ABSTRACT
To determine the contribution of injectable iron administered to hemodialysis (HD) patients in causing oxidative stress and the beneficial effect of N-acetylcysteine (NAC) in reducing it, we studied in a prospective, double blinded, randomized controlled, cross over trial 14 adult HD patients who were randomized into two groups; one group received NAC in a dose of 600 mgs twice daily for 10 days prior to intravenous iron therapy and the other group received placebo. Both the groups were subjected to intravenous iron therapy, 100 mg of iron sucrose in 100 mL of normal saline given over a period of one hour. Blood samples for the markers of oxidative stress were taken before and after iron therapy. After the allowance of a week of wash out period for the effect of N-acetylcysteine we crossed over the patients to the opposite regimen. We measured the lipid peroxidation marker, malondiaaldehyde (MDA), to evaluate the oxidative stress and total anti-oxidant capacity (TAC) for the antioxidant level in addition to the highly sensitive C-reactive protein (HsCRP). Non-invasive assessment of endothelial dysfunction was measured by digital plethysmography before and after intravenous iron therapy. There was an increase of MDA (21.97 + 3.65% vs 7.06 + 3.65%) and highly sensitive C-reactive protein (HsCRP) (11.19 + 24.63% vs 13.19 + 7.7%) after iron administration both in the placebo and the NAC groups. NAC reduced the baseline acute systemic generation of oxidative stress when compared to placebo, which was statistically significant with MDA (12.76 + 4.4% vs 9.37 + 4.40%: P = 0.032) but not with HsCRP though there was a declining trend (2.85 + 22.75 % vs 8.93 + 5.19%: P = 0.112). Pre-treatment with NAC reduced the endothelial dysfunction when compared to placebo, but it was not statistically significant, except for reflection index (RI). We conclude that in our HD patients NAC reduced the oxidative stress before and after the administration of intravenous iron therapy in addition to the endothelial dysfunction induced by this treatment.
Subject(s)
Acetylcysteine/therapeutic use , Anemia, Iron-Deficiency/drug therapy , Antioxidants/therapeutic use , Ferric Compounds/administration & dosage , Hematinics/administration & dosage , Oxidative Stress/drug effects , Renal Dialysis , Adult , Anemia, Iron-Deficiency/blood , Anemia, Iron-Deficiency/etiology , Biomarkers/blood , C-Reactive Protein/metabolism , Cross-Over Studies , Double-Blind Method , Endothelium, Vascular/drug effects , Endothelium, Vascular/metabolism , Endothelium, Vascular/physiopathology , Female , Ferric Compounds/adverse effects , Ferric Oxide, Saccharated , Glucaric Acid , Hematinics/adverse effects , Humans , India , Infusions, Intravenous , Lipid Peroxidation/drug effects , Male , Malondialdehyde/blood , Middle Aged , Placebo Effect , Plethysmography , Prospective Studies , Renal Dialysis/adverse effects , Time Factors , Treatment OutcomeABSTRACT
To evaluate the efficacy and safety of the monthly pulse IV cyclophosphamide (IVC) therapy in patients with severe lupus nephritis, we studied 39 patients of lupus nephritis on IVC therapy between 1998 to 2002. Single monthly cyclophosphamide (0.75-1 g/m(2)) was infused intravenously with oral prednisolone (0.5 mg/kg per day) and appropriate hydration. Of the 39 patients 25 (86.2%) patients were females and 4 (13.8%) were males. Six (2%) cases had irregular follow-up and 3 patients had expired during the initial cycles and were excluded from the study. The mean age was 25.6 + 6.72 years (range 10-40 years). The mean duration of the disease from the onset to renal biopsy was 24.2 + 18.5 months. The clinical presentations included nephrotic syndrome (34.5%), acute glomerulonephritis (31.0%), Pyrexia of unknown origin (PUO) (10.3%), and rapidly progressive renal failure (6.7%). Renal insufficiency was present in 47.2% cases. Twenty-two (75.9%) patients had diffuse proliferative glomerulonephritis (class IV), 6 (20.7%) focal proliferative glomerulonephritis (class III), and one (3.4%) class Vd. After a mean follow-up of 15.8 months, out of 29 patients, 13 (44.8%) had achieved complete remission, 7 (24.1%) partial remission and 9 (31.0%) cases did not respond to the therapy. Side effects of the therapy included vomiting and nausea (100%) and hair loss during the first few doses of IVC. In addition, one case had dysfunctional uterine bleeding and two patients had avascular necrosis of femoral head. We conclude that our data indicate that IVC in severe lupus nephritis is effective in Indian patients though longer follow-up is required.
Subject(s)
Cyclophosphamide/administration & dosage , Immunosuppressive Agents/administration & dosage , Lupus Nephritis/drug therapy , Administration, Oral , Adolescent , Adult , Biopsy , Child , Cyclophosphamide/adverse effects , Drug Therapy, Combination , Female , Humans , Immunosuppressive Agents/adverse effects , India , Infusions, Intravenous , Lupus Nephritis/complications , Lupus Nephritis/pathology , Male , Prednisolone/administration & dosage , Prospective Studies , Pulse Therapy, Drug , Remission Induction , Severity of Illness Index , Time Factors , Treatment Outcome , Young AdultSubject(s)
Health Planning , Health Services Needs and Demand , Kidney Failure, Chronic , National Health Programs , Delivery of Health Care , Humans , India , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/prevention & control , Kidney Failure, Chronic/therapy , Preventive Health Services , World Health OrganizationABSTRACT
Selecting the correct method for routine analysis by 'method evaluation' is an important component of quality assurance. It is a step-wise procedure that evaluates various analytical parameters like accuracy, precision etc of the given method. Finally reference intervals are established for selected population. We evaluated an enzymatic method for serum creatinine. The results show that it is an acceptable method based on the above mentioned criteria.