Disseminated strongyloidiasis in a patient with membranoproliferative glomerulonephritis- case report

Strongyloides stercoralis (SS) is a unique nematode with an auto infective cycle, so that it completes its life cycle within the human host and can live there for many years. In immunocompromised patients, infection can cause Strongyloides hyperinfection syndrome (S.H.S) that is associated with serious morbidity and mortality. As vari-ous infections are one of the leading causes of membranoproliferative glomerulo-nephritis (MPGN), we should consider subclinical strongyloidiasis as a possible underlying disease, especially in endemic areas. Here we describe a case of strongy-loidiasis following immunosuppressive therapy for MPGN, the diagnosis of which was made, only a few hours before death, by stomach biopsy. © 2015, Iran J Parasitol. All rights reserved

C4d in lupus nephritis and correlation with clinicopathologic findings

Background: Lupus nephritis (LN) is a serious complication of systemic lupus erythematosus (SLE). Activation of complement system which leads to the production of C4 and its ultimate product, C4d, plays an important role in the pathogenesis of LN. Objectives: Although serum C4d levels correlate with disease activity, there is almost no study on the correlation between tissue deposition of C4d and classes of LN. Patients and Methods: Seventy-two patients with a diagnosis of SLE who met � 4 criteria of American Rheumatism Association (ARA) were enrolled in this study. Blood levels of anti-nuclear antigens (ANA), anti-double stranded DNA (Anti-dsDNA), C3, C4 and antiphospholipid antibodies were measured. Renal tissue obtained by biopsy was examined regarding diffuse granular deposition of C4d along the glomerular capillary loops and classes of LN according to the World Health Organization (WHO) classification. Results: LN class IV was the most prevalent and LN class I had the least prevalence. There was no correlation between positive C4d staining and classes of LN (P > 0.05), but a significant correlation between positive Anti-dsDNA and C4d positive LN was found (P = 0.05). Likewise no correlation was detected between the low levels of complements and classes of LN or C4d positivity. Conclusions: The presence of C4d indicates activation of classical complement pathway in LN. C4d deposition in glomerular capillaries of LN does not indicate the present disease activity but may be a useful marker to predict the prognosis of LN. Anti-dsDNA is a valuable test for disease activity and is correlated with C4d positive staining. © 2018 The Author(s)

An in-vivo study exploring correlations between early-to-moderate disc degeneration and flexion mobility in the lumbar spine

Purpose: Early disc degeneration (DD) has been thought to be associated with loss of spine 6 stability. However, before this can be understood in relation to back pain, it is necessary to 7 know the relationship between DD and intervertebral motion in people without pain. This 8 study aimed to find out if early to moderate DD is associated with intervertebral motion in 9 people without back pain. 10 Methods: Ten pain free adults, aged 51-71 received recumbent and weight bearing MRI 11 scans and quantitative fluoroscopy (QF) screenings during recumbent and upright lumbar 12 flexion. Forty individual level and 10 composite (L2-S1) radiographic and MRI DD gradings 13 were recorded and correlated with intervertebral flexion ROM, translation, laxity, and 14 motion sharing inequality and variability for both positions. 15 Results: Kinematic values were similar to previous control studies. DD was evidenced up to 16 moderate levels by both radiographic and MRI grading. Disc height loss correlated slightly, 17 but negatively with flexion during weight bearing flexion (R=-0.356, p=0.0.025). Composite 18 MRI DD and T2 signal loss evidenced similar relationships (R= -0.305, R= -0.267) but did not 19 reach statistical significance (p=0.056, p=0.096). No significant relationships between any 20 other kinematic variables and DD were found. 21 Conclusion: This study found only small, indefinite associations between early-to-moderate 22 DD and intervertebral motion in healthy controls. Motion sharing in the absence of pain 23 was also not related to early DD, consistent with previous control studies. Further research 24 is needed to investigate these relationships in patients. 25 Key words: back pain, disc degeneration, instability, imagin

Effects of l-carnitine Supplement on Serum Amyloid A and Vascular Inflammation Markers in Hemodialysis Patients: A Randomized Controlled Trial

Objective: We studied the effects of l-carnitine supplement on serum amyloid A (SAA), a systemic inflammation marker, and vascular inflammation markers in hemodialysis patients. Design: This was a randomized, double-blind, placebo-controlled trial. Setting: The study was performed in Soodeh Hemodialysis Center in Islamshahr, Iran. Patients: We included 36 hemodialysis patients (15 men and 21 women). Intervention: The patients on hemodialysis were randomly assigned to either a carnitine or a placebo group. Patients in the carnitine group received 1,000 mg/day oral l-carnitine for 12 weeks, whereas patients in the placebo group received a corresponding placebo during the study. Main Outcome Measures: Serum free carnitine, SAA, soluble intercellular adhesion molecule type 1, soluble intercellular adhesion molecule type 2, soluble vascular cell adhesion molecule type 1, sE-selectin, sP-selectin, and oxidized low-density lipoprotein were measured at baseline and at the end of week 12 of the study. Results: Mean serum free carnitine concentration increased significantly to 150 of baseline in the carnitine group at the end of week 12 (P < .001), whereas serum SAA showed a significant 32 decrease (P < .001). No significant changes were observed in the serum concentrations of free carnitine and SAA in the placebo group during the study. There were no significant differences between the two groups in mean changes in serum soluble intercellular adhesion molecule type 1, soluble intercellular adhesion molecule type 2, soluble vascular cell adhesion molecule type 1, sE-selectin, sP-selectin, and oxidized low-density lipoprotein concentrations. Conclusion: The study indicates that l-carnitine supplement reduces serum SAA, which is a risk factor for cardiovascular diseases in hemodialysis patients, but has no effect on vascular inflammation markers. © 2011 National Kidney Foundation, Inc

Effects of L-Carnitine supplement on plasma coagulation and anticoagulation factors in hemodialysis patients

Background: Hypercoagulability is an important risk factor for thrombosis and its complications in hemodialysis patients. This study was designed to investigate the effects of l-carnitine supplement on plasma coagulation and anticoagulation factors in hemodialysis patients. Methods: Thirty-six hemodialysis patients were randomly assigned to either a carnitine or a placebo group. Patients in the carnitine group received 1000 mgday oral l-carnitine for 12 weeks, whereas patients in the placebo group received a corresponding placebo. At baseline and the end of week 12, 5 mL blood was collected after a 12- to 14-hour fast and plasma fibrinogen concentration, activity of plasma protein C, coagulation factors V, VII, IX, and serum concentrations of tissue plasminogen activator (tPA), plasminogen activator inhibitor type-1 (PAI-1), free carnitine, and C-reactive protein (CRP) were measured. Results: In the carnitine group, mean serum free carnitine concentration increased significantly to 150 of baseline (p < 0.001), whereas plasma fibrinogen and serum CRP had 98 mg/dL (p < 0.01) and 41 (p < 0.01) significant decreases, respectively, at the end of week 12 compared with baseline. The reductions were significant compared with the placebo group (p < 0.05). No significant differences were observed between the two groups with regard to mean changes of the activity of plasma protein C, coagulation factors V, VII, IX, and serum PAI-1 to tPA ratio. Conclusion: l-Carnitine supplement reduces serum CRP, a marker of systemic inflammation, and plasma fibrinogen, an inflammation-related coagulation factor, in hemodialysis patients. Therefore, l-carnitine may play an effective role in preventing cardiovascular diseases in these patients. © 2010 Informa UK Ltd

A 4-year follow-up of living unrelated donors of kidney allograft in Iran

Introduction. Shortage of deceased donor kidneys has resulted in an increased rate of kidney transplantation from living unrelated donors (LURDs). However, there are concerns about short-term and long-term morbidity of the donors. This study reports the clinical and biochemical factors in a follow-up program of Iranian LURDs, one of the largest reported series of kidney donors. Materials and Methods. Of 7500 individuals who underwent living donor nephrectomies between 2005 and 2008, a total of 1549 participated in this study. They were followed for 18 to 48 months after the kidney donation. The average time for the first study visit was 316.72 days after donation. Results. The mean age of donors was 30.43 ± 6.16 years old. Men consisted 82.5 of the group. Systolic hypertension was detected in 0.2 and diastolic hypertension in 1 of the LURDs; however, anemia prevalence was as high as 47.2. Hyperuricemia was found in 21.2 of the LURDs, while proteinuria was seen in 13.7. Glomerular filtration rate was greater than 90 mL/min in 38.2 of the donors, 60 mL/min to 90 mL/min in 54.5, and less than 60 mL/min in 7.3. A GFR less than 45 mL/min was seen in 0.1 of the donors. Conclusions. Data suggested that the LURDs in Iran have an appropriate health condition comparable to other donors in other parts of the world. Considering the high prevalence of hyperuricemia in our population and its importance as a risk factor for kidney failure, monitoring serum uric acid in follow-up programs is suggested. © 2015, Iranian Society of Nephrology. All rights reserved

Recurrence of primary hyperoxaluria after kidney transplantation

Primary hyperoxaluria is a genetic disorder in glyoxylate metabolism that leads to systemic overproduction of oxalate. Functional deficiency of alanine-glyoxylate aminotransferase in this disease leads to recurrent nephrolithiasis, nephrocalcinosis, systemic oxalosis, and kidney failure. We present a young woman with end-stage renal disease who received a kidney allograft and experienced early graft failure presumed to be an acute rejection. There was no improvement in kidney function, and she was required hemodialysis. Ultimately, biopsy revealed birefringent calcium oxalate crystals, which raised suspicion of primary hyperoxaluria. Further evaluations including genetic study and metabolic assay confirmed the diagnosis of primary hyperoxaluria type 1. This suggests a screening method for ruling out primary hyperoxaluria in suspected cases, especially before planning for kidney transplantation in patients with end-stage renal disease who have nephrocalcinosis, calcium oxalate calculi, or a family history of primary hyperoxaluria

The added value of trabecular bone score in fracture risk assessment of kidney transplant recipients

Introduction. Trabecular Bone Score (TBS) is an index of bone microarchitecture independent of Bone Mineral Density (BMD). Recently, TBS data has been used to optimize the predictive value of the Fracture Risk Assessment Tool (FRAX). The aim of this study was to evaluate the clinical value of FRAX adjustment with TBS in kidney transplant recipients. Methods. Seventy post-transplant Iranian kidney recipients were included in this study. After the evaluation of BMD and TBS, the risk of major osteoporotic fracture (MOF) and hip fracture (HF) was assessed once with and once without TBS adjustment. The proportion of patients who needed a therapeutic intervention was compared before and after TBS adjustment. The association between TBS and BMD data was also evaluated. Results. The mean age of the patients was 54 ± 8.8 years (range: 40 to 77). The mean TBS of the patients was 1.30 ± 0.12. In multivariate analysis, the TBS was significantly associated with the age (P < .05) and dialysis period (P < .05). A strong correlation was found between the spine BMD and TBS data (r = 0.612, P < .001). A significant correlation was found between the MOF and HF of the patients before and after adjustment for TBS. The proportion of patients needed a therapeutic intervention significantly increased from 17.1 to 25.7 after TBS adjustment of FRAX. Conclusion. Adjustment of FRAX with TBS will reclassify the treatment decision in a considerable number of kidney transplant recipients. This clinical value warrants the adjustment of FRAX data with TBS in future workouts. © 2020, Iranian Society of Nephrology. All rights reserved