Erythropoietin ameliorates oxidative stress and tissue injury following renal ischemia/reperfusion in rat kidney and lung.

OBJECTIVE: To study the effect of erythropoietin (EPO) treatment on renal and lung injury following renal ischemia/reperfusion (I/R). MATERIALS AND METHODS: Thirty male Wistar rats were assigned to three groups of 10 rats each. The first group was sham-operated, the second was subjected to renal I/R (30 min of ischemia followed by 24 h of reperfusion). The third group was subjected to renal I/R and treated with EPO in two doses: the first dose 1 h prior to ischemia (1,000 U/kg) and the second dose 6 h after ischemia (1,000 U/kg). RESULTS: The renal and lung tissue injury index, tissue serum blood urea nitrogen and creatinine (Cr) were higher in the renal I/R group compared to the renal I/R + EPO group; the difference was statistically significant (p < 0.05). Kidney and lung tissue glutathione peroxidase and superoxide dismutase levels were higher in the renal I/R + EPO group than the renal I/R group; the difference was also statistically significant (p < 0.05). CONCLUSION: The data showed that EPO pretreatment could be effective in reducing renal and lung injury following renal I/R and could improve the cellular antioxidant defense system. Hence EPO pretreatment may be effective for attenuating renal and lung injury after renal I/R-induced injury during surgical procedures, hypotension, renal transplantation and other conditions inducing renal I/R.

Hypothyroidism-induced rhabdomyolysis and renal failure.

Renal failure, due to rhabdomyolysis, is a rare complication of hypothyroidism. We report an elderly patient with primary hypothyroidism symptoms initially presented with inability to walk, leading to renal failure. Laboratory examinations disclosed rhabdomyolysis and primary hypothyroidism. Creatinine phosphokinase, lactate dehydrogenase, and renal function test decreased to normal values shortly after thyroid hormone replacement. This report highlights that hypothyroidism should be considered in patients presenting with renal impairment associated with rhabdomyolysis.

Hereditary thrombophilia and thrombosis of tunneled hemodialysis catheters: A single center study.

Introduction: Vascular access thrombosis increases the risk of mortality and morbidity in end-stage renal disease (ESRD) patients on hemodialysis (HD). This study aimed to evaluate hereditary thrombophilia factors in HD patients and its association with tunneled cuffed catheters' thrombosis. Methods: In this cross-sectional study, 60 consecutive patients with ESRD on HD with tunneled cuffed catheters were selected. Inherited thrombophilia factors (Anti-thrombin III, Protein C, Protein S, and Factor V Leiden) were measured and the patients were followed for 3 months to evaluate the incidence of catheter-related thrombosis. The association between these factors and catheter thrombosis was assessed. Results: The mean age of patients was 60.30 ± 8.69 years. Forty-seven patients (78.30%) were female and thirteen patients (21.70%) were male. The most common cause of ESRD was diabetes mellitus (41.67%). The most catheter site was the right internal jugular vein (55%). There were 22 (36.67%) and 8 (13.33%) cases of thrombosis and mortality, respectively. The association between hereditary thrombophilia factors and catheter thrombosis was not statistically significant (P > 0.05). Conclusion: In this small group of our patients, the frequency of hereditary thrombophilia was not significantly different between those with and without thrombosis of tunneled HD catheter.

Acute tubular necrosis after renal allograft segmental infarction: the nephrotoxicity of necrotic material.

OBJECTIVES: Renal allograft dysfunction can be caused by renal vessel thrombosis, acute tubular necrosis, hyperacute or acute rejection, nephrotoxicity induced by cyclosporine or tacrolimus, thrombotic microangiopathy, or urinary tract obstruction. MATERIALS AND METHODS: We describe a renal transplant recipient in whom oliguria developed during the first week after transplant, although his early renal allograft function was good. RESULTS: A Doppler ultrasonographic study revealed a lack of perfusion in the lower pole of the allograft. A perfusion defect was noted in the lower pole that was supplied by a polar artery, which had been damaged during engraftment. Light microscopy disclosed tubular cell necrosis without evidence of vascular or humoral rejection. CONCLUSIONS: We suggest that toxic molecules such as tumor necrosis factor-alpha released from a segmental infarcted area can induce tubular cell damage and necrosis leading to renal allograft dysfunction.

Serendipitous diagnosis of aortic coarctation by bilateral parvus et tardus renal Doppler flow pattern.

BACKGROUND: Aorta Coarctation (AC) is uncommon condition that in most adult patients is asymptomatic. Diagnosis of AC is made during routine physical examination by detection of Blood Pressure (BP) difference between arm and leg. AIM: To describe a novel renal artery Doppler flow pattern pathognomonic of aortic coarctation. METHODS: We enrolled 4 consecutive patients referred to renal artery Doppler Ultrasonography (DU) for diagnostic work-up of secondary arterial hypertension. All met the following inclusion criteria: 1) arterial hypertension at age <30 years; 2) referred for renal DU to rule out renovascular hypertension. RESULTS: We found in all 4 patients (age range 10 to 27 years) a bilateral "parvus-tardus" renal Doppler flow pattern. In all, echocardiographic and angiographic work-ups showed aortic coarctation. CONCLUSION: Careful physical examination should be performed in all hypertensive patients. Furthermore, the suspicion of AC can be raised by a bilateral renal arteries "parvus-tardus" Doppler flow pattern in young hypertensive patients screened for secondary hypertension.

Nephrotoxic Effect of Aspartame as an Artificial Sweetener: a Brief Review.

Aspartame is one of the most popular artificial sweeteners over the world. Although its consumption is considered to be safe in acceptable daily intake ranges which were set by the United States Food and Drugs Administration and other regulatory agencies, there are lots of controversies regarding its safety nowadays. Some of the recent experimental and epidemiological studies showed that consumption of aspartame may causes some adverse health effects including obesity, metabolic syndrome, and alteration in gut microbiota. Moreover, studies on the nephrotoxic effect of aspartame have increased. A search of several literature databases for publications on adverse effects of aspartame on the kidney function from 1980 to 2016 showed that long-term consumption of aspartame led to a dose-dependent increased production of free radicals in renal tissues as well as kidney injury, based on several studies on animals However, given the lack of clinical data in this area, it is difficult to make a definitive conclusion regarding nephrotoxic effect of aspartame. Overall, consumers should be aware of the potential side effects of aspartame and other artificial sweeteners. At present it may be recommended that only a minimal amount of them would be consumed.

Genetics and Epigenetics of Chronic Allograft Dysfunction in Kidney Transplants.

Chronic allograft dysfunction is the most common cause of allograft lost. Chronic allograft dysfunction happens as a result of complex interactions at the molecular and cellular levels. Genetic and environmental factors both influence the evolution and progression of the chronic allograft dysfunction. Epigenetic modification could be considered as a therapeutically modifiable element to pause the fibrosis process through novel strategies. In this review, the PubMed database was searched for English-language articles on these new areas.

Global scientific vision with local vigilance: renal transplantation in developing countries.

CONTEXT: Renal Transplantation is the most effective treatment for patients with end-stage renal disease, which is fortunately available in the developing countries, even for poor people. Nonetheless, the way forward should be the implementation of advanced science of transplantation, allograft monitoring abilities, knowledge about the epidemiology of renal disease in any specific region, awareness about the influence of ethenic and genetic factors immunosuppressant bioavailability, and post-transplant complications all strongly affecting the patients and allograft survival. EVIDENCE ACQUISITIONS: In this process we searched mainly in PubMed, Web of Science and Google Scholar data bases for key words of renal allograft monitoring, post-transplant infections, renal/kidney transplantation and Iran. We followed the cross articles to follow our main idea to find a connection between modern advancement in renal allograft monitoring and our practice in developing countries. Another focus was on the special infectious and non-infection complication that do exist in specific region and need specific considerations. RESULTS: Implementation of modern techniques of immune monitoring, allograft function, awareness about the specific infectious and non-infectious disease in each region improves the quality of renal transplantation. CONCLUSIONS: We need to combine the advance scientific vision with local vigilance to achieve the best outcome in renal allograft recipients.

Herbs and hazards: risk of aristolochic acid nephropathy in Iran.

Herbs are usually considered as inherently harmless products. Nonetheless, various renal injuries have been reported in association with several herbs. The best-known herb-induced chronic kidney disease is aristolochic acid nephropathy. Aristolochic acid is found in Chinese slim herbs. Balkan endemic nephropathy is nowadays considered as an aristolochic acid nephropathy. Plants of Aristolochiaceae (also known as birthwort, dutchman's pipe, and somersworth) is named zaravand or chopoghak in Persian and it grows in different mountainous and rural areas of Iran. The fruit and the steam of the Aristolochiacae are named zaravand gerd (nokhod alvand) and zaravand dearaz, respectively, and have different usage in Iranian teadirional such as treatment of headache, back pain, and anxiety. Some patients with end-stage renal disease and bilateral small kidneys have a history of exposure to some herbal remedies. We need to consider the possibility of environmental toxins and even Aristolochia nephrotoxicity as a potential danger in Iran.

Confusing combination of thrombocytopenia and thrombosis after heparin therapy in a patient with cardiac leiomyosarcoma; a nephrologist viewpoint.

We represent here a 30-year-old woman with cardiac leiomyosarcoma who developed thrombocytopenia and deep vein thrombosis a few days after the start of low molecular weight heparin. Thrombocytopenia improved after replacement of low molecular weight heparin with hirudine. We speculated that cardiac leiomyosarcoma is a predisposing factor for development of heparin induced thrombocytopenia.

Black kidney in Albinism.

Implication for health policy/practice/research/medical education: Oculocutaneous albinism may be similar to two related syndromes (Hermansky-Pudlak and Chediak-Higashi) and could lead to more widespread lysosome excretory defects. These defects could lead to accumulation of some intracellular material, leading to the gross discoloration of the kidney.

Effects of alpha lipoic acid supplementation on serum levels of IL-8 and TNF-α in patient with ESRD undergoing hemodialysis.

BACKGROUND: Chronic renal failure is a progressive and irreversible loss of kidney function, and the hemodialysis (HD) is one of the most common modalities in this regard. Oxidative stresses [like interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-α)] and inflammation are the main risk factors associated with cardiovascular diseases and other complications in many organs in hemodialysis patients; meanwhile, antioxidants like alpha lipoic acid (ALA) may reduce the oxidative stress markers and the levels of inflammatory cytokines, so can improve of the patient's quality of life. METHODS: In this randomized clinical trial study, 60 HD patients were randomly categorized in two case and control groups. Case group received a daily capsule of 600 mg of ALA supplementation for 8 weeks, and the control group received placebo capsules daily. The serum level of IL-8 and TNF-α was measured in both groups before and after the intervention. RESULTS: There were no significant differences in age, gender, duration of dialysis, and causative factor for dialysis between both groups (P > 0.05). The mean of IL-8 and TNF-α after the intervention in case group was 26.20 ± 15.34 and 21.25 ± 9.61, respectively; the difference between both groups was not statistically significant (P > 0.05). CONCLUSION: Based on the better feeling and other beneficial effects of ALA were found in our study; we can conclude that it is a beneficial and recommended supplement, especially, for diabetic and dialysis patients.

Seventeen years' experience of peritoneal dialysis in Iran: first official report of the Iranian peritoneal dialysis registry.

BACKGROUND: To facilitate planning, national renal registries provide reliable and up-to-date information on numbers of patients with end-stage renal disease (ESRD), developing trends, treatment modalities, and outcomes. To that end, the present publication represents the first official report from Iranian Peritoneal Dialysis Registry. METHODS: The prevalence, demographics, and clinical characteristics of patients on peritoneal dialysis (PD) were collected from all PD centers throughout the country. RESULTS: By the end of 2009, the prevalence of ESRD was 507 per million population in Iran. The most common renal replacement modality was hemodialysis (51.2%), followed by kidney transplantation (44.7%), and then PD (4.1%). The mean age of PD patients was 46 years, and the most common causes of ESRD were diabetes (33.5%), hypertension (24.4%), and glomerulonephritis (8.2%). Overall patient mortality was 25%, with cardiac events (46%), cerebral stroke (10%), and infection (8%) being the main causes of death. The 1-, 3-, and 5-year survivals were 89%, 64%, and 49% respectively. The most common cause of dropout was peritonitis (17.6%). Staphylococcus (coagulase-negative and S. aureus) was the most prevalent causative organism in peritonitis episodes; however, in more than 50% of episodes, a sterile culture was reported. Mean baseline serum hemoglobin and albumin were 10.7 g/dL and 3.6 g/dL respectively. CONCLUSIONS: Our registry results, representing the second largest report of PD in the Middle East, is almost comparable to available regional data. We hope that, in future, we can improve our shortcomings and lessen the gap with developed countries.

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.

Association of serum vitamin D level with age in individuals with normal renal function.

There is no sufficient data on the relation between vitamin D status and age in subjects with normal renal function. The aim of this study was to investigate the association of serum 25-hydroxy vitamin D (25[OH]D) concentrations with age of Iranian healthy individuals. The data were collected from 259 ambulant healthy medical staffs who had the inclusion criteria of the study. Fasting 25-hydroxy vitamin D level was measured. Vitamin D deficiency was defined as having a 25(OH)D concentration <25 nmol/L. The average of persons ages were 20-65 years with mean age of 34±9 years, and about 57.5% of the participants were female. The mean±SD vitamin D level of the subjects was 29±16 nmol/L (median=26 nmol/L). Also 48% of the individuals had vitamin D deficiency. In this study, there was no association between vitamin D level and gender of the participants. A significant positive correlation of age with vitamin D level was found (r =0.002). It seems that for evaluation of 25-OH-vit D status, age should be noticed.

Association between the proportion of globally sclerotic glomeruli and various morphologic variables and clinical data of IgA nephropathy patients.

INTRODUCTION: Immunoglobulin A nephropathy is the most common form of glomerular nephropathy among children and young adults. OBJECTIVES: To evaluate the possible correlation between the extent of sclerotic glomeruli and various morphologic variables and clinical data of IgA nephropathy (IgAN) patients, we conducted an observational study, on 136 IgAN patients' biopsies. PATIENTS AND METHODS: Of the 136 patients, 94 (69.1%) were male. The mean age of the patients was 37.6 ± 13.4 years. The mean of serum creatinine was 1.94±3.7 mg/dl (median=1.2mg/dl), also mean of proteinuria was 1726±1247 mg/day (median=1500 mg/day). In this study of 14.9±3.7 glomeruli in biopsies, 2.5±3.2 (median=2) were globally sclerotic. RESULTS: In this study we found, significant positive correlation between proportion of globally sclerotic glomeruli and serum creatinine, amount of proteinuria, and also quantity of tubulointerstitial fibrosis. Also, in this study, the association of proportion of globally sclerotic glomeruli with M, E, S and T variables of Oxford classification was significantly positive. CONCLUSION: We propose firstly that, sclerotic glomeruli reported routinely in the pathology reports of IgA nephropathy patients and secondly we suggest further investigations to possible inclusion of other morphologic variables like proportion of sclerotic glomeruli to Oxford classification of IgAN to widen the scope of this classification.