Comparison of Complications of Arteriovenous Fistula with Permanent Catheter in Hemodialysis Patients: A Six-month Follow-up.

BACKGROUND: Arteriovenous fistula (AVF), permanent catheter (PC), and vascular graft are three vascular access types used for hemodialysis procedure. Due to insufficient reliable information on the comparison between AVF and PC, this study was conducted to compare AVF and PC regarding dialysis adequacy. MATERIALS AND METHODS: This prospective study was carried out from March, 2013 to September, 2013. In this study, 76 hemodialysis patients were enrolled and assigned to two unequal groups of AVF and PC. Before and after the dialysis session, blood samples were taken for laboratory examinations and measurement of urea reduction ratio (URR) and Kt/V. The patients were followed up for six months, and then laboratory examinations were repeated. RESULTS: Of the 76 hemodialysis patients, 30 had AVF and others PC. During the 6-month follow-up, 24 patients in PC group but only one patient in AVF group showed infection (P = 0.006), while in each group, three cases of thrombosis were seen (P = 0.58); however, catheter dysfunction was seen in 13 patients of PC group but no patients of AVF group (P = 0.004). There was no difference between the two groups in Kt/V and URR at the beginning of the study; however, after six months, Kt/V and URR were greater in AVF group (P < 0.05). CONCLUSIONS: In addition to some advantages of AVF over PC, such as lower rate of infection and thrombosis, we also found better dialysis adequacy in AVF group. We recommend that AVF be created in all of patients with chronic kidney disease who are candidates for hemodialysis.

Renin-Angiotensin System Blockage for Reduction of Plasma Adiponectin Level in Maintenance Hemodialysis Patients: a Randomized Controlled Trial.

INTRODUCTION: Plasma adiponectin level is markedly in-creased among patients on hemodialysis. This investigation aimed to evaluate the relationship between renin-angiotensin system blockade and serum adiponectin concentration in nondiabetic patients on hemodialysis. MATERIALS AND METHODS: This randomized double-blind controlled trial was conducted on a group of nondiabetic patients on regular hemodialysis. The first group received losartan, 12.5 mg twice per day for the 1st week, 25 mg twice per day during the 2nd week, and 75 mg/d from the 3rd week to the end of the 16th week. Patients of the control group received placebo. Blood samples from all of the patients were collected at the beginning and at the end of the study to measure serum adiponectin. RESULTS: Seventy-three hemodialysis patients were divided randomly into the losartan group (40 patients) and the control group (33 patients). The mean adiponectin level in all of the patients was 10.6 ± 3.9 µg/mL. A significant decrease of serum adiponectin level was observed after 4 months of treatment with losartan (8.86 ± 3.43 µg/mL for losartan group versus 10.71 ± 3.94 µg/mL for the control group; P = .04). None of the patients had a serum potassium value greater than 5 mg/dL or hypotension during the intervention. There was no significant difference in serum potassium levels between the two groups.   Conclusions. The decrease in serum adiponectin level in nondiabetic patients on regular hemodialysis by losartan might offer a potential protective approach in these patients. Mechanisms responsible for this reduction remain to be investigated.

Clinicopathological correlations in lupus nephritis; a single center experience.

BACKGROUND: Renal biopsies play an important role in the diagnosis, management and prognosis of patients with lupus nephritis (LN). OBJECTIVES: To determine the correlation between the pathological features of LN and the demographic, clinical and laboratory parameters. PATIENTS AND METHODS: This retrospective study was conducted from 2008 to 2014 on all consecutive cases of biopsy-proven LN at a nephropathology laboratory in Iran. The demographic, clinical and laboratory data were obtained from patients(') files and the biopsy findings from the original biopsy request forms. RESULTS: Of the 84 patients enrolled, 69 (82.2%) were females and 15 (17.8%) males. The mean age was 32.7±12 years. The mean serum creatinine was 1.5±0.94 mg/dl and the mean 24-h proteinuria, 1.6±1.9 grams. The majority of cases belonged to classes III and IV. The extracapillary proliferation was found in 42.86% of biopsies and endocapillary proliferation in 66.67% of biopsies. Patients of class IV-LN had a higher mean serum value of creatinine in comparison to class III-LN (2.19±1.09 versus 1.2±0.56 mg/dl; p= 0.0001). There was no significant difference of 24-h proteinuria between the two classes (p= 0.882). A significant association of serum creatinine with 24-h proteinuria (p= 0.041) was seen. Serum creatinine had significant positive correlation with activity percent (p< 0.001), and chronicity percent (p= 0.006), and also with proportion of glomeruli with crescents (p < 0.001). While there was a significant relationship of proteinuria with chronicity percent (p= 0.001), this association for activity percent was not significant (p= 0.094). Furthermore, the association of proteinuria with totally sclerotic glomeruli and proportion of crescents was not statistically significant (p= 0.186 and p= 0.0145 respectively). CONCLUSIONS: In conclusion, the results from our study on biopsy-proven cases of LN largely concur with the previously reported studies from Iran and other parts of the world.

Impact of Momordica charantia extract on kidney function and structure in mice.

BACKGROUND: Bitter Melon (BM) is known for its hypoglycemic effect and is commonly used in populations. OBJECTIVES: This study examined the effects and safety of bitter melon fruit in laboratory mice. MATERIALS AND METHODS: In this experimental study 70 male mice (25-30 gr) were randomly divided into 7 groups. The mice were injected intraperitoneally with single doses of 0, 100, 500, 1000, 2000 and 4000 mg/kg and multiple doses 500 mg/kg daily for 7 days. The mice were then observed for 72 hours before sacrificing. Immediately kidneys were taken out for histological examinations. Tubular cell vacuolization and flattening as well as hyaline casts, debris and dilatation of tubular lumen were the morphologic lesions which were assessed with scores from 0 to 4, while zero score addressed normal renal tissue. Serum samples were assayed for kidney function (creatinine; Cr and Blood Urea Nitrogen; BUN). Blood and bitter melon antioxidant activities were measured, too. Data were analyzed with Stata software (Stata Corp. 2011. Stata Statistical Software: Release 12. College Station, TX: Stata Corp LP)using ANOVA and Bonferroni tests. RESULTS: All single dose groups showed normal behavior after the dosing and no statistical changes were observed in blood parameters (p>0.05). Histological examinations revealed normal organ structures, however, the group treated for 7 days showed statistically a significant change in BUN (p=0.002) and a borderline significance in Cr (p=0.051). CONCLUSIONS: Administration of up to 4000 mg/kg did not have any effect on the mice kidney function and histology, however chronic administration were nephrotoxic. More studies with different dosage regimens are suggested.

Association of helicobacter pylori infection with serum magnesium in kidney transplant patients.

INTRODUCTION: Few studies are available regarding the various promoting factors of H. pylori infection in kidney disease patients especially renal transplant individuals. OBJECTIVES: This study was therefore conducted to examine the association of serum magnesium with H. pylori infection among kidney transplant patients. This cross-sectional investigation was conducted on a group of stable kidney transplant patients. Peripheral venous blood samples were collected for biochemical analysis after an overnight fast, Also urea breath test (UBT) was conducted for patients. PATIENTS AND METHODS: A total of 50 cases was enrolled to the study. Mean serum magnesium value of the patients was 1.98 ± 0.62 mg/dl. Serum magnesium level in positive H. pylori patients was more than negative H. pylori patients (p=0.0005). In this study population, there was no significant difference in serum intact PTH, calcium, alkaline phosphatase, albumin levels and body mass index (BMI) between males and females or H. pylori positive and H. pylori negative subjects (p>0.5). CONCLUSION: It is possible that, magnesium aggravates H. pylori infection in kidney transplant patients through the mechanisms like hemodialysis, which we had reported previously. However, more studies are necessary to prove the association of magnesium with H. pylori infection in renal transplant patients and finding the clinical relevance of our findings.

Bright renoprotective properties of metformin: beyond blood glucose regulatory effects.

Metformin, a biguanide drug, is widely prescribed to treat high blood glucose in individuals with type 2 diabetes mellitus. Type 2 diabetes mellitus is a troubling chronic disease and diabetic nephropathy is one of the most important complications of diabetes mellitus. Recent studies suggest that metformin, in addition to its efficacy in treating type 2 diabetes, may also have therapeutic efficacy in other conditions, including diabetic nephropathy or ameliorative property against tubular cell injury. Moreover, metformin significantly decreases albuminuria in patients with type 2 diabetes mellitus. However, the exact mechanisms beyond the effect of metformin on blood glucose are still unknown. Recent studies suggest that the therapeutic effect of metformin is mediated by its action on adenosine monophosphate-activated protein kinase in tissues. Various investigations show that metformin decreases intracellular reactive oxygen species. Metformin protects against tubular injury by restoring the biochemical alterations and regulation of oxidative stress on renal tubules. It also protects podocytes in nephropathy of diabetes. These findings can more strongly potentiate the clinical use of metformin in the prevention of nephropathy of diabetes. In this regard, to better understand the metformin nephroprotective properties, more experimental rat models and clinical studies are needed.

Contrast induced nephropathy; recent findings.

Contrast induced nephropathy is one cause of acute renal failure. Contrast induced nephropathy is the third most common cause of hospital-acquired acute renal failure. The incidence of contrast induced nephropathy in the general population is 0.6% to 2.3%, but when focusing on specific high-risk patients the incidence can increase to more than 40%. Studies suggest that intravenous hydration is the most effective strategy to prevent contrast induced nephropathy. Hydration is inexpensive and is usually risk-free. Administration of optimal fluids before and after the contrast procedure allows for increased urine output and improved outcomes.

Correlation of immunostaining findings with demographic data and variables of Oxford classification in IgA nephropathy.

BACKGROUND: Oxford classification for IgA nephropathy (IgAN) did not include pattern of immunostaining in the analysis. OBJECTIVE: The aim of this study is to determine the potential correlation between the immunostaining data and morphologic variables of Oxford classification (MEST) and various clinical and demographic data of patients with IgAN. PATIENTS AND METHODS: The pathologic diagnosis of IgAN requires the demonstration of IgA-dominant mesangial or mesangio-capillary immune deposits through immunofluorescence (IF) microscopy. The immune deposits were semiquantitatively assessed as 0 to 3+ positive bright. These were correlated with various clinical, demographic and histological variables of Oxford classification. RESULTS: A total of 114 biopsies were enrolled to the study (70.2% were male).  Mean age of the patients was 37.7 ± 13.6 years. This study showed that, only C3 deposits had a significant correlation with serum creatinine. Other antibodies (IgA, IgM and IgG) had no significant association with serum creatinine. This study also showed that IgA deposition score had significant positive association with endocapillary proliferation (E) and segmental glomerulosclerosis (S) variables of Oxford classification. Moreover, IgM deposition score had positive association with S variable. There was no significant association of IgG deposition score with four morphologic variables of Oxford classification. There was significant association of C3 deposition score with S and E variables too. CONCLUSIONS: The significant relationships of IgA and C3 deposits with some of the Oxford variables need more attention. We propose to further investigate this aspect of IgAN disease.

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

BACKGROUND: There is a limited knowledge about the morphological features of IgA nephropathy (IgAN)in the middle east region. OBJECTIVES: The objective of this study was to evaluate the spectrum of histopathological findings in IgAN patients at our laboratory. PATIENTS AND METHODS: At this work, an observational study reported which was conducted on IgAN patients using the Oxford-MEST classification system. RESULTS: 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). CONCLUSIONS: 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.