The efficacy of camel milk and Tarangabin (manna of Alhagi maurorum( combination therapy on glomerular filtration rate in patients with chronic kidney disease: A randomized controlled trial.

OBJECTIVE: This study was designed to investigate the effect of camel milk and Tarangabin (manna of Alhagi maurorum) combination therapy in addition to conventional treatments in patients with chronic kidney disease (CKD). MATERIALS AND METHODS: Forty-four patients of 15 to 70 years old, with CKD due to hypertension or diabetes, and estimated glomerular filtration rate (eGFR) of 15-60 ml/min per 1.73 m2, were enrolled in this trial. The patients were randomized to receive either 400 cc of camel milk with 10 cc of Tarangabin syrup orally in two divided daily doses for 3 months plus conventional therapy or conventional therapy alone. The conventional treatment included diabetes medications and angiotensin converting enzyme inhibitors or angiotensin receptor blockers. RESULTS: The baseline characteristics of patients were similar in the two groups. Serum levels of creatinine (p=0.01), blood levels of urea nitrogen (p=0.0001), triglyceride (p=0.02), and potassium (p=0.05), and diastolic blood pressure (p=0.0001) decreased, while eGFR (p=0.001) improved in intervention group significantly. CONCLUSION: It seems that the therapeutic protocol used in this study can improve renal function in patients with CKD through regulating glucose and anti-inflammatory, laxative, and immunostimulatory properties.

Restless leg syndrome in chronic hemodialysis patients in Mashhad hemodialysis centers.

Introduction: Restless leg syndrome (RLS) is a sensory motor disorder. Patients with this syndrome have serious and uncontrollable desire to move their legs, which is mostly due to an uncomfortable feeling intensified when they are motionless. It may be a genetic disorder or secondary to iron deficiency, neurodegenerations, pregnancy, some drugs and severe kidney diseases. Objectives: This study was designed to find out the prevalence and its risk factors of RLS in hemodialysis patients. Patients and Methods: This multicenter cross-sectional study was done on 260 hemodialysis patients. The prevalence of RLS was measured using International Restless Legs Syndrome Study Group (IRLSSG)'s RLS Questionnaire (RLSQ). Potential risk factors for RLS including underlying cause of chronic renal failure, duration on dialysis, biochemical tests, dialysis adequacy, and erythropoietin and also venofer dosage in recent month and demographic data were also evaluated. Results: The prevalence of RLS was 55% including 59.4% males and 40.6% females. Their mean age of RLS patients and their dialysis duration were significantly higher than other group (P<0.05). Their body mass index (BMI) and serum calcium were significantly higher (P<0.05). However erythropoietin dosage and serum hemoglobin level were lower in RLS patients (P<0.05). Significant predictors of RLS were history of diabetes mellitus (DM), hypertension (HTN), smoking (P<0.05). There was not significant relation between RLS and dialysis adequacy, serum intact parathyroid hormone (iPTH), urea, ferritin and venofer dosage (P>0.05). Conclusion: According to the results, RLS is a common disorder in hemodialysis patients which can affect strongly on their life. So particular attention and sooner diagnosis of RLS in high risk patients for better management is necessary.

Association of metabolic syndrome with serum fibroblast growth factor 21 in kidney transplanted patients.

INTRODUCTION: Fibroblast growth factor 21 (FGF21) is a metabolic regulator with multiple beneficial effects on glucose and lipid homeostasis and insulin sensitivity. OBJECTIVES: The aim of this study was to investigate the relation between the serum level of FGF21 with and metabolic syndrome (MS) in kidney transplant recipients. PATIENTS AND METHODS: We performed a cross-sectional study on 86 stable renal transplant recipients to detect possible relation between serum FGF21 level and MS during October 2014 and Mach 2015. Patients with past history of diabetes mellitus were excluded. RESULTS: There were 43 patients in each group with and without MS. Totally, they were 52 (60.5%) male and 34 (39.5%) female. The mean age of the MS group was significantly higher than that of non-MS group. There was not significant difference between mean serum creatinine level and glomerular filtration rate (GFR) between two groups (P > 0.05). The MS patients had higher weight and body mass index (BMI) (P < 0.05). The prevalence of BMI >25 kg/m(2) in MS group was 25 (58.8%) versus non-MS group that only 10 (23.3%) had this condition (P < 0.05). The mean of FGF21 level in MS and non-MS groups was 1.23 ± 0.67 ng/l and 1.18 ± 0.71 ng/l, respectively (P > 0.05). There was not significant difference of serum FGF21 level between MS and non-MS patients (P > 0.05). CONCLUSION: While the elevated serum FGF21 level was found in subjects with insulin resistant states, however, this study revealed that serum FGF21 levels were not significantly increased in renal transplanted recipients with MS as compared with non-MS group.

Prevalence of chronic kidney disease and its risk factors in Gonabad, Iran.

INTRODUCTION: Chronic kidney disease (CKD) is an important health problem in Iran, with an increasing prevalence rate. Knowledge about the prevalence and risk factors of this disease in different health jurisdictions can help in planning to control this condition. MATERIALS AND METHODS: In this cross-sectional study, 1285 individuals aged between 20 and 60 years old were recruited. Participants were selected from the general population residing in Gonabad, Iran, via simple random sampling in 2012. Demographic data were collected. Urine and blood test were performed, and the glomerular filtration rate was estimated based on the simplified Modification of Diet in Renal Disease equation. RESULTS: Sixty-five participants (5.1%) had CKD (5.1% men and 5% women; P = .90). The mean age was significantly higher in the CKD group (P = .001). Hypertension and diabetes mellitus were significantly more prevalent among the participants with CKD than those without CKD (P < .001 for both). Proteinuria was significantly associated with CKD, whereas a history of urinary tract infection, a history of nephrolithiasis, smoking, serum uric acid level, lipid profile, and blood glucose level were not. CONCLUSIONS: Chronic kidney disease has a high prevalence rate in this part of Iran. We suggest further studies in other parts of our country for the better estimation of the prevalence of CKD in Iran and for better planning to prevent and treat this condition.

Graft function based on two hours peak level monitoring of cyclosporine A during the first six months of renal transplantation.

Inadequate cyclosporine blood levels may cause acute rejection in transplanted renal graft, and its increase is accompanied with graft toxicity. Cyclosporine has variable bioavailability and pharmacokinetics among patients at different times after transplantation. In this study, we compared the effects of cyclosporine blood levels (trough versus 2-hour peak, C2) on renal graft function during the first six months after transplantation in order to find better methods for drug levels assessment in our patients. We studied 50 patients who received grafts at Mashhad transplant centers from October 2006 to May 2007. Drug levels were monitored seven times during the study; in each assessment, more than 80% of the patients did not reach the therapeutic C2 levels. There was no significant correlation between age, sex, times of transplantation and acute rejection with drug C2 levels. There was no difference between graft function in patients with therapeutic C2 level and those with inadequate C2 levels. However, we found a significant correlation between trough levels and acute rejection (P <0.05). Only during the 6 th month after transplantation was the drug dosage significantly higher in patients with therapeutic C2 level than that in other patients (P >0.05). Apparently, peak levels were not a suitable method in drug monitoring in our patients, or peak levels might have occurred at a different time (like 1.5 or 3 or 4 h after ingestion of the drug) in our population. Based on this study, trough level may be a better method of evaluation of cyclosporine effects on renal allografts than 2-h peak levels in our patients.

Should Guidelines for Conventional Hemodialysis Initiation in Acute Methanol Poisoning, Be Revised, When no Fomepizloe is Used?

BACKGROUND: Consumption of home-distilled alcohol may lead to epidemic or sporadic cases of severe acute methanol poisoning. The difficulty of establishing strict indications for hemodialysis in acute methanol poisoning is a widely recognized issue. MATERIALS AND METHODS: The determination of the clinical, especially hemodialysis, and para clinical factors influencing patient survival in 46 acutely methanol poisoned patients was the aim of this cross sectional retrospective study. Clinical and paraclinical variables compared in surviving and non-surviving patients were hemodialysis and ventilation requirements, the level of consciousness, ABG parameters the serum methanol, creatinine and BUN levels. Only ethanol was used for ADH (Alcohol Dehydrogenize) blockade. RESULTS: Receiver operative curve characteristics showed that a serum methanol threshold level of 15mg/dl, instead of 25mg/dl, has a better sensitivity and rather the same specificity for predicting patient mortality. CONCLUSIONS: With no fomepizloe and using conventional hemodialysis, lowering the threshold of methanol concentration for hemodialysis initiation, may save lives in acute methanol intoxication.

Cyclosporine trough levels and its side effects in kidney transplant recipients.

INTRODUCTION: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Thyroid hormone changes in early kidney transplantation and its correlation with delayed graft function.

INTRODUCTION: Thyroid hormones affect kidney function and may alter with changes in kidney function, as well. We evaluated changes in serum levels of triiodothyronine (T3), thyroxin (T4), and thyroid-stimulating hormone (TSH) early after kidney transplantation and their relationship with delayed graft function (DGF). MATERIALS AND METHODS: Fifty-five consecutive kidney allograft recipients were enrolled in the study. Serum levels of T3, T4, and TSH were measured on the day before transplantation, and also on posttransplant days 1, 3, 7, 14, and 21. Results were compared between patients with a normal allograft function and those with DGF. RESULTS: The mean T3 level decreased from 110.41 +/- 49.79 ng/dL before transplantation to 80.78 +/- 51.42 ng/dL on the 1st day after transplantation (P = .04), while T4 reduction reached a significant level on the 3rd day after transplantation (8.27 +/- 3.27 microg/dL to 5.50 +/- 2.57 microg/dL, P = .004). Patients with DGF experienced a significantly greater decrease in the serum level of T3 at the end of the 1st week after transplantation compared with patients with normal kidney function (P = .02). This significant decrease in T3 continued until the end of the 2nd week. Serum levels of T4 reduced comparably in the two groups, until the end of the 1st week, when it showed a significantly more reduction in the patients with DGF (P = .04). CONCLUSION: Both T3 and T4 reduced early after kidney transplantation, and this reduction was significantly more prominent in those with DGF. This is compatible with a consequence rather than a cause of DGF, explained in the setting of sick euthyroid syndrome.

Elevated serum C-reactive protein level and microalbuminuria in patients with type 2 diabetes mellitus.

INTRODUCTION: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Impact of treatment with oral calcitriol on glucose intolerance and dyslipidemia(s) in hemodialysis patients.

This study was conducted to assess the effect of oral calcitriol on glucose metabolism in patients on hemodialysis (HD). A total of 27 patients on HD at the Mashhad University of Medical Sciences, Iran, none of whom had received calcitriol or had history of diabetes, were selected. The patients were randomly divided into two groups; Group I: patients who received oral calcitriol for eight weeks and, Group II: patients who received placebo. In all cases, levels of fasting glucose, insulin, lipid profile, calcium, phosphorous, parathormone (PTH), HbA1C and blood sugar after administration of 75 grams of glucose, insulin resistance and beta cell function were measured, before and after the treatment period. The two sets of results were then compared with one another. In Group l patients, the levels of the parameters studied before and after the study period were as follows: blood sugar after 75 grams of glucose (88.67 +/- 8.68 versus 99.83 +/- 34.42 mg/dL, p = 0.045), HOMA-IR (2.05 +/- 1.42 versus 2.42 +/- 1.33, p = 0.035), HbA1C (5.99 +/- 1.00 versus 6.14 +/- 1.19, p= < 0.001), total cholesterol (153.3 +/ 43.80 mg/dl versus 157.0 +/52.62, p = 0.037) and triglycerides (175.30 +/- 99.65 versus 214.9 +/- 117.7 mg/dL, p = 0.036). Thus, there was a significant decrease after the study period. In Group II, fasting blood sugar (110.7 +/- 26.12 versus 81.14 +/- 13.31 mg/dL, p = 0.002), HbA1C (6.99 +/- 1.44 versus 6.17 +/- 1.66, p = 0.004) and HOMA-IR (5.85 +/- 5.11 versus 3.20 +/- 2.39, p = 0.036) significantly increased and beta cell function significantly decreased (149.5 +/- 90.57 versus 355.7 +/- 299.3, p = 0.032) after the study period. In conclusion, our results show that vitamin D has a significant influence on glucose metabolism. Similar studies on larger sample size are required to confirm this observation.

Effect of oral granisetron in uremic pruritus.

BACKGROUND: Renal itch is a relatively common and distressing problem for patients with chronic renal failure. Granisetron, is a potent and selective inhibitor of 5-HT3 receptors. There have been some studies about the effect of ondansetron in uremic pruritus and one case report has recently described relief of renal itch with granisetron. AIMS: To evaluate the effect of Granisetron on uremic pruritus in Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis (HD) patients. METHODS: To study the prevalence of uremic pruritus, patients on CAPD and HD were asked to complete a pruritus questionnaire. Their replies were scored based on numerical scales. Pruritus was graded, according to the total points for each patient, as mild, moderate or severe. Fourteen patients with moderate to severe pruritus were enrolled in the trial. During treatment, patients received granisetron (1 mg tablet twice a day P.O), for a period of 1 month. They were asked to score the severity of pruritus twice a day. RESULTS: Seventy seven percent of the patients responded to the treatment and at 1 st, 2 nd and 4 th week the mean values of the pruritus scores were 23, 16 and 8 points respectively. Before starting treatment the score was 31 points (P =0.03). Weekly clinical and laboratory examination showed no important side effects. CONCLUSION: Granisetron might be an effective, safe and well tolerated drug for the treatment of uremic pruritus.

Kidney transplantation in patients with alport syndrome.

INTRODUCTION: The aim of this study was to evaluate the results of kidney transplantation in patients with Alport syndrome. MATERIALS AND METHODS: A total of 15 patients with Alport syndrome underwent kidney transplantation and the result of their transplantation was compared with the results in patients without Alport Syndrome. Rejection episodes and the presence of antiglomerular basement membrane (anti-GBM) nephritis were assessed in these patients. RESULTS: Fifteen patients with Alport syndrome were compared with a control group including 212 kidney allograft recipients. One patient with Alport syndrome (6.7%) and 30 controls (14.2%) experienced delayed graft function. Renal artery thrombosis was reported in 1 patient (6.7%) with Alport syndrome and 10 (4.7%) in the control group, which led to nephrectomy in all cases. Acute rejection was confirmed in 2 patients (13.3%) by kidney biopsy and classic treatment yielded relative response. However, they lost their grafts 35 and 44 months after the transplantation. On pathologic examination, no specific finding of anti-GBM nephritis was found. In the control group, 43 cases of acute rejection (20.3%) were reported and 12 patients (5.7%) returned to dialysis. The 1-, 3-, and 5-year graft survival rates were 100%, 92%, and 84% in the patients with Alport syndrome, which was not different from those in the control group (P = .53). CONCLUSION: In spite of the risk of anti-GBM nephritis in the patients with Alport Syndrome, it seems that kidney transplantation can yield favorable results and anti-GBM nephritis is not a common etiology of rejection.

Influence of dialysis duration, peritoneal transport parameters, and gender on effluent CA125 concentration in patients on peritoneal dialysis.

INTRODUCTION: 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. MATERIALS AND METHODS: 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. RESULTS: 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). In 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). CONCLUSIONS: 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.