Sevelamer, a phosphate-binding resin with beneficial effect in diabetic kidney disease; a modern paradigm shift

The proportion of individuals diagnosed with diabetes mellitus is increasing throughout the world, which sequentially drives upward the global frequency of diabetic kidney disease (1, 2). Diabetes is a costly and deadly disease. Patients with diabetic kidney disease are at an increased risk for cardiovascular disease, premature death, and other severe diseases that ensue in increased health-care utilization and frequent hospitalizations (1, 2). In fact, type II diabetes mellitus is an ongoing medical dilemma that clinicians deal with on a daily basis

Aggressive jaw brown tumor in a 28-year-old man with long-lasted chronic kidney disease

Brown tumors are bony lesions triggered by rapid osteoclastic activity, which rarely involved jaws (1-3). In fact brown tumors or osteoclastomas are erosive bony lesions appearing as a complication of hyperparathyroidism. Renal osteodystrophy is the result of secondary hyperparathyroidism and is associated with various pathogenetic mechanisms, such as disorder of calcium-phosphate metabolism, increased parathyroid activity that lead to extreme concentrations of parathormone and impaired metabolism of vitamin D (1-7). We

Oxford-MEST classification in IgA nephropathy patients: A report from Iran.

BACKGROUND There is a limited knowledge about the morphological features of IgA nephropathy (IgAN)in the middle east region. OBJECTIVES The objective of this study was to evaluate the spectrum of histopathological findings in IgAN patients at our laboratory. PATIENTS AND METHODS At this work, an observational study reported which was conducted on IgAN patients using the Oxford-MEST classification system. RESULTS In this survey, of 102 patients 71.6 % were male. The mean age of the patients was 37.7 ± 13.6 years. Morphologic variables of MEST classification was as follows; M1: 90.2 %, E: 32 %, S: 67 % also,T in grads I and II were in 30% and 19% respectively, while 51% were in grade zero. A significant difference was observed in segmental glomerulosclerosis (P=0.003) and interstitial fibrosis/tubular atrophy frequency distribution (P= 0.045), between males and females . Furthermore, it was found that mesangial hypercellularity was more prevalent in yonger patients. Moreover, there was a significant correlation between serum creatinine and crescents (P<0.001). There was also significant correlation of serum creatinine with segmental glomerulosclerosis (P<0.001). CONCLUSIONS Higher prevalence of segmental glomerulosclerosis and interstitial fibrosis/ tubular atrophy, as the two of, four variables of Oxford-MEST classification of IgAN in male patients further attests that male gender is a risk factor in this disease.In this study the significant correlation between serum creatinine and crescent was in an agreement with previous studies and suggests for the probable accomodation of extracapillary proliferation as a new variable in MEST system

Occult hepatitis B virus infection among hemodialysis patients

Hepatitis B virus is a major public health impasse all over the world. Recently a new form of hepatitis B infection named Occult hepatitis B Infection (OBI) has appeared globally. The OBI is defined as the presence of HBV DNA in the liver and/or blood in the absence of detectable serum HBsAg with/without anti-HBc or anti-HBs. The prevalence of OBI has been reported in hemodialysis (HD) patients in different regions of the world. Thus, this study investigated the prevalence of OBI among HD patients. The cross-sectional study was carried out on 84 HD patients. These sera were checked for HBsAg, HBc-IgG assessment using Enzyme linked immunosorbent assay. The DNA was extracted from the sera samples and tested for HBVDNA detection using Nested Polymerase Chain Reaction (Nested PCR). The liver function tests including serum alanine aminotransferase and aspartate aminotransferase levels were carried out for all the HD individuals. 52/84(61.9%) of HD were males and 32/84 (38.1%) were females. The patient’s age ranged from 25 to 64 with a mean age of 52.4±15.2 years. HBsAg and HBc-IgG were detected in 1(1.1%) female. 2 (2.4%; a female and a male) patients were positive for HBsAg. 14/84 (16.7%; 6 female and 8 male) HD patients were positive for anti-HBc but negative for HBsAg, among them 4(28.6%; 2 female and 2 male) cases were positive for HBV DNA, indicating the presence of OBI in HD patients. Even distribution of OBI among the HD was found in 2(2.36%) male and 2(2.36%) female (P>.0.05). In the present study the moderate rate of 4.76% OBI has been observed in HD patients. The prevalence of seropositive OBI among the gender was 2(2.36%) male and 2(2.36%) female. The seronegative OBI have not been detected in the present study but requires further investigation. In this study the affliction of OBI in HD patients is not clear

Kaposi Sarcoma in Kidney Transplanted Patients

Purpose: Newly developed malignancies in kidney transplanted patients are one of the complications attributed to immunosuppression. Kaposi sarcoma is an unusual malignancy in general population, but may develop in kidney transplanted patients with highly varying prevalence. Our aim is to evaluate the prevalence, clinical manifestations, and outcome of Kaposi sacoma in kidney transplanted patients.Materials and Methods: Five hundred and eighty cases (330 male, 250 female) with a mean age of 38.2 were followed for 36 months (range 9 months to 10 years), visiting every two months. History taking and physical examination with emphasis on skin and mucosa were taken. Biopsy of suspicious sin, mucosal, and visceral lesions assigned by other paraclinical methods was performed. Except 7 cases which were HLA identical to donors, all patients were managed with cyclosporine, Azathioprine and Prednisolone.Results: Fourteen patients (2.2%) developed Kaposi sarcoma (biopsy documented which constituted 60% of all post-transplantation malignancies. They were 11 males and 3 females with a mean age of 41 years. Sarcoma developed 8 to 31 months after transplantation with an average of 18 months. Of these patients, 13 had skin involvement that one of them had pulmonary involvement too. Another patient had only abdominal involvement. Azathioprine was discontinued all patients, and cyclosporine was reduced in skin affected patients. In patients with visceral involvement cyclosporine was discontinued and then chemotherapy was initiated. All 3 patients with visceral involvement didn't respond to chemotherapy and expired after 6 months. Of 11 patients with skin involvement, one had complete and 2 had incomplete remission of whom, one expired due to acute rejection. Renal function in 8 patients was acceptable, but 2 had impaired renal function, yet didn't need dialysis.Conclusion: Prevalence of Kaposi sarcoma in our patients is more than western countries. Visceral involvement is uncommon. But has poor prognosis. Reducing immunosuppression with discontinuation of azathioprine and significant reducing cyclosporine dosage can cease skin evolvement, with preserving renal function in most of the patients.</p

Ambulatory monitoring of blood pressure and pregnancy outcome in pregnant women with white coat hypertension in the third trimester of pregnancy

Introduction: If the blood pressure of a pregnant woman is ≥140/90 mmHg at the clinic, but her ambulatory blood pressure is less <135/85 mmHg at daytime and <125/75 at night and her average ambulatory in 24 hours is <130/80 mmHg, her high blood pressure at clinic is considered white coat hypertension. Objectives: To evaluate the value of ambulatory blood pressure monitoring in pregnant women. Patients and Methods: This prospective cohort study was conducted in Imam-Khomeini hospital of Ahwaz, Iran between 2011 to 2012. A total of 105 pregnant women who had blood pressure of higher than 140/90 mmHg during the third trimester of pregnancy were monitored. Thirty five women with white coat hypertension, 35 women with gestational hypertension and 35 women with normal blood pressure were followed. The data were analyzed using the Kolmogorov-Smirnov test, Pearson correlation coefficient and Chi-square tests. Results: The prevalence of white coat hypertension was 31.3%. The maternal and neonatal outcomes and laboratory examinations in white coat hypertension were similar to the normal blood pressure, but the frequency of caesarean section was more than the other two groups. Conclusion: The findings of the study indicate the efficacy of 24 hour holter monitoring of blood pressure and using it more comprehensively , compared to the limited visits

Effect of rituximab on reducing the panel-reactive antibody in dialysis patients of transplant candidate

Introduction: Based on the evidence, rituximab may be an effective treatment for kidney transplantation for reducing panel-reactive antibody. Objectives: This study was conducted to investigate the effect of rituximab on reducing the panel in transplant dialysis patients. Patients and Methods: This is an interventional study that was conducted on 20 dialysis patients who were candidates for kidney transplantation. Patients first had a panel-reactive antibody test and patients with a panel-reactive antibody above the age of 30 were included in the study. First, rituximab was administered at a dose of one gram and then after two weeks, another dose of one gram was administered. Panel-reactive antibody was measured baseline, one and six months later. Results: One and six months after stopping the drug, we found a significant decrease in the mean amount of reactive antibodies. Additionally, six months after stopping the drug, a significant decrease in the level of patients’ reactive antibodies in comparison to one month before taking the drug was detected (P&lt;0.05). Conclusion: The findings showed that treatment with rituximab is useful for reducing panel-reactive antibody in kidney transplant patients. However, more studies are needed to optimize rituximab injection protocols. </jats:p