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INTRODUCTION: The prevalence of hyperuricemia shows an increasing trend among kidney transplant recipients. The association between metabolic syndrome and hyperuricemia among the recipients of kidney transplants may consequently lead to reduction in graft survival. In this regard, the present study aimed at comparing the kidney transplant recipients with and without metabolic syndrome in terms of the prevalence of hyperuricemia. METHODS: This cross-sectional study was carried out on kidney transplant recipients who were referred to the Kidney Transplant Clinic of Montaserieh Organ Transplant Hospital, Mashhad University of Medical Sciences, from 2019 to 2020. The serum uric acid, anthropometric data, renal function, glucose levels, and lipid profile of the study participants were evaluated. RESULTS: According to our findings, higher mean uric acid levels were reported in recipients with metabolic syndrome (6.9 ± 1.51 mg/dL), compared to recipients without metabolic syndrome (6.11 ± 1.47 mg/dL; P < .001). It was also found that 55.6 and 38.5% of the cases with and without metabolic syndrome had hyperuricemia, respectively (P < .05). Additionally, the results showed no significant association between hyperuricemia and the number of metabolic syndrome criteria (P > .05). A comparison between recipients with and without hyperuricemia revealed significantly lower levels of tacrolimus in the hyperuricemia group (P < .05). Regarding serum Tacrolimus levels, no significant difference was found between recipients with and without metabolic syndrome (P > .05). Moreover, there was no significant difference between recipients with and without hyperuricemia (P > .05) or metabolic syndrome (P > .05) in terms of serum cyclosporine level. CONCLUSION: The findings of the current study indicate that kidney transplant recipients suffering from metabolic syndrome have higher mean serum levels of uric acid than those without metabolic syndrome. DOI: 10.52547/ijkd.7141.
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Hiperuricemia , Trasplante de Riñón , Síndrome Metabólico , Humanos , Trasplante de Riñón/efectos adversos , Hiperuricemia/epidemiología , Tacrolimus , Síndrome Metabólico/epidemiología , Ácido Úrico , Estudios TransversalesRESUMEN
BACKGROUND & OBJECTIVE: Polyomaviruses types BK and JC and Cytomegalovirus (CMV) have been shown to be related to kidney transplantation complications. This study aimed to assess the prevalence of these viruses in patients receiving kidney transplantation. METHODS: This cross-sectional study was performed on 40 kidney transplant recipients and 44 donors. Urine samples were used for the extraction of viral DNA. The prevalence of JC and BK viruses and their viral loads were determined by real-time polymerase chain reaction. RESULTS: JC and BK viruses were identified in 31% and 92.3% of all subjects, respectively. The frequency of JC and BK cases was not statistically different between the recipient and donor groups (P>0.05). All patients in the donor group and 96.8% of the recipients were positive for CMV IgG antibody. The mean viral load of BK in donors and recipients was 4.5×1010 and 3.3×1011 copies, respectively. The mean viral load of JC was 8.6×107 copies in donors and 2.9×108 copies in recipients. The distribution of BKV was significantly higher in recipients than donors (P=0.001), while no difference was observed between the two studied groups for JCV. CONCLUSION: This study showed a relatively high prevalence of BK and JC viruria in both renal transplant donors and recipients. The viral load for BKV, but not JCV, was higher in recipients than in donors.
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Background: The performance of a transplanted kidney is evaluated by monitoring variations in the value of the most important markers. These markers are measured longitudinally, and their variation is influenced by other factors. The simultaneous use of these markers increases the predictive power of the analytical model. This study aimed to determine the simultaneous longitudinal effect of serum creatinine and blood urea nitrogen (BUN) markers, and other risk factors on allograft survival after kidney transplantation. Methods: In a retrospective cohort study, the medical records of 731 renal transplant patients, dated July 2000 to December 2013, from various transplant centers in Mashhad (Iran) were examined. Univariate and multivariate joint models of longitudinal and survival data were used, and the results from both models were compared. The R package joineRML was used to implement joint models. P values <0.05 were considered statistically significant. Results: Results of the multivariate model showed that allograft rejection occurred more frequently in patients with elevated BUN levels (HR=1.68, 95% CI: 1.24-2.27). In contrast, despite a positive correlation between serum creatinine and allograft rejection (HR=1.49, 95% CI: 0.99-2.22), this relationship was not statistically significant. Conclusion: Results of the multivariate model showed that longitudinal measurements of BUN marker play a more important role in the investigation of the allograft rejection.
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Supervivencia de Injerto/fisiología , Trasplante de Riñón/normas , Adulto , Biomarcadores/análisis , Nitrógeno de la Urea Sanguínea , Estudios de Cohortes , Creatinina/análisis , Creatinina/sangre , Femenino , Humanos , Irán , Riñón/fisiopatología , Riñón/cirugía , Trasplante de Riñón/métodos , Trasplante de Riñón/estadística & datos numéricos , Masculino , Análisis Multivariante , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Graft and patient survival are of great importance after transplantation. This study aimed to determine the long-term survival rate of kidney transplantation and its effective factors among transplanted patients in Mashhad transplantation centers in northeastern Iran. METHODS: Overall, 618 kidney transplant recipients were examined in different transplantation centers during the years from 2000 to 2015 in a historical cohort study. The Kaplan-Meier method and the Log-rank test were used to calculate the survival rate of the kidney transplant, and to check the difference between survival curves respectively. Modeling of effective factors in survival rate was performed using Cox regression model. RESULTS: Overall, 1, 3, 5, 7, 10, and 15-year survival rate of kidney transplantation were 99%, 98%, 97%, 93%, 88 and 70% respectively. The adjusted hazard ratio indicated that variables such as recipient age >40 yr [HR=0.22, 95% CI=(0.071,0.691)], serum creatinine after transplantation >1.6 Mg/dl [HR=3.03, 95% CI=(1.284,7.125)], history of hypertension [HR=6.70, 95% CI=(2.746,16.348)], and BMI [HR (normal weight versus underweight)=0.26, 95% CI=(0.088,0.761), HR (over weight versus underweight)=0.13,95% CI=(0.038,0.442)] were significant factors on kidney transplant survival rate. CONCLUSION: The short-term transplant survival rate was good in transplant patients. What's more, through a consideration of variables such as age, creatinine serum after transplantation, history hypertension and body mass index, as well as proper planning to control their effect, it is possible to improve the long-term graft survival rate.
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We present a new investigation of the habitability of the Milky Way bulge, that expands previous studies on the Galactic Habitable Zone. We discuss existing knowledge on the abundance of planets in the bulge, metallicity and the possible frequency of rocky planets, orbital stability and encounters, and the possibility of planets around the central supermassive black hole. We focus on two aspects that can present substantial differences with respect to the environment in the disk: (i) the ionizing radiation environment, due to the presence of the central black hole and to the highest rate of supernovae explosions and (ii) the efficiency of putative lithopanspermia mechanism for the diffusion of life between stellar systems. We use analytical models of the star density in the bulge to provide estimates of the rate of catastrophic events and of the diffusion timescales for life over interstellar distances.
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INTRODUCTION: Knowing the national statistics of glomerular diseases will help in the management and minimizing their burden in the community. The aim of this study was to assess the overall distribution of subtypes of glomerulonephritis (GN) and the prevalence of renal diseases in a subgroup of diabetic and hypertensive patients. METHODS: This cross-sectional study was conducted on 860 patients with different subtypes of GN diagnosed by percutaneous renal biopsy and histological examination. RESULTS: The most common subtype of GN was membranous GN (30.1%) followed by minimal change disease (20.1%), IgA nephropathy (9.5%) and Lupus nephritis (8.8%), as well as membranoproliferative GN (6.4%), focal segmental GN (5.6%), crescent GN (43, 5%), and DM nephropathy (36, 4.2%). IgA nephropathy and focal segmental GN were mostly common among maleswhile the most female dominant GN was Lupus nephritis. Lupus nephritis was the most common GN diagnosis among subjects who were younger than 29 years old (50%), while the diabetic nephropathy was the most common GN diagnosis among subjects who were older than 53 years old (44.4%). The most common GN among hypertensive subgroups was focal segmental GN (41.7%) followed by diabetic nephropathy (33.3%) whereas the most common subtypes of GN among diabetics was diabetic nephropathy. CONCLUSION: The most common type of GN among Iranian population in Mashhadwas membranous GN and minimal change disease. The distribution of each subtype of glomerular disease depend on the baseline determinants including age, gender and hypertensive state.
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Glomerulonefritis , Adulto , Biopsia , Estudios Transversales , Femenino , Humanos , Irán , Riñón , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVE: This study was designed to investigate the effect of camel milk and Tarangabin (manna of Alhagi maurorum) combination therapy in addition to conventional treatments in patients with chronic kidney disease (CKD). MATERIALS AND METHODS: Forty-four patients of 15 to 70 years old, with CKD due to hypertension or diabetes, and estimated glomerular filtration rate (eGFR) of 15-60 ml/min per 1.73 m2, were enrolled in this trial. The patients were randomized to receive either 400 cc of camel milk with 10 cc of Tarangabin syrup orally in two divided daily doses for 3 months plus conventional therapy or conventional therapy alone. The conventional treatment included diabetes medications and angiotensin converting enzyme inhibitors or angiotensin receptor blockers. RESULTS: The baseline characteristics of patients were similar in the two groups. Serum levels of creatinine (p=0.01), blood levels of urea nitrogen (p=0.0001), triglyceride (p=0.02), and potassium (p=0.05), and diastolic blood pressure (p=0.0001) decreased, while eGFR (p=0.001) improved in intervention group significantly. CONCLUSION: It seems that the therapeutic protocol used in this study can improve renal function in patients with CKD through regulating glucose and anti-inflammatory, laxative, and immunostimulatory properties.
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INTRODUCTION: Contrast-induced nephropathy (CIN) is the most common cause of iatrogenic acute kidney injury. It is happened more commonly in patients with underlying kidney diseases. It is appeared that the oxidative stress is the main mechanism of contrast nephropathy. Curcumin is suggested as an herbal antioxidant agent, so we decided to assess the effect of curcumin in preventing of this complication in patients with underlying chronic kidney disease (CKD) who need coronary angiography. METHODS AND MATERIALS: We conducted double blind, placebo-controlled clinical trial in 60 moderate to severe CKD patients who underwent coronary angiography or angioplasty. Adjusted dose of Iodixanol was used as contrast agent in all of them. Curcumin or placebo administered orally, 1.5 g daily from 2 days before procedure to 3 days after it. CIN was defined by an increased serum creatinine level≥0.3mg/dl or an increase to ≥1.5 times of the baseline within 48 hours after procedure. Urinary NGAL test was also done the next day after angiography. RESULTS: CIN occurred in 12(20%) of patients, 5(16.7%) in Curcumin group and 7(23.3%) in placebo group (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.18 to 2.36; P0.51). Serum Creatinine was increased after72 hours of intervention from 1.65±0.26 mg/dl to 1.79±0.33 mg/dl in Curcumin group and from 1.61±0.23 mg/dl to 1.86±0.35 in placebo group. There is no significant difference between the mean increase in serum creatinine concentration in the placebo group and Curcumin group (difference of 0.006 mg/dL; 95% CI, - 0.06 to 0.08; P0.85). Urinary NGAL test was significantly higher in patients with AKI (p=0.000), but there weren't differences in its level in two groups (p=0.761) Conclusion: It is appeared prophylactic oral Curcumin hasn't protective effects on CIN in high risk patients who have undergone coronary procedure.
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Lesión Renal Aguda/inducido químicamente , Antioxidantes/administración & dosificación , Medios de Contraste/efectos adversos , Curcumina/administración & dosificación , Ácidos Triyodobenzoicos/efectos adversos , Lesión Renal Aguda/prevención & control , Administración Oral , Angioplastia/efectos adversos , Angiografía Coronaria/efectos adversos , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/inducido químicamente , Complicaciones Posoperatorias/prevención & control , Insuficiencia Renal Crónica/complicacionesRESUMEN
BACKGROUND: In end-stage renal disease (ESRD) kidneys stop functioning effectively, and transplantation is considered as the best therapeutic intervention. Because of the increasing number of ESRD patients and the limited number of organ donors, identification of the right candidates for kidney transplantation on the waiting lists is of great importance. AIM: The purpose of the present study is to identify the factors affecting the prioritization of transplantation candidates based on the advice of a number of board-certified, local nephrologists. MATERIALS AND METHODS: This cross-sectional study was conducted in 2017 based on the Standard for Reporting Qualitative Research (SRQR) protocol. In the first phase, 15 nephrology specialists were interviewed to collect their viewpoints, and results were analyzed based on the tagging framework. Then, a collection of the resulting factors were compiled into a checklist and validated using a Delphi method by 11 specialists. Eventually, final factors were selected using a weighting method followed by a practicality checking step. Weighting of factors was done by the analytic hierarchy process (AHP) technique and Expert Choice 11.0 was used to analyze the weightings. RESULTS: After removing duplicates, 35 factors were extracted. Finally, using a Delphi study and the weighting method and a subsequent practicality checking step, 12 factors were identified. Age, body mass index, time on dialysis, history of kidney transplantation, and 8 other factors were among the final identified factors. The factor with the highest weight was simultaneous disease. CONCLUSION: Given the long waiting lists for kidney transplantation and the limited number of donated kidneys, selecting the candidate with highest priority is vital. Altogether, using these factors in the candidate identification process results in selecting the most suitable candidate for kidney transplantation; this may consequently increase the patient and graft survival rate.
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Fallo Renal Crónico/cirugía , Trasplante de Riñón , Selección de Paciente , Adulto , Actitud del Personal de Salud , Estudios Transversales , Femenino , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina , Diálisis Renal , Tasa de Supervivencia , Donantes de Tejidos , Listas de EsperaRESUMEN
Introduction: Restless leg syndrome (RLS) is a sensory motor disorder. Patients with this syndrome have serious and uncontrollable desire to move their legs, which is mostly due to an uncomfortable feeling intensified when they are motionless. It may be a genetic disorder or secondary to iron deficiency, neurodegenerations, pregnancy, some drugs and severe kidney diseases. Objectives: This study was designed to find out the prevalence and its risk factors of RLS in hemodialysis patients. Patients and Methods: This multicenter cross-sectional study was done on 260 hemodialysis patients. The prevalence of RLS was measured using International Restless Legs Syndrome Study Group (IRLSSG)'s RLS Questionnaire (RLSQ). Potential risk factors for RLS including underlying cause of chronic renal failure, duration on dialysis, biochemical tests, dialysis adequacy, and erythropoietin and also venofer dosage in recent month and demographic data were also evaluated. Results: The prevalence of RLS was 55% including 59.4% males and 40.6% females. Their mean age of RLS patients and their dialysis duration were significantly higher than other group (P<0.05). Their body mass index (BMI) and serum calcium were significantly higher (P<0.05). However erythropoietin dosage and serum hemoglobin level were lower in RLS patients (P<0.05). Significant predictors of RLS were history of diabetes mellitus (DM), hypertension (HTN), smoking (P<0.05). There was not significant relation between RLS and dialysis adequacy, serum intact parathyroid hormone (iPTH), urea, ferritin and venofer dosage (P>0.05). Conclusion: According to the results, RLS is a common disorder in hemodialysis patients which can affect strongly on their life. So particular attention and sooner diagnosis of RLS in high risk patients for better management is necessary.
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Metabolic syndrome (MS) is characterized by a combination of cardiovascular (CV) risk factors (hypertension, dyslipidemia, obesity, and alterations in glucose homeostasis). Insulin resistance is suggested to be the common pathogenic background. This syndrome is also a risk factor for diabetes and chronic kidney disease. In renal transplant recipients, MS has been shown to be an independent risk factor for chronic allograft dysfunction, graft failure, new-onset diabetes, and CV disease. We performed a cross-sectional study on 106 stable renal transplant recipients to detect MS between January 2013 and August 2013. This syndrome was diagnosed according to the National Cholesterol Education Program-Adult Treatment Panel III criteria. Patients with history of diabetes mellitus were excluded from the study. In this group of patients, 56 (52.8%) had MS. There were 32 males (57.1%) and 24 females (42.9%). The mean age of the MS group was significantly higher than the non-MS group. The mean serum creatinine was higher in the MS group than the non-MS group, but there was no significant difference between them (P >0.05). The calculated glomerular filtration rate was also similar in the two groups (P >0.05). The patients with MS had higher body weight (64.61 ± 14.17 kg vs. 58.76 ± 11.70 kg, P <0.05) and also higher body mass index (BMI) (P <0.05). The prevalence of BMI >25 kg/m2 in the MS group was 75% versus 25% in the non-MS group (P <0.05). Since MS is an important and common risk factor in renal transplant recipients, we have to try to prevent it by educating the patients to control it by modifying their lifestyle. Efforts toward promoting healthy diets, physical activity, and blood pressure control must be undertaken.
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Trasplante de Riñón , Riñón/cirugía , Síndrome Metabólico/epidemiología , Receptores de Trasplantes , Adulto , Índice de Masa Corporal , Peso Corporal , Estudios Transversales , Femenino , Tasa de Filtración Glomerular , Supervivencia de Injerto , Humanos , Irán/epidemiología , Riñón/fisiopatología , Trasplante de Riñón/efectos adversos , Masculino , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/prevención & control , Persona de Mediana Edad , Prevalencia , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: It is known that cytomegalovirus (CMV) infection is a common problem among kidney transplant patients. This infection can be increased morbidity and decreased graft survival. This problem has been associated with acute rejection too. PATIENTS AND METHODS: One hundred and thirty renal transplant patients were included in a prospective, case-control study. The renal transplant patients were divided into two groups; patients group with CMV infection and control group without CMV infection. Serum CMV-IgG in all patients was positive (donor and recipients). None of patients had received anti-thymocyte-globulin and thymoglobulin. CMV infection was diagnosed by quantitative CMV-PCR (polymerase chain reaction) test (more than 500 copies/µg). Rejection episode was defined by kidney isotope scan or biopsy. RESULTS: In the group of 66 CMV infection patients (41 male [62.1%] and 25 female [37.9%]) the incidence of graft rejection was 36%, however in the group of 64 control patients the incidence of graft rejection was 9.4 % (P < 0.005). CONCLUSION: CMV infection is important predisposing factor for acute allograft rejection after kidney transplantation. The results of this study suggests that the control of CMV infection could decrease episodes of acute kidney rejection.
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INTRODUCTION: Fibroblast growth factor 21 (FGF21) is a metabolic regulator with multiple beneficial effects on glucose and lipid homeostasis and insulin sensitivity. OBJECTIVES: The aim of this study was to investigate the relation between the serum level of FGF21 with and metabolic syndrome (MS) in kidney transplant recipients. PATIENTS AND METHODS: We performed a cross-sectional study on 86 stable renal transplant recipients to detect possible relation between serum FGF21 level and MS during October 2014 and Mach 2015. Patients with past history of diabetes mellitus were excluded. RESULTS: There were 43 patients in each group with and without MS. Totally, they were 52 (60.5%) male and 34 (39.5%) female. The mean age of the MS group was significantly higher than that of non-MS group. There was not significant difference between mean serum creatinine level and glomerular filtration rate (GFR) between two groups (P > 0.05). The MS patients had higher weight and body mass index (BMI) (P < 0.05). The prevalence of BMI >25 kg/m(2) in MS group was 25 (58.8%) versus non-MS group that only 10 (23.3%) had this condition (P < 0.05). The mean of FGF21 level in MS and non-MS groups was 1.23 ± 0.67 ng/l and 1.18 ± 0.71 ng/l, respectively (P > 0.05). There was not significant difference of serum FGF21 level between MS and non-MS patients (P > 0.05). CONCLUSION: While the elevated serum FGF21 level was found in subjects with insulin resistant states, however, this study revealed that serum FGF21 levels were not significantly increased in renal transplanted recipients with MS as compared with non-MS group.
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Urinalysis is a mandatory diagnostic tool for the evaluation of patients with kidney diseases. A workshop on urinalysis was held for nephrologists in Isfahan, Iran, on October 11-12, 2012. After the presentation of the results of a survey of the nephrology centers of Iran on urine microscopy, the most important aspects of urinalysis were presented and discussed. These included the following: (1) urinalysis by dipstick, which provides results in a few seconds, is simple to use, has a low cost, and is used worldwide for screening purposes, in spite of some limitations; (2) measurement of proteinuria by 24-hour urine collection, which still represents the reference method in spite of limitations due to frequent over or under collection errors; (3) protein-creatinine ratio in a random urine sample, which is recommended by international guidelines as an alternative to the measurement of 24-hour protein excretion; (4) microalbuminuria, which is seen as a marker of systemic endothelial damage; and (5) the urinary sediment, which is underused even among nephrologists in spite of the relevant diagnostic information it can supply in a wide spectrum of kidney diseases.
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Enfermedades Renales/orina , Microscopía/métodos , Nefrología/educación , Proteinuria/diagnóstico , Urinálisis/métodos , Albuminuria/orina , Congresos como Asunto , Creatinina/orina , Humanos , Irán , Proteinuria/orinaRESUMEN
BACKGROUND: Acute kidney injury (AKI) is commonly occurred in intensive care unit (ICU) patients. The aim of the study was a comparison of RIFLE (Risk of renal injury/Injury to the kidney/Failure of kidney function/Loss of kidney function/End stage disease) classification with other scoring systems in the evaluation of AKI in ICUs. MATERIALS AND METHODS: We performed a retrospective study on 409 ICU patients who were admitted during the 5 years period. RESULTS: At the 1(st) day of admission and time of discharge, the total and non-renal Acute Physiology and Chronic Health Evaluation II and sequential organ failure assessment scores were compared to max RIFLE criteria. In this assessment, there was concordance among the results (P < 0.05). CONCLUSION: The RIFLE classification can be used for detection of AKI in ICU patients.
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Ketoacidosis can occur most often as a result of uncontrolled diabetes mellitus. However, it can be seen with fasting and alcohol consumption, as well. Ketoacidosis in association with fasting has less severity, and ketoacid levels do not exceed 10 mEq/L. In the literature, there are a few reports about severe high anion gap acidosis that were associated with fasting. We report a case of pregnancy associated with high anion gap acidosis as a result of fasting.
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Equilibrio Ácido-Base , Ayuno/efectos adversos , Cetosis/etiología , Complicaciones del Embarazo/etiología , Adulto , Antieméticos/uso terapéutico , Femenino , Fluidoterapia , Humanos , Resistencia a la Insulina , Cetosis/sangre , Cetosis/diagnóstico , Cetosis/fisiopatología , Cetosis/terapia , Embarazo , Complicaciones del Embarazo/sangre , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/fisiopatología , Complicaciones del Embarazo/terapia , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Inadequate cyclosporine blood levels may cause acute rejection in transplanted renal graft, and its increase is accompanied with graft toxicity. Cyclosporine has variable bioavailability and pharmacokinetics among patients at different times after transplantation. In this study, we compared the effects of cyclosporine blood levels (trough versus 2-hour peak, C2) on renal graft function during the first six months after transplantation in order to find better methods for drug levels assessment in our patients. We studied 50 patients who received grafts at Mashhad transplant centers from October 2006 to May 2007. Drug levels were monitored seven times during the study; in each assessment, more than 80% of the patients did not reach the therapeutic C2 levels. There was no significant correlation between age, sex, times of transplantation and acute rejection with drug C2 levels. There was no difference between graft function in patients with therapeutic C2 level and those with inadequate C2 levels. However, we found a significant correlation between trough levels and acute rejection (P <0.05). Only during the 6 th month after transplantation was the drug dosage significantly higher in patients with therapeutic C2 level than that in other patients (P >0.05). Apparently, peak levels were not a suitable method in drug monitoring in our patients, or peak levels might have occurred at a different time (like 1.5 or 3 or 4 h after ingestion of the drug) in our population. Based on this study, trough level may be a better method of evaluation of cyclosporine effects on renal allografts than 2-h peak levels in our patients.
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Ciclosporina/farmacocinética , Rechazo de Injerto/prevención & control , Supervivencia de Injerto/efectos de los fármacos , Inmunosupresores/farmacocinética , Trasplante de Riñón/inmunología , Adulto , Análisis de Varianza , Distribución de Chi-Cuadrado , Ciclosporina/administración & dosificación , Ciclosporina/sangre , Monitoreo de Drogas/métodos , Femenino , Rechazo de Injerto/inmunología , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/sangre , Irán , Masculino , Estudios Prospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
The renin-angiotensin system has a major role in the development of diabetic nephropathy (DN). It is reported that vitamin D analogues are able to suppress renin excretion. Thus, this study was conducted to determine whether there is any correlation between albuminuria as a marker of DN with vitamin D levels in diabetic patients. Also, an assessment was made on the effects of vitamin D therapy on albuminuria in this group of patients. We conducted this cross-sectional study on 119 outpatients with type-2 diabetes. The serum levels of 25-hydroxy vitamin D [25 (OH) D] and the albumin to creatinine ratio were assessed in all the study patients. Patients with vitamin D deficiency/insufficiency received calcitriol therapy for eight weeks, following which the laboratory tests were repeated. The mean age of the study patients was 55.3 ± 11.2 years, 43 (36.13%) had vitamin D insufficiency [25 (OH) D <25 ng/mL] and 31 (26.1%) had vitamin D deficiency [25 (OH) D <15 ng/mL]. We found a significant correlation between 25 (OH) D levels and presence of microalbuminuria (P = 0.04) in patients with vitamin D deficiency. Therapy with calcitriol had a beneficial effect on the albumin excretion rate, although this change was not significant (P = 0.22). However, the effects of calcitriol on reduction of diastolic blood pressure (P = 0.004), glycosylated hemoglobin (P = 0.014) and levels of total cholesterol (P = 0.019), low-density lipoprotein (0.04) and high-density lipoprotein (P = 0.001) was significant. Our study suggests that vitamin D deficiency has a negative effect on albuminuria in diabetic patients, and its replacement may be associated with a beneficial effect on the risk factors of DN, such as hyperlipidemia and hypertension.
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Albuminuria/tratamiento farmacológico , Calcitriol/uso terapéutico , Diabetes Mellitus Tipo 2/complicaciones , Nefropatías Diabéticas/tratamiento farmacológico , Deficiencia de Vitamina D/tratamiento farmacológico , Vitaminas/uso terapéutico , Adulto , Anciano , Albuminuria/sangre , Albuminuria/etiología , Albuminuria/fisiopatología , Biomarcadores/sangre , Presión Sanguínea/efectos de los fármacos , Colesterol/sangre , Estudios Transversales , Diabetes Mellitus Tipo 2/sangre , Nefropatías Diabéticas/sangre , Nefropatías Diabéticas/etiología , Nefropatías Diabéticas/fisiopatología , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Irán , Lipoproteínas HDL/sangre , Lipoproteínas LDL/sangre , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Vitamina D/análogos & derivados , Vitamina D/sangre , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/fisiopatologíaRESUMEN
INTRODUCTION. Hyperuricemia is an independent risk factor for kidney dysfunction in diabetic patients. On the other hand, albuminuria is considered as the proxy of early stages of diabetic nephropathy. We investigated the correlation between hyperuricemia and albuminuria in patients with diabetes mellitus. MATERIALS AND METHODS. In a cross-sectional study of 1275 patients (555 men and 720 women) with type 2 diabetes mellitus, serum uric acid and urinary albumin-creatinine ratio were determined. Other metabolic parameters including lipid profile, hemoglobin A1c, glomerular filtration rate, body mass index, blood pressure, blood glucose were assessed, as well. RESULTS. The mean age of the patients was 52.45 ± 10.11 years old. Serum uric acid levels for normoalbuminuric, microalbuminuric, and macroalbuminuric patients were 4.49 ± 1.22 mg/dL, 4.84 ± 1.52 mg/dL, and 6.15 ± 1.68 mg/dL, respectively. Among patients with clinical metabolic syndrome, 233 (27.5%) were in the forth upper quartile of uric acid level (> 5.3 mg/dL), but in diabetic patients without this syndrome, only 80 (18.7%) were in this group. There was a significant relationship between hyperuricemia and serum triglyceride, fasting blood glucose, hemoglobin A1c, glomerular filtration rate, and serum creatinine levels (P < .001). No significant correlation was found between hyperuricemia and cholesterol levels, age, duration of diabetes mellitus, and body mass index. Serum uric acid level correlated positively with urinary albumin-creatinine ratio (P = .04). CONCLUSIONS. We showed that higher serum uric acid concentrations were associated with a greater probability of albuminuria in patients with type 2 diabetes mellitus.