Tubulointerstitial nephritis and uveitis: report of a rare syndrome

Tubulointerstitial nephritis and uveitis [TINU] is a rare syndrome with unknown pathogenesis. Data have shown a higher prevalence in female gender. We present a man with tubulointerstitial nephritis and uveitis syndrome and antitubular antibody. A 23-year-old man presented with a history of weight loss, nausea, and vomiting, and uveitis. His serum creatinine was 2.1mg/d with pyuria and proteinuria in urinalysis. Other laboratory and imaging studies were unremarkable. Kidney biopsy showed granulomatous interstitial nephritis. Normal renal tissue specimen treated with patient's serum showed focal cytoplasmic staining in cortical tubular cells. The patient received prednisolone for 1 month. Interstitial nephritis and uveitis were well controlled. There was no recurrence in 1-year follow-up. We suggest that tubulointerstitial nephritis and uveitis syndrome should be considered in differential diagnosis of patients with interstitial nephritis and uveitis. Antitubular antibody may be used as a diagnosis marker for this syndrome

Different doses of oral folic acid for homocysteine-lowering therapy in patients on hemodialysis a randomized controlled trial

We compared the effect of higher and lower doses of folic acid compared to our routine daily dose on plasma homocysteine levels, in our hemodialysis patients. Eighty patients on hemodialysis receiving oral folic acid, 10 mg/d, were randomized to receive folic acid at either doses of 5 mg/d [group 1] or 15 mg/d [group 2] for 2 months. Plasma levels of total homocysteine were measured before and after the study period. Hyperhomocysteinemia was seen in 75 patients [93.8%] before, and in 37 patients of group 1 [92.5%] and 39 of group 2 [97.5%] after the study period. In group 1, a nonsignificant decrease occurred in plasma homocysteine level [29.67 +/- 12.26 micro mol/L to 27.78 +/- 9.94 micro mol/L, P = .30], while in group 2, there was a significant decrease in homocysteine level [32.40 +/- 9.76 micro mol/L to 29.58 +/- 9.62 micro mol/L, P = .01]. Changes in homocysteine level correlated with its baseline level [r = -0.42, P < .001]. In both groups, significant reductions in homocysteine level were seen mostly in those patients with high baseline homocysteines. Routine folic acid supplementation of 10 mg/d could not normalize plasma homocysteine levels in most of our patients. Increasing folic acid dose made a statistically significant but clinically trivial decrease in homocysteine levels, and could not normalize homocysteine level in most patients. Patients with a higher baseline homocysteine level achieved a greater reduction, which may be explained by primary noncompliance of some patient. Further investigation of folic acid dosage is suggested

Value of prostate-specific antigen and prostate-specific antigen density in detection of prostate cancer in an Iranian population of men

The objective of this study was to evaluate the value of serum prostate-specific antigen [PSA] and prostate-specific antigen density [PSAD] in the diagnosis of prostate cancer. A total of 330 consecutive patients suspected of having prostate cancer due to either abnormal digital rectal examination or elevated serum PSA levels underwent transrectal ultrasonography-guided sextant biopsy of the prostate. The PSA and PSAD values were assessed based on the biopsy results. One hundred and twenty-one patients [36.7%] had prostate cancer. In this group, the mean PSA was 31.60 +/- 30.85 ng/mL [range, 1.9 ng/mL to 166.0 ng/mL] and the mean PSAD was 0.83 +/- 1.01 [range, 0.04 ng/mL/ cm[3] to 6.38 ng/mL/cm[3]]. In those without prostate cancer the mean PSA and PSAD levels were 13.80 +/- 18.72 ng/mL [range, 0.4 ng/mL to 130.0 ng/mL; P < .001] and 0.24 +/- 0.32 [range of 0.01 ng/mL/cm[3] to 2.29 ng/mL/ cm[3] P < .001]. The receiver operating characteristic curve analysis revealed that the discriminating power of serum PSA for detecting prostate cancer, as estimated by the area under the curve, was 0.74 while that for PSAD was 0.81 [P < .001]. For the PSA range of 3.5 ng/mL to 41 ng/mL [gray zone] the areas under the curve was 0.68 for PSA, while it was 0.78 for PSAD [P < .001]. The use of PSAD instead of PSA in the diagnosis of prostatic cancer improves the diagnostic accuracy