Rhino-orbitocerebral mucormycosis in a patient with idiopathic crescentic glomerulonephritis.

Mucormycosis, caused by mucorales, is an acute, rapidly progressive infection associated with high mortality. Rhino-orbitocerebral infection is the most common variant and is generally seen in association with immune deficiency syndromes. Prompt medical treatment of this infection and debridement decreases the mortality rate. We describe a 47-year-old man with crescentic glomerulonephritis on maintenance prednisolone therapy. He had earlier received steroid and cyclophosphamide pulse therapies. Renal functions improved following immunosuppressive treatment. In the third month of maintenance therapy, he presented to us with left-sided facial swelling and bloody nasal discharge. He had high blood sugar and acidic blood pH (ketoacidosis), probably due to steroid therapy. Magnetic resonance imaging of the head and sinuses showed inflammation and mass in the ethmoid sinus and nose with partial septal destruction, proptosis, global destruction of the left eye, brain infarction and carotid artery obliteration. Endoscopic biopsy of the sinuses revealed severe tissue necrosis. Samples of nasal discharge and biopsy tissue showed aseptate hyphae on light microscopy and culture, compatible with Rhizopus. The patient was treated with amphotericin B and multiple wound debridements along with ethmoidectomy and enucleation of the left eye. He was discharged in good general condition but with mild right hemiparesis. On follow-up examination at one year, there were no signs of fungal infection or renal dysfunction.

Attitude and willingness of high school students toward organ donation.

Public awareness of organ donation fundamentally affects the organ transplantation programs. This study was performed to assess the attitude and willingness of high school adolescents regarding organ donation. The study population consisted of 416 high school girls who were studying in four grades of three educational courses. Data were collected by a questionnaire and included demographic variables and attitude and willingness, which were assessed based on the Likert scale. The SPSS v.16 was used for data analysis. The mean age of the study subjects was 16.26 ± 1.06 years, 31% studied in grade-1, 27% in grade-2 (25% natural sciences, 27% mathematics and 48% humanities), 26% in grade-3 (30% natural sciences, 34% mathematics and 36% humanities) and 16% in pre-university stage (32% natural sciences, 42% mathematics and 26% humanities). The students had a highly positive attitude toward organ donation (mean score 4.2 ± 0.54). The greatest willingness for organ donation was concerning the kidney (88%) and heart (84%), followed by the liver (83.4%), pancreas (79.6%), cornea (67.8%) and skin (51%). Willingness for deceased as well as living organ donation was indicated by 92% and 47%, respectively, of the participants. Organ donation was considered acceptable only to relatives by 5% of the participants when the donors were deceased donors and by 16% of the participants when the donors were living donors; donation to all needy persons from deceased donors was accepted by 87% of the participants and from living donors by 31%. The purpose of donation was stated as lending help to others by 89% and progression of science by 40.2% of the participants. Willingness for organ donation from a deceased relative was declared by 63% of the students. There was significant positive correlation between willingness for organ donation and attitude (P <0.001). In addition, attitude and willingness had positive correlation with educational levels, age and educational courses. Our study suggests that Iranian adolescents have a great attitude and willingness toward organ donation, which reflects favorable knowledge of transplantation. Further research on public awareness in both genders and various age ranges is needed.

Effect of submaximal aerobic exercise in hypoxic conditions on proteinuria and hematuria in physically trained young men.

INTRODUCTION: Exercise-induced proteinuria is predominantly caused by alterations in renal hemodynamics. The present study was conducted to determine the effect of aerobic exercise in hypoxia on proteinuria and hematuria. MATERIALS AND METHODS: The study population consisted of 17 physically trained healthy young men. They were asked to attend in 4 sets of 30-minute running sessions, separated by 72-hour resting intervals, to attain 70% of maximal heart rate in normoxia (fraction of inspired oxygen of 0.21) and 3 different levels of hypoxia (lower fraction of inspired oxygen equivalent to the heights of 2750 m, 3250 m, and 3750 m above the sea level). Urine samples were collected before exercise and immediately and 1 hour after each session to measure total protein, albumin, beta2-microglobulin, and erythrocyte count. RESULTS: Postexercise urinary total protein, albumin, and beta2-microglobulin showed significant increases compared to basline values, while no significant difference was found in urinary total protein between hypoxia and normoxia conditions. However, there was a significant positive correlation between the amount of albuminuria and the height (P = .01), and a significant difference in beta2-microglobulinuria between normoxia and the simulated 2750-m altitude (P = .007), which disappeared at higher elevations. None of the participants developed hematuria. CONCLUSIONS: Aerobic exercise with moderate intensity in trained men might induce mixed proteinuria with glomerular predominance correlated with height, while tubular component loses this relation at altitudes above 2750 m. Further research on the influence of exercise on urinary abnormalities, particularly in different environmental conditions, is recommended.

Acute renal failure as an initial manifestation of multiple endocrine neoplasia (MEN) type 1.

Multiple endocrine neoplasia (MEN) is a group of heritable syndromes characterized by aberrant growth of benign or malignant tumors in a subset of endocrine tissues. There are three major syndromes: MEN1, 2A and 2B. We describe a 60-year-old woman who initially manifested acute renal failure due to hypercalcemia and dehydration and, finally, was diagnosed as a sporadic MEN1 case.

An unusual presentation of antineutrophil cytoplasmic antibody-associated vasculitis: discrepancy between histopathology and clinical presentation.

A 60-year-old man was admitted to our clinic with dyspnea, hemoptesis, anuria, nephritic syndrome, and a positive myeloperoxidase antineutrophil cytoplasmic antibody titer. He was diagnosed with antineutrophil cytoplasmic antibody-associated vasculitis due to Wegener granulomatosis, microscopic polyangiitis, or drug induction. Unexpectedly, histopathologic examination of the kidney biopsy specimen revealed the diagnosis of noncrescentic and nonnecrotizing glomerulonephritis. We report this case because of the unusual histologic type of renal involvement.

Effects of intradialytic aerobic training on sleep quality in hemodialysis patients.

INTRODUCTION: Sleep disorders are common in hemodialysis patients. They can affect their quality of life. The purpose of this study was to evaluate the effects of aerobic training on sleep quality, inflammatory status, and serum leptin levels in hemodialysis patients. MATERIALS AND METHODS: Twenty-eight men in the age range of 28 to 74 years who were on maintenance hemodialysis and had sleep problems were enrolled in this study. They were randomly assigned into control and training groups (14 patients in each group). Patients in the training group performed a 10- to 30-minute stationary cycling, 3 times a week, during the 1st two hours of every dialysis session, for 8 weeks. The Pittsburgh Sleep Quality Index and the Baecke questionnaire on physical activity were filled out for all participants. To assess serum leptin and C-reactive protein levels, blood samples were drawn before the beginning and at the end of the eighth week. RESULTS: At the end of the study, serum leptin and C-reactive protein levels were significantly reduced (P < .001 and P < .001, respectively). Furthermore, the Pittsburgh Sleep Quality Index scores of the training group declined significantly after 8 weeks (P < .001). There was a positive correlation between sleep quality and serum levels of leptin and C-reactive protein (P = .03 and P = .04, respectively). CONCLUSIONS: Aerobic exercise with moderate intensity during the first two hours of a dialysis session could improve sleep quality and inflammatory status of hemodialysis patients, which predicts morbidity, mortality, and quality of life. However, additional research is needed to confirm these effects.

Subacute thyroiditis following ginger (Zingiber officinale) consumption.

A woman with subacute thyroiditis following ginger consumption is presented. The diagnosis was confirmed by physical examination and laboratory tests, in two distinct episodes. The patient was cured and recommended to refuse ginger consumption.

Hematological profile of chronic kidney disease (CKD) patients in Iran, in pre-dialysis stages and after initiation of hemodialysis.

Anemia is a common sequealae of chronic kidney disease (CKD), associated with significant morbidity. A cross-sectional study was conducted on 100 CKD patients (54 hemodialyzed, 46 pre-dialyzed). Data including, complete blood count, BUN, creatinine, creatinine clearance, underlying diseases and hemodialysis duration were collected by a questionnaire. The most frequent morphologic features were normochromic-normocytic (80%), hypochromic-microcytic (15%) and macrocytic (5%). The frequency of anemia in hemodialyzed and pre-dialyzed patients (with mean Hgb level of 10.27 and 11.11 g/dL) were 85% and 75%. Hemoglobin concentration was positively correlated to calculated creatinine clearance (P < 0.001). The severity of anemia among hemodialyzed patients was mild (Hgb > 10 g/dL) in 5%, moderate in 70% and severe (Hgb < 7 g/dL) in 25%, while in pre-dialyzed was mild in 45% and moderate in 55%. There was no correlation between the anemia and CKD causes or hemodialysis duration. In conclusion, data shows that anemia in our patients with CKD is a predominant manifestation, with high frequency but of moderate degree. The most likely cause is inadequate erythropoietin production.

Effect of intradialytic change in plasma volume on blood pressure in patients undergoing maintenance hemodialysis.

BACKGROUND: Hypervolemia is a common complication in patients on hemodialysis (HD). To determine the effect of volume change on blood pressure in HD population, this cohort was conducted. MATERIALS AND METHODS: The study population was composed of 60 non-diabetic patients on maintenance HD, with mean age of 59.95±15.28 years. They were divided into hypertensive group A (n=26) and normotensive group B (n=34). Data were collected by a questionnaire. Pre and post-dialysis blood levels of urea, sodium, total protein, and hemoglobin were measured and intradialytic change of plasma volume were calculated. Data analyses were performed by the SPSS v.16. RESULTS: Out of 60 patients, 58.3% were male and 41.7% female. Post-dialysis systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly lower than pre-dialysis values in both groups (P=0.001, each). No correlation was found between intradialytic change in plasma volume or body weight and alterations of SBP or DBP during HD in the study groups (P>0.05, each). Intradialytic changes of body weight did not correlate to intradialytic changes of plasma volume (P=0.15). CONCLUSION: HD effectively reduces blood pressure and volume expansion, however, intradialytic changes of plasma volume and body weight do not influence on SBP and DBP.

Recurrent septicemia in a renal transplant recipient.

The incidence of infection is significantly elevated in renal transplant recipients,but native kidney infection is an uncommon event in these patients. We describe a 52-year-old renal transplant recipient with infection of the native kidneys that had atypical clinical presentation and a unusual course.

Urinary sodium and potassium excretion following karate competitions.

INTRODUCTION: Exercise induces renal hemodynamic alterations and stimulates electrolytes excretion. The purpose of this study was to assess urinary excretion of sodium and potassium in karate practitioners, following competitions. MATERIALS AND METHODS: The study population composed of 18 healthy men, aged 18 to 21 years, with similar physical characteristics. They were professional karatekas with a history of at least 7 years of karate training. The participants competed in 3 rounds of about 3 minutes in duration with 10 minutes resting intervals between them. The 24-hour urine samples were collected before (while trainings were stopped) and after the match and their sodium and potassium concentrations were measured. Also, blood samples were obtained before and after the match for measurement of these electrolytes in the participants' sera. RESULTS: Before the match, the mean values of urinary sodium and potassium were 200.3 +/- 89.3 mEq/L/d and 68.5 +/- 12.9 mEq/L/d, respectively. After the match, they changed into 206.9 +/- 74.7 mEq/L/d and 67.1 +/- 14.4 mEq/L/d, respectively. No significant alterations were observed in urinary sodium and potassium excretion following karate match (P = .94 and P = .96, respectively). Serum sodium levels were 136.7 +/- 3.1 mEq/L and 136.3 +/- 2.9 mEq/L, before and after the match, respectively (P = .11), serum potassium levels were 4.2 +/- 0.3 mEq/L and 4.1 +/- 0.2 mEq/L, respectively (P = .16). CONCLUSIONS: With regard to short duration and anaerobic nature of karate, it seems that a Karate match does not contribute to excessive urinary electrolytes excretion.