Systemic lupus erythematosus (SLE) in pregnancy and severe nephritis (a case-report)

زمینه و هدف: نفریت لوپوسی یکی از خطرناکترین تظاهرات بیماری است. لوپوس در حاملگی ممکن است باعث نارسایی حاد کلیه و مرگ مادر و جنین شود. در این گزارش یک خانم حامله با نارسایی حاد کلیه معرفی می شود که نفروپاتی لوپوسی اولین تظاهر بیماری وی بود. گزارش مورد: خانم 30 ساله، با حاملگی 30 هفته بدلیل تورم اندام تحتانی و پرفشاری خون بستری شد. در بررسی بیمار نکات مهم معاینه و پاراکلینیک شامل، ادم گوده گذار، ازوتمی، آنمی، هماچوری، پروتئینوری، کلیه های با اندازه بزرگتر از طبیعی، ته نشت ادرار فعال، افیوژن پلور و پریکارد، آسیت، تیتر بالای آنتی بادی ضد هسته ای (ANA) آنتی بادی dsDNA (DNA Anti dauble strand,) و لوپوس آنتی کواگولانت بود. بیوپسی کلیه انجام شد و بیمار تحت درمان با پالس متیل پردنیزولون و همودیالیز قرار گرفت و پس از ختم حاملگی پالس سیکلوفسفامید دریافت نمود و وضعیت کلیوی بهبود یافت. نتیجه گیری: بیمار معرفی شده قبل از حاملگی علائمی از اختلالات روماتولوژیک نداشت و اولین تظاهر لوپوس بیمار در حاملگی و بصورت نفریت شدید بود. بیمار به خوبی به درمان های انجام شده پاسخ داد و پس از حدود سه سال از شروع درمان عملکرد کلیه طبیعی است و فرزند بیمار نیز در سلامت کامل قرار دارد

Serum uric acid and diabetic nephropathy.

Implication for health policy/practice/research/medical education: Diabetic nephropathy is the most common cause of end-stage renal disease worldwide. Recently, some prospective randomized controlled trials suggested that lowering of uric acid with allopurinol could decrease the severity of proteinuria and probably slow the progression of renal failure in diabetic patients. Mechanism of beneficial effect of xanthine oxidase inhibitor may related to preventing uric acid-induced renal inflammation

Relationship between serum leptin level and peritonitis in CAPD patients

Background: Leptin is produced by fat cells and is secreted into the blood stream. Leptin is freely filtered into the renal tubules but its concentration in the urine is very low. Serum leptin level is higher in continuous ambulatory peritoneal dialysis (CAPD) patients, compared to the healthy individuals. Serum leptin level may have correlation with inflammatory markers and peritonitis. Objectives: The aim of this study was to evaluate relationship of serum leptin level with peritonitis, the major complication of CAPD, in these patients. Patients and Methods: In a cross sectional study, 75 CAPD patients in Al-Zahra Hospital in Isfahan were enrolled from October 2007 to February 2008. Serum levels of leptin, Kt/V, demographic findings, total numbers of peritonitis and presence of peritonitis in last year, were recorded in all patients, based on history, physical exam and patients’ files. Results: Mean age of the patients was 53 ± 15 years. Mean serum leptin level in females and males were 27 ± 23μg/L and 16 ± 13μg/L respectively. At univariate general linear model (GLM), there was a significant correlation between serum leptin level with body mass index (BMI) (P < 0.001, ɵ = 2.7) and duration of renal failure (P = 0.01). No correlation was seen between serum leptin level and total number of peritonitis in the past. However, there was negative relationship between serum leptin level and presence of peritonitis in the last year (P = 0.004, ɵ = 6). Conclusions: Presumably, we could not use serum leptin level as a marker of infection in long term; however, serum leptin level may be used as an index of peritonitis and morbidity in short time

Concurrent diabetic nephropathy and C1q nephropathy in a young male patient: The first report in literature

Background: C1q nephropathy (C1qN) is an uncommon glomerulopathy with a significant deposition of C1q in mesangium without clinical evidence of lupus. According to the best of our knowledge, there is not any report on coincidence of diabetes mellitus and C1qN. Case presentation: In this report, we presented a 28 years-old-patient with type 1 diabetes and nephrotic range proteinuria, glomerular hematuria and C1q glomerulopathy in renal biopsy. Conclusions: According to the best of our knowledge, there is no previous report about the association between type 1 DM and C1qN. Prevalence of autoimmune disease is higher in type 1 DM and this may explain the relation between DM and C1qN in our patient. © 2013, Society of Diabetic Nephropathy Prevention. All rights reserved

Reduction of left ventricular ejection fraction after 12-month follow-up in hemodialysis patients.

INTRODUCTION Cardiovascular disease is the most common cause of morbidity and mortality in hemodialysis patients. OBJECTIVES The aim of this study was to detect echocardiographic abnormality in the beginning and after 12-month follow-up in the hemodialysis patients. PATIENTS AND METHODS In a cross-sectional study, 60 hemodialysis patients older than 18 years and the dialysis duration longer than three months were enrolled. At the beginning of the study, echocardiography was done and after 12 months was repeated in all of the patients by the same cardiologist. At the end of the study, data were analyzed using SPSS software (version 19). RESULTS From the total of cases 37 were male and 23 female. At the beginning of the study, mitral regurgitation, tricuspid regurgitation and aortic insufficiency were found in 54, 47 and 11 patients respectively. After 12 months left ventricular ejection fraction (LVEF) decreased significantly, however there was no significant difference between other echocardiographic findings at the beginning and after 12 months. CONCLUSION Decrease in LVEF over time in hemodialysis patients may be due to negative effect of uremia on cardiac function, so it seems that periodical cardiac evaluation of these patients is essential and beneficial