Prevalence of chronic kidney disease and its associated risk factors: the first report from Iran using both microalbuminuria and urine sediment

The incidence of major risk factors of chronic kidney disease [CKD] in the world is on the rise, and it is expected that this incidence and prevalence, particularly in developing countries, will continue to increase. Using data on urinary sediment and microalbuminuria, we aimed to estimate the prevalence of CKD in northeast Iran. In a cross-sectional study, the prevalence of CKD in a sample of 1557 regionally representative people, aged >/= 18 years, was analyzed. CKD was determined based on glomerular _ltration rate [GFR] and microalbuminuria. Life style data, urine and blood samples were collected. Urine samples without any proteinuria in the initial dipstick test were checked for qualitative microalbuminuria. If the latter was positive, quantitative microalbuminuria was evaluated. 1557 subjects with a mean age of 56.76 +/- 12.04 years were enrolled in this study. Based on the modi_cation of diet in renal disease [MDRD] equation, 137 subjects [8.89%] were categorized as CKD stages III-V. Based on urine abnormalities, the prevalence of combined CKD stages I and II was 10.63%, and based on macro- and microalbuminuria it was 14.53%. The prevalence of CKD was significantly associated with sex, age, marital status, education, diabetes mellitus [DM], hypertension [HTN], ischemic heart disease [IHD], waist to hip ratio, myocardial infarction [MI], and cerebrovascular accident [CVA]. CKD and its main risk factors are common and represent a definite health threat in this region of Iran. Using and standardizing less expensive screening tests in low resource countries could be a good alternative that may improve the outcome through early detection of CKD

Prevalence of renal artery stenosis and it's predictors in patients undergoing coronary angiography

Renal artery stenosis]RAS[is a frequent finding in patients with CAD. Although the prevalence of RAS in Europe and America has been reported as high as 13.5-18% in patients with suspected coronary artery disease, there is limited information about the prevalence of this disease in IRAN. To evaluate the prevalence of RAS in Iranian patients suspected of cardiovascular disease and the relationships among the vascular risk factors, renal angiography was performed in 301 patients receiving diagnostic coronary angiography, in Lalch Pars and Sasan hospitals during 10 months from Deceniber, 2006 to October 2007. RAS with stenosis diameter equal or more than 70% was considered significant. The prevalence of significant RAS was 6%]l8/301[including 15%]5[cases of unilateral stenosis and 3%]1[of bilateral stenosis]. Among to the number of diseased coronary arteries, the prevalence of RAS was, 7%, 6%, 10% and 3% of 0, 1, 2 and 3-vessel disease respectively. Thus our study showed the RAS is not significantly common in patients with established CAD, except for in those with 2-vessel disease. The prevalence in patient with hypertension was 7% and 3% in normotensive patients. So our study showed that hypertension does not have a close relationship with RAS

Acute cellular rejection

The incidence of acute rejection of the kidney allograft in the world has been around 15% during the period between 2001 and 2003. It is clinically defined as an elevation in the level of serum creatinine by more than 0.3 mg/dL and is diagnosed by kidney biopsy. On pathologic examination, the interstitium of the allograft is diffusely edematous and infiltrated by CD4 and CD8 lymphocytes. Tubulitis occurs when the lymphocytes and monocytes extend into the walls and lumina of the tubules. Presence of leukocytes determines infection or antibody-mediated rejection. Typically C4d staining is negative. Other causes of acute allograft dysfunction included prerenal factors, interstitial nephritis, infection, acute tubular necrosis, toxicity by drugs, and obstruction in the urinary tract. The primary diagnostic assessments include history, especially adherence to immunosuppressive therapy, physical examination, blood and urine laboratory tests, measurement of the serum levels of the drugs, and ultrasonography. Diagnosis of acute cellular rejection depends on biopsy, CD20 staining for refractory cases, negative C4d staining, presence of markers of activating lymphocyte, and proteomic study. Treatment of acute cellular rejection in kidney transplant recipients include pulse steroid for the first rejection episode. It can be repeated for recurrent or resistant rejection. Thymoglobulin and OKT3 are used as the second line of treatment if graft function is deteriorating. Changing the protocol from cyclosporine to tacrolimus or adding mycophenolate mofetil or sirolimus might be effective. Prognosis depends on number of rejection episodes, the use of potent drugs, time of rejection from transplantation, and response to treatment

Molecular study of pkd[1]and pkd[2] genes by linkage analysis and determining the genotype/phenotype correlations in several Iranian families with autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease [ADPKD] is an inherited disorder with genetic heterogeneity. Up to three loci are involved in this disease, PKD1 on chromosome 16p 13.3, PKD2 on 4q21, and a third locus of unknown location.Here we report the first molecular genetic study of ADPKD and the existence of locus heterogeneity for ADPKD in the Iranian population by performing linkage analysis on 15 affected families.Eleven families showed linkage to PKD1 and two families showed linkage to PKD2. In two families, PKD1 markers are common in all affected members but PKD2 markers were not informative.The results of this study demonstrate significant locus heterogeneity in autosomal dominant PKD in Iran. Analysis of clinical data confirms a milder ADPKD phenotype for PKD2 families. Our results showed relatively high heterozygosity rates and PIC values for some markers, while the most informative markers were KG8 and 16AC2.5 for PKD1 gene and AFM224x6 for PKD2 gene