[ effects of dietary supplementation with alpha-lipoic acid and vitamin E, individually and combined, on insulin resistance and lipid profile in hemodialysis patients]

Due to their antioxidant properties, vitamin E [VitE] and alpha-lipoic acid[ALA] may have a protective role against cardiovascular disease [CVD] risk factors, e.g., insulin resistance [IR] and dislipidemia, in hemodialysis patients.The main objective of this study was to determine the effects of dietary supplementation with alpha-lipoic acid and vitamin E, individually and combined, on insulin resistance and lipid profile in hemodialysis patients. This study was a randomized clinical placebo-controlled trial, including 85 patients [45 men and 40 women] from Shiraz hemodialysis centres.We examined the effects of a 2-month daily supplementation with VitE [400IU] and ALA [600mg], individually and combined, on fasting blood sugar [FBS], insulin, the HOMA index, and lipid profile [serum total, VLDL-, LDL- and HDL cholesterol, and triglycerides]. A placebo group was also included in the study.At the beginning and at the end of the intervention weights and heights of the patients were measured, body mass index [BMI] was calculated, dietary intake assessed, and blood samples were taken for analysis. Significant reductions were observed in mean FBS [4.2], insulin [10.4] and the HOMA index [1.5] in theALA+VitE-supplemented group compared to the placebo group [P-values=0.02, 0.006, and 0.002, respectively]; changes in these parameters were not statistically significant in the groups supplemented with either one alone. Also, supplementation with VitE or ALA, either alone or combined, had no statstically significant effects on the lipid profile. Combined supplementation with vitamin E and alpha-lipoic acid ALA canimprove insulin resistance in hemodialysis

Endothelial nitric oxide synthase gene t-786c polymorphism in renal transplant recipients

Nitric oxide [NO] is a major mediator in vascular biology, regulating regional blood flow. NO and the enzymes required for its production contribute to ischemia-reperfusion injury. The T-786C functional polymorphism in the promoter region substantially reduces promoter activity of the endothelial nitric oxide synthase [eNOS] gene and compromises endothelial NO synthesis. To examine the association between T-786C [rs 2070744] single nucleotide polymorphism [SNP] in eNOS gene and the development of acute rejection in renal transplant patients. 60 renal transplant recipients [30 with episodes of acute rejection [ARs] and 30 without rejection [non-ARs]], between June 2008 and March 2010, were included in this study. The polymorphism was determined by PCR-restriction fragment-length polymorphism analysis. The distribution of the genotypes were TT/TC/CC 60%, 33.4%, 6.6%, and 43%, 46.7%, 13.3% in ARs and non-ARs, respectively [p=0.28]. The frequency of T-allele was 76.7% and 66.3%; and for C-allele was 66.6% and 33.3% in ARs and non-ARs, respectively [p=0.09]. There were no significant associations between these polymorphisms and acute and chronic kidney allograft rejection. We could not detect any significant association between polymorphism in T-786C of eNOS gene and the development of acute rejection

Half-saline versus combined normal saline and 1/3-2/3 intravenous fluid therapy in kidney transplantation

Sufficient intravascular volume should be established for optimal graft function after renal transplantation. However, there is no recommendation for the type of fluid therapy post-operatively. We compared half-saline vs. normal saline and 1/3-2/3 intravenous fluid replacement after renal transplantation. We enrolled all patients who underwent kidney transplantation between June 2008 and March 2010 in Golestan Hospital, Ahwaz, southwestern Iran. Patients were randomly divided into two groups using a blinded allocation technique. Group A patients [Case] received half saline, and group B patients [Control] received normal saline and 1/3-2/3 intravenous fluid. According to our protocol, we replaced as much as 100% of hourly urine output in the first day, followed by 90% and 70% of every 2-hour urine output in the 2nd and 3rd days, respectively. Blood pressure and pulse rate were recorded hourly. Serum sodium, potassium, creatinine and pH were assessed twice a day. There were 34 and 36 eligible patients in the case and control groups, respectively. The mean +/- SD 6-hour urine output in the first 5 days after surgery was 2586 +/- 725 mL in the control group and 2764 +/- 758 mL in the case group [p=0.31]. The mean +/- SD serum creatinine level at the end of the 5th post-operative day was 1.3 +/- 0.5 and 1.4 +/- 0.7 mg/dL in the case and control groups, respectively [p=0.56]. Serum creatinine level did not reduce to 1.5 mg/dL or lower in 6 of 36 control subjects and in 4 of 34 cases at the end of the 5th day [p=0.558]. The mean +/- SD time to creatinine level<1.5 mg/dL was 1.3 +/- 1 days in the control group and 1.7 +/- 0.8 days in the case group [p=0.635]. Hyperkalemia occurred in 3 of 36 patients in the control group and in 2 of 34 patients in the case group [p=0.318]. The incidence of hyponatremia in the control group was 11% [4 of 36 patients] vs no patients in the case group [p=0.115]. Either half-saline or normal saline and 1/3-2/3 intravenous solution can be safely used as fluid replacement therapy after kidney transplantation

effect of simvastatin on lowering panel reactive antibody titer in sensitized dialysis patients: a randomized placebo controlled clinical trial

Patients with panel reactive antibodies [PRA] have many difficulties to find a crossmatch-nega- tive kidney for transplantation and are at a higher risk of post-transplantation rejection. To evaluate the effect of simvastatin on PRA and post-transplant outcome of these sensitized pa- tients. 82 patients with end-stage renal disease [ESRD] with a PRA >/= 25% were evaluated. In a one-year follow-up, the patients were treated with simvastatin. These patients were compared with 82 matched con- trols receiving placebo tablets. At the end of the second and 12th month, PRA was rechecked in all patients. Those patients who underwent transplantation continued to take simvastatin six months after transplanta- tion. Serum creatinine levels were checked at monthly intervals post-operation. The mean +/- SD PRA level at the end of the second month was 36.63% +/- 31.14% and 45.34% +/- 24.36% in cases and controls, respectively [P=0.012]. Seven patients in the case group and 10 in the control group were lost to follow-up. The remaining patients continued to take simvastatin for 12 month. The mean +/- SD PRA level at the end of the 12[th] month was 24.02% +/- 31.04% in cases and 43.15% +/- 26.56% in controls [P=0.001]. 25 patients underwent renal transplantation and continued to receive simvastatin 6 months after transplantation. These patients were matched with 25 controls treating with placebo. The mean +/- SD creatinine level 6 months after kidney transplantation was 2.05 +/- 1.14 mg/dL and 3.15 +/- 1.09 mg/ dL in cases and controls consecutively [P=0.02]. Simvastatin can be safely used to lower PRA and improve post-transplantation outcomes

Emphysematous pyelonephritis in a transplant kidney

Emphysematous pyelonephritis [EPN] is a severe necrotizing infection of the kidney and its surrounding tis- sues. It is characterized by the production of gas within the kidney and perinephric structures. EPN often affects diabetic women but can also occur in nondiabetic patients who have ureteral obstruction and in im- munocompromised patients. Herein, we report EPN in a 23-year-old woman who had a renal transplantation

Prevalence and risk factors of acute renal failure after cardiac surgery in Southern Iran

Acute renal failure requiring renal replacement therapy after cardiac surgery is still a cause of major morbidity and mortality worldwide. A number of risk factors for the development of acute renal injury after cardiac surgery have been previously described and based on these variables; several scoring algorithms were proposed. Predictive value of these algorithms in Iran is not described. This study investigates these risk factors among our patients in southern Iran. Two hundred and forty patients with normal kidney function who were candidates for cardiac surgery were enrolled and their baseline data were collected. Diabetes mellitus and age were selected as more controversial preoperative risk factors. Clamp and pump time were also selected as intra-operative risk factors and the type of operation was also considered as an independent risk factor. The patients were categorized in two groups including group 1: Patients with post-operation normal kidney function and group 2: Patients with post-operation ARF. All patients were followed with serial measurement of serum creatinine post-operation. The incidence of acute renal failure was 11.25%. Mean age of the patients in group 1 was 54.24 +/- 15.88 and in group 2 was 52.85 +/- 18.20 years. There was not any significant correlation between duration of clamp time and post operation acute renal failure. Clamp time in group 1 was 51.49 +/- 11.88 and in group 2 was 53.48 +/- 13.40 min. Duration of pump time in group 1 was 63.31 +/- 12.56 min and in group 2 was 78.07 +/- 10.85 min. The difference was statistically significant. Forty two [20%] of the patients in group 1 and 13 [50%] in group 2 were diabetic. Although several scoring algorithms are available for prediction of post-cardiac surgery complications, these can also be matched with our patients' criteria enhancing their accuracy for our situation

Urine cytology: useful screening method for polyoma virus nephropathy in renal transplant patients

Polyoma virus nephropathy occurs in 3% to 4% of renal transplant recipients, causing graft loss in 50% of cases. The objective of the present study was to explore the effects of age, sex, post-transplantation period and plasma creatinine levels on the polyoma virus infection in kidney transplanted patients. Urine samples were collected from 362 patients, centrifuged and microscopic slides prepared using Papaniclaou staining method. The slides then examined and decoy cells were identified in 96 [27%] patients. The prevalence of the infection increased with increased post-transplantation period and the age of the patients. Moreover, patients with positive decoy cells had more abnormal plasma creatinine levels than those with negative for such cells. In conclusion identification of decoy cells might be of value for the diagnosis of nephropathy, especially if the presence of such cells is accompanied with the elevated plasma levels of creatinine