Relationship between donated kidney volume determined by ultrasound adjusted for clinical factors and 1-month and 1-year creatinine clearance: A retrospective study.

BACKGROUND: Graft volume as a surrogate of nephron numbers correlates with allograft function. The primary aim of this study was to correlate renal volume determined by ultrasound, adjusted to recipient clinical parameters in order to determine post-transplant renal function at the end of the first year. MATERIALS AND METHODS: A total of 140 patients were enrolled in this study, including 75 males, with a total mean age of 41.2 ± 13.5 years. Clinical data of all donors and recipients undergoing kidney transplantation at our institution between 2003 and 2019 were reviewed. The volume of transplanted kidney was measured by ultrasonography on the fifth day after the operation and correlated with recipients' clinical parameters and then adjusted with first-month and first-year post-transplantation creatinine clearance. RESULTS: The mean allograft volume measured using ultrasonography was 175.0 ± 37.2 mL. Absolute donor kidney volume had a non-significant correlation with creatinine clearance at 1 month and at 1 year after transplantation. The kidney volume/recipient body weight ratio had a positive, and significant, correlation with creatinine clearance at 1 month and at 1 year after transplantation (r = 0.326, p < 0.001, and r = 0.183, p = 0.038, respectively). CONCLUSION: Our data demonstrated that 12-month creatinine clearance is influenced by ratio of donated kidney volume/recipient body weight.

Determining host factors contributing to the reactivation of JC virus in kidney transplant recipients.

BACKGROUND AND AIMS: The John Cunningham virus (JCV) is the established etiological agent of the polyomavirus-associated nephropathy among renal transplant recipients. In the present study, we aimed to determine the probable predictive factors leading to JCV replication in renal transplant patients. MATERIAL AND METHODS: Urine and plasma samples were collected from a total of 120 consecutive renal-transplanted patients without preliminary screening from Jan 2018 to Mar 2019. After DNA extraction, the simultaneous detection and quantification of JCV and BK polyomavirus (BKV) were conducted using a Real-time quantitative PCR method. Moreover, statistical analyses were performed using the statistical software packages, SPSS version 21. RESULTS: The prevalence of JCV viruria and viremia among renal transplant recipients were 26 (21.67%) and 20 (16.67%), respectively. A significant association was observed between the JCV and two risk factors, diabetes mellitus (P = 0.002) and renal stones (P = 0.015). The prevalence of JCV viremia among recipients who were grafted near time to sampling was significantly higher (P = 0.02). There was a statistically significant coexistence between BK and JC viruses among our patients (P = 0.029). The frequency of JCV viruria in males was reported almost three times more than in females (P = 0.005). The JCV shedding in urine was significantly associated with the tropical steroids like prednisolone acetate, which have been the standard regimen (P = 0.039). Multivariable analysis revealed duration of post-transplantation (OR, 0.89; P = 0.038), diabetes mellitus (OR, 1.85; P = 0.034), and renal stone (OR 1.10; P = 0.04) as independent risk factors associated with JCV viremia post-renal transplantation. CONCLUSION: It seems that the discovery of potential risk factors, including immunological and non-immunological elements, may offer a possible preventive or therapeutic approach in the JCV disease episodes. The results of this study may also help clarify the probable clinical risk factors involving in progressive multifocal leukoencephalopathy development.

Evaluation of the Effect of Lavender Aroma on Fatigue Among Hemodialysis Patients.

Fatigue is a complication of hemodialysis (HD). We examined the effect of aromatherapy on fatigue in 62 HD patients. Data were collected using a questionnaire and the Piper Fatigue Scale. It was found that fatigue decreased in the intervention group (P < .05). Lavender aromatherapy is useful in reducing fatigue.

COVID-19 in renal transplant recipients and general population: a comparative study of clinical, laboratory, and radiological features, severity, and outcome.

INTRODUCTION: Coronavirus disease 2019 (COVID-19), a novel disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to millions of deaths worldwide. Kidney transplant recipients (KTRs) are a fragile population due to their immunosuppressed status. However, there are limited studies available comparing this population with the general population regarding clinical symptoms, and laboratory and imaging features as well as disease severity and clinical outcomes. METHODS: A total of 24 KTRs and 40 patients from the general population (control group) were enrolled after applying exclusion criteria. Clinical symptoms, laboratory values, and lung involvement patterns in high-resolution computed tomography (HRCT) were compared between KTRs with COVID-19 and their counterparts from the general population. Moreover, the category of disease severity and adverse outcomes such as intensive care unit (ICU) admission, mechanical ventilation (MV), and mortality rate were also compared between these two groups. RESULTS: Hypertension was significantly higher among KTRs. Dyspnea was significantly more among the control group (P = 0.045). There was no significant difference in the rest of clinical symptoms (P > 0.05). There was no significant difference in CT features as well, except pleural effusion, which was more prevalent in the control group. A lower absolute lymphocytic count (ALC) and platelet count were observed in KTRs. Renal transplant recipients (RTRs) had a higher elevation in creatinine level than their counterparts. The ICU admission, MV, duration of hospital stay, and mortality as adverse outcomes were not significantly different between the KTR and control groups. CONCLUSION: In conclusion, there was no significant difference in the severity and risk of adverse outcomes, including MV, ICU admission, and mortality between KTRs under chronic immunosuppression and the control group.

Analysis of risk factors influencing the BK polyomavirus replication in patients with ESRD waiting for kidney transplantation.

BACKGROUND: Since the pre-transplant status affects the renal transplantation success and ultimately the survival rate, identifying the probable risk factors that increase the chance of BK virus replication in end-stage renal disease patients can be included in proposing proper surveillance guidelines during pre and post-transplantation. METHODS: A descriptive cross-sectional study was performed by collecting plasma samples from 192 ESRD patients undergoing hemodialysis for at least 3 months. Quantitative Real-time PCR assay was used to detect and measure the BK viral load. Demographic and clinical characteristics of the patients who had BK viremia were documented. RESULTS: 14 (7.3%) out of our 192 participants had BK virus viremia (95%CI 4.2%-11.6%). Demographic characteristics including etiology of ESRD and underlying diseases, mean duration and frequency of dialysis, co-infection with HBV and HCV did not affect the virus replication, since the difference between patients with BK virus viremia and BK virus negative individuals was not statistically significant. However, the statistical significance of the mean age of men with BKV and without BK virus viremia was found (OR: 3.42, P = 0.02 95%CI 0.86-13.61). Also, multiple regression analyses of some other parameters revealed that old age, high body mass index and male gender can be predictive factors of BK virus viremia in ESRD patients. CONCLUSION: Based on our findings, elderly male had higher chance of being exposed to BK virus viremia. Some other demographic characteristics such as a high BMI, old age and gender (male) can increase the risk of BK viremia in patients with ESRD prior to kidney transplantation.

Clinical characteristics and outcome of COVID-19 pneumonia in kidney transplant recipients in Razi hospital, Rasht, Iran.

BACKGROUND: In late December 2019, a novel coronavirus SARS-CoV-2 started to spread around the world in different populations. Its clinical and laboratory characteristics and outcome in kidney transplant recipients are little known. Therefore, we describe 22 kidney transplant recipients with SARS-CoV-2-induced pneumonia. METHODS: All kidney transplant recipients who referred to the Razi Hospital of Rasht with a diagnosis of SARS-CoV-2 infection from February 20 to 19th of April 2020 have been included in this observational study. RESULTS: We present 22 cases of COVID-19 in kidney transplant recipients (median age 52 years [interquartile range 40.75-62.75 years]) and baseline eGFR 60 (mL/min/1.73 m2 ) (44.75-86.75). Patients complained of cough (72.7%), dyspnea (63.6%), fever (68.2%), and chill (72.7%) with greater prevalence. We decreased the dose of immunosuppression and started stress dose of intravenous hydrocortisone or equivalent oral prednisolone. Each patient received antiviral therapy based on the latest updated version of local protocol at the time of admission. CT scan findings in 90.9% of patients showed bilateral multifocal lesions. Acute kidney injury (AKI) was observed in 12 patients during hospitalization. Six patients died after a median of 12 days from admission (IQR, 1-21). CONCLUSIONS: In this small observational study, we observed high AKI occurrence and mortality rate in kidney transplant recipients with COVID-19.

Residual kidney function and sleep quality in hemodialysis patients.

Background: Sleep disorders frequently affect end-stage renal disease patients on dialysis. However, the relationship between sleep quality and residual kidney function is still unclear. Therefore, this study aimed to investigate this relationship. Methods: In this analytical cross-sectional study, 225 patients who were referred to dialysis centers were studied, and based on renal function, they were classified into two groups with and without residual kidney function. The study employed the Pittsburgh Sleep Quality Index questionnaire to evaluate sleep quality. Multiple linear regression was utilized to determine the factors affecting sleep quality with a significance level consideration at p<0.05. Results: The mean age of patients was 58.23 ± 13.50 years. 58.7% of patients were males. The problem of serious and very serious sleep in the Sleep latency and sleep duration has been more than other components. 72% of hemodialysis patients had poor sleep quality. In the multiple linear regression model, age (ß = 0.442, 95% CI: 0.096, 0.788), sex (ß = -0.847, 95% CI: -1.641, -0.054), Body mass index (ß = 0.153, 95% CI: 0.058, 0.249) and dialysis duration (ß = 0.097, 95% CI: 0.002, 0.192) were independently and significantly associated with sleep quality score. However, there was no statistically significant relationship between sleep quality and residual kidney function. Conclusion: In conclusion, poor sleep quality is very common in patients undergoing hemodialysis. Therefore, sleep disorders in hemodialysis patients should be considered as one of the most challenging problems by healthcare providers, and early diagnosis and intervention are essential to improve sleep quality.

Comparison of the Effect of Omega-3 vs. MCT Supplementation on Iron-Related Indices in Patients Undergoing Dialysis.

Chronic kidney disease (CKD), characterized by progressive kidney failure, significantly increases mortality and comorbidity risks such as anemia. This study contrasts the impacts of omega-3 and medium-chain triglycerides (MCT) oil on levels of iron, ferritin, total iron-binding capacity (TIBC), hemoglobin (Hb), and transferrin saturation in patients with CKD undergoing dialysis. This interventional trial was conducted on 120 patients with CKD undergoing dialysis in Rasht, Iran. For 8 weeks, the omega-3 group was orally administered three 1000-mg capsules of omega-3 fatty acid supplement, and the MCT group was administered three 1000-mg capsules containing MCT oil daily. Serum concentrations of ferritin, iron, TIBC, Hb, and transferrin saturation were assessed pre-intervention and after the intervention. There was a significant increase in serum iron levels in the MCT group compared to the omega-3 group (103.72 ± 57.8 vs. 77.48±40.13; P = 0.031). No effect was found regarding other iron-related factors such as TIBC, Hb, transferrin saturation, and ferritin levels. The results of our study indicated that taking MCT oil increased serum iron levels compared to omega-3 supplementation in patients with CKD undergoing dialysis. Further research is needed to better understand the potential benefits of MCT oils in patients with CKD.

The effects of omega-3 fatty acids supplementation on hemoglobin, hematocrit, and platelet levels of patients with ESRD condition undergoing dialysis.

Background: Concomitant inflammation may boost the cardiovascular complications in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Omega-3 fatty acids may have certain health benefits in HD patients. The aim of this study was to investigate the effects of omega-3 fatty acids supplementation on hematocrit (HCT), hemoglobin (HB) level and platelet (PLT) counts of HD patients. Methods: A randomized controlled trial was conducted on HD patients at a private dialysis center in Rasht, Iran. Three omega-3 fatty acid supplement capsules (3 g/d) were administered daily for two months to patients in the intervention group (n = 55). The control group (n = 60) were given three placebo capsules containing medium chain triglyceride (MCT) oil, similar to the supplemental dose of the intervention group at the same period. Three parameters of HCT, HB and PLT were measured at baseline and after the intervention. Results: The PLT count decreased in the intervention group compared to the control group (173.38 ± 74.76 vs. 227.68 ± 86.58 103/mm3, F = 4.83, P = 0.03). No significant change was found on the levels of HCT and HB parameters between the two groups after the intervention. Conclusion: Omega-3 supplementation in HD patients may decrease the risk of forming blood clots in the blood vessels. Further studies are warranted.

Effectiveness of omega-3 fatty acid supplementation for pruritus in patients undergoing hemodialysis.

Background: Patients undergoing hemodialysis (HD) frequently experience the chronic kidney disease-associated pruritus (CKD-aP). Objective: The aim of this study was to investigate the effectiveness of omega-3 supplementation in the management of CKD-aP in patients undergoing hemodialysis. Methods: In this triple blind, randomized clinical trial, the effect of the omega-3 supplement on uremic CKD-aP was assessed in 112 chronic hemodialysis patients at Caspian Hemodialysis Center in Rasht, Iran. Patients were randomly divided into the intervention group receiving omega-3 supplements (3 g/day) and the control group receiving placebo containing MCT oil for 2 months. Results: Omega-3 supplementation had no effect on CKD-aP. The results did not change after adjusting for age and sex, additional adjustments for weight, height, physical activity, smoking, and alcohol use, additional adjustments for underlying diseases and weight, height, physical activity, smoking, and drinking alcohol, and further adjustments for underlying diseases and biochemical indices. Discussion: Omega-3 supplementation for 2 months had no effect on CKD-aP in patients with CKD. Further studies with longer duration are warranted. Clinical Trial Registration: https://www.irct.ir/trial/66638, IRCT20151226025699N6.

Muco-cutaneous manifestations in 178 renal transplant recipients.

INTRODUCTION: Mucosal membrane and skin can be affected by immunosuppressive drug(s) and immunosuppression itself. The spectrum of muco-cutaneous lesions can range from malignancy at one end to infection, iatrogenic lesions, and esthetic effects on the other end. METHOD: In Razi Hospital of Guilan University of Medical Sciences, a cross-sectional study for the detection of muco-cutaneous lesions in 178 renal transplant recipients (RTRs) was conducted from the years 2001 to 2006. Biopsy and skin scraping according to the type of skin lesions were performed. RESULTS: A total of 31 RTRs (25%) had normal skin. Iatrogenic lesions were the most common (70%) followed by infectious lesions (57%), and miscellaneous skin lesions were exhibited by 26% of the patients. Among the iatrogenic skin lesions, gingival hyperplasia was the most common lesion (48%), followed by hypertrichosis and acne. Malignant lesions (biopsy proven) were recorded in seven patients (5%). Four patients were found to have Kaposi's sarcoma, and three patients were identified with basal cell carcinoma. CONCLUSION: Our results showed that muco-cutaneous lesions are crucial problems with RTRs. Attending physicians must pay close attention to skin care regularly and consider reduction of immunosuppression to a safe level, and patient must have self-checkups.

Schrier Robert W.

No Abstract.

Relation Between Fibroblast Growth Factor-23 and Red Cell Distribution Width in Patients with End-Stage Renal Disease Undergoing Hemodialysis.

INTRODUCTION: Fibroblast growth factor-23 (FGF23) is responsible for regulating the metabolism of phosphorus and vitamin D by affecting the kidneys and parathyroid gland. Phosphate is present in the 2, 3-diphosphoglycerate (2,3DPG) ester composition, which can shift the O2-Hb dissociation curve to the right. Therefore, we hypothesized that maybe there is an association between red cell distribution width (RDW) and FGF23 level. The aim of this study was to investigate the relationship between iFGF23 and RDW in patients with end-stage renal disease undergoing hemodialysis. METHODS: This cross-sectional study was performed on 254 endstage renal diseases (ESRD) patients undergoing hemodialysis who were admitted to Rasht Razi Hospital Hemodialysis Center, in 2017. We used Shapiro-Wilk, Spearman correlation coefficient, Mann- Whitney U-test, and Multiple Linear Regression Analysis. All statistical analyses were performed by SPSS software. RESULTS: The median age of patients was 60 years (IQR: 49 to 69). The mean and median iFGF23 concentration in patients were 59.5 ± 14.6 and 62 (IQR: 49 to 69) pg/mL, respectively. According to spearman test, iFGF23 had a statistically significant association with age (r = 0.856, P < 0.001), MCV (r = 0.202, P < .001), phosphorus (r = -0.176, P < .05), weight difference before and after dialysis (r = -0.264, P < .05), and Vitamin D (r = -0.201, P < .05). Also in multiple linear regression analysis, the variables of RDW, IDWG, iPTH, MCH, DM, HTN, Age, and CRP were considered as predictors of iFGF23 . CONCLUSION: RDW was identified as one of the predictors of iFGF23 changes. Perhaps in the future, more value will be given to the role of RDW in dialysis patients. DOI: 10.52547/ijkd.6502.

Bone Mineral Density and Related Factors in Renal Transplant Recipients, in the North of Iran.

INTRODUCTION: Renal transplantation can lead to or be associated with Low bone mineral density (BMD). The aim of this study is evaluation of BMD and related factors in our renal transplant patients. METHODS: In this descriptive cross-sectional analytical study, 148 kidney transplant patients from university hospital, were enrolled. BMD of hip and lumbar spine was measured by dual-energy X-ray absorptiometry (DXA) and patients were divided into 3 groups: normal, osteopenia, and osteoporosis; according to T-score. Laboratory parameters and a series of variables were investigated, and the results were compared with BMD findings. RESULTS: In this study, 73 patients (49.3%) had osteopenia and 28 patients (18.9%) were osteoporotic. BMI was significantly lower in the osteoporosis group compared with the normal group (P < .05). Cumulative dose of prednisolone and calcium supplement were higher in osteoporotic group compared with normal group. CONCLUSION: According to our results, osteoporotic and osteopenia groups have lower BMI that is associated with lower BMD. This can lead to increased risk of bone fractures in the future. Early discontinuation or reduction of prednisolone dose can improve BMD.

Investigating Risk Factors for the Development of BK Virus Infection in Kidney Transplant Recipients in Guilan Province during 2007-2015.

PURPOSE: Polyomavirus nephropathy has been recognized as an important cause of silent loss of kidney transplant function in up to 50% of kidney recipients (1). The present study aimed to evaluate the risk factors associated with BK virus infection in kidney transplant recipients. MATERIALS AND METHODS: Clinical information, urinary Decoy cells, and blood polymerase chain reaction (PCR) tests were collected for polyomavirus infection in 223 kidney transplant recipients undergoing surgery at Razi hospital at Guilan University of Medical Sciences between 2007 and 2015. Kidney biopsies were performed in patients with BKPyV- DNAemia more than 10,000 Copies/ml or increased plasma creatinine. RESULTS: Among 223 patients, 116 (52%) were male. The mean age of participants was 49.57±13.48 years. Out of 223 participants, 41 (18.4%) had Decoy cells in their urine, and 182 (81.6%) did not, 15 of whom (6.7%) had viral genome in their blood. Only did 3 patients out of 10 have BK Virus nephropathy in their kidney biopsy. Among risk factors, it was found that post-transplant duration (P< 0.001) and the use of anti-thymocyte globulin (P= 0.001) were the most significant risk factors for finding decoy cells in patients' urine. CONCLUSIONS: Post-transplant time, particularly the first 6 months, was found as the most important risk factor for the reactivation of polyomavirus infection in our patients because of strong immunosuppression and use of anti-thymocyte globulin (for prophylaxis or rejection treatment). It is concluded that kidney transplant recipients should be monitored in episodically after transplantation.

Incidence and Risk Factors of Post-renal Transplantation Malignancies in North of Iran, A 20-year Experience.

INTRODUCTION: The main causes of death in kidney transplant recipients are cardiovascular diseases and malignancy. This study aimed to determine the types of post-transplant malignancy, incidence, and related factors in renal transplant recipients referred to Razi Hospital in Rasht, Iran. METHODS: This retrospective cross-sectional study was conducted on 549 kidney transplant recipients between 1998 and 2018. Patient-, transplant-, and medication-related factors and pathology reports were recorded in the check list. Chi-square, T-test and Logistic Regression were used to investigate the effect of variables. Malignancy-person-year incidence rate was calculated using survival tables and Kaplan-Mayer analysis. RESULTS: 43 (7.8%) recipients had malignancies. The most common site of malignancy was the skin (53.5%). Non-Melanoma Skin Cancer (NMSC) was the most common cancer (32.6%) followed by Kaposi sarcoma (20.9%). The standardized incidence ratio (SIR) of post-transplant malignancies in renal transplant recipients was 26.9 times the malignancies in Guilan province and 21.7 times the malignancies in Iran. Cox proportional hazard models identified older age at the time of transplantation and history of azathioprine consumption seems to be associated with risk for post-transplant malignancy. CONCLUSION: The most common malignancies in these people were non-melanoma skin cancer, Kaposi sarcoma and then GI malignancies. According to the information obtained in this study, regular periodic examinations of kidney transplant recipients for early detection of malignancy is important.

Investigating the Relationship Between Blood Pressure and Serum FGF23 Level in Patients Undergoing Hemodialysis in Guilan Province, A Cross Sectional Study.

INTRODUCTION: The aim of current study is investigation of theimpact of serum FGF23 levels on blood pressure of patients withend-stage renal disease (ESRD) undergoing hemodialysis. METHODS: Based on registry, 68 patients who underwent hemodialysis(HD) in the dialysis center of Shahid Beheshti hospital, Anzali,north of Iran, from April 2016 to May 2017 were enrolled. Enzyme-Linked ImmunoSorbent Assay (ELISA) was used to determineserum FGF23 levels. 24 hours blood pressure monitoring method,AMBB, was used to monitor the mean arterial pressure of patients.Spearman related analysis method was used to statistically analyzethe correlation of serum FGF23 level with mean arterial pressure,age, HD duration, kt/v, URR weight gaining, cause of ESRD, andthe mentioned laboratory parameters. RESULTS: Serum FGF23 levels of ESRD patients were not significantlyrelated to age, time of HD and gaining weight. Furthermore,these parameters were not related to blood pressure. However,FGF23 expression levels in serum were positively correlated withphosphorous and calcium- phosphorous. The mentioned laboratoryparameters had no significant correlation with 24 hours bloodpressure changes. Meanwhile, the minimum diastolic pressureand intact parathyroid hormone (iPTH) level showed a significantdirect linear correlation. CONCLUSION: We suggest that understanding relationship betweenphosphate, FGF23 and cardiovascular disease can be applied intargeted phosphate-based treatment. Kidney failure and the nondippercondition may be highly related to one another and leadto ESRD. Therefore, a special investment in controlling bloodpressure and examining it with a tool such as ABPM can greatlyhelp patients to progress effectively.

BK virus replication in renal transplant recipients: Analysis of potential risk factors may contribute in reactivation.

BACKGROUND: Considering the increasing problem of BK virus infection during post renal transplant surveillance, it is necessary to distinguish the main risk factors leading to reactivation of latent BK virus. Up to now, some probable risk factors have been investigated in some studies, but the results have been confusing and contradictory. OBJECTIVES: The goal of the present study was to determine the frequency and potential risk factors that may play a role in BK polyomavirus reactivation and nephropathy. STUDY DESIGN: In this cross-sectional study, 110 patients, who underwent consecutive transplantation between 2010 and 2013, were enrolled without preliminary screening. Urine and blood samples were taken, and quantitative Real-time PCR assay was used to detect and measure the viral load. Demographic and clinical characteristics of the patients who had BK viremia and/or viruria were documented. RESULTS: Among 110 cases of renal transplant recipients, BK viruria and viremia were found in 54 (49%) and 22 people (20%) respectively. The pre-transplant durations of dialysis among patients with BK viruia were found longer in comparison to BK negative patients. Treatment with Tacrolimus (p=0.03) was found to be a risk factor for development of BK viruria. In patients with viruria and viremia the median creatinine levels were 1.45mg/dl and 1.35mg/dl respectively, which were higher than those in the patients with negative results for BK viruria (p=0.002) and viremia (p=0.02). Also, treatment with Cyclosporine could significantly increase the incidence of BK virus shedding in both urine and blood among patients who received it (p=0.01). Significant relation between reactivation of BK virus and other factors such as age, sex, acute rejection and diabetes was not found. CONCLUSION: Based on our findings, the main potential risk factors for shedding of BK virus into urine in renal transplant recipients were prolonged pre-transplant dialysis and Tacrolimus regimen. Cyclosporine regimens could be considered as risk factor for both BK viruria and viremia. A significant correlation between BK virus replication and elevated creatinine level was seen among our patients.

Cytomegalovirus disease with atypical presentation in a renal transplant patient: case report.

Infection is a major problem after kidney transplantation. Cytomegalovirus (CMV) is the most common viral infection affecting transplant patients. This report presents a rare clinical manifestation of CMV in the form of a hemorrhoid in a 58-year-old woman. One week after undergoing an external hemorrhoidectomy, the patient presented with fever, leukopenia, and thrombocytopenia. Pathological analysis showed CMV in the hemorrhoidal tissue, which was confirmed via a positive PP65 antigenemia assay. Therapy with ganciclovir (250 mg IV b.i.d. for 2 weeks) was started. The patient's response to treatment was good, and she has been doing well since that time. Her plasma creatinine level 2 years later was 79.2 micromol/L (normal range, 53-106 micromol/L). Physicians must always be aware of the hazards of CMV in immunocompromised patients with typical, and even with atypical, presentations. Taking into consideration the statement, "prophylaxis precedes treatment," nephrologists must try to detect CMV in their patients (especially during the first 6 months after transplantation) prior to the appearance of any clinical manifestations. If CMV is detected, pre-emptive therapy with ganciclovir should be started.

Hyperhomocysteinemia and assessment of its associated factors in renal transplant recipients: a single-center study in northern Iran.

INTRODUCTION: Hyperhomocysteinemia (hyperHcy) is an important risk factor for atherosclerosis, which is currently a major cause of death in renal transplant patients (RTRs). The aim of this study was to determine the associated factors of hyperHcy in RTRs in northern Iran. METHODS: In 148 stable RTRs, total serum homocysteine (tHcy) level, folate, serum albumin and creatinine, creatinine clearance, lipid status, body mass index (BMI), and blood cyclosporine levels (C0 and C2) were determined. The mean doses of cyclosporine A (mg/kg/day) were recorded. RESULTS: In this analytic cross-sectional study the prevalence of hyperHcy was 70.3%. Hyperhomocysteinemia was defined as total serum homocysteine of 12 µmol/L or greater. The comparison of the group of 44 patients with tHcy level less than 12 and the group of 104 patients with tHcy level of 12 µmol/L or greater revealed that those subjects with hyperHcy were mostly younger, male, with lower BMI, history of glomerulonephritis, higher serum level of uric acid, and blood cyclosporine trough level (C0) and used higher doses of cyclosporine A. Significant correlation was found between tHcy level and recipients age, serum creatinine, BUN, folate concentrations, and creatinine clearance. However, multivariate analysis indicated that serum folate (P=0.01), vitamin B12 (P=0.05), creatinine (P=0.03), and BUN (P=0.05), and blood cyclosporine trough level (C0, P=0.005) were independently associated with tHcy levels. CONCLUSION: HyperHcy persists after successful kidney transplantation in the majority of RTRs. Serum creatinine, BUN, folate and vitamin B12, and blood cyclosporine trough level (C0) are independently associated with tHcy levels.