Ifosfamide nephropathy in patients with sarcoma

Ifosfamide is an alkylating agent, frequently used in the treatment of sarcoma. Major side effects of ifosfamide are classified as nephropathy, neuropathy, and hematologic complications. The aim of present study was to determine the frequency and severity of ifosfamide nephropathy in patients with various types of sarcoma. Ninety patients [52 males and 38 females] who had received ifosfamide chemotherapy for sarcoma were included in this study. Data on physical examination, laboratory studies, and estimation of glomerular filtration rate were collected. The median duration of follow-up was 6 to 12 months. Records of documented nephropathy were identified in these patients. The age range of patients on ifosfamide was 5 to 59 years. Thirty-four of the patients were children and 56 were adults. The most common renal side effects were proteinuria [15.5%], glycosuria [7.8%], elevation of serum creatinine [2.2%], hematuria [14.4%], and combination of proteinuria and glycosuria [5.5%]. None of the patients had gross hematuria, but microscopic hematuria was present in 14.4%. Ifosfamide nephropathy was seen with different degrees of severity in patients with sarcoma. Monitoring of the side effects of ifosfamide should be revised in different populations

Outcomes of fasciotomy in patients with crush-induced acute kidney injury after Bam earthquake

Fasciotomy may increase the morbidity and mortality in patients with crush-induced acute kidney injury [AKI], by creating an open wound, increasing the risk of bleeding, coagulopathy, and potentially fatal sepsis. This study evaluates the outcomes of fasciotomy in these patients after Bam earthquake in Iran. We reviewed medical records of victims of Bam earthquake complicated with crush-induced AKI. Demographic, biochemical, and clinical data of patients who underwent fasciotomy were evaluated and compared with other patients with AKI. Fasciotomy was performed for 70 of 200 patients with crush-induced AKI [35.0%]. There were no significant differences regarding sex, age, time under the rubble, and muscle enzymes level between these patients and those without fasciotomy. They did not experience higher rates of disseminated intravascular coagulopathy, sepsis, adult respiratory distress syndrome, amputation, and dialysis session. Neither did they have a longer hospitalization period or higher death rate. This study showed that fasciotomy did not have any deteriorating effect on morbidity and mortality of patients with crush-induced AKI after Bam earthquake

Bone mineral density in kidney transplant recipients and patients on hemodialysis. A comparison with healthy individuals

We measured bone mineral density [BMD] before and after transplantation to determine the frequency and severity of preoperative and postoperative osteoporosis and compare them with the BMD in healthy individuals. We determined the BMD at the lumbar spine and femoral levels in 22 men and 18 women who were on long-term dialysis in Yazd, Iran, and a group of kidney transplant recipients including 43 men and 18 women. They were compared with each other and healthy individuals studied in a recent study in Iran. Factors potentially associated with alterations of the BMD were studied in each group. The frequency of osteoporosis in the vertebrae and femoral neck was higher in the kidney transplant recipients than the healthy population [21.3% versus 4.9%; P = .001; odds ratio, 5 and 9.8% versus 2.4%; P = .02; odds ratio, 5.4, respectively] but not significantly different from those in the patients on dialysis [17.9% and 17.5%, respectively]. In transplantation group, multivariate analysis showed that there was a significant negative correlation between the lumbar BMD and the cumulative prednisolone dose [r = -0.36, P = .003]. No correlation was found between BMD of lumbar or femoral neck and the body mass index, age, and cumulative cyclosporine level. Osteoporosis is more frequent in patients on dialysis and kidney transplant recipient than in general population. However, there is no difference in osteoporosis frequency between transplanted patients and those on dialysis. In the lumbar spine, a higher cumulative prednisolone dose results in decreased BMD among kidney transplant recipients