Relative availability of metabolizable methionine from 2 ruminally protected sources of methionine fed to lactating dairy cattle.

Our objective was to evaluate the lactational responses of dairy cows to methionine provided from 2 ruminally protected sources of methionine activity. Twenty-one Holstein dairy cows [11 primiparous (634 kg of body weight, 140 d in milk) and 10 second-parity (670 kg of body weight, 142 d in milk)] were assigned to a treatment sequence in 4 replicated 5 × 5 Latin squares plus 1 cow, with 14-d periods. Treatments were as follows: control; 7.5 or 15 g/d of a ruminally protected product of 2-hydoxy-4-methylthio-butyric acid (NTP-1401; Novus International Inc., St. Charles, MO); or 7.5 or 15 g/d of a ruminally protected dl-methionine product (Smartamine M; Adisseo, Alpharetta, GA). The diet was predicted to meet metabolizable protein and energy requirements. Diets contained 16.1% crude protein, and the control diet was predicted to be deficient in metabolizable methionine (1.85% of metabolizable protein) but sufficient in lysine (6.8% of metabolizable protein). Feed intake and milk yield were measured on d 11 to 14. Blood was collected on d 14. Dry matter intake, milk yield, energy-corrected milk, milk fat yield and percentage, and efficiencies of milk and energy-corrected milk yield were not affected by treatment. Milk protein percentage and milk protein yield increased linearly with supplementation, without differences between methionine sources or interactions between source and level. Linear regressions of milk protein percentage and milk protein yield against supplement amount within source led to slope ratios (NTP-1401:Smartamine M) of 95% for protein percentage and 84% for protein yield, with no differences between sources for increasing milk protein. Plasma methionine concentrations were increased linearly by methionine supplementation; the increase was greater for Smartamine M than for NTP-1401. Plasma d-methionine was increased only by Smartamine M. Plasma 2-hydoxy-4-methylthio-butyric acid was increased only by NTP-1401. Our data demonstrated that supplementation with these methionine sources can improve milk protein percentage and yield, and the 2 methionine sources did not differ in their effect on lactation performance or milk composition.

Matrix metalloproteinase 9 polymorphisms and systemic lupus erythematosus: correlation with systemic inflammatory markers and oxidative stress.

Systemic lupus erythematosus (SLE) is an autoimmune disease that involves multiple organs and is characterized by persistent systemic inflammation. Among the effects of inflammatory mediators, the induction of matrix metalloproteinases-2 and -9 (MMP-2 and MMP-9) and oxidative stress has been demonstrated to be important in the development of SLE. In this study, the possible association between MMP-9 and MMP-2 functional promoter polymorphism, stress, and inflammatory markers with development of severe cardiovascular disease (CVD), high blood pressure (HBP), and lupus nephropathy (LN) in SLE patients was investigated. The present case-control study consisted of 109 SLE patients with and without CVD, HBP and LN and 101 gender- and age-matched unrelated healthy controls from a population in western Iran. MMP-2 -G1575A and MMP-9 -C1562T polymorphisms were detected by PCR-RFLP, serum MMP-2 and MMP-9, neopterin, malondialdehyde (MDA) and lipid levels were determined by ELISA, HPLC and enzyme assay, respectively. We found that MMP-9 -C1562 T and MMP-2 -G1575A alleles act synergistically to increase the risk of SLE by 2.98 times (p = 0.015). Findings of this study also demonstrated that there is a significant increase in the serum levels of MMP-2, neopterin and MDA and a significant decrease in serum level of MMP-9 in the presence of MMP-9-C1562 T and MMP-2 -G1575A alleles in SLE patients compared to controls. Further, SLE patients with MMP-9 (C/T + T/T) genotype had significantly higher serum concentrations of MMP-2, neopterin, MDA and LDL-C, but lower serum MMP-9 and HDL-C levels than corresponding members of the control group. MMP-9 (C/T + T/T) genotype increased risk of hypertension in SLE patients 2.71-fold. This study for the first time not only suggests that MMP-9 -C1562 T and MMP-2 -G1575A alleles synergistically increase the risk of SLE but also high serum levels of MDA, neopterin, and circulatory levels of MMP-2 and lower MMP-9 in SLE patients. This information may be important in the evaluation of SLE progression and in the elucidation of the mechanisms of the disease pathogenesis.

Effect of rumen-protected choline and methionine on physiological and metabolic disorders and reproductive indices of dairy cows.

The objective of this study was to investigate the effect of feeding different levels of ruminally protected methionine and choline on the incidence of physiological and metabolic disorders, production, and some of the reproductive indices of Holstein dairy cows. Forty Holstein dairy cows in their first and second lactation were used from 4-week pre-partum through 20-week post-partum and randomly assigned to receive one of the following treatments: 18 g/day of rumen-protected methionine (RPM), 60 g/day of rumen-protected choline (RPC), 18 g/day of RPM + 60 g/day of RPC, and neither supplement (control). The treatments significantly affected services per conception and open days of lactating dairy cows (p < 0.05), but did not affect significantly on days to first oestrus and number of pregnant cows. RPM + RPC-fed cows had the lowest open days, days to first oestrus and services per conception compared with other groups. The effect of treatments was significant on the incidence of metabolic and physiological problems except for foot/leg problems. Cows fed RPM+RPC had the lowest health problems compared with other groups (p < 0.05). Results indicate that the supplementation of RPM and RPC can improve reproductive performance and health status of dairy cows.

MEFV mutations in Iranian Azeri Turkish patients with familial Mediterranean fever.

Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disorder with more than 60 disease-associated mutations in the responsible gene, MEFV. In the present study, we determined 15 MEFV mutations in Iranian Azeri Turkish FMF patients. Five hundred and twenty-four unrelated patients were tested for 15 known mutations in the MEFV gene using amplification refractory mutation system-polymerase chain reaction and polymerase chain reaction-restriction fragment length polymorphism methods. Thirty-five different genotypes were characterized among the studied patients. Of the alleles investigated, the most common mutation was p.M694V (42.4%), followed by p.V726A (17%), p.E148Q (16.2%), and p.M680I (c.2040G>C) (15.2%). The p.R761H mutation (4.7%) was found to be the most frequent among the rare mutations. The mutations p.M680I (c.2040G>A), p.I692del, p.M694del and p.K695R were not found in this cohort. The remaining mutations account for 7.7% of the identifiable mutations. Five different types of complex alleles were also identified. The results show the diversity and the frequency of the mutations in the Iranian Azeri Turkish FMF patients. The p.R761H mutation is rather prevalent in Azeri Turks; therefore, it should be included in the routine molecular diagnosis of FMF patients from this ethnic group.

Postrenal transplant hemophagocytic lymphohistiocytosis and thrombotic microangiopathy associated with parvovirus b19 infection.

Persistent anemia is a known consequence of Parvovirus B19 (B19) infection following renal transplantation. However, to date, no description of B19-related hemophagocytic lymphohistiocytosis (HLH) exists in renal transplant recipients. We report a 24-year-old male kidney recipient, who presented with fever, severe anemia and allograft dysfunction two years following transplantation. Hyperferritinemia, hypertriglyceridemia, elevated serum lactate dehydrogenase, pancytopenia and fragmented red blood cells on the peripheral blood were also noted. Bone marrow examination revealed giant pronormoblasts and frequent histiocytes with intracellular hematopoietic elements, consistent with HLH. Renal allograft biopsy revealed closure of the lumen of glomerular capillaries and thickening of the capillary walls compatible with thrombotic microangiopathy. The presence of anti-B19 IgM antibody and viral DNA in the patient's serum (detected by real-time PCR) confirmed an acute B19 infection. Following high-dose intravenous immunoglobulin therapy, the anemia gradually resolved and renal function improved. As far as we know, this is the first report of B19-associated HLH and thrombotic microangiopathy in a renal transplant recipient.

Impact of donor/recipient body weight mismatch on allograft outcome in renal transplant recipients.

BACKGROUND: There have been conflicting reports that kidneys from small donors may be at risk for graft loss if they are transplanted into large recipients. The aim of this work was to examine the impact of donor/recipient body weight ratio (D/RBWR) on allograft outcome. PATIENTS AND METHODS: Two hundred and seventeen kidney transplant recipients from living unrelated donor with 5-year follow-up underwent immunosuppression with cyclosporine, mycophenolate mofetil (or azathioprine), and prednisolone. According to the D/RBWR, the patients were divided into 3 groups: low (less than 0.8; G1), medium (0.81-1.1; G2), and high (more than 1.1; G3). We recorded 1-, 3-, and 5-year graft survivals, episodes of acute rejection, and mean serum creatinine values. RESULTS: Among the patients, 126 (58%) were female and the overall mean age was 41.62 years. There were no significant differences in 1-, 3-, and 5-year allograft survivals between the groups. CONCLUSION: We concluded that low D/RBWR had no effect on short- or long-term renal allograft survival.

Renal transplantation in patients with lupus nephritis: a single-center experience.

BACKGROUND: Few data are available about the long-term outcome of renal transplantation in patients with systemic lupus erythematosus (SLE). METHODS: We retrospectively studied all lupus nephritis patients who received kidney allografts in our center between June 1989 and 2006. Patient and allograft outcomes were compared with those of 60 controls. RESULTS: Mean follow-up after renal transplantation was 87 +/- 39 months for patients with lupus and 88 +/- 54 months for controls. Actuarial 10-year patient (83% vs 85%; P = .62) and death-censored graft survival rates (73% vs 69%; P = .36) were not significantly different between lupus patients and controls. Intravascular thrombotic events occurred in 4 patients with SLE (17.4%) and 3 controls (5%; P < .05). Recurrence of lupus nephritis was documented in 1 renal allograft (4.3%). CONCLUSION: Long-term patient and graft survivals were similar in SLE and non-SLE renal transplant recipients. The risk for thrombotic complications was greater among SLE patients.

Renal transplantation in elderly recipients: a single-center experience.

BACKGROUND: Chronic renal failure is a disease of the elderly, who are the fastest growing population of dialysis patients and those waiting for kidney transplantation. The objective of this study was to analyze the results of the renal transplantation among recipients older than 60 years. METHODS: All renal transplant recipients older than 60 years at the time of transplantation were included in the study, which analyzed patient and graft outcomes. RESULTS: Among 1400 renal transplantations 80 patients were at least 60 years old, including 44 (55%) men and an overall mean age 67.3 +/- 5.95 (range = 60 to 72). One-, 3-, 5-, and 10-year patient survivals were 92.25%, 87.79%, 73.56%, and 64.32%, respectively. One-, 3-, 5-, and ten 10-year death-censored graft survivals were 92.11%, 87.71%, 72.32%, and 62.12%. The most common complications were cardiovascular and infectious. CONCLUSIONS: Our single-center results confirmed that transplantation is a good option for renal replacement therapy among patients older than 60 years.

Do mechanical fluid laws dictate the branching pattern of the renal artery?

INTRODUCTION: Anatomy of the renal artery is an important issue in the renal transplantation era. Multi-detector computed tomography angiography (MDCTA) is an accurate modality for the preoperative assessment of live renal donors, and it provides excellent details of donor arterial anatomy. We studied the relationship between the angle of emergence of the renal artery from the aorta and its branching pattern. METHODS: In this study, the MDCTA images obtained from the 138 kidneys of 77 potential renal transplant donors were studied. The courses of the right and left renal arteries from the aorta to the kidney hilus were delineated. The branching angle of the renal artery from the aorta (beta, angle) and the length of the renal artery from the aorta until its first division were measured (Delta, distance). The renal artery deviation from the perpendicular plane of the aorta (D, factor of deviation) was calculated by the following formula: D = (1 - sin [beta]). The cosine of this angle (cos [beta]) was also calculated. Statistical analyses were performed with Pearson correlation tests. The P value was set at .05. RESULTS: The mean age of patients was 28.7 +/- 4.3 with a male to female ratio of 63:14. The mean Delta distance and small de, Cyrillic diameter were 34.37 +/- 10.68 mm (range, 10-58) and 6.13 +/- 1.37 mm (range, 2.8-9.9), respectively. The mean beta angle, factor of deviation, and cos (beta) were 62.19 degrees +/- 16.44, 0.15 +/- 0.14, and 0.45 +/- 0.25, respectively. Significant negative correlations were found between the beta angle, and Delta distance (r = -0.308; P < .001), and small de, Cyrillic diameter (r = -0.303; P = .003). Factor of deviation and cos (beta) were directly associated Delta distance and small de, Cyrillic diameter. CONCLUSION: These findings indicated that with the main renal artery axis deviating from the perpendicular plane of the aorta or with a smaller branching angle, this artery had a greater diameter and underwent late branching. This study suggested that the renal artery diameter and branching pattern might be determined by the mechanical fluid laws.

Effect of prophylaxis with low-dose anti-thymocyte globulin on prevention of acute kidney allograft rejection.

INTRODUCTION: During kidney transplantation, the first contact between the recipient's immune system and the donor organ takes place immediately following the arterial anastomosis. The aim of this study was to evaluate the efficacy of a single, low-dose anti-thymocyte globulin (ATG) prophylaxis in the reduction of early acute rejection in renal allograft recipients. METHODS: In a randomized, controlled clinical trial, we studied the rate of acute rejection within the first month of kidney transplantation in patients who had received their transplant at a single center between the years 2004 and 2007. The patients were divided into 2 groups: group 1 (n = 37) received cyclosporine, mycophenolate mofetil or azathioprine, and prednisolone; group 2 (n = 31) received the above-mentioned agents plus a single ATG bolus (Thymoglobulin; SangStat, Lyon, France; 4-5 mg/kg) the night before the transplantation ( approximately 12 hours before the operation). Blood urea and serum creatinine levels were measured regularly in the posttransplantation period. Acute allograft rejection was justified clinically and/or pathologically. Statistical analysis was performed by SPSS 13.0 using Student t test and Fisher exact test. A P value < or = .05 was considered to indicate statistical significance. RESULTS: There were no significant differences regarding the age and gender ratio between the 2 groups. Acute allograft rejection was found in 32.4% (n = 12) of group 1 patients, and was reduced to 12.9% (n = 4) in group 2 (P = .05). Hence, the first-month acute rejection episodes decreased by approximately 60% with ATG prophylaxis in renal transplant recipients. CONCLUSION: Prophylactic administration of a single and low-dose ATG the night before kidney transplantation could reduce the risk of acute allograft rejection in renal transplant recipients. However, further studies with a greater number of patients should be conducted to confirm these results.

Screening for renal artery stenosis in patients with aorticoiliac occlusive disease.

BACKGROUND: The prevalence of atherosclerotic renal artery disease has increased with improved life expectancy. Because renal artery stenosis is a potentially correctable cause of hypertension and ischemic nephropathy, early identification of this entity may lead to proper hypertension control and improved renal function and survival. The aim of this study was to determine the prevalence and patterns of subclinical renal artery stenosis in patients with aorticoiliac atherosclerosis. PATIENTS AND METHODS: The abdominal angiographies of 44 patients with high-grade aorticoiliac occlusive disease (> 70% stenosis) were reviewed for evidence of renal artery stenosis. This was compared to a group of 20 patients with mild-to-moderate aorticoiliac disease (< 70% stenosis). These patients had no history of renal artery disease or renal failure. RESULTS: In patients with high-grade aorticoiliac occlusive disease, renal artery stenosis was found in 25 patients (56.8%); 13 with unilateral (29.5%) and 12 (27.3%) with bilateral involvement. A hemodynamically significant stenosis (> 50%) was found in 11 patients (25%), one of whom had bilateral stenosis (2.3%). High-grade renal artery stenosis (> 70%) or complete arterial occlusion was noted on seven sides (7.9%). The most common sites of stenosis were the origin and first centimeter of the renal artery. In patients with mild-to-moderate aorticoiliac disease, renal artery stenosis was found in two patients (10%). CONCLUSIONS: The present study revealed that subclinical renal artery disease may be present in more than half of the patients with high-grade aorticoiliac atherosclerosis highlighting the need for proper risk stratifications and screening programs. Based on our results, we suggest that examination of the renal arteries in these patients may be necessary in order to delay or prevent complications. Additionally, such information may have important therapeutic implications in planning reconstructive vascular surgeries or percutaneous angioplasties.

A correlation between direct and indirect Doppler ultrasonographic measures in transplant renal artery stenosis.

Screening for transplant renal artery stenosis (TRAS) with Doppler ultrasonography (DUS) is increasingly used in the era of kidney transplantation. Direct Doppler study of the stenotic site is a time- consuming and difficult method that requires an angle of interrogation parallel to the vessel. The aim of this study was to assess the correlation between the direct-PSVs (peak systolic velocity at the stenotic site), PSVs/PSVi (PSVi, peak systolic velocity of the adjacent iliac artery)-and indirect-intrarenal arterial resistive index (RI), perfusion index (PI), acceleration time (AT)-DUS findings in the kidney transplant recipients with TRAS. We performed 26 DUS studies of both intrarenal and main renal arteries in 19 TRAS patients (who had PSVs > 150 cm/s, PSVs/PSVi > 2). The mean values of PSVs and PSVs/PSVi were 212 +/- 44.19 cm/s and 2.77 +/- 0.77, respectively. The mean intrarenal RI, PI, and AT were 0.48 +/- 0.065, 0.70 +/- 0.12, and 177.8 +/- 54.6 msec, respectively. A significant negative correlation was found between PSVs and intrarenal RI (Pearson correlation coefficient (r) = -0.4, two-tailed P = .043). No correlation was found between intrarenal PI or AT and the direct DUS findings (P > .05). With a cutoff level of 0.55 for intrarenal resistive index, the sensitivity of this parameter to detect proximal renal arterial stenosis was about 85%. Conclusively, PSVs and intrarenal RI were negatively correlated. Intrarenal resistive index can be used as an screening measure for detection of TRAS.

Kidney transplantation candidates and cardiovascular risk factors.

OBJECTIVE: We sought to determine the prevalence of cardiovascular disease and risk factors among chronic renal failure (CRF) patients on the transplantation waiting list. METHODS: Fifty CRF patients on chronic hemodialysis who underwent evaluation for transplantation were compared with 60 hypertensive patients matched for age. We used Framingham scoring to calculate the absolute risk; relative risk was calculated based on the low-risk Framingham cohort. RESULTS: According to traditional risk factors, a significant difference was observed in systolic blood pressure and total cholesterol (greater in the hypertensive group), and in the prevalence of the male gender, smoking, and diabetes, which were greater in the CRF group. The latter had a greater degree of left ventricular hypertrophy, lower diastolic blood pressure, and a lower prevalence of familial history of cardiovascular disease and obesity. Patients with CRF had a greater relative risk compared with the Framingham control population, but it did not differ from that observed in the group of hypertensive individuals. CONCLUSION: The prevalence of cardiovascular disease and traditional risk factors is high among renal transplantation candidates. The Framingham equations do not adequately quantify the real cardiovascular risk; other risk factors specific for that population probably contribute to their greater cardiovascular risk.

Time-dependent variations in urine output after renal transplantation.

INTRODUCTION: Diuresis begins soon after renal transplantation. Although controversial, early post kidney transplant urine volume may correlate with favorable short- and long-term allograft survival. The aim of the present study was to examine the potential changes in urine volume within the first 6 months after renal transplantation. METHODS: In a prospective study, the first month serum creatinine level and daily urine volume were measured at 24 and 48 hours, and at 1 month after renal transplantation in patients with stable kidney function without the evidence of allograft rejection (n = 54). Fifteen patients were also followed for their urine output at least 6 months post kidney transplantation. Data are expressed in mean values +/- SD. Statistical analysis was performed by SPSS version 13.0 using ANOVA. Correlation between continuous variables was performed using the Pearson test. The P value was set at .05. RESULTS: The mean age of the renal allograft recipients was 35.5 +/- 12.1 years with a male to female ratio of approximately 1.3. The mean first month serum creatinine was 1.26 +/- 0.4 mg/dL. The mean urine outputs were 10.06 +/- 5.89, 5.45 +/- 3.05, and 3.44 +/- 1.25 L at 24 and 48 hours and 1 month post renal transplantation. Those patients who were followed for 6 months post transplant (n=15) were observed to have a mean urine volume of 3.20 +/- 1.24 L at the end of this period. This trend showed that urine volume steadily decreased from 24 and 48 hours to 1 month after renal transplantation (P<.05). However, urine volumes were rather comparable at one month and 6 months after transplantation (P>.05). A positive correlation was found between the first-month serum creatinine and the urine volume at one month (r=0.302 and P=.035). CONCLUSION: Although urine volume showed considerable variation early after renal transplantation, it stabilized by 1 month after transplantation, which was also positively correlated with the first-month serum creatinine. Moreover, we concluded that in stable patients, the final urine output was related to early graft function.

Calcitriol started in the donor, expands the population of CD4+CD25+ T cells in renal transplant recipients.

OBJECTIVES: Alloreactive T cells recognize antigens via direct and indirect pathways. The competency of costimulatory molecules on antigen-presenting cells (APC) is important. An active form of vitamin D (1,25(OH)(2)D(3), calcitriol) inhibits APC cell maturation and expression of costimulatory molecules. Herein we studied the immunosuppressive effects of calcitriol, which was started in the donors and continued in the kidney recipients. METHODS: In this prospective study, candidates for living donor renal transplantation were randomly assigned into two groups: the treatment group were prescribed calcitriol (0.5 microg/day) started in the donor 6 days before donation and continued in recipient side for 6 months after transplantation. The control group received the conventional immunosuppressive regimen, namely, cyclosporine/mycophenolate mofetil and prednisolone. In each group, a recipient blood sample was obtained before and 6 months after transplantation. Diagnostic study of the T-cell markers-CD3, CD4, and CD25-were performed with a flow cytometry technique. RESULTS: The mean values of CD3(+)CD4(+)CD25(+) T cells in the treatment group (four women and five men; 40.8 +/- 8.5 years) and the control group (four women and six men; 37.2 +/- 10 years) were at 14.2 +/- 4.2% and 15.4 +/- 4.5% of total peripheral lymphocytes. Six months after transplantation, these percentages increased to 29 +/- 6.3% in the treatment group and decreased to 12.1 +/- 4.5% in the controls (P<.0001). No clinical rejection was detected in either group during the study period. CONCLUSION: Calcitriol started in the donors and continued in the kidney allograft recipients lead to expansion of CD4(+)CD25(+) regulatory T cells in recipients. We speculated that costimulatory deficient APC for both direct and in-direct pathways may play a role.

Serum erythropoietin levels and their correlation with the erythropoietic system in hemodialysis patients and renal allograft recipients.

BACKGROUND: Following renal transplantation, serum erythropoietin (EPO) levels gradually increase during the first 2 to 3 months. However, some transplant recipients continue to remain anemic. The aim of the present study was to correlate serum EPO concentrations with hematocrit (Hct) and hemoglobin (Hb) levels in hemodialysis (HD) patients and renal allograft recipients. METHODS: In a comparative cross-sectional study, serum EPO concentrations and Hb and Hct levels were measured in 35 chronic HD patients and 40 transplant recipients who had stable kidney function for at least 6 months after transplantation (group 1). The HD patients were further divided based on their recombinant human (rHu) EPO supplementation into those who received rHu EPO during dialysis (group 2A, n=15) and those who were not on rHu EPO (group 2B, n=20). Data are presented as mean values +/- SD. The statistical analysis was performed by SPSS version 11.0 using chi-square, ANOVA, and Pearson correlation tests. A general linear model (GLM) was used to compensate for the effects of age. The P value for significance was set at .05. RESULTS: Group 2B patients tended to be older than groups 1 and 2A (P=.014). The sex ratios were comparable among groups. Mean EPO level was 17.09 +/- 10.99 mIU/mL in recipients, which was comparable with that of HD patients (18.54 +/- 26.18 mIU/mL; P>.05). No significant correlation was observed between the serum EPO concentrations and Hb and Hct levels in recipients (P>.05). When comparing the 3 groups, EPO was not correlated with Hct and Hb in any group. Hb and Hct were significantly higher among HD patients not on rHu EPO therapy (P=.02). GLM, with age as a covariate, did not yield a significant difference between EPO levels of the studied groups (P=.36). CONCLUSIONS: This study showed that serum EPO level was in the normal range in recipients and HD patients. We were not able to find any correlation between Hb and Hct levels and EPO concentrations in any group of patients irrespective of rHu EPO supplementation. Hence, impaired EPO stimulatory effects may be considered a potential contributor to anemia in these patients.

Black tea improves endothelial function in renal transplant recipients.

BACKGROUND: Endothelial damage and dysfunction are commonplace in renal transplant recipients. Impaired endothelial function is an important contributor to cardiovascular diseases. We hypothesized that short-term black tea consumption may improve endothelium-dependent arterial dilation in kidney recipients. METHODS: Fifteen recipients were studied on an outpatient basis in a single, university-affiliated clinic. Inclusion criteria were stable and good allograft function. The main exclusion criteria were uncontrolled hypertension, smoking, alcohol consumption, coffee drinking, diabetes mellitus, and coronary artery disease, or a history of upper limb vascular manipulations. After overnight fasting, the brachial artery diameter (BAD) was measured at the end of diastole using an ultrasound machine before (basal BAD) and 1 minute after temporary ( approximately 3 minutes) external occlusion (posthyperemia BAD). Flow-mediated vasodilation (FMV) and percent of FMV (FMV%) were calculated by appropriate formula. FMV and FMV% were determined at baseline and 2 hours after consuming 0.5 L freshly brewed black tea. For control, the study was repeated for each patient the next day and FMV and FMV% were determined before and 2 hours after consuming 0.5 L of water. RESULTS: The men age of patients was 37.2 +/- 9.7 years (range, 25 to 50) with a male:female ratio of 3:2. Patients were 26.8 +/- 10.6 months postrenal transplantation. Black tea consumption significantly increased posthyperemia BAD, FMV, and FMV% (P<.05). However, water consumption did not alter the basal or posthyperemia BAD, FMV, or FMV% (P>.05). CONCLUSION: Based on our study, short-term consumption of black tea may improve endothelial function and endothelium-dependent arterial vasodilation in renal transplant recipients.

Renal allograft hemodynamic and diameter changes after living donor transplantation.

Renal ultrasound is a valuable tool to measure allograft diameters and hemodynamic changes, some of which may help us to predict ongoing rejection. Longitudinal (L) and horizontal (H) diameters, and resistive index (RI) of intrarenal arteries of kidneys were measured before transplantation in the donor site, as well as 1 week after transplantation in the recipient site (7.5 MHz probe). We excluded patients with acute rejection, delayed graft function, perinephric collection, suspected allograft artery stenosis, or serum creatinine >2 mg/dL. Finally, allograft measurements were compared with the donor parameters. The mean values of L and H diameters in 32 normal allografts were: L 119 +/- 10.4 mm; H 54 +/- 8.4 mm; L/H ratio 2.25 +/- 0.27; RI 0.57 +/- 0.55. The mean values of these measurements when the kidney was in the donor body were: L 110 +/- 9.4 mm; H 44.3 +/- 5.4 mm; L/H ratio 2.97 +/- 0.25; RI 0.61 +/- 0.040. Both L and H diameters were increased significantly after transplantation, but the L/H ratio and RI were decreased significantly (P < .05). The presumed physiologic explanations for these findings in allograft are increased blood flow, decreased intrarenal arterial resistance, stress relaxation, and lack of sympathetic innervation.

Effects of azathioprine and mycophenolate mofetil-immunosuppressive regimens on the erythropoietic system of renal transplant recipients.

INTRODUCTION: Azathioprine (AZA) and mycophenolate mofetil (MMF) are major immunosuppressants used to prevent rejection following renal transplantation. Bone marrow suppression is a potential adverse effect of these agents manifesting itself as leukopenia, thrombocytopenia, and anemia. The aim of this study was to compare the effects of AZA versus MMF immunosuppressive regimens on the erythropoietic system of renal transplant recipients within 6 months after transplantation. METHODS: Eighty kidney allograft recipients who were on AZA (n = 40) or MMF (n = 40) plus cyclosporine and prednisolone were enrolled in this study. Hematologic parameters included red blood cell counts, hemoglobin (Hb), hematocrit, mean corpuscular volume, mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) and were measured before and at 1 week, as well as 1 and 6 months posttransplantation. Plasma erythropoietin level was measured at the end of 6 months. Statistical analysis was performed with Student t test; a P value less than .05 was considered significant. RESULTS: There was no significant difference between the two groups regarding red blood cell counts. High Hb level was noted at 1 and 6 months posttransplantation among patients who received MMF. MCH and MCHC were higher among patients on MMF compared with those on AZA at 1 week and 1 month posttransplant. Although the mean plasma erythropoietin levels in AZA-treated patients were higher than those of MMF-treated patients, the trend did not reach statistical significance (P = .066). CONCLUSION: MMF administration was apparently associated with a higher level of hemoglobin compared with AZA among renal allograft recipients with good graft function at 6 months posttransplantation.

Unexplained pulmonary hypertension in peritoneal dialysis and hemodialysis patients.

OBJECTIVES: To compare the prevalence of unexplained pulmonary artery hypertension (PAH) in hemodialysis (HD) and peritoneal dialysis (PD) patients and to compare laboratory parameters between patients with unexplained PAH and those with normal pulmonary artery pressure (PAP). METHODS: We retrospectively reviewed the medical records of 278 chronic HD and 145 chronic PD patients. Laboratory findings including hemoglobin, calcium, phosphorus, alkaline phosphatase, albumin, parathyroid hormone level, serum iron, total iron binding capacity, ferritin, creatinine and blood urea nitrogen were documented. The results of transthoracic Doppler echocardiography were used to determine the pulmonary artery pressure (PAP). PAH was defined as a systolic pulmonary artery pressure (SPAP) ≥35 mmHg. To rule out secondary PAH, patients with cardiac disease, pulmonary disease, collagen vascular disease, volume overload at the time of echocardiography and positive human immunodeficiency virus test were excluded. RESULTS: Data from 34 patients in group HD and 32 individuals in group PD were analyzed. The median age of the study population was 57 (45-68) years. The median SPAP value in patients with PAH was 37.5 (35-45)mmHg. According to the echocardiographic findings, PAH was found in 14 (41.1%) patients of HD group and in 6 (18.7%) patients of PD group (P=0.04). The median serum iron and hemoglobin was significantly lower in patients with PAH compared to those in patients with normal PAP (P<0.05). CONCLUSION: Unexplained PAH seems to be more frequent in patients undergoing HD than patients in PD group. Moreover, hemoglobin and serum iron levels are lower in patients with PAH compared to those in normal PAP group.