Prevalence of chronic kidney disease and its risk factors in Gonabad, Iran.

INTRODUCTION: Chronic kidney disease (CKD) is an important health problem in Iran, with an increasing prevalence rate. Knowledge about the prevalence and risk factors of this disease in different health jurisdictions can help in planning to control this condition. MATERIALS AND METHODS: In this cross-sectional study, 1285 individuals aged between 20 and 60 years old were recruited. Participants were selected from the general population residing in Gonabad, Iran, via simple random sampling in 2012. Demographic data were collected. Urine and blood test were performed, and the glomerular filtration rate was estimated based on the simplified Modification of Diet in Renal Disease equation. RESULTS: Sixty-five participants (5.1%) had CKD (5.1% men and 5% women; P = .90). The mean age was significantly higher in the CKD group (P = .001). Hypertension and diabetes mellitus were significantly more prevalent among the participants with CKD than those without CKD (P < .001 for both). Proteinuria was significantly associated with CKD, whereas a history of urinary tract infection, a history of nephrolithiasis, smoking, serum uric acid level, lipid profile, and blood glucose level were not. CONCLUSIONS: Chronic kidney disease has a high prevalence rate in this part of Iran. We suggest further studies in other parts of our country for the better estimation of the prevalence of CKD in Iran and for better planning to prevent and treat this condition.

Evaluation of the effect of pentoxifylline on erythropoietin-resistant anemia in hemodialysis patients.

Use of recombinant human erythropoietin (rh-Epo) improves hemoglobin (Hgb) in 90-95% of the cases of anemia of chronic kidney disease (CKD). However, it is known that pro-inflammatory cytokines such as interferon-gamma (IFN-γ), tumor necrosis factor-alfa (TNF-α) and interleukin-1 (IL-1) suppress erythropoiesis, resulting in inadequate response to rh-Epo. Pentoxifylline has been shown to have modulatory effects on the immune system. This prospective study to evaluate the effect of pentoxyphylline on erythropoeisis was performed on 15 (eight males, seven females) clinically stable patients who had been on hemodialysis for at least six months with anemia (Hgb of <10.7 g/dL) unresponsive to rh-Epo despite high doses. They were treated with 400 mg pentoxifylline tablets once daily for 12 weeks. Hgb increased after one and two months of drug administration, but significant changes were observed in eight (53%) patients after three months (P <0.05). Our study illustrates a probable new use for an old medicine. Three months treatment with pentoxifylline was seen to increase Hgb significantly in rh-Epo-resistant patients. More prospective studies with a larger sample size are needed to determine the inhibitory role of cytokines on hematopoiesis and exploring new drugs or new drug indications to overcome anemia in advanced renal failure.

Association of urinary lipocalin-2 with lupus nephritis.

OBJECTIVE(S): Lupus nephritis (LN) is the main cause of mortality and disability in systemic lupus erythematosus (SLE) patients. Therefore, utilizing a reliable and non-invasive method for serial measurements of renal function seems to be necessary. The aim of this study was to evaluate the role of urinary lipocalin-2 as a biomarker of renal involvement in SLE patients. MATERIALS AND METHODS: Fifty two lupus patients in this cross sectional study were divided into two groups: patients with and without nephritis. For each group, urinary lipocalin-2, values were measured and reported according to urinary lipocalin-2/creatinine. Urinary lipocalin-2/creatinine sensitivity and specificity for identifying biopsy-proven nephritis were calculated, and a receiver operating characteristic (ROC) curve was constructed. Results : The mean urinary lipocalin-2/creatinine value of patients with biopsy-proven LN was 2.99 ± 4.1 ng/mg, and in non-LN patients was 1.16 ± 1.27 ng/mg. Urinary lipocalin-2/creatinine levels in LN patients were significantly higher than those in non-LN patients (P- Value = 0.03). In LN patients, urinary lipocalin-2/creatinine significantly correlated with proteinuria (r = 0.68; P = 0.0001). Using a cutoff value of 0.896 ng/mg, urinary lipocalin-2/creatinine had a sensitivity of 89.7% and a specificity of 39.1% for identifying SLE patients with biopsy-proven LN. The area under the ROC curve was 0.664 ± 0.076 with a 95% confidence interval of 0.52-0.81 (P=0.04). Analysis of variance showed that urinary lipocalin-2/creatinine is the same in different classes of LN (P-value=0.28). CONCLUSION: An important clinical conclusion is that measurement of urinary Lipocalin-2 may result in earlier diagnosis of LN.

Urine Monocyte Chemoattractant Protein-1(UMCP-1) as a Biomarker of Renal Involvement in Systemic Lupus Erythematosus.

OBJECTIVES: Lupus nephritis (LN) is frequently associated with a poor long-term prognosis. Renal biopsy is the diagnostic method of choice in this condition. Urine biomarkers have been mentioned in the diagnosis of LN. The study(,)s purpose was to evaluate the performance of urinary monocyte chemoattractant protein 1(UMCP-1) as a biomarker of renal involvement in systemic lupus erythematosus. MATERIALS AND METHODS: Forty-one recently diagnosed systemic lupus erythematosus patients (8 male and 33 female) without renal involvement (group 1) and twenty six patients (8 male and 18 female) with LN (group 2), proven by biopsy, were recruited to this study. UMCP-1 sensitivity and specificity for identifying biopsy-proven nephritis were calculated, and a receiver operating characteristic (ROC) curve was constructed to quantify how definitely UMCP-1 distinguishes between patients with and without LN. RESULTS: The mean value of UMCP-1 levels were 733.07 pg/ml ± 1282.54 and 144.16 pg/ml ± 137.90 in patients with and without LN respectively. The UMCP-1 level was significantly higher in group 2 than group 1. There was no significant correlation between UMCP-1 and 24-hour urine protein (r = 0.031, P= 0.874). The area under the ROC curve was 0.727 with a CI 95% of 0.597 to 0.857 (P=0.002). Using a cut-off value of 82 pg/ml,UMCP-1 had a sensitivity of 88.5% and a specificity of 46.3% for identifying LN. CONCLUSION: UMCP-1 can serve as a biomarker of LN although further longitudinal studies of these biomarkers are required in LN.

Tuberous sclerosis, deep vein thrombosis and lack of C and S proteins: A case report.

INTRODUCTION: Tuberous sclerosis, an autosomal dominant disorder, is characterized by hamartomas in different organs of body. Kidney involvement is quite common in this disorder and sometimes it is accompanied by adult polycystic kidney disease. CASE: A 46-year-old woman who was being treated for adult polycystic kidney disease and systemic hypertension was admitted to this hospital because of acute lower limb edema. Color Doppler sonography study showed deep vein thrombosis of lower limbs and also left iliac vein. Despite the initiation of hourly heparin infusion, the patient involved by pulmonary emboli on the 2(nd)day of admission. Lab tests revealed protein C and S deficiency. The patient had already experienced episodes of pneumothorax too. Cutaneous lesions due to sebaceous adenoma were seen on her cheeks, nose and neck. She had also periungual fibroma suggestive of tuberous sclerosis. CONCLUSION: Although, according to our patient with both tuberous sclerosis and protein C and S deficiency, a significant relation between these two diseases, cannot confirmed, however, evaluation of other patients who have tuberous sclerosis can help to confirm or rule out this relation.

Cyclosporine trough levels and its side effects in kidney transplant recipients.

INTRODUCTION: Cyclosporine is the backbone of immunosuppression in kidney transplantation. However, it is associated with side effects, some of which are dose-dependent. We evaluated association between cyclosporine trough level and its side effects. MATERIALS AND METHODS: In 50 kidney transplant recipients, serum cyclosporine level, fasting blood glucose, and serum creatinine were measured 7 times during first 6 months after transplantation. The participants were also assessed for blood pressure, hand tremor, and headache at each visit. The relationship between cyclosporine trough level and hypertension, hyperglycemia, hand tremor, and headache were evaluated. RESULTS: There were no significant relationship between cyclosporine levels and allograft function. Except at the second week and sixth month, there were no significant differences between drug doses in various serum cyclosporine trough level groups. At the second week, the mean drug dose in patients with cyclosporine trough levels less than the target therapeutic level was 279.16 +/- 56.23 mg/d, while in the patients with cyclosporine levels higher than the therapeutic level, its dose was 302.08 +/- 66.61 mg/d (P < .05). At the sixth month, the mean drug dose was 137.50 +/- 17.67 mg/d in the patients with lower than target cyclosporine levels, and it was 242.18 +/- 58.25 mg/d in those with cyclosporine levels higher than the therapeutic level (P < .05). There was no significant relationship between serum cyclosporine level and its side effects. CONCLUSIONS: We demonstrated cyclosporine trough level had no direct relation with drug side effects and it is not a suitable measure for assessment of drug side effects.

Weight-gain-related factors in renal transplantation.

OBJECTIVES: Previous studies of renal transplant recipients have suggested that weight gain after transplantation is relatively common. The purpose of this study was to define the occurrence, magnitude, and predictors of weight gain in this group. MATERIAL AND METHODS: We conducted a prospective study of 100 renal transplant recipients from 2002 to 2004 at Imam-Reza Hospital in Mashhad, Iran, to identify patterns of weight change attributed to sex, age at transplantation, socioeconomic class, and duration of dialysis. A descriptive study also was made on serum cholesterol and triglyceride levels in renal transplant recipients 12 months after transplantation. Patients' weights were evaluated at 3, 6, 9, and 12 months after transplantation. RESULTS: Univariate analyses at 1 year posttransplantation showed that women had greater weight gains than did men (P = 0.003); older recipients had greater weight gains than did younger recipients (P = 0.009); weight gain was correlated with an increase in serum triglyceride and cholesterol levels (P = 0.000 and P = 0.004); and socioeconomic class was not correlated with weight changes (P = 0.955). CONCLUSIONS: Female sex, older age, and increasing incidences of hypercholesterolemia and hypertriglyceridemia were significantly associated with weight gain 1 year after organ transplantation.