Limited knowledge of chronic kidney disease and its main risk factors among Iranian community: an appeal for promoting national public health education programs

The aim of this survey was to explore the baseline knowledge of the Iranian community about Chronic Kidney Disease [CKD] definition and its two main risk factors, i.e. diabetes and hypertension. This study also introduced a model of public education program with the purpose of reducing the incidence of CKD in high-risk groups and thereby decreasing the economic burden of CKD in Iran. This cross-sectional study was conducted on world kidney day 2013 in Isfahan, Iran. Self-administered anonymous questionnaires evaluating the knowledge of CKD and its risk factors were distributed among subjects who participated in a kidney disease awareness campaign. Chi-square test and logistic regression analysis were used to examine the differences in the level of knowledge across different socio-demographic groups. The questionnaires were completed by 748 respondents. The majority of these respondents believed that "pain in the flanks" and "difficulty in urination" was the early symptoms of CKD. Roughly, 10.4% knew that CKD could be asymptomatic in the initial stages. Only 12.7% knew diabetes and 14.4% knew hypertension was a CKD risk factor. The respondents who had a CKD risk factor [i.e. diabetes and/or hypertension] were significantly more likely than respondents without CKD risk factor to select "unmanaged diabetes" [Odds Ratio [OR]= 2.2, Confidence Interval [CI] [95%]: 1.4-3.6] and "unmanaged hypertension" [OR= 1.9, CI[95%]: 1.2-3.0] as "very likely to result in CKD". No more than 34.6% of all respondents with diabetes and/or hypertension reported that their physician has ever spoken with them about their increased risk for developing CKD. The knowledge of Iranian population about CKD and its risk factors is low. Future public health education programs should put efforts in educating Iranian community about the asymptomatic nature of CKD in its initial stages and highlighting the importance of regular renal care counseling. The high-risk individuals should receive tailored education and be encouraged to adopt lifestyle modifications to prevent or slow the progression of CKD

Oxford-MEST classification in IgA nephropathy patients: a report from Iran

There is a limited knowledge about the morphological features of IgA nephropathy [IgAN]in the middle east region. The objective of this study was to evaluate the spectrum of histopathological findings in IgAN patients at our laboratory. At this work, an observational study reported which was conducted on IgAN patients using the Oxford-MEST classification system. In this survey, of 102 patients 71.6% were male. The mean age of the patients was 37.7 +/- 13.6 years. Morphologic variables of MEST classification was as follows; M1: 90.2%, E: 32%, S: 67% also, T in grads I and II were in 30% and 19% respectively, while 51% were in grade zero. A significant difference was observed in segmental glomerulosclerosis [P=0.003] and interstitial fibrosis/tubular atrophy frequency distribution [P=0.045], between males and females. Furthermore, it was found that mesangial hypercellularity was more prevalent in yonger patients. Moreover, there was a significant correlation between serum creatinine and crescents [P<0.001]. There was also significant correlation of serum creatinine with segmental glomerulosclerosis [P<0.001]. Higher prevalence of segmental glomerulosclerosis and interstitial fibrosis/tubular atrophy, as the two of, four variables of Oxford-MEST classification of IgAN in male patients further attests that male gender is a risk factor in this disease. In this study the significant correlation between serum creatinine and crescent was in an agreement with previous studies and suggests for the probable accomodation of extracapillary proliferation as a new variable in MEST system

Granulomatosis with polyangiitis [Wegener's] presenting as the right ventricular masses: a case report and review of the literature

Granulomatosis with polyangiitis [Wegener.s] is a systemic necrotizing vasculitis. Cardiac involvement in Wegener.s has rarely been reported. In this study the echocardiographic findings of granulomatosis with polyangiitis [GPA] in a patient is described. The case was a 45 years old man admitted to the hospital with a 3 months history of persistent fever and sinusitis. Mild left and right ventricular enlargements as well as three small masses in the right ventricular cavity were identified in echocardiography. One mass was attached to the tricuspid valve and the other two masses were attached to the right septum. Pulmonary artery hypertension [45mmHg] was also reported. The masses responded dramatically to plasma exchanges in combination with steroid therapy, followed by oral cyclophosphamid and low-dose steroid therapy. In the kidney biopsy, 8 out of 11 golomeruli contained fibrous crescents along with sclerotic lesions. Spleen has 140 mm diameter with multiple echo-free lesions and coarse parenchyma in abdominal ultrasound. Serum C-ANCA=671, P-ANCA=1.7 [normal=up to 15U/mL]. The diagnosis of granulomatosis with polyangiitis [Wegener's] was established. Presence of three small masses in right ventricular cavity and pulmonary artery hypertension in association with the spleen lesions were an uncommon presentation of GPA. GPA should be considered in the differential diagnosis of any nonspecific illnesses with cardiac involvement

Pyuria as a screening test for detection of urinary tract infection in patients on long-term hemodialysis

This study was conducted to evaluate the sensitivity and specificity of pyuria detection in centrifuged urine samples of patients on hemodialysis, and its relationship with urinary tract infection. Clean-catch midstream urine samples of 90 hemodialysis patients [34 women and 56 men] were obtained and divided into two parts for examination of urine sediment and urine culture. Pyuria was defined as the presence of more than 10 leukocytes per high-power field of microscope. Ninety patients with a mean age of 52.8 +/- 14.2 and a mean period of dialysis of 3.3 +/- 2.3 years were studied. Forty-five participants had pyuria and only 16 [35.5%] of them had a positive urine culture for infection. Pyuria and urinary tract infection were present in 52.9% and 29.4% of the women and 48.2% and 10.7% of the men, respectively. The sensitivity and specificity of pyuria screening for urinary tract infection was 100% and 61.8%, respectively. The positive and negative predictive values were 35.5% and 100%, respectively. In patients on hemodialysis, because of the low specificity and positive predictive values, samples with positive pyuria should be cultured to confirm urinary tract infections