebrae. The frequency of mineral bone density reduction one year after kidney transplant in patients with a good transplanted kidney function was high

Hyperuricemia and albuminuria in patients with type 2 diabetes mellitus

Hyperuricemia is an independent risk factor for kidney dysfunction in diabetic patients. On the other hand, albuminuria is considered as the proxy of early stages of diabetic nephropathy. We investigated the correlation between hyperuricemia and albuminuria in patients with diabetes mellitus. In a cross-sectional study of 1275 patients [555 men and 720 women] with type 2 diabetes mellitus, serum uric acid and urinary albumin-creatinine ratio were determined. Other metabolic parameters including lipid profile, hemoglobin A1c, glomerular filtration rate, body mass index, blood pressure, blood glucose were assessed, as well. The mean age of the patients was 52.45 +/- 10.11 years old. Serum uric acid levels for normoalbuminuric, microalbuminuric, and macroalbuminuric patients were 4.49 +/- 1.22 mg/dL, 4.84 +/- 1.52 mg/dL, and 6.15 +/- 1.68 mg/dL, respectively. Among patients with clinical metabolic syndrome, 233 [27.5%] were in the forth upper quartile of uric acid level [> 5.3 mg/dL], but in diabetic patients without this syndrome, only 80 [18.7%] were in this group. There was a significant relationship between hyperuricemia and serum triglyceride, fasting blood glucose, hemoglobin A1c, glomerular filtration rate, and serum creatinine levels [P < .001]. No significant correlation was found between hyperuricemia and cholesterol levels, age, duration of diabetes mellitus, and body mass index. Serum uric acid level correlated positively with urinary albumin-creatinine ratio [P = .04]. We showed that higher serum uric acid concentrations were associated with a greater probability of albuminuria in patients with type 2 diabetes mellitus

[Changes in body fluid composition before and early after renal transplantation and comparing it with normal persons]

In this study we evaluated the body composition before and two weeks after kidney transplantation and compared it with the healthy people by BIA. A total of 23 progressive renal failure patients who attended the transplantation were recruited for this study. The control group included 27 graft donors .Patients were checked one day before hemodialysis and a day before transplantation, by BIA. After transplantation, body composition was assessed between days 1-7 and on the 14[th] day of post transplantation. The control group included 27 graft donors. The comparison of body composition between two groups [donors and recipients] showed significant changes before hemodialysis and after transplantation, and TBW% decreased from the 7[th] day post transplantation. The Main cause of low level of TBW% was the decrease in ECW% and ECW/ICW from the beginning of 2[nd] week after transplantation. Just TBW% in normal males was different from that it normal females but in recipients there was no difference between males and females. The body composition takes a long time to reach to the normal level and two weeks after transplantation some agents are probably responsible for intense changes of body composition including drugs and mild prerenal azotemia specially on the 2[nd] week after transplantation

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

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

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